bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Evaluation of Tetralogy Patients with Pulmonary Valvular Insufficiency Resulting from Outflow-Patch Correction Across the Pulmonic Annulus
Authors: JONES ELLIS L. , CONTI C. RICHARD , NEILL CATHERINE A. , GOTT VINCENT L. , BRAWLEY ROBERT K. , HALLER J. ALEX 
Published: June 2012

In the operative correction of tetralogy of Fallot with a severely narrowed right ventricular outflow tract, widening of the pulmonic annulus is frequently necessary to prevent a high residual pressure gradient and to reduce right ventricular pressure overload. This can be accomplished by incising the pulmonic annulus and inserting a patch graft across the valve, but this usually results in pulmonary valvular insufficiency.
Of 426 patients who underwent total correction of Fallot's tetralogy between 1959 and 1970, 63 required a patch across the pulmonic annulus. The mortality rate for this group was 30.1%, compared with a total mortality among the 426 patients of 18%. The high mortality rate is influenced by the fact that the majority were corrected in the early years of the series.
Fifteen patients were restudied by cardiac catheterization and cineangiography an average of 9.1 years after total correction. Twelve patients were asymptomatic and three patients had only mild symptoms on exertion in spite of angiographically significant pulmonic regurgitation. The average right ventricular systolic pressure was 40 mm Hg; right ventricular end-diastolic pressure was 7 mm Hg; and the right ventricular/pulmonary arterial peak systolic pressure gradient was 14.9 mm Hg. This experience suggests that after a more difficult immediate postoperative period, patients who have right ventricular outflow reconstruction with patches across the pulmonic ic annulus tolerate their chronic pulmonic regurgitation very well.
Recognition of Postoperative Acute Myocardial Infarction
Authors: DIXON SEWELL H. , LIMBIRD LEE E. , ROE CHARLES R. , WAGNER GALEN S. , OLDHAM H. NEWLAND , SABISTON DAVID C. 
Published: June 2012

Routine enzymatic and electrocardiographic diagnosis of postoperative acute myocardial infarction (AMI) is frequently inconclusive. The detection and quantitation of isoenzymes of lactate dehydrogenase (LDH) and creatine phosphokinase (CPK), especially the cardiac-specific CPK-MB isoenzyme, have allowed earlier recognition of AMI in nonsurgical patients. Serial monitoring with these methods has been utilized during the postoperative period in 20 noncardiac surgical patients and 100 patients undergoing coronary artery bypass grafting (CABG).
In the noncardiac surgery group, both isoenzymes were accurate in diagnosing AMI in the early postoperative period. Of the 100 patients in the CABG group, CPK-MB appearance in 21 correlated with AMI by electrocardiogram. The absence of CPK-MB postoperatively in 49 patients permitted a 73% incidence of new ECG abnormalities to be effectively resolved. Autopsy confirmation of AMI was obtained in two patients with nondiagnostic ECG, but with elevated CPK-MB. The elevated CPK-MB without ECG evidence of AMI in the remaining patients could possibly be explained by varying degrees of myocardial damage produced by intraoperative cardiac manipulation. These data demonstrate the value and sensitivity of CPK-MB isoenzyme determinations in the early recognition of postoperative acute myocardial infarction.
Experience with Emergency Aortocoronary Bypass Grafts in the Presence of Acute Myocardial Infarction
Authors: KEON WILBERT J. , BEDARD PIERRE , SHANKAR KANAKAIAHNAVARA R. , AKYUREKLI YASH , NINO ALFREDO , BERKMAN FRANK 
Published: June 2012

In the past 18 months 15 patients have undergone emergency aortocoronary bypass grafts using saphenous vein in the presence of acute myocardial infarction. Eight patients were in a state of cardiogenic shock, and seven patients were having severe cardiac arrhythmias, persistent hypotension, or signs of extending infarction.
There were three operative deaths, all of which occurred in the cardiogenic shock group of patients. One patient died three months after operation of a cerebrovascular accident. There are 11 surviving patients. One patient presently has angina, and one patient shows signs of left heart failure. The remaining patients are well at the present time.
We feel that angiography and surgery early in the course of a complicated myocardial infarct should diminish the immediate risk of death from both pump failure and cardiac rupture. Controlled prospective studies are required to elucidate the timing and indications for operation.
Direct Anastomosis of the Bilateral Internal Mammary Artery to the Distal Coronary Artery, Without a Magnifier, for Severe Diffuse Coronary Atherosclerosis
Authors: SUZUKI AKIO , KAY EARLE B. , HARDY JAMES D. 
Published: June 2012

Forty-three cases of direct anastomosis of unilateral or bilateral internal mammary artery (IMA) and distal coronary artery (DCA), with or without saphenous vein graft (SVG), for severe, diffuse, ischemic coronary artery disease are reported. The technique of anastomosis of IMA and DCA without a magnifier or microscope is discussed in detail. The operative mortality was less than 5% (2 of 43 patients). The initial patency rate of IMA and DCA anastomosis was 97% (34 of 35). Only 8 patients have been restudied 4 to 16 months after surgery. Flow through the IMA ranged from 30 to 60 cc/min, averaging 45 cc/min at the time of surgery. Postoperative ventricular function studies suggest an increase of left ventricular emptying and endocardial fiber-short-ening rate in those with well-functioning grafts.
The significant advantage of this technique is that it extends the indications for direct coronary artery reconstruction by anastomosing bilateral IMA to DCA near the apex, where the size of the artery is 1 to 1.5 mm and the SVG is more likely to occlude because of the size discrepancy and expected relatively low blood flow.
Clinical and Pathological Findings in Patients with "Floppy" Valves Treated Surgically
Authors: MCKAY ROXANE , YACOUB MAGDI H. 
Published: June 2012

Fifty-one patients underwent operation for "floppy" aortic or mitral valves during a three-year period between 1969 and 1972. Aortic valve disease occurred predominantly in men, while mitral valve lesions were equally distributed between men and women. In all groups, the mean age at operation was in the fifth decade; only patients with Marfan's syndrome came to operation before the age of 30 years. The clinical course was characterized by rapid deterioration in left ventricular failure after the onset of symptoms; an asymptomatic murmur was often present for many years prior to decompensation. Hemodynamic findings showed a wide range of abnormalities, with cardiac index consistently reduced to 1.5 L/m
2
/min ± 0.3 in aortic disease, and 1.6 L/m
2
/min ± 0.4 in mitral disease.

At operation the aortic cusps were thin and prolapsing and, in 5 of 11 patients, an aneurysm of the ascending aorta required resection. Mitral valves were soft, voluminous, with elongated and ruptured chordae. Prolapse of the cusps or billowing of a flail segment produced mitral regurgitation. In 3 patients, mitral valve replacement was complicated by acute dissection of the aorta at the site of the aortic clamp; this was diagnosed at operation and successfully repaired in 2 and discovered at autopsy in 1.
Histology of the valves confirmed the presence of diffuse myxomatous tissue in all cusps, cystic medial necrosis in the aorta, and varying degrees of collagen disorganization and necrosis in chordae tendineae. There was frequently deposition of similar myxomatous tissue around chordae and on the ventricular endocardium, possibly as a response to friction. Forty-four patients survived operation and have been followed up for periods up to 36 months. There were 2 late deaths, and 2 valves were replaced at a second operation. There has been no evidence of valve dehiscence.
It is concluded that heart disease resulting from connective tissue abnormalities is unique in its clinical course, the high incidence of associated aortic aneurysms and ruptured chordae tendineae, and the postoperative complications of valve dehiscence. Homograft replacement has given encouraging results.
Function of Cardiac Receptors
Authors: LINDEN R. J. 
Published: June 2012

Stimulation of right and left atrial receptors causes an increase in activity in sympathetic nerves [see table in the PDF file] to the sinoatrial node resulting in 1) an increase in heart rate, 2) a decrease in activity in nerves to the kidney, with an unknown effect, and 3) a diuresis caused by a blood-borne agent which is said by others to be a reduction in the concentration of antidiuretic hormone.
This exciting finding leaves us with many questions both pure and applied. One may be important to us now. Remembering that these receptors have been vividly demonstrated in the atria of man should we not ask, Are these two small chambers not more important in man than commonly appreciated?
P Wave Analysis in 2464 Orthogonal Electrocardiograms from Normal Subjects and Patients with Atrial Overload
Authors: ISHIKAWA KYOZO , KINI P. MANOHAR , PIPBERGER HUBERT V. 
Published: June 2012

The purpose of this study was to establish limits of normal for P wave measurements, and to propose criteria for routine electrocardiographic readings and for multivariate analysis to recognize left atrial overload (LAO) and right atrial overload (RAO) in the orthogonal electrocardiogram (ECG). Frank ECG's were obtained from 2464 subjects, including 580 normals, 164 patients with mitral valve disease (MVD) forming the LAO group, and 623 with chronic lung disease (CLD) as the RAO sample. Each group was divided into training and test sets. Using a digital computer, 120 different P wave measurements were computed for each ECG to find optimal discriminators between normal (N), LAO, and RAO.
In the training set of MVD, using three scalar measurements, LAO was recognized in 57% with 3% false positives. These criteria diagnosed LAO in 70% of the test cases of MVD. Four discriminators identified RAO in 30% and 37% of training and test cases of CLD with 11% false positives.
A set of 15 measurements obtained by multivariate analysis was used in a classification in which the three groups, N, LAO, and RAO were considered simultaneously. Ninety-four percent N, 74% LAO, and 45% RAO in the training sets, and 95%, 71%, and 24% in N, LAO, and RAO test sets were correctly identified. An attempt was made to correlate the rate of recognition of LAO with the degree of LAO estimated by cardiac catheterization. Data reported in the present study can serve as standard for P wave analysis in the Frank ECG.
Correlations Between the Chest Film and Hemodynamics in Acute Myocardial Infarction
Authors: KOSTUK WILLIAM , BARR JOHN W. , SIMON ALLEN L. , ROSS JOHN 
Published: June 2012

A series of 169 standardized chest films was analyzed relative to hemodynamic parameters obtained within 2 hr of the roentgenogram in 86 patients with acute myocardial infarction. The films were evaluated for cardiomegaly using the cardiothoracic ratio and the standardized, external left heart dimension. The radiographic appearance of the pulmonary vasculature was divided into levels of increasing severity: normal, pulmonary venous congestion, interstitial pulmonary edema, alveolar pulmonary edema. These were compared with wedge pressure levels of ⪕12, 13-18, 19-25, and >25 mm Hg, respectively. Correlations with the admission films of the 86 patients showed: 1) The appearance of the pulmonary vasculature accurately predicted the patient's wedge pressure on admission in 43% of the cases, overestimated it in 33% and underestimated it in 24%. 2) The presence of cardiomegaly and/or pleural effusion indicated an elevated wedge pressure with a high degree of certainty; however the absence of these signs did not exclude an elevated wedge pressure. 3) In only 62% of the studies was the chest film able to detect or exclude the presence of pulmonary venous hypertension. However, when wedge pressures were elevated to 19-25 mm Hg and over 25 mm Hg, 74% and 100%; respectively of roentgenograms had some evidence of pulmonary venous hypertension. 4) There was a high degree of correlation between the patient's admission physical findings, as evidenced by clinical classification, and the radiologic assessment of pulmonary venous hypertension.
There was no statistical variation in the accuracy of the estimate of wedge pressure in relation to the time elapsed from onset of symptoms of myocardial infarction. However, a therapeutic phase lag was encountered in 21 patients, the chest films remaining abnormal for a period of 1 to 4 days following return of the wedge pressure to normal. A diagnostic phase lag was encountered in 6 patients in whom the chest film did not correlate with elevation of wedge pressure for up to 12 hr. Furthermore, in 17 patients the films were normal in spite of a persistently elevated wedge pressure for 6 to 24 hr.
These studies document the limitations of the chest roentgenogram in predicting the hemodynamic status of patients with acute myocardial infarction.
Critical Pulmonary Stenosis with a Diminutive Right Ventricle in Neonates
Authors: FREED MICHAEL D. , ROSENTHAL AMNON , BERNHARD WILLIAM F. , LITWIN S. BERT , NADAS ALEXANDER S. 
Published: June 2012

Thirteen of 19 neonates seen in the first months of life with critical pulmonary stenosis (PS) and an intact ventricular septum had a diminutive right ventricle (RV) evidenced by electrocardiographic and angiocardiographic criteria. All were critically ill and at catheterization had hypoxemia secondary to right-to-left shunting at the atrial level, and RV hypertension. Right ventricular angiogram was useful to evaluate RV size and differentiate the children with PS from those with pulmonary atresia.
Pulmonary valvulotomy was the procedure of choice and in ten children the operation resulted in marked improvement with disappearance of cyanosis and cardiomegaly within one year. All are well six months to eight and one half years later. Two children had an additional unrecognized infundibular stenosis and required a shunt after valvulotomy because of persistant cyanosis. One child had a shunt without valvulotomy and died three years later in congestive failure.
The three children who have been recatheterized at two to three years postoperatively have RV pressures less than 60 mm Hg. In two the right ventricles more than doubled in size but remain small.
These children are critically ill and a good salvage rate depends on rapid evaluation and valvulotomy.
Pathogenetic Mechanisms of Prolapsing Aortic Valve and Aortic Regurgitation Associated With Ventricular Septal Defect
Authors: TATSUNO KATSUHIKO , KONNO SOUJI , ANDO MASAHIKO , SAKAKIBARA SHIGERU 
Published: June 2012

The developmental mechanisms of prolapse and regurgitation of the aortic valve which complicate ventricular septal defect (VSD) were investigated from the anatomical, angiographic, and surgical viewpoints on the basis of autopsied heart specimens, preoperative thoracic aortography, and surgical records.
Two major, conceptually distinct but functionally interdependent factors contribute to the aortic valve's prolapse into the VSD. The major feature of the first category is the lack of anatomical support for the valve. In subpulmonary VSD, a regional defect of the conal septal musculature which supports a section of the right coronary sinus and the annulus was observed. In infracristal VSD, a deficiency of the sinus of Valsalva was noted.
The hemodynamic effects, which actually produce prolapse of the anatomically unsupported valve into the VSD, is the second contributing factor. The left-to-right shunt of blood through the VSD during the early systolic phase pulls the sagging aortic valve into the defect. The distinctive feature of the second category is that prolapse of the anatomically unsupported valve is produced by hemodynamic effects. Diastolic aortic pressure does not appear to contribute greatly to bulging of the aortic valve into the right ventricular cavity. However, in the diastolic phase, the closed valve is subject to intra-aortic pressure, causing the free margin of the prolapsed cusp to hang down, to gradually become elongated, and finally to separate from the free margin of the other two cusps, and thus be rendered incompetent.
The Value of Left Parasternal Impulse Recordings in the Assessment of Mitral Regurgitation
Authors: BASTA LOTFY L. , WOLFSON PAUL , ECKBERG DWAIN L. , ABBOUD FRANCOIS M. 
Published: June 2012

Left parasternal cardiograms were recorded at the fifth intercostal space in 30 patients with mitral regurgitation. Early systolic outward movements (E), late systolic outward movements (LOM), and the ratio of the LOM area to the total area occupied by the left parasternal cardiogram (LPC area) were examined. Thirteen patients had pure mitral regurgitation due to ruptured chordae tendineae (ten patients) or "floppy mitral valve" (three patients). In these patients LOM/E correlated significantly with the regurgitation volume determined by the difference between angiographic and Fick stroke volumes, (
r
= 0.93,
P
< 0.01), and with the height of the "v" wave in the pulmonary artery wedge pressure tracings (
r
= 0.79;
P
< 0.01). Simultaneous recordings of left parasternal movements and pulmonary wedge pressures in eight patients in this group showed a close relationship between LOM and "v" waves.

Fourteen patients had rheumatic heart disease and mitral regurgitation associated with mitral stenosis of varying degrees of severity. In this group there was no significant correlation between LOM/E or LOM area/LPC area and the regurgitation volume or the height of the "v" wave. Of three patients who had congenital atrial septal defect in addition to mitral regurgitation, none had prominent LOM in the left parasternal cardiogram.
This study suggests that if mitral stenosis and atrial septal defect can be excluded on clinical evidence, the left parasternal cardiogram may be used to obtain a noninvasive assessment of the severity of mitral regurgitation, particularly in patients with recent onset of the disease.
The Missing Waveform Information in the Orthogonal Electrocardiogram (Frank Leads)
Authors: KORNREICH F. 
Published: June 2012

The orthogonal electrocardiogram (Frank leads) is a reasonable compromise between the demands of practicability and diagnostic accuracy. The accuracy has been enhanced by the use of computerized multivariate statistical procedures. The work of the last two or three decades, however, has shown that these leads account for only part of the total available surface information. In this paper, the missing waveform information with respect to the Frank leads is quantitatively and systematically determined and a method of retrieval is worked out.
The essence of this method rests on the empirical evidence obtained by testing each of the 126 surface electrocardiograms for the XYZ content. The results are analyzed by a least squares, best fit procedure. The poorly fitted curves are considered as additional waveform sources. The number and the sites of the additional information are determined on a test group of 207 patients. The "total" surface waveform information is found to be represented by nine surface leads. This set of waveforms is then tested on a control group consisting of 205 patients. An average resynthesis coefficient of 96% is reached. No further resynthesis is looked for because of the estimated noise level.
Although the waveforms recorded at these sites represent the minimum number of unique building blocks capable of synthesizing any waveform on the body surface, they cannot predict the surface potential distribution at all surface points. This information is "total" as far as statistical procedures-performing discriminant analysis on time-functions—are concerned. This "total" waveform information consists of a set of electrocardiograms recorded in each individual at nine well-defined anatomical locations.
Hemodynamic and Metabolic Responses to Vasodilator Therapy in Acute Myocardial Infarction
Authors: CHATTERJEE KANU , PARMLEY WILLIAM W. , GANZ WILLIAM , FORRESTER JAMES , WALINSKY PAUL , CREXELLS CARLOS , SWAN H. J. C. 
Published: June 2012

Hemodynamic effects of vasodilator therapy (phentolamine or nitroprusside) were studied in 38 patients with acute myocardial infarction (AMI). Cardiac metabolism was studied in 19 of the 38 patients. According to the initial level of left ventricular filling pressure (LVFP) and left ventricular stroke work index (SWI), patients were divided into three groups: Group I-nine pa- tients with LVFP 15 mm Hg or less; Group II-14 patients with LVFP > 15 mm Hg and SWI >20 g-m/m
2
; Group III-15 patients with LVFP > 15 mm Hg and SWI < 20 g-m/ m
2
. In Group I most patients were clinically uncomplicated. In Group IL most patients had clinical left ventricular failure including one patient who had clinical features of cardiogenic shock. Group III patients all had severe left ventricular failure, with eight patients in clinical shock.

In all groups LVFP, pulmonary artery pressure, right atrial pressure, and systemic and pulmonary vascular resistance decreased significantly with vasodilator therapy with only a slight to moderate decrease in arterial pressure. In Group I patients SVI decreased (-7%) together with an increase in heart rate. Significant improvement in left ventricular performance, however, was observed in Groups II and III as indicated by increased stroke volume index (SVI) and cardiac index (CI) and decreased LVFP. The increase in SVI and CI was of similar magnitude in both Group LI (SVI +18%, CI +24%) and Group III (SVI +28%, CI +29%) patients, a change suggesting that vasodilation thereby may be applicable and beneficial even in the presence of severe depression of cardiac performance.
Improved left ventricular performance in group II and III patients was accompanied by a slight decrease in coronary blood flow, myocardial oxygen consumption, and transmyocardial oxygen extraction. There was no change in myocardial lactate metabolism in any group. In vitro studies in isolated cat papillary muscle preparations showed no direct positive inotropic effect of either phentolamine or nitroprusside. Thus, significant improvement in left ventricular performance occurs during vasodilator therapy in patients with AMI and elevated LVFP, even in the presence of severe depression of cardiac performance. Furthermore, this improvement is not accompanied by increased metabolic cost. Vasodilator therapy, therefore, may have an important role in the treatment of pump failure complicating myocardial infarction.