bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemodynamic Observations One and Two Years after Cardiac Transplantation in Man
Authors: STINSON EDWARD B. , GRIEPP RANDALL B. , SCHROEDER JOHN S. , DONG EUGENE , SHUMWAY NORMAN E. 
Published: June 2012

Cardiac catheterization studies were performed in eight patients 1 year after cardiac transplantation and in two of these again at 2 years. Intracardiac pressures at rest were normal in all patients, both 1 and 2 years postoperatively. Average cardiac index at rest at 1 year was 2.3 liters/min/m
2
and average heart rate was 90 beats/min. Responses to amyl nitrite, atropine, and tyramine failed to demonstrate efferent autonomic reinnervation of the donor hearts. Findings associated with a 10-min period of submaximal supine bicycle exercise 1 year after transplantation included: (1) a gradual rise in heart rate throughout most of the exercise period; (2) prompt elevation of left ventricular end-diastolic pressure by an average increment of 10 mm Hg, followed by a decrease during late exercise in some patients; (3) a progressive increase in LV systolic pressure throughout the first half of the exercise period; (4) a continuously positive change in LV rate of pressure change (dp/dt) throughout exercise; (5) an average 44% increase in stroke volume; and (6) an average 92% increase in cardiac output. The slope of the regression of cardiac output on oxygen uptake during exercise was within the range of normal. Cardiac output, however, was lower than normal both at rest and during exercise, and the arteriovenous oxygen diflerence was accordingly widened.

In one patient studied 1 and 2 years after transplantation, hemodynamic findings were comparable on both occasions. In the other, however, the cardiac output response to exercise was distinctly diminished at 2 years as compared to 1 year, due almost entirely to failure of the stroke volume to increase. Coronary arteriography in this recipient revealed evidence of occlusive coronary disease compatible with graft atherosclerosis.
These studies demonstrate the sustained capacity of the transplanted human heart to support normal physical activity late in the postoperative period. Although utilizing atypical adaptive mechanisms characteristic of the denervated heart, the transplanted heart responds in a directionally appropriate manner to the metabolic demands of exercise.
Results over a Ten-Year Period of Palliation followed by Corrective Surgery for Complete Transposition of the Great Arteries
Authors: CLARKSON PATRICIA M. , BARRATT-BOYES BRIAN G. , NEUTZE JOHN M. , LOWE JAMES B. 
Published: June 2012

One hundred and twenty patients with transposition of the great arteries (TGA) were encountered over a decade. Survivors have been followed until after definitive repair, and 39% were alive when reviewed.
The majority (69%) had no significant communication between the pulmonary and systemic circulations. Of 48 patients in this poor-mixing group who had an atrial septectomy, 23 (48%) survived to have an atrial baffle repair at an average age of 37 months, and 37% were alive at the time of review. In contrast, 18 of 22 (82%) patients with poor mixing who had a balloon septostomy had a definitive operation at an average age of 13 months, and 17 (77%) survived.
Twenty patients (17%) had good mixing between the two circulations due to the presence of a large ventricular septal defect (VSD) or patent ductus arteriosus, and presented with mild cyanosis and heart failure. Of this group, 35% were alive when reviewed. Four of the five patients who had a successful atrial baffle repair and correction of associated lesions were less than 4 months of age when this was performed. Where TGA was associated with VSD and pulmonary stenosis, 36% survived.
Definitive operation at an early age has been made possible by the introduction of a surgical technic using profound surface-induced hypothermia and limited cardiopulmonary bypass.
Atrioventricular Conduction System in Left Bundle-Branch Block with Normal QRS Axis
Authors: CANNOM DAVID S. , GOLDREYER BRUCE N. , DAMATO ANTHONY N. 
Published: June 2012

In nine patients with left bundle-branch block (LBBB), normal QRS axis, and normal P-R interval, atrial, His bundle, and ventricular electrograms were recorded. The extrastimulus method was utilized to determine the relative refractoriness of the various components of the atrioventricular conducting system.
The functional refractory period (FRP) of the A-V node was normal in all but one patient. In six patients, the effective refractory period (ERP) of the ventricular specialized conducting system (VSCS) was greater than the FRP of the A-V node. The differential refractoriness within the three components of the VSCS was determined. Before the ERP of the VSCS was reached, a leftward shift in the mean QRS axis was noted in all six patients, thus documenting participation of the left anterior division of the LBB in ventricular depolarization. We found no evidence that the left posterior division participated in ventricular activation and conclude that it is functionally silent in LBBB. Conduction abnormalities in the right bundle branch were demonstrated both by long H-V intervals and the fact that its ERP was prolonged.
The increased refractoriness of all three divisions of the VSCS suggests that the conduction abnormalities producing evidence of LBBB on the surface are trifascicular in nature.
Sail Sound in Ebstein's Anomaly of the Tricuspid Valve
Authors: FONTANA MARY E. , WOOLEY CHARLES F. , Goodwin Richard S. , Rieser George F. 
Published: June 2012

Ebstein's anomaly represents an anatomic, pathologic, and physiologic spectrum. There have been few hemodynamic correlates for the observed auscultatory events. Multiple components of the first sound and "ejection" sounds are frequently described.
Cardiac catheterization, intracardiac sound-pressure studies (Telco), and cineangiograms were performed in three patients with Ebstein's anomaly who had a prominent early systolic sound.
The right ventricular pressure pulse was abnormal in all; an initial delta-wave configuration, followed by a more rapid pressure rise, produced a prolonged rise to peak pressure. The right ventricular pressure pulse is not that of a conduction defect alone; rather it suggests that the altered pattern of ventricular contraction and abnormal leaflet placement are contributing factors.
The early systolic sound was recorded in the atrialized right ventricle or right ventricle in all. It occurred just after the peak of the c wave in the atrialized right ventricle. In the right ventricle the sound occurred at the point where initial slow delta portion of right ventricular pressure pulse gave rise to rapid upstroke. The early systolic sound most likely occurs when the large, sail-like tricuspid valve reaches the limit of systolic excursion. The sound has been designated as the "sail sound," and may be the most specific auscultatory event in Ebstein's anomaly.
Echocardiography in the Diagnosis of Hypoplasia of the Left or Right Ventricles in the Neonate
Authors: MEYER RICHARD A. , KAPLAN SAMUEL 
Published: June 2012

Echocardiographic studies were performed on six patients with autopsy-proved aortic atresia and hypoplastic left ventricle and two patients with surgically proved tricuspid atresia and hypoplastic right ventricle. The findings were compared to those from the echograms of 50 normal newborns who served as a control group. The ultrasound measurements obtained in the normal newborns were as follows: mean right ventricular end-diastolic dimension, 1.3 cm (range, 1.0 to 1.7), mean left ventricular end-diastolic dimension, 1.6 cm (range, 1.2 to 2.0), mean left atrial dimension, 0.9 cm (range, 0.6 to 1.3), and mean left ventricular outflow tract dimension, 1.0 cm (range, 0.7 to 1.2). The mean velocities of closure of the mitral and tricuspid valves during passive filling of the ventricles were 53 mm/sec and 43 mm/sec. The ranges were 36 to 80 mm/sec for the mitral valve and 34 to 56 mm/sec for the tricuspid valve.
In the patients with aortic atresia, the significant findings were a larger than normal right ventricular chamber (mean, 2.5 cm), a left ventricular chamber measuring less than 0.9 cm, and an absent or grossly distorted mitral valve echo. By contrast the patients with tricuspid atresia had very small right ventricular dimensions less than 0.6 cm, no demonstrable tricuspid valve echo, and a larger than normal left ventricle (mean, 2.3 cm). The above findings were diagnostic and were not confused with the normal newborn or other forms of congenital heart disease.
Serum Lipids and Lipoproteins in Men after Myocardial Infarction compared with Representative Population Sample
Authors: GUSTAFSON ANDERS , ELMFELDT DAG , WILHELMSEN LARS , TIBBLIN GÖSTA 
Published: June 2012

A nonselected series of 229 postmyocardial infarction (MI) patients was studied for up to 2 years following hospitalization. Their lipoprotein patterns, serum cholesterol, and triglyceride values were compared to those of a random population sample of men at comparable ages.
Hyperlipoproteinemia, cholesterol, and triglyceride elevations were more common in MI patients than in men in the random sample, occurring with greatest frequency in the younger patients. There was a trend toward higher mortality among patients with hyperlipoproteinemia. Types II A and B were very common in young patients.
Serum cholesterol values were significantly higher in the youngest patients and serum triglycerides higher than in the controls in age groups ≦ 40, 46-50, and 51-55 years.
Clinical Diagnosis
Authors: FOWLER NOBLE O. 
Published: June 2012

In the majority of instances, the clinical diagnosis of angina pectoris can be made from the history alone. The chest discomfort is characteristically a sensation of deep pressure, is occasionally of burning quality, is found near the sternum, not sharply localized, and has a gradual buildup. Its duration is most often 2-10 min, but may be 30 sec to 30 min or more. Physical effort, emotional strain, large meals, nightmares, or sexual intercourse are common precipitating factors. Nitroglycerin tends to relieve the distress within 1-2 min, but the response is often difficult to evaluate, especially with angina of brief duration or with acute unstable rest angina. Physical examination of the anginal patient is often negative between attacks. During an attack of rest angina, the physical examination usually reveals increased systolic blood pressure and tachycardia. A fourth heart sound and a delayed apical systolic murmur may be found. Premature ventricular beats may develop.
The resting electrocardiogram is normal in the majority of patients with angina pectoris. During the anginal attack, the electrocardiogram usually reveals an increase of the heart rate and ischemic flat or downsloping S-T-segment depressions of 0.08-sec duration or more. The exercise electrocardiogram is most useful when the stress is sufficient to increase the heart rate to 85 or 90% of the predicted maximum for the age of the patient. An abnormal exercise electrocardiogram is found in 80-90% of patients with angina when they are tested by the graded treadmill exercise test of Sheffield and Reeves, but in only 50-60% of those tested by the Master's exercise test.
Varieties of angina pectoris which may differ from the foregoing include: Prinzmetal's variant angina, unstable angina (acute coronary insufficiency, crescendo angina), atypical angina, and angina with syncope.
Angina pectoris must be distinguished from the discomfort of anxiety neurosis, hiatal hernia, cervical spine disease, gallbladder disease, Tietze's syndrome, and post-herpetic neuralgia.
Management of the Patient with Severe Angina Pectoris
Authors: SAMPSON JOHN J. , HYATT KENNETH H. 
Published: June 2012

Severe angina pectoris may be reduced to tolerable levels by suppressing below the pain threshold those factors elevating systolic blood pressure and heart rate and prolonging systolic ejection period. Their product parallels myocardial oxygen consumption (MVO
2
) as noted in several excellent reviews. The level of this product associated with angina, the "angina index," defines the individual threshold for onset of angina.

Prevention of angina-inducing physical and psychic stress is desirable, but often impractical, and the use of nitroglycerin preceding or following stress may lead to years of acceptable life. Prolonged, spontaneous, or readily induced angina, especially with a change in pattern, may be due to an acute coronary occlusive episode, whether defined as a prodromal period or an actual myocardial infarct. This form of attack requires close observation and appropriate care. The psychic stress-prone patient may repeatedly present a benign duplicate of such pain production, producing a diagnostic challenge. Routine protection of the angina patient, especially against arrhythmias, is discussed.
Different therapeutic modalities for control of intractable angina are presented, many with promise, but those currently giving the best results are: (1) elimination of precipitating conditions, i.e. (a) brady- and tachyarrhythmias, (b) hypertension, (c) hyperthyroidism, (d) mechanical obstruction of ventricular outflow, and (e) heart failure (2) beta-adrenergic blocking agents, i.e. propranolol, with or without nitrates or nitroglycerin; and (3) surgical revascularization preceded by selective coronary angiography.
The aortocoronary saphenous vein bypass has been effective in prompt relief of angina in patients with viable myocardium and potentially good flow in the distal artery, with acceptably low operative mortality from skilled teams. Mechanical efficiency and thus congestive failure may improve, and there is hope for increased longevity. Contraindications are poorly defined, especially as related to its performance in recent infarction of varying magnitude. With only 3 years' experience in determining long-term benefits, it seems rational to repeatedly redefine indications for surgery, but currently not to operate on every patient with "significant" coronary disease.
Angina Pectoris in Men
Authors: FRANK CHARLES W. , WEINBLATT EVE , SHAPIRO SAM 
Published: June 2012

Prognosis of men whose first manifestation of coronary heart disease was angina without antecedent infarction was found to resemble closely that of men followed after an initial MI. Overall mortality over a period of 4.5 years following a baseline examination was the same in the two cohorts: 17.5%.
In both groups of men electrocardiographic abnormalities and blood pressure elevation identified subsets of coronary patients with a relatively poor prognosis, but the course of disease was apparently not influenced by the serum cholesterol level. Among the men with angina no relationship emerged between symptomatic status at time of baseline and risk of mortality in the ensuing observation period.
The findings are from the HIP (Health Insurance Plan of Greater New York) study of the incidence and prognosis of coronary heart disease, a prospective study of a general population of 110,000 men and women aged 25-64 years.
An Angiographic Severity Index for Pulmonary Embolism
Authors: WALSH PETER N. , GREENSPAN RICHARD H. , SIMON MORRIS , SIMON ALLAN L. , HYERS THOMAS M. , WOOSLEY PAUL C. , COLE CHRISTINE M. 
Published: June 2012

This report has discussed the use of an angiographic severity index for pulmonary embolism in the analysis of pulmonary angiograms from 160 patients admitted to the Urokinase-Pulmonary Embolism Trial. Angiographic studies done before and after treatment with urokinase or heparin were analyzed independently by three radiologists who had no knowledge of treatment assignment. A subjective evaluation and a subsequent objective recording of abnormalities were made. The computation of a severity index was based on a numerical grading system for definite abnormalities specific for pulmonary embolism (intraluminal filling defects and vascular obstructions).
The procedure for computing the severity index was simple enough that recorded abnormalities were coded and punched by a statistical clerk and analyzed by computer. Correlations between subjective evaluations and objective severity indices were high. There was excellent agreement among the three radiologists for both subjective and objective methods. Highly significant treatment differences were detected.
The angiographic severity index might help to classify patients, predict prognosis, plan clinical studies, and assess treatment effects.
Repair of Transposition of the Great Arteries in 123 Pediatric Patients
Authors: CHAMPSAUR GERARD L. , SOKOL DAVID M. , TRUSLER GEORGE A. , MUSTARD WILLIAM T. 
Published: June 2012

From May 1963 to July 1972, 123 patients ranging in age from 20 days to 15 years, with D-transposition of the great arteries, underwent an intraatrial baffle operation using a pericardial baffle. They previously had had a total of 121 various palliative procedures.
Twenty-six children (21%) died in the early postoperative period. The operative mortality was 13% in transposition of the great arteries with intact ventricular septum, 45% in trasnposition of the great arteries plus ventricular septal defect, and 33% in transposition of the great arteries plus ventricular septal defect and left ventricular outflow tract obstruction. By contrast the overall mortality has decreased to 15% in the 72 patients operated upon over the last 2 years.
There were 12 late deaths, 10 of which occurred within the first year postoperatively. Unexplained heart failure accounted for four deaths. Two sudden deaths were attributed to arrhythmias. Three patients died of proven pulmonary venous obstruction, one of them at reoperation. Pulmonary hypertension, reoperation for detachment of the baffle, and hypoglycemia were each the cause of one late death. There were no proven cases of tricuspid incompetence.
Eighty children have been repeatedly reexamined for up to 8 years and 6 months. The actuarial 6-year survival was 74.8% for survivors of operation.
Seventy-three children were leading a normal life at the time of the report.
Ventricular Septal Defect Associated with Aortic Insufficiency
Authors: KAWASHIMA YASUNARU , DANNO MICHIAKI , SHIMIZU YUKIHIKO , MATSUDA IKARU , MIYAMOTO TAKESHI , FUJITA TSUYOSHI , KOZUKA TAKAHIRO , MANABE HISAO 
Published: June 2012

Thirty-five consecutive patients with ventricular septal defect (VSD) associated with aortic insufficiency (AI) who underwent corrective surgery are presented. There were seven operative and three late deaths among the patients operated upon before 1968. No death, however, was encountered among the most recent 18 consecutive patients. The VSD was closed directly in 14 patients and with a Teflon patch in 21. The aortic valve was repaired in 16 patients, replaced in eight, and no interference was indicated in 11.
They were classified from the surgical viewpoint according to the location of the VSD, the anatomic type of the right ventricular outflow tract, and the severity of the aortic herniation as follows: type Ia, supracristal VSD and AI without aortic cusp herniation; type lb, supracristal VSD and AI with aortic cusp herniation and conal muscular rim beneath the pulmonic valve; type Ic, supracristal VSD and AI with aortic cusp herniation without conal muscular rim beneath the pulmonic valve; type IIa, infracristal VSD and AI without aortic cusp herniation; type IIb, infracristal VSD and AI with aortic cusp herniation; type III, infracristal VSD and AI with infundibular pulmonic stenosis (PS); type IV, supracristal VSD and AI with infundibular PS.
In type Ia and IIa, VSD was closed directly and the aortic valve was replaced. In most of type Ib, VSD was closed directly and no direct procedure was performed upon the aortic valve. In most of type Ic, VSD was closed with a Teflon patch and the aortic valve was repaired. In type IIb, VSD was closed with a Teflon patch and the procedure upon the aortic valve was not uniform. In type III, VSD was closed with a Teflon patch and the aortic valve was repaired in most of them. In type IV, VSD was closed with a Teflon patch and no direct procedure was performed upon the aortic valve.
The basic policy for repair of this association of anomalies is selected according to the above mentioned anatomic classification.
Disturbances in Cardiac Conduction and their Management
Authors: MERIDETH JOHN , PRUITT RAYMOND D. 
Published: June 2012

A simple classification of atrioventricular block, criteria for diagnosis, and suggested therapy are discussed. The differences between Mobitz I and II second-degree A-V block are reviewed.
Good management of patients who have bundle-branch or other forms of intraventricular block depends on informed judgment which includes consideration of (1) the effect of intraventricular conduction disturbances on the pumping action of the heart, and (2) the likelihood that a specific intraventricular conduction disturbance will be complicated by complete heart block.
Evidence suggests that common forms of intraventricular disturbance, unlike ventricular fibrillation, do not alter significantly the pumping action of the heart. The role of intraventricular conduction disturbances in the genesis of ventricular fibrillation is assessed.
We concluded that only when right bundle-branch block is combined with block of the anterior or posterior fascicle of the left bundle branch is complete heart block sufficiently imminent to warrant special concern. If bilateral block is associated with symptoms of episodic severe bradycardia, pacemaker therapy is indicated.
Blood Lidocaine Levels and Kinetics following High-Dose Intramuscular Administration
Authors: ZENER JULIAN C. , KERBER RICHARD E. , SPIVACK ALFRED P. , HARRISON DONALD C. 
Published: June 2012

In order to evaluate further the potential benefit of prophylactic intramuscular lidocaine administration in coronary artery disease, 24 patients with suspected acute myocardial infarction were given an intramuscular injection of lidocaine (10% solution) in the deltoid and gluteal muscles on consecutive days. Twelve patients received an intermediate dose (4 mg/kg), and 12 received a high dose (6 mg/kg) of lidocaine, and blood lidocaine levels were measured over a 4-hour study period.
Intradeltoid injection produced higher blood lidocaine levels and more rapid development of peak blood levels than did intragluteal injection. Administration of high-dose lidocaine (average dose 450 mg) into the deltoid muscle produced the ideal combination of rapid peak blood levels (6.5 µg/ml ± 2.1 SEM at 5 min) and persistence of therapeutic levels (>1.5 µg/ml) for over 2 hours. Although drowsiness, paresthesias, slurred speech, and tinnitus occurred in seven of the 12 patients in the high-dose group, no major neurotoxicity, such as grand mal seizures, were observed, nor was there evidence of hypotension or increase in atrioventricular block. Prophylactic administration of high-dose 10% lidocaine into the deltoid muscle appears to have potential for reducing the early mortality following acute myocardial infarction.