bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Atrial Contraction on Left Ventricular Performance in Valvular Aortic Stenosis
Authors: KROETZ FRANK W. , LEONARD JAMES J. , SHAVER JAMES A. , LEON DONALD F. , LANCASTER JOHN F. , BEAMER VIRGINIA L.
Published: June 2012

The instantaneous response of the left ventricle to loss or recovery of effective atrial contraction was studied in 12 patients with valvular aortic stenosis by producing A-V dissociation by electrical pacing of the ventricles so that some ventricular contractions were preceded by an effective atrial contraction while others were not. A conventional hydraulic formula relating size of the aortic valve orifice, pressure gradient, and flow was used to estimate beat to beat stroke volume. A properly timed atrial contraction augmented left ventricular performance in all patients, increasing stroke volume index from 14 to 55% (mean, 27%) and stroke work from 17 to 85% (mean, 45%).

The contribution of atrial contraction to integrated cardiac performance was studied in six of the same patients by comparing cardiac performance with right atrial pacing and right ventricular pacing. With right atrial pacing, each ventricular contraction was preceded by an atrial contraction, while with right ventricular pacing many ventricular contractions were not preceded by atrial contraction. Right atrial pacing increased cardiac index in four of six patients: The mean increase for the total group was 13% and the mean increase in left ventricular minute work index was 17%.

Although atrial contraction was capable of augmenting left ventricular performance in all patients studied, loss or recovery of effective atrial systole did not always alter integrated cardiac performance. Factors influencing atrial contribution remain poorly understood. Atrial contraction does not appear to have an unusual effect on the performance of the hypertrophied left ventricle.
Clinical Features and Prognosis in Dissecting Aneurysm of the Aorta
Authors: LINDSAY JOSEPH , HURST J. WILLIS
Published: June 2012

The records of 62 patients on whom the diagnosis of aortic dissection was proved are reviewed with particular attention to the clinical features and prognosis in each case. This was the consecutive experience of a large general hospital over approximately 17 years. The initial and long-term survival was far better in patients in whom the ascending aorta was spared by the disease process. No patients in whom such involvement was present were known to survive more than 3 weeks. Eight of 19 patients whose disease began distal to the arch of the aorta are known to have survived 6 to 69 months even though six of these eight were not operated on. Striking differences in the clinical findings of the two groups were also found. Aortic regurgitation, impairment of a radial or carotid pulse, neurological signs, and hypotension were rare in the group whose dissection began beyond the left subclavian artery. Marked systemic hypertension was frequently observed in this group, over a third having a diastolic pressure over 140 mm Hg and nearly two thirds over 120 mm Hg. Such hypertension was unusual when the ascending aorta was the origin of the disease. Despite the present study the available data do not allow any definite conclusions about the efficacy of any form of therapy of this disorder.
Effect of Angiotensin on the Renal Transport of Sodium in Essential Hypertension
Authors: VILLARREAL HERMAN , ARCILA HERIBERTO , DÍAZ JORGE , SIERRA PEDRO
Published: June 2012

The renal function, including sodium excretion rates, were studied in 27 patients with early essential hypertension, before and during angiotensin infusions. The patients had a preparatory period of salt loading for four days taking a supplement of 7 g of NaCl. Determinations were made during two 30-minute periods before the angiotensin and for two 30-minute periods afterward. Arterial blood pressure was increased in all 27 patients and renal plasma flow decreased in 25. The glomerular filtration rate changes were not statistically significant, showing some increase in 15 and a decrease in 11 patients. When the group was divided into those in which there was a
decrease
in sodium excretion (11 patients), and those in which there was an
increase
in sodium excretion (16 patients), with angiotensin infusion, a correlation with the control blood pressure was evident. The patients in whom an increase occurred had a control mean blood pressure greater than 136 mm Hg, and those exhibiting a decrease of sodium excretion, a blood pressure less than 136 mm Hg. Salt excretion did not correlate with the increment in blood pressure or renal resistance changes. The minor changes in glomerular filtration of sodium of the two groups could not explain the different excretory patterns which are attributed to an alteration of the tubular transport of sodium.
Interrelations Between Total Exchangeable Sodium, Potassium, Body Water, and Serum Sodium and Potassium Concentrations in Hyponatremic and Normonatremic Heart Disease
Authors: OLESEN KNUD H.
Published: June 2012

Interrelations between total body water, total exchangeable cation (sodium + potassium), and cation (sodium + potassium) concentration of serum water were examined in 20 normonatremic and 11 hyponatremic edematous cardiac patients. The total exchangeable cation and total body water were highly significantly correlated in the normonatremic and hyponatremic groups. However, for the combined groups the correlation coefficient was lower than that found in the individual populations, and in covariance analysis the cation content in relation to total body water was significantly lower in the hyponatremic than in the normonatremic group. When it is assumed that the total exchangeable cation differs little from the total osmotically active cation, and that the cation concentrations of the extracellular and intracellular water are approximately equal, the ratio: total exchangeable cation ÷ cation concentration in serum water, that is, the cation space, should reflect the total body water. The cation space and total body water were highly significantly correlated in the normonatremic and hyponatremic groups, and the correlation coefficient remained at the same high level for the combined groups. The relationship between cation space and body water was very close to unity, and in covariance analysis no significant difference was found in cation space in relation to total body water. These results were confirmed in 10 sequential studies. It is concluded that the cation space in hyponatremic and normonatremic cardiac patients has proved to reflect the total body water very closely, and the implications of this finding are discussed.
Effect of Flow and Pressure on Pulmonary Vessels
Authors: WAGENVOORT C. A. , NAUTA J. , VAN DER SCHAAR P. J. , WEEDA H. W. H. , WAGENVOORT NOEKE
Published: June 2012

Of a total of over 1,000 lung biopsies, carried out over a 3½-year period on patients, the great majority of whom were operated on for various acquired or congenital cardiac diseases, 86 were on patients operated upon for atrial septal defect, 99 on patients with a ventricular septal defect, and 82 on patients with patent ductus arteriosus. The morphological data, particularly with regard to the lung vessels, were correlated with hemodynamic findings in these patients. In atrial septal defect the pulmonary vessels did not differ significantly from those in normal controls of the same ages. Notably there were no differences between patients with relatively low pulmonary arterial flow and those with high flow. In patent ductus arteriosus the only difference was an increase in intimal fibrosis of the pulmonary arteries as compared to normals. In ventricular septal defect, on the other hand, there was an increase in thickness of both media and intima and also in incidence of hemosiderosis. These changes did show a correlation with increased pulmonary arterial pressure but not with pulmonary arterial flow. It is concluded that pulmonary hypertension may provoke these vascular lesions and conversely may be maintained or increased by these lesions, while an increased flow in itself has little or no effect with regard to the morphological alterations, if it is not accompanied by pulmonary hypertension.
Characterization of the Circulatory Response to Maximal Upright Exercise in Normal Subjects and Patients with Heart Disease
Authors: EPSTEIN STEPHEN E. , BEISER G. DAVID , STAMPFER MORRIS , ROBINSON BRIAN F. , BRAUNWALD EUGENE
Published: June 2012

The circulatory responses to mild and maximal upright exercise were studied in six normal subjects and 21 patients with various types of cardiac disease. It was found that the usual hemodynamic indices employed to evaluate cardiac performance during exertion were unreliable in separating patients from normal persons. In contrast, the cardiac index achieved at a pulmonary arterial (PA) O
2
saturation of 30% was found to be highly reliable and sensitive for distinguishing the normal from the abnormal response to exercise. At a level of exercise that lowers PA O
2
saturation to 30%, all normal subjects achieved a cardiac index greater than 7.0 L/minm
2
while no patient exceeded 4.8 L/min/m.
2
In addition, the maximal capacity to extract O
2
was greater in patients than in normal subjects; thus, during maximal exercise it was not unusual for patients to achieve PA O
2
saturations of 15% or less, while the lowest value achieved in normal subjects was 23%.
Subvalvular and Apical Left Ventricular Aneurysms in the Bantu as a Source of Systemic Emboli
Authors: CHESLER E. , TUCKER R. B. K. , BARLOW J. B.
Published: June 2012

Systemic emboli originating from apical and subvalvular left ventricular aneurysms are described in two Bantu patients. The infrequency of embolism from these aneurysms is probably related to the fact that such aneurysms usually have small ostia. The pertinent literature is reviewed and the similarity between these aneurysms, congenital epicardial cysts, and fibrous diverticula is discussed. It is postulated that these conditions share a common etiology, namely, a congenital weakness in the left ventricular wall in the form of a persistent primitive endothelial-lined channel. The high pressure in the left ventricle converts these channels into fibrous aneurysms with ostia lined by endocardium at the two sites where the ventricular wall is thinnest, namely, the apical and subvalvular areas.
SPECIAL ARTICLE
Authors: REPLOGLE ROBERT L. , MEISELMAN HERBERT J. , MERRILL EDWARD W.
Published: June 2012

Blood viscosity is dependent on the shear rate at which it is measured. Reversible red cell aggregation is largely a function of fibrinogen-red cell interaction at normal hematocrits. Red cell aggregation is the basis for the anomalous rheological behavior of blood, since a considerable fraction of the shear stress applied to blood flowing at low shear rates is required to break up the aggregates accounting for the greater shear stress required to produce a given shear rate of low magnitude. Erythrocyte sedimentation rate is also a measure of red cell aggregation and has been used as an indicator of the "suspension stability" of blood. The tendency for red cell aggregation is greatest during periods of low flow states and is maximum when the blood is standing still. At such times, a certain shear stress, the yield stress, must be applied to overcome the reversible red cell-fibrinogen bond, causing the blood to "yield" or begin to flow. Manipulation of blood viscosity and yield shear stress, by hemodilution or fibrinogen dilution are readily accomplished, and experimental studies indicate that these rheological alterations have circulatory and metabolic significance.
Exercise and Intermittent Claudication
Authors: SKINNER JAMES S. , STRANDNESS D. EUGENE
Published: June 2012

Four men with arteriosclerosis obliterans (ASO) were exercised on a treadmill on 4 different days to determine their maximal walking time (MWT) and the point at which their claudication pain (CPT) began. Each subject was exercised at 60%, 75%, and 90% of his MWT to determine the effect of work intensity on the systolic blood pressure at the ankle (AP). To measure the effect of exercise repeated on the same day, each subject walked five times each day on 4 different days at each of the three workloads. After each subject completed the required number of walks, his MWT was again measured on 4 separate days (one subject was retested only once) to determine whether it had changed.

In every case the greatest reduction in AP occurred after the initial maximal walk but the submaximal intensities caused different responses in the different subjects. With repetition of exercise each subject displayed a progressive increase in either the AP level taken 2 minutes postexercise or the rate of recovery of AP to the pre-exercise level. There were significant increases in MWT, in CPT, and in the resting and postexercise AP levels in some of these subjects. This was most probably due to increased collateral circulation before, during, and after exercise.
Diffuse Tortuosity and Lengthening of the Arteries
Authors: ERTUGRUL ALI
Published: June 2012

This article describes the case of a 10-year-old girl with generalized tortuosity and lengthening of all her major arteries-the carotid arteries, the aorta from the arcus to the bifurcation, and the iliac, femoral, splenic, hepatic, renal, and intercostal arteries. The condition appears to be a new entity. Pertinent abnormalities were as follows: gross pulsation of the arteries in the neck, telangiectasis of both cheeks, high palate, tortuosity of all the arteries, aortic valvular insufficiency, 1+ to 2+ capillary fragility on tourniquet test (lacet), 1+ Wassermann reaction, 4+ cephalin flocculation, and histological fragmentation of the internal elastic membrane of the arteries.

Syphilis, arteriosclerosis, hypertension, mucopolysaccharidosis, and defects of amino acid metabolism were ruled out and the author concludes that the condition was most probably caused by a congenital defect of the elastic tissues of the arterial system.
Myxoma of the Left Atrium
Authors: PITT AUBREY , PITT BERTRAM , SCHAEFER JOCHEN , CRILEY J. MICHAEL
Published: June 2012

Two patients with myxoma of the left atrium were studied by left heart catheterization and cineangiography, and the diagnosis was confirmed at operation in both cases. An electrocardiographic timing signal on the cineradiographs permitted correlation of heart sounds and pressure waves with movement of the tumor between the left atrium and the left ventricle. In early systole, the tumor suddenly moved from the left ventricle to the left atrium, and a notch in the rising left ventricular pressure, a prominent
c
wave, and loud, late elements of the first sound were noted. In early diastole, the tumor moved rapidly through the mitral valve, causing an abrupt diminution in the left atrial volume, thus causing a rapid
y
descent despite severe obstruction of the mitral valve. An early diastolic sound, thought to be an opening snap, appeared to be related to the checking of the tumor in the left ventricle ("tumor plop").

The unusual left atrial pressure pulse seen in these two cases resembles data from other cases of myxoma reported in the literature, and recognition of these unusual pressures may permit accurate preoperative diagnosis in other patients. Diagnostic changes may be present on apexcardiograms.
Intramural Ventricular Cardiac Fibroma
Authors: GEHA ALEXANDER S. , WEIDMAN WILLIAM H. , SOULE EDWARD H. , MCGOON DWIGHT C.
Published: June 2012

Two cases in which large intramural ventricular cardiac fibromas were successfully removed from children are reported. In one the fibroma was principally septal, and in the other it lay in the free wall of the left ventricle. These are the second and third such operations reported. A review of these two cases plus 34 other reported cases of cardiac fibroma indicates that a primary mural tumor of the heart should be suspected in patients, particularly children, with unexplained cardiac failure, unexplained cardiac dysrhythmia, intracardiac calcifications, irregular shadows on roentgenograms, or unexplained newly developing cardiac symptoms and murmurs. Angiocardiography is the best way of confirming the diagnosis. In view of the potential hazard of these tumors, their surgical removal should be undertaken, and this experience indicates that even very large and extensive intramural ventricular tumors may be removed successfully.
Diagnostic Accuracy of Selective Coronary Cinearteriography
Authors: KEMP HARVEY G. , EVANS HILARY , ELLIOTT WILLIAM C. , GORLIN RICHARD
Published: June 2012

The premortem selective coronary cinearteriograms of 29 patients who subsequently died of their underlying disease have been compared to findings at postmortem examination. Only three errors of functional significance were found. Possible sources of these errors were analyzed. The most important single factor in determining the accuracy was the radiographic quality of the arteriogram. The data support the conclusion that selective coronary cinearteriography is a highly accurate means of evaluating the morphology of both normal and diseased coronary vessels, but high quality arteriograms and experienced interpreters are required.
Vascular Lesions in Infants with Congenital Rubella
Authors: ESTERLY JOHN R. , OPPENHEIMER ELLA H.
Published: June 2012

Vascular lesions were reviewed in 13 autopsied infants with congenital defects of maternal rubella. The characteristic finding was intimal fibromuscular proliferation. The internal elastic lamella and media were almost always unchanged, even in the presence of a greatly thickened intima. These arterial changes appeared to be unlike other vascular lesions described in infancy.

Severe and extensive lesions were found in four infants, and lesser changes in another five. The lesions in the pulmonary artery were probably related to clinically diagnosed peripheral pulmonary artery stenosis. Ostial stenosis of a renal artery was found in an infant with documented systemic hypertension.
Permanent Ventricular Pacemakers
Authors: MORRIS JAMES J. , WHALEN ROBERT E. , MCINTOSH HENRY D. , THOMPSON HOWARD K. , BROWN IVAN W. , YOUNG W. GLENN
Published: June 2012

In the series of 86 patients with the Stokes-Adams syndrome or with symptomatic bradycardia managed with permanently implanted ventricular pacemakers reported on, 35 patients had primary implantation of epicardial leads at thoracotomy and 51 had transvenous endocardial electrodes passed via the jugular venous system for permanent ventricular pacing. The transvenous method of permanent pacemaker implantation appears to be easier to apply with less serious complications and provides the same overall mortality as the transthoracic approach. However, pacemaker failure, both permanent and temporary, is more likely to occur with the transvenous approach.

A series of unique complications and findings noted in the transvenous group were thought to be related to the permanent pacing electrode catheter. These included myothought cardial perforation, pericardial friction rubs, intermittent ventricular pacing, and diaphragmatic stimulation.

The experience suggests that it is reasonable to employ a transvenous pacemaker initially, recognizing that replacement with a transthoracic pacemaker will be necessary in approximately 16% of the patients and remanipulation of the electrode catheter will be needed in another 13%. Therefore, to undertake transvenous permanent implantation of a pacemaker, one must also be prepared to employ the transthoracic approach in a small but significant number of patients.
SPECIAL ARTICLE
Authors: EPSTEIN FREDERICK H.
Published: June 2012

This review article deals with the relation between hyperglycemia and myocardial infarction as observed after recovery from the acute attack or, to the extent that such data are available, antedating it. Hyperglycemia must be added to the various forms of hyperlipemia, positive caloric balance, hypertension, smoking, and others as a risk factor toward the development of manifest atherosclerosis. It remains to be established to what extent hyperglycemia, as one of multiple predisposing influences, is a predictive indicator in its own right. One part of this answer must come from prospective, epidemiological studies, the other from investigations of the interrelationships between lipid and carbohydrate metabolism in the different forms of hyperlipemia and the mechanisms by which hyperglycemia is produced.
Reevaluation of Electrocardiographic and Bedside Criteria for Diagnosis of Ventricular Tachycardia
Authors: MASSUMI R. A. , TAWAKKOL A. A. , KISTIN A. D. , Jackson Howard
Published: June 2012

Electrically induced ventricular and atrial tachycardias were observed in 12 cases, and ventriculoatrial (V-A) and atrioventricular (A-V) relationships were studied. It was noted that retrograde V-A conduction is a common phenomenon and that A-V dissociation is not a prerequisite for diagnosis of ventricular tachycardia. Conduction through the A-V node occurred readily in both antegrade and retrograde directions; and, all grades of block from first to complete and including the Wenckebach phenomenon were observed in both directions. The intensity of the first heart sound and the amplitude of the jugular
a
wave were governed directly by the temporal relationship between the P and the QRS regardless of whether conduction was antegrade, atrioventricular, or retrograde, ventriculoatrial.

It is concluded that at present no electrocardiographic or bedside criteria are available for an unequivocal diagnosis of ventricular tachycardia and that further studies are needed.
The Role of Premature Beats in the Initiation and the Termination of Supraventricular Tachycardia in the Wolff-Parkinson-White Syndrome
Authors: DURRER D. , SCHOO L. , SCHUILENBURG R. M. , WELLENS H. J. J.
Published: June 2012

In four patients with WPW syndrome atrial and ventricular premature beats were induced and the changes in form of the ventricular and atrial complexes were studied. Results indicate that, depending upon the timing of the premature atrial beat and the state of refractoriness of the His and Kent bundles, excitation of the ventricles occurs predominantly through the atrioventricular nodal system, predominantly through the Kent bundle or exclusively through one or both conduction systems. With short delays conduction through the Kent bundle may be blocked and only normal excitation of the ventricles occurs. In one patient with a history of attacks of tachycardia these normal QRS complexes were followed by retrograde activation of the atria by the Kent bundle, and attacks of supraventricular tachycardia of shorter or larger duration occurred. They stopped spontaneously, sometimes by delay or block, either of retrograde Kent conduction or of antegrade A-V nodal conduction, making it possible for the sinus node to capture the ventricles. They also could be terminated by induced atrial premature beats.

In two patients tachycardias could be induced by appropriately timed ventricular premature beats during regular driving of the right ventricle. In one of these patients a circus movement, involving the Kent bundle, is probably present. By appropriate stimulation of the atria or ventricles during an attack of supraventricular tachycardia in this patient, one cycle length could be shortened without changing those of the following beats. These results suggest that a circus movement involving the atria, the normal atrioventricular conduction system and the Kent bundle is present. In the other patient, not fulfilling the WPW criteria, ventricular or atrial premature beats did not interfere with the basic rhythm of the tachycardia. Two hypotheses for this tachycardia are given: nodal tachycardia caused by rapid firing of the A-V node or a nodal tachycardia caused by a reciprocal mechanism in the A-V junction. The attacks could be blocked too by appropriately timed atrial and ventricular premature beats. No ventricular type of tachycardia could be demonstrated.
Experimental Production of Aberrant Ventricular Conduction in Man
Authors: COHEN STAFFORD I. , LAU SUN H. , HAFT JACOB I. , DAMATO ANTHONY N.
Published: June 2012

Aberrant ventricular conduction (AbC) was produced in 17 of 18 subjects, including six normal persons, by the introduction of electric stimuli via a transvenous catheter situated in the right atrium.

Analysis of electrophysiological determinants indicated that AbC was favored by a long cycle preceding the short cycle which terminated in the aberrant complex, a short R to stimulus coupling interval, and fast atrioventricular conduction time.

Electrocardiographic analysis of AbC revealed that all patients had right bundle-branch block (RBBB). In addition, incomplete right bundle-branch block was present in eight patients and was transformed to RBBB in all cases by shortening the coupling interval. Ten patients had slight but distinct variations of their RBBB pattern. There were two instances each of left bundle-branch block and intraventricular conduction disturbance. Hence, any patient may have the potential to produce a variety of AbC patterns. AbC was produced in six normal subjects and must be considered a physiological event which does not require covert pathology of the specialized conduction system.
Effect of Hyperventilation on Precordial T Waves of Children and Adolescents
Authors: THOMSEN J. H. , WASSERBURGER R. H.
Published: June 2012

Following the taking of 12-lead routine electrocardiograms, three precordial leads were recorded before, during, and after 10 to 15 seconds of voluntary hyperventilation in 296 students, ranging in age from 8 to 17 years.

Fifteen per cent of the total group, comprising 212 Caucasians and 84 Negroes, inverted one or more previously upright precordial T waves following hyperventilation. The incidence of T-wave inversion in children 12 years of age and under was nearly four times greater in Caucasians than in Negroes. There was no significant difference when the older Negro and Caucasian students were similarly compared. Sinus tachycardia, T-wave flattening, and "tucking," short of frank inversion, as well as junctional depression of the ST segment, were commonly seen following hyperventilation.

The similarity of the hyperventilation-induced T-wave inversion in children to those previously documented in adults is noted, and the clinical implication of this study requires continued cognizance of the occurrence of "nonpathological" T-wave inversion in adults, so as to avoid iatrogenic heart disease.
Effect of Artificial Pacing of the Heart on Cardiac and Renal Function
Authors: HUMPHRIES J. O. , HINMAN E. J. , BERNSTEIN L. , WALKER W. G.
Published: June 2012

Six patients with complete heart block provided an opportunity to study renal hemodynamic responses to increases in heart rate produced by an artificial pacemaker. Observations were made at rest and following exercise during idioventricular rhythm and slow rates and were repeated after increasing the rate to 70/min by means of an artificial pacemaker. Ability to excrete a water load was impaired at the slow idioventricular rate; this was associated with a reduced glomerular filtration rate. No acute improvement in renal function occurred with pacemaker-induced increase in heart rate except in the presence of congestive heart failure. With long-term pacing (7 to 8 months), the glomerular filtration rate and the ability to excrete solute-free water increased in all patients studied. The acute increase in free water clearance which occurred with increased heart rate in the presence of congestive heart failure suggests that decreased renal perfusion may be responsible for the inability to excrete excess water. The dilutional hyponatremia in congestive heart failure may be explained on this basis. Changes in indices of cardiac function in these patients were similar to those reported by others. No change in resting cardiac output occurred at heart rates between 40 and 70/min in the absence of congestive heart failure. The response to exercise, however, was greater at the higher rates.
Aortic Origin of the Right Pulmonary Artery
Authors: KIRKPATRICK STANLEY E. , GIROD DONALD A. , KING HAROLD
Published: June 2012

Surgical repair of an anomalous right pulmonary artery arising from the ascending aorta is rare. Angiocardiography is the procedure of choice in establishing the diagnosis. Surgical correction of the defect is mandatory; otherwise most of these children die in refractory heart failure. The present paper reports the first successful anatomic repair without a graft in a 2-month-old baby. Five months after operation the boy is asymptomatic and demonstrating normal growth and development.
Truncal Inversion with Biventricular Pulmonary Trunk and Aorta from Right Ventricle (Variant of Taussig-Bing Complex)
Authors: SHAFFER AARON B. , LOPEZ JOSÉ F. , KLINE IRWIN K. , LEV MAURICE
Published: June 2012

A heart is described pathologically in which the aorta emerged from the right ventricle and was not related to the ventricular septal defect, while the pulmonary trunk emerged from both ventricles, but mostly the right, and was related to the ventricular septal defect. This Taussig-Bing arrangement of vessels was coupled with the presence of the aortic orifice to the left and the pulmonic orifice to the right, which is an inverted position. The anatomic concept of inversion is an abnormality in position from the standpoint of laterality. A careful study of the conal regions of the left and right ventricles showed that those regions were not inverted. Therefore, this represents a case of Taussig-Bing complex with exclusively truncal inversion, which is unique. This may be explained on the basis of opposite metameric contribution to the development of the truncus.
Serial Electrocardiographic Changes in Treated Hypertensive Patients with Reference to Voltage Criteria, Mean QRS Vectors, and the QRS-T Angle
Authors: DERN PHILIP L. , PRYOR RAY , WALKER STROTHER H. , SEARLS DONALD T.
Published: June 2012

Serial changes in voltage, QRS vectors, and QRS-T angles were studied in 44 patients who had shown improvement in their electrocardiograms during treatment for hypertension. Changes were observed in a number of electrocardiographic voltage criteria often used in the study of left ventricular hypertrophy. This is consistent with a change in the magnitude of the mean QRS vector and its reflection on a variety of ECG leads even if pretreatment records were normal. Improvement also occurred in the mean T vectors and the QRS-T angle. It is proposed that serial changes in the ECG might be of greater value than pretreatment abnormalities in diagnosing the disorder of cardiac structure or function that occurs in hypertension.
Chromosomal Abnormalities and Congenital Heart Disease
Authors: EMERIT INGRID , DE GROUCHY J. , VERNANT P. , CORONE P.
Published: June 2012

In this study the authors attempted to determine the frequency of the classical chromosomal syndromes as a cause of congenital heart disease and sought other cytogenetic abnormalities in patients with congenital heart disease, selected either for the presence of extracardiac abnormalities or the existence of congenital heart disease in other members of the family.

Of the 275 patients whose karyotypes were determined, 119 had a known syndrome. A chromosomal aberration, such as trisomy 21, a sex chromosomal aneuploidy, such as XO, XXY, XYY, XXX, or a more complex mosaic was found in 39. Among the other patients of this group, only a patient with Fanconi's anemia showed abnormalities of the karyotype (numerous chromatid and isochromatid breaks).

Among 100 other patients with unclassifiable associated malformations, 10 had abnormal karyotypes. The following abnormalities were noted: complex structural rearrangements, minute chromosome fragments, variations in size of the satellites, presence of unusual satellites on chromosome 17, deletion of the short arm of a D-chromosome, lengthening of chromosome 16, and chromosome breaks.

The remaining 56 patients were studied for familial congenital heart disease. Two chromosomal abnormalities were detected in this group.

If the classical aberrations are included, the frequency of chromosomal abnormalities as a cause of congenital heart disease may be estimated at between 3 and 5%. This figure should be considered in relation to the methods of recruitment which excluded all patients less than 3 years of age.
Vascular Changes in Pulmonic Stenosis and Tetralogy of Fallot Studied in Lung Biopsies
Authors: WAGENVOORT C. A. , NAUTA J. , VAN DER SCHAAR P. J. , WEEDA H. W. H. , WAGENVOORT NOEKE
Published: June 2012

The present study deals with the results of the histological investigation of lung biopsies from 44 patients with pulmonic stenosis and 117 with tetralogy of Fallot in correlation with their clinical and hemodynamic data. Particularly cases without additional complicating malformations have been considered.

Medial atrophy and luminal widening of the muscular pulmonary arteries and veins were confirmed in both isolated pulmonary stenosis and tetralogy of Fallot but were more marked in pulmonic stenosis. Intimal fibrosis in the pulmonary vessels on the other hand gave the impression of being greater in the cases of tetralogy of Fallot than in pulmonic stenosis even within the same age group, but this difference is not statistically significant. Intimal fibrosis was even more pronounced in tetralogy of Fallot with a previous shunt operation. The intimal fibrosis is thought to be based on organization of thrombi.

The explanations for the medial atrophy and the widening of the arterial lumen are unknown, but it is thought likely that the flatness of the pressure curve in the pulmonary artery plays a role in causation.
Renal Venous Renin Determinations in the Diagnosis of Surgically Correctable Hypertension
Authors: FITZ ANNETTE
Published: June 2012

Renin activity in renal vein plasma was measured in six normal subjects and 59 hypertensive patients. The average renin value in renal venous plasma in normal subjects was the same as that found in patients with essential hypertension and renal parenchymal hypertension. Renal venous renin levels were markedly elevated in patients with significant renal lesions who were improved by surgery but were normal in patients with insignificant renal artery stenosis. We defined an abnormal renal vein renin level as one which is higher than 4.1 ng/ml of plasma, the highest normal, and which is also more than twice as great as the level obtained from the opposite kidney. On 19 patients who were operated upon for renal hypertension, there were no "false positive tests," and two "false negative tests." One patient with essential hypertension had abnormal values by these standards. Since occasional "false positive" and "false negative" results occur, we presently recommend that this test be used with, but not to the exclusion of, other tests of renal function in preoperative evaluations. As experience with the test increases, and as more prospective studies are done, it may prove to be the single most useful device to predict surgical success in patients with renal artery and renal parenchymal hypertension.
Renin-Angiotensin-Aldosterone System During Chronic Thiazide Therapy of Benign Hypertension
Authors: BOURGOIGNIE J. J. , CATANZARO F. J. , PERRY H. M. , Schoepfle Esther , Kurz Linda
Published: June 2012

Activity of the renin-angiotensin-aldosterone system was investigated in 53 patients with benign essential hypertension treated with thiazides. Following acute (less than 3 weeks) exposure to thiazide, renin activity was increased in peripheral plasma and sensitivity to infused angiotensin was decreased but only when dietary salt was simultaneously restricted. During chronic (more than 2 months) exposure to hydrochlorothiazide, 32 patients with unrestricted salt intake had normal renin activity in peripheral plasma (39 of 43 determinations), normal sensitivity to infused angiotensin (18 of 22 tests), and normal aldosterone excretion (nine of nine assays). Renin activity correlated well with angiotensin sensitivity (r=0.661;
P
<0.001). Therefore, chronic ingestion of thiazide apparently induces no change in the renin-angiotensin-aldosterone system and hence presumably neither secondary aldosteronism nor negative sodium balance.
Systolic Time Intervals in Heart Failure in Man
Authors: WEISSLER ARNOLD M. , HARRIS WILLARD S. , SCHOENFELD CLYDE D.
Published: June 2012

The duration of the systolic time intervals in nondigitalized patients with heart failure was determined from simultaneous fast speed recordings of the electrocardiogram, phonocardiogram, and carotid arterial pulsation. These were compared with the systolic time intervals corrected for heart rate and sex in 211 normal subjects. The failing left ventricle is characterized by a prolongation in the systolic pre-ejection period and a diminution in the left ventricular ejection time while total electromechanical systole remains relatively unaltered. Both components of the pre-ejection period, the Q-1 interval and the isovolumic contraction time, were prolonged. These alterations in the phases of systole occur in the absence of a measurable change in ventricular depolarization time. The prolongation in the pre-ejection period is well correlated with the reduced stroke volume and cardiac output in heart failure and is independently augmented by high levels of arterial pressure. The abbreviation in left ventricular ejection time is also correlated significantly with the stroke volume and cardiac output. It is postulated that a defect in the mechanical performance of the heart is responsible for the abnormal systolic time intervals in human heart failure.
Lipid and Carbohydrate Studies in Coronary Artery Disease
Authors: FALSETTI HERMAN L. , SCHNATZ J. DAVID , GREENE DAIVD G. , BUNNELL IVAN L.
Published: June 2012

Twenty-seven patients with arteriographically proved coronary artery disease, aged 27 to 59 years, were studied for abnormalities of lipid or carbohydrate metabolism. All patients were referred because of cardiac symptoms and none had any prior history of lipid or carbohydrate abnormality. Twenty-three patients were found to have some abnormality of carbohydrate or lipid metabolism, and four had none. Seventeen patients had an abnormal lipoprotein electrophoretic pattern, 12 had elevated serum cholesterol concentrations, and 15 elevated serum triglyceride values. Eighteen patients had an abnormality of carbohydrate metabolism, 11 as determined on standard glucose tolerance tests and seven on cortisone glucose tolerance tests. These abnormalities of carbohydrate and lipid metabolism were not related to age or ponderal-index ratio. This high incidence of carbohydrate and lipid abnormalities in association with coronary artery disease may be important in the pathogenesis of the vascular disease as well as management of these patients and their progeny.
Correction of Shunt from Right Conal Coronary Artery to Pulmonary Trunk with Relief of Symptoms
Authors: LEE GERALD B. , GOBEL FREDARICK L. , LILLEHEI C. WALTON , NEFF WALTER S. , ELIOT ROBERT S.
Published: June 2012

A case of a small right coronary conal branch to pulmonary trunk shunt with surgical correction is reported. The patient, a 45-year-old housewife, had chest pain, labile hypertension, and intermittent left bundle-branch block with normal serum cholesterol and triglyceride levels. Selective coronary arteriography was necessary to demonstrate the abnormal communication between the conal branch of the right coronary artery and the pulmonary trunk. Symptoms disappeared after surgical correction of the shunt. Transient left bundle-branch block appeared during exercise after surgery, but the patient was improved subjectively and resumed all household chores without difficulty. Shunting of oxygenated blood away from the myocardium thereby decreasing coronary blood flow to a specific area may have been responsible for significant symptomatology.
Double-Inlet Left Ventricle
Authors: DE LA CRUZ MARÍA V. , MILLER B. LYNN
Published: June 2012

Two pathological specimens are presented in which the morphological left ventricle contains the right atrioventricular ostium, completely or in its major portion and, totally, the left atrioventricular ostium. It is suggested from a consideration of these cases and of the pathological material available in the literature that this constitutes an entity that can be usefully separated from the heterogeneous group of single ventricle with which it has previously been classified. The entity is called double-inlet left ventricle and is defined as existing when two separate atrioventricular ostia open in a morphological left ventricle.

An ontogenetic explanation is presented based on the study of normal human embryos. These cases resemble the heart of the embryo during the horizons XIII to XVI of Streeter. It is suggested that there has been a partial arrest in the widening of the atrioventricular canal and the changing relation of the atria with the ventricles at these stages.

It is noted that both atria open into the morphological left ventricle whether situated to the left or to the right. This is an expected finding, since the left ventricle is derived from the primitive ventricle and the primitive ventricle is always connected with both atria during the early stages of embryological development.

Other malformations include transposition of the great arteries in both cases and ventricular inversion in one.
Comparative Exercise-Cardiorespiratory Performance of Normal Men in the Third, Fourth, and Fifth Decades of Life
Authors: HANSON JOHN S. , TABAKIN BURTON S. , LEVY ARTHUR M. , HILL DAVID B.
Published: June 2012

The circulatory and respiratory responses to five levels of treadmill exercise were recorded for 75 normal males divided equally in the age groups 20 to 29, 30 to 39, and 40 to 49 years. Parameters studied included heart rate, cardiac output, stroke volume, intra-arterial blood pressure, minute ventilatory volume, oxygen uptake, and carbon dioxide elimination. Values for peripheral vascular resistance, left ventricular work, and stroke work indices were calculated. Intergroup and intragroup differences were analyzed by modified covariance technique using oxygen uptake per square meter of body surface area as the concomitant variable reflecting a specific midrange work level. Significant differences were observed between groups in cardiac output, stroke volume, systolic, diastolic, and mean arterial blood pressure as well as pressure-related variables with regard to absolute values and trend over the exercise spectrum. The results indicate that normal untrained males in the fourth and fifth decades of life react to moderate and heavy upright exercise with statistically significant systemic pressure elevations as compared to 20-year-olds. A tendency toward initially high cardiac output and stroke volume during light exercise was observed in the older men. Relatively small subsequent increments in cardiac output with resultant low absolute values during heavier work were also characteristic for this group as reflected in their decreasing stroke output at submaximal loads.
REPORT OF COMMITTEE ON GRADING LESIONS, COUNCIL ON ARTERIOSCLEROSIS, AMERICAN HEART ASSOCIATION
Authors: MCGILL HENRY C. , BROWN B. W. , GORE IRA , MCMILLAN GARDNER C. , PATERSON JAMES C. , POLLAK O. J. , ROBERTS JAMES C. , WISSLER ROBERT W.
Published: June 2012

The American Heart Association's Committee on Grading Lesions of the Council on Arteriosclerosis has devised a method of grading the severity of atherosclerosis in human coronary arteries and aortas. The method uses two series of color photographs of arteries arranged in increasing severity of atherosclerosis. The Committee tested the method for inter-observer reproducibility by exhibiting the panel at two national scientific conventions and inviting visitors to grade a set of arteries with the panel. The test demonstrated a reasonable degree of inter-observer reproducibility despite a wide range of experience and disciplinary background. Inter-observer variability decreases with increasing experience in working with atherosclerotic lesions. Training graders who participate in a study may reduce inter-observer bias. For populations with predominantly less or predominantly more atherosclerosis, the investigator should construct special panels with different ranges of severity. The Committee revised the panel in the light of the results of the two exhibits and the comments of users in a field trial. The revised panel provides seven possible scores for each coronary artery and for each aorta. This panel provides a relatively simple and speedy quantitative method of comparing autopsy data on atherosclerosis among many kinds of studies and has the added advantages of facilitating comparisons between different geographic locations and different times.
False Aneurysm of the Left Ventricle Secondary to Bacterial Endocarditis with Perforation of the Mitral-Aortic Intervalvular Fibrosa
Authors: CHESLER ELLIOT , KORNS MICHAEL E. , PORTER GERALD E. , REYES CESAR N. , EDWARDS JESSE E.
Published: June 2012

In an infant with bacterial endocarditis of the aortic valve a mycotic false aneurysm of the left ventricular outflow tract was a complication. The unusual nature of the case relates to the fact that the mouth of the false aneurysm lay in the mitral-aortic intervalvular fibrosa, the junctional tissue between the mitral and aortic valves. The close relationship between this structure and the epicardium was responsible for the peculiar location of the aneurysm in the epicardium between the aorta and the left atrium. Rupture of the false aneurysm led to a fatal hemopericardium.
Hypertensive Retinopathy
Authors: RAMALHO P. S. , DOLLERY C. T.
Published: June 2012

Caliber changes in retinal vessels of groups of hypertensive patients were measured after the blood pressure had been lowered by successful renal surgery, posture with adrenergic blocking drugs, and parenteral hydralazine. The small arterioles dilated when the pressure was reduced, whatever means were used. Larger arterioles dilated in three younger hypertensive patients but in the remainder they were unchanged or narrowed by pressure reduction.

Inhalation of oxygen constricts normal retinal arterioles but the response in hypertensive patients was much less. A response to oxygen was restored in some small arterioles that dilated when the blood pressure was lowered.

As retinal arterioles have no adrenergic vasomotor supply, changes in their caliber probably occur because of autoregulation. Narrowing caused by autoregulation during a rise in systemic arterial pressure may become irreversible in long-standing hypertension because of structural changes in the vessel wall.
Influence of a Defoaming Agent upon the Hematological Complications of Pump Oxygenators
Authors: WELLS ROE , BYGDEMAN M. STELLAN , SHAHRIARI ALI A. , MATLOFF JACK M. , Geyer Robert P. , Harken Dwight E.
Published: June 2012

Measurements of plasma hemoglobin values were made at many different sites of a Cross-Kay disk pump oxygenator during extracorporeal bypass in patients undergoing reparative valve surgery. Hemoglobin values were always higher in the line of the aspirator and defoaming chamber than in any other part of the system. Sampling immediately proximal and distal to the defoaming chamber revealed significant increases in plasma hemoglobin values as a result of the defoaming process.

Studies of the hematological effects of the defoaming agent, polymethylsiloxane, which coats the disposable stainless steel sponge in the defoaming chamber, showed it greatly reduced the resistance of red cells to lysis by mechanical trauma. Similar studies of plasma showed the hemolytic effects of the defoaming agent are to some extent mediated by the plasma.

It is concluded that the widely used defoaming agent, polymethylsiloxane, contributes to the hemolytic action of the bubbling, suctioning, and defoaming processes during open heart surgery. The addition of a water soluble surfactant material, that stabilizes emulsions (Pluronic F68), blocked or prevented the hemolytic process without interfering with the action of the antifoam material.