bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial Septal Defect in Patients over the Age of Forty Years
Authors: GAULT JAMES H. , MORROW ANDREW G. , GAY WILLIAM A. , ROSS JOHN 
Published: June 2012

The fate of 62 patients with atrial septal defect (ASD) who were 40 years of age and older was analyzed in detail. All patients were studied hemodynamically, those who underwent operation were recatheterized postoperatively, and the subsequent clinical courses of the entire group were determined. Cardiorespiratory symptoms were reported by 94% of the patients; 45% were in functional class III or IV. Fifty-four patients had moderate or large left-to-right shunts; pulmonary arterial (PA) hypertension was present in 69% of these patients, and was severe in 28%. PA hypertension or a large left-to-right shunt, or both were found in all 28 patients in functional classes III and IV. Eight patients (13%) exhibited evidence of severe obliterative pulmonary vascular disease, with balanced or predominantly right-to-left shunting. Operative correction of the ASD was performed in 48 patients. The overall operative mortality of 12.5% was reduced to 6.5% in the 31 patients operated upon after 1961.
At the initial follow-up, which averaged 8 months postoperatively, 29 of 41 patients, including all those in classes III and IV, were improved by at least one functional class. No patient was worse, and only four of 20 patients in class II failed to benefit symptomatically. PA hypertension was abolished in 15 of 25 patients, and in the remainder an average reduction in systolic PA pressure of 20 mm Hg occurred. Symptomatic benefit has been sustained in all but three of 37 patients in whom late (average, 5 years) follow-up information after operation was obtained. It is concluded that operative treatment of ASD may be undertaken with a relatively low operative mortality in patients in the fifth decade, despite the presence of PA hypertension, large left-to-right shunt, or congestive heart failure, and that sustained clinical and hemodynamic benefit may be anticipated, even in patients with advanced symptomatic disability.
Atrial Pressure-Flow Dynamics in Atrial Septal Defects (Secundum Type)
Authors: LEVIN AARON R. , SPACH MADISON S. , BOINEAU JOHN P. , CANENT RAMON V. , CAPP M. PAUL , JEWETT PAUL H. 
Published: June 2012

This study was conducted to determine the instantaneous pressure-flow relationships across secundum atrial septal defects. Simultaneous right and left atrial pressures and the pressure difference (determined with an analog computer) were recorded with matched catheter systems. Biplane cineangiocardiography was used to evaluate the timing of the shunts in various phases of the cardiac cycle.
These studies indicated that the major left-to-right shunt and pressure gradient occurred over an interval encompassing late ventricular systole and early diastole. Also, there was augmentation of the left-to-right shunt during atrial contraction. Minute right-to-left shunting and pressure gradients occurred at two times in the cardiac cycle: (1) with the onset of ventricular contraction; and (2) during early ventricular diastole (heart rate, 80 to 100 beats/min). Detection of systemic right-to-left shunts by dye curves was enhanced by relatively slow heart rates (prolonged diastasis) which allowed the shunted blood to flow into the left venrticle. The effects of respiration during phasic changes in intrathoracic pressure resulted in an increasing left-to-right gradient during periods of increasing intrathoracic pressure and a fall in the left-to-right gradient across the defect during periods of decreasing intrathoracic pressure.
Effects of Atrial Fibrillation on Exercise Performance in Patients with Cardiac Disease
Authors: HORNSTEN TOM R. , BRUCE ROBERT A. 
Published: June 2012

Cardiac performance in 25 male and 40 female cardiac patients with atrial fibrillation was compared with that of age, sex, and function-matched controls with sinus rhythm. All had rheumatic valvular heart disease treated with digitalis. Multistage maximal exercise was tested on a motor-driven treadmill with increasing work loads every 3 minutes to the limits of fatigue.
Mean heart rates of patients with atrial fibrillation were greater at rest, at all levels of exercise, and immediately after it regardless of sex or anatomic lesion; however, recovery heart rate was significantly higher in the males than in the females with sinus rhythm.
As is true for normals, mean duration and intensity of exercise was greater in male than in female cardiac patients regardless of rhythm or anatomic lesion.
Replacement of Left Ventricular Myocardium
Authors: COLLINS HAROLD A. , COLLINS ISABELLA S. 
Published: June 2012

The feasibility of resection and prosthetic replacement of left ventricular myocardium as a therapeutic adjuvant in myocardial infarction was assessed in a series of 72 dogs. Intracardiac pressures and cardiac output were measured in each dog several days preoperatively. During temporary cardiopulmonary bypass a large segment of the anterolateral wall of the left ventricle was excised. The defect was closed with either Teflon felt, woven Teflon cloth, or a pedicled diaphragmatic flap. Cardiac outputs and intracardiac pressures were measured immediately before and for several hours after myocardial replacement. Survivors were evaluated for periods up to three years by cardiac catheterization at appropriate intervals and pathological observation.
Forty-four dogs survived longer than 24 hours. The immediate hemodynamic consequences of myocardial replacement were a diminished systemic arterial pressure and a low, fixed cardiac output. The arterial pressure and cardiac output gradually increased over a period of weeks, occasionally attaining preoperative levels. Left ventricular end-diastolic pressures were always within normal limits.
The most common cause of death in the first two postoperative weeks was graft detachment. Observations of healing characteristics revealed Teflon felt to be the most satisfactory prosthesis. The diaphragmatic flap frequently necrosed, and woven Teflon produced intraventricular thrombus and incomplete healing.
This study demonstrated the feasibility of resection and prosthetic replacement of large segments of left ventricular myocardium. Complications of the procedure were related to a temporarily diminished cardiac output and inadequate healing of the prosthesis to myocardium.
Rational Approach to the Surgical Management of Tricuspid Atresia
Authors: GLENN WILLIAM W. L. , GARDNER THOMAS H. , TALNER NORMAN S. , STANSEL HORACE C. , MATANO ICHIRO 
Published: June 2012

A rational approach to the surgical management of tricuspid atresia with diminished blood flow to the lungs is as follows: A cava-pulmonary artery shunt is performed as the initial operation whenever possible. In the newborn infant and in patients where the pulmonary artery is less than one-half the diameter of the superior vena cava where the two vessels cross, the right pulmonary artery is anastomosed end-to-side to the ascending aorta. Subsequently, when the right pulmonary artery has enlarged, it is detached from the aorta and anastomosed to the superior vena cava.
Closure of the outflow from the right ventricle to the left lung can be expected in tricuspid atresia after the first year of life, and unless the ductus remains patent, a systemic artery-pulmonary artery shunt on the left side will be required to supplement the cava-pulmonary artery shunt. This shunt will also be required as a preliminary step to replacing the ascending aorta-right pulmonary artery shunt with a cava-right pulmonary artery shunt if blood flow to the left lung is by bronchial collateral arteries only.
Banding of the pulmonary artery is indicated in those patients with excessive blood flow to the lungs.
In the present series of 19 patients with tricuspid atresia, there were 17 with diminished flow to the lungs and two with excessive flow.
Eight patients with small pulmonary arteries had a shunt made between the ascending aorta and right pulmonary artery. Five patients were less than two weeks of age. All survived operation; one died a year postoperatively of unknown causes. Two shunts have been replaced with cava-pulmonary artery shunts.
Ten patients had a shunt made between the superior vena cava and the right pulmonary artery one to eight years ago. There has been no operative or late mortality. A supplemental systemic artery-pulmonary artery shunt on the left side has been established in three patients. Two patients have had operative enlargement of the interatrial communication.
Excessive blood flow to the lungs was present in two patients. Neither patient survived banding of the pulmonary artery.
Alterations in Regional Pulmonary Blood Flow in Patients with Congenital Heart Disease Studied by Radioisotope Scanning
Authors: FRIEDMAN WILLIAM F. , BRAUNWALD EUGENE , MORROW ANDREW G. 
Published: June 2012

External scintillation scanning of intravenously administered
131
I-labeled macro-aggregates of human serum albumin (
131
I-MAA) was employed to evaluate the distribution of pulmonary arterial blood flow in 61 normal subjects and in 100 patients with various congenital cardiovascular malformations. Intra-aortic administration of
131
I-MAA demonstrated that blood flow through subclavian-pulmonary artery anastomoses is directed principally to the lung on the side of the anastomosis; the relative concentration of
131
I-MAA in each lung after intravenous injection provided an index of the patency of the anastomosis or of the development of pulmonary atresia or pulmonary hypertension. In contrast to the findings in patients with a patent subclavian-pulmonary shunt, scans obtained from patients with a patent ductus arteriosus did not reveal a separation of the systemic arterial and systemic venous inflows to the lungs. The patency of superior vena caval-right pulmonary arterial anastomosis could be assessed after injection of
131
I-MAA into an upper-extremity vein.

Anomalies characterized by increased pulmonary blood flow or elevated pulmonary arterial pressures, or both, increased the ratio of pulmonary blood flow in the lung apices relative to that in the dependent lung zones. Anomalies characterized by elevated pulmonary venous pressure, such as cor triatriatum and mitral regurgitation, were readily detected by demonstrating both a decrease in blood flow to the lung bases as well as an increase to the apices. Thus, in patients with known pulmonary arterial hypertension (mean pressure, >30 mm Hg) the ratio of upper to lower zone blood flow was always significantly higher if the arterial hypertension was accompanied by venous hypertension. For this reason, lung scans facilitated the screening of patients with pulmonary arterial hypertension for surgically correctable lesions such as cor triatriatum and mitral stenosis.
The method described is technically simple, without risk, easily applicable to large numbers of patients, and provides clinically important information concerning many forms of congenital heart disease.
Patterns of Anomalous Pulmonary Venous Drainage
Authors: SNELLEN H. A. , INGEN H. C. , HOEFSMIT E. CH. M. 
Published: June 2012

All of our cases of abnormal pulmonary venous connections collected to the middle of 1965 and verified at surgery or autopsy have been reviewed by means of diagrams and tabulations, using a specially devised code to facilitate the survey. The material consisted of 52 autopsy cases (half of them obtained after surgery) and the cases of 72 patients who survived operation. The postmortem group was much younger than the surgical group and differed also from the latter by showing male preponderance as well as relatively many instances of total abnormal pulmonary venous connection and frequently associated cardiac anomalies.
Partial anomalous connection of right pulmonary veins was 10 times more frequent than that of the left pulmonary veins. This was caused by (1) the frequent drainage of some of the right pulmonary veins into the junctional area between right atrium and superior vena cava in the presence of normal left pulmonary veins, and (2) the complete absence of isolated left pulmonary venous connection to the right atrium. Abnormal connection of solitary pulmonary veins was always effected to the most proximal venous structure among the four possible ones which are derived from the main embryonic channels (superior vena cava and inferior vena cava on the right side, and left superior vena cava and coronary sinus on the left side). Common pulmonary veins from one lung also drained in accordance with this proximity rule, if this may be taken to apply also to the drainage of right pulmonary veins into the right atrium. The one exception in our material was the drainage of all right pulmonary veins into the portal venous system. Total abnormal pulmonary venous connection may be found with all structures mentioned, but most frequently with the left superior vena cava, or coronary sinus, or both, usually by way of a common pulmonary vein. In a few cases however, drainage into different sites, all of them abnormal, did occur. Then again the proximity rule seemed to apply.
A tentative embryological explanation is given for the patterns described.
Vocational and Emotional Status of 263 Patients After Heart Surgery
Authors: BLACHLY P. H. , BLACHLY B. J. 
Published: June 2012

The vocational and emotional status of 263 patients following heart surgery was sampled with a questionnaire mailed to 329 patients thought to be living. Return to work was most clearly related to the duration of unemployment. Age and sex did not influence rate of return to work. The kind of operation had a small but definite influence. A "Law of the Year" stating that if a person is unemployed for more than a year for any reason, the chance of reemployment is poor is proposed. From one third to one half of the patients complained that their "nerves were worse" postoperatively. The number complaining of worsening exceeded those improving by two to five times and was directly related to the type of operation.
Most pleasant recollection of the surgical experience was the dedicated attitude of doctors and staff. There was wide diversity of opinion about most unpleasant experiences, but complaints about environmental conditions in the recovery room, noise, unpleasant roommates, and insufficient visitors were minimal.
Establishment of a cardiac reconditioning program is recommended, since 41% felt unable to work.
Subintimal Dissection of the Coronary Arteries
Authors: HAAS JOHN M. , PETERSON CHARLES R. , JONES ROBERT C. 
Published: June 2012

Selective coronary arteriography is now the procedure of choice in the determination of the existence and the delineation of the extent of chronic obstructive coronary artery disease. Since Sones and Shirey's original description of this technique, variations in the procedure and the approach have evolved. More recently, the percutaneous transfemoral artery approach to selective coronary arteriography has gained increasing favor because of the ease of intubation of both coronary arteries, stability of the catheter once positioned in the coronary ostium, and the high quality of cinefluorography and direct serial radiography.
Because of the tapered-tip design and positrol feature, the depth to which the coronary artery can be cannulated, and the angle formed by the tip of the catheter and the intima of the vessel, the possibility of subintimal dissection of the coronary arteries as an inherent complication of this approach arises.
Two such cases of subintimal dissection of the left coronary artery are described with cinefluorographic documentation.
It is recommended that after cannulation of the coronary vessels the catheter be withdrawn several millimeters from the lumen of the vessel in order to avoid this complication of an otherwise valuable diagnostic approach to selective coronary arteriography.
Cigarette Smoking
Authors: JENKINS C. DAVID , ROSENMAN RAY H. , ZYZANSKI STEPHEN J. 
Published: June 2012

The association of the incidence of coronary heart disease (CHD) with smoking habits was studied for 4½ years in over 3,000 healthy, employed men, aged 39 to 59 years, at intake into a prospective, epidemiological investigation. The risk of CHD was significantly associated both with current and former cigarette usage. More specifically, this association was found to prevail in men suffering symptomatic and fatal myocardial infarction but not in men sustaining silent myocardial infarction or angina pectoris only and was much stronger in younger than in older age groups. Altered risk of CHD was not found in pipe or cigar smokers.
Cigarette habits at intake were associated with differences in serum lipids and other risk variables, but when the latter were controlled statistically, the smoking-CHD associations remained.
The cigarette-CHD relationship was studied further in men with and without the coronary-prone behavior pattern (type A). In the younger age decade the increased risk of CHD associated with moderate and heavy cigarette smoking occurred primarily in men with the type A behavior pattern.
Interrelationships of Hyperinsulinism and Hypertriglyceridemia in Young Patients with Coronary Heart Disease
Authors: TZAGOURNIS MANUEL , CHILES ROSS , RYAN JOSEPH M. , SKILLMAN THOMAS G. 
Published: June 2012

Fasting serum lipid levels, glucose tolerance, and immunoreactive insulin concentrations of 50 young patients with coronary heart disease (CHD) and 30 control subjects were evaluated to study the interrelationships of these metabolic factors. Abnormalities in one or more of these factors could be shown in 90% of the patients and 20% of the control subjects. Thirty-four of the 50 patients had elevated cholesterol or triglyceride levels, or both, 30 had abnormally elevated or delayed insulin responses after glucose, and 17 had abnormal glucose tolerance. A significant correlation existed between serum triglyceride and insulin concentrations. When insulin levels were reduced by phenformin, triglyceride concentrations fell toward normal.
These findings indicate that carbohydrate, insulin, and lipid abnormalities are rather prevalent in patients with CHD. Excessive insulin secretion secondary to mild glucose intolerance probably induces hepatic synthesis of triglycerides and hypertriglyceridemia. Dietary alterations or pharmacological agents may help to control some of the metabolic abnormalities associated with premature CHD.
Atherosclerosis
Authors: PAGE IRVINE H. 
Published: June 2012

The effectiveness of the research endeavor in atherogenesis is searchingly considered because neither how to prevent nor how to cure atherosclerosis is known, and there is no decision about what atherosclerosis looks like.
In the overview one of the most serious problems is failure to see the whole problem. Systematic marshalling of detail is vital; yet there must be a longer look. The first broad suggestion is to curtail the divisive trends, view the blood vessels and heart as a whole, and declare unabashedly in favor of atherosclerosis as the prime interest no matter where it appears or under what guise. The time has come when those who study atherosclerosis and myocardial infarction should rethink their approach. Research excellence is the ability to select the few experiments most likely to get at the heart of the matter. An important question is, If the experiment is successful, will it contribute to the solution of the problems of atherogenesis?
There is urgent need to reduce the amount of repetitive, almost trivial, investigation and to seek more creative approaches. Several problems are suggested as examples: the neural component, the atherogenic mosaic, and the inextricable association of atherosclerosis with myocardial infarction. Even such sacrosanct rights as how to do research are briefly considered. This all constitutes an apologia of the author's own failures in this pressingly important field.
Sequential Cardiorespiratory Events During and After Dextran-4O Infusion in Normal and Shock Patients
Authors: MOHR PATRICIA A. , MONSON DAVID O. , OWCZARSKI CYNTHIA , SHOEMAKER WILLIAM C. 
Published: June 2012

Sequential measurements of cardiac output, intravascular pressures, blood gases, pH, blood volume, and oxygen consumption were made in normal subjects and patients in shock before, during, and after infusions of dextran-40. In eight normal subjects the responses were: increased central venous pressure, increased cardiac index, decreased peripheral resistance, and decreased hemoglobin concentrations. These changes were of short duration and were attributed largely to increased plasma volume from the infusion.
Nineteen of 26 patients in shock responded to administration of dextran-40 with increased central venous pressure, cardiac index, plasma volume, and central blood volume, as well as decreased mean transit time and total peripheral resistance. Lesser increases in blood pressure, stroke index, and left ventricular stroke work were observed. The increase in cardiac index was preceded by increased central venous pressure and decreased peripheral resistance. The hemodynamic changes were more marked and of longer duration than those of the normal subjects. In addition to these hemodynamic changes, dextran increased oxygen consumption in all but one of the patients whose major problem was hemorrhage and trauma. Increased oxygen consumption suggests that tissue perfusion improved after dextran possibly because of increased small vessel flow as well as increased plasma volume.
In patients who were in shock because of sepsis, no change in oxygen consumption was observed despite hemodynamic improvement. As in the normal subjects, these hemodynamic changes were attributable to plasma expansion.
In seven patients, dextran increased central venous pressure without improving cardiac index or other hemodynamic parameters. It is suggested that these patients were functioning with limited cardiac reserve.
Factors in the Mortality and Morbidity Associated with Surgical Treatment of Cerebrovascular Insufficiency
Authors: RANSON J. H. C. , IMPARATO A. M. , CLAUSS R. H. , REED G. E. , HASS W. K. 
Published: June 2012

The mortality and morbidity associated with 267 surgical procedures for cerebrovascular insufficiency carried out over a 5-year period are reviewed. Patients with marked intracranial arterial disease on angiogram, with completed strokes, over 70 years old or who required continuous nursing care are identified as the highest surgical risks.
The introduction of monitoring of the oxygen saturation of lateral sinus venous blood has reduced the incidence of intra-operative new neurological deficit during general anesthesia from 9.1 to 4.4%.
Episodes of hypotension occurred in 27% of patients but were associated with 48% of grave complications. The occurrence of hypotension is related to diabetes, preoperative hypertension, and to the extent of the operative procedure.
Evidence is presented that hypotension is due to abnormal circulatory reflexes and may best be prevented by careful maintenance of intravascular volume.
Further Evaluation of Aortic Valve Homografts Sterilized by Electron-Beam Energy
Authors: BOWMAN FREDERICK O. , MALM JAMES R. , HARRIS PAUL D. , KAISER GERARD A. , KOVALIK ANTHONY T. 
Published: June 2012

Clinical results with the use of irradiated aortic valve homografts in 45 patients are reported. These valves have functioned satisfactorily up to 2 years.
Forty-four per cent of the surviving patients developed a murmur suggestive of a degree of aortic valvular insufficiency. One required re-operation, and all others remain in excellent compensation.
Emphasis is placed on the precise surgical technique of implantation and the proper selection of graft size, as well as the technique of preservation of the graft in obtaining a satisfactory hemodynamic result.