bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total Correction of Tetralogy of Fallot
Authors: LANDTMAN BERNARD , WOLF MURIEL D. 
Published: June 2012

The material comprised the data of 146 patients with tetralogy of Fallot treated by corrective intracardiac surgery. Electrocardiograms were recorded in all cases before and in 108 cases after operation. The majority of the patients were between 5 and 20 years of age at the time of surgery and have been followed for an average of 1.5 years.
Arrhythmias, mostly extrasystoles, were recorded in eight cases before operation and in 14 cases on the last follow-up examination. The amplitude of the P wave in lead II decreased by 1 mm. or more after surgery in one third of the cases.
Seventeen patients developed complete AV block postoperatively, seven died; of the 10 who survived operation, in all but two the electrocardiogram reverted to normal sinus rhythm.

The electrocardiogram showed right axis deviation and right ventricular hypertrophy in the majority of cases. A balanced axis and signs of combined ventricular hypertrophy were commonest in acyanotic patients and more common in cyanotic patients who had had previous shunt procedures than in cyanotic patients who had had no previous shunt. Two patients showed electrocardiographic signs of left ventricular hypertrophy. After corrective cardiac surgery, the mean electrical axis and the pattern of the QRS complex in V
1
and V
6
changed toward normal in the eight patients in whom intraventricular conduction defects did not appear and in the 26 patients with incomplete right bundle-branch block.

Two of nine surviving patients in whom a small coronary artery was divided at surgery developed the pattern of myocardial infarction in the postoperative electrocardiogram.
Conduction disturbances frequently appeared during operation; they were considered to be caused mainly by direct trauma to the conduction system during closure of the ventricular septal defect or during infundibulum resection. Complete right bundle-branch block appeared in 74 (69 per cent) and incomplete right bundle-branch block developed in 20 (19 per cent) of surviving patients. Only eight patients showed no disturbances of conduction after surgery. The right bundle-branch blocks persisted throughout the follow-up period. The conduction disturbances have not adversely affected the postoperative course, nor have they caused any discomfort to the patients.
Electrocardiographic "Peri-Infarction Block"
Authors: CASTLE C. HILMON , KEANE WILLIAM M. 
Published: June 2012

Detailed analysis for the presence and type of heart disease was made in 96 deceased patients who had electrocardiographic "peri-infarction block." Evidence for disease of the left ventricle was found in 80 per cent of these patients. Left ventricular hypertrophy and diffuse scarring of the left ventricle were the most common abnormalities on pathologic examination. Definite myocardial infarction was found in only 12 of the 55 patients (22 per cent) subjected to postmortem examination. Electrocardiographic "peri-infarction block" was therefore not specific for myocardial infarction although it was often associated with it. Use of the term should be restricted to left intraventricular conduction defect of the "peri-infarction block type."
In spite of the nonspecificity of this type of intraventricular conduction defect, it can be a useful clinical sign. If chronic obstructive airway disease and emphysema can be excluded, the presence of some type of left ventricular disease is almost assured.
Natural History of Pulmonary Hypertension in Surgically Treated Patent Ductus Arteriosus
Authors: ANABTAWI ISAM N. , ELLISON ROBERT G. , ELLISON LOIS T. 
Published: June 2012

One hundred consecutive surgically treated patients with patent ductus arteriosus underwent preoperative and/or pulmonary artery and aortic pressure measurements at the time of surgery, prior to and following temporary occlusion or division of the ductus. Patients with persistent elevation in pressure following division of the ductus subsequently underwent single or multiple catheterizations at various intervals ranging between one and four years following surgery.
Pulmonary hypertension prior to division was present in 35 patients (35%). This was mild in 19, moderate in nine, and severe in seven. The pressure returned to normal immediately after division of the ductus in 13, indicating that in this group the pressure elevation was hyperkinetic. In 22, the pressure remained elevated immediately after division, pulmonary hypertension being mild in seven, moderate in eight, and severe in seven. In the mild group, the pressure subsequently returned to normal in all but one. In the moderate group, the pressure failed to return to normal in six out of eight, indicating the presence of vaso-occlusive changes in the pulmonary bed. The pressure usually exceeded 60 mm Hg systolic. In seven patients with severe pulmonary hypertension, division was performed in four. Two died in the immediate postoperative period, and two survived. Follow-up cardiac catheterization showed a return of pressure to normal in one and persistent elevation in the other. Of three patients in whom division was not performed, two are living and well two and seven years later, respectively, and one has been lost to follow-up.
Although the rate of blood flow and vaso-constriction contributed considerably to the elevation of pulmonary arterial pressure, the blood pressure failed to return to normal in the majority of patients whose systolic pressure was elevated in excess of 60 mm Hg after division of the ductus, indicating pathological pulmonary vascular alterations.
Hemodynamic Effects of Cerebral Arteriovenous Aneurysms
Authors: WALLACE JOHN M. , NASHOLD BLAINE S. , SLEWKA ANTHONY P. 
Published: June 2012

The hemodynamic alterations produced by large cerebral arteriovenous aneurysms are qualitatively similar to those caused by arteriovenous aneurysms elsewhere in the body. Congestive heart failure was not observed in our eight patients; it appears to be unusual in adult cases.
By comparing cardiac outputs with a control group the mean aneurysm blood flow in six patients was estimated to be 2,804 ml. per minute at rest. Isoproterenol increased cardiac output relatively more than the estimated aneurysm flow.
Implications of the present data with respect to the concept of "central" blood volume are discussed.
Progressive mental and neurologic deterioration is the rule with large cerebral arteriovenous aneurysms. Repeated bleeding episodes, which may not be obvious clinically, appear to be partially responsible.
Acute Effects of Countershock Conversion of Atrial Fibrillation upon Right and Left Heart Hemodynamics
Authors: REALE ATTILIO 
Published: June 2012

Right and left heart hemodynamics were studied in 12 patients with mitral valvular disease and atrial fibrillation before and immediately after external direct-current countershock resulting in restoration of normal sinus rhythm. The change of rhythm was accompanied by the following hemodynamic variations in the majority of cases: Systolic and mean pressures in the right and left ventricles and in the pulmonary and brachial arteries were not systematically altered, with a tendency, however, to a decrease in ejection pressures in the right heart and increase in the left heart. Mean right atrial and right ventricular end-diastolic pressures as well as left ventricular end-diastolic pressure decreased significantly. The behavior of the mean left atrial pressure appeared to be influenced by the degree of mitral valvular disease. Cardiac output and index and stroke volume and index increased; pulmonary vascular and systemic resistances decreased.
The stroke work of the ventricles also increased in the majority of patients.
An analysis of the changes in left ventricular end-diastolic pressure in relation to the left ventricular stroke work indicated that sinus rhythm resulted usually in a shift of the ventricular function curve to an area of improved performance.
Precordial Movements over the Right Ventricle in Children with Pulmonary Stenosis
Authors: SCHMIDT ROLAND E. , CRAIGE ERNEST 
Published: June 2012

Twenty-three children with pulmonary stenosis were studied by means of displacement tracings taken over the right ventricle. The transducer was selected to pick up vibrations in the ultra-low frequency or palpable range. The patients were studied by cardiac catheterization and angiocardiography.
Criteria previously established for normal children were applied to the patients with pulmonary stenosis. These provide a measure of the duration and relative height of the out-ward movement associated with ventricular systole.
Recordings of precordial movement over the right ventricle in all of five children with severe pulmonary stenosis were abnormal by these criteria. Patients with mild pulmonary stenosis were normal in six of seven cases. An intermediate group (right ventricular peak pressures 60 to 100 mm. Hg) had abnormal records in seven of 11 instances. The "a" wave resulting from atrial contraction was exaggerated in severe pulmonary stenosis and was larger than normal in many of the mild and moderate cases.
Recordings of precordial movement in pulmonary stenosis, though nonspecific in morphology, are nevertheless useful as an index of severity of the lesion, in timing phases of the cardiac cycle, in following the progress of cases before and after surgical interference, and as a method of improving appreciation of palpable phenomena at the bedside.
Late Hemodynamic Response to Correction of Isolated Pulmonary Stenosis by Open Operation during Pulmonary Bypass
Authors: LILLEHEI C. WALTON , SIMMONS ROBERT L. , TODD DAVID B. 
Published: June 2012

A group of 25 patients was studied by cardiac catheterization before and after open operation for isolated pulmonary stenosis by direct vision with use of cardiopulmonary bypass Organic infundibular obstruction, when present, was resected. The hypertrophied infundibulum, when it constitutes a severe obstruction, must also be resected. The average right ventricular systolic pressure preopratively was 124 mm. Hg and postoperatively it was 35 mm. Hg.
The average gradient across the pulmonary valve preoperatively was 99 mm. Hg and postoperatively it was 17 mm. Hg, a mean decrease of 82 mm. Hg.
The long-term hemodynamic response was distinctly superior in this group of patients operated upon under total bypass when compared with a similar series operated upon by us with a closed transventricular approach.
The specific diagnosis of lesions causing obstruction to the outflow of the right ventricle is particularly crucial in selecting an operative approach if open operation by inflow stasis is utilized.
Careful review of the selective right ventriculograms is an excellent preoperative guide in determining whether infundibular obstruction is present and hemodynamically significant.
Patients having severe valvular stenosis, with right ventricular pressures above 140 to 150 mm. Hg should have an immediate one-third to one-half decrease in their right ventricular systolic pressures at the time of surgery, or infundibular resection should be done to reduce postoperative mortality.
Significance of the QX/QT Ratio and the QT Ratio (QTr) in the Exercise Electrocardiogram
Authors: ROMAN LAURIAN , BELLET SAMUEL 
Published: June 2012

Recently, a junctional depression of small amplitude (less than 2 mm.) of the ST segment was considered to be a positive or equivocal result for the electrocardiographic exercise test if the QX/QT ratio was ⪖ 50 per cent or the QTr ⪖ 1.08.
In 150 normal, young students with no clinical evidence of heart disease, a junctional depression of the ST segment with a QX/QT ratio ⪖ 50 per cent or a QTr ⪖ 1.08 or both, was observed in 22 per cent.
These observations, supported by other published reports concerning the QX/QT ratio and the QTr, indicate that these criteria are not reliable for the determination of a positive electrocardiographic exercise test.
Influence of a Diet High in Unsaturated Fat upon Composition of Arterial Tissue and Atheromata in Man
Authors: DAYTON SEYMOUR , HASHIMOTO SAM , PEARCE MORTON LEE 
Published: June 2012

Detailed chemical analyses have been carried out on aorta, and on coronary and aortic atheromata, of men who died during a study of prolonged use of diets rich in unsaturated fat and of control subjects. Concentrations of total aortic lipid and of total aortic calcium were not significantly different for the two groups of subjects. Concentrations of cholesterol and cholesterol esters, triglyceride, and phosphatide showed no difference between the two groups in analyses of aorta, uncomplicated aortic atheromata, complicated aortic atheromata, and coronary atheromata. Coronary atheroma lipid contained substantially more triglyceride than did aortic atheroma lipid, whether derived from complicated or uncomplicated plaques.
Atheroma triglyceride in experimental subjects contained more linoleic acid than in control subjects, in all types of plaques. Lesser but significant increases in linoleic acid were seen in cholesterol ester and phosphatide of coronary atheromata and complicated aortic atheromata. In the case of uncomplicated aortic atheroma, changes in linoleic acid of cholesterol ester and phosphatide were smaller and not significant. In both groups of subjects, coronary atheroma contained more cholesteryl oleate and less linoleate than did aortic atheroma.
Linoleic acid contents of atheroma lipid fractions were positively correlated with the linoleic acid figures for corresponding fractions of the most recent antemortem serum samples. Ratio of linoleic acid in an atheroma lipid fraction to the linoleic acid content of the corresponding serum fraction was, in most cases, constant after the time of the first sample, obtained after 495 days on experimental diet. It is postulated that this ratio constitutes an estimate of the fraction of atheroma fatty acid derived from plasma. In cholesterol ester and triglyceride, the ratio was about 0.65 in experimental subjects, higher in subjects on the control diet. The ratio for phosphatide was about 0.5 in both groups of subjects.
The Effect of Nitroglycerin on the Systemic and Coronary Circulation in Man and Dogs
Authors: BERNSTEIN L. , FRIESINGER G. C. , LICHTLEN P. R. , ROSS R. S. 
Published: June 2012

The pharmacodynamics of nitroglycerin have been studied in dogs and man.
In dogs, intravenous nitroglycerin (TNG) caused a decrease in left ventricular work, myocardial blood flow (MFB), and myocardial oxygen consumption, and no significant change in coronary vascular resistance.
Intracoronary artery TNG in dogs caused an immediate increase in MBF and a decrease in coronary vascular resistance that persisted until arterial pressure fell.
In man, sublingual TNG (0.4 mg.) caused a decrease in left ventricular work, MBF, and myocardial oxygen consumption, and no significant decrease in coronary vascular resistance in patients with and without arteriographically proven coronary artery disease.
The injection of doses of 0.1 to 0.2 mg. of TNG directly into the coronary artery in man caused an immediate increase in MBF and a decrease in coronary vascular resistance in patients with and without arteriographically proven coronary artery disease.
The hypothesis proposed for the mechanism of action of TNG in the relief of angina pectoris is first, a decrease in coronary vascular resistance due to its effect on the coronary circulation, and, secondly, a decrease in cardiac work due to its effect on the systemic circulation.
Hemodynamic Changes Associated with Injection of Angiocardiographic Contrast Medium in Assessment of Valvular Lesions
Authors: RAHIMTOOLA SHAHBUDIN H. , DUFFY JOHN P. , SWAN H. J. C. 
Published: June 2012

Measurements of flow and pressures related to the left heart were made on 21 patients immediately prior to and at intervals of 2 and 4 minutes after angiocardiography. These patients had normal mitral valves (group 1), mitral incompetence (group 2), or mitral stenosis (group 3). There was an increase in left ventricular end-diastolic pressure accompanied by an increase in "pulmonary artery wedge" (PA wedge) pressure in all patients. Patients with mitral valve disease generally develop higher PA wedge pressures; those with mitral stenosis develop, in addition, significantly increased mean diastolic and end-diastolic gradients across the mitral valve.
These increased gradients in mitral stenosis are due to increased flow across the mitral valve, which results from a combination of increased cardiac output and decreased diastolic filling time. Diagnostic angiocardiography affords an opportunity of observing the effects of valve lesions at a higher flow rate and is particularly useful in those patients with normal PA wedge pressure and small gradients initially.
The Assessment of Operative Results in Congenital Heart Disease by Intraoperative Indicator-Dilution Curves
Authors: MORROW ANDREW G. , OLDHAM H. NEWLAND , CALLARD GEORGE M. , BRAUNWALD EUGENE 
Published: June 2012

In 260 patients with intracardiac shunts, indicator-dilution curves were recorded immediately after corrective operations. In every patient, the effectiveness of the repair was also determined at late postoperative cardiac catheterization or necropsy. In 248 patients (96 per cent) the presence or absence of a shunt, determined from the intraoperative curves, was confirmed by the findings at postoperative study. The intraoperative curves were normal in 213 patients, 209 of whom had no residual communication at late evaluation; in four patients, the studies indicated initial complete correction followed by recurrence of the shunt. Abnormal intraoperative curves were recorded in 47 patients, eight of whom died. In 17 of the 39 surviving patients, postoperative catheterization revealed persistent residual shunts comparable in magnitude to those present before operation. Fourteen patients had residual shunts that did not necessitate reoperation, and in eight patients, shunts present at the conclusion of the operation were shown to close in the postoperative period.
The study indicates that the recording of intraoperative indicator-dilution curves provides a reliable objective method for evaluating the effectiveness of operation in patients with circulatory shunts. If normal curves are recorded, no residual shunt may be expected in 98 per cent of patients, and postoperative catheterization may be unnecessary unless other hemodynamic data are required. If abnormal intraoperative curves are recorded, however, postoperative study is mandatory, since the shunt will persist in 80 per cent of patients, in many of whom a second operation will be indicated.
Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery
Authors: CASTAÑEDA ALDO R. , INDEGLIA ROBERT A. , VARCO RICHARD L. 
Published: June 2012

Nine cases of anomalous origin of the left coronary artery from the pulmonary artery, the patients ranging in age from two months to seven years, have been reviewed. Six of these patients have had mitral insufficiency as well.
Of these nine patients, four have undergone operation and all have survived. There have been no postoperative complications. A fifth patient was taken to the operating room, but developed ventricular fibrillation during induction and could not be resuscitated. The remaining patients were not operated upon, and all have died.
In a typical case, nonspecific respiratory complaints were present. In addition, some patients experienced episodes of pallor, dyspnea, and excessive perspiration. The electrocardiogram and vectorcardiogram proved helpful in the diagnosis of this anomaly, although selective right coronary arteriography was most effective in establishing the diagnosis.
The surgical treatment in all four patients consisted of transection and ligation of the anomalous coronary artery at its origin from the pulmonary artery. The technique is simple and has been described. Of the four surgically treated patients, three have so far remained asymptomatic. One patient continues postoperatively to suffer from angina-like symptoms. The electrocardiogram, vectorcardiogram, and chest X-rays do not show any marked change from preoperative observations in three patients; however, the youngest child operated upon (aged three months) reveals changes consistent with improvement in the electrocardiographic pattern.
Early recognition and treatment of this lesion are advocated if preventable deaths from irreversible myocardial damage are to be avoided.
A Study of Coronary Heart Disease in Young Men
Authors: HATCH FREDERICK T. , REISSELL PENTTI K. , POON-KING THEO. M. W. , CANELLOS GEORGE P. , LEES ROBERT S. , HAGOPIAN LILLIAN M. 
Published: June 2012

To study metabolic factors in the genesis of coronary heart disease in previously healthy young adults, 24 men (aged 23 to 49 years) who had recovered from proven myocardial infarction were compared with an age-matched series of 20 healthy subjects-10 business and professional men and 10 prisoners. Both series averaged 10% above ideal body weight. The patients were shorter, were heavier smokers, and had a high familial incidence (70%) of coronary heart disease. The controls had more familial diabetes.

Oral glucose tolerance tests without and with cortisone showed higher peak blood sugar levels and delayed return in the patients. Four patients were found to have fasting serum triglycerides above 300 mg% and were placed in a separate category of essential hyperlipidemia. In the remaining 20 patients, serum cholesterol and triglycerides in combination were higher than in the controls, together with elevation of pre-β-lipoproteins. α
1
-Lipoprotein was decreased. Mean postheparin lipolytic activity was slightly less in the patients-in the lower part of the normal range.

In the combined series of patients and control subjects, the relative body weight showed significant correlations-directly with the 1-hour blood sugar level in the glucose tolerance test and with the fasting serum triglyceride level, and inversely with the α
1
-lipoprotein. The relative body weight did not show a significant correlation with the serum cholesterol level.

A set of 10 characteristics and biochemical variables, referred to in preceding paragraphs, was found to discriminate well between the patients and their controls. The total incidence of abnormal findings was high among the patients (mean, 4.9 per man) and low among the controls (mean, 1.9 per man), but the positive items were grouped in many different ways in individuals.
Analysis of the data suggests that over-nutrition and heavy smoking interact with hereditary factors in certain individuals to accelerate the progress of coronary atherosclerosis. Since individuals who exhibit many of the criteria indicative of increased risk are not uncommon in our population, their identification as candidates for coronary heart disease early in life is a significant public health problem.
Depletion of Body Potassium by Diuretics
Authors: REMENCHIK ALEXANDER P. , MILLER CHARLES , TALSO PETER J. , WILLOUGHBY EDWARD O. 
Published: June 2012

A study was designed to evaluate the [see table in the PDF file] [see table in the PDF file] hypothesis that the hypokalemia associated with the administration of thiazide diuretics reflects a redistribution of potassium rather than a depletion of body potassium. Exchangeable potassium, total body potassium, total body water, extracellular fluid volume, and serum sodium, potassium, chloride, bicarbonate, and pH of a group of hypertensive subjects were measured before and after 4 weeks of administration of dichlorphenamide and hydrochlorothiazide to these subjects.
Significant decreases were observed in serum potassium (1.05 mEq/L), serum chloride (8.22 mEq/L), exchangeable potassium (21.1%), and total body potassium (16.7%) without a significant change in serum pH, sodium, and bicarbonate. Body weight, total body water, and extracellular fluid volume also decreased, but the change in body weight was not sufficient to explain the potassium deficit produced. The mechanisms responsible for the loss of potassium are discussed.