bluuebunny/crossref_metadata_2025 huggingface dataset:
Immediate Hemodynamic Response of Patients with Atrioventricular Block and Cardiac Failure to Transvenous Pacing
Authors: GOBEL FREDARICK L. , MEDINA JOSE R. , GUENTER CLARENCE A. , WANG YANG , Olds David P.
Published: June 2012

Immediate hemodynamic improvement in patients with complete heart block occurs when the ventricular rate is increased by electrical pacing. During pacing, there is reduction in the pulmonary artery wedge, right atrial, and left and right ventricular filling pressures. The mean rate of ejection, stroke volume, and stroke work decreased following pacing, whereas the ejection time per minute increased, and dye curves assumed a more normal configuration. Very little change was noted in the resting cardiac output.

The paced heart is able to obtain greater increases in cardiac output, stroke volume, and mean rate of ejection during exercise than when unpaced. In addition, pacing tends to return elevated exercising filling pressures in the right and left ventricles toward normal.
Complete Repair of Transposition of the Great Arteries with Pulmonary Stenosis
Authors: RASTELLI G. C. , WALLACE ROBERT B. , ONGLEY PATRICK A.
Published: June 2012

Complete surgical correction of transposition of the great arteries associated with subvalvular pulmonary stenosis carries a high mortality rate. A new surgical technique that achieves redirection of the ventricular outflows and relieves pulmonary stenosis by bypassing it, was successfully used to repair complete transposition of the great arteries associated with ventricular septal defect (VSD) and valvular and subvalvular pulmonary stenosis in a 14½-year-old patient. The repair consists of (1) division of the pulmonary artery, the cardiac end of which is oversewn, (2) repair of the VSD with a patch in such a way as to connect the left ventricle with the aorta, and (3) reconstruction of the pulmonary artery with an aortic homograft, including the aortic valve, which is anastomosed between the distal end of the pulmonary artery and the right ventricle.

A review of the cases in which the current techniques were used indicates that the location and nature of the obstruction in the left ventricular outflow tract defies successful repair in most instances. Localized ridges and diffuse hypoplastic outflow tracts are recognized causes of obstruction, but anomalies of the mitral valve commonly contribute to or are the primary cause of subvalvular obstruction.
Corrected Transposition of the Great Vessels in a 73-Year-Old Man
Authors: LIEBERSON ALAN D. , SCHUMACHER RICHARD R. , CHILDRESS RICHARD H. , GENOVESE PASQUALE D.
Published: June 2012

The case of a 73-year-old white man with corrected transposition of the great vessels and associated mitral and mild aortic regurgitation is reported. The patient's survival was the longest of any patient with this defect reported to date. Although the condition is theoretically compatible with a normal life span, few patients with this lesion survive past 40 years of age because of associated congenital defects or the subsequent development of A-V valvular insufficiency or heart block, or both.
Effects of Propranolol and Isosorbide Dinitrate on Exercise Performance and Adrenergic Activity in Patients with Angina Pectoris
Authors: BATTOCK DENNIS J. , ALVAREZ HECTOR , CHIDSEY CHARLES A.
Published: June 2012

Twelve patients with angina pectoris were evaluated in a single blind crossover study with respect to objective changes in exercise performance on the treadmill and subjective, clinical improvement on oral administration of propranolol, isosorbide dinitrate (ISD), and a combination of propranolol and ISD. Combined objective and subjective evaluations showed that nine of 12 patients improved on propranolol, seven of 10 on ISD, and all 10 on the combination of drugs. The differences in objective improvement between the various drug regimens were not significant. However, subjectively all patients on the combination of drugs improved markedly. The patients on propranolol or the combination had a decrease in pressure-rate index of about 30% both at rest and during exercise, while these values did not change on ISD. A significant reduction in exercise-induced S-T depression was observed with propranolol alone and in combination with ISD at grade 3+ pain. Adrenergic activity, estimated from plasma and urinary catecholamines, appeared to be increased in these patients before drug treatment and was not altered during treatment. It is concluded that propranolol, ISD, and the combination of these drugs all improve exercise performance in patients with angina. Although the combination of drugs could not be shown to produce a greater increase in exercise performance than either drug alone, the combination effected a greater overall clinical improvement.
Effect of Ventricular Extrasystoles on Closure of Mitral Valve
Authors: VANDENBERG RUSSELL A. , WILLIAMS JOHN C.P. , STURM RALPH E. , WOOD EARL H.
Published: June 2012

Mitral valve function was assessed by roentgen videodensitometry. Mitral reflux was rare when single ventricular ectopic systoles were produced by electronic stimulation of the right or left ventricle at various times in the cardiac cycle. It was also rare during the compensatory pause after the ectopic systole or with the following postectopic systole. Recurrent ventricular ectopic systoles interposed once per cycle were associated with minor reflux when introduced in mid-cycle. Such extrasystoles occurred late enough in the cardiac cycle for the ventricle to relax after the primary systole and for the mitral valve to open before the extrasystole. The extrasystolic contractions were, however, weak and incapable of opening the aortic valve. When interposed early in the cardiac cycle, extrasystolic potentiation of the primary ventricular contraction occurred, and no or minimal mitral reflux was observed.
The Hemodynamic Results of Instrumental and Digital Valvotomy in Patients with Mitral Stenosis
Authors: GOBEL F. L. , ANDREW D. J. , WITHERSPOON J. M. , LILLEHEI R. C. , CASTANEDA A. , WANG YANG
Published: June 2012

In order to evaluate the postoperative results from mitral valvotomy when patients were selected according to age, sex, cardiac rhythm, and mode of operation, the mitral valve area (MVA) was determined by cardiac catheterization in 32 patients before and 1 year following closed mitral valvotomy. There was a significantly greater increase in MVA in female patients, younger patients, and patients with sinus rhythm than in males, patients over 45 years of age, and patients with atrial fibrillation. Patients who had an instrumental valvotomy (20 patients) did not have a greater postoperative increase in MVA than patients who had a digital valvotomy (12 patients); however, patients with the largest postoperative MVA had instrumental valvotomy. The incidence of postoperative mitral insufficiency was similar in patients with digital and instrumental valvotomy. Small flecks of mitral valve calcification, as determined by preoperative image-intensification fluoroscopy, did not influence the postoperative MVA.
The Familial Occurrence of the Syndrome of Mid-Late Systolic Click and Late Systolic Murmur
Authors: SHELL WILLIAM E. , WALTON JOSEPH A. , CLIFFORD MARY E. , WILLIS PARK W.
Published: June 2012

Patients with late systolic murmurs, with and without mid-late systolic extra sounds, have recently been shown to have mitral regurgitation. This syndrome has been found to be familial in each of the four families we have studied. These families were found to have a high prevalence of mid-late systolic extra sounds, late systolic murmurs, pansystolic murmurs, abnormal electrocardiograms, and unexplained premature sudden death.

The prognosis for these patients is unknown but is generally considered good. Periodic medical observation of these patients and their families seems warranted, however, in view of the current lack of knowledge concerning the cause of the chest pain, the rate of progression of the mitral regurgitation, the significance of the electrocardiographic abnormalities, the frequency of important arrhythmias, and the mechanism of sudden death. In addition, antibiotic prophylaxis to attempt to prevent bacterial endocarditis seems clearly indicated.
Increased Sympathetic Nerve Activity Following Resection of Coarctation of the Thoracic Aorta
Authors: GOODALL MCC. , SEALY W. C.
Published: June 2012

Twenty patients who underwent resection of the thoracic aorta and six patients operated on for hiatial hernia, patent ductus, mitral insufficiency, or A-V fistula were studied to determine whether there was an increase in sympatho-adrenal medullary activity following resection.

Daily 24-hour urine samples were collected from each patient and control, and outputs of noradrenaline (norepinephrine) and adrenaline (epinephrine) were determined. The preoperative outputs were similar in the coarctation group and the controls.

Postoperatively, however, although noradrenaline was elevated in both groups, it was elevated more in the coarctation group and remained elevated for a longer period than in the control subjects. Both the subjects with coarctation and the controls had marked increases in urinary output of adrenaline after operation. In the coarctation arctation group, however, the increase was greater and extended for a longer period.

The mechanism for increase in noradrenaline output seems to be directly related to the baroreceptors. After resection of aorta for coarctation, pressure in the proximal segment of the aorta decreases. The proximal baroreceptors then reduce their inhibitory influence on the bulbar vasomotor centers, and these centers, in order to compensate for the decreased proximal blood pressure, increase sympathetic nerve activity which is reflected by an increased release of noradrenaline.
The Hemodynamic Response to Chronic Anemia
Authors: DUKE MARTIN , ABELMANN WALTER H.
Published: June 2012

To determine whether the hyperkinetic circulatory response to chronic anemia is obligatory and to assess its strength and potential reversibility, the hemodynamic state at rest was assessed (indicator-dilution method) in 24 patients with chronic anemia before and after certain interventions.

A comparison of cardiac output measured before and after treatment established the consistency of the hyperdynamic response to anemia. In the absence of convalescent data, this response might have been overlooked in some anemic patients whose cardiac output fell within the normal range. In the anemic state, cardiac output correlated negatively and significantly with age (r=-0.752). This relationship may account for the apparent absence of the hyperkinetic circulation in elderly, anemic patients.

In only the most anemic (hemoglobin, 3.8 g/100 ml) of six patients did inhalation of 100% oxygen lower cardiac output significantly.

In four patients, studied in both the supine and sitting posture, orthostatic stress was consistently accompanied by a decrease in central blood volume (7%) and an increase in total systemic resistance (64%), resulting in a reduction of both stroke index (28%) and cardiac index (23%).

Administration of methoxamine to seven anemic patients resulted in increases in mean arterial blood pressure (24%) and total systemic resistance (40%) in all and a decrease in cardiac output in all but one patient (mean, 20%).

Peripheral vasoconstriction induced by means of orthostatic stress or by a pressor amine thus effected an acute reversal of the high output state in chronic anemia. These observations suggest that redistribution of blood volume and vasodilatation play a dominant role in the hyperkinetic circulatory response to chronic anemia and indicate that this state is labile rather than fixed.
The Anatomic Basis for High-Frequency Components in the Electrocardiogram
Authors: FLOWERS NANCY C. , HORAN LEO G. , THOMAS J. R. , TOLLESON WILLIAM J.
Published: June 2012

In a correlative study between selected body-surface potential recordings and anatomic findings, multilead sets of high-fidelity, high-speed records from 128 persons were studied in connection with the results of our detailed postmortem dissections of their hearts. Attention was focused on high-frequency components (notching and slurring of the expanded QRS) as described by Langner.

We found that (1) groups with ventricular enlargement without scarring were indistinguishable from groups with infarction on the basis of the number of high-frequency components; (2) both of these groups were clearly distinguishable from normal subjects on this basis alone; and (3) the high-frequency component count in the group with ventricular enlargement showed high negative correlation with age and high positive correlation with right and left ventricular weights.

These findings suggest that the appearance of high-frequency components in the vectorcardiogram or electrocardiogram may relate to the struggle between competing generator sites of ventricular enlargement as well as to the classic concept of shattering of the wave of activation on the shoals of infarction.
Single (Primitive) Ventricle
Authors: LEV MAURICE , LIBERTHSON RICHARD R. , KIRKPATRICK JAMES R. , ECKNER FRIEDRICH A. O. , ARCILLA RENÉ A.
Published: June 2012

Single ventricle is that condition in which both atrioventricular (A-V) orifices enter a common ventricular sinus, from which the arterial trunks emerge with their coni. The following types of single ventricle were found: (1) with regular (noninverted) transposition in levocardia; (2) with inverted transposition in levocardia; (3) with normal position of arterial trunks in levocardia; (4) in dextrocardia, and (5) in mesocardia. This entity is differentiated from common ventricle which is basically a heart with a large ventricular septal defect. Single ventricle does not include mitral and tricuspid atresia by definition, nor does it include straddling tricuspid orifice, in which two distinct ventricles are present. The concept of single ventricle herein defined differs from de la Cruz and Miller's concept of double-inlet left ventricle which includes straddling tricuspid orifice. Embryologically in single ventricle we are dealing with persistence of the primitive state of the bulboventricular loop, due to a lack of expansion of the atrial canal to the right during the process of absorption of the bulbus.
Diagnosis of Atrial Tumors by Ultrasound
Authors: WOLFE STANLEY B. , POPP RICHARD L. , FEIGENBAUM HARVEY
Published: June 2012

A rapid, harmless, noninvasive technic using ultrasound to diagnose intra-atrial mass lesions is described. The technic permits detection of those tumors which pass through the atrioventricular orifice. Two patients with left atrial myxomata and one with a right atrial myxoma were studied with pulsed, reflected ultrasound, cardiac catheterization, and cineangiography. The diagnosis in each case was confirmed at surgery. The ultrasound technic for detecting atrial tumors was based on recording a mass of echoes immediately behind the echoes originating from the mitral or tricuspid valve leaflets. The mass held the leaflet open during diastole, causing abnormal valve motion. In one case of left atrial myxoma, the tumor plop sound, clinically confused with an opening snap, was shown to occur at a different time in the ultrasound cycle than the true opening snap. This examination is simple enough to be considered as a screening examination for the detection or exclusion of this rare but potentially dangerous abnormality.
Hemodynamic Effects of Nitroglycerin, Propranolol, and Their Combination in Coronary Heart Disease
Authors: WIENER LESLIE , DWYER EDWARD M. , COX J. WILLIAM
Published: June 2012

The hemodynamic effects of 10 mg of propranolol given intravenously (iv) were studied in 10 patients (group I) with coronary heart disease (CHD). These results were compared with the hemodynamic effects in a similar group of the nine (CHD) patients (group II) who were studied after administration of 0.6 mg of nitroglycerin and then after receiving 10 mg of propranolol iv with a second 0.6-mg dose of nitroglycerin. Measurements were obtained at rest and during exercise: before treatment, after nitroglycerin alone, after propranolol alone, and after nitroglycerin-propranolol in combination. Pretreatment exercise showed a 125% increase in mean pulmonary artery pressure (PAP) to 43 mm Hg and a 163% increase in left ventricular end-diastolic pressure (LVEDP) to 29 mm Hg. Nitroglycerin decreased PAP (–45%) and LVEDP (–66%); as did nitroglycerin-propranolol: PAP (–33%) and LVEDP (–38%). Nitroglycerin reduced tension-time index (TTI) –21%, and increased cardiac index (CI) +17%, heart rate (HR) +10%, left ventricular work index (LVWI) +11%, and left ventricular dp/dt (LV dp/dt) +22%. By contrast, nitroglycerin-propranolol reduced LVWI –14%, LV dp/dt –30%, TTI – 15%, and HR – 13% but did not significantly alter CI from pretreatment.

Propranolol increased PAP to 40 mm Hg, did not change LVEDP at 29 mm Hg and decreased stroke index (SI) 16%. Nitroglycerin-propranolol diminished PA and LVED pressure and increased SI 14%. Effects of propranolol alone and of nitroglycerin-propranolol on HR, TTI, and LV dp/dt were not significantly different.

Nitroglycerin-propranolol appears to have important advantages over nitroglycerin or propranolol alone. A reduction in HR, TTI, and LV dp/dt, determinants of myocardial oxygen consumption, concurrent with improved left ventricular function, demonstrates a beneficial synergistic hemodynamic action for nitroglycerin combined with propranolol.
Impaired Maximal Exercise Performance with Hypertensive Cardiovascular Disease
Authors: WONG HEE ONG , KASSER IRWIN S. , BRUCE ROBERT A. , Pettet Gladys , Hofer Verona
Published: June 2012

Responses to a multistage treadmill test of maximal exercise were studied in 61 hypertensive patients: 13 had uncomplicated hypertension; 15 had associated retinopathy; 22 had left ventricular hypertrophy; and 11 also had coronary heart disease. Because of significant differences with aging normally, and differences in ages of these subgroups, responses were compared with those of normotensive persons matched for age and sex.

With only elevated blood pressure there was no impairment of exercise performance and no increase in S-T segment depression. With ventricular hypertrophy and particularly with retinopathy, maximal exercise duration was shortened. Prevalence of postexertional myocardial ischemia, manifested by S-T segment depression, was increased threefold in those with hypertrophy of the left ventricle.

Even greater impairment of exercise duration, maximal heart rate, and systolic pressure was observed in patients with coronary heart disease and hypertension. Prevalence of S-T segment depression was sevenfold greater.

This ECG manifestation of myocardial ischemia may represent either an augmented contractile force or a significantly restricted coronary blood supply to limit myocardial perfusion. Differences in duration of exercise and circulatory responses, particularly the product of maximal heart rate and maximal systolic pressure/100, indicate these variations in pathophysiological mechanisms.
Effects of Breathing 10 Per Cent Carbon Dioxide on the Pulmonary Circulation of Human Subjects
Authors: KILBURN K. H. , ASMUNDSSON T. , BRITT R. C. , CARDON R.
Published: June 2012

The effects on the pulmonary circulation of breathing 10% CO
2
for 10 to 20 min were studied in five eucapnic and 11 convalescing hypercapnic patients to recreate the CO
2
tensions which they had experienced during respiratory failure. Right heart catheterization permitted measurements of pulmonary arterial and wedge pressures and obtaining samples of mixed venous blood. Breathing CO
2
increased mean pulmonary arterial pressures from 33 to 50 mm Hg (52%); pulmonary arterial wedge pressures were unchanged, and cardiac output increased only 22%. In three hypercapnic and two eucapnic subjects reduction of blood hydrogen ion levels by rapid infusion of 120 to 135 mEq NaHCO
3
during CO
2
breathing did not lower pulmonary arterial pressure significantly, nor raise cardiac output. Neither vascular pressures nor cardiac outputs changed during oxygen breathing. Larger increases in cardiac output, which were produced by exercise, raised pulmonary artery pressure only half as much as breathing 10% CO
2
did. Therefore, pulmonary vascular resistance (PVR) that was elevated to an average of 4.8 mm Hg/L/min at rest while breathing air was increased to 6.5 mm Hg/L/min during CO
2
breathing (
P
<0.01). In contrast, PVR was unchanged (4.6 mm Hg/L/min) during exercise. This difference between PVR while breathing CO
2
and during exercise was statistically significant (
P
<0.02). Restoration of the pH of the blood toward normal by the infusion of bicarbonate during breathing of CO
2
raised the pulmonary arterial pressure. The five eucapnic subjects showed similar changes during CO
2
breathing and exercise, although their base-line values were significantly different. The differences were due, at least in part, to lower Paco
2
. This evidence suggests that CO
2
acts on pulmonary arterioles and capillaries that are exposed to alveolar gases to increase the pulmonary vascular impedance.
Assessment of Pulmonary Photoscanning and Angiography in Experimental Pulmonary Embolism
Authors: MOSER KENNETH M. , HARSANYI PAUL , RIUS-GARRIGA GEORGE , GUISAN MICHEL , LANDIS GLEN A. , MIALE AUGUST
Published: June 2012

The diagnostic reliability and specificity of pulmonary angiography and perfusion photoscanning were examined by applying both technics in two series of dogs: one subjected to multiple small pulmonary emboli; the other, to massive embolization. Interpretations of the angiograms and photoscans by two observers were correlated with each other and autopsy data. Analysis disclosed a high degree of agreement between the two technics. Application of both technics, however, led to a greater incidence and accuracy of embolic detection than either method provided alone. Both technics were subject to interpretive errors leading to false positive and false negative diagnoses. The factors promoting such errors are discussed. It is concluded that the two technics are complementary, not competitive, and that each is least reliable in detecting emboli at the extremes of size.
Hypertension and Cerebral Atherosclerosis
Authors: BAKER A. B. , RESCH JOSEPH A. , LOEWENSON RUTH B.
Published: June 2012

This study consisted of an analysis of autopsy material from 3,824 persons who were 30 years of age or older in whom the arterial circle of Willis was scored for the severity and extent of atherosclerosis. Several criteria were used for hypertension. These consisted of the heart weight, the clinical diagnosis of hypertension, and the blood pressure. Regardless of which criterion was used, a definite increase in the severity of atherosclerosis of the circle of Willis was noted in the presence of hypertension. The increase was most pronounced when clinical criteria were used.
Hemodynamic Studies in Patients with 2M and 3M Starr-Edwards Prostheses: Evidence of Obstruction to Left Atrial Emptying
Authors: GLANCY D. LUKE , O'BRIEN KEVIN P. , REIS ROBERT L. , EPSTEIN STEPHEN E. , MORROW ANDREW G.
Published: June 2012

The hemodynamic findings in 28 patients with small (2M uncovered, 2M and 3M covered) Starr-Edwards mitral prostheses are compared with the findings in 12 patients with larger (3M and 4M uncovered) prostheses. Although most patients with the smaller prostheses evidenced both clinical and hemodynamic improvement after operation, the majority continued to have a significant left atrial-left ventricular pressure gradient and an elevated left atrial pressure at rest. During exercise the gradient increased, and left atrial pressure was abnormally elevated in each patient. The hemodynamic findings were decidedly less satisfactory in patients with smaller prostheses than in patients in whom it had been possible to insert larger prostheses. It is concluded that the major site of obstruction to left atrial emptying in patients with smaller prostheses is the small primary orifice of the prosthesis present at the time of insertion. Further narrowing of the primary or secondary orifices by thrombus and/or tissue ingrowth probably contributes to the obstruction in some patients.
Clinical and Hemodynamic Findings Following Replacement of the Mitral Valve with a Beall Valve Prosthesis (Dacron Velour-Covered Teflon-Disc Valve)
Authors: LINHART JOSEPH W. , BAROLD S. SERGE , HILDNER FRANK J. , SAMET PHILIP , PICCININI JUAN C. , MARSTEN JAMES L. , GREENBERG JACK J.
Published: June 2012

The first 21 survivors of mitral valve replacement with a Beall valve prosthesis were evaluated clinically and hemodynamically five months after surgery. Significant clinical improvement was noted in 18 of 21 patients. When compared with preoperative data, a significant improvement occurred in pulmonary artery and left atrial pressures, cardiac index, pulmonary vascular resistance, and in the mitral valve gradient. However, the majority of the patients still had mildly elevated left atrial and pulmonary artery pressures secondary to a mean resting prosthetic gradient of 7 mm Hg. Right heart pacing and exercise significantly increased the gradient and left atrial and pulmonary artery pressures. A remarkable freedom from thromboembolic complications was noted in this series of patients.
Hemodynamic Effects of Glucagon in Patients Following Prosthetic Valve Replacement
Authors: PARMLEY WILLIAM W. , MATLOFF JACK M. , SONNENBLICK EDMUND H.
Published: June 2012

The intravenous administration of 5.0 mg of glucagon to 16 digitalized patients on the first postoperative day after prosthetic valve replacement resulted in significant cardiac inotropic effects. Since glucagon is effective in the presence of catecholamine depletion or beta-adrenergic blockade and appears to have little arrhythmogenic potential, it would appear to be a useful agent for the treatment of myocardial depression occurring in association with open cardiac surgery.
Changes in Pulmonary Vascular Resistance Following Closure of Ventricular Septal Defects
Authors: PARK C. D. , NICODEMUS H. , DOWNES J. J. , MILLER WILLIAM W. , WALDHAUSEN JOHN A.
Published: June 2012

In five patients with pulmonary arterial hypertension (PAH) associated with ventricular septal or endocardial cushion defects, measurements of pulmonary vascular resistance (PVR) were made up to seven days after surgical closure. Before operation, the ratio of mean pulmonary arterial pressure [See Equation in PDF File] to mean systemic arterial pressure [See Equation in PDF File] averaged
0.77
. Catheters placed at operation were used to measure pressure in the pulmonary artery, a systemic artery, and right and left atria. Cardiac output was determined by dye dilution. Controlled mechanical ventilation maintained a normal alveolar ventilation and arterial PO
2
.

Postoperative [See Equation in PDF File], [See Equation in PDF File], and PVR were initially elevated, averaging 42 mm Hg, 0.57, and 1,132 dyne sec cm
-5
, respectively. These values decreased to 29, 0.38, and 459 in three to seven days in the four survivors, but rose in the single death. With unassisted ventilation and 100% 0
2
, or with acidosis (pH 7.21), [See Equation in PDF File] and PVR increased as much as +177% and 570%, respectively.

These studies show the relative pulmonary vasoconstricting effect of systemic acidosis and of spontaneous unassisted breathing with 100% O
2
. In patients with markedly elevated, but reversible, hyperkinetic pulmonary vascular resistance, the beneficial effects of prolonged mechanical ventilation enabled the pulmonary circulation to return toward normal.
Double-Outlet Right Ventricle with Transposed Great Arteries and Subpulmonary Ventricular Septal Defect
Authors: HIGHTOWER BILLY M. , BARCIA ALBERTO , BARGERON LIONEL M. , KIRKLIN JOHN W.
Published: June 2012

The angiocardiographic findings and successful surgical treatment of three patients with double-outlet right ventricle, bilateral conus, transposition of the great arteries, subpulmonary ventricular septal defect, and pulmonary-mitral valve discontinuity are reported. The atria, viscera, and ventricles were normally located, and the aorta originated to the right and anterior to the pulmonary artery.

Surgical repair was accomplished by closure of the ventricular septal defect in such a way that left ventricular outflow was routed via a prosthetic tunnel to the pulmonary artery. Then systemic venous return was transposed intra-atrially by the Mustard technique.

All patients survived complete repair and have continued to improve over a period ranging from several months to 1 year after operation. In one patient complete heart block developed postoperatively, necessitating the insertion of a permanent electronic pacemaker. Details of the method of repair and preoperative studies are presented.
Direct Measurement of Instantaneous Coronary Blood Flow after Total Correction of Anomalous Left Coronary Artery
Authors: REIS ROBERT L. , COHEN LAWRENCE SOREL , MASON DEAN T.
Published: June 2012

An anomalous left coronary artery was excised from the pulmonary artery and connected by a reversed segment of autogenous saphenous vein to the ascending aorta in a 20-year-old man. Before it was anastomosed to the aorta, retrograde flow of oxygenated blood from coronary artery to pulmonary artery occurred predominantly during diastole; the pressure in the left main coronary artery was 30/15 mm Hg and rose to systemic levels following occlusion of the coronary artery at its junction with the pulmonary artery. After transplantation to the aorta, the vessel was encircled with an electromagnetic flow probe and instantaneous left coronary artery blood flow was measured simultaneously with the pressures in the left ventricle and ascending aorta. The pattern of instantaneous coronary blood flow and its relation to ventricular and aortic pressure were similar to the pattern that has been observed in normal animals. Mean flow through the left coronary artery was 104 ml/min. Following operation, the left ventricular enddiastolic pressure decreased to normal levels and the anastomosis was proved to be patent.

Transplantation of the anomalous coronary artery to the systemic circulation restores normal coronary dynamics and may be preferable to simple ligation.
Pathological Changes in Human Aortic Valve Homografts
Authors: REICHENBACH DENNIS D. , MOHRI HITOSHI , MERENDINO K. ALVIN
Published: June 2012

The pathological changes in 34 homograft valves transplanted to the subcoronary position are described. The valves had been in place up to 30 months and did not show evidence of graft rejection. There was evidence of repopulation of the graft by host cells and endothelialization of the leaflet in one case. There were ten instances of homograft valve failure with valve cusp rupture in eight. In four patients who died 7 to 17 months after implantation, unusual organisms were demonstrable in the thickened calcified valve, although no organisms could be isolated during life. An unidentified fungus was present in two cases and possible mycoplasma in two other cases. The demonstration of homograft infection with unusual organisms suggests that special attention needs to be placed on attempted isolation of organisms in patients with homografts. The relationship of the method of sterilization and storage of homografts used in this series to these infections is unclear.
Acute Influence of Internal Mammary Artery Implantation on Ventricular Function
Authors: MCNAMARA J. JUDSON , URSCHEL HAROLD C.
Published: June 2012

Ventricular function was studied acutely before and after internal mammary artery implantation in dogs with the following findings: (1) A single ventricular function study alone did not significantly alter the ventricular function curve obtained 45 minutes later. (2) Single IMA implant and two tunnels without implants appeared to depress ventricular function, although the depression was not significant in degree or frequency when compared with control values. (3) Double internal mammary artery implants depressed ventricular function more than 10% in eight of ten animals studied which was significantly more frequent than in control group I (
P
< 0.05). In addition, the magnitude of the depression (average 18.3%) was significant when compared with pre-implant control values (
P
<0.05).
New Method to Delineate Myocardial Damage at Surgery
Authors: KAISER GERARD A. , WALDO ALBERT L. , HARRIS PAUL D. , BOWMAN FREDERICK O. , HOFFMAN BRIAN F. , MALM JAMES R.
Published: June 2012

A technique is described for obtaining unipolar and bipolar ventricular electrograms at surgery.

The alterations in the form of the electrogram in various pathologic states are consistent, reliable, and reproducible.

The method has advantages over dye technique for delineating areas of damaged myocardium and has been used in a clinical series of 12 patients undergoing cardiac surgery.
Hemodynamic Changes During Sleep in Hypertensive Patients
Authors: KHATRI IBRAHIM M. , FREIS EDWARD D.
Published: June 2012

Hemodynamic studies were carried out during nonsedated all-night sleep on 14 patients with established hypertension. The significant changes from awake control values were as follows: mean arterial pressure fell 7.3% in stages I and II sleep and 8.8% in deep (stages III and IV) sleep; cardiac output decreased 10.3, 9.8, and 8.8% in stages I, II, and III and IV sleep, respectively; heart rate fell 4% in stage II sleep. Total peripheral resistance was not significantly altered. These hemodynamic responses during sleep were similar both quantitatively and qualitatively to those previously found in normal subjects. A small difference, which was of questionable significance, was noted between the two groups of subjects with respect to rapid eye movement sleep. While these observations do not disprove a primary neurogenic component in hypertension, they do not support such an hypothesis.
The Use of Procaine Amide in Cardiac Arrhythmias
Authors: KAYDEN HERBERT J. , STEELE J. MURRAY , MARK LESTER C. , BRODIE BERNARD B.
Published: June 2012

Procaine amide, a new synthetic analogue of procaine, has marked antiarrythmic activity and is relatively stable in the body. It is effective when administered orally or intravenously, and has few toxic effects in therapeutic doses. The drug has been used successfully in the suppression of ventricular premature contractions and in the interruption of ventricular tachycardia. Some patients treated successfully with procaine amide had been given quinidine to the point of toxicity without affecting the aberrant rhythm. Procaine amide appears to be less effective in interrupting auricular than ventricular arrhythmias.
The Effects of Splanchnicectomy on the Blood Pressure in Hypertension
Authors: HOOBLER S. W. , MANNING J. T. , PAINE W. G. , MCCLELLAN S. G. , HELCHER P. O. , RENFERT HENRY , PEET M. M. , KAHN E. A.
Published: June 2012

The effect of supradiaphragmatic splanchnicectomy on the blood pressure of 294 hypertensive patients followed for 10 to 18 months after surgery is compared with the effects of nonspecific medical management in a control group of 79 patients similarly studied. The data are presented in simple graphic form. It is concluded that 29 per cent of the hypertensive patients had reductions in blood pressure outside the range of spontaneous variation, that the vascular complications of hypertension decreased the likelihood of a good result, and that extension of the sympathetic ganglionectomy upward appeared to increase the frequency of good results without requiring a two-stage operation or producing significant postoperative orthostatic hypotension.
Water and Electrolyte Metabolism in Congestive Heart Failure
Authors: MILLER GEORGE E.
Published: June 2012

The over-all metabolic balance of sodium, chloride and water has been studied in 8 subjects recovering from congestive heart failure. During the release of edema the observed loss of water in excess of sodium and chloride, as they are normally present in extracellular fluid, has suggested that the concept of initial retention of sodium in the development of heart failure may be untenable.
Significance of the Nitroglycerin-Flicker Fusion Response in Normal Subjects and Patients with Cardiovascular Disease
Authors: RUSSEK HENRY I. , ANDERSON WILLIAM H. , DOERNER ALEXANDER A.
Published: June 2012

The Krasno-Ivy nitroglycerin-flicker fusion test was carried out in normal persons, and in patients with arterial hypertension and/or coronary disease. A positive test was obtained more often in patients with cardiovascular abnormalities than in normal individuals. In the former group the frequency of negative results and the inconstancy of response to multiple tests indicate the unreliability of this procedure for "the early detection of heart disease tendency." No correlation could be demonstrated between the results of the flicker fusion test, the Master two step or the cold pressor test. The evidence does not support the, alleged clinical usefulness of the nitroglycerin-flicker fusion test.
The Effect of Intravenously Administered Digoxin on Water and Electrolyte Excretion and on Renal Functions
Authors: FARBER SAUL J. , ALEXANDER J. D. , PELLEGRINO E. D. , EARLE D. P.
Published: June 2012

Digoxin causes a prompt and considerable water and salt diuresis in congestive heart failure. This may occur with little or no change in renal hemodynamics, but usually is associated with decreased venous pressure. At times, increased glomerular filtration rate may contribute to the diuresis. In patients with noncardiac edema and without edema, Digoxin may also initiate a slight but definite sodium diuresis. This effect is not as great as in patients with congestive heart failure and apparently is not associated with changes in renal hemodynamics, cardiac output or venous pressure.
Lumbar Sympathectomy for Peripheral Arteriosclerosis
Authors: PEARL FELIX L. , ROSENMAN LEONARD D.
Published: June 2012

Lumbar sympathectomy as treatment for obliterative arteriosclerosis of the legs has developed in accordance with better understanding of the physiology of the collateral circulation. Its importance is demonstrated by the results observed in 44 extremities followed postoperatively up to 14 years. The indications for sympathectomy and method of case selection are discussed at length. As experience has broadened, more advanced cases have been operated on, and good results have been obtained.
Evaluation of Anticoagulant Therapy in Congestive Heart Failure
Authors: LEVINSON DAVID C. , GRIFFITH GEORGE C. , Troutman Mary F.
Published: June 2012

A one year study evaluating anticoagulant drugs as an adjunct in the management of congestive heart failure has been carried out on 300 patients. Depo-Heparin and dicumarol were the drugs employed. The effect of anticoagulant therapy upon the incidence of thromboembolic complications and mortality has been studied.
Studies of the Antiadrenergic Effects of Nitroglycerin on the Dog Heart
Authors: ECKSTEIN RICHARD W. , NEWBERRY WILLIAM B. , MCEACHEN JAMES A. , SMITH GEORGE
Published: June 2012

Using anesthetized dogs, the possible antiadrenergic effects of nitroglycerin upon the myocardium were studied. Observations were made upon changes in heart rate, myocardial oxygen consumption, systolic vigor, and the electrocardiograms. Data are presented showing the effects of nitroglycerin and adrenergic agents when given separately and in combination. Results indicate that in dogs, nitroglycerin produces no antiadrenergic effects on the myocardium. The suggestion is made that the T wave changes seen after adrenergic stimulation in dogs may not be due to anoxia.
Peripheral Vasomotor Effects of Adrenaline and Noradrenaline Acting upon the Isolated Perfused Central Nervous System
Authors: TAYLOR ROBERT D. , PAGE IRVINE H.
Published: June 2012

The problem of the participation of the nervous system in the control of blood pressure has received scant attention. Our purpose was to learn more of the nervous mechanisms which participate in its control. By means of a special technic which allows the brain to be perfused with blood from another animal and yet be connected with the body only by the nervous system, it was shown that pressor substances perfused through the brain cause a fall in pressure in the body. On the contrary, substances which are depressor in the donor's body cause a rise in pressure in the recipient's body when they act on the brain. We conclude that the brain contains hitherto unrecognized chemoreceptors independent of the carotid sinuses. Baroreceptors were not found in the blood vessels. This cerebral buffer mechanism must have important functions in determining the response to vasoactive substances, especially in hypertension and shock.
The Effect of Cycle Length on the Time of Occurrence of the First Heart Sound and the Opening Snap in Mitral Stenosis
Authors: MESSER ADDISON L. , COUNIHAN TIMOTHY B. , RAPPAPORT MAURICE B. , SPRAGUE HOWARD B.
Published: June 2012

Phonocardiography is often more valuable than electrocardiography in timing mechanical events in the cardiac cycle. This study shows that the opening and closing of the mitral valve are related to the length of the previous heart cycle as demonstrated by the variations occuring in auricular fibrillation. These variations in valve action are controlled by the pressure gradient between left auricle and ventricle.
New Aspects of Blood Pressure Regulation
Authors: HEYMANS C. , VAN DEN HEUVEL-HEYMANS G.
Published: June 2012

Experiments show that the state of tone and contraction and thus the resistance to stretch of the arterial wall where the pressoceptors of the carotid sinus are located, are the primary factors affecting these receptors which regulate and moderate reflexly the systemic arterial pressure. Decrease of resistance to stretch of the arterial wall, where the receptors of the sinoaortic nerves which moderate reflexly the general arterial pressure are situated, could be the primary mechanism of essential hypertension.
Experimental Production of Diffuse Proliferative Glomerulonephritis Utilizing Arteriovenous Fistula Stress with Bacteremia
Authors: LILLEHEI C. WALTON , BOBB J. R. R. , WARGO D. , VISSCHER M. B. , SHAFFER J. M. , BELL E. T.
Published: June 2012

By combining the effects of systemic cardiovascular stress produced by large arteriovenous fistulas with bacteremia, a new method has been found by which acute diffuse proliferative glomerulonephritis may be produced experimentally.
The Dye Dilution Method for Describing the Central Circulation
Authors: NEWMAN ELLIOT V. , MERRELL MARGARET , GENECIN ABRAHAM , MONGE CARLOS , MILNOR WILLIAM R. , MCKEEVER WILLIAM P.
Published: June 2012

In addition to providing accurate measurement of circulation times and cardiac output, the dye dilution curves may reveal the size and location of the volumes of blood with which the dye is mixed in the central circulatory system. A trivalent approach to the analysis of these curves is presented by a combination of theoretic analysis, mechanical system experimentation and clinical observation.
Chronic Cardiac Compression (Chronic Constrictive Pericarditis)
Authors: CHAMBLISS J. R. , JARUSZEWSKI E. J. , BROFMAN B. L. , MARTIN J. F. , FEIL H.
Published: June 2012

Sixty-one patients with chronic cardiac compression were studied critically, the largest series in the literature. All patients had pericardiectomy performed. The operative mortality was 18 per cent. Satisfactory result was obtained 72.1 per cent of the patients operated. Tuberculosis was the cause in 28.2 per cent. In most of the remaining cases the etiology was obscure. The symptoms, physical signs, and laboratory examinations are reported. The physiologic studies after operation demonstrate improved cardiac filling and emptying.

The importance of diagnosis and the desirability of pericardiectomy are stressed. With antibiotic therapy there is less risk in operating patients with active infection and the compression syndrome.
Clinical Experiences with 4-Hydroxycoumarin Anticoagulant No. 63 and the Antagonistic Effect of Menadione and Vitamin K
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Authors: HANSON HUGH H. , BARKER NELSON W. , MANN FRANK D.
Published: June 2012

The successful use of dicumarol in the prevention of intravascular thrombosis and subsequent embolism has led to the investigation of other coumarin compounds as therapeutic anticoagulants. 4-Hydroxycoumain anticoagulant No. 63 is such a compound. Like dicumarol, it induces hypoprothrombinemia and daily tests of prothrombin time are necessary as a guide to dosage. Our experience indicates that a less fluctuating and somewhat more consistent therapeutic hypoprothrombinemia can be established and maintained with anticoagulant No. 63 than with dicumarol. The potential disadvantage of the prolonged hypoprothrombinemia after administration is stopped is counter balanced by the strong and relatively rapid antagonistic effect of vitamin K
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Venous System of the Myocardium with Special Reference to the Conduction System
Authors: TRUEX RAYMOND C. , SCHWARTZ MARTIN J.
Published: June 2012

Myocardial veins and sinusoids of the right atrioventricular junction of the heart were studied in serial section, and their relations to the common conduction bundle and nodal tissues were anatomically demonstrated by wax model reconstructions. It is suggested these venous channels may well explain the complete, but transient, bundle block of children observed in certain toxic diseases. On the other hand, the same sinusoids functioning as capillaries may nourish the bundle tissues in older decades, thus explaining the low incidence of bundle block in cases of gradual coronary occlusion. The possible role of these vessels to the intercoronary circulation is discussed.
Cardiac Asthma
Authors: LOMBARDO THOMAS A. , HARRISON TINSLEY R.
Published: June 2012

Cardiac asthma may be defined as the clinical syndrome induced by acute passive congestion and edema of the lungs. It occurs when the left side of the heart suffers from a sudden disproportion between work load and work capacity. It may result, therefore: (1) from disorders which cause rapid impairment of the myocardium, the load being constant (for example, myocardial infarction); (2) from disorders which suddenly increase the resistance or pressure load (such as paroxysmal hypertension consequent to an adrenal medullary tumor); (3) from disorders which markedly elevate the inflow or venous load without impairing the myocardium (such as strenuous exertion in a person with mitral stenosis); or (4) from a combination of these factors. The most common cause is increased venous return in a recumbent subject with left ventricular strain consequent to hypertension. Of the numerous conditions which may produce increased venous return, nocturnal reabsorption of extracellular fluid from dependent parts is probably the most common. The therapeutic implications are obvious.

Cardiac asthma must be differentiated from the various primary diseases of the lungs which cause paroxysms of wheezing or panting. The differentiation is usually readily made by simple clinical measures; in doubtful instances measurements of circulation time may be of crucial value.

The management of cardiac asthma involves chiefly three therapeutic principles: (1) Control of precipitating factors (and especially treatment of latent edema and control of nocturnal cough); (2) measures aimed at reducing the inflow load (sitting position, morphine, venesection, tourniquets on extremities, positive pressure breathing); (3) attempts to reduce the amount of residual blood in the left ventricle (rapid digitalization, use of oxygen, and aminophyllin).

A severe attack of cardiac asthma associated with rapidly developing pulmonary edema constitutes one of the commonest and gravest of all medical emergencies. There are few conditions in the broad domain of internal medicine in which prompt and energetic therapy, based on an understanding of the mechanism of the disorder, can produce such immediate and gratifying benefit.