bluuebunny/crossref_metadata_2025 huggingface dataset:
Rupture of a Papillary Muscle of the Tricuspid Valve Following Acute Myocardial Infarction Report of a Case
Authors: EISENBERG SHLOMO , SUYEMOTO JOE
Published: June 2012

A case of rupture of a tricuspid papillary muscle due to myocardial infarction, apparently the first to be reported in the English literature, is presented. Anatomic, physiologic, and pathologic reasons for the rarity of such a rupture are advanced.
Transluminal Treatment of Arteriosclerotic Obstruction
Authors: DOTTER CHARLES T. , JUDKINS MELVIN P.
Published: June 2012

The rationale and technic of a new procedure—transluminal recanalization of arterio-sclerotic obstructions—has been described.

Of the 11 extremities treated, six have shown marked improvement (four amputations averted). It is reasonable to assume that with a perfected technic and patients with less advanced disease, the percentage of successful recanalizations would increase.

Early treatment with this technic may well prevent otherwise serious disease, not just prevent amputation of extremities not suitable for definitive surgery. We are satisfied that percutaneous transluminal recanalization is the treatment of choice for many lesions of the femoral and popliteal arteries. We believe this method is ready for application to obstructions up to approximately 10 cm. by those skilled in the use of vascular catheters. No doubt the interest and ingenuity of others will lead to refinements of technic as well as further clarification of the role of this attack on arteriosclerotic obstructions.
Pressor Responses to Noxious Stimuli in Hypertensive Patients
Authors: SHAPIRO ALVIN P. , KRIFCHER EMANUEL
Published: June 2012

The pressor and pulse rate responses to several standardized stimuli were determined in hypertensive patients receiving guanethidine sulfate or alpha methyldopa in therapeutic doses. Despite differences between the two compounds in their mode of action, both demonstrated functionally sympatholytic effects. Both drugs produced a greater blood pressure fall in the erect posture than in the supine and impaired the pressor response to the cold pressor test. The pressor reactivity to intravenous angiotensin, however, persisted. Responses to psychophysiologic stimuli were decreased. The implications of these findings for both therapy and for understanding of physiologic mechanisms of pressor reactivity are discussed.
Lipid-Binding Capacity of Intimal Globulins in Human Aortic Atherosclerosis
Authors: MATHUR K. S. , SHARMA R. D. , KASHYAP S. K. , SAPRU R. P.
Published: June 2012

One hundred forty-seven aortas obtained from medicolegal autopsies were studied. According to the extent of involvement of the intimal surface and the types of lesions, aortic atherosclerosis was classified as mild, moderate, and severe. The globulin content of the intima and its lipid-binding, and cholesterol-binding capacity were determined in each specimen.

No relation could be established between the globulin content of aortic intima and the degree of atherosclerosis. A direct correlation was observed, however, between the lipid-binding capacity and the cholesterol-binding capacity of the globulins and the severity of atherosclerosis, suggesting the possibility of a qualitative change in the globulins of the ground substance in atherosclerosis.
The Recognition of Strictly Posterior Myocardial Infarction by Conventional Scalar Electrocardiography
Authors: PERLOFF JOSEPH K.
Published: June 2012

This study was undertaken in order to determine whether the standard scalar electrocardiogram contains sufficient information to permit the recognition of strictly posterior myocardial infarction. Sixteen patients were selected on the basis of vectorcardiographic evidence and four on the basis of autopsy evidence. One hundred normal adult electrocardiograms served as controls. The data indicate that strictly posterior infarction causes (1) R waves of 0.04 second in V
1
and in contiguous right anterior chest leads with upright T waves and, in the acute phase, ST-segment depressions, (2) Q waves of 0.04 second in an area posteriorly between the spine and the left scapula, (3) R/S ratios equal to or greater than one in V
1
and V
2
, (4) slurring of the descending limb of the R wave in lead V
1
due to abrupt change in QRS direction, and (5) no pathologic Q waves in the standard 12 leads unless diaphragmatic or lateral infarction coexists. Extra chest leads derived from the right anterior and left posterior thorax serve principally to corroborate the diagnoses. R waves of 0.04 second or R/S ratios equal to or greater than one in lead V
1
were also found in the normal child, complete right bundle-branch block, the Wolff-Parkinson-White syndrome with an anteriorly directed delta wave, right ventricular hypertrophy, and an occasional normal adult especially with vertical frontal plane electrical axis. Attention to these differential diagnoses and to the foregoing manifestations of strictly posterior infarction facilitate its recognition by conventional scalar electrocardiography.
Atresia of the Aortic Arch
Authors: PILLSBURY R. CREE , LOWER RICHARD R. , SHUMWAY NORMAN E.
Published: June 2012

A case report of a 16-year-old white girl is presented with the cardiovascular anomaly consisting of interruption of the aortic arch between the innominate artery and the left common carotid artery and distal to a right ligamentum arteriosum. This case is unique because the interruption of the aortic arch was not associated with intracardiac anomalies, a patent ductus arteriosus was not present, and the patient had minimal symptoms. This is the sixth reported attempt at surgical correction of interruption of the aortic arch and represents the fourth successful one.
Occlusion of Peripheral Arteries
Authors: WIDMER L. K. , GREENSHER A. , KANEEL W. B.
Published: June 2012

A group of 6,400 volunteers aged 15 to 64 employed in the pharmaceutical industry in Basle, Switzerland, were examined for occlusions of limb arteries. Each subject was given a screening examination including a cardiovascular history, palpation, and electronic recording of foot and wrist pulses. An additional, more detailed examination was done on 294 subjects with pathologic or doubtful screening findings. This included arteriography for 83 subjects.

Occlusions of peripheral arteries were found in 99 extremities of 75 subjects. One sixth was located in arteries of the upper extremities; 14 per cent concerned the iliac, 49 per cent the femoral arteries, and 23 per cent the arteries of the lower leg. In the age group 15 to 39 years occlusions occurred as frequently in women as in men, while a male predominance of 1.6:1 was noted in the 40 to 64 age group. The prevalence rose progressively from 0.1 per cent below age 40 to 8 per cent in the 60 to 64-year-old men. Occlusions were not infrequent in young men; 1 per cent was noted in the age group 40 to 44.

The history was not found reliable for detection of peripheral arterial occlusions. About two of three subjects with demonstrated occlusions failed to exhibit classical symptoms of reduced blood flow in skin or muscle. Conversely, approximately one of four men and one of three women with patent arteries complained of some discomfort in the legs suggestive of occlusions of peripheral arteries.

Evidence of general arterial disease was already present in many subjects with peripheral arterial occlusions: 41 per cent had an occlusion in more than one extremity, 27 per cent presented symptoms of coronary heart disease, and 90 per cent had arteriographic evidence of atherosclerosis in nonoccluded arteries of pelvis and extremities.

A similar sex ratio, age distribution, and the frequent concurrence of occlusions of peripheral arteries and coronary heart disease in the same subject strongly suggest a common process responsible for both diseases.

A thorough examination of the readily accessible peripheral arteries by methods within the reach of most physicians may lead to the early detection of asymptomatic atherosclerotic disease, permitting the institution of preventive or therapeutic measures before the appearance of myocardial infarction, gangrene, or cerebral vascular accidents.
The Frank Vectorcardiogram in Mitral Stenosis
Authors: TAYMOR ROBERT C. , HOFFMAN IRWIN , HENRY EDWARD
Published: June 2012

The vectorcardiographic findings in 29 patients with mitral stenosis are presented.

Five patients had normal QRS loops, and five had classical loops of right ventricular hypertrophy with predominant anterior forces. The remaining 19 patients had posteriorly oriented loops with normal rotation. The characteristics of these latter loops were analyzed in detail and compared with the findings in series of normal subjects.

The midportions of the horizontal plane QRS loops were found to be significantly more posterior in orientation. Posterior voltage was increased while maximum QRS voltage was decreased.

It was thought that the findings represent early right ventricular hypertrophy, and quantitative criteria to differentiate these loops from normal are suggested.
Bundle-Branch Block
Authors: OSTRANDER LEON D.
Published: June 2012

As part of an inclusive health examination of the population of Tecumseh, Michigan, electrocardiograms were recorded from 8,641 persons of all ages, 87.9 per cent of those living in the study area. Eighteen persons, twelve men and six women, had complete right bundle-branch block and a like number, composed of six men and 12 women, had left. All affected persons were past 20 years of age and 67 per cent were past 60.

Twenty-five of the 36 persons had no clinical evidence of valvular heart disease, angina pectoris, or myocardial infarction.

Bundle-branch block occurred mostly in the older age groups where there was a high prevalence of hypertension, hypercholesteremia, hyperglycemia, and obesity, although these conditions were no more frequent among the affected persons than among others of the same age and sex.
Aneurysm of the Right Ventricle Caused by Selective Angiocardiography
Authors: VANDENBERG RUSSELL , DONNELLY GEORGE L. , MACLEOD K. W. , MONK IAN
Published: June 2012

Two cases are reported of aneurysm formation in the outflow tract and body of the right ventricle following selective angiocardiography. The technic and complications of angiocardiography in our hands have been reviewed, and it is concluded that there is no absolute means of preventing injections of contrast material into the wall of the ventricle, if multiple side hole catheters are used. It seems probably that single end hole catheters are safer than multiple side hole catheters for selective ventriculography.

The first patient developed a marked pulsation in the second and third left intercostal spaces together with changes in the plain x-ray that permitted a preoperative diagnosis of aneurysm. The second case was diagnosed at operation. The first patient developed variable cyanosis preoperatively, and during operative correction arterial desaturation together with hypotension. These changes were attributed to outflow tract obstruction by the aneurysm.
Congenitally Unguarded Tricuspid Orifice with Coexistent Pulmonary Atresia
Authors: KANJUH VLADIMIR I. , STEVENSON JAMES E. , AMPLATZ KURT , EDWARDS JESSE E.
Published: June 2012

A rare malformation of the tricuspid valve is described in which neither valvular tissue nor papillary muscles were formed, while a tricuspid orifice was present. The case involved a cyanotic newborn female infant in whom pulmonary valvular atresia was also present.

The functional, clinical, and angiocardiographic manifestations were similar to those that may be observed either in tricuspid atresia or in pulmonary atresia with intact ventricular septum.

As far as we are aware, the literature contains only one other case which bears some similarity but is not identical to the one herein reported.
Saccular Aortic Aneurysm due to Aortic Valve Stenosis
Authors: DITCHEK THEODORE , BOOKSTEIN JOSEPH J.
Published: June 2012

A case of congenital aortic stenosis with an associated discrete saccular aortic aneurysm is presented. The few previously reported cases of this combination of lesions are reviewed and the nature and mechanisms of the aneurysmal changes are discussed. The apparent etiologic importance of the systolic jet striking a localized area of vessel wall is emphasized.
Analog Computer Model of the Vectorcardiogram
Authors: SELVESTER RONALD H. , COLLIER CLARENCE R. , PEARSON ROBERT B.
Published: June 2012

This Study demonstrates the feasibility of developing an analog computer model of the electrical events of the heart, based on a rational application of experimental knowledge of ventricular depolarization.

Not only did the results resemble normal vectorcardiographic loops, but also changes were analogized from concepts of pathologic physiology that produced configurations resembling known clinical vectorcardiographic abnormalities.

It is expected that all known vectorcardiographic deviations can eventually be simulated on a rational basis, and, further, that previously unrecognized alterations may be found permitting diagnosis of infarction or other processes not possible by present knowledge and criteria.

The present study strongly supports the view that most, if not all, of the factors known to influence the electrical field of the heart can be simulated by computer technics. When this is accomplished, it may be possible to remove much of the dogma and empiricism from traditional electrocardiographic theory and place it on a more rational foundation. The need for further exploration in this area seems imperative.
The Preoperative and Postoperative Vectorcardiogrom in Tetralogy of Fallot
Authors: KHOURY GEORGE H. , DUSHANE JAMES W. , ONGLEY PATRICK A.
Published: June 2012

The analysis and description of the preoperative and postoperative vectorcardiograms in tetralogy of Fallot are presented. The spatial orientation of the maximum QRS vectors to the right, anteriorly, and inferiorly in group I is indicative of right ventricular hypertrophy. In group II patients, the vectorcardiogram showed evidence of increased electrical activity of the left ventricle.

Vectorcardiographic patterns of complete right bundle-branch block were noted in nine patients in group III.
Coarctation in the Elderly
Authors: BRAIMBRIDGE M. V. , YEN A.
Published: June 2012

The clinical presentation and operative results have been assessed of a series of patients with coarctation over the age of 40, and have been compared with a larger group of all ages.

Long-standing hypertension increased markedly the incidence of symptoms due to left ventricular strain and cerebral hypertension. There was little increase in symptoms due to poor peripheral blood flow and no case of subacute bacterial endarteritis.

The preoperative systolic blood pressures, when related to the normal for the age and sex of the patient, were higher and the diastolic pressures lower than an average group but signs of left ventricular strain were more common.

At operation the aortic narrowing was found to be of usual severity. Grafts were necessary because of poor anastomotic tissue rather than long narrow segments as in the larger group. The operative mortality was doubled in the elderly, due entirely to hemorrhage from friable aortas. Morbidity was increased as a result of pulmonary and pleural complications.

Postoperative blood pressures were almost exactly comparable with those of the over-all group when related to normal for age and sex. Symptoms were usually relieved but there was relatively slight radiologic or electrocardiographic change. The operative mortality and morbidity are acceptable in view of the risks of inaction and the satisfactory results of operation in the survivors.
The Use of Fiberoptics in Clinical Cardiac Catheterization
Authors: GAMBLE WALTER J. , HUGENHOLTZ PAUL G. , MONROE R. GRIER , POLANYI MICHAEL , NADAS ALEXANDER S.
Published: June 2012

Intracardiac blood oxygen saturation was determined in 31 patients, at cardiac catheterization, by means of a fiberoptic in vivo hemoreflection system, giving an immediate report. When compared to in vitro spectrophotometric analysis of samples obtained through a second catheter, a standard error of estimate of only 1.99-per cent saturation (r = 0.966) was found for the higher speed instrument (response time 0.07 second) and 1.13-per cent saturation (r = 0.992) for the slower instrument (response time 1.5 seconds).

The average of the standard deviations of saturation values in cardiac chambers in which no primary mixing occurred, was only 0.88-per cent saturation. The continuous recording of oxygen saturation while moving the catheter, permits measurements at multiple sites within a brief period of time (14 to 26 seconds through the right side of the heart). Oxygen saturation changes can be continuously monitored under changing conditions, such as exercise. Finally, the higher speed instrument permits investigation of changes in oxygen saturation in patients with congenital heart disease within portions of the cardiac cycle.
The Use of Fiberoptics in Clinical Cardiac Catheterization
Authors: HUGENHOLTZ PAUL G. , GAMBLE WALTER J. , MONROE R. GRIER , POLANYI MICHAEL
Published: June 2012

The fiberoptic instrument and catheters described in the preceding study were employed in the measurement of indocyanine-green concentrations in the circulatory system by a simple change of filters.

Cardiac output was calculated from the recorded curves in 19 instances. In 13 of these, the results were compared with cardiac output determinations simultaneously obtained by a conventional method. There was good agreement for each of the values obtained (range 2.37 to 7.32L./min., r = 0.985). The only blood withdrawn in each patient was the 8 ml. needed for calibration.

Distinct step-function was seen in the descending as well as the ascending portions of the curves. In three instances left ventricular injections were done and end-diastolic and end-systolic volumes calculated. The results are similar to those reported for thermodilution methods.

From the rapidly changing concentration of dye within one cardiac cycle in the presence of aortic regurgitation, a formula was derived by which the amount of regurgitation could be calculated. This method was tested in a model where regurgitation varied up to twice the forward stroke volume by means of a ther-modilution method. Good agreement between measured and calculated degrees of regurgitation (r = 0.928) in 26 observations is shown. The application of the formula to a patient with proven aortic regurgitation is demonstrated.
Hemodynamic Studies during Angina Pectoris
Authors: COHEN LAWRENCE S. , ELLIOTT WILLIAM C. , ROLETT ELLIS L. , GORLIN RICHARD
Published: June 2012

Sixteen patients developed angina pectoris during cardiac catheterization.

During an anginal attack, left ventricular end-diastolic pressure did not uniformly rise. When it did occur, it seemed to be more closely related to acute left ventricular hypertension.

During a stress-induced anginal attack, the rise, if any, in systolic ejection rate of the left ventricle, was markedly decreased below that achieved in normal subjects or in subjects with coronary artery disease without angina. The impaired augmentation in systolic ejection rate was associated with subnormal increases in cardiac output as well as in stroke volume during the anginal state. Average heart rate and systolic ejection period were no different from the nonanginal patients.

Myocardial excess lactate was found in the vast majority of cases during an anginal episode, and actual myocardial lactate production was seen in one half of the patients during angina.

The abnormalities in left ventricular function may be related to abnormalities in oxygen supply to the myocardium.
Work Experience of Cardiac Patients Following Referral to a Work Evaluation Unit
Authors: STEIN SAMUEL W. , ALTMAN GEORGE E.
Published: June 2012

A study of 537 patients referred to the Cardiac Work Evaluation Unit of Boston during the 5-year period from 1955 to 1960 has been undertaken. The present report concerns the 375 individuals with coronary or hypertensive heart disease evaluated during the period of study.

Of the total number, 76 were considered unemployable and 299 (80 per cent) employable. Of the employable, 64 (21 per cent) are known to have died subsequently. Of those for whom some follow-up was obtained, 82 per cent returned to work or continued working after initial evaluation. When last known, 64 per cent of those still alive were still working. The mean duration of follow-up for this series was 4.5 years.

Consideration of the factors that may influence the subsequent employment experience indicated that successful employment was significantly more frequent for subjects below the age of 50, with favorable current cardiac classification (IIB or better), with apparently good motivation, or after a period of unemployment less than 1 year, than for patients in whom any of these factors was unfavorable. Certain specific medical factors, such as heart size, history of previous myocardial infarctions, and blood pressure, had a less constant relation to subsequent employment, though they did have some relation to the medical prognosis.

There was no indication in the present study that employment influenced the mortality statistics.
Acute Pharmacodynamic Effects of Glucocorticoids
Authors: SAMBHI MOHINDER P. , WEIL MAX H. , UDHOJI VASANT N.
Published: June 2012

Cardiac output and intravascular pressure were measured before and after large doses of glucocorticosteroids administered intravenously to nine normal subjects and nine patients in shock. Glucocorticoids caused a sustained increase in cardiac output and a decrease in calculated peripheral resistance. No changes in mean arterial and venous pressures were observed. Possible mechanisms underlying these pharmacologic effects and their implications for the treatment of shock are discussed.
Chronic Atrial Flutter in Brothers with the Marfan Syndrome
Authors: CIPOLLONI P. BENNY , SHANE STANLEY R. , MARSHALL ROBERT J.
Published: June 2012

Chronic atrial flutter was found in two teenage brothers with classical features of the Marfan syndrome. Since neither patient has a gross cardiovascular defect, it is postulated that the arrhythmias may be secondary to an alteration in the fine structure of the atrial myocardium.
Partial Anomalous Pulmonary Venous Drainage with Intact Interatrial Septum Associated with Congenital Mitral Stenosis
Authors: ALDRIDGE HAROLD E. , WIGLE E. DOUGLAS
Published: June 2012

A case of partial anomalous pulmonary venous drainage with intact interatrial septum associated with mitral stenosis is reported. The roentgenogram showed plethora confined to the anomalously draining lung tissue, i.e., right upper amd middle lobes, and when the patient developed pulmonary edema, rales were confined to normally draining lung tissue, i.e., left lung and right lower lobe.

The pulmonary capillary "wedge" pressures recorded from the normally draining lung tissue reflected the left atrial hypertension, while "wedge" pressures recorded from anomalously draining lung tissue were much lower and reflected the right atrial pressure. Left heart catheterization confirmed the presence of mitral stenosis. Autopsy examination revealed congenital mitral and aortic stenosis, anomalous venous drainage from the right upper and middle lobes and an intact interatrial septum. The differential pulmonary plethora, the differential pulmonary edema, and the differential pulmonary capillary wedge pressures suggested the correct diagnosis during life.
Pathology of Left Ventricular Outflow Tract Obstruction
Authors: EDWARDS JESSE E.
Published: June 2012

Lesions causing obstruction to the outflow of blood from the left ventricle may reside in the ascending aorta, the aortic valve, or the outflow tract of the left ventricle.

Conditions involving the ascending aorta are usually congenital, and designated as supravalvular aortic stenosis. A tendency is present for this condition to be associated with mental retardation, stenosis of peripheral pulmonary arteries, stenosis of branches of the aortic arch, and a peculiar facies. Secondary narrowing of coronary arteries may occur.

Obstruction at the aortic valve is usually represented by a stenotic lesion. In some instances, the basis for stenosis is congenital; in others, it is acquired either through the direct effects of rheumatic endocarditis or through calcification of an acquired or congenital bicuspid aortic valve.

Atresia of the aortic valve causes death in infancy.

Subaortic stenosis is a complicated subject. It may be represented by a primary anomaly of the left ventricular outflow tract or may be secondary either to conditions primary in the mitral valve or to generalized diseases of the myocardium.

In some instances of subaortic stenosis, this process is one part of a complex cardiac malformation.
Recognition of Left Ventricular Outflow Obstruction
Authors: BRISTOW J. DAVID
Published: June 2012

The purpose of this report is to summarize the syndromes of obstruction to left ventricular outflow. Emphasis is placed upon the correlations between clinical, hemodynamic, and angiographic features that permit an accurate diagnosis. An exact definition of the problem in each patient has become of great importance because of rapid advances in cardiac surgery, which now offers specific treatment for each of the syndromes described.
Successful Treatment of
Pseudomonas aeruginosa
Septicemia Following Total Aortic Valve Replacement
Authors: LITTLEFIELD JAMES B. , MULLER WILLIAM H. , DAMMANN J. FRANCIS
Published: June 2012

The successful treatment of
Pseudomonas aeruginosa
septicemia in a 24-year-old patient by antibiotic therapy, reoperation, and insertion of a new aortic valve prosthesis three weeks after total aortic valve replacement is reported. This patient also presented other interesting features. She had a Hufnagel valve inserted for severe aortic insufficiency in December, 1955; a Teflon subcoronary, tricuspid, cage prosthesis replaced her destroyed aortic valve in April, 1960; and two Starr-Edwards aortic valve prostheses were inserted during September and October, 1963. The patient is clinically well 12 months after her last operation.
Plasma and Urinary Amino Acids During and After Cardiopulmonary Bypass
Authors: DIMILILER ISMAIL , TROUT ROBERT G.
Published: June 2012

The amount of amino acids in the blood during cardiopulmonary bypass has been studied in two stages by thin-layer chromatography with modifications necessary for this study. In the first stage fresh heparinized blood was recirculated for four to five hours in a heart-lung machine containing a rotating disc oxygenator and nonocclusive roller pumps. This apparatus caused considerable hemolysis, and there was a definite increase in most of the amino acids. Histidine, proline, hydroxyproline, serine, alanine, threonine, aspartic acid, asparagine, glycine, glutamic acid, tyrosine, and tryptophane showed a marked increase; arginine, lysine, valine, cystine, cysteine, and phenylalanine showed a moderate increase. Leucine, isoleucine, and methionine did not change. In the second part of the study, similar investigations were done on blood and urinary samples taken during open-heart operations on five cases. Eight to ten blood samples and a similar number of urinary samples were studied and evaluated repeatedly. The apparatus used, which contained a stationary screen oxygenator and occlusive roller pumps, caused minimal hemolysis. The amino acids increased similarly during open-heart surgery, and this increase continued until four hours postoperatively. During the actual bypass the renal excretion of amino acids slowed down considerably; however, on the evening of the operation there was an increase which continued for four to five days. The hyperamino-acidemia seemed to be related to plasma protein breakdown.
Patterns of Circulatory Response to the Use of Respirators
Authors: CLOWES GEORGE H. A. , COOK WILLIAM A. , VUJOVIC VESELIN , ALBRECHT MISA
Published: June 2012

Serial determinations of the cardiac output, blood gas, and electrolyte values have revealed three basic patterns of circulatory response in 42 patients whose respiratory tidal gas exchange was assumed by a volume displacement respirator for periods up to 12 days:

1. In 15 patients with severe chest and pulmonary injuries, the cardiac indices increased from very low levels (average 1.7±0.3 L/m
2
/min) to 2.8±0.7 L/m
2
/min as profound hypoxia and acidosis were corrected.

2. Eight patients with severe bronchial obstruction or respiratory insufficiency (emphysema or pulmonary fibrosis accompanied by pneumonitis) responded by a decrease of the cardiac output from an average of 3.3 L/m
2
/min to 2.4±0.7 L/m
2
/min. Usually, in a state of combined respiratory and metabolic acidosis (pCO
2
81 mm Hg, pO
2
47 mm Hg), these patients became alkalotic as the arterial pCO
2
approached 40 mm Hg.

3. Nine patients with low cardiac outputs (average 1.4±0.4 L/m
2
/min) following cardiac operations were markedly improved by use of a respirator. Although there was little change in the cardiac output (average 1.4±0.3 L/m
2
/min) for one or two days, metabolic acidosis was dramatically reduced (–7.4 to –1.3 mEq/L). A circulatory output previously inadequate for body perfusion became adequate when the work of respiration was removed.

Ten patients with combined respiratory and cardiac dysfunction exhibited mixed circulatory reactions to the use of a respirator.

From these data, it is concluded that mechanical ventilation can improve an abnormal metabolic status due to cardiac or pulmonary dysfunction by increasing blood gas exchange. When a normal cardiovascular system is present and capable of responding, cardiac output rises to a value sufficient to satisfy the total body requirements for circulation. By decreasing the perfusion requirements of the respiratory muscles, the total demand for circulation is reduced, and perfusion to other parts of the body is improved in patients incapable of elevating the cardiac output.
Comparison of Blood Flow During External and Internal Cardiac Massage in Man
Authors: DEL GUERCIO LOUIS R. M. , FEINS NEIL R. , COHN JOSEPH D. , COOMARASWAMY RAMA P. , WOLLMAN STUART B. , STATE DAVID
Published: June 2012

Cardiorespiratory variables measured during attempts at cardiac resuscitation in 11 patients are presented. These were obtained ten times during closed-chest massage and 15 times during open-chest massage. Three patients were studied during both techniques of resuscitation. Cardiac index and stroke index were significantly better with the internal method, and the mean circulation time was significantly shorter.
Obliterative Aortic Disease in Children in the Tropics
Authors: PATON BRUCE C. , CHARTIKAVANIJ KASARN , BURI PREM , PRACHUABMOH KUMPOL , JUMBALA M. R. BAJARISAN
Published: June 2012

Seven cases of obliterative disease of the aorta have been described, all occurring in Thai children. This disease is believed to be a variant of Takayasu's disease and the clinical manifestations, etiology, and treatment have been discussed.
Palliative Procedure for Treatment of Transposition of the Great Vessels
Authors: LINDESMITH GEORGE G. , MEYER BERT W. , JONES JOHN C. , GALLAHER MARIAN
Published: June 2012

1. Extreme efforts at palliation seem indicated in the very young infant with transposition of the great vessels and no accompanying defects of note since good candidates for later total correction may thereby be preserved.

[see table in the PDF file]

2. A palliative procedure is presented wherein an atrial septal defect is created, and the blood flow from the inferior vena cava is diverted through the defect.

3. Presented are nine patients less than two months of age and with arterial oxygen saturations less than 35% who underwent the described procedure.

4. There were two early and two late deaths. The survivors are all doing well clinically and have required no further procedure.
Selection of Palliative Operation for Transposition of the Great Vessels
Authors: REED WILLIAM A.
Published: June 2012

In view of our present experience, it is our belief that adequate palliation is available for the majority of patients with transposition. Recent success with total correction makes an aggressive approach to palliative surgery more urgent.
Surgical Considerations in the Management of Supravalvular Aortic Stenosis
Authors: SHUMACKER HARRIS B. , MANDELBAUM ISIDORE
Published: June 2012

Nine cases of surgically treated supravalvular aortic stenosis have been presented. The pertinent literature has been reviewed. It is concluded that this anomaly can be managed satisfactorily by insertion of a large patch graft into an aortic incision placed across the stenotic area and extended well beyond it in both directions. Total cardiopulmonary bypass is utilized. Left ventricular decompression and coronary arterial perfusion are valuable adjuvants. The risk of operation appears to be small and the results rewarding.
Results of Total Surgical Correction for Fallot's Tetralogy
Authors: SHUMWAY NORMAN E. , LOWER RICHARD R. , HURLEY EDWARD J. , PILLSBURY R. CREE
Published: June 2012

Forty-four consecutive patients have been operated upon for total correction of Fallot's anomaly since the opening of the Stanford Medical Center. There were no hospital or operative deaths. The combination of uniformly reversible cardiac arrest, meticulous placement of sutures for closure of the ventricular septal defect, and a flexible plan for enlarging the outflow tract has markedly reduced the operative risk for total surgical correction of Fallot's tetralogy.
Ebstein's Malformation of the Tricuspid Valve
Authors: LILLEHEI C. WALTON , GANNON PAUL G.
Published: June 2012

Two cases of complete correction of Ebstein's malformation are presented. The deformed tricuspid valve was excised. A ball-valve prosthesis was anchored at the true annulus. This procedure removes the obstruction to right ventricular outflow, eliminates tricuspid insufficiency, increases right ventricular diastolic capacity, and improves the pumping action of the right ventricle by increasing the size and effectiveness of the pump chamber. Preoperatively, both patients were cyanotic because of large right-to-left shunts at the atrial level.

No attempt was made to close the associated atrial septal defect in our first case. This patient continued to shunt right-to-left postoperatively but expired early in the postoperative period as a result of right-heart failure.

A flap-valve type closure of the large associated atrial septal defect in the second patient with Ebstein's malformation permitted right-to-left shunting until the right ventricle became competent to pump the entire venous return to the lungs. About two weeks after surgery the right-to-left shunting ceased in this patient.

Both patients developed complete heart block during the tricuspid valve prosthesis insertion. This complication was compensated for by a myocardial electrode and external pacemaker in the early postoperative interval.

The second patient was discharged in an asymptomatic condition following insertion of an implantable pacemaker. A possible method for avoiding heart block in these cases in the future is discussed.
Hypotensive Effect of Ethacrynic Acid
Authors: CONWAY JAMES , LEONETTI GASTONE
Published: June 2012

Ethacrynic acid has been found to possess a similar antihypertensive action to the thiazide diuretics. The use of the two drugs together results in a greater fall in pressure than that obtained with either drug alone. When thiazide therapy is supplemented by ethacrynic acid and dietary restriction of sodium a substantial additional reduction in blood pressure averaging 48/18 mm. Hg was obtained.
The Safety of Hydrogen in Shunt Detection
Authors: DICKERSON ROBERT B. , JENSEN WALTER L. , HOLLISON ROBERT V.
Published: June 2012

The hazards of hydrogen as used for the detection of shunts has been studied under clinical conditions with the Standard Mine Safety Appliance Explosimeter and under additional simulated circumstances far more extreme than would ever be encountered in a catheterization laboratory. Because of the lightness of the gas and its ready diffusibility, explosive concentrations were transiently identified in small zones that were grossly different from those reportedly associated with "heavier than air" explosive gases. With its use in single inhalations for the identification of an intracardiac shunt and with allowances for a liberal safety factor, no explosive risk exists outside a conical envelope, which may be considered to extend 3 feet above, 6 inches below, and 12 inches laterally in all directions from the patient's mouth. Ordinary electronic apparatus, motor-driven syringes, and x-ray equipment, provided they are commonly grounded and outside this zone, require no explosive safety precautions in their use when hydrogen is used in this manner for shunt detection. Room ventilation is desirable for personal comfort but should not be considered a safety requirement. Release of large quantities of hydrogen has shown that there is no reason to specify a time interval between inhalations for the dispersion of hydrogen.

These conclusions are not intended to bemean those measures that are routinely followed to avoid the generation of static electricity.
16
But were a spark generated, it would be of no significance unless it occurred in the restricted zone described.
Salmonella Aortitis in a Patient with a Hufnagel Valve
Authors: WEINSTEIN LOUIS , KAPLAN KENNETH
Published: June 2012

A patient is described in whom
Salmonella schwarzengrund
bacteremia was associated with infection of the aorta in the area at which a Hufnagel valve had been implanted 4 years earlier. Despite prolonged and repeated therapy with antimicrobial agents to which the organism was sensitive, an abscess developed in the aortic wall and led to a dissecting aneurysm and death.

The role of the Hufnagel valve in altering the anatomy and hemodynamics in the lower aorta and predisposing to local and persistent infection is discussed. It is suggested, on the basis of the course of this patient's illness, that the appearance of bacteremia is especially ominous when such a prosthesis is present, and that antimicrobial therapy should be initiated as early as possible, that the doses used be large, and that the treatment be prolonged, without interruption. If manifestations consistent with aortic tear appear, despite apparent control of the infection, the presence of an abscess in the aortic wall must be suspected and the possibility of removal of the prosthesis and excision of the infected area be given serious consideration.
Bronchial Circulation in Severe Multiple Peripheral Pulmonary Artery Stenosis
Authors: LEES MARTIN H. , DOTTER CHARLES T.
Published: June 2012

In an infant with severe, multiple, peripheral pulmonary artery stenoses angiography clearly demonstrated enlarged tortuous bronchial arteries, especially in the right lung, where a major tortuosity corresponded closely to the point of maximal intensity of a loud continuous murmur. Increased bronchial circulation may be responsible for continuous murmurs in patients with severe multiple peripheral pulmonary artery stenosis.
Left Ventricular Oxygen Consumption, Blood Flow, and Performance in Mitral Stenosis
Authors: FRANK MARTIN J. , LEVINSON GILBERT E. , HELLEMS HARPER K. , Stevelman Harold , Migliori Angelo J.
Published: June 2012

The restriction imposed by mitral stenosis on the cardiac output response to exercise provides a unique opportunity in man to evaluate determinants of coronary flow and myocardial oxygen consumption, since one or several variables may be limited. Coronary and systemic hemodynamic patterns were therefore evaluated in 12 patients with mitral stenosis and compared with normal subjects.

While cardiac output and left ventricular work were lower than normal at rest, coronary flow and myocardial oxygen consumption did not differ from normal. During exercise, despite subnormal cardiac output and left ventricular work responses, coronary blood flow and myocardial oxygen consumption increased normally in the group of patients in whom arterial pressure rose. However, coronary flow fell in four patients who experienced exertional hypotension, while myocardial oxygen consumption was reduced or unchanged. In both groups, myocardial oxygen extraction was above normal at rest and rose further during exercise. Changes in myocardial oxygen consumption followed alterations in the pressure-time index, but the excessive heart rate response to exercise resulted in a greater oxygen expenditure per unit of tension developed per beat than that found in normal subjects.

It is concluded that the primary determinant of coronary blood flow in mitral stenosis is the arterial perfusion pressure while myocardial oxygen consumption is primarily dependent on the pressure-time index. In addition, heart rates inappropriately high for a given state result in energy expenditures above that required for maintenance of pressure and cardiac output.
The Incidence of Arrhythmias in Acute Myocardial Infarction Studied with a Constant Monitoring System
Authors: KURLAND GEORGE S. , PRESSMAN DAVID
Published: June 2012

Sixteen patients with acute myocardial infarction were studied with continuous cardiac monitoring for 1 to 3 weeks. Patients were excluded from the study if arrhythmias were present on admission or if arrhythmias might have occurred as a result of treatment. The results indicate that cardiac arrhythmias occur with a much higher frequency (94 per cent) than previously reported. They may occur many days after the infarction. They occur in asymptomatic patients and may go undetected by conventional observation. Continuous cardiac monitoring has immediate practicality in the management of these patients, and might, if used as a guide to therapy, [see table in the PDF file] reduce the mortality from acute myocardial infarction.
Increased Sensitivity of a Volume-Regulating Mechanism in the Pre-Hypertensive State
Authors: ULLMANN T. D. , AVIRAM A. , CZACZKES W. J. , BEN-ISHAY D. , SADOWSKY E.
Published: June 2012

Normotensive women after toxemia of pregnancy reacted to the infusion of reconstituted human plasma with a water diuresis, whereas control subjects exhibited an antidiuretic response. The latter was probably due to the presence of antidiuretic material in the infused plasma, whereas the water diuresis, which has also been found in hypertensive subjects, can be explained as the manifestation of an increased sensitivity of a volume-regulating mechanism in the hypertensive as well as in the "pre-hypertensive" state.
The Effect of a β-Adrenergic-Blocking Agent (Nethalide) and Nitroglycerin on Exercise Tolerance in Angina Pectoris
Authors: MACALPIN REX N. , KATTUS ALBERT A. , WINFIELD MARK E.
Published: June 2012

A study was made of the acute effects of orally administered nethalide on the subjective and electrocardiographic responses to treadmill exercise in 11 patients with angina pectoris. Nethalide lowered the standing heart rate at rest and the maximum heart rate attained with exercise whether or not nitroglycerin was used concurrently. No consistent change in exercise capacity or time of onset of anginal pain and electrocardiographic abnormalities was noted after nethalide administration in the doses used in this study. However, the combination of nethalide and nitroglycerin in most subjects caused a strikingly greater exercise tolerance and delay in the onset of pain and electrocardiographic changes than did nitroglycerin alone.
Masked Infundibular Pulmonary Obstruction in Ventricular Septal Defect with Pulmonary Hypertension
Authors: VOGEL JOHN H. K. , BLOUNT S. GILBERT
Published: June 2012

Recent observations have suggested that infundibular pulmonary obstruction may exist in association with a ventricular septal defect and pulmonary hypertension but not be apparent because of greater obstruction in the pulmonary arterial bed which "masks" the more proximal infundibular obstruction. Following the administration of the pulmonary vasodilator tolazoline to patients with a ventricular septal defect and pulmonary hypertension, pullback tracings have revealed infundibular obstruction where none was apparent in control studies.

An analysis of the catheterization findings in those patients with a ventricular septal defect and pulmonary hypertension revealed 32 subjects who had received and responded to tolazoline. Twenty-seven of these patients had gradients after tolazoline ranging from 8 to 73 mm. Hg.

The findings suggest that in the presence of pulmonary hypertension, infundibular obstruction is present from birth and continues to develop, becoming apparent or "unmasked" by virtue of a reduction (acutely with drugs or slowly by delayed maturation) in pulmonary vascular resistance.
Electrocardiographic Findings Among the Adult Population of a Total Natural Community, Tecumseh, Michigan
Authors: OSTRANDER L. D. , BRANDT RALPH L. , KJELSBERG MARCUS O. , EPSTEIN FREDERICK H.
Published: June 2012

Electrocardiograms were recorded from 2,449 men and 2,689 women past 16 years of age, 85 per cent of the adult population of Tecumseh, Michigan. The tracings were classified according to the system of Blackburn and associates and the various categories are tabulated and discussed.

Abnormal Q waves and certain "nonspecific" changes such as left axis deviation, high-amplitude R waves, ST-segment depression, T-wave inversion, first-degree atrioventricular block, complete intraventricular block, and arrhythmias increased in frequency with age. Hypertension and hyperglycemia occurred with significant frequency among persons with some of these changes. It seems likely that such "nonspecific" electrocardiographic abnormalities are frequently signs of coronary or hypertensive heart disease.

The mean amplitudes of QRS complexes of men less than 50 years of age were greater than those of women. Such sex differences should be taken into account in the interpretation of clinical electrocardiograms.

Further examinations and surveillance of the participants of this study are expected to clarify the significance of the electrocardiographic features discussed and the relationships between such features and other physiologic variables.
The Thoracic Duct
Authors: RABINOVITZ ADOLPH J. , SAPHIR OTTO
Published: June 2012

In a search for atheromata, multiple sections of thoracic ducts from 119 autopsied individuals, varying in age from newborns to 91 years, were studied histologically with various stains, including fat stains on frozen sections of 84 different ducts.

No atheromata were found. Changes in the wall of the duct apparently related to aging included increasing density, minimal intimal fibrosis, degenerative changes in the internal elastic plate, and the appearance of occasional microscopic fibrous polypoid projections into the lumen.

Although fat was demonstrated with ease in the wall of the duct and did not appear to be related to the intimal fibrosis, it appeared to be passing through the wall of the vessel without exciting either inflammatory reaction or fibrosis.

The findings in the thoracic duct were evaluated with respect to the conventionally accepted definitions of atherosclerosis and phlebosclerosis. It was concluded that the sclerotic changes found in the thoracic duct are more like phlebosclerosis and unlike atherosclerosis in that they bear no relationship to lipid infiltration and reaction thereto. The term "lymphatic sclerosis" was suggested for the condition.

The common presence of lipid in the wall of the thoracic duct without reaction and without true atheroma formation indicates that factors beyond mere lipid infiltration of vascular walls must play an important role in the pathogenesis of atherosclerosis.