bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Results and Late Developments of the Waterston Anastomosis
Authors: TAY DANIEL J. , ENGLE MARY ALLEN , EHLERS KATHRYN H. , LEVIN AARON R.
Published: June 2012

The early results and late developments are presented of a consecutive series of 36 patients who underwent anastomosis of the ascending aorta to right pulmonary artery during a six-year period for a variety of congenital malformations associated with cyanosis and severe pulmonary stenosis or atresia. Twenty-six were infants under one year of age, and 16 of these were under one month of age at the time of operation. The early operative mortality of 22% was related to the severity of the anomaly and the young age of the patient. There were no early deaths in those aged three months or more. If the anastomosis was patent, symptomatic relief was good. However, the long-term mortality was 53%. Except for one baby who died of an associated congenital anomaly, the deaths were related to some consequence of the Waterston anastomosis that was unforeseen at the time of its employment. These included obliteration of the anastomosis, kinking of the anastomosis with partial or complete interruption of continuity between right and left pulmonary arteries, obliteration of the right pulmonary artery, progressive severe obstruction to right ventricular outflow and decreased flow to the left lung, as well as the complications of an excessive shunt with cardiac failure and pulmonary vascular obstructive disease. One or more subsequent palliative operations were required in nine symptomatic patients. Of the ten children with tetralogy of Fallot who underwent later open-heart repair, four died because of the difficulty in takedown of the Waterston and relief of the acquired stenosis or atresia of the right pulmonary artery and of the right ventricular outflow tract and hypoplasia of the left pulmonary artery. This mortality rate of 40% in these tetralogies contrasts with a concurrent mortality rate of less than 5% in a consecutive series of 50 patients with a tetralogy who had not had a previous Waterston procedure. We believe that this form of palliation should be reserved for those symptomatic, cyanotic newborns who are candidates for palliative rather than reparative surgery and who are not suitable for a Blalock-Taussig or Potts anastomosis.
Multiple Crystal Cross-Sectional Echocardiography in the Diagnosis of Cyanotic Congenital Heart Disease
Authors: SAHN DAVID J. , TERRY RICHARD , O'ROURKE ROBERT , LEOPOLD GEORGE , FRIEDMAN WILLIAM F.
Published: June 2012

A new multiple crystal echocardiographic system was used to assess cross-sectional cardiac anatomy in real time in fifty infants and children with cyanotic heart disease, and the findings were compared to normals. Four standard transducer positions were employed to evaluate sagittal and transverse cardiac cross-sections. Studies in patients with tetralogy of Fallot demonstrated an enlarged aorta overriding the septum with preservation of mitral-aortic continuity. In the absence of pulmonary atresia the main pulmonary artery could be identified in all of these patients. The diagnosis of
d
-transposition of the great vessels was established by viewing great vessel orientation in transverse section at the second intercostal space and observing a rightward and anteriorly placed great artery. In sagittal projections a retrosternal aorta and mitral-pulmonic continuity was observed. In one patient with
d
-transposition, apposition in systole of the ventricular septum and anterior leaflet of the mitral valve was identified as the cause of left ventricular outflow tract obstruction. Descriptions are provided of the findings in patients with
l
-transposition, double outlet right ventricle, and truncus arteriosus. The new multiscan method allows a substantially more precise determination of intra- and extra-cardiac spatial relationships than single crystal techniques. Multiscan echocardiography is safe, widely applicable, and provides clinically important information to assist in the diagnosis and management of infants and children with cyanotic heart disease.
Sensitivity and Specificity of Echocardiographic Diagnosis of Pericardial Effusion
Authors: HOROWITZ MICHAEL S. , SCHULTZ CLIFFORD S. , STINSON EDWARD B. , HARRISON DONALD C. , POPP RICHARD L.
Published: June 2012

In order to evaluate the reliability and sensitivity of echocardiograms for detecting and quantitating pericardial effusion, 41 patients had echocardiograms on the day prior to cardiac operation. A fluid trap was used to aspirate the pericardium at operation. Thirty-nine of 41 patients had echocardiograms of diagnostic quality. In 25 patients, the echocardiogram was negative for pericardial effusion, with 0-16 ml identified at operation. In 13 patients, the echocardiogram was positive for pericardial effusion, with 15-775 ml aspirated at operation. A transition of patterns of relative posterior epicardial-pericardial movement was noted as the pericardial fluid volume increased. More than 15 ml was always found when a posterior echo-free space persisted throughout the cardiac cycle between a flat pericardium relative to the epicardium. In the presence of such a posterior echo-free space, a large anterior echo-free space made a moderately large pericardial effusion likely. In the absence of this diagnostic posterior echo-free space, an anterior echo-free space had no diagnostic significance, as it was found in 11 patients with less than 16 ml of pericardial effusion. A small posterior echo-free space persisting throughout the cardiac cycle between pericardial and epicardial echoes demonstrating virtually identical movements was found in two patients without any surgical evidence for pericardial effusion, but with evidence of adhesive fibrocalcific pericardial disease. A method of estimating pericardial volume is proposed, which uses the difference between the cubed diameters at the end-diastole of the pericardium and epicardium.
Depression of Escape Pacemakers Associated with Rapid Supraventricular Rate in Patients with Atrioventricular Block
Authors: ARAVINDAKSHAN V. , SURAWICZ BORYS , DAOUD FUHEID S.
Published: June 2012

Intermittent failure of escape pacemakers to maintain an effective rate when the supraventricular rate was rapid was observed in three patients with complete, or high degree atrioventricular block. In two of these patients asystole or slowing of escape pacemaker rate to less than 20 per minute was reproduced by atrial pacing at rates from 125 to 150 per minute. We localized the site of the block and the site of escape pacemaker proximal to the bifurcation of the His bundle in all patients. We assume that a critical increase in atrial rate facilitates penetration of the nonconducted supraventricular impulses into the area of block causing discharge of the escape pacemaker. We suggest that such concealed discharge of escape pacemakers should be considered as a cause of slow and variable rate of escape pacemakers in patients with block proximal to the bifurcation of the His bundle.
The Prognosis of Patients with Coronary Artery Disease After Coronary Bypass Operations
Authors: ANDERSON RICHARD P. , RAHIMTOOLA SHAHBUDIN H. , BONCHEK LAWRENCE I. , STARR ALBERT
Published: June 2012

The clinical progress of 532 patients who were treated for ischemic heart disease by coronary bypass grafting during a five-year period was studied. All patients had at least 50% luminal narrowing of one or more major coronary arteries determined by preoperative coronary arteriography and relatively stable and disabling (New York Heart Association Functional Class III and IV) angina pectoris. During the total observation period there were 35 deaths: 18 early and 17 late. The over-all 4-year survival rate by life-table methods was 89%, and it differed among patients with one-vessel involvement (96%), two-vessel involvement (89%), and three-vessel involvement (84%), but not significantly so. The patency rate of bypass grafts determined in 191 patients at a mean time of six months postoperatively was 76%. Functional class I and II status was 93% during the first year and was 75% during the fourth year after operation in observed survivors.
Comparative Effectiveness of Exercise Testing and Continuous Monitoring for Detecting Arrhythmias in Patients with Previous Myocardial Infarction
Authors: CRAWFORD MICHAEL , O'ROURKE ROBERT A. , RAMAKRISHNA NALLAN , HENNING HARTMUT , ROSS JOHN
Published: June 2012

To detect unsuspected arrhythmias, 60 patients with previous myocardial infarction were studied by both submaximal treadmill exercise testing and 10 hours of continuous ECG monitoring (Holter technique) during normal activity. Significant arrhythmias were detected in 28 of 60 patients (47%). Eight patients (13%) had one or more premature ventricular contractions on their resting ECG and all had significant arrhythmias detected by exercise and/or Holter monitoring. Eighteen patients (30%) had frequent ectopic beats during or within 15 minutes after treadmill exercise and 22 patients (37%) had significant arrhythmias during continuous ECG monitoring. In 10 patients (17%) continuous ECG monitoring detected significant arrhythmias when exercise did not, while in six instances (10%) frequent premature ventricular beats were present with exercise but not during Holter monitoring. In four of 12 patients in whom both tests were positive, continuous ECG monitoring detected ventricular tachycardia when exercise showed only isolated ectopic ventricular beats. Fourteen patients (23%) had major arrhythmias detected by ECG monitoring; only six of the 14 were also detected by exercise testing. We conclude that both treadmill exercise and continuous ECG monitoring are useful for arrhythmia detection in post myocardial infarction patients but that continuous ECG monitoring often discloses different and more serious arrhythmias than treadmill exercise.
Shape and Volume Changes During "Isovolumetric Relaxation" in Normal and Asynergic Ventricles
Authors: RUTTLEY MICHAEL S. , ADAMS DOUGLASS F. , COHN PETER F. , ABRAMS HERBERT L.
Published: June 2012

Clinically suspected coronary artery disease was assessed in 52 patients by 16-mm biplane left ventriculography. Outward movement of the left ventricular wall was observed prior to mitral valve opening in normal patients and those with coronary artery disease. In the normal ventriculogram, outward movement was usually visible in the anterior wall and the apex. In the asynergic ventricle, the outward movement almost invariably occurred at the region of optimal contraction. Outward movement of the ventricular wall during protodiastole and isovolumetric relaxation was accompanied by a significant volume increase over the end-systolic volume. The volume increase was greater in the abnormal than in the normally contracting ventricle.

The altered ventricular volume was probably associated with the return to the ventricle of blood contained between the patent aortic leaflets at the end of ventricular ejection. This event occurs during aortic valve closure when ventricular pressure is falling more rapidly than aortic pressure. It accounts for the alteration in volume between end ejection and pre-mitral valve opening.

The stroke volume, which is generally calculated from end-systolic and end-diastolic volumes, may therefore be inaccurate by at least 10% because ventricular volume immediately before mitral valve opening is not utilized in the calculation. Some of the discrepancies between angiocardiographic stroke volume and ejection fraction measurements and those obtained by other methods may be explained by failure to use preinflow volume (PIV) in the calculations.
Alteration of Systolic Time Intervals in Right Ventricular Failure
Authors: ALPERT JOSEPH S. , RICKMAN FRANK D. , HOWE JOHN P. , DEXTER LEWIS , DALEN JAMES E.
Published: June 2012

Systolic time intervals (STI) were measured in matched patients with and without right ventricular failure (RVF). STI were calculated from brachial arterial pressure tracings obtained at cardiac catheterization in four groups of patients: 1) controls, without RVF; 2) acute pulmonary embolism with and without acute RVF; 3) mitral stenosis, with and without chronic RVF; 4) primary pulmonary hypertension, with chronic RVF.

In patients with pulmonary embolism without acute RVF, STI were normal. However, patients with acute RVF due to pulmonary embolism had significantly shortened left ventricular ejection times (LVETc) and significantly increased pre-ejection periods (PEPc) and increased PEPc/LVETc ratios (
P
< 0.05,
P
< 0.001,
P
< 0.001 respectively).

Similar results were obtained in patients with chronic RVF. In patients with mitral stenosis without RVF, STI were normal. However, in patients with chronic RVF due to mitral stenosis or primary pulmonary hypertension, PEPc and PEPc/LVETc ratios were lengthened and LVETc was shortened (
P
< 0.003,
P
< 0.005, and
P
< 0.001 respectively).

PEPc/LVETc ratios increased as stroke index decreased (
r
= –0.55). There was also an association between PEPc/LVETc and right atrial mean pressure (
r
= 0.70). These data demonstrate that patients with acute and chronic right ventricular failure have abnormal systolic time intervals possibly secondary to left ventricular dysfunction.
Effect of Cigarette Smoking and Breathing Carbon Monoxide on Cardiovascular Hemodynamics in Anginal Patients
Authors: ARONOW WILBERT S. , CASSIDY JOHN , VANGROW JACK S. , MARCH HAROLD , KERN JOHN C. , GOLDSMITH JOHN R. , KHEMKA MAHAVEER , PAGANO JAMES , VAWTER MICHAEL
Published: June 2012

Smoking high-nicotine cigarettes caused a significant increase in systolic and diastolic arterial pressure, heart rate, left ventricular end-diastolic pressure, and coronary sinus, arterial, and venous CO levels, no significant change in left ventricular dp/dt, aortic systolic ejection period, and cardiac index, and a significant decrease in stroke index and coronary sinus, arterial, and venous PO
2
levels in eight anginal patients with documented coronary disease. One week later, these patients inhaled 150 ppm of carbon monoxide until their increase in coronary sinus CO was similar to that produced after smoking their third cigarette. Inhaling carbon monoxide caused a significant increase in left ventricular end-diastolic pressure and coronary sinus, arterial, and venous CO levels, no significant change in systolic and diastolic arterial pressure, heart rate, and systolic ejection period, and a significant decrease in left ventricular dp/dt, stroke index, cardiac index, and coronary sinus, arterial, and venous PO
2
levels. Nicotine caused the increased systolic and diastolic arterial pressure and heart rate after smoking. Carbon monoxide caused the negative inotropic effect which increased the left ventricular end-diastolic pressure and decreased the stroke index after smoking.
The Effects of Digitalis Glycosides on the Ventricular Fibrillation Threshold in Innervated and Denervated Canine Hearts
Authors: GEORGE ANTHONY , SPEAR JOSEPH F. , MOORE E. NEIL
Published: June 2012

Digitalis glycosides have been implicated in increased vulnerability to ventricular fibrillation in man. In order to investigate the genesis and occurrence of ventricular fibrillation in the presence of digitalis, the effects of both acetylstrophanthidin and ouabain on the ventricular fibrillation threshold (VFT) were studied in the open-chest anesthetized dog. The current required to induce ventricular fibrillation was determined by passing a train of 12 constant current pulses through epicardial electrodes during the vulnerable period of the cardiac cycle. It was found that an intravenous bolus infusion of acetylstrophanthidin (0.050-0.097 mg/kg) or ouabain (0.035-0.075 mg/kg) in intact innervated dog hearts raised the VFT from 40% to 260% above control values. Continuous infusions of acetylstrophanthidin to toxic levels also resulted in an elevated VFT. Vagotomy alone did not qualitatively change the effects of acetylstrophanthidin on VFT. However, following vagotomy and stellate sympathectomy, infusions of both toxic and subtoxic doses of acetylstrophanthidin resulted in a decrease in the VFT from 40 to 80% below control values. In denervated animals in which the peripheral ramifications of the left stellate ganglion nerves were stimulated, the VFT decreased below control values in the absence of acetylstrophanthidin, but during stellate stimulation in the presence of acetylstrophanthidin the VFT was increased above control values. These studies demonstrated that the increase in VFT by digitalis in the healthy, innervated heart was mediated via an associated increase in sympathetic activity; in the absence of neural influences digitalis decreased the VFT.
Nonsurgical Closure of Oversized Patent Ductus Arteriosus with Pulmonary Hypertension
Authors: PORSTMANN W. , HIERONYMI K. , WIERNY L. , WARNKE H.
Published: June 2012

Safe and permanent closure of patent ductus arteriosus (PDA) can be accomplished with an ivalon plug introduced by catheterization from the femoral artery. The authors' experience thus far obtained from treating more than a hundred patients suggests that the technique described in this paper is a feasible alternative to the surgical approach. A prerequisite has been the size and shape of the PDA, the lumen of which had to be conical in shape and smaller than the lumen of the femoral artery. Now safe closure of oversized PDA complicated by pulmonary hypertension has become possible, using a plug designed with a special mechanism for anchorage to the PDA. The technique of this closure is described in detail in this report of its successful use in a 50-year-old woman patient with an oversized, calcified PDA complicated by pulmonary and systemic hypertension and cystic lung disease. Treating such high-risk cases with transfemoral closure means real improvement in therapy over surgical treatment.
Demand Pacemaker Malfunction Due to Abnormal Sensing
Authors: WAXMAN MENASHE B. , BERMAN NEIL D. , SANZ GINES , DOWNAR EUGENE , MENDLER PAUL , TAYLOR KENNETH W. G.
Published: June 2012

Two cases with external demand pacemakers are presented because of abnormal prolongation in the pacing interval. In both cases, pacemaker inhibition was caused by signals which were not recorded by the conventional surface electrocardiograms. In one case, inhibition was related to a partial lead fracture which generated a voltage transient in the region of the T wave. In the other case, inhibition was caused by current emitted from a faulty pacemaker unit. In both cases precise localization of the problem was possible by simple bedside recordings and measurements.
De Subitaneis Mortibus
Authors: JAMES THOMAS N. , MARSHALL MARY L. , CRAIG MICHAEL W.
Published: June 2012

Disseminated intravascular coagulation was the cause of death of a 19-year-old woman with a lifelong history of paroxysmal atrial tachycardia. Her final illness began with a bout of tachycardia during her second trimester of pregnancy and was then characterized by sustained tachycardia with hypotension, oliguria, and renal failure, with a steadily falling hematocrit in the absence of significant bleeding externally. At necropsy there were numerous platelet and fibrin emboli throughout the heart. Small arteries in both the sinus node and in the atrioventricular (A-V) node and His bundle were involved. The sinus node was virtually destroyed by recent infarction. Structural variation in the A-V node and His bundle, probably congenital in nature, provided an anatomic substrate for re-entrant loops which may have been the basis for the paroxysmal atrial tachycardia.
The Progression of Arteriosclerosis
Authors: CHILVERS A. S. , THOMAS M. LEA , BROWSE N. L.
Published: June 2012

This paper reports the results of a study made on 25 patients who have had two or more translumbar aortograms at intervals varying from one to four years. A technique was devised for the measurement of the diameter of the vessels from the radiographs and the type of atherosclerosis was also classified. The arterial tree, from the lower abdominal aorta to the division of the popliteal artery, was divided into nine anatomical segments. A total of 324 segments were studied.

The results show that atherosclerosis must not be assumed to be a progressive and exclusively stenotic disease. In 30% the aorta and common iliac arteries became wider and in another third they showed no change. Fifty percent of the ilio-femoral segments became longer and most of these also became wider, which suggests that a considerable proportion of patients will ultimately develop arteriomegaly. In the superficial femoral arteries 50% of the cases developed further narrowing.

Short narrow segments did not all progress to occlusion — 40% of the short stenoses in the aorta and iliac arteries became 2 to 5% wider. Long narrow segments more often became occluded, especially in the superficial femoral artery.

It is concluded that arteriosclerotic degeneration is just as often a disease of dilatation as narrowing and that the only way to obtain evidence upon which to base a long-term prognosis is to repeat arteriograms over a period of years.
The Polyuria of Paroxysmal Atrial Tachycardia
Authors: KINNEY MICHAEL J. , STEIN RICHARD M. , DISCALA VINCENT A.
Published: June 2012

Two patients with paroxysmal atrial fibrillation and an associated polyuria were studied to delineate the mechanism of the increase in urine flow. A striking saluresis was noted in both patients. The increased sodium excretion was probably due to decreased sodium reabsorption, perhaps at proximal tubular nephron sites. This inhibition of sodium reabsorption could explain both the saluresis and some part or all of the polyuria. Re-evaluation of earlier case reports reveals patterns of concomitant salt and water excretion consistent with this mechanism. The saluresis cannot be explained by the previously favored hypothesis of antidiuretic hormone inhibition.
Coarctation of the Aorta
Authors: SIMON ARTHUR B. , ZLOTO ALAN E.
Published: June 2012

One hundred and ninety patients over the age of two operated upon for coarctation of the aorta from 1957 to 1972 at one institution were followed for one to 15.5 years (mean, 6.6 years). There were eleven cardiovascular deaths in the follow-up period. The mean age at death was 32.5 years. Two-thirds of the patients had an associated cardiovascular anomaly; 74 had coexistent aortic valve disease, and 19 had mitral stenosis or insufficiency. Five patients had a significant central nervous system event in the late postoperative period. Left ventricular hypertrophy by electrocardiogram was noted in 45, and 72 had radiographic left ventricular hypertrophy. A significant persistent or residual hemodynamic abnormality, either congenital heart disease, residual coarctation or persistent diastolic hypertension, could account for the residual electrocardiographic or radiographic abnormality. The data indicate that this population requires continuing care despite correction of the coarctation.
Concealed Retrograde Conduction in Complete Atrioventricular Block
Authors: COHEN STAFFORD I. , SMITH L. KENT , AROESTY JULIAN M. , VOUKYDIS PANAGIATOS , MORKIN EUGENE
Published: June 2012

Atrio-ventricular (A-V) conduction and retrograde concealed conduction were assessed in 13 patients with complete heart block distal to the His bundle. Antegrade conduction was defined by His bundle study. The presence or absence of retrograde concealed conduction of the atrio-ventricular node was determined during ventricular pacing. Four instances of retrograde concealed conduction of the A-V node were observed.
The Efficacy of Antiarrhythmic Agents During Acute Myocardial Ischemia and the Role of Heart Rate
Authors: HOPE RONALD R. , WILLIAMS DAVID O. , EL-SHERIF NABIL , LAZZARA RALPH , SCHERLAG BENJAMIN J.
Published: June 2012

The influence of lidocaine, procaine amide, and propranolol on ventricular arrhythmias during acute myocardial ischemia in the dog was examined. Ischemic zone epicardial (IZE) activation delay and the time of onset of ventricular tachycardia (VT
t
) were studied. Progressive IZE delay always preceded ventricular tachycardia (VT). Ventricular tachycardia occurred when IZE delay extended into the T wave of the standard electrocardiogram but areas of ischemic epicardium were found in which activation delayed beyond the T wave. Fast heart rates during acute ischemia were associated with an accelerated time course of IZE delay and early VT. Slow heart rates resulted in minimal IZE delay and delayed onset or absence of VT. Sympathectomized dogs with heart rates 32% slower than normal dogs did not develop significant IZE delay or VT during ischemia. When heart rates were increased by atrial pacing, these dogs behaved in the same fashion as the normal dogs with respect to IZE delay and VT
t
. Lidocaine was found to hasten the time course of IZE delay but to have no significant effect on VT
t
. Procaine amide did not influence IZE delay nor VT
t
during ischemia. Propranolol slowed the mean heart rate by 20% and appeared to protect against arrhythmia. When the heart rate (115 ± 10 beats/min; mean ± standard deviation) was increased by atrial pacing (184 ± 9 beats/min), propranolol did not significantly influence IZE delay or VT
t
as compared to the untreated controls. The clinical counterpart of our experiments during acute ischemia may relate to the prehospitalization phase of myocardial infarction.
Ectopic Ventricular Prematurity and Its Relationship to Ventricular Tachycardia in Acute Myocardial Infarction in Man
Authors: DE SOYZA NEIL , BISSETT JOE K. , KANE JAMES J. , MURPHY MARVIN L. , DOHERTY JAMES E.
Published: June 2012

In order to determine the role of the coupling interval of a premature ventricular contraction (PVC) in the development of paroxysmal ventricular tachycardia (PVT) during the early phase of acute myocardial infarction in man, 52 male patients with documented acute myocardial infarction had 24-hour Holter monitoring commenced within 24 hours of the onset of prolonged chest pain. Review of the tape recordings revealed that 27 patients had PVT documented, while 25 patients did not. Analysis of the data on the two groups showed that the frequency of PVCs, coupled PVCs, and accelerated idioventricular rhythm (AIVR) were found to be associated with a significantly increased incidence of ventricular tachycardia.

The mean coupling interval of the PVCs initiating episodes of ventricular tachycardia was not significantly different from either the mean coupling interval of the isolated PVCs in the patients with PVT or the mean coupling interval of the PVCs in the patients without PVT. This suggests that the coupling interval of a ventricular ectopic is a poor predictor of ventricular tachycardia in the early phases of acute myocardial infarction.
Role of Autonomic Nervous System in the Pathogenesis of Prinzmetal's Variant Form of Angina
Authors: YASUE HIROFUMI , TOUYAMA MASATO , SHIMAMOTO MITSUOMI , KATO HIROFUMI , TANAKA SATORU , AKIYAMA FUMIYA
Published: June 2012

In ten patients with Prinzmetal's variant form of angina the effects of various drugs were assessed: subcutaneous injection of methacholine (10 mg), atropine (0.7 mg), and epinephrine (0.7 mg); intravenous infusion of isoproterenol (20-25 µg/min); and in the three of the above patients who were having recurrent spontaneous attacks at the time of the examination, oral administration of atropine (0.6-1.2 mg), propranolol (30-90 mg), and phenoxybenzamine (10 mg in one patient). Master's triple two-step test and selective coronary arteriography were done on all the patients.

In the three patients who were having spontaneous attacks at the time of the examination, the administration of methacholine induced the attacks and that of atropine suppressed the attacks. Epinephrine induced the attacks in two patients and propranolol was without effect in suppressing the attacks. Phenoxybenzamine (in one patient) suppressed the attacks. Neither Master's triple two-step test nor isoproterenol infusion precipitated the attacks, though heart rate increased to more than 110 beats/min and 160 beats/min respectively in all the patients. Coronary arteriograms were normal in seven of the ten patients.

It is concluded that enhanced activity of the parasympathetic nervous system, which occurs at rest, is involved in the initiation of the attack by stimulating the sympathetic nerve which in turn probably induces coronary arterial spasm by way of activating alpha (vasoconstrictor) receptors present in the large coronary arteries.
Effect of Isoproterenol on Coronary Blood Flow in Primary Myocardial Disease
Authors: HORWITZ LAWRENCE D. , CURRY GEORGE C. , PARKEY ROBERT W. , BONTE FREDERICK J.
Published: June 2012

At cardiac catheterization, the effect of isoproterenol on coronary blood flow was compared in six patients with primary myocardial disease and six patients who appeared to have no cardiac disease. Coronary blood flow was measured by selective coronary artery injection of xenon-133 and external monitoring of disappearance curves with a dual probe, digital scintillation counter. In the presence of similar changes in cardiac output and heart rate-systolic pressure product, changes in coronary blood flow and coronary resistance in response to isoproterenol were significantly less (
P
< 0.05) in the subjects with primary myocardial disease than in the normal subjects.
Clofibrate Reversal of Platelet Hypersensitivity in Hyperbetalipoproteinemia
Authors: CARVALHO ANGELINA C. A. , COLMAN ROBERT W. , LEES ROBERT S.
Published: June 2012

Platelet function was evaluated in 29 patients with familial hyperbetalipoproteinemia; 17 were untreated and 12 were receiving clofibrate (Atromid-S). In comparison with 26 normal subjects, the untreated patients aggregated in response to 1/3 the concentration of adenosine diphosphate (ADP), 1/25 the concentration of epinephrine, and 1/4 the concentration of collagen. Treatment with clofibrate, 2 g daily, returned the ADP sensitivity of the platelets to normal and returned epinephrine and collagen sensitivity towards normal, even though it did not alter total cholesterol, low-density-lipoprotein (LDL) cholesterol, or triglyceride concentrations significantly.

Platelet nucleotide release was also 3-to-5 fold increased in untreated type II patients. Clofibrate treatment failed to diminish the elevated platelet nucleotide release.

Incubation of clofibrate at therapeutic concentrations (100-200 µu/ml) with normal platelets
in vitro
decreased their sensitivity to ADP and epinephrine and reduced
14
C-serotonin release by these agents. The effect on the release was probably mediated through decreased platelet sensitivity since higher doses of epinephrine could reverse the inhibitory effect of clofibrate.

Clofibrate may decrease the incidence of thrombotic complications of atherosclerosis by altering platelet sensitivity to aggregation.
Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery
Authors: NECHES WILLIAM H. , MATHEWS ROBERT A. , PARK SANG C. , LENOX CORA C. , ZUBERBUHLER JAMES R. , SIEWERS RALPH D. , BAHNSON HENRY T.
Published: June 2012

Anomalous origin of the left coronary artery from the pulmonary artery has been surgically corrected by means of a technique that avoids direct suturing of the coronary artery itself. The anomalous left coronary artery is removed from the pulmonary artery with a cuff of pulmonary artery tissue about its orifice. In a five-and-one-half-year-old patient the anomalous coronary artery was anastomosed directly to the aorta using this technique. In another patient, seven months of age, the anomalous coronary artery could not be anastomosed directly to the aorta and a segment of the patient's subclavian artery was interposed between the left coronary artery and the aorta to complete the anastomosis. In the latter patient, profound hypothermia and circulatory arrest were used during construction of the anastomosis in an attempt to minimize further myocardial damage. The establishment of a two coronary artery system has been demonstrated to be feasible in the infant or young child with this anomaly.
Unusual Longevity in Persistent Common Atrioventricular Canal
Authors: TANDON RAJENDRA , MOLLER JAMES H. , EDWARDS JESSE E.
Published: June 2012

Five of 139 patients with persistent common atrioventricular canal (AVC) confirmed at necropsy had lived to the age of 46 years or older. The complete type of the malformation was present in one, the transitional type in one and the partial type in three. The oldest of the latter group was 79 years of age at the time of death.

In a study of ages at death among 139 cases of AVC the following observations were made. Of the 91 patients with the complete type of AVC, 37 percent survived more than one year and 17.6 percent more than five years. Of the 48 patients with the transitional and partial types of the defect, 67 percent lived more than one year and 37.5 percent beyond five years.

One of our cases was highly unusual in that AVC was associated with corrected transposition.
Correlation of Serum Concentrations with Heart Concentrations of Digoxin in Human Subjects
Authors: GÜLLNER H. -G. , STINSON E. B. , HARRISON D. C. , KALMAN S. M.
Published: June 2012

Biopsies of cardiac tissue were taken from patients undergoing surgery for coronary artery or valvular disease. All subjects were on maintenance doses of digoxin, which were stopped 48 hours before surgery. The ratios, heart:serum, for digoxin content were remarkably similar and the variance was small.
Coronary Arteriography by the Single Catheter Percutaneous Femoral Technique
Authors: SCHOONMAKER FRED W. , KING SPENCER B.
Published: June 2012

A new percutaneous femoral method for studying the coronary arteries, left ventricle and saphenous vein bypass grafts using a single catheter has been developed. A #8 French 100 cm polyurethane catheter with wire incorporated and a 45° curved tip has been used in 6,800 patients. This technique combines the speed and simplicity of the percutaneous femoral approach with the safety of the single catheter technique by eliminating multiple catheter and guidewire changes. Manipulation techniques for selective right and left coronary artery and saphenous vein bypass graft injections as well as for left ventriculography are described. In only 10% of the cases has it been necessary to change to a second catheter, and catheterization time has averaged less than 15 minutes. Complications have been infrequent: femoral thrombosis 0.3%, hematoma 0.2%, myocardial infarction 0.04%, cerebrovascular accident 0.03% and death 0.07%. The speed of the technique and the elimination of multiple catheter changes seem to have contributed to the low complication rate.
The Effects of Transfemoral Catheterization on Blood Flow in the Extremities
Authors: VYDEN JOHN K. , NAGASAWA KOICHI , GRAETTINGER WILLIAM , MARCUS HAROLD S. , GROSETH-DITTRICH MARSHA , SWAN H. J.C.
Published: June 2012

The peripheral hemodynamics of 20 patients were studied 24 hours before and 24 hours following completion of Seldinger transfemoral cardiac catheterization. All patients were catheterized in the right femoral artery and vein, while in 13 an arterial needle was placed in the left femoral artery.

In the catheterized leg, mean calf blood flow and venous capacitance fell while mean calf vascular resistance was increased. The placement of an indwelling arterial needle caused mean calf blood flow to fall with an increase in calf vascular resistance. Venous capacitance was unchanged. The above changes while present 24 hours after catheterization had returned to normal one week later. While no symptoms or signs of limb ischemia occurred, oscillometry showed deterioration in the lower limb pulsation amplitudes in 13 of the 20 patients. No significant changes in peripheral hemodynamics were seen in the limbs, the arteries of which had not been catheterized.

Thus, although all patients were symptomless and free of signs suggestive of ischemia clinically, arterial and venous catheterization and/or the placement of an arterial needle causes significant changes which last at least 24 hours distal to the invasion of the vessels.
Echocardiography in the Diagnosis of Idiopathic Hypertrophic Subaortic Stenosis Co-existing With Aortic Valve Disease
Authors: NANDA NAVIN C. , GRAMIAK RAYMOND , SHAH PRAVIN M. , STEWART SCOTT , DEWEESE JAMES A.
Published: June 2012

Echocardiographic studies demonstrated the presence of co-existing idiopathic hypertrophic subaortic stenosis (IHSS) in six patients with aortic valve disease (four calcific aortic stenosis, two pure aortic incompetence). The characteristics of IHSS were a narrow left ventricular outflow tract, a systolic anterior movement of the mitral valve (SAM), and asymmetric ventricular septal hypertrophy. Large SAMs were observed in two patients with pure aortic incompetence and one with aortic stenosis. Relatively small, inconstant, and often incomplete SAMs were noted in the remaining three patients with aortic stenosis. In contrast to isolated IHSS, the small SAMs observed in this group did not become prominent with the Valsalva maneuver or amyl nitrite inhalation. These features may be related to the afterload provided by the fixed, distal stenosis. Echocardiographic evidence of aortic valve disease was present in all patients. Clinically, co-existence of IHSS was not suspected in five patients. Associated IHSS was established using provocative measures during cardiac catheterization in three cases, while in the remainder it was substantiated at surgery. Three of four patients who underwent myotomy/myectomy concomitant with aortic valve replacement survived and postoperative echocardiographic studies revealed complete absence of SAMs in two of them. Echocardiography appears to be useful in the diagnosis of associated IHSS in the presence of aortic valve disease.
Adolescent Hypertension
Authors: KILCOYNE MARGARET M. , RICHTER RALPH W. , ALSUP PEGGY A.
Published: June 2012

Blood pressure screening of 3537 high school students in the Harlem community was performed to determine the frequency distribution of blood pressures in this age group and to investigate the prevalence of hypertension in adolescence. The major inscription of the frequency distributions of both systolic and diastolic blood pressures was comparable among black, latin, and white students. However, female students of all races had lower systolic pressures than males. An over-all prevalence of 5.4% systolic and 7.8% diastolic hypertension was observed during the initial screening, and no significant difference in prevalence among the races was detected. With follow-up screening of those students with elevated blood pressures (BP ≧ 140/90 mm Hg) prevalence declined markedly to 1.2% systolic and 2.4% diastolic hypertension and showed that black males had a higher prevalence of persistent diastolic hypertension (3.7%) than all other groups. This difference did not achieve statistical significance; however, the racial comparison was not wholly satisfactory because of the limited sample of white students. Nevertheless, the observed prevalence in black males was more than twice that reported in the National Health Survey during a single screening.

The data suggest two features of adolescent blood pressure which should be taken into account in hypertension detection programs for this age group: 1) the criteria selected to define blood pressure elevations in a maturing circulation would be more meaningful if related to the observed frequency distributions of blood pressure in an adolescent sample population. Values exceeding one standard deviation above the means reported herein are recommended (males: 132/85 mm Hg; females: 123/82 mm Hg); and 2) serial measurements of blood pressure appear to be required to detect the potentially hypertensive adolescent as well as to determine prevalence rates with accuracy.

A finding which deserves further study is the striking increase in the percent of elevated blood pressures noted between the ages of 17 and 18 years, particularly in black males. Black males represent a vulnerable segment of the adult hypertensive population as well.

The results indicate that over-all, contrary to traditional views, the development of hypertension may begin in adolescence and that methods of detection which appear satisfactory in adulthood are insufficient to uncover the true prevalence rates of hypertension in this age group.
Aberrant Coronary Artery Origin From the Aorta
Authors: LIBERTHSON RICHARD R. , DINSMORE ROBERT E. , BHARATI SAROJA , RUBENSTEIN JOEL J. , CAULFIELD JAMES , WHEELER EDWIN O. , HARTHORNE J. WARREN , LEV MAURICE
Published: June 2012

Twenty-one patients with anomalous coronary artery origin from the aorta are discussed, and the cases reported in the literature are reviewed. The left anterior descending (LAD) and left circumflex (Cx) arteries arose aberrantly from the right sinus of Valsalva of the aorta (RSV) in six patients. In four of these patients the connecting branch from the anomalous origin passed anterior to the aorta and the right ventricular in-fundibulum (RVinf), and in two patients, this branch passed between the aorta and RVinf. In 11 patients only the Cx was aberrant, and arose either from the RSV directly or from the right coronary artery (RCA), and passed posterior to the aorta and RVinf. In four patients the RCA arose aberrantly — in three from the left sinus of Valsalva of the aorta passing anteriorly, and in one from the left Cx passing posteriorly.

Aberrant coronary artery origin from the aorta had clinical consequences only when the branch connecting the LAD and Cx to the RSV passed between the aorta and RVinf. Both our findings and those reported in the literature associate this variant with exertional sudden death in young persons. Anomalous coronary patterns can be delineated readily by selective coronary cineangiography, and as illustrated, the right anterior oblique projection can readily distinguish those prone to sudden death from the clinically insignificant variants. The former can be corrected with coronary artery bypass surgery.
Electrophysiologic Identification of the Specialized Conduction System in Corrected Transposition of the Great Arteries
Authors: KUPERSMITH JOEL , KRONGRAD EHUD , GERSONY WELTON M. , BOWMAN FREDERICK O.
Published: June 2012

Electrophysiologic identification of the specialized conduction system was performed during open-heart surgery in two cases of corrected transposition of the great arteries (1-TGA) with situs solitus, dextrocardia or dextroversion and membranous ventricular septal defect (VSD). In one case there was accompanying subvalvlar pulmonary stenosis and in the other there was an Ebstein-like deformity of the systemic atrioventricular (A-V) valve. Electrograms were recorded throughout the right atrium and morphologic left ventricle in the case with subvalvar pulmonary stenosis and throughout the left atrium and morphologic right ventricle in the case with the Ebstein-like deformity of the systemic A-V valve. Specialized conduction system electrograms were recorded exclusively at sites anterior to the membranous VSD in both cases and at no other sites in the respective atrium or ventricle studied. There was first degree A-V block in both cases and in each the site within the specialized conduction system of this delay was proximal to the specialized fiber electrogram recording sites and thus probably proximal to the bifurcation of the bundle branches. In addition, on, the Ebstein-like deformity of the systemic A-V valve present in one case was confirmed by directly recording ventricular electrograms in an area of "atrialized-ventricle above the valve.
Asymmetric Septal Hypertrophy (ASH) in Infancy
Authors: MARON BARRY J. , EDWARDS JESSE E. , HENRY WALTER L. , CLARK CHESTER E. , BINGLE GLEEN J. , EPSTEIN STEPHEN E.
Published: June 2012

Clinical and pathologic observations were made in four infants who died with asymmetric septal hypertrophy in the first five months of life. One of these infants was stillborn and the other three were aged 1½ months, 4½ months, and 5 months at the time of their deaths. The three live-born infants demonstrated severe congestive heart failure and cardiac enlargement. The clinical features present in these three infants during life suggested a variety of other congenital cardiac malformations, including congenital mitral regurgitation, pulmonary stenosis, and endocardial fibroelastosis. In each of the four infants the ventricular septum was markedly hypertrophied and was thicker than the postero-basal left ventricular wall; septal to postero-basal free wall thickness ratios ranged from 1.8 to 2.6. Moreover, the septum of each infant contained a disordered arrangement of hypertrophied cardiac muscle cells. In three of the infants the myocardial cellular abnormalities were less marked in the left ventricular free walls than in the ventricular septum. In the fourth infant disorganized cardiac muscle cells were distributed widely in both the ventricular septum and left ventricular free wall; the clinical findings suggested the absence of left ventricular outflow obstruction in this infant. Asymmetric septal hypertrophy was documented in one first degree relative of each infant. It is concluded that asymmetric septal hypertrophy is a genetically transmitted disease that may present clinically in infancy and lead to infant death. Furthermore, the characteristic pathologic feature of asymmetric septal hypertrophy in adults, a disproportionately thickened ventricular septum containing numerous hypertrophied and disorganized cardiac muscle cells, can be present at birth.
Pathways and Functional Significance of the Coronary Collateral Circulation
Authors: LEVIN DAVID C.
Published: June 2012

Two hundred coronary arteriograms and left ventriculograms of patients having significant coronary artery disease were reviewed. Collateral circulation was seen only when the degree of arterial narrowing exceeded 90%. Ten different collateral pathways were noted in patients having right coronary obstruction; seven different pathways were noted in left anterior descending obstruction; five different pathways were noted in left circumflex obstruction.

The role of collateral circulation in preserving myocardial function was assessed by comparing regional left ventricular contractility in 86 instances of total arterial occlusion and adequate collateral circulation with that in 80 instances of total arterial occlusion and inadequate collateral circulation. Among the group with adequate collaterals, regional left ventricular contraction was normal in 43%, mildly impaired (hypokinetic) in 52% and severely impaired (akinetic or dyskinetic) in only 5%. Among the group lacking adequate collaterals, regional contraction was normal in 11%, mildly impaired in 16% and severely impaired in 73%. Chi square analysis reveals that the difference between the two groups is significant at the .01 level. These data indicate that collateral circulation plays an important role in preserving myocardial contractility in patients with coronary artery disease.