bluuebunny/crossref_metadata_2025 huggingface dataset:
Histogenesis of Coronary Arteriosclerosis
Authors: MOON HENRY D. , RINEHART JAMES F.
Published: June 2012

The coronary arteries of 250 individuals dying suddenly from traumatic or natural causes were studied. Many different histopathologic processes were found to participate in the development of coronary arteriosclerosis. The earliest changes which occurred, even in infants, were increased fibroblastic activity, deposits of mucopolysaccharide and degeneration of elastic tissue. These changes were not related to lipid deposition. Moderately advanced lesions were characterized by regeneration of elastic tissue, formation of collagen and lipid deposition. The far-advanced lesions showed hyalinization, abundant lipid deposition, calcification, intramural hemorrhage and thrombosis. The possible mechanisms involved in the development of coronary arteriosclerosis are discussed.
Clinical Use of the Anticoagulant Phenylindanedione
Authors: PRESTON FREDERICK W. , O'CONNOR WM. R. , THOMPSON CHARLES E. , CHRISTENSEN ELDIS N.
Published: June 2012

Phenylindanedione is an anticoagulant similar in action to the coumarin series of compounds. Like dicumarol, it is effective orally, acts by lowering blood prothrombin content, and its administration is controlled by daily blood prothrombin determinations. A study of the effective dosage, rapidity of action, cumulative effect and hemorrhagic complications produced by this drug shows that it is a practical anticoagulant for clinical use and has certain advantages over dicumarol.
The Determination of Cardiac Output by a Continuous Recording System Utilizing Iodinated (I
131
) Human Serum Albumin
Authors: PRITCHARD WALTER H. , MACINTYRE WILLIAM J. , SCHMIDT WILLIAM C. , BROFMAN BERNARD L. , MOORE DOUGLAS J.
Published: June 2012

A method previously described for the determination of cardiac output by the injection of iodinated (I
131
) human serum albumin has been extended to a study of its application to patients. A technic suitable for clinical use has been described and values obtained have been compared with those simultaneously determined by cardiac catheterization. The average deviation from Fick principle values was ±8.3 per cent over a range from –8.4 per cent to +18.7 per cent. Certain precautions in technic necessary for accuracy have been stressed.
Studies Utilizing the Portable Electromagnetic Ballistocardiograph
Authors: MANDELBAUM HARRY , MANDELBAUM ROBERT A.
Published: June 2012

Ballistocardiographic studies were done on 28 subjects with left bundle branch block and on 18 subjects with right bundle branch block. The influence of ventricular asynchronism, and the predominance of left or right ventricular disease, upon the derivation and interpretation of the ballistocardiogram, is discussed. The ballistocardiogram was found to be a valuable objective guide in the detection of subjects whose bundle branch block was not associated with significant heart disease. The ballistocardiogram also provided helpful confirmatory evidence of coronary artery or hypertensive heart disease when this was the suspected or certain diagnosis in subjects with bundle branch block.
Massive Infarction of the Right Ventricle and Atrium
Authors: ZAUS EARL A. , KEARNS WALTER M.
Published: June 2012

This is a report of a case of massive infarction of the right ventricle and atrium, expanded to include similar cases found in the literature. The clinical manifestations are believed to confirm views expressed by others that peripheral congestive failure is not immediately related to failure of the right ventricle. The diagnostic value of the electrocardiogram in this lesion is examined.
The George E. Brown Memorial Lecture
Authors: STARR ISAAC
Published: June 2012

The therapy for thromboangiitis obliterans advised by George E. Brown and his collaborators in 1928 is taken as a starting point for a discussion of modern conservative measures now properly used in the treatment of peripheral vascular disease of the obstructive type.
Respiratory Burns with Special Reference to Pulmonary Edema and Congestion
Authors: AVIADO DOMINGO M. , SCHMIDT CARL F.
Published: June 2012

The functional changes in respiration, circulation, blood composition and blood temperature were investigated in anesthetized dogs that were subjected to the inhalation of steam. The pathogenesis of the accompanying pulmonary congestion and edema was analyzed by measurements of: (a) pulmonary blood flow, (b) pressures in pulmonary artery and vein, (c) pulmonary blood (P
32
) volume, (d) electrical (AC) resistance of the lungs, and (e) edema fluid of the excised lung. The peculiarities of the pulmonary circulation that were demonstrated by bleeding and blood infusion explain the difficulties of correcting the congestion that regularly preceded thermal edema.
Hemodynamic Studies in Rheumatic Heart Disease
Authors: FERRER M. IRENÉ , HARVEY RÉJANE M. , CATHCART RICHARD T. , COURNAND ANDRÉ , RICHARDS DICKINSON W.
Published: June 2012

Hemodynamic studies were made in 42 patients with rheumatic heart disease with various valvular lesions and in different stages of cardiac function. These studies include observations not only at rest, but also during exercise, following the acute administration of Digoxin, and after recovery from failure. The relationship between symptomatology and hemodynamic findings were considered and the importance of differentiating between mechanical block and left ventricular myocardial failure as causes for pulmonary artery hypertension is stressed.
Factors in the Production of Coronary Artery Disease
Authors: PATERSON J. C.
Published: June 2012

The recent tendency to accept the syndromes of coronary artery disease as an indication of the presence or relative absence of coronary atherosclerosis in the living patient is open to serious objection. The production of these syndromes would appear to depend, not so much on the degree of coronary atherosclerosis, as on the presence of extraneous factors which precipitate occlusion. Of these factors, hemorrhage into atherosclerotic plaques is of major importance. The etiology of this lesion, and the manner in which it precipitates occlusion, are reviewed.
Oximetry in Congenital Heart Disease with Special Reference to the Effects of Voluntary Hyperventilation
Authors: VAN LINGEN B. , WHIDBORNE JOANNA
Published: June 2012

An oximeter has been used to measure the arterial oxygen saturation of patients with a variety of congenital heart anomalies. The effects of exercise and oxygen administration have been of value in ascertaining the presence of a venous-arterial shunt. The rise in arterial oxygen saturation during a vigorously performed voluntary hyperventilation appears to offer a means of gaging the extent to which the pulmonary circulation may be increased; a less than normal increase has only been found in the presence of pulmonic stenosis or in some instances of pulmonary hypertension and a relatively fixed pulmonary resistance. The results of hyperventilation are sufficiently distinctive to be of diagnostic value in cases of Fallot's tetralogy, Eisenmenger's complex, isolated pulmonic stenosis, pulmonic stenosis with intact ventricular septum and patent foramen ovale, and Ebstein's anomaly of the tricuspid valve with patent foramen ovale.
Myxoma of the Left Atrium
Authors: GOLDBERG HENRY P. , GLENN FRANK , DOTTER CHARLES T. , STEINBERG ISRAEL
Published: June 2012

A case of intra-atrial myxoma manifested clinically by evidences of mitral stenosis and peripheral emboli is presented in detail. The diagnosis was made during life and confirmed by angiocardiography. The surgical procedure, attempted as a last resort, is described, as are the postmortem findings. This case points the way to possible surgical cure in similar lesions.
The Diagnosis of Congenital Subaortic Stenosis
Authors: BROFMAN BERNARD L. , FEIL HAROLD
Published: June 2012

Optically recorded subclavian pulse curves obtained with a simple cup-tambour system give graphic evidence of aortic valve mobility. Differentiation between congenital subaortic stenosis and aortic stenosis was aided by the demonstration in the former of a sharp incisura accompanied by a good aortic second sound; these two features were lacking or rudimentary in the latter. Despite marked auscultatory findings, there is usually little hemodynamic impairment in subaortic stenosis.
Studies of the Mitral Valve. I. Anatomic Features of the Normal Mitral Valve and Associated Structures
Authors: RUSTED IAN E. , SCHEIFLEY CHARLES H. , EDWARDS JESSE E.
Published: June 2012

This study attempts to bring into focus certain details which have not been described adequately in textbooks of anatomy. This information is now of considerable significance because of its role in the genesis and surgical treatment of mitral stenosis. Variations in the size and shape of the mitral valve are described, with particular reference to the fact that valve commissures, or junctional zones between the leaflets, occur in the normal valve. Measurements of commissures, chordae tendineae and valve leaflets are presented, with a discussion of the significance of some of these measurements.
Encephalomyocarditis
Authors: SAPHIR OTTO
Published: June 2012

Simultaneously occurring inflammations of the cerebrospinal system and myocardium are rare if one excludes poliomyelitis. The encephalomyocarditis virus and related strains have been shown to produce such lesions. Three instances in man are related and the reasons for a possible virus origin of this disease entity are given. A plea is made for virus studies in other pertinent cases.
Chronic Lung Disease, Polycythemia and Congestive Heart Failure
Authors: LEWIS CEYLON S. , SAMUELS ARTHUR J. , DAINES MERRILL C. , HECHT HANS H.
Published: June 2012

The relationship of chronic lung disease, congestive heart failure and polycythemia has been examined in 32 subjects including "normal" and "abnormal" controls. The study revealed differences and similarities between cor pulmonale and other types of heart disease. The observations demonstrated a correlation between arterial oxygen tension, as calculated from oxygen content and oxygen capacity, and pulmonary artery pressure. Lowered renal clearance was present in all instances of congestive failure, irrespective of its etiology or of the resting level of cardiac output. It seemed from this preliminary study that bleeding a polycythemic subject with chronic lung disease uncovers a state of oxygen unsaturation that may reflect the conditions which originally led to the development of secondary polycythemia. The possible significance of "oxygen transport" and of altered blood fluidity on the mechanism of heart failure in chronic lung disease is discussed.
The Cardiac Output in Chronic Cor Pulmonale
Authors: FOWLER NOBLE O. , WESTCOTT RICHARD N. , SCOTT RALPH C. , HESS EMILY
Published: June 2012

A comparative study was made of the resting cardiac index in 12 cases of chronic cor pulmonale, in 14 normal subjects, and in 10 patients suffering from heart failure due to vascular or valvular disease. The mean cardiac index in the subjects with chronic cor pulmonale was significantly higher than in the group with other types of heart disease and was significantly lower than in the normal individuals. An explanation for the failure to observe elevation of cardiac output in some of these cases of chronic cor pulmonale is offered.
Studies of Hemodynamic Changes in Humans Following Induction of Low and High Spinal Anesthesia
Authors: MUELLER RICHARD P. , LYNN R. BEVERLEY , SANCETTA SALVATORE M. , HECKMAN GLADYS , JANOUSKOVEC HANNA
Published: June 2012

Low and high spinal anesthesia were administered to a group of 10 waking patients without the use of vasopressor drugs. Preliminary evidence does not support the view that the induced hypotension is accompanied by significant splanchnic vasoconstriction or by homeostatic diversion of blood from the splanchnic bed to maintain the circulation in "more vital" areas.
Further Studies on the Effects of Changes in the Distribution of Extracellular Fluid on Sodium Excretion
Authors: LUSK JOHN A. , VIAR WILLIAM N. , HARRISON TINSLEY R.
Published: June 2012

Bandaging of the legs of sitting subjects resulted in an increase in the renal excretion of sodium which declined after the bandages were removed. Consistent results were not obtained in recumbent subjects. The findings appear to constitute further evidence that the distribution, rather than the total volume of extracellular fluids, has a regulatory action on sodium excretion.
Effect of acute ischemia, nitroglycerin and nitroprusside on regional myocardial thickening, stress and perfusion. Experimental echocardiographic studies.
Authors: Kerber R E , Martins J B , Marcus M L
Published: June 2012

The purposes of this study were to demonstrate that echocardiography can be used to demonstrate the systolic wall thinning of acutely ischemic myocardium, and to compare the effects of nitroglycerin and nitroprusside on systolic thinning, wall stress and perfusion of ischemic myocardium. In 37 dogs, the ratio of end-systolic-to-end-diastolic posterior wall thickness fell from 1.30 +/- 0.02 to 0.88 +/- 0.01 ((p less than 0.001) after circumflex coronary occlusion; perfusion of the area supplied by the occluded artery fell from 98.2 +/- 7.5 ml/100 g/min to 36.5 +/- 2.9 ml/100 g/min (p less than 0.001). Nitroglycerin and nitroprusside were given to lower mean arterial pressure by 7% and 15%. Despite the reduction in coronary perfusion pressure, transmural perfusion, endocardial/epicardial perfusion ratio and systolic thinning remained constant. Both drugs reduced the ischemic "wall stress index" (ventricular pressure x ventricular diameter/wall thickness) by almost 50%. Thus, both nitroglycerin and nitroprusside were equally beneficial in this model of acute myocardial ischemia.
Regional left ventricular function assessed by contrast angiography in acute myocardial infarction.
Authors: Rigaud M , Rocha P , Boschat J , Farcot J C , Bardet J , Bourdarias J P
Published: June 2012

The relationship of segmental left ventricular (LV) wall motion abnormalities to LV function 2-6 days after acute transmural myocardial infarction (MI) was investigated in 45 patients by quantitative contrast ventriculography. Patients were divided into four classes according to the MIRU criteria. Segmental wall motion was assessed by determining the percentage of systolic shortening (deltaS) along nine hemiaxes and the extent of akinetic or dyskinetic abnormally contracting segments (% ACS) expressed as a percentage of end-diastolic perimeter. When compared with that in 17 normal control-subjects, the LV end-diastolic volume was increased only in patients in class III and class IV; the LV end-systolic volume increased progressively from normal through class IV. Ejection fraction had a negative linear correlation with %ACS (r = 0.97). The size of ACS was larger in anterior (34 +/- 14%) than in inferior MIs (23 +/- 7%), resulting in greater LV dysfunction. However, for a comparable size of ACS, infarct location alone did not influence LV function parameters. In the noninfarcted zone, deltaS was increased when the size of ACS was less than 25% and reduced when the size of ACS was greater than 25%. Thus, the size of ACS is a major determinant of LV dysfunction in acute MI. The compensatory mechanisms operate either through an augmented mechanical function of residual myocardium when the infarct is small, or through the Frank-Starling mechanism when the infarct is large.
Effect of extension of infarction on serial CK activity.
Authors: Cobb F R , Irvin R G , Hagerty R C , Roe C C
Published: June 2012

The effects of extension of myocardial infarction by reduction of regional myocardial blood flow (RMBF) to an ischemic region on serum CK activity was examined in 14 awake dogs. Initial infarction was effected by occlusion of the distal left circumflex coronary artery (LCCA) and subsequent extension was produced by occlusion of the proximal LCCA 6, 12 or 18 hours after distal occlusion. Extension was verified by serial measurements of RMBF using radioisotope-labeled microspheres before and after proximal occlusion. Serum CK activity increased initially 2-4 hours after distal coronary occlusion and then increased rapidly and reached peak values 12 hours after occlusion. When the infarction was extended at 6, 12 or 18 hours after initial occlusion, CK appearance was immediately reduced in the 6- and 12-hour experiments, but not in the 18-hour experiments. Extension of infarction at each interval caused delayed increases in CK activity beginning 2-5 hours after proximal occlusion, with peak values occurring 12 hours later. The immediate effects of extension of infarction by reducing blood flow on CK activity are a function of whether the infarcted myocardium continued to release CK, e.g., at 6 and 12 hours after occlusion, or CK release was completed, e.g., 18 hours. The immediate effects of extension of infarction were the result of perfusion on myocardium that is infarcted and continues to release CK, and do not necessarily indicate alterations in the extent of myocardial injury. The delayed effects of proximal and distal occlusion on CK activity were comparable, suggesting that delayed and not immediate alterations in CK activity represent extension of infarction.
Venous admixture in human septic shock: comparative effects of blood volume expansion, dopamine infusion and isoproterenol infusion on mismatching of ventilation and pulmonary blood flow in peritonitis.
Authors: Jardin F , Eveleigh M C , Gurdjian F , Delille F , Margairaz A
Published: June 2012

A hemodynamic study with blood gas analysis was performed so we could observe changes induced by blood volume expansion, dopamine infusion and isoproterenol infusion in 20 adult patients suffering from peritonitis complicated with septic shock and acute respiratory failure. Blood volume expansion increased cardiac index (from 2.6 +/- 1.21/min/m2 to 3.4 +/- 1.31/min/m2; p less than 0.001), but also enhanced venous admixture (QS/QT) from 27 +/- 14% to 36 +/- 13%; p less than 0.01). Dopamine infusion increased cardiac index (from 2.6 +/- 0.9 1/min/m2 to 3.4 +/- 1 l/min/m2; p less than 0.001), but also enhanced venous admixture (from 25 +/- 11% to 31 +/- 12%, p less than 0.001). Isoproterenol infusion increased cardiac index (from 2.6 +/- 0.9 l/min/m2 to 3.6 +/- 1.1 l/min/m2; p less than 0.001), but also enhanced venous admixture (from 27 +/- 12% to 33 +/- 11%; p less than 0.001). This worsening in mismatching of ventilation and blood flow is correlated with the enhancement in pulmonary blood flow obtained by these three therapeutic procedures.
Evolution of QRS-T relationship from birth to adolescence in Frank-lead orthogonal electrocardiograms of 1492 normal children.
Authors: Rautaharju P M , Davignon A , Soumis F , Boiselle E , Choquette A
Published: June 2012

Patterns of evolution of QRS-T relationship were investigated by determining statistical distributions of QRS and STT integral vectors and the ventricular gradient vector in 1492 normal children divided into 12 age groups from birth to the age of 16 years. From birth to the age of 4 days, the ventricular gradient vector shifts posteriorly and to the left due to posterior shift of the STT integral vector and an increase in the spatial angle between QRS and STT integral vectors to a mean value of 103 degrees. These early neonatal changes in QRS-T relationship probably reflect the sudden reduction of hemodynamic load and the subsequent postnatal atrophy of the right ventricle while the left ventricular load slowly increases. The magnitude of the ventricular gradient vector increases from age 3 weeks until about 7 years. The increase appears to be related to a gradual increase in the magnitude of the QRS and STT integral vectors and a drastic decrease in the spatial angle between them. The spatial angle between QRS and STT integral vectors reaches it minimum (22 degrees) in the age group 1.5--4.5 years, suggesting that at that age the average direction of ventricular excitation and repolarization wavefronts are nearly opposite to each other. In addition to the shifting balance between the left and right ventricular hemodynamic load, other factors, such as the maturation of the sympathetic nervous system, may be important in determining spatial gradients in the duration of action potentials, thus influencing the relationship between ventricular excitation and repolarization.
Normal left ventricular function.
Authors: Parker J O , Case R B
Published: June 2012

The Starling relationship in the normal human ventricle may be different than usually portrayed. In normal, resting, supine man the ventricular function curve is at its peak at a left ventricular end-diastolic pressure of approximately 10 mm Hg. Below this point is a strong direct relation between filling pressure and stroke work, while at higher filling pressures, a plateau occurs. Limitation of ventricular response is related to a sharply rising ventricular pressure-volume curve at a normal level of filling pressure. Thus, in the supine position, the normal heart is not on the active portion of the ventricular function curve, but is in a unique position in which cardiac output is probably controlled by factors other than ventricular filling pressure. In ventricular failure, the peak of the ventricular function curve is displaced to a higher level.
Impaired left ventricular function in chronic aortic valve disease: survival and function after replacement by Björk-Shiley prosthesis.
Authors: Schwarz F , Flameng W , Langebartels F , Sesto M , Walter P , Schlepper M
Published: June 2012

Postoperative survival and left ventricular function were studied in 128 patients who underwent isolated aortic valve replacement by the Björk-Shiley valve between 1973 and 1977. The average follow-up was 2.1 years. Patients with associated coronary artery disease or mitral valve disease were excluded. Preoperative ejection fraction ranged from 15-84%. Forty-two patients were restudied by cardiac catheterization 9.1 +/- 1.1 months (mean +/- SEM) after valve replacement. The hospital mortality was 11%. Preoperative type of valve lesion, functional class, cardiothoracic ratio, and ejection fraction (EF) had no significant effect on postoperative survival up to 4 years. After operation, left ventricular mass (LVMI) and peak systolic wall stress (PSWS) fell significantly, while EF and mean normalized systolic ejection rate (MNSER) increased in aortic stenosis and in aortic insufficiency. Neither in aortic stenosis nor in aortic insufficiency was there a significant relation between preoperative ejection fraction and postoperative LVMI, EF, MNSER and PSWS. We attributed this to a marked improvement of left ventricular function in patients with preoperative impaired ventricular function. Six patients with paravalvular leak to restudy has a significantly lower EF and MNSER, and a higher PSWS than patients without leak. Patients without leak had normal EF, MNSER and PSWS when compared with 10 normal persons, but LVMI remained moderately elevated. Postoperative transprosthetic gradient was 11.9 mm Hg (range 0-64 mm Hg). We conclude that impaired cardiac function is completely restored after aortic valve replacement by Björk-Shiley valve, if valve function is good. Patients with impaired cardiac function preoperatively did not have a poorer prognosis after operation than patients with normal function.
Aortoventriculoplasty for tunnel subaortic stenosis and other obstructions of the left ventricular outflow tract. Clinical and hemodynamic results.
Authors: Björnstad P G , Rastan H , Keutel J , Beuren A J , Koncz J
Published: June 2012

A new therapeutic concept of enlarging the outflow tracts of both ventricles with a patch and inserting an aortic prosthesis has been developed for the treatment of tunnel subaortic stenosis. This operation has been applied clinically since June 1974 on several types of obstruction in the outflow tract of the left ventricle. Twenty-one operations have been performed on 20 patients under the age of 18 years, with an overall mortality of 24% and no late deaths. Seven patients developed complete right bundle branch block or left anterior hemiblock or both as a result of this operation; transient atrioventricular block and complete left bundle branch block occurred in one patient each. In no case, however, did rhythm disturbances contribute to death. In one patient, the septal incision injured a septal coronary artery, with fatal result. Fourteen patients had catheterization studies postoperatively. Although previous conventional surgery had been unsuccessful, aortoventriculoplasty (AoVPI) reduced the mean gradient across the left ventricular outflow tract significantly (p less than or equal to 0.01), from 94.7 +/- 25.5 mm Hg to 14.4 +/- 17.2 mm Hg, leaving the end-diastolic pressure practically unchanged. No significant defect remained in the patch-covered septal incision. Thus, we consider AoVPI to be the operation of choice for tunnel subaortic stenosis, for valvular aortic stenosis with a narrow annulus and in cases where an artificial aortic valve has become too small because of the patient's growth.
Status of patients 5 or more years after correction of coarctation of the aorta over age 1 year.
Authors: Hubbell M M , O'Brien R G , Krovetz L J , Mauck H P , Tompkins D G
Published: June 2012

In this retrospective study, we reviewed the records of patients who had coarctectomies at the University of Virginia Hospital after 1 year of age. Follow-up data for 5 years or more after surgery were available for 52 patients. Data from 23 similar patients from the Medical College of Virginia brought the total postoperative sample size to 75. The blood pressure of this group of patients did not differ significantly from that of the population at large. We conclude that successful repair of coarctation of the aorta in childhood or early adolescence does not lead to a higher-than-expected incidence of resting hypertension in childhood.
Subclavian arterioplasty for the ipsilateral subclavian-to-pulmonary artery shunt.
Authors: Laks H , Williams W , Trusler G , Castaneda A
Published: June 2012

A new technique is described to avoid kinking and improve flow in the ipsilateral subclavian-to-pulmonary artery shunt. Experience with this procedure is reviewed in 35 infants and children with a variety of cyanotic congenital heart disease, including 10 with tricuspid atresia. Of these, 17 had had previous shunts: a Waterston shunt in six, a Glenn shunt in six, and a contralateral Blalock-Taussig shunt in five. The mean age was 5.6 years (range, 1 day to 16 years), and the mean follow-up was 24 months (range, 11 months to 4.5 years). There were no early deaths (less than 30 days), but there were two late deaths. There were three shunt failures at 2 weeks, 1 month, and 10 months; two of the failures were in infants aged 1 day and 4 days at operation. There were no late shunt failures. The patency by the life table method was 91.4% at 6 months, 88.5% at 1 year, with no further drop-off. It is concluded that subclavian arterioplasty can be performed safely and offers improved shunt patency in comparing to the ipsilateral Blalock-Taussig shunt.
The elderly patient with severe arterial insufficiency of the lower extremity: limb salvage by femoro-popliteal reconstruction.
Authors: Reichle F A , Rankin K P , Tyson R R , Shuman C R , Finestone A J
Published: June 2012

To determine the feasibility of limb salvage in elderly patients in whom severe ischemia of the lower extremity is present, the results of femoro-popliteal reconstruction done primarily for limb salvage were reviewed. Of 310 femoro-popliteal bypasses, 72 were performed on patients 70 years of age or older. In the over-70 group, ischemic necrosis was present in 70.8% rest pain in 22.2%, and claudication in 7.0%. Initial limb salvage patients 70 years of age or older was 71.4%. Cumulative limb salvage at 5 years was 51.1% and at 10 years was 44.8%. Operative mortality, including mortality of subsequent amputation, when required, was 8.3%. Appreciable limb salvage can be achieved by femoro-popliteal arterial reconstruction in lieu of primary amputation in elderly patients in whom severe arterial insufficiency of the lower extremity is present.
Results of ophthalmosonometry and supraorbital photoplethysmography in evaluating carotid arterial stenoses.
Authors: Duke L J , Slaymaker E E , Lamberth W C , Wright C B
Published: June 2012

A total of 263 patients underwent either periorbital ophthalmosonometry (Doppler ultrasound) or a combination of ophthalmosonometry and supraorbital photoplethysmography (SOPPG) to determine the presence or absence of a hemodynamically significant lesion (occlusion or greater than 50% reduction in lumen diameter). There were 522 vessels studied with Doppler ultrasound and 272 vessels with a combination of the two modalities. The tests were correlated with carotid arteriography to determine their accuracy. Overall accuracy of the Doppler ultrasound examination was 95%. A normal Doppler ultrasound examination was obtained in 367 vessels and arteriography confirmed the absence of a hemodynamically significant lesion in 93%. Of 155 vessels with an abnormal Doppler examination, 149 (96%) were proven on arteriography to have hemodynamically significant lesions. The Doppler ultrasound examination had a high incidence of false-negative examinations (26%) in those vessels that were between 50% and 99% stenotic, however. The SOPPG alone had a high incidence of false-positive examinations (19%); however, in 155 vessels with a normal SOPPG, 98% were proved to have no hemodynamically significant lesion. The combination of Doppler ultrasound and SOPPG was highly accurate in identifying patients with hemodynamically significant lesions. Of 97 vessels with such lesions, 96 (99%) had either an abnormal Doppler ultrasound examination or an abnormal SOPPG. In 240 vessels with concordant results of the Doppler ultrasound and SOPPG, the presence or absence of a hemodynamically significant lesion was accurately predicted in 235 (98%).
Improved survival after surgical therapy for chronic angina pectoris: one hospital's experience in a randomized trial.
Authors: Loeb H S , Pifarre R , Sullivan H , Palac R , Croke R P , Gunnar R M
Published: June 2012

Between 1972 and 1974, 121 patients with chronic stable angina pectoris and operative coronary artery disease, excluding significant left main coronary obstruction, were randomized to either medical therapy (60 patients) or surgical therapy (61 patients) as part of a larger Veterans Administration Cooperative Study of Surgery for Coronary Arterial Occlusive Disease. At the time of randomization, medical and surgical groups were similar with regard to clinical and hemodynamic features as well as degree of left ventricular impairment and extent of coronary disease. Follow-up to June 1, 1978, reveals significantly improved survival in surgical patients from 3 through 6 years after randomization. Sixteen cross-over patients (13 medical to surgery, and 3 surgical without surgery) do not appear to influence results. Results of this randomized study from a single hospital differ from the preliminary results of the larger cooperative study, primarily because of a higher mortality in the medical group. The medical mortality in our group is in keeping with other reports of the natural history of patients with angina pectoris, and we propose that the population of patients we randomized closely simulates the usual type of patient with chronic angina being considered for surgical treatment. Our good surgical results thus contrast significantly with the survival of medically treated patients, and this separates our study from the body of the Veterans Administration Cooperative Study.
Factors influencing the success of ventricular defibrillation in man.
Authors: Kerber R E , Sarnat W
Published: June 2012

To define the factors influencing the success of emergency ventricular defibrillation, we identified 52 patients defibrillated at the University of Iowa Hospital during 1974--1976. Thirty-eight patients were successfully defibrillated at least once; 14 could not be defibrillated, despite multiple attempts. Comparisons between these groups revealed no significant differences in body weight, heart weight, energy per kilogram of body weight and energy per gram of heart weight. Factors that militated against successful defibrillation included a prolonged delay before the first defibrillatory shock (successful 7 +/- 7 minutes (SD); unsuccessful 17 +/- 13 minutes, p less than 0.001), acidosis (successful pH 7.36 +/- 0.22; unsuccessful pH 7.23 +/- 0.12, p = 0.05) and hypoxia (successful PO2 100 + 98 torr; unsuccessful PO2 40 +/- 67 torr; p = 0.06). These three conditions tended to occur together in individual patients. Metabolic factors are important in determining defibrillation success; however, the role of high-energy doses is uncertain.
Determinants of ventricular defibrillation in adults.
Authors: Gascho J A , Crampton R S , Cherwek M L , Sipes J N , Hunter F P , O'Brien W M
Published: June 2012

Conventional defibrillators which stored no more than 400 J and used damped sine wave pulses defibrillated 240 of 253 (95%) episodes of ventricular fibrillation (VF) in 94 prospectively assessed resuscitations in 88 adults. Shocks of 80--240 J (under 3 J/kg) delivered to the chest wall defibrillated more often than higher energy levels. Defibrillation rate did not correlate with weight. Defibrillation was determined by the diagnosis and setting in which VF occurred. Patients with acute myocardial infarction (AMI) and primary VF or with coronary disease and no AMI defibrillated more easily than patients with AMI and secondary VF or with no coronary disease. VF in a terminal patient (agonal VF) defibrillated less often than VF in other clinical situations. Age, weight, delivered energy, duration of pulse wave, and duration of VF had little, if any, influence on rate of defibrillation. These data fail to support the use of more expensive, high-output defibrillators sold by 11 or 14 American manufactures.
Evaluation of myocardial ischemic damage of various ages by computerized transmission tomography. Time-dependent effects of contrast material.
Authors: Higgins C B , Siemers P T , Schmidt W , Newell J D
Published: June 2012

The potential role of computerized transmission tomography (CTT) in the detection and quantitation of acute myocardial ischemic damage was assessed in 42 excised canine hearts at 2 hours, 8 hours, and 48 hours after coronary occlusion. The CTT scan detected by myocardial damage that was 2-48 hours old each time the presence of regional ischemia was confirmed by histochemical straining or epicardial electrocardiographic mapping. Intravenous administration of contrast material enhanced the x-ray attenuation of areas of ischemic damage of 8 and 48 hours duration compared with normal myocardium, but enhanced only normal myocardium in those of 2 hours duration. Volumetric estimation of the extent of damage from the CTT scans in dogs with ischemia of 48 hours duration showed a close linear relationship with the morphometric volume in the absence of contrast material. Quantitation of the area of ischemic damage from the CTT scan after contrast administration resulted in substantial underestimation of the volume of damaged tissue.
Imaging experimental myocardial infarction with indium-111-labeled autologous leukocytes: effects of infarct age and residual regional myocardial blood flow.
Authors: Thakur M L , Gottschalk A , Zaret B L
Published: June 2012

The external imaging patterns and the kinetics of infiltration of indium-111 labeled polymorphonuclear leukocytes (PMNs) occurring in the course of the inflammatory response associated with myocardial infarction were studied in dogs subjected to closed-chest anterior wall infarction. The effects of infarct age and regional residual myocardial blood flow upon PMN infiltration were investigated and quantified, and the capacity of indium-111 PMNs to image the experimental infarction was evaluated qualitatively. The epicardial accumulation of indium-111 PMNs occurred primarily in infarct zones with residual blood flow of 0.6 times normal and was maximal (14.8 +/- 3.8 times normal) in the lowest blood flow zone (less than 0.1 times normal). PMN accumulation in the endocardial infarct zones occurred in the regions with blood flow less than 0.6 times normal and was maximal (26.8 +/- 4.9 times normal) in the lowest blood flow zone. However, contrary to the maximal epicardial infiltration period, which occurred within the first 24 hours after infarction, the maximal endocardial infiltration occurred at 72 hours after infarction. In both endocardium and epicardium, PMN uptake was minimal at 120 hours after infarction. In vivo cardiac images were abnormal and revealed discrete, anatomically distinct areas of increased myocardial radioactivity uptake in the anterior wall of all dogs studied within 24--96 hours after infarction. All images obtained 120 hours after infarction were negative. Thus, indium-111 PMNs provide a noninvasive means of in vivo imaging of the inflammatory response to myocardial infarction and allow quantification of this response at a tissue level.
Veterans Administration cooperative study of surgery for coronary arterial occlusive disease: view from a noncooperating hospital.
Authors: Carey J S , Cukingnan R A , Groner G F
Published: June 2012

Wadsworth Veterans Administration Hospital (VA-W) dropped out of the VA Coronary Cooperative Study (VA-Coop) in 1971 because of difficulty adhering to selection criteria, and because of the lack of standardization of surgical methods. Comparison of results from 1972-1974 showed the following differences: cardiopulmonary bypass time per graft, 61 minutes (VA-Coop) vs 33 minutes (VA-W); perioperative myocardial infarction (MI), 18% vs 6%; hospital mortality, 6% vs 1%; revascularization index (patent grafts per patient determined by postoperative angiography divided by diseased arteries per patient), 0.55 (VA-Coop) vs 0.84 (VA-W). However, the slopes of the actuarial survival curves were similar after the first year. In a group of patients operated on at UCLA and VA-W (UC-VA) during 1969-1971, the 1-year survival rate was 85%, but the annual death rate thereafter was also approximately 2% per year. The survival of VA-Coop surgical patients with three-vessel disease without left main lesions was significantly better (p less than 0.05 by Wilcoxon test) than the medical group with the 6-month (surgical) mortality adjusted to a more acceptable level (5%). These results indicate that coronary bypass surgery produces an annual mortality of approximately 2% per year after the first year. Differences in survival rates are due primarily to variations in first-year mortality, which is influenced by operative mortality as well as morbidity, incomplete revascularization, and low graft patency rate. In our view, the surgical results reported by the VA Cooperative Study are representative of an intermediary step in the development of coronary bypass surgery. The data, however, still indicate that surgical treatment results in better survival in patients with multivessel coronary disease.
Measurement of aortic and mitral regurgitation by gated cardiac blood pool scans.
Authors: Rigo P , Alderson P O , Robertson R M , Becker L C , Wagner H N
Published: June 2012

A simple, noninvasive radionuclide technique which measures the severity of valvular regurgitation has been developed. The technique compares right and left ventricular stroke volume indices (change in counts between diastole and systole over the left and right ventricles) from 45 degrees LAO gated cardiac blood pool scans. In 14 control subjects, the left-to-right ventricular stroke index ratio was near unity (1.15 +/- 0.15 [SD]). In 26 patients with mitral and/or aortic regurgitation it was larger (range 1.36--5.30, mean 2.44). Comparison between the stroke index ratio and qualitative angiographic estimates of regurgitation revealed good agreement (F = 45.5, p less than 0.001). Gated cardiac blood pool scans permit noninvasive assessment of the severity of valvular regurgitation.
A comparison of simultaneous measurements of systolic function in the baboon by electromagnetic flowmeter and high frame rate ECG-gated blood pool scintigraphy.
Authors: Green M V , Ostrow H G , Scott R N , Douglas M A , Bailey J J , Johnston G S
Published: June 2012

Left ventricular (LV) systolic timing and relative volume variations were simultaneously measured by electromagnetic flowmeter (EMF) and high frame rate ECG-gated blood pool scintigraphy in five baboons. No significant differences (p greater than 0.1, paired t test) were observed in the time (from R wave) to peak aortic flow (maximum LV ejection rate), time to cessation of aortic flow (end-systole) or in the duration of aortic flow (LV ejection time). A small (approximately 15 msec) but significant systematic difference (p less than 0.02) was noted in the time to onset of aortic flow. The shape of each scintigraphic time-activity curve during systole was compared to an equivalent curve synthesized from 10 EMF flow profiles obtained in the same baboon. Comparison of these paired curves over systolic ejection yielded an average correlation or r = 0.95 (range 0.90--0.99). The ratio of peak flow to stroke volume determined from these data did not differ significantly (p greater than 0.05). In the baboon, quantitative high temporal resolution ECG-gated scintigraphy appears to reflect closely the detailed timing and relative magnitude variation of LV volume during the entire period of systolic ejection. We conclude that the assumptions underlying the scintigraphic method are valid in the baboon during the ejection interval.
The force-interval relationship of the left ventricle.
Authors: Anderson P A , Manring A , Serwer G A , Benson D W , Edwards S B , Armstrong B E , Sterba R J , Floyd R D
Published: June 2012

We have carried out a quantitative analysis of the force-interval relationship of the human left ventricle and compared it to previous studies done in both intact subjects as well as isolated muscle. The characteristics of the force-interval relationship of the normal patient resembed those of normal isolated mammalian muscle (except when exposed to high levels of catecholamines). The relationship in group 2 (patients with increased left ventricular dimensions and normal pressure indices) resembled those obtained from isolated muscles from hypertrophied hearts. The relationship from group 3 (patients with increased left ventricular EDDs and depressed pressure indices, two of whom were in clinical heart failure) resumbled those induced in normal muscles exposed to high levels of catecholamines, and those obtained from experimentally induced heart failure. The force-interval relationships of the four patients who fell into the third group were strikingly different from the other groups. This suggests that the force-interval relationship may be useful to describe changes in the inotropic state of the patient's heart.
Morphologic development of the pulmonary vascular bed in experimental coarctation of the aorta.
Authors: Levin D L , Mills L J , Parkey M
Published: June 2012

Although electrocardiographic evidence of right ventricular hypertrophy is considered common in newborn infants with coarctation of the aorta, the reason for this finding is not well established. Investigations of the pulmonary vascular bed of these infants have resulted in variable findings, probably due to the differences in morphometric techniques, coexisting cardiac defects, and variable postnatal age at time of death. To study more carefully the pulmonary vascular bed, we produced coarctation of the aorta in fetal lambs at 103--126 days gestation. Twelve to 32 days later the fetuses were reoperated on and systemic and pulmonary arterial blood pressures, and arterial blood gas tensions were determined to be normal. At autopsy, juxtaductal coarctations extended a mean of 2.8 mm into the aortic lumen and occupied 9.5 mm of the aortic circumference. The fifth-generation pulmonary resistance vessels had increased medial width (p less than 0.01), decreased external diameter (p less than 0.001), and increased medial width/external diameter ratios (p less than 0.001) compared with vessels from control fetuses. The number of small muscular pulmonary vessels/cm2 lung tissue was significantly reduced (p less than 0.01) in the study animals compared with the control animals. These alterations of the pulmonary vascular bed were not due to fetal pulmonary arterial hypertension or fetal hypoxemia. These pulmonary vascular changes may explain the occurrence of pulmonary hypertension and right ventricular hypertrophy in newborn infants with coarctation of the aorta.
Noninvasive detection of pulmonary hypertension in patent ductus arteriosus by pulsed Doppler echocardiography.
Authors: Stevenson J G , Kawabori I , Guntheroth W G
Published: June 2012

Twenty-five patients with proven patent ductus arteriosus were examined by pulsed Doppler echocardiography (PDE) before invasive assessment. Ten patients had normal pulmonary artery pressures, and by PDE, pandiastolic ductal flow. Fifteen patients had elevation of mean pulmonary artery pressure, and by PDE, all had abbreviations of diastolic ductal flow. PDE correctly distinguished between patients with normal pressure and those with evidence of pulmonary hypertension; the ECG did not allow such differentiation. Detection by PDE of pulmonary hypertension complicating patent ductus arteriosus appears to be clinically useful.
Hemodynamic, pulmonary vascular, and myocardial abnormalities secondary to pharmacologic constriction of the fetal ductus arteriosus. A possible mechanism for persistent pulmonary hypertension and transient tricuspid insufficiency in the newborn infant.
Authors: Levin D L , Mills L J , Weinberg A G
Published: June 2012

The prostaglandin synthetase inhibitor indomethacin was given orally or intravenously to pregnant ewes. This resulted in a significant rise in the fetal pulmonary-to-systemic arterial mean blood pressure difference across the ductus arteriosus, presumably secondary to constriction of the ductus arteriosus. In five experiments the pressure difference could be promptly but temporarily reversed by the administration of prostaglandin E1 (PGE1) into the fetal inferior vena cava. Fetal lungs from study and control animals were fixed by perfusion at measured pulmonary arterial mean blood pressure, and fifth-generation resistance vessels were studied. The medial width/external diameter ratio was significantly increased in the study vs the control lungs due to increased smooth muscle and decreased external diameter. In addition, study fetuses had acute degenerative myocardial changes in the tricuspid valve papillary muscles, the right ventricular free wall and the interventricular septum. Similar changes were not seen in control fetuses. Indomethacin administration during pregnancy causes constriction of the fetal ductus arteriosus, fetal pulmonary arterial hypertension, and right ventricular damage. If severe, this may cause rapid fetal death. If less severe, in the newborn infant, this mechanism may be one cause of persistent pulmonary hypertension due to vasoconstriction and increased pulmonary arterial smooth muscle and/or tricuspid insufficiency due to papillary muscle infarction.