bluuebunny/crossref_metadata_2025 huggingface dataset:
De subitaneis mortibus. XIV. Bacterial arteritis in Whipple's disease.
Authors: James T N , Haubrich W S
Published: June 2012

Although Whipple's disease is clinically recognized for its features of arthritis and diarrhea, pericarditis and cardiac valvular disease are frequently present and a significant number of such patients die suddenly and unexpectedly. This report includes special postmortem cardiovascular examinations in a 55-year-old man who died of Whipple's disease. Pericarditis and valvular disease were extensively present. There was also focal myocardial degeneration, including the sinus node, A-V node and His bundle. Typical Schiff-positive bacilli were found in the tunica media and endothelium most numerously in the small coronary and hepatic arteries, less in splenic and renal arteries, and least in small pulmonary arteries. Large coronary arteries and the aorta were not involved. Three stages of bacterial invasion of the arteries included a noninflammatory phase in which the bacilli were most numerous, a pancreatic phase in which bacilli were distinctly less numerous, and a healed scarring of arteries previously damaged. The combination of pericarditis, valvular disease of the heart, coronary and systemic bacterial arteritis and focal myocardial degeneration and myocarditis is unusual for Whippl'e disease. Studies of other cases are warranted to determine whether bacterial arteriopathy and arteritis have previously been overlooked or if the present case is unique. Evidence that the conduction system of the heart may be involved indicated that careful attention to cardiac rhyth and conduction is merited in future studies of patients with Whipple's disease.
Echocardiographic features of supravalvular aortic stenosis.
Authors: Bolen J L , Popp R L , French J W
Published: June 2012

A method for the echocardiographic detection of supravalvular aortic stenosis (SVAS) is described and the findings in a series of patients are presented. When compared to angiography, the echo tended to underestimate the severity of the supravalvular aortic obstruction. However, echocardiography appears to be a valuable, noninvasive method for detecting SVAS.
Noninvasive quantitation of myocardial infarction with technetium 99m pyrophosphate.
Authors: Botvinick E H , Shames D , Lappin H , Tyberg J V , Townsend R , Parmley W W
Published: June 2012

We sought to quantitate infarct size using radioactive imaging techniques. Infarcts were created in closed chest dogs. Using a scintillation camera interfaced to a computer, infarct images were made in the anterior, left lateral, LAO, and RAO projections, 48 hours after infarction and 75 to 90 min following the intravenous injection of 15 mCi of Technetium 99m pyrophosphate (Tc-PYP). Images were computer enhanced and area was calibrated with a radioactive grid source of known dimensions. Image radioactivity was normalized for decay and dose corrected for body weight. Animals were sacrificed two hours following the injection Tc-PYP. Postmortem images were also computer enhanced and calibrated. Gross infarct area and weight were estimated and transmural biopsies were evaluated for Tc-PYP activity and analyzed for creatine phosphokinase (CPK) content. Contiguous biopsies were pathologically analyzed and graded. There was a negative correlation between tissue Tc-PYP activity and CPK content (r=0.89). Pathologic severity worsened with increased Tc-PYP activity and diminished CPK content. There was a good correlation between gross infarct area and image infarct area, both in vivo (r
Echocardiography of the "floppy" aortic valve. Report of a case.
Authors: Chandraratna P A , Samet P , Robinson M J , Byrd C
Published: June 2012

The echocardiographic features of a patient with severe aortic regurgitation due to a "floppy" aortic valve are presented. The salient abnormality observed was marked fluttering of the aortic valve cusps in diastole. Fluttering of the anterior leaflet of the mitral valve and left ventricular enlargement were noted. The diagnosis of a "floppy" aortic valve was substantiated at surgery.
Electrophysiologic effects of nitroglycerin during experimental coronary occlusion.
Authors: Levites R , Bodenheimer M M , Helfant R H
Published: June 2012

Previous studies have shown that nitroglycerin (TNG) exerts beneficial electrophysiological effects in the setting of acute myocardial ischemia. To investigate the basis for these actions, the effects of TNG during coronary occlusion were studied in 19 anesthetized mongrel dogs. Refractory periods (obtained by extrastimulus method) and conduction times measured from local electrograms were determined in potentially ischemic and nonischemic areas prior to and after varying periods of occlusion of the left anterior descending coronary artery and following administration of TNG (300-400 mug intravenous bolus followed by an infusion titrated to reduce systolic blood pressure by 20 mm Hg). Following 15 minutes of occlusion, refractory periods in the ischemic zones shortened to 83% of control (P less than 0.001) resulting in a difference between refractory periods in the nonischemic and ischemic zones of 17.7%. After TNG administration this difference was decreased to 10.0% (P less than 0.001). However, with periods of occlusion of 60-90 min TNG did not significantly affect the difference of refractory periods. TNG had no significant effects on conduction times in nonischemic or ischemic areas. In six dogs, the effects of coronary occlusion and TNG on ventricular automaticity were examined by induction of complete heart block. The idioventricular rate and ventricular escape intervals after cessation of ventricular overdrive were used as indices of automaticity. Control idioventricular rates (62.5 +/- 3.7 beats/min) remained unchanged following both coronary occlusion (62.0 +/- 3.9) and TNG administration (60.7 +/- 3.2). Similarly, mean control escape intervals (1.84 +/- 0.2 sec) did not change after occlusion (1.78 +/- 0.3 sec) or TNG administration (1.86 +/- 0.2 sec). In conclusion, these observations suggest that 1) TNG enhances the electrical stability of the acutely ischemic myocardium by decreasing the difference of refractory periods between nonischemic and ischemic areas in the immediate period following occlusion, 2) since TNG has no significant effects on ventricular automaticity, its beneficial effects might be limited in suppression of arrhythmias of re-entrant origin.
Left ventricular performance assessed by radionuclide angiocardiography and echocardiography in patients with previous myocardial infarction.
Authors: Henning H , Schelbert H , Crawford M H , Karliner J S , Ashburn W , O'Rourke R A
Published: June 2012

In 61 patients (77 studies) who had a transmural myocardial infarction, we compared the left ventricular ejection fraction by echocardiography with the ejection fraction determined by a computerized radioisotope technique that makes no assumptions regarding left ventricular geometry. In 31 studies of 26 patients with normal left ventricular wall motion by videotracking and normal left heart size, ejection fraction averaged 0.57 +/- 0.09 (SD) by ultrasound and 0.62 +/- 0.10 by the isotope method. Measurements of ejection fraction by both techniques correlated well (r = 0.86) and there was complete separation between patients with normal and reduced ejection fraction. In 46 studies of 35 patients in whom left ventricular wall motion abnormalities were recorded by videotracking, ejection fraction by the isotope method averaged 0.46 +/- 0.08, while average echo ejection fraction was 0.62 +/- 0.12. The correlation between the ultrasound and isotope methods in these 46 studies was poor (r = 0.33) and in 28 studies measurement of the ejection fraction by the two techniques was discordant. In 26 of the 27 studies where there was a reduced ejection fraction by the isotope method and a normal ejection fraction by echo, the dyssynergy involved the anterolateral left ventricular wall. These data indicate that echocardiographic measurements frequently overestimate left ventricular performance in patients with previous myocardial infarction associated with anterolateral wall motion disorders.
Quantitative relationships between potassium-43 imaging and left ventricular cineangiography following myocardial infarction in man.
Authors: Zaret B L , Vlay S C , Freedman G S , Wolfson S , Cohen L S
Published: June 2012

To evaluate the quantitative relationships between resting potassium-43 (43K) myocardial imaging and left ventricular segmental contraction abnormalities, 15 patients were studied by both radionuclide and contrast angiographic techniques at least two months following transmural myocardial infarction. The ECG location of infarction involved the anterior wall alone in six patients, inferior wall alone in three patients, both anterior and inferior walls in five patients, and in one patient ECG-anatomic correlation was obscured by newly developed left bundle branch block. 43K defects were noted in all patients. Anterior wall 43K defects were noted in all patients with previous anterior infarction and seven of nine inferior infarcts. These 43K defects were associated with a quantifiable decrease in regional radioactivity of at least 20% of normal appearing zones, and their location correlated with the angiographic site of akinesis or dyskinesis. The extent of the 43K defect (% 43K HP [% potassium 43 hypoperfusion]) was measured by planimetry and averaged 49% of the anterior view image (range 25-66%), 43% of the left anterior oblique image (range 0-58%), with the mean of both views being 47% (range 17-62%). The mean total area of the anterior image was 58 cm2 (range 40-101 cm2). The extent of the 43K defect (% 43K HP) was related to the extent of segmental contraction abnormality (% ACS). Correlations between % ACS and anterior view % 43K HP (r = 0.67), left anterior oblique % 43K HP (r = 0.54), and mean % 43K HP (r = 0.77) were found. The total size of the anterior view image correlated with left ventricular end-diastolic volume (r = 0.79). Thus, in this initial group of patients following transmural infarction, potassium-43 imaging can be accurately and quantitatively correlated with the site and extent of regional ventricular dysfunction as it is assessed by quantitative left ventricular angiography.
Correlation between echocardiographically demonstrated segmental dyskinesis and regional myocardial perfusion.
Authors: Kerber R E , Marcus M L , Ehrhardt J , Wilson R , Abboud F M
Published: June 2012

In order to evaluate the relationship between regional myocardial perfusion and segmental dyskinesis, 22 open chest dogs were studied using ultrasound to register cardiac wall motion and radioactive labeled microspheres to determine myocardial perfusion. In six dogs, motion and perfusion were correlated at two levels of partial circumflex coronary artery occlusion followed by complete occlusion. A good correlation between declining myocardial perfusion of all the ischemic segments and development of aneurysmal bulging (during isometric contraction) was seen: r = minus 0.80. A similar correlation between myocardial perfusion and endocardial wall velocity (during systolic ejection) was observed: r = 0.92. In nine dogs, the effect of 45 minutes of complete coronary occlusion followed by 30 minutes of reperfusion was evaluated with respect to perfusion and motion. After coronary reperfusion myocardial perfusion of the ischemic area returned to control levels (from 32.6 +/- 3.5 to 130.3 +/- 13.3 ml/100 g/min), but aneurysmal bulging during isometric contraction persisted. Endocardial wall velocity during systolic ejection showed a variable response to reperfusion, achieving values ranging from 32% to 162% of the preocclusion levels. In seven dogs the ultrasound beam was reflected off nonischemic myocardium adjacent to areas of ischemia resulting from coronary occlusion. Despite preservation of normal myocardial perfusion in these nonischemic areas wall motion abnormalities were evident: endocardial wall velocity declined from 25.8 +/- 5.8 to 14.0 +/- 4.9 mm/sec (P less than 0.01), and aneurysmal bulging in three animals. These changes may be due to transient undetected ischemia in the segments struck by the ultrasound beam, or to passive alteration of the motion of the normally perfused areas by the severe dyskinesis of the adjacent ischemic myocardium.
Long-term survival after aortic valve replacement using Smeloff-Cutter prosthesis.
Authors: Lee S J , Barr C , Callaghan J C , Rossall R E
Published: June 2012

The long-term prognosis of 187 consecutive patients who received single aortic valve replacement using Smeloff-Cutter prosthesis was studied. Of the 163 patients who survived the operation, a long-term follow-up (up to eight years) was obtained in 153 patients (95%). A total of 34 patients (22%) died during the follow-up period. Including the hospital mortality, the actuarial survival rate of our patients with Smeloff-Cutter prosthesis was 0.69 after the fifth year and 0.611 after the eighth year of follow-up. This is similar to the actuarial survival rate of patients with Starr-Edwards prosthesis but it appears significantly better than the expected survival rate of symptomatic patients with aortic stenosis treated without surgery. Thus, this result supports the contention that aortic valve surgery in properly selected patients can prolong life expectancy in addition to relieving symptoms in patients with aortic valve disease. The majority of surviving patients reported to have improved (88%) since the operation and to be symptom free (82%).
De subitaneis mortibus. XV. Hereditary stenosis of the His bundle in Pug dogs.
Authors: James T N , Robertson B T , Waldo A L , Branch C E
Published: June 2012

Syncope and sudden death occurs in certain purebred Pug dogs which have been found to have intermittent sinus pauses and paroxysmal second degree heart block on electrocardiographic (ECG) study. We have established a colony of such dogs to study this problem and here report the results of histological examination of the cardiac conduction system in twenty-one of them. These include a dam which may be considered the proband, three of her offspring (two littermates) and three fetal pups in an unborn litter of one of these; three of the four adult dogs died suddenly and unexpectedly. Two groups of puppies descendants of these lines were also studied after they all died within three days of birth. The first group of puppies (8) did not have suitable ECG studies but the second group (6) did and showed ECG changes similar to those in the adult dogs. In all 21 dogs the sinus node was anatomically normal, but in every one there was significant stenosis of the midportion of the His bundle. There was no abnormality of the atrioventricular (A-V) node or of the bundle branches, and the cardiac valves and coronary arteries were normal. Two pups had ventricular septal defects and one of these had an atrial defect as well. All the dogs were of the normal fawn color, had a normal physical appearance and no visible evidence of associated extracardiac abnormalities. The adult dogs were able to hear normally but the puppies died too early to test their hearing. The paroxysmal heart block may in part be attributable to the abnormality in the His bundle, but other factors possibly leading to heart block and long sinus pauses are discussed. Stenosis of the midportion of the His bundle appears to be a heritable trait in these purebred Pug dogs.
Rapidly progressive obstructive cardiomyopathy in infants with Noonan's syndrome. Report of two cases.
Authors: Hirsch H D , Gelband H , Garcia O , Gottlieb S , Tamer D M
Published: June 2012

Two patients with hypertrophic obstructive cardiomyopathy and Noonan's syndrome are presented. Both patients were found at postmortem examination to have gross malformation of the mitral valve and obliteration of the left ventricle due to muscle hypertrophy. Each case demonstrated similar clinical, echocardiographic, and angiographic findings. The poor response to medical and surgical therapy are noted.
Complete interruption of the aortic arch. 2. Characteristic angiographic features with emphasis on collateral circulation to the descending aorta.
Authors: Jaffe R B
Published: June 2012

The angiocardiograms of 17 patients with aortic arch interruption are reviewed to emphasize the variations in arch interruption and origin of the brachiocephalic vessels, and collateral circulation to the descending aorta. Depending on the anatomical type and subtype of arch interruption, collateral flow to the descending aorta in the presence of a stenotic or closed ductus will be dependent on the development of intercostal collaterals and/or the presence of retrograde flow in all brachiocephalic vessels arising from the descending aorta. Familiarity with the potential pathways for collateral circulation may permit differentiation into types and subtypes on chest radiograph. Patients with Type I interruption may have bilateral rib notching if the right subclavian artery originates normally from the innominate artery, but will have rib notching confined to the left side if the origin of the right subclavian artery is aberrant. Type II or Type III interruption patients will have rib notching confined to the right side if the right subclavian has a normal origin, but no rib notching if the origin of the right subclavian artery is aberrant.
Diagnosis of prosthetic mitral valve malfunction with combined echo-phonocardiography.
Authors: Brodie B R , Grossman W , McLaurin L , Starek P J , Craige E
Published: June 2012

Fifty-three patients were studied with combined echo-phonocardiography or phonocardiography alone following prosthetic valve replacement. In sixteen of these patients, clinical deterioration developed, and all subsequently underwent cardiac catheterization and/or surgery. Two patients came to autopsy. Included in this group of sixteen patients were five with obstructed prosthesis, six with paravalvular regurgitation, and five with left ventricular dysfunction. Measurements were made of the time interval from the aortic valve closure sound to the peak opening of the mitral prosthesis determined echocardiographically or to the mitral prosthetic opening click (A2-MVO). Echocardiographic studies of left ventricular wall motion were also performed. The A2-MVO interval was significantly shortened (P less than 0.01) with prosthetic valve obstruction (.05 +/- .02 sec) and paravalvular regurgitation (.05 +/- .01 sec) compared with normally functioning prostheses (Starr-Edwards ball valves .10 +/- .02 sec, Lillehei-Kaster tilting disc prostheses .09 +/- .01 sec). Shortening of this interval was not specific for these conditions because it was sometimes shortened with left ventricular dysfunction. Echocardiographic studies of left ventricular wall motion were helpful in distinguishing among prosthetic valve obstruction, paravalvular regurgitation and left ventricular dysfunction. The combined echo-phonocardiographic technique was especially helpful in detecting malfunction of tilting disc prostheses, because the technique enables measurement of the A2-MVO interval in the absence of an audible opening click.
Vectorcardiographic criteria for the diagnosis of anterior myocardial infarction.
Authors: Starr J W , Wagner G S , Draffin R M , Reed J B , Walston A , Behar V S
Published: June 2012

Frank lead vectorcardiograms (VCG) from four carefully selected patient subgroups (226 patients) were analyzed to develop optimal criteria for the diagnosis of anterior myocardial infarction. Specificity was evaluated using 100 healthy volunteers under age 30 and 80 patients with normal left ventriculogram and normal coronary arteriograms. Sensitivity was determined using 25 patients with evolutionary ST-T wave changes (V1-2), and LDH and CPK isoenzyme evidence of acute myocardial infarction; and 21 patients with anterior wall akinesia or dyskinesia and greater than 70% occlusion of the left anterior descending coronary artery. Patients with VCG evidence of bundle branch block, left or right ventricular hypertrophy were excluded. The criterion for the diagnosis of anterior myocardial infarction which was found to give the highest sensitivity with greater than or equal to 95% specificity was: initial anterior QRS forces must not exceed 0.1 mV in maximal anterior amplitude and also must not exceed 24 msec in duration. The performance of this proposed criterion was then tested using four similarly defined patient subgroups consisting of a total of 222 patients. The incidence of false positive diagnosis in these test subgroups was less than 1% with a sensitivity of greater than 95%. The overall performance of the proposed criterion was found to be significantly superior to both the widely accepted VCG and ECG criteria for anterior myocardial infarction. Thus, this quantitative criterion using both time and duration of initial anterior forces is both a highly specific and a sensitive indicator of anterior myocardial infarction.
Statistical analysis of pacemaker follow-up data. Rate stability and reliability.
Authors: Grunkemeier G L , Dobbs J L , Starr A
Published: June 2012

In a rate-stable pacemaker, pacemaker rate reflects battery voltage level and should remain constant or be slightly depleted with time in a linear fashion until failure occurs. Linear regression techniques are therefore particularly suited to the analysis of pacemaker rate data. Data on model 8114/8114A Starr-Edwards pacemakers followed at the University of Oregon Health Sciences Center were studied. For a given pacemaker both the slope of the regression line and the standard deviation about the regression line are proportional to the original rate. Natural indices of rate depletion and rate stability for each pacemaker can therefore be calculated by dividing the slope and the standard deviation, respectively, by the inpercept of the corresponding regression line. This model pacemaker has a small average standard deviation so that significant variations from the line of regression, indicating impending pulse generator failure, can be detected in spite of random fluctuations. Emergency and prophylactic replacements can therefore be kept to a minimum so that pulse generator lifetime is maximized. Success in extending pulse generator longevity can be measured by actuarial techniques, which show this pacemaker to have a median battery depletion time of 38 months and a median replacement time of 35 months.
Localization of aortic valve vegetations by echocardiography.
Authors: Hirschfeld D S , Schiller N
Published: June 2012

Nine patients with anatomically documented vegetations on one or more cusps of the aortic valve had echocardiograms in which abnormal echoes were associated with the aortic leaflet echoes. The motion of the abnormal echoes during systole correlated well with the anatomic location of vegetations: a vegetation on the right coronary cusp moved anteriorly with systole while a vegetation on the noncoronary cusp moved posteriorly during systole. Our data, although inconclusive, suggest that echoes from a vegetation on the left coronary cusp maintain a mid-aortic position throughout the cardiac cycle. The echocardiographic appearance of vegetations is not specific, but in the setting of septicemia, dense mobile echoes in the region of the aortic valve are strongly suggestive of vegetation. A normal echocardiographic appearance of the aortic valve does not exclude the possibility that vegetation is present, especially if the growth is less than 5 mm in size.
Noninvasive evaluation of ventricular hypertrophy in professional athletes.
Authors: Roeske W R , O'Rourke R A , Klein A , Leopold G , Karliner J S
Published: June 2012

Athletes often exhibit ECG findings which are considered to be abnormal. Therefore, we used noninvasive graphic methods to study 42 active professional male basketball players, ranging in age from 21 to 31 years, without clinically evident heart disease. Of the 42, 11 (25%) met the Romhilt-Estes ECG voltage criteria for left ventricular hypertrophy, and 12 (29%) satisfied VCG criteria for left ventricular enlargement; nine (21%) had left ventricular hypertrophy by both methods. In 33 subjects (79%) the 0.04 sec vector in the horizontal plane was anterior, and 29 of these exhibited one or more standard criteria for right ventricular enlargement; the ECG and VCG were concordant for right ventricular hypertrophy in 16 subjects (38%). Submaximal treadmill exercise tests (Bruce protocol) were normal in eight athletes, while in one subject ventricular premature beats occurred during the test. In 24 of 25 athletes (96%) from whom phonocardiograms were obtained a third heart sound was recorded, while in 14 (56%), a fourth heart sound was present. Of the 14 athletes who had a fourth heart sound, 12 (86%) had either ECG or VCG evidence of ventricular hypertrophy. Only four of 23 athletes had an increased cardiothoracic ratio (greater than .50) on routine chest X-ray. Ten athletes and ten control subjects matched for height, weight and body surface area had echocardiograms satisfactory for analysis. The left ventricular end-diastolic dimension in the athletes averaged 53.7 +/- 1.3 (SE) mm compared with a value of 49.9 +/- 0.7 mm in the control subjects (P less than 0.02), and was increased (greater than or equal to 56 mm) in four. Left ventricular posterior wall thickness averaged 11.1 +/- 0.6 mm, compared with a value of 9.8 +/- 0.5 mm in the control subjects (P less than 0.05), and was increased (greater than or equal to 11 mm) in six athletes. The right ventricular end-diastolic dimension averaged 20.8 +/- 1.1 mm compared with a value of 12.9 +/- 2.2 mm in the controls (P less than 0.004), and was increased (greater than or equal to 23 mm) in four athletes. No athlete or control subject exhibited paradoxical septal motion. In the athletes, ejection fraction (cube method) averaged 79 +/- 2.0% and mean Vcf averaged 1.13 +/- 0.04 circ/sec; these values did not differ from those of the control subjects. Thus, both right and left ventricular enlargement ("physiological hypertrophy") are often present in the well-trained athlete, but left ventricular performance remains normal in the basal state in such individuals. We condlude that these individuals represent a selected subgroup of subjects who are variants of normal.
Surgical repair of atrial septal defect in patients over 60 years of age. Long-term results.
Authors: Nasrallah A T , Hall R J , Garcia E , Leachman R D , Cooley D A
Published: June 2012

In order to evaluate results of surgical repair of secundum atrial septal defect (ASD) in patients 60 years of age or older, a review was made of 16 patients who had undergone such operation between January 1964 and December 1974. Before operation eight patients were in functional classification III (New York Heart Association), seven were in class II, and one was in class I. Twelve patients had a left-to-right shunt greater than 3:1. Pulmonary artery systolic pressure was greater than 40 mm Hg in 12 patients and greater than 60 mm Hg in five. Four patients had documented paradoxical emboli and were being treated with Coumadin. Before operation all patients but one were receiving digoxin. Repair was accomplished by direct suture in two patients and Dacron patch graft in 14. No deaths occurred during the postoperative period. Postoperatively, ten patients were in class I, five in class II, and one remained in class III. The hospital stay ranged from eight to 20 days (average 11 days). Two patients died one year and another (at the age of 77) five years after surgery. The remaining 13 patients are alive and well three months to 11 years after surgery. We conclude that repair of secundum ASD in patients over the age of 60 is safe, has low morbidity, and produces considerable clinical improvement.
Heart rate and arterial blood pressure during exercise in patients with angina pectoris. Effects of training and of nitroglycerin.
Authors: Clausen J P , Trap-Jensen J
Published: June 2012

In 29 patients with typical exertional angina pectoris, intra-arterial systolic blood pressure (SBP), heart rate (HR), and the rate-pressure product (RPP = HR X SBP X 10(-2) were continuously recorded during repeated bouts of leg or arm exercise. Development of chest pain was independent of the workload and occurred at a fairly constant value of RPP, of HR, and of SBP in each patient for a given type of exercise, but the pain threshold values for all three variables were consistently higher during arm exercise than during leg exercise. The reproducibility of the pain threshold values was assessed for leg exercise. The variation, based on individual coefficients of variation, ranged from 1.3% to 13% (group mean, about 6%). There was no significant difference between the SBP values obtained by the traditional, noninvasive cuff technique and the values during intra-arterial monitoring. In 25 patients a physical training program of an average of three months increased the maximal amount of work (watt X sec) performed before onset of pain by 100%. The most conspicuous effect of training on cardiac function was a 10% reduction of HR at a given workload, SBP being unchanged. Over-all, the data suggest that the increased exercise capacity caused by training could be accounted for by the reduction in the relation between RPP and external workload. The improvement in exercise capacity resulting from training was on the same level of magnitude as the 90% increase obtained in 11 untrained patients after administration of 0.25 to 0.50 mg of nitroglycerine sublingually prior to exercise. In contrast to the finding after training, nitroglycerin administered to subjects increased HR by 10%, but reduced SBP by 13%, RPP remaining unchanged. Therefore to explain the effect of nitroglycerin on exercise capacity additional economizing changes in myocardial performance (e.g., reduction of heart volume) are required.
Electrophysiological and clinical observations in patients with alternating bundle branch block.
Authors: Wu D , Denes P , Dhingra R C , Amat-Y-Leon F , Wyndham C R , Chuquimia R , Rosen K M
Published: June 2012

Electrophysiological studies (His bundle recordings and atrial stimulation) were performed in nine patients who manifested periods of both right and left bundle branch block (RBBB and LBBB). In seven of the patients, alternating bundle branch block appeared to reflect intermittent or chronic bundle branch block superimposed on incomplete (but electrocardiographically complete) block of the contralateral bundle branch. In three of these seven, shift from one bundle branch block pattern to the other was associated with reproducible change in H-V (mean change 30 msec), and could be induced by alteration of cardiac rate with carotid massage, coupled atrial stimulation, and rapid atrial pacing. In one of the seven, RBBB with a P-R of 0.20 seconds preceded chronic LBBB with a P-R of 0.24 seconds, implying that RBBB had been incomplete. In three of the seven, although a definite mechanism of alternation could not be demonstrated, transient contralateral bundle branch block occurred superimposed on chronic ipsilateral bundle branch block, implying that the ipsilateral block was incomplete. Two patients manifested periods of narrow QRS, LBBB, RBBB, and paroxysmal A-V block. Based upon pathological data (one case), this pattern appeared to reflect a lesion involving the distal His bundle and proximal bundle branches. In the total group of patients, clinical course was primarily determined by the severity of heart disease and not by occurrence of A-V block. The conduction defect in the majority of patients was surprisingly benign.
Mitral and tricuspid valve closure in congenital heart disease.
Authors: Milner S , Meyer R A , Venables A W , Korfhagen J , Kaplan S
Published: June 2012

Echocardiography was used to evaluate mitral and tricuspid valve closure in patients 1 day to 20 years of age. When possible, simultaneous phonocardiograms were obtained. The difference in time between the Q wave of the electrocardiogram and mitral closure and between Q and tricuspid closure was designated the delta value. Four groups of patients were assessed: 1) normals (40), secundum atrial septal defect (ASD) (10), mitral valve prolapse syndrome (Barlow's syndrome) (13), pulmonary hypertension (12), and pulmonic stenosis (6); 2) Ebstein's anomaly (10); 3) transposition of the great vessels (15); 4) right bundle branch block (RBBB) (25). Ten patients with surgically induced right bundle branch block were studied by phonocardiography alone. Group I had values of 50 msec or less (-5 to 50 milliseconds) and served as controls. Ebstein's anomaly showed prolongation of the delta value to 65 msec or greater in eight out of ten patients. Patients with transposition of the great vessels showed a striking difference from the preceding groups in that an average negative delta value was obtained. Twenty-two patients of group 4 (RBBB) had delta values within the normal range. This study has shown that a delta value greater than 65 msec is suggestive of Ebstein's anomaly. In addition, if the delta value is negative, transposition of the great vessels can be suspected.
Hemodynamic studies in children four to ten years after the Mustard operation for transposition of the great arteries.
Authors: Godman M J , Friedli B , Pasternac A , Kidd B S , Trusler G A , Mustard W T
Published: June 2012

Fourteen patients have been studied hemodynamically 4-10 years (mean 5.5 years) after the Mustard operation for transposition of the great arteries. Investigation was directed principally at 1) the detection of baffle obstruction by catheterization of the pulmonary veins (PV) and venae cavae and recording of simultaneous right ventricular (RV) and pulmonary capillary wedge pressures (PCW); 2) the detection of intra-atrial baffle leaks by dye curves and selective angiography; 3) the assessment of RV and LV function by calculating peak VCE (dp/dt/28p) from high fidelity recordings in 11 patients. Severe baffle obstruction to the PV return was found in only one patient. The others had no or minimal gradients between RV end-diastolic and PCW pressures (mean 1.3 +/- 0.69 mm Hg). Cardiac output was normal at rest (4.1 +/- .22) and increased to 7.1 +/- .62 L/min/m2 (+73%) but the gradient between the RV end-diastolic and PCW pressures remained insignificant (2.2 +/- 1.13 mm Hg). No evidence of caval obstruction was found in any patient. Baffle leaks were found in five patients with mild bidirectional shunting. All arterial oxygen saturations were above 90%. Mild tricuspid regurgitation was demonstrated in two patients by RV angiography and was absent in 12 others. The contractility index peak VCE averaged 1.87 +/- .122 sec-1 for the RV and was significantly lower in the LV (1.53 +/- 1.35 SEC-1, P less than 0.01). Only one patient presented significantly decreased RV contractility with a peak VCE of 1.07 sec-1 and poor contraction on the RV angiogram. These data indicate that the long-term prognosis after the Mustard operation should be good in most patients and that the right ventricle is capable of functioning at the level of contractility of a normal left ventricle.
Mechanism of atrial sounds in atrial fibrillation. Phonoechocardiographic correlation. Report of a case.
Authors: Bamrah V S , Hughes C V , Tristani F E
Published: June 2012

Audible atrial sounds were noted in a patient with congestive cardiomyopathy and atrial fibrillation with slow ventricular rate. Oscillatory motion of similar periodicity as fibrillation waves in the ECG and the sounds in the phonocardiogram was demonstrated in aortic and left ventricular walls, mitral, tricuspid and aortic leaflets by echocardiography. This suggests that the fibrillation motion of the atria is forceful enough to cause vibration of the cardiohemic system resulting in the audible sounds.
Intervention ventriculography. Comparative value of nitroglycerin, post-extrasystolic potentiation and nitroglycerin plus post-extrasystolic potentiation.
Authors: Banka V S , Bodenheimer M M , Shah R , Helfant R H
Published: June 2012

The comparative value of nitroglycerin (TNG), post-extrasystolic potentiation (PESP) and their combination (TNG + PESP) to unmask asynergic residual contraction was examined, each patient serving as his own control. Twelve of 13 hypokinetic zones improved both with TNG and PESP. One remained unchanged with either. Of 15 akinetic zones, four improved with both TNG and PESP, while ten remained unchanged. One akinetic zone, although improved with TNG, remained unchanged with PESP. Four dyskinetic zones did not change with either. Six asynergic zones responding to TNG alone demonstrated further augmentation with TNG + PESP. However, none of 13 TNG unresponsive zones improved with TNG + PESP. Thus, TNG, PESP, and TNG + PESP are each equally capable of unmasking asynergic residual contractile ability.
Determinants of left ventricular hypertrophy and oxygen supply in chronic aortic valve disease.
Authors: Trenouth R S , Phelps N C , Neill W A
Published: June 2012

Ventricular mass and O2 supply of the myocardium were evaluated in patients with left ventricular hypertrophy due to stenosis or insufficiency of the aortic valve and in control patients without cardiac disease. Calculation of left ventricular mass from the angiogram was verified by autopsy data in seven patients. Total mass, O2 consumption, and coronary blood flow, each was related quantitatively to left ventricular total load (force) in all patients. Left ventricular equatorial tension, however, was greater in proportion to mass in aortic stenosis than in aortic insufficiency patients. This discrepancy could be explained by the more eccentric shape of the left ventricle in aortic stenosis. Oxygen consumption and coronary blood flow per gram of myocardium were normal at rest in patients with hypertrophy. Tachycardia induced by atrial pacing provoked myocardial lactate production in half of the patients with aortic stenosis but in none of the patients with aortic insufficiency. Surgical mortality was related to myocardial mass and lactate production.
Echo-phonocardiographic and contrast studies in conditions associated with systemic arterial trunk overriding the ventricular septum: truncus arteriosus, tetralogy of Fallot, and pulmonary atresia with ventricular septal defect.
Authors: Assad-Morell J L , Seward J B , Tajik A J , Hagler D J , Giuliani E R , Ritter D G
Published: June 2012

Echocardiography was performed in 62 patients--20 with truncus arteriosus, 14 with tetralogy of Fallot, and 28 with pulmonary atresia with ventricular septal defect. Features common in all three groups were: large single systemic arterial trunk overriding the ventricular septum, mitral-semilunar continuity, large right ventricular dimension, and normal septal motion. Indocyanine green contrast flow patterns were similar and were most helpful in detecting an associated atrial septal defect and in studying the timing and pattern of right-to-left shunting. Echo-phonocardiographic studies revealed that the ejection click coincided with the point of maximal opening of aortic or truncal valve. Left atrial dimension was measured in 55 patients and was normal or small in 41 patients and large in 14 patients. Our observations indicate that left atrial dimension provides a good index of pulmonary flow and can help differentiate those patients with increased pulmonary flow and can help differentiate those patients with increased pulmonary flow (truncus arteriosus) from those patients with reduced pulmonary flow (tetralogy of Fallot and pulmonary atresia with associated ventricular septal defect).
Impedance plethysmography using the occlusive cuff technique in the diagnosis of venous thrombosis.
Authors: Hull R , van Aken W G , Hirsh J , Gallus A S , Hoicka G , Turpie A G , Walker I , Gent M
Published: June 2012

Impedance plethysmography using the cuff technique has been compared with venography in 346 consecutive patients with suspected venous thromboembolism. The limbs were classified according to the venographic results as no thrombosis, proximal (popliteal, femoral, or iliac) vein thrombosis, and calf thrombosis. A discriminant analysis was performed. The impedance plethysmographic result was normal in 386 of 397 limbs which were normal on venography, a specificity of 97%, and abnormal in 124 of 133 limbs which showed proximal vein thrombosis, a sensitivity of 93%. Seventy-three of 88 limbs with calf vein thrombi and a normal impedance plethysmographic result. The sensitivity in 29 limbs with asymptomatic proximal vein thrombosis was 83%. Impedance plethysmography is an accurate method for detecting proximal vein thrombosis but has limitations which include the possibility of false positive results due to arterial insufficiency and muscle tension.
Recurrence risks in children having one parent with a congenital heart disease.
Authors: Nora J J , Nora A H
Published: June 2012

The risk of recurrence of a congenital cardiovascular malformation in a child having one parent with congenital heart disease has been determined for each of the seven most common anomalies presently compatible with survival to reproductive age. The range of risk is 2.5% to 4.3% depending on the lesion. This is within the range of expectation for the model of multifactorial inheritance previously used to predict recurrence in other first-degree relatives of probands (siblings and parents) with congenital heart disease. The cardiovascular abnormality occurring in the child was most often the same as in the parent or was a closely related variant of it.
Reversible asynergy. Histopathologic and electrographic correlations in patients with coronary artery disease.
Authors: Bodenheimer M M , Banka V S , Hermann G A , Trout R G , Pasdar H , Helfant R H
Published: June 2012

Histopathologic-electrographic studies of ventriculography depicted nitroglycerin responsive and unresponsive asynergic areas were performed in 25 patients. Of 29 areas, 12 improved with nitroglycerin, showing less than 10% muscle loss. Seventeen unimproved zones demonstrated significant fibrosis. Epicardial electrograms showed R waves in eight of nine improved zones. Of 11 unimproved zones, eight had Q waves. Histopathologic-electrographic data from five responders showed less than 10% muscle loss, of whom four had epicardial R waves. Six unresponsive areas had significant fibrosis, with a QS over four. Thus, nitroglycerin responsive asynergic areas are generally comprised of histologically intact myocardium and are associated with epicardial R waves.
Atherosclerotic narrowing of the left main coronary artery. A necropsy analysis of 152 patients with fatal coronary heart disease and varying degrees of left main narrowing.
Authors: Bulkley B H , Roberts W C
Published: June 2012

Histologic sections of the left main (LM) and the other three major coronary arteries were studied in 152 patients. The lumen of the LM in 35 patients was greater than 75% narrowed; in thirty, 50-75%; and in 87, less than 50% narrowed. The patients with greater than 75% narrowing were younger. Angina pectoris and hyperlipoproteinemia, specifically type II, were more common (P less than 0.02) and acute transmural and healed subendocardial myocardial infarcts were less frequent (P less than 0.05) in the patients with greater 75% LM narrowing than in those with less than 50% narrowing. Of the three other major coronary arteries, the average number narrowed in the patients with greater than 75% LM narrowing was 2.9; in those with 50-75% LM narrowing 2.7, and in those with less than 50% LM narrowing, 2.4. Of the 35 patients with greater than 75% LM narrowing, 33 had greater than 75% luminal narrowing of each of the other three major coronary arteries. Narrowing of the LM, therefore, indicates severe narrowing of usually all major coronary arteries.
Right and left ventricular volume characteristics in children with pulmonary stenosis and intact ventricular septum.
Authors: Nakazawa M , Marks R A , Isabel-Jones J , Jarmakani J M
Published: June 2012

Right (RV) and left ventricular (LV) volume variables were calculated in 27 patients with pulmonary stenosis (PS) during routine cardiac catheterization. These included 21 patients with isolated PS (group I) and seven studies in six patients (group II) with PS and right-to-left atrial shunt. Right and left ventricular volumes were calculated according to Simpson's rule and the area length methods respectively. In group I, right ventricular end-diastolic volume (RVEDV) was not different from normal, RVEF (0.70 +/- 0.02) was significantly higher than normal, and right ventricular stroke index (RVSI) (4.36/L/min/M2 +/- 0.23) was normal. The RVEDV/LVEDV ratio was significantly less than normal (P=0.001). Multiple regression analysis indicated that RVEDV (% of normal) decreased with both age and severity of RV outflow obstruction (r=0.77). In group II, RVEDV and RVSI were both less than normal (P less than 0.001), while RVEF was normal. LVEDV in the group was slightly higher than normal (P=0.026) while LVEF was less than normal (P=0.027) and resulted in normal LVSI. The data suggest that RV and LV function in children with isolated PS are normal, and that knowledge of the RV volume variables is not essential for the management of these patients. In contrast, hearts of patients with PS and right-to-left interatrial shunt have evidence that suggest depressed ventricular function, and the quantitation of RV volume may be helpful in the management of these patients.
The lateral chest film as an unreliable indicator of azygos continuation of the inferior vena cava.
Authors: O'Reilly R J , Grollman J H
Published: June 2012

Recognition of azygos continuation of the inferior vena cava (AC-IVC) is necessary to prevent unnecessary surgery, to modify the approach to right heart catheterization and to avoid potentially fatal azygos ligation at the time of thoracic surgery. Absence of the inferior vena cava (IVC) shadow on the lateral chest film has been claimed to be an important feature of AC-IVC. Our findings, however, indicate that AC-IVC is frequently associated with a normal appearing IVC shadow on lateral chest film study. When the findings on frontal chest film examination suggest AC-IVC, a caval shadow on the lateral view does not exclude the diagnosis. There persists a need for further radiographic evaluation and, if necessary, angiographic confirmation. The lateral chest film does not provide reliable evidence for or against the diagnosis of azygos continuation of the inferior vena cava.
Uremic pericarditis as a cause of cardiac tamponade.
Authors: Baldwin J J , Edwards J E
Published: June 2012

Uremic pericarditis may complicate either acute or, more commonly, chronic renal failure. When dialysis is not employed, uremic pericarditis is usually a preterminal event and is characterized by a serofibrinous exudation of an amount inadequate to cause cardiac tamponade. Nevertheless, cardiac tamponade may uncommonly be observed in nondialyzed patients. Cardiac tamponade, which may be life-threatening, is more common in dialyzed than in nondialyzed patients with chronic renal failure. The primary causes of cardiac tamponade in uremic pericarditis in order of decreasing frequency are (1) pericardial effusion, usually of the serosanguineous type, (2) massive hemorrhage into the pericardial sac and (3) collagenization of pericardial exudate. From pathologic evidence, the following forms of therapy appear appropriate to manage uremic pericarditis that has reached the stage of causing cardiac tamponade. For effusion, pericardiocentesis or parietal pericardiectomy are logical procedures. Massive hemorrhage into the pericardial sac is usually attended by clotting and requires pericardiotomy and evacuation of clot. Collagenization of exudate yields an encasing, fibrous shell over the heart and requires decortication, as is practised in classical constrictive pericarditis.