bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis and Surgical Correction of Congenital Coronary Artery-Coronary Sinus Fistula
Authors: HALLER J. ALEX , LITTLE JOSEPH A.
Published: June 2012

Congenital coronary arteriovenous fistula is easily confused with patent ductus arteriosus. An illustrative case is presented which emphasizes the special tests that are necessary to establish the diagnosis. Finally, the successful surgical correction of this abnormality is described.
An Evaluation of Treatment of Hypertension Associated with Occlusive Renal Arterial Disease
Authors: DUSTAN HARRIET P. , PAGE IRVINE H. , POUTASSE EUGENE F. , WILSON LEIGH
Published: June 2012

Of 131 patients with hypertension and renal arterial stenosis, 99 were treated either by nephrectomy or revascularization operations and 32 were treated medically. Anti-hypertensive effects of surgical treatment were analyzed in 76 patients in whom operations had been performed 1 to 6 years before. Of the remaining 23, 10 died in the immediate postoperative period; in 11, operative treatment was incomplete at the time of review; and, in 2, who did not have sustained diastolic hypertension, operation was performed only to conserve renal function.

Diastolic hypertension remitted in 47 patients (62 per cent); in 12 (16 per cent) arterial pressure was much reduced but not to normal levels, and in 17 (22 per cent) it was unchanged.

The antihypertensive effects of surgical treatment could not be predicted preoperatively. In general, patients less than 21 years of age did not respond with as much blood pressure reduction as did those older, and patients hypertensive for longer than 5 years responded less well than those hypertensive for less than 1 year. Results of function tests of individual kidneys were not helpful in prediction.

Surgical treatment seemed contraindicated in 32 patients because of diffuse atherosclerosis, azotemia from severe nephrosclerosis, unsustained diastolic hypertension or because lesions had not caused disparity in function of the two kidneys. In three of these patients diastolic hypertension remitted spontaneously and in 11 arterial pressure was controlled at near normal levels with antihypertensive drugs. Eighteen patients have persistent diastolic hypertension; 13 of these have been inadequately treated with drugs.

In the group treated surgically, there were 10 immediate postoperative deaths, seven of which were due to atherosclerotic complications. Twelve patients died later, and 11 deaths were due to atherosclerosis. Most of the patients who died had no blood pressure reduction following operation. Ten of the medically treated group have died of atherosclerosis. The mortality was 50 per cent in the patients with ineffective treatment and poor blood pressure control and only 7 per cent in those with good blood pressure control.
Concealed Ventricular Extrasystoles
Authors: SCHAMROTH LEO , MARRIOTT HENRY J. L.
Published: June 2012

Evidence is presented for the new concept that ventricular extrasystoles can be "concealed," i.e., that the extrasystolic focus may be discharged without its impulse invading the surrounding myocardium, as in the "exit block" of parasystole.
Concealed bigeminy
is recognized when only odd numbers of sinus beats intervene between consecutive extrasystoles.
Concealed trigeminy
is recognizable when a multiple of 3 plus 2, i.e., 5, 8, 11, 14, etc., sinus beats invariably occupy the interectopic intervals. These concealed extrasystolic rhythms are illustrated and discussed.

A genetic relationship between ventricular bigeminy and parasystole is reaffirmed.
The Quantitative Determination of Renin in the Plasma of Patients with Arterial Hypertension
Authors: HELMER OSCAR M. , JUDSON WALTER E. , Sanders R. M.
Published: June 2012

A method was described for the quantitative determination of renin in small amounts of dialyzed human plasma, utilizing the first order reaction constant.

A wide variation was found in the renin-substrate (angiotensinogen) content of plasma of patients with arterial hypertension. Many of these patients had high concentrations of this factor.
Effect on Circulation of Conversion of Atrial Fibrillation to Sinus Rhythm
Authors: GILBERT ROBERT , EICH ROBERT H. , SMULYAN HAROLD , KEICHLEY JOHN , AUCHINCLOSS J. HOWLAND
Published: June 2012

Treadmill exercise tests were performed in cardiac subjects before and after conversion from atrial fibrillation to sinus rhythm. The most striking changes following conversion were a marked reduction in exercise heart rate and increase in stroke volume and cardiac output. Exercise performance as judged by a standardized exercise test improved significantly in some but not all subjects following conversion. Duplicate control studies in nonconverting subjects failed in general to show these improvements. The results indicate that conversion from atrial fibrillation to sinus rhythm is worthwhile from a functional standpoint in patients with valvular heart disease, and is especially indicated after successful mitral commissurotomy.
Studies on the Structure of the Pulmonary Trunk
Authors: SALDAÑA MARIO , ARIAS-STELLA JAVIER
Published: June 2012

A study of the elastic configuration of the pulmonary trunk was undertaken in 443 normal autopsy cases, ranging in ages from the second month of intrauterine life to 96 years.

It has been shown that during the whole of fetal life the elastic configuration of the pulmonary trunk is similar to that observed in the ascending aorta.

The "aortic" configuration of the pulmonary trunk, which is characterized by a great content of long elastic fibers, was observed in the first trimester of life, especially in the 29 days that follow birth.

Two models of the "transitional" configuration have been distinguished. The "transitional-A" model is characterized by a marked fragmentation of the elastic fibers. This elastic pattern has been found between 25 days and 3 years. In the "transitional-B" model most of the fibers are partially disintegrated but not fragmented. Cases with this characteristic were found from 1 month to 9 years.

The "adult" type of pulmonary configuration, which exhibits a poor content in elastic tissue, was already present in the twelfth month of life. Over the ninth year it constituted the totality of cases.

A fourth elastic configuration has been added to the already known "aortic," "transitional," and "adult" types. The designation of "persistent" given to this elastic type alludes to the presence of numerous long elastic fibers that are more characteristic of the "aortic" type, alternating with others that have suffered fragmentation. Cases of the "persistent" type were found from 1 month to 5 years.

A hemodynamic interpretation of the changes observed in the "transitional" models and "persistent" configuration is proposed.
Studies on the Structure of the Pulmonary Trunk
Authors: SALDAÑA MARIO , ARIAS-STELLA JAVIER
Published: June 2012

Measurements of the thickness of the media of the pulmonary trunk and ascending aorta were made in 200 normal autopsy cases ranging in ages from birth to 80 years. One hundred cases were persons who were born and lived permanently in places between 11,300 to 14,900 feet above sea level. One hundred persons of comparable ages, born at sea level, served as control.

It is shown that at high altitudes the pulmonary trunk exhibits a thicker media than at sea level, in the course of the whole of life. This fact is explained by the occurrence, at high altitudes, of a mild degree of pulmonary arterial hypertension from birth.

The media of the ascending aorta of high altitude natives was found to be thinner than that of sea level inhabitants, after 30 years. This characteristic appears to be related to the existence of a lower systolic pressure at high altitudes than at sea level.
The Holmes Heart—A Variant of Cor Triloculare Biatriatum
Authors: ROSENQUIST G. , OLNEY MARY , ROE BENSON B.
Published: June 2012

A fourth case of Holmes heart is described in a 12-year-old boy, and developmental and corrective considerations are compared and discussed.

The first catheterization data in this condition are presented.
Myocardial Infarction Following Transmural Extravasation of Contrast Medium during Left Ventricular Cineangiography
Authors: CHENG TSUNG O.
Published: June 2012

An instance of accidental injection of contrast medium into the wall of the left ventricle during retrograde cineangiocardiography is described. The transmural extravasation led to myocardial infarction from which the patient made an uneventful recovery. The mode of occurrence of this complication during selective cineangiocardiography and measures for its prevention are discussed.
Epinephrine in the Treatment of Cardiac Failure due to Shunts
Authors: RUDOLPH ABRAHAM M. , MESEL EMMANUEL , LEVY JAY M.
Published: June 2012

A technic for establishing a controlled aorto-pulmonary shunt in closed-chest, spontaneously breathing dogs has been developed. Wide opening of the shunt is well tolerated in some animals, but others develop acute left ventricular failure. Administration of sympathetic blocking agents may induce a failure response on opening the shunt, in an animal that previously tolerated it well.

Epinephrine infusion during the control period consistently prevented cardiac failure when the shunt was widely opened. Epinephrine was also capable of reversing the failure, if rapidly infused before left ventricular systolic pressure had dropped to extremely low levels. It was also effective in countering the adverse effects of sympathetic blocking agents. The optimal rate of infusion was found to be 0.5 to 1.5 µg./Kg./min. of epinephrine hydrochloride.

A constant infusion of epinephrine hydrochloride was administered to three infants with large left-to-right shunts who had failed to respond to intensive decongestive measures, and who manifested severe cardiac failure with severe pulmonary edema. Marked clinical improvement resulted, and anesthesia and surgery were well tolerated while the infusion was continued.

Epinephrine should be administered with a constant infusion apparatus to avoid induction of ventricular ectopic beats due to overdosage. Its use is reserved, at present, for the management of the desperately sick infant with acute left ventricular failure due to systemic-pulmonary shunts.
Physiologic Studies Early after Repair of Tetralogy of Fallot
Authors: THEYE RICHARD A. , KIRKLIN JOHN W.
Published: June 2012

Physiologic studies have been carried out during the first 3 days after intracardiac repair of tetralogy of Fallot. All patients survived. The ratio between systolic pressure in right ventricle and a systemic artery was 0.7 or less in all cases and did not vary significantly during the period of study. Residual left-to-right shunts of moderate degree were demonstrated in three patients (repaired with Teflon prostheses). In one of these three, no definite evidence of shunt could be found 2 weeks after operation. Additional abnormal circulatory pathways exist in these patients. Clear evidence was obtained of left-to-right shunting through aorticopulmonary collateral connections in one case. Systemic index was usually below normal or in the low normal range. It was usually lower on the second and third postoperative days than on the first postoperative day. Left atrial pressure was sometimes strikingly higher than right atrial pressure 30 minutes after repair, but not thereafter. Pulmonary vascular resistance was normal or slightly elevated. Gas exchange and management were adequate to maintain normal or near normal oxygen and carbon dioxide levels in arterial blood. Mild metabolic acidosis existed on the first 2 days, but had generally cleared by the third day.

The implications of these data are discussed relative to ventricular function and performance, adequacy and technic of surgical repair, administration of blood after operation, and the state of preparedness in the lung and left ventricle in patients with tetralogy of Fallot.
Chronic Pericardial Effusion Complicating Endomyocardial Fibrosis
Authors: ABRAHAMS D. GORDON , PARRY E. H. O.
Published: June 2012

Six patients are described in whom right ventricular endomyocardial fibrosis was accompanied by a large pericardial effusion. This effusion did not appear to modify either the course of the disease or the physical signs, which included gross elevation of the venous pressure, tricuspid incompetence, and massive ascites with complete absence of dependent edema. Atrial fibrillation was a very common finding.

Cardiac catheterization confirmed the presence of tricuspid incompetence and showed a "dip-and-plateau" contour in the right ventricular tracing. In addition the mean pressures recorded from the pulmonary artery and all parts of the right heart were virtually the same.

Two patients died and were examined postmortem. The findings included gross enlargement of the right atrium, complete disorganization of the tricuspid valve, and progressive obliteration of the right ventricular cavity. It is suggested that death may be due to gradual occlusion of the right atrium by antemortem thrombosis.

The condition must be distinguished from tuberculous pericarditis. Important factors in the differential diagnosis are the presence of tricuspid incompetence with systolic expansion of the neck veins, atrial fibrillation, and the demonstration of cardiac enlargement, due to aneurysmal dilatation of the right atrium.
Premature Mitral Valve Closure
Authors: MEADOWS W. R. , VAN PRAAGH STELLA , INDREIKA MEILUTE , SHARP J. T.
Published: June 2012

The phenomenon of premature mitral valve closure is described in three patients with severe aortic insufficiency and related to absence of the first heart sound.

The occurrence of premature mitral closure is favored by severe aortic regurgitation probably with increased impedance to left ventricular filling.

Available evidence suggests that this phenomenon usually occurs in the more rapidly developing forms of aortic incompetence (bacterial endocarditis, post surgical, and traumatic rupture of the valve), that it is uncommon, and that it often implies a grave prognosis.

It should be suspected when the apical first heart sound is absent in aortic incompetence.
Pathology of the Cardiac Conduction System in a Case of Diphtheria Associated with Atrial Arrhythmias and Heart Block
Authors: JAMES THOMAS N. , REYNOLDS ERNEST W.
Published: June 2012

The histopathology of the sinus node, the atrioventricular node, and the atrioventricular bundle of the heart from a child dying of diphtheria is presented. The terminal illness included atrial arrhythmias and heart block. [see figure in the PDF file] [see figure in the PDF file] The possible importance of the neuropathology of the diphtheritic heart is indicated.
Demonstration of Peripheral Conduction System in Human Hearts
Authors: SPACH MADISON S. , HUANG SHAO-NAN , ARMSTRONG SARA I. , CANENT RAMON V.
Published: June 2012

The peripheral conduction system was demonstrated grossly by iodine staining in a normal newborn heart and in one with a muscular ventricular septal defect. Staining of the conduction system was unsuccessful in a third heart when attempted over 2 hours after death. The left ventricular conduction system was easily visualized; however, the arborizations of conduction tissue over the right ventricular free wall endocardium were demonstrated poorly.
Analysis of the RSR' Complex in Lead V
1
Authors: DEPASQUALE N. P. , BURCH G. E.
Published: June 2012

An RSR' complex was present in lead V
1
in the electrocardiograms of 44 of 870 normal people from birth to 30 years of age; an overall incidence of 5 per cent. Analysis of the RSR' from these 44 patients demonstrated the importance of considering age when interpreting the RSR' complex. Criteria for distinguishing normal and abnormal RSR' complexes for various age groups was suggested. These criteria were 85 per cent successful in distinguishing the RSR' complex in patients with congenital heart disease from the RSR' complex in normal subjects.
Effect of Exercise on Cardiac Performance in Human Subjects with Coronary Artery Disease
Authors: MESSER JOSEPH V. , LEVINE HERBERT J. , WAGMAN RICHARD J. , GORLIN RICHARD
Published: June 2012

Cardiac performance and oxygenation have been studied in resting and exercising subjects with coronary artery disease. Disturbances exist in myocardial function and energetics, characterized by preservation of pressure development, but with impaired systolic ejection and failure to increase mechanical efficiency during exercise. Resultant elevation of myocardial oxygen need by impaired performance undoubtedly aggravates coronary reserve inadequacy during exercise.
Digital Hemodynamics in the Normotensive and Hypertensive States
Authors: CALIVA FRANCIS S. , NAPODANO RUDOLPH J. , STAFFORD ROBERT M. , LOFTUS WILLIAM , LYONS RICHARD H.
Published: June 2012

Rheoplethysmographic studies were conducted to evaluate the digital hemodynamics of the hypertensive state. It is concluded that digital blood flow is similar in normal and hypertensive subjects; digital mean arterial pressures and calculated vascular resistances were significantly elevated in the hypertensive as compared to the normal subject; there is a small but definite increase in digital venous pressure in the hypertensive state; and the digital vasculature and in particular the arteriovenous shunts are otherwise similar in both the normal and the hypertensive subject.
Single Coronary Artery with Fistulous Communication
Authors: MURRAY RAYMOND H.
Published: June 2012

Two cases of single coronary artery with fistulous communication (one to the right ventricle and one to the pulmonary artery) are presented as extremely rare combinations of two rare coronary anomalies. There have been two, previous, similar cases reported in the medical literature.
Mitral Valve Area: Measurement Soon After Catheterization
Authors: RICHTER HOWARD S.
Published: June 2012

A rare opportunity to measure mitral valve area at autopsy shortly after its estimation by means of cardiac catheterization was afforded without the complicating influences of surgery, subacute bacterial endocarditis, smouldering rheumatic valvulitis, or a long enough time interval between catheterization and postmortem study for increased stenosis or increased cardiomegaly to occur. The postmortem estimation of mitral valve area varied between 75 and 213 per cent greater than the mitral valve area estimated from cardiac catheterization data.
Cinefluorographic Studies of the Extracranial Cerebral Circulation
Authors: WHALEN ROBERT E. , HEYMAN ALBERT , MCINTOSH HENRY D.
Published: June 2012

Selective retrograde femoral catheterization with cinefluorographic visualization of the major extracranial cerebral vessels has been carried out in 35 patients with cerebrovascular insufficiency. Examples of partial and complete arterial occlusion have been illustrated. Selective retrograde catheterization avoids the hazards associated with the percutaneous injection of the arteries supplying the brain. Cinefluorography has demonstrated alterations in flow associated with occlusive disease and physiologic maneuvers. Although the combination of selective catheterization and cinefluorographic visualization of the extracranial cerebral circulation has certain limitations, it has proved to be a valuable diagnostic tool.
The Cost of Respiratory Effort in Postoperative Cardiac Patients
Authors: THUNG NALDA , HERZOG P. , CHRISTLIEB IGNACIO I. , THOMPSON W. M. , DAMMANN J. FRANCIS
Published: June 2012

The Engstrom volume-controlled respirator is used routinely in patients after open-heart surgery as a short-term prophylaxis to avoid hypoxia, respiratory acidosis, and excessive fatigue. The respirator should be discontinued when pulmonary function is improved sufficiently to the point where the work of breathing is no longer excessive. With a spirometer designed for the Engstrom respirator, we have determined oxygen consumption and cardiac output in the spontaneously breathing patient and while assisted by the respirator. The difference between the two measurements reflects the oxygen cost of breathing and thus the work that can be spared the heart, by proper mechanical ventilation, during the period of acute postoperative stress. We have demonstrated that the work of breathing, even in good risk patients, is appreciably increased postoperatively, that it is maximal immediately and then falls. These data lend objective support for the prophylactic use of respiratory assistance in patients after cardiac surgery. A similar application to other debilitated surgical and medical patients should be investigated.
Combined Supravalvular Aortic and Pulmonic Stenosis
Authors: BOURASSA M. G. , CAMPEAU L.
Published: June 2012

The association of supravalvular aortic stenosis and postvalvular pulmonic stenosis is described in three patients. In addition to the clinical findings resulting from obstruction to both ventricular outflow tracts, other unusual features were also present, such as a difference in the pulses and blood pressure of the upper extremities and absence of poststenotic dilatation of the ascending aorta. Diagnosis was established at cardiac catheterization by the demonstration of important pressure gradients in the aorta and in the pulmonary arteries with characteristic and almost identical pressure tracings on both sides. The pathologic lesions demonstrated in our patients by selective angiocardiography, surgery, and autopsy are discussed. The possibility of a common etiology for both entities is suggested.
Visualization of the Renal Artery
Authors: KONG YIHONG , BARRY WILLIAM F. , WHALEN ROBERT E. , POLITANO VICTOR A. , MCINTOSH HENRY D.
Published: June 2012

Renal arteriograms were performed by both percutaneous translumbar single film and percutaneous transfemoral catheter seriographic technics on each of 29 hypertensive patients with suspected renal arterial disease. Comparison of the renal arteriograms obtained by these two methods demonstrates [see figure in the PDF file] that the transfemoral catheter seriographic technic is a simpler and more reliable procedure and results in better visualization of the renal artery. Ninety-three per cent of the studies by this method resulted in excellent diagnostic renal arteriograms, whereas only 60 per cent of the studies utilizing the translumbar technic were of equal quality. Pathologic and congenital abnormalities were also better demonstrated with the transfemoral catheter seriographic technic. The advantages and pitfalls of both methods have been discussed.
Observations on the Atrial Sound in Hypertension
Authors: KONTOS HERMES A. , SHAPIRO WILLIAM , KEMP V. ERIC
Published: June 2012

Recovery from heart failure in hypertensive patients having an audible atrial sound was associated with decrease in the intensity of this sound and lengthening of the P-G interval. In most patients the atrial sound disappeared entirely. The rapid intravenous infusion of saline was invariably associated with the appearance of an audible atrial sound in 10 hypertensive patients with left ventricular disease. This procedure was ineffective in producing an audible atrial sound in nine normal subjects and in eight of nine hypertensive patients without left ventricular disease. In four hypertensive patients with left ventricular disease and an audible atrial sound, the infusion of saline resulted in increase in the intensity of the sound and shortening of the P-G interval. An audible atrial sound was most frequently found in association with left ventricular disease and elevation of atrial and ventricular diastolic pressures. The findings suggest that an audible atrial sound is frequently a manifestation of cardiac dysfunction.
Effects of Surface-Active Aerosols and Pulmonary Congestion on Lung Compliance and Resistance
Authors: OBENOUR RICHARD A. , SALTZMAN HERBERT A. , SIEKER HERBERT O. , GREEN JAMES L.
Published: June 2012

Pulmonary compliance and resistance were studied in normal subjects after quiet respiration, deep breathing, and the nebulization of surface-active agents. Deep breathing resulted in a significant rise in pulmonary compliance and decrease in airway and tissue resistance. Alcohol nebulizations increased compliance and decreased resistance in normal subjects. Siliconized superinone and water nebulizations had an opposite effect.

Simulated pulmonary congestion in normal subjects and congestive heart failure with pulmonary edema inhibited the anticipated response to alcohol aerosols. Responsiveness returned in part to patients with congestive heart failure after restoration of cardiac compensation. These observations suggest that pulmonary vascular congestion is a major cause of altered respiratory mechanics in heart failure. In the presence of pulmonary congestion, surface-active aerosols do not demonstrably affect compliance.
Long-Term (10 to 13 Years) Follow-Up Study after Transventricular Pulmonary Valvulotomy for Pulmonary Stenosis with Intact Ventricular Septum
Authors: MIROWSKI M. , SHAH KISHOR D. , NEILL CATHERINE A. , TAUSSIG HELEN B.
Published: June 2012

A long-term follow-up study on 46 patients with pulmonary stenosis and intact ventricular septum who survived transventricular pulmonary valvulotomy performed at the Johns Hopkins Hospital between 1949 and 1951 was carried out; the mean follow-up period was 11.2 years. Preoperatively these patients were severely incapacitated, 76 per cent were cyanotic, 80 per cent had cardiomegaly, and 52 per cent were in congestive cardiac failure.

All 46 survivors of the pulmonary valvulotomy were alive at the time of the present evaluation. In almost half of these patients the long-term results were excellent and the pulmonary stenosis appeared to be virtually relieved. The results were good in 26 per cent of the patients; these patients also had remarkable subjective and objective improvement but still presented signs of residual right ventricular hypertrophy on the electrocardiogram. In 26 per cent of patients the long-term results were poor; seven of these patients have been reoperated upon. Twenty-nine per cent of the patients developed pulmonary insufficiency after surgery; there was no evidence, however, that this complication affected the long-term results.

The long-term studies indicate that for patients with mild to moderate pulmonary valvular stenosis a transventricular pulmonary valvulotomy gives extremely satisfactory results. For patients with congestive cardiac failure, cyanosis, or severe incapacity, the long-term results frequently are less satisfactory.
Cardiac Performance after Open Intracardiac Surgery
Authors: KIRKLIN JOHN W. , THEYE RICHARD A.
Published: June 2012

Cardiac output and related variables were measured in patients after open intracardiac surgery. Factors affecting cardiac performance during this period were the original anatomic lesions, the details of the operative procedure, ventricular-outflow resistance, transfusion of blood, the stage of convalescence, and digitalis. In postoperative patients, metabolic rate, level of hemoglobin, and level of oxygen in arterial blood varied more widely and acutely than in nonsurgical patients, resulting in a less predictable relation between cardiac output and oxygen saturation of mixed venous blood.

Therapeutic applications of these observations were discussed.
Hypertonicity Following Selective Angiocardiography
Authors: GIAMMONA SAMUEL T. , LURIE PAUL R. , SEGAR WILLIAM E.
Published: June 2012

Plasma osmolality and serum sodium concentrations were studied in 30 children with a variety of cardiac abnormalities who underwent selective angiocardiography. A significant increase of osmolality occurred, but there were no significant changes in sodium concentration. The pathologic effects of hypertonic solutions including contrast media are discussed and it is concluded that hypertonicity is a preventable factor in serious reactions seen after angiocardiography.
Spread of the "Mitral" Sound over the Chest
Authors: SHAH P. M. , MACCANON D. M. , LUISADA A. A.
Published: June 2012

Five subjects with prosthetic Starr-Edwards valve replacement of the mitral valve were studied in order to delineate the transmission characteristics of the sounds produced by this valve. In sharp contrast to the first (so-called "mitral") component of the first sound, this sound, arising at the mitral ring, arrived earlier on the surface of the chest in the third and fourth left interspaces near the sternal edge as compared to the apex. This was well correlated to the location of the prosthetic valve as seen from roentgenogram of the chest. It is concluded that the transmission of sound from the prosthetic mitral valve is mainly in the form of transverse vibrations. Different transmission characteristics of this sound, as compared to the first component of the first heart sound, indicate a different source for the two sounds.
The Congenital Variety of the "Subclavian Steal" Syndrome
Authors: MASSUMI R. A.
Published: June 2012

A case of the subclavian steal syndrome due to congenital atresia of the left subclavian artery is described. Attention is called to the alterations in contour and peak time of the pulse in the involved arm, making clinical diagnosis possible. Absence of signs and symptoms of basilar arterial insufficiency is pointed out and ascribed to the youthful state of the cerebral arteries. The continued use of the term "subclavian steal" is encouraged.
Congenital Pericardial Defect Associated with Tetralogy of Fallot
Authors: HIPONA FLORENCIO A. , CRUMMY ANDREW B.
Published: June 2012

Congenital pericardial defect is a rare anomaly with a total of 115 cases in the literature. The two cases discussed are the first reported to be associated with tetralogy of Fallot. The only known case of herniation of normal lung through a pericardial defect into the pericardial cavity is described.
Effect of Vitamin C on Serum Cholesterol in Patients with Hypercholesterolemia and Arteriosclerosis
Authors: SAMUEL PAUL , SHALCHI OLYA B.
Published: June 2012

The daily oral administration of 1 Gm., 2 Gm., 4 Gm., and 6 Gm. of vitamin C for 5 to 16 weeks to 14 patients with hypercholesterolemia (300 mg. per cent or higher) and arteriosclerosis, failed to alter the concentration of serum cholesterol in all but one patient. This finding is in contradiction to previously reported Russian studies.
General Circulatory Alterations Induced by Intravenous Infusion of Synthetic Bradykinin in Man
Authors: DE FREITAS FLAVIO M. , FARACO EDUARDO Z. , DE AZEVEDO DECIO F.
Published: June 2012

The general hemodynamic effects induced by a continuous intravenous infusion of synthetic bradykinin were studied in ten patients submitted to simultaneous right- and left-heart catheterization. A significant drop in systemic arterial pressure and in total peripheral resistance was observed, coincident with an increase of the cardiac output, heart rate, and stroke volume. There was no consistent change of the pulmonary arterial and left atrial pressures, but the pulmonary vascular resistance decreased significantly.
Aneurysms of the Thoracic Aorta
Authors: JOYCE JOHN W. , FAIRBAIRN JOHN F. , KINCAID OWINGS W. , JUERGENS JOHN L.
Published: June 2012

The clinical features and follow-up data on 107 patients who had a clinical diagnosis of aneurysm of the thoracic aorta made at the Mayo Clinic in the period 1945 through 1955 were reviewed. The ratio of male to female was 2.8 to 1, and the average age at the time of diagnosis was 59.3 years. Fusiform aneurysms were four times as frequent as saccular aneurysms; the most common location of the former was the descending thoracic aorta and of the latter the ascending thoracic aorta. Most of the aneurysms (73 per cent) were probably arteriosclerotic in origin. Symptoms, usually pain, and physical signs were present in a minority of patients and indicated a large aneurysm with a poor prognosis.

Diastolic hypertension was present in almost half of the patients at the time of diagnosis and had an adverse effect on the patient's survival. Associated arteriosclerotic cardiovascular disease was present in 40 (37 per cent) of the patients at the time of diagnosis; some of these patients had multiple associated cardiovascular lesions. The presence of associated coronary, cerebral, or other peripheral arterial occlusive or aneurysmal disease had the most deleterious effect on survival. The prognosis for patients with large aneurysms was poorer than for those with small aneurysms.

Information as to the cause of death was available in 59 (83 per cent) of the 71 patients known to be dead at the time of follow-up. Approximately a third of the deaths were due to rupture of the thoracic aortic aneurysm, and approximately a half, to associated cardiovascular disease, particularly that due to arteriosclerosis.

It is believed that this study of patients with untreated aneurysms of the thoracic aorta may be used as a guide to the selection of patients with aneurysm for surgical treatment and may serve as a basis for evaluating the long-term results of such treatment.
QRS-Voltage Criteria for Left Ventricular Hypertrophy in a Normal Male Population
Authors: MANNING G. W. , SMILEY J. R.
Published: June 2012

In this study the range and upper limits of seven QRS-voltage criteria for left ventricular hypertrophy have been established in healthy, fit male young and middle-aged populations. The upper limits of normal for younger and older populations differ considerably. Agreement with the published literature occurred with some of the criteria in the older age group.
Initial Ventricular Impulse
Authors: RUSHMER ROBERT F. , Harding Donald , Baker Donald , Watson Nolan
Published: June 2012

During the early stages of ventricular systole, myocardial tension develops very rapidly, ventricular pressure rises steeply to exceed arterial pressure, and momentum is then rapidly imparted to the blood flowing out of the ventricles. The acceleration of blood out of the ventricles is an expression of the force being applied by the contracting myocardium, and the peak flow velocity can be regarded as the product of the net force applied over the time from the onset of ejection to the peak. The product of force and time is designated by a well-established physical term: impulse (I=Ft). Thus, "initial ventricular impulse" appears to be an appropriately descriptive term for the dynamic properties of ventricular ejection. Direct and continuous records of acceleration, the outflow rate of blood, and the rates of change of ventricular and arterial pressure demonstrate that ejection of blood from both ventricles (particularly the left) is more like striking a piston with a mallet than like squeezing blood out of a chamber. These dynamic characteristics of ventricular ejection are greatly altered by autonomic control and by simulated disease conditions.

Initial ventricular impulse is greatly augmented during exercise, by stimulation of sympathetic nerves to the heart, and following long diastolic intervals. On the contrary, initial ventricular impulse is markedly depressed during premature ventricular contractions, acute coronary occlusion, exsanguination hypotension, general anesthesia, etc. Thus, signs of changing ventricular impulse may have significant value in assessing the performance capability of the heart. For this purpose, certain clinical tests of cardiac performance (e.g., arterial pressure pulses, electrokymograms, precordial displacements, ballistocardiograms) may have unsuspected importance. Experiments on animals have considerable value in suggesting measurements that might be appropriately employed on human subjects and patients, but because of species differences, the validation of initial ventricular impulse as clinical test of value must ultimately be accomplished by appropriate measurements conducted on human subjects. For this reason, a specific experimental design is suggested for the evaluation of certain indirect indicators that may have potential value in routine assessment of the cardiac status. By means of modern high-speed computers, cross correlations, and factor analysis could bring to light the aspects of peripheral arterial pulse waves, kinetocardiograms, electrokymograms, and ballistocardiograms of reliable predictive value in assessing initial ventricular impulse in man.
Electrode Catheters and the Diagnostic Application of Intracardiac Electrography in Small Children
Authors: WATSON HAMISH
Published: June 2012

The history of intracardiac electrography has been reviewed with particular reference to its practical application.

The increasing versatility of electrode catheters is stressed and a new multipurpose diagnostic catheter with a platinum electrode is described.

Electrograms chosen from 500 consecutive cases have been presented to demonstrate the use of an intracardiac lead during routine cardiac catheterization, and the special value of this technic in the investigation of congenital heart disease in babies and small children is emphasized.
Isolated Congenital Mitral Insufficiency with Particular Reference to Left Heart Volumes
Authors: MILLER GRAHAM A. H. , BROWN RICHARD , SWAN H. J. C.
Published: June 2012

Clinical, hemodynamic, and angiocardiographic findings are described in seven cases of congenital mitral insufficiency. The volumes and changes in volume of the left atrium and left ventricle were calculated from the angiocardiograms and were found to be increased above the range of normal. Left ventricular stroke volumes thus obtained were compared with forward flows calculated from indicatordilution curves in order to quantitate regurgitant flow. Regurgitant flows varied between 19 and 94 per cent of the total left ventricular ejection volume, and forward flow was maintained as a result of a considerable increase in left ventricular volume. The left ventricular ejection volume was 50 to 64 per cent of the end-diastolic volume.
The Circulatory Response of Patients with Idiopathic Hypertrophic Subaortic Stenosis to Nitroglycerin and to the Valsalva Maneuver
Authors: BRAUNWALD EUGENE , OLDHAM H. NEWLAND , ROSS JOHN , LINHART JOSEPH W. , MASON DEAN T. , FORT LYNN
Published: June 2012

The circulatory responses to nitroglycerin and to the Valsalva maneuver were studied in seven patients with idiopathic hypertrophic subaortic stenosis, in five patients with valvular aortic stenosis, and in three patients without obstruction to left ventricular outflow. In contrast to the patients with valvular stenosis who showed no changes or decreases in their aortic valvular pressure gradients, in all the patients with idiopathic hypertrophic subaortic stenosis an increased pressure gradient was observed following nitroglycerin administration. Similar effects on the pressure gradients were observed during the Valsalva maneuver, an augmentation occurring in patients with hypertrophic obstruction, and a fall being noted in patients with valvular stenosis. In one patient with idiopathic hypertrophic subaortic stenosis, the gradients across the right ventricular outflow tract were increased by nitroglycerin and the Valsalva maneuver. It is postulated that this increase in obstruction resulted primarily from a decrease in ventricular size secondary to the reduction in venous return induced by these interventions. It is proposed that reduction in the size of the left ventricle in patients with idiopathic hypertrophic subaortic stenosis, whether induced by changes in venous return, a decrease in arterial pressure, or by agents having a positive inotropic action, reduces the effective size of the outflow orifice. The administration of nitroglycerin and the performance of the Valsalva maneuver in the course of left heart catheterization provide simple methods for detecting the presence of latent obstruction in patients with idiopathic left ventricular hypertrophy and for differentiating idiopathic hypertrophic subaortic stenosis from other forms of obstruction to left ventricular outflow.
Hypertriglyceridemia in Gout
Authors: FELDMAN ELAINE B. , WALLACE STANLEY L.
Published: June 2012

Serum triglyceride levels were significantly higher in 34 patients with gout (42 mg. per 100 ml.) in comparison to the levels in 28 healthy men over 35 years of age (100 mg. per 100 ml.). There was no significant predictive relation between levels of serum uric acid and triglycerides in either group. No significant difference in serum cholesterol levels nor lipoprotein profile was apparent between the two groups. The patients with gout had been selected to exclude any manifestations of atherosclerosis or other disease known to be associated with abnormalities in circulating lipids. The results provide support for possible linkage of genetic factors influencing uric acid and triglyceride metabolism. The presence of hypertriglyceridemia in gout may be correlated with the increased incidence of arteriosclerosis.
Acute Infusion of Synthetic Angiotensin II in Patients with Essential Hypertension
Authors: VAGNUCCI ANTONIO I. , LAULER DAVID P. , HICKLER ROGER B. , THORN GEORGE W.
Published: June 2012

Angiotensin II (1-
l
-asparaginyl-5-
l
-valyl angiotensin octapeptide) infused intravenously in subjects with idiopathic hypertension caused depression of the renal hemodynamics in all of them. In agreement with the findings of other investigators, more than one third of the patients showed a decrease in the rate of the sodium excretion; in the remaining subjects, the pressor infusion increased the excretion of sodium.

In all the hypertensive patients, angiotensin II favored renal reabsorption of water.

From the available evidence, it appears that angiotensin II acts upon the renal tubules. The reason for the opposite effect on sodium excretion in hypertensive patients remains unexplained.
Clinical Experience with Fluorescence Retinal Cinematography
Authors: LINHART JOSEPH W. , MCINTOSH HENRY D. , HEYMAN ALBERT , HART LEONARD M.
Published: June 2012

Clinical experience with fluorescence retinal cinematography in 70 patients is presented.

The sequence of normal retinal vascular filling is described. Of particular interest is the demonstration that the retinal circulation consists of a number of vascular segments, each of which may have different flow characteristics.

The pathologic alterations in patients with diabetic and hypertensive retinopathy, papilledema, and other disease states are discussed.

The dynamic portrayal of the retinal circulation, enabling moment-to-moment evaluation, and the efficiency of the cinematographic technic are distinct advantages over the singlefilm method.
Complete Transposition of the Great Vessels
Authors: STERNS LAURENCE P. , BAKER ROY M. , EDWARDS JESSE E.
Published: June 2012

A case of survival to the age of 11 years is reported in a patient with complete transposition of the great vessels. Additional malformations in the form of subpulmonary stenosis, ventricular septal defect, and patent ductcus arteriosus may have contributed to the unusually long period of survival. Surgical creation of an atrial septal defect and of a subclavian-pulmonary arterial anastomosis when the patient was 3 years old may have augmented the beneficial effects of the existing associated malformations.
A Method for Determining Left Ventricular Mass in Man
Authors: RACKLEY CHARLES E. , DODGE HAROLD T. , COBLE YANK D. , HAY ROBERT E.
Published: June 2012

A method for determining left ventricular mass by the use of biplane angiocardiography is described. This method was tested on 23 postmortem human hearts with left ventricular weights of 121 to 453 Gm. The left ventricular chambers of these hearts were distended with known volumes of contrast material and biplane x-rays were recorded over an 80- to 300-ml. range of volumes. Values for left ventricular mass were calculated from the biplane x-ray films and were demonstrated to agree closely with directly measured left ventricular weights. The standard error of estimate was 23 Gm. In six patients, left ventricular weights were calculated from angiocardiograms performed during life and compared with postmortem left ventricular weights. There was close agreement between the calculated and measured values for ventricular weight in all but one subject. This subject had marked right ventricular hypertrophy which resulted in an erroneously large calculated value of left ventricular mass.
Innocent Cardiovascular Murmurs in the Adult
Authors: WEAVER WALT F. , WALKER COLIN H. M.
Published: June 2012

One hundred young adults who were known to have had innocent murmurs as children were re-examined 16 or more years after the murmur was detected. In all individuals a murmur was again heard. Whether or not this was the same murmur could not be determined. While most (85 per cent) had the vibratory quality similar to the childhood vibratory innocent murmur, 87 per cent were audible at or above the third left intercostal space, a higher proportion than is usually found in children. The murmurs could be divided into three main groups: those maximum at the lower left sternal border (58 per cent), the pulmonary area (31 per cent), and the aortic area and neck (10 per cent). Only one was maximum at the apex. No true cardiorespiratory murmurs were heard.

In this study the cardiac sounds and murmurs were faithfully reproduced by the taperecording equipment employed, thus supporting the view that this technic could be used in heart-screening programs but offers no advantage over simple auscultation.
The Effect of Digitalis on Ventricular Ejection in Normal Human Subjects
Authors: WEISSLER ARNOLD M. , GAMEL WILLIAM G. , GRODE HARVEY E. , COHEN SIDNEY , SCHOENFELD CLYDE D.
Published: June 2012

The administration of deslanoside to normal subjects was associated with an abbreviation in the duration of all phases of mechanical systole in the absence of a change in cardiac output. The decrease in the ejection time index following deslanoside is an expression of the [see figure in the PDF file] diminution in the duration of ventricular ejection relative to heart rate and reflects the enhanced mean rate of left ventricular ejection following the drug. These observations lend additional evidence for the positive inotropic effect of digitalis in the normal heart.

Serial determinations of the left ventricular ejection time index following deslanoside afforded observations on the temporal course of the effect of the drug. The decrease in the left ventricular ejection time index proved to be dose dependent, lending evidence for a direct relationship between the positive inotropic effect and the decreased duration of left ventricular ejection.
The Study of Left Ventricular Function in Man by Increasing Resistance to Ventricular Ejection with Angiotensin
Authors: ROSS JOHN , BRAUNWALD EUGENE
Published: June 2012

The performance of the left ventricle was studied in 18 patients by determining the effects of increasing the resistance to left ventricular ejection with graded infusions of angiotensin. By this means, left ventricular function curves, i.e., the relationship between ventricular end-diastolic pressure and stroke work, were constructed. In patients without left ventricular disease the ventricular function curves exhibited steep ascending limbs, large increases in stroke work occurring with small elevations of left ventricular end-diastolic pressure; in contrast, in patients with cardiac disease, the ventricular function curves were either flat, i.e., small changes in stroke work occurred with large elevations in left ventricular end-diastolic pressure, or the function curves exhibited descending limbs. Prior to the infusion of angiotensin many patients with and without depression of their left ventricular function curves had comparable values of left ventricular end-diastolic pressure and stroke work. Thus, the angiotensin test may prove useful for detecting impairment of myocardial function and for expressing the severity of the impairment in a quantitative form.