bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successful Surgical Correction of Supravalvular Aortic Stenosis
Authors: DEBAKEY MICHAEL E. , BEALL ARTHUR C. 
Published: June 2012

Stenotic lesions in the aortic valve region may be acquired or congenital, and may be valvular, subvalvular, or supravalvular in location. As more of these patients are offered the benefits of surgical correction, cases of supravalvular aortic stenosis are being reported with increasing frequency. At least seven previous cases have been corrected successfully and another is reported.
The diagnosis of supravalvular aortic stenosis usually cannot be made on clinical grounds alone. Definitive diagnostic technics are available, however, and allowed accurate delineation of the lesion in the case reported. Surgical correction consists of enlarging the aortic lumen in the area of supravalvular constriction. This usually is possible by longitudinal aortotomy through the area of constriction followed by patch angioplasty, as employed in this case in conjunction with modified endarterectomy. In most instances of supravalvular aortic stenosis, the valve itself is perfectly normal, and total correction is possible if the correct diagnosis is made.
Analogy of Electronic Pacemaker and Ventricular Parasystole with Observations on Refractory Period, Supernormal Phase, and Synchronization
Authors: BURCHELL HOWARD B. 
Published: June 2012

The artificial pacemaker has been compared to a physiologic ventricular parasystolic focus. In hearts being driven by a pacemaker, in the absence of atrioventricular (AV) block, capture (interference) phenomena are constantly seen. While variations in QRS complexes have been observed when the external pacemaker stimulus occurs early in the T-wave period of a sinus conducted beat, no sequence of aberrant beats has been observed. One patient showed occasional sinus beats interpolated between ventricular beats arising from the artificial pacemaker, and these occurred at a very narrow time band suggesting that AV conduction was permitted by phenomenon of a supernormal phase. At a later date this patient showed also
retrograde
conduction believed related to a supernormal phase during recovery of junctional tissue penetrated by an impulse entering from above, though the impulse itself was blocked.

Records of two patients are used to illustrate grossly aberrant QRS complexes produced by the stimulus of the electric pacemaker when this fell in the semirefractory period. Noteworthy was the presence of a latent period before potentials of the propagated impulse were recorded, there being evident stimulus-to-QRS delays. The situation wherein the rhythm is most chaotic is that where AV block is absent, the sinus rate is fast, and the electric pacemaker rate is relatively slow. In two patients, retrograde activation of the atria occurred as a stable mechanism. In one patient, nodal rhythm of the RP type occurred, and sequences of the records suggested that the AV node might have become synchronized with the extrinsic pacemaker cycle. In this last instance three independent centers of effective impulse formation coexisted, the sinus node, AV node, and stimulating electrodes of the electronic pacemaker.
A marked increase in the refractory period of the ventricle, as measured by its response to the set stimulus of the electric pacemaker delivered at varying instants with respect to the sinus mechanism, occurred in one case within a few days. The possibility that reserpine therapy contributed to this change is possible but has not been established, for the effective refractory period, as measured, later remained constant over a period of many weeks.
Termination of Supraventricular Tachycardia Complicating the Wolff-Parkinson-White Syndrome with External Countershock
Authors: KNOEBEL SUZANNE B. , KING HAROLD , FISCH CHARLES 
Published: June 2012

A case that demonstrates the feasibility of using external electric countershock for termination of paroxysmal supraventricular tachycardia complicating the Wolff-Parkin-son-White syndrome is presented.
The occurrence of fusion complexes between impulses originating in the sinoatrial and atrioventricular nodes was observed.
A Longitudinal Study of Coronary Heart Disease
Authors: PAUL OGLESBY , LEPPER MARK H. , PHELAN WILLIAM H. , DUPERTUIS G. WESLEY , MACMILLAN ANNE , MCKEAN HARLLEY , PARK HEEBOK 
Published: June 2012

Certain of the data accumulated over the course of more than 4 years in a prospective study of coronary heart disease being carried on in an industrial population have been presented.
In a base population of 1,989 men, 88 cases of coronary heart disease have developed: angina pectoris, 47 men; myocardial infarction, 28 men; death from coronary, disease, 13 men. This approximates one case per 100 men per year.
The development of clinical coronary heart disease has shown an association with early age of death of father, history of "noncardiac" chest discomfort, history of chronic cough, history of shortness of breath, history of peptic ulcer, presence of increased skinfold thickness, elevated blood pressure, AV nicking in the fundi, elevated blood cholesterol, ST and T abnormalities in the electrocardiogram, and use of cigarettes and coffee.
No relation was encountered between body weight, mean blood sugar levels, lipoprotein lipase levels, or diet (other than coffee), and the development of coronary heart disease. Similarly, there was no association with job type and no certain relation to physical activity off the job.
Location of Coronary Arterial Occlusions and Their Relation to the Arterial Pattern
Authors: PITT BERTRAM , M. ZOLL PAUL , L. BLUMGART HERRMAN , G. FREIMAN DAVID 
Published: June 2012

The present study shows that the coronary artery pattern is not related to the prognosis after infarction nor can it be correlated with the incidence of occlusion or with the severity of atherosclerosis. This analysis re-emphasizes the severity of the occlusive process in patients with angina pectoris and, conversely, the relatively large percentage of patients having coronary occlusion who had either congestive heart failure or who were asymptomatic.
The proper selection of patients for coronary artery surgery requires accurate angiography. The occurrence of multiple occlusions in a large number of cases points to certain difficulties in the interpretation of the coronary angiogram and also indicates the extremely limited role endarterectomy may be expected to play in the therapy of angina pectoris. Until such a time as the operative mortality and secondary failure rate, due to restenosis, can be reduced through new surgical technics, coronary endarterectomy should be considered an experimental procedure to be investigated vigorously in the laboratory but not to be applied for therapeutic purposes in man.
Anatomy of the Atrioventricular Conduction System in Ventricular Septal Defect
Authors: TITUS JACK L. , DAUGHERTY GUY W. , EDWARDS JESSE E. 
Published: June 2012

The major parts of the atrioventricular conduction system of the human heart were traced in 21 instances of ventricular septal defect: 19 were examples of variously located uncomplicated ventricular septal defects and two of the tetralogy of Fallot.
In the presence of a ventricular septal defect, the conduction system was found to have a normal course, except when the ventricular septal defect lay in a position normally occupied by the conduction system. In each specimen with a defect posterior and inferior to the crista supraventricularis, the conduction system occupied a position posterior and inferior to the defect. In no instance did the conduction system occupy a position superior to a defect of this type. Defects located in the posterobasal portion of the muscular part of the ventricular septum sometimes were posterior to the main parts of the conduction system, so that the conduction tissue was related to the anterior edge of the defect. No example of a defect lying superior to the crista supraventricularis was studied. In our two examples of tetralogy of Fallot, the position of the conduction system was essentially similar to that occurring in the usual variety of ventricular septal defect, that is, posterior and inferior to the crista supraventricularis.
Auscultatory and Phonocardiographic Findings in Ventricular Septal Defect
Authors: HOLLMAN ARTHUR , MORGAN J. J. , GOODWIN J. F. , FIELDS H. 
Published: June 2012

The phonocardiogram was studied in 93 patients whose ventricular septal defect was completely closed at open-heart surgery. The chief aim was to correlate the phonocardiographic findings with the presence and extent of pulmonary vascular disease, as measured by the postoperative pulmonary artery pressure.
The systolic murmur of the ventricular septal defect proved to be an excellent guide to the severity of pulmonary vascular disease. With a pansystolic murmur there was rarely severe pulmonary vascular disease, but with a short ejection murmur moderate or severe pulmonary vascular disease was always present.
The systolic thrill was weak or absent in 26 patients, and 80 per cent of these had an anatomic complication or severe pulmonary hypertension.
The mitral diastolic murmur was not a good guide to the severity of pulmonary vascular disease.
An associated patent ductus arteriosus gave rise to an early diastolic murmur, never to a continuous murmur, and on auscultatory grounds it could not reliably be distinguished from pulmonary or aortic incompetence.
The degree of splitting and the intensity of the second heart sound correlated well with the presence and severity of pulmonary vascular disease.
Pulmonary stenosis produced characteristic auscultatory features.
A pulmonary ejection click usually indicated the presence of moderate or severe pulmonary vascular disease.
Clinical Evaluation of Diazoxide
Authors: FINNERTY FRANK A. , KAKAVIATOS NIKOS , TUCKMAN JOHN , MAGILL JOHN 
Published: June 2012

Forty-six hypertensive patients have received diazoxide intravenously. Three hundred milligrams (one ampule) administered rapidly undiluted resulted in a 27 per cent average reduction in mean arterial pressure in 1 to 2 minutes. During the next 3 to 5 minutes the arterial pressure increased gradually to a 15 per cent average reduction as compared to the control. The average duration of diazoxide in these patients was 4.7 ± 1.7 hours. No signs of postural hypotension, cerebral ischemia, or collapse were noted. At the peak of hypotensive action there was a 41 per cent average reduction in total peripheral resistance.
Repeated doses of diazoxide in both nonpregnant patients with acute hypertension and pregnant patients with toxemia adequately controlled the arterial pressure and were not associatetd with the development of drug resistance. The standard dosage of 300 mg. (one ampule), the immediate onset of action and the moderately long duration of action, the maintenance of cardiac output, the lack of significant side effects, and the fact that it can be administered repeatedly without the development of drug resistance make diazoxide administered intravenously the ideal therapy for acute hypertension.
Perforation of Heart during Cardiac Catheterization and Selective Angiocardiography
Authors: KEATES P. G. , WAGNER G. R. 
Published: June 2012

A case is reported in which cardiac catheterization and selective angiocardiography led to perforation of the heart without any further complications.
It is suggested that distortion of the pressure tracing indicates partial obstruction of the catheter holes and that it should serve as a warning sign not to proceed with the injection of contrast medium, but to re-position the catheter first. Furthermore, inspection of the electrocardiogram immediately after the injection may give an early indication of myocardial disturbance in the form of ST-segment depression.
The Continuous Heart Rate in Men Exhibiting an Overt Behavior Pattern Associated with Increased Incidence of Clinical Coronary Artery Disease
Authors: FRIEDMAN MEYER , ROSENMAN RAY H. , BROWN ALVIN E. 
Published: June 2012

The continuous heart rates of a group of subjects exhibiting behavior pattern A (associated with a high incidence of clinical coronary heart disease) were obtained by means of a specially designed instrument at various times of the total day and compared with that obtained from subjects exhibiting a converse pattern (behavior pattern B). In addition, the heart rates of patients suffering from functional cardiovascular disease and from clinical coronary heart disease were measured throughout the day.
The average daily heart rates appeared to be about the same in subjects with pattern A and in subjects with pattern B. Moreover, their average heart rates were approximately the same as those in patients with functional cardiovascular disease.
Patients suffering from coronary heart disease with or without a previous infarction, if essentially asymptomatic, showed about the same average daily heart rate as did the subjects of the other groups. However, the patients who had suffered from a previous infarction and who were experiencing symptoms exhibited a faster heart rate.
Massive Myocardial Necrosis with Calcification
Authors: LITTMAN MARGARET S. , MEADOWS W. R. 
Published: June 2012

The clinical and autopsy observations on two cases with myocardial necrosis and calcification are presented. In each case there also was subacute membranous and proliferative glomerulonephritis.
The myocardial lesions closely resemble those produced experimentally by potassium depletion and differ from those in other myocardial necroses.
Selective Renal Arteriography in the Diagnosis of Renal Hypertension
Authors: MEANEY THOMAS F. , DUSTAN HARRIET P. 
Published: June 2012

Renal arteriography following percutaneous femoral arterial catheterization (Seldinger technic) was performed in 100 selected hypertensive patients. Eighty-four per cent of the renal arteries encountered were individually catheterized. This procedure permitted a more detailed study of arterial branches than previously possible with aortic injection of contrast material. No serious complications occurred.
Fifty-two patients were found to have disease of renal arteries or their branches. Eleven or 21 per cent of these patients, had lesions of main arterial trunks. Thirty (58 per cent) had disease of primary branches either alone or in combination with main renal arterial lesions. Aneurysms of primary arterial branches were found in five patients, and avascular segments of renal parenchyma in four. The frequency of primary branch arterial disease was greater in this group of patients than in others previously reported. This difference may be due to improved visualization of the renal arterial system obtained with selective arteriography.
Modification of the Atrial Sound by the Cold Pressor Test, Carotid Sinus Massage, and the Valsalva Maneuver
Authors: HARRIS WILLARD S. , RODIN PHILIP , TABATZNIK BERNARD 
Published: June 2012

Three procedures were investigated for their effect on the atrial sound. The cold pressor test caused the atrial sound to appear in one subject and to become louder in 15 of 28 subjects; it increased the atriosystolic murmur in two subjects with mitral stenosis. These effects were at least partly independent of changes in arterial diastolic pressure and heart rate. Carotid sinus massage decreased the atrial sound in five of 10 subjects and produced an unexplained increase in one. Following release of the strain of the Valsalva maneuver the atrial sound became louder than before the strain; in seven subjects its amplitude increased progressively and the sound also migrated from the first heart sound.
Increase of the atrial sound by the cold pressor test is attributed to sympathetic action upon peripheral veins, arteries, and the left atrium; its decrease by carotid sinus massage, to parasympathetic action upon these structures and the cardiac pacemaker; and its increase following release of the strain of the Valsalva maneuver, to combined increases of venous return and cardiovascular sympathetic activity. The proposed explanations require investigation by more direct methods.
Sympathetic activity may contribute to the increased amplitude of atrial sounds during states of exercise and heightened emotion and, in part, for their frequent occurrence in thyrotoxicosis.
Absence of a Primary Division of the Pulmonary Trunk
Authors: CUCCI CESARE E. , DOYLE EUGENIE F. , LEWIS ELMORE W. 
Published: June 2012

An ontogenetic theory is proposed to explain the absence of a primary division of the pulmonary trunk on the basis of an error in the septation of the truncus arteriosus, and the two common varieties of the syndrome are discussed in detail. It is suggested that:
Both lateral pulmonary arteries are present in this syndrome, but one of them arises anomalously from the systemic circulation.
The aberrant origin of one lateral pulmonary artery derives from the dorsal shifting of one of the two ridges responsible for the septation of the truncus arteriosus. The sixth arch on the side of the dorsorotated truncal ridge then becomes incorporated into the newly formed ascending aorta.
The combination of tetralogy of Fallot, right aortic arch, and absent left primary pulmonary division results from a single primordial error: a dorsorotation of the left ridge extending throughout the truncoconus.
The initial portion of the aberrant (systemic) pulmonary artery may obliterate postnatally, thus impairing maturation of the terminal portion. This would explain the frequent failure to demonstrate the artery by angiography and, occasionally, at dissection.
Anomalous Left Coronary Artery Originating from the Pulmonary Artery
Authors: NADAS ALEXANDER S. , GAMBOA RAUL , HUGENHOLTZ PAUL G. 
Published: June 2012

Case histories of two infants with anomalous origin of the left coronary artery from the pulmonary artery are presented.
Both infants underwent ligation of the left coronary artery at its entrance into the pulmonary artery. One survived the operation and is asymptomatic 3 years postoperatively, whereas the second one died at surgery.
A classification of instances of anomalous left coronary artery according to adequacy of the collateral circulation between the left and right coronary systems is proposed.
Surgical ligation of the pulmonary artery orifice of the left coronary artery is indicated only if the presence of a left-to-right shunt into the pulmonary artery is demonstrated.
If the direction of blood flow is from pulmonary artery to left coronary artery, surgical procedures should be aimed toward increasing either pulmonary artery oxygen content or left coronary artery perfusion pressure.
Plasma Vasoconstrictor Activity in Patients with Renal, Malignant, and Primary Hypertension
Authors: FITZ ANNETTE E. , ARMSTRONG MARK L. 
Published: June 2012

Polypeptide vasoconstrictor activity was assayed in the peripheral venous blood of 45 hypertensive patients and 20 normal subjects. The average activity was significantly increased in all hypertensive groups, and activity tended to be much higher in patients with renovascular and malignant hypertension than in primary hypertension.
In confirmation of previously reported results by Helmer and Judson, there was no correlation between vasoconstrictor activity and renal excretory function. The plasma level of vasoconstrictor activity did not correlate with mean arterial pressure except when malignant or renovascular hypertension was present.
A significant inverse relationship was found between the serum potassium concentration and vasoconstrictor activity: as activity levels increased, the potassium fell. The data suggest that a renin-like substance may be present in various hypertensive states in amounts sufficient to depress serum potassium, presumably by activation of the renin-angiotensin-aldosterone mechanism.
Atherosclerosis in Europeans and Bantu
Authors: MEYER B. J. , PEPLER W. J. , MEYER A. C. , THERON J. J. 
Published: June 2012

The atherosclerotic "profile" of the aorta, coronary, and cerebral arteries was gauged by the atherosclerotic index method of Gore and Tejada
12
in 540 unselected white and Bantu autopsy cases. The atherosclerotic indices were very low in all cases until about the third decade. Thereafter there was a progressive rise, which was most dramatic in the aorta and coronary arteries of white men.

The aorta and coronary arteries of the white subjects were more severely affected than those of the Bantu whereas the cerebral arteries were about equally affected in the two racial groups.
The 540 cases included 87 white men, 58 white women, 111 Bantu men, and 85 Bantu women over the age of 25 years. Of the 87 white men 10 had died from coronary occlusion and five from cerebrovascular accidents. Of the 111 Bantu men none died from coronary occlusive disease and seven of cerebrovascular accidents. Five of the 58 white women died at an advanced age from coronary occlusion; seven died from cerebrovascular accidents. None of the Bantu women died from coronary occlusion and seven from cerebrovascular accidents.
Severe atherosclerosis was almost invariably present in cases that died from coronary occlusion suggesting that at least in white persons, coronary atherosclerosis directly predisposes to coronary occlusion. In patients who died from cerebrovascular accidents, macroscopically discernible atherosclerosis was not invariably present.
It is suggested that the wide difference in the percentage of "coronary deaths" in the two ethnic groups is due to the much greater frequency of severe coronary atherosclerosis in white persons than in the Bantu. The close correlation between the percentage of "cerebral deaths" in white and Bantu subjects, on the other hand, is not merely the result of equal occurrence or equal susceptibility of the cerebral arteries to atherosclerosis in the two racial groups, but is rather the integrated result of one or more of the following factors: (1) the relative weakness of the cerebrovascular walls, (2) the relative common occurrence of cerebral artery aneurysms (congenital aneurysms), (3) such atherosclerosis as may be present, and (4) rise in blood pressure.
Atherosclerosis of the cerebral arteries apparently played a somewhat more important role in white persons than in the Bantu.
Successful Therapy of Prolonged Hypotension with an Adrenergic Beta-Receptor Blocking Agent
Authors: LURIA MYRON H. , MILLER ALBERT J. , KAPLAN BENJAMIN M. 
Published: June 2012

Two patients with prolonged hypotension requiring continuous vasopressor therapy are described.
In both patients treatment with nethalide, a beta-receptor blocking agent, appeared clinically effective in allowing the withdrawal of metaraminol therapy and the maintenance of normotension. The results in these patients tend to fortify a hypothesis of peripheral adrenergic beta-receptor dominance in patients with prolonged hypotension.
Pulmonary Artery Stenosis Associated with Ductus Arteriosus Following Maternal Rubella
Authors: EMMANOUILIDES GEORGE C. , LINDE LEONARD M. , CRITTENDEN I. HUNTER 
Published: June 2012

Nine patients with pulmonary artery stenosis associated with patent ductus arteriosus following maternal rubella are described.
Five of the patients had bilateral pulmonary artery stenosis and four cases involved only the right pulmonary artery. Mild pulmonary valvular stenosis was present in five and a ventricular septal defect in one.
The persistence of a systolic murmur transmitted to the lateral chest wall, after ligation or division of a patent ductus arteriosus, should arouse suspicion of the presence of pulmonary artery stenosis.
This report supports the recently described implication of maternal rubella as a cause of pulmonary artery stenosis. Careful auscultation in patients with history of maternal rubella may discover the presence of such an arterial anomaly, but cardiac catheterization and angiocardiography are necessary for substantiation of diagnosis.
The natural history of these lesions is not known.