bluuebunny/crossref_metadata_2025_split huggingface dataset:
Study of the Right Atrial Pressure Pulse in Functional Tricuspid Regurgitation and Normal Sinus Rhythm
Authors: RUBEIZ GEORGE A. , NASSAR MUNIR E. , DAGHER IBRAHIM K. 
Published: June 2012

Six patients having mitral stenosis, functional tricuspid regurgitation, and normal sinus rhythm were studied.
All patients had a systolic murmur at the lower left sternal border that increased with inspiration. Five patients had right heart catheterization while all six had right atrial pressure-pulses obtained by direct puncture of the right atrium with a 20-gage needle during right thoracotomy. Functional tricuspid regurgitation was proved by subsequent digital exploration of the tricuspid valve. The right atrial pressure pulses obtained were analyzed. The curves taken with the needle-puncture of the right atrium were comparable to those obtained at right heart catheterization. The X descent was well preserved in all six cases. In five patients the X descent was deeper than the Y descent, while in only one patient was the X descent equal to the Y descent. There was no exaggeration of the V wave in any of the curves. The role played by the compliance of the right atrium in preserving the normal contour of the right atrial curve, in spite of tricuspid regurgitation, is discussed.
It is concluded that in functional tricuspid regurgitation with normal rhythm the normally preserved X descent followed by a normal V wave may persist in the right atrial curve. The application of this finding to the clinical study of the jugular venous pulse in functional tricuspid regurgitation and normal rhythm is evident.
The Normal Apex Cardiogram
Authors: TAFUR EMILIO , COHEN LAWRENCE S. , LEVINE HAROLD D. 
Published: June 2012

The configuration of the apex cardiogram and its temporal relationship to the electrocardiogram, phonocardiogram, carotid pulse, and jugular venous pulse were analyzed in 25 normal subjects. In two patients with rheumatic valvular disease simultaneous electrocardiograms, phonocardiograms, left intraventricular pressure and apex cardiograms were obtained. In all cases the apex cardiogram showed a characteristic and reproducible contour in both its systolic and diastolic components. The curves of the apex cardiogram display all consecutive phases of the cardiac cyle; contraction-and-emptying and relaxation-and-filling. It bears a constant relationship to the phonocardiogram and is more useful as a reference tracing for acoustic events than the electrocardiogram, carotid pulse, or jugular venous pulse. The onset of the systolic wave of the apex cardiogram precedes the rise of left intraventricular pressure and mitral valve closure. The maximal systolic peak of the apex cardiogram occurs simultaneously with the onset of left ventricular ejection and the rise of the carotid pulse pressure. Small deflections are frequently inscribed on the apex cardiogram at the time of mitral, tricuspid, and aortic valve closure.
The wave form of the apex cardiogram is caused primarily by movements of the left ventricle against the chest wall. It is thus a translation of the sequence of hemodynamic events occurring in the underlying left ventricle. The inaccuracy of the jugular venous pulse for timing right- and left-sided cardiac events is emphasized.
Asymmetric Division of the Pulmonary Artery
Authors: GIKNIS FRANCIS L. , BAISCH BRUCE F. 
Published: June 2012

Asymmetric division of the pulmonary artery is reported in two cases. The right pulmonary artery arose immediately above the right cusp of the pulmonary valve, from a dilated trunk, which, although mistaken for main pulmonary artery, actually represented the proximal portion of the left pulmonary artery. A large interventricular septal defect, biventricular hypertrophy, and aortic hypoplasia complete the syndrome.
In one case the malformation was not recognized at the time of a banding procedure. The infant died, and the unprotected lung showed marked congestion at autopsy.
The nature of the pulmonary artery division may be such that an effective single band is technically impossible. Our case 1 suggests that unilateral banding in such an instance could be fatal if not immediately recognized and revised. Bilateral simultaneous banding would appear to be the palliative procedure of choice.
Atheromatous Embolism
Authors: ELIOT ROBERT S. , KANJUH VLADIMIR I. , EDWARDS JESSE E. 
Published: June 2012

From ulcerated atheromatous arterial lesions, crystals of cholesterol (cholesterol embolism) or larger fragments of atheromas (atheroembolism) may be dislodged. Such emboli may originate either in the aorta or in any of the major systemic arteries and lodge in their small ramifications.
Atheromatous embolism may yield states varying from those of subclinical nature to those of obvious arterial occlusion. Myocardial ischemia or infarction, small strokes, cutaneous nodules, splenic infarction, gastrointestinal bleeding, pancreatitis, hypertension, renal failure, and peripheral gangrene are among the clinical manifestations when arteries are occluded by emboli originating in atheromas of the aorta. Syndromes resembling polyarteritis nodosa and bacterial endocarditis may result from widespread embolism to small arteries.
The Coexistence of Acute Rheumatic Fever and Sickle Cell-Hemoglobin C Disease
Authors: IISKER SHELDON , FINKELSTEIN DAVID , SCHWARTZ STANLEY , MARULYALI KERIMAN , VALDES-DAPENA ANTONIO 
Published: June 2012

The clinical and postmortem findings in a case of sickle cell-hemaglobin C disease complicated by acute rheumatic fever with accompanying carditis, and rheumatic pneumonitis are presented and discussed. This is believed to be the first such case reported.
The recent literature pertaining to the cardiac manifestations of SS and SC hemoglobinopathies is briefly reviewed.
A possible explanation for the failure of the rheumatic process to respond to conventional therapy in our patient is given.
Ethacrynic Acid
Authors: CANNON PAUL J. , HEINEMANN HENRY O. , STASON WILLIAM B. , LARAGH JOHN H. 
Published: June 2012

Ethacrynic acid, a chemically different diuretic, has been evaluated in 82 patients. The drug was remarkably potent when administered intravenously (0.5 to 1 mg./Kg.) or by mouth (doses to 50 mg. four times per day). It proved particularly effective in patients with refractory edema, and in edematous states accompanied by azotemia or electrolyte disturbances. Its natriuretic effects added to those of other diuretics and potentiation actually appeared to occur when it was combined with a carbonic-anhydrase inhibitor.
Renal clearance data indicated that ethacrynic acid has a unique mode of action. There was little effect on glomerular filtration or renal plasma flow and its major action was to block sodium and chloride reabsorption probably in both proximal and distal portions of the renal tubules.
Ion exchange mechanisms seemed little affected by the drug because it characteristically increased both hydrogen and potassium ion excretion. In general the degree of induced potassium loss correlated well with the rate of endogenous aldosterone secretion. Furthermore, ethacrynic acid did not cause potassium loss in one adrenalectomized subject nor in another subject pretreated with an aldosterone antagonist.

Diuresis induced by ethacrynic acid was often accompanied by the development of systemic metabolic alkalosis. Factors in the development of this alkalosis were (1) urinary K
+
loss with hypokalemia, (2) urinary H
+
loss, and (3) in edematous patients the rapid large loss of relatively HCO
3
-
-free fluid from the extracellular fluid space. The systemic alkalosis was found to be accompanied by compensatory alveolar hypoventilation. These studies of the mechanisms of the alkalosis point to the occasional importance of the administration of chloride, of potassium, or of saline as corrective measures.

Diuresis with ethacrynic acid, like other diuretic agents, produced marked increases in the rate of aldosterone secretion of normal subjects. More variable effects were observed in patients with heart disease, possibly because improvement in their circulatory status operated to lower hormone secretion activity.
Ethacrynic acid had effects on urate excretion that resembled thiazide diuretics. Higher blood levels of intravenous administration were uricosuric. Lower blood levels of oral therapy caused renal urate retention and hyperuricemia.
Most of the problems associated with the use of ethacrynic acid appeared to be related more to its pharmacologic potency than to any truly toxic effect. Because of this it is suggested that the sensitivity and response pattern of each patient be determined in stepwise fashion. In most patients with edema an intermittent dosage schedule provides a more efficient diuretic response and allows time intervals for correction of any electrolyte imbalance. If used with a thorough understanding of its pharmacologic effects ethacrynic acid promises to be a most useful agent in the therapy of patients with difficult or refractory edema.
A Clinical Profile of Paroxysmal Hyperpnea in Cyanotic Congenital Heart Disease
Authors: MORGAN BEVERLY C. , GUNTHEROTH WARREN G. , BLOOM RONALD S. , FYLER DONALD C. 
Published: June 2012

A large series of patients with cyanotic congenital heart disease and inadequate pulmonary blood flow who required a systemic to pulmonary artery anastomosis was reviewed, along with a small current series of patients unselected as to surgical intervention.
Thirty-eight per cent of 190 patients in the first group had definite spells consisting of paroxysmal hyperpnea and increased cyanosis, frequently progressing to loss of consciousness. In the current group, 13 of 24 had spells. In the combined groups, there were three convulsions, eight cerebral vascular accidents, and six deaths due to the spell.
Age of onset varied from 1 month to 2 years, with the peak incidence between 2 to 3 months of age. The time of day at which spells occurred was recorded in only 15 patients in the large series: 11 occurred in the morning and four in the evening. In the smaller series, the patients who had only occasional episodes had them exclusively in the morning, whereas the severely affected patients had attacks at almost any time.
Precipitating factors, in order of over-all frequency, were crying, defecation, and feeding.
The most surprising finding was the lack of correlation of hyperpneic spells with resting arterial desaturation, although all arterial saturations obtained during attacks were quite low. Two patients with observed, typical paroxysms had arterial saturations under sedation of 93 and 98 per cent, in contrast to a patient with a 44-per cent saturation who had had no spells.
Cor Triatriatum as a Problem of Adult Heart Disease
Authors: MCGUIRE LOCKHART B. , NOLAN THOMAS B. , REEVE RICHARD , DAMMANN J. FRANCIS 
Published: June 2012

The occurrence of severe pulmonary venous obstruction due to the congenital anomaly known as cor triatriatum in a 19-year-old furniture mover is described. Relentless and massive hemoptysis led to pulmonary edema, and an attempt at surgical correction under unfavorable conditions was not successful.
Seven other cases of cor triatriatum in adults are reviewed. The hemodynamic abnormalities closely resemble mitral stenosis, except that pressures in the true left atrium were normal in the presence of elevated pulmonary capillary pressures. The availability of flow across the obstructing membrane during systole as well as diastole is probably the major element in the surprisingly good tolerance of severe degrees of anatomic obstruction for long periods of time. Slow increase in the degree of obstruction could also be a factor.
The clinical picture in these patients very closely resembles mitral stenosis. Hemoptysis appeared to be more frequent in cor triatriatum. Features suggestive of the correct diagnosis would include the absence of an opening snap, the absence of a typical murmur of mitral stenosis, regular rhythm, and lesser evidence of left atrial enlargement in the presence of obvious pulmonary hypertension. Five of these patients have undergone successful correction of their disease by operation.
Representative films from the first known angiograms in this condition in an adult are reproduced and discussed.
Fluid Retention Produced by Guanethidine
Authors: SMITH A. J. 
Published: June 2012

Total exchangeable sodium and blood volume increased during the first year's treatment of seven hypertensive patients with guanethidine. Creatinine clearance values fell over the same period.
A similar change was seen in two patients receiving reserpine. It is suggested that the hemodynamic changes produced by hypotensive drugs are insufficient completely to explain the observations. A direct effect of guanethidine on sodium reabsorption in the kidney may also be involved.
Experimental Large-Volume Hemodilution
Authors: GADBOYS HOWARD L. , LITWAK ROBERT S. , ISHIGURO JUNICHI , KAHN MELVIN 
Published: June 2012

1. Large-volume hemodilution was experimentally performed with a standardized reservoir arteriovenous fistula preparation in which intra- and extracorporeal volumes were kept constant. Vasopressors, buffers, hypothermia, and overinfusion were not employed.
2. Control studies with 10 ml/kg of various diluents revealed hemodynamic, volumetric, and biochemical stability of the experimental preparation.
3. Homologous blood exchange (100 ml/kg) with heart worm-free donors and recipients caused arterial hypotension, hepatic and pulmonary congestion, and depressed renal function.
4. All diluents tested produced hypotension and metabolic acidosis under the conditions of the experiment when used in amounts approximately equivalent to canine blood volumes. Ten per cent of the diluted animals expired from shock.
5. Blood pressure was initially better sustained with low molecular weight dextran, dextrose-Ringer's-albumin, and dextrose-Ringer's solutions, but the effect was short lived.
6. Cardiac outputs and total blood volumes did not change appreciably during the exchange infusions. Hematocrit changes reflected maintenance of intravascular volume. Peripheral resistance fell significantly, shortly after the onset of constant volume exchange.
7. Osmolality and oncotic activity of the diluents showed no clear-cut relationship to over-all stability of the infused animals.
8. The clinical advantages of hemodilution have been well established. Hemodynamic, volumetric, and biochemical differences between clinical perfusions and the experiments outlined herein attest to the roles of over-infusion, buffering, and hypothermia in ameliorating the experimentally observed sequelae.
9. The data suggest that the search should be continued for a more ideal blood substitute, as well as for low-prime, high-flow extra-corporeal systems.
Cardiopulmonary Bypass with Large Volume Nonblood Perfusate
Authors: NEVILLE WILLIAM E. , SCICCHITANO LEON , MABEN HAYWARD , BANUCHI FEDOR , PEACOCK HOWARD 
Published: June 2012

Experimental and clinical data have been presented which support the efficacy of using a large-volume nonblood perfusate for cardiopulmonary bypass. Dogs have consistently survived hemodilution of 100 to 120 ml/kg body wt when manifest hypoxic acidosis has been ameliorated with THAM (tris [hydroxymethyl] aminomethane) or sodium bicarbonate.
Fifty-eight patients have undergone total bypass with the disc oxygenator totally primed with 2,500 to 3,000 ml of buffered Ringer's or Ringer's lactate solution. Normothermia and moderate hypothermia have been employed with a hemodilution of 33 to 60 ml/kg body wt and a mean perfusion hematocrit of 24%. Despite the decrease in oxygen-carrying capacity of the blood, acidosis has not been observed during prolonged perfusions at median flow rates. Following oxygenator reinfusion, the postoperative total blood volume has been normal. However, a decrease in red cell mass was observed which necessitated the administration of "packed red cells." With this technique, the clotting time was more readily restored to normal, and kidney function was markedly improved over a comparable series of patients perfused with donor blood.
Effects of Aortic Regurgitation on Left Ventricular Performance
Authors: MORROW ANDREW G. , BRAWLEY ROBERT K. , BRAUNWALD EUGENE , Seipp Harry W. , Cobb David E. , Montgomery Maxine P. 
Published: June 2012

The volume of regurgitant blood flow and its effects on the performance of the left ventricle were assessed at operation in 14 patients with varying degrees of aortic regurgitation. Instantaneous forward and regurgitant flows in the ascending aorta were measured with a sine-wave electromagnetic flowmeter simultaneously with left ventricular and aortic pressures. In eight patients who had aortic regurgitation without associated stenosis, 63 to 75% of the total forward stroke volume regurgitated during the succeeding diastole. The calculated regurgitant orifice areas ranged from 0.13 to 0.44 cm
2
/m
2
. After replacement of the aortic valve with a Starr-Edwards prosthesis, the absence of regurgitant flow was proved in every patient, and the records of aortic blood flow closely resembled those seen in patients with normal aortic valves. Net forward blood flow increased by an average of 60%, total left ventricular stroke volume fell 42%, and the mean aortic pressure rose 29%. The pressure work of the left ventricle was elevated preoperatively in five of the eight patients (average 89 g-m/stroke/m
2
) and fell significantly to an average of 34 g-m/stroke/m
2
after valve replacement. Kinetic ventricular work was high in seven of the eight patients and comprised 10% of total work before replacement but only 4.8% afterward.

Similar observations were made in five patients with aortic stenosis and associated aortic regurgitation, ranging in severity from 24 to 72% of total forward stroke volume. In four patients in whom the valve was replaced, no residual regurgitation was present afterward, and net forward flow rose an average of 49%. Kinetic left ventricular work was extremely high in every patient and averaged 26% of total work preoperatively and 13% after valve replacement. In this group, pressure work was variable both before and after operation.
The studies described provide definitive information concerning the effects of aortic valve disease on left ventricular performance in man and document the favorable changes in flow, pressure, and left ventricular work which immediately follow aortic valve replacement.
The Changes in Cardiac Output with Reversion of Atrial Fibrillation to Sinus Rhythm
Authors: MORRIS JAMES J. , ENTMAN MARK , NORTH WILLIAM C. , KONG YIHONG , MCINTOSH HENRY 
Published: June 2012

Twelve patients were reverted from atrial fibrillation to sinus rhythm by the technic of "cardioversion." Brief, light anesthesia was the only drug employed. Under conditions of comparable oxygen consumption cardiac output was measured first in atrial fibrillation and then in sinus rhythm. Eleven patients were studied at rest and five during exercise.
Ten of the 11 patients studied at rest showed a reduced arteriovenous oxygen difference with sinus rhythm and seven of the 11 increased cardiac output 0.6 L./min. or greater, an average increase of 34 per cent. All five patients studied at exercise decreased the arteriovenous oxygen difference with sinus rhythm and cardiac output rose 1.1 L./min. or greater in all, an average increase of 17 per cent.
The Circulatory Effects of Intravenous Phentolamine in Man
Authors: TAYLOR S. H. , SUTHERLAND G. R. , MACKENZIE G. J. , STAUNTON H. P. , DONALD K. W. 
Published: June 2012

Circulatory observations have been made on six normal subjects and six hypertensive patients before and after the acute intravenous injection of 5 mg. of phentolamine.
The drug caused a prompt reduction in systemic vascular resistance which resulted in a rapid fall in systemic blood pressure in spite of an increase in heart rate and cardiac output.
Evidence is presented that the predominant vascular activity of the drug is to cause a direct relaxation of vascular smooth muscle, an effect far more potent than its antagonism of circulating catecholamines or its very much weaker sympathetic-blocking action. This direct depressor effect on vascular smooth muscle unaccompanied by any but slight sympathetic blocking activities endows the drug with theoretically ideal antihypertensive properties.
Phentolamine caused a transient but significant reduction in oxygen uptake in the majority of individuals. It is suggested that this may be due to a direct inhibition of cellular oxidative mechanisms.
An appraisal of the circulatory activities of the drug with particular regard to its use as a diagnostic test for pheochromocytoma leads to serious doubts, not only with regard to the precision with which the results of such tests can be interpreted, but also to the validity of the use of the drug as a reliable screening test for excessive circulating catecholamines.
Rheumatic Nephrosclerosis
Authors: BRUETSCH WALTER L. 
Published: June 2012

Three instances of rheumatic nephrosclerosis are described in patients with chronic rheumatic valvular heart disease. The underlying mechanism of this renal lesion consists of an obliterating rheumatic endarteritis, involving mainly medium-sized and small arteries of the renal cortex. The arterioles take relatively little part in these changes. The widespread occlusive vascular disease gives rise to innumerable microscopic infarctions, resulting in a coarsely granular external surface of the kidneys.
A similar granular appearance of cerebral convolutions may or may not occur in these cases, depending on whether the small meningeal and cortical vessels of the brain are extensively involved.
Cineradiographic Studies of the Early Systolic Click in Aortic Valve Stenosis
Authors: EPSTEIN ELLIS J. , CRILEY J. MICHAEL , RAFTERY EDWARD B. , HUMPHRIES J. O'NEAL , ROSS RICHARD S. 
Published: June 2012

An early systolic click and a normal or accentuated aortic second sound have been found in cases of aortic valve stenosis characterized cineradiographically by a mobile, dome-shaped valve. Impaired valve mobility was usually associated with a systolic click of low intensity, and in the presence of an immobile aortic valve there was no systolic click. The aortic second sound was correspondingly diminished or absent.
Early systolic clicks and loud aortic closure sounds were also present in patients in whom a diseased aortic valve had been replaced by three Teflon prosthetic leaflets. In most of these patients there was no systolic click before insertion of the prosthesis.
In the patients studied, the systolic click occurred at the end of the opening movement of the aortic valve at the onset of left ventricular ejection. It followed the crossover point of the left ventricular and aortic pressure pulses by a time interval ranging from 15 to 45 msec. (average 33 msec.).
The opening movement of the valve was thought to produce the systolic click by causing sudden tension of the valve membrane or sudden alteration in the velocity of blood flow. By analogy with the opening snap in mitral stenosis, the early systolic click may be regarded as the "opening snap" of the aortic valve. A systolic click is clinical evidence of a mobile aortic valve in patients with aortic valve disease.