bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular Abnormalities Following Surgery for Left-to-Right Shunts
Authors: LUEKER RICHARD D. , VOGEL JOHN H. K. , BLOUNT S. GILBERT 
Published: June 2012

Seventy-two patients with left-to-right shunts were studied an average of 5 years after operation. Persistent residual shunts occurred in 24 of the 72 patients and were unsuspected clinically in 11. While significant residual shunts were usually suspected in the group with ventricular septal defects (VSD), residual shunts in the group with atrial septal defects (ASD) were frequently unsuspected.
Abnormalities in pulmonary vascular reactivity as determined by excessive responses to hypoxia or exercise, or both, were noted in a significant number of cases of VSD and patent ductus arteriosus. Such unusual reactivity was not seen as frequently in the ASD group. Low cardiac output responses to exercise were noted in nearly half of the patients.
These studies illustrate the importance of long-term follow-up hemodynamic studies on postoperative patients with left-to-right shunts and indicate the necessity for exercise and hypoxia studies in addition to resting observations.
Percutaneous Right and Left Heart Catheterization in Children
Authors: SIMOVITCH HARVEY , HOHN ARNO R. , WAGNER HENRY R. , VLAD PETER , SUBRAMANIAN S. , LAMBERT EDWARD C. 
Published: June 2012

One thousand patients, ranging in age from 4 months to 26 years, underwent percutaneous catheterization of the femoral artery and femoral vein. Cardiac catheterization was combined with selective angiocardiography in all patients.
The catheter entered the right ventricle in 972 of 990 patients (98%) and the left ventricle in 832 of 856 (97%), including 82 of 89 patients (92%) with aortic stenosis.
There were no deaths, perforations of the heart, or loss of tissue. The peripheral pulse was decreased in 6% (49 of 856) and absent in 2% (17 of 856). Other complications included two uneventful perforations of the aortic arch, two lacerations of the femoral artery, three lacerations of the femoral vein, a false aneurysm of the femoral artery, and a cerebrovascular accident.
Our findings indicate that, in children more than 2 years old and weighing more than 10 kg, the percutaneous method is safe, informative, and associated with less arterial circulatory complications than the approach from the surgically exposed artery.
Juxtaposition of Atrial Appendages Associated with Normally Oriented Ventricles and Great Arteries
Authors: BECKER ANTON E. , BECKER MIES J. 
Published: June 2012

A case is reported of a stillborn infant in whom both atrial appendages lay to one side of the great arteries, so-called juxtaposition of the atrial appendages.
The unusual features of the case reported are twofold. First, both atrial appendages lay to the right of the great vessels while, more commonly, juxtaposed atrial appendages lie to the left of the aorta and pulmonary trunk.
Second, in our case the great vessels were normally related and no major intracardiac malformations were present (only an atrial septal defect and a bicuspid pulmonary valve), while, more commonly, the great vessels are transposed and major intracardiac malformations are associated.
Complications of Left Heart Angiography
Authors: BECKMANN CHARLES H. , DOOLEY BYRON 
Published: June 2012

A study of 1,000 consecutive left heart cineangiocardiograms was made to determine the frequency of various complications. Ten per cent of angiographic procedures caused minor complications such as nausea, vomiting, transient arrhythmias, loss of pulse, or hives. Most of these complications were gone before the patient left the cardiac catheterization laboratory.
Major problems were associated with 3.1% of the angiograms performed. The majority involved either vessel thrombosis (1.2%) or cardiac complications such as arrhythmias, intramyocardial dye injection, or myocardial infarcts (1.4%). Femoral arterial thrombosis was especially frequent in patients with mitral valve disease and low cardiac index. The use of lidocaine-lubricated catheters, tape traction hemostasis, and Fogerty catheter clot removal virtually eliminated brachial arterial thromboses. This route is now used almost exclusively for left heart angiography at our institution.
Most cardiac complications resulted from open-end catheter angiography, especially through transseptal catheters. The frequency of major cardiac complications has decreased markedly since the regular use of closed-tip catheters via the brachial artery route was begun for left heart angiography.
Arterial Thrombus Formation During Clinical Percutaneous Catheterization
Authors: FORMANEK GUSTAVE , FRECH ROBERT S. , AMPLATZ KURT 
Published: June 2012

Deposition of thrombotic material on catheters was observed following more than 50% of 93 diagnostic catheterizations. The incidence of deposition of thrombotic material on catheters remaining in the body for more than 1 day was 100%. Polyethylene and siliconized polyurethane catheters were less thrombogenic than Teflon end-occluded catheters.
A definite time relationship between the thrombus formation and the duration of the catheterization procedure was noted.
The growth of thrombi on the outside of catheters does not appear to be linear since catheters can remain in place for 10 days or more.
Postcatheterization thrombosis is believed to be due to thrombi stripped from the catheter by the arterial wall. The thrombus which originally encases the catheter will pile up at the puncture site as the catheter is withdrawn. The thrombus may remain attached at the puncture site or embolize peripherally.
Heterograft Replacement of the Mitral Valve: Clinical, Hemodynamic, and Pathological Features
Authors: KOUCHOUKOS NICHOLAS T. , KERR ALAN R. , SHEPPARD LOUIS C. , CEBALLOS RICARDO , KIRKLIN JOHN W. 
Published: June 2012

Seventeen patients had replacement of their diseased mitral valves with formalin-fixed, mounted porcine heterografts over a ten-month period with no operative or postoperative mortality.
Hemodynamic studies early after operation indicate that patients with heterograft mitral valves behave no differently than patients who have had replacement of the mitral valve with ball valves. The early postoperative myocardial dysfunction present after mitral valve replacement is probably not related to the presence of a caged ball or other such device in the left ventricle. Late hemodynamic studies in two patients have shown complete competence of the valves and minimal mean diastolic and absent end-diastolic gradients at rest between the left atrium and left ventricle.
Six of the valves became incompetent and were removed from 2 to 11 months after operation. Histological study of these valves suggests that the development of incompetence in five of them was related to absorption of muscle beneath the right coronary cusp with retraction of the tissues supporting this cusp and subsequent avulsion of the adjacent tissues from the supporting frame.
The 11 patients whose valves remain competent are all clinically improved 6 to 15 months after operation. There have been no thromboembolic complications in any of the patients although long-term anticoagulation has not been used.
The failure of the aortic valve heterografts mounted on rigid frames in this series appears related to mechanical stress resulting from imperfect coaptation of the valve cusps, either from resorption of heterograft tissue or improper mounting. Further studies are necessary to clarify these observations.
Total Excitation of the Isolated Human Heart
Authors: DURRER DIRK , VAN DAM R. TH. , FREUD G. E. , JANSE M. J. , MEIJLER F. L. , ARZBAECHER R. C. 
Published: June 2012

To obtain information concerning the time course and instantaneous distribution of the excitatory process of the normal human heart, studies were made on isolated human hearts from seven individuals who died from various cerebral conditions, but who had no history of cardiac disease. Measurements were made from as many as 870 intramural terminals.
In the isolated human hearts three endocardial areas were synchronously excited 0 to 5 msec after the start of the left ventricular activity potential. These areas increased rapidly in size during the next 5 to 10 msec and became confluent in 15 to 20 msec. The left ventricular areas first excited were (1) high on the anterior paraseptal wall just below the attachment of the mitral valve; (2) central on the left surface of the interventricular septum and (3) posterior paraseptal about one third of the distance from apex to base. The last part of the left ventricle to be activated usually was the posterobasal area. Endocardial activation of the right ventricle was found to start near the insertion of the anterior papillary muscle 5 to 10 msec after onset of the left ventricular cavity potential. Septal activation started in the middle third of the left side of the interventricular septum, somewhat anteriorly, and at the lower third at the junction of the septum and posterior wall. The epicardial excitation pattern reflected the movements of the intramural excitation wave. Conduction velocity was determined in one heart by an appropriate stimulation technic. Atrial excitation, explored in two hearts, spread more or less according to concentric isochronic lines.
Control studies, carried out on five canine hearts, disclosed that the pattern of ventricular excitation did not change after isolation and perfusion. However, total excitation was completed earlier in the isolated heart, and conduction velocity increased.
Careful mapping illustrations are presented.
Observations on Atrioventricular Conduction in Patients with Bilateral Bundle-Branch Block
Authors: SCHUILENBURG R. M. , DURRER DIRK 
Published: June 2012

Atrioventricular conduction was studied in three patients, each representing a different grade of bilateral bundle-branch block. His bundle activity was recorded by a catheter technic. Two of the three patients had experienced Adams-Stokes attacks.
The first patient had right bundle-branch block with left axis deviation at the time of catheterization. Increases in the atrial driving rate resulted in progressive lengthening of the A-H interval, the H-V interval remaining constant and within normal limits. Second degree A-V block occurred at atrial rates higher than 140/min. The site of this block was located above the His bundle. On no occasion was the impulse blocked distally to the His bundle.
The second patient had a Mobitz type II A-V block with complete left bundle-branch block and a prolonged P-R interval in the conducted beats. The block of the nonconducted beats could be located distal to the His bundle. H-V block occurred more frequently when the atrial rate was increased. Second degree A-H block occurred at rates above 140/min. At these rates interesting patterns were seen due to conduction impairment at two levels in the A-V conduction system.
The third patient presented with complete A-V block. The site of this block could be located at a level lower than the His bundle. A-H conduction studied with increases of atrial rate and with atrial premature beats seemed to be normal. There was evidence for the existence of retrograde V-A conduction in this patient.
Total Anomalous Pulmonary Venous Connection
Authors: GATHMAN GARY E. , NADAS ALEXANDER S. 
Published: June 2012

Experience with 75 cases of proven total anomalous pulmonary venous connection without other significant cardiac malformations treated at the Children's Hospital Medical Center in Boston from January 1950 to June 1968 forms the basis of this report. Clinical observations of patients with this defect presenting in infancy are reviewed in depth, and the few patients presenting after 1 year of age are included to give a spectrum of this disease in the pediatric age group.
Chest x-rays and complete electrocardiograms were available in each case. Sixty-one patients had partial or complete cardiac catheterizations. The anatomic and physiologic data from these studies are presented, and the results of medical management are evaluated.
On the basis of the physiologic data, an approach to management is proposed which includes early operative intervention in those patients with pulmonary vascular obstruction. If pulmonary hypertension is present without vascular obstruction, medical management may be tried. If pulmonary hypertension is not present and particularly if there is a significant gradient across the right ventricular outflow tract, medical management appears to be the treatment of choice until operative intervention can be undertaken with less operative mortality.
Transvenous Cardiac Pacing
Authors: GULOTTA STEPHEN J. 
Published: June 2012

Optimal electrode position for long-term transvenous cardiac pacing is in the apex of the right ventricle. Intracardiac electrograms, surface electrocardiograms, frontal fluoroscopy, lateral roentgenograms, and pacing threshold levels were studied in two groups of patients: One group was comprised of five patients with permanent pacemakers who had inadvertent malplacement of the pacing catheter, and the second group was composed of six patients undergoing temporary pacing from selected sites within the coronary venous system. The results of this study indicate that the appearance of a characteristic right ventricular endocardial complex recorded from the catheter tip is the most reliable guide to proper electrode placement. Low threshold levels, good position demonstrated roentgenographically, and typical surface electrocardiographic patterns of left bundle-branch block were all noted during intentional and following inadvertent malpositioning of the electrode within the coronary venous system and do not, therefore, guarantee proper positioning.
A successful routine for pacemaker insertion has been established which includes fluoroscopy, lateral roentgenograms, intracardiac and surface electrocardiograms, and threshold analysis. Satisfaction of all these tests appears to insure proper electrode positioning.
Therapeutic Defibrination and Heparin Therapy in the Prevention and Resolution of Experimental Venous Thrombosis
Authors: RAHIMTOOLA SHAHBUDIN H. , RAPHAEL MAURICE J. , PITNEY W. ROBERT , OLSEN ECKHARDT J. G. , WEBB-PEPLOE MICHAEL 
Published: June 2012

The application of phenol to the femoral veins of anesthetized dogs resulted in an occluding thrombus in 24 of 25 veins at 1 week. Serial venography and eventual histology showed that these veins remained occluded over a 5-week observation period, the thrombi undergoing organization. Therapeutic defibrination was achieved with administration of an enzyme from venom of the pit viper (Arvin). Arvin, administered for 1 week immediately following phenol application and before thrombus formation had occurred, prevented thrombosis in all 10 such veins, and serial venography for a further 4 weeks showed that the veins remained patent. Administration of Arvin was begun 24 hours postoperatively, when venography had demonstrated an occluding thrombus and failed to clear any of 11 veins after 3 weeks of treatment.
Intravenous administration of heparin, 10,000 units, at 6, 6, and 12-hour intervals in a 24-hour period, was begun immediately after phenol application and continued for 1 week; 10 of 12 veins were blocked at 1 week. Following the same dose of heparin every 6 hours four of eight veins were blocked at 1 week.
The results indicate that when the vascular endothelium is damaged, therapeutic defibrination is more effective than heparin therapy in preventing venous thrombosis. Arvin therapy has no significant thrombolytic effect even if the thrombus is less than 24 hours old.
Left Ventricular Dynamics in Complete Right Bundle-Branch Block with Left Axis Deviation of QRS
Authors: BARAGAN J. , FERNANDEZ F. , COBLENCE B. , SAAD Y. , LENÈGRE J. 
Published: June 2012

The time intervals defined by the simultaneous recording of an electrocardiogram, phonocardiogram, indirect carotid pulse curve, and apexcardiogram made it possible to compare the left ventricular (LV) dynamics in a group of 33 cases of complete right bundle-branch block with left axis deviation (RBBB-LAD) with two control groups, one consisting of 30 cases of complete right bundle-branch block without left axis deviation (RBBB without LAD) and the other of 30 cases of left axis deviation (LAD) alone.
The LV dynamics of RBBB-LAD differed from those of both control groups of RBBB without LAD and of LAD alone by a significantly late onset of LV ejection in the former, resulting from both late onset and slow rise of LV contraction. On the other hand, the delayed LV activity was not significantly different between the group of RBBB-LAD and a previously studied group of complete left bundle-branch block.
Normal limits for these intervals were looked for to make it possible to diagnose a late LV activity in the individual patient, and so provide a further argument in the discussion for an eventual cardiac pacing in doubtful cases.
Finally, it was not felt possible to use these intervals to try to localize the site of the conduction disturbance, whether in the bundle branch or in the ventricular wall itself.
Electrocardiographic Differentiation Between Left Ventricular Hypertrophy and Anterior Myocardial Infarction
Authors: KINI P. M. , EDDLEMAN E. E. , PIPBERGER H. V. 
Published: June 2012

Electrocardiograms recorded from patients with uncomplicated left ventricular hypertrophy (LVH) often show loss of initial anteriorly directed QRS forces. An attempt was made to differentiate these records from electrocardiograms showing a similar pattern as a result of anterior myocardial infarction (MI). Orthogonal ECGs (Frank system) obtained from 103 patients with LVH were compared to ECG obtained from 327 patients with MI. The ECG were selected on the basis of absence of Q waves in lead Z which in the conventional ECG corresponds to absence of the R wave in right precordial leads. With two simple scalar measurements, namely R amplitude in lead X ≥ 1.2 mv and the sum of amplitudes of R in leads X and Z ≥ 2.5 mv, 66% of LVH cases were recognized. With these criteria, 88% of the MI records were also correctly classified. The same measurements identified 59% of an independent sample of 66 cases of LVH with no Q in lead Z. By utilizing linear discriminant function analysis, 75% of the cases of LVH, 80% of the MI, and 70% of the independent group of LVH were correctly classified.
Classification procedures were also tested on 48 autopsy cases with results slightly inferior to those obtained on clinical samples.
Direction of initial instantaneous QRS vectors in the transverse plane proved to be much less efficient than scalar measurements or multivariate analysis in the separation between LVH and MI.
This study confirms the difficulties concerning the correct interpretation of the significance of loss of anteriorly directed forces in the presence of LVH. However, the error rate in diagnosis can be considerably reduced by the use of criteria proposed on the basis of this investigation.
Atrial Septal Defect in the Older Patient
Authors: SAKSENA FRANKLIN B. , ALDRIDGE HAROLD E. 
Published: June 2012

Twenty-four patients over 35 years of age with a secundum atrial septal defect (ASD) had a clinical and hemodynamic assessment prior to surgical closure and a follow-up assessment an average of 6 years afterward. All were initially in functional class III or IV. Twenty-three patients had a moderate to large left-to-right shunt. Five had elevated pulmonary vascular resistance (PVR); all had moderate to severe pulmonary hypertension. Left ventricular dysfunction (LVD) was found in 17.
Following surgical closure, 22 patients showed sustained clinical improvement and were in class I or II. The mean pulmonary artery pressure fell to normal or mildly elevated values in 21. The PVR was now elevated in 14 patients, suggesting continued progression of obliterative pulmonary vascular disease. Three had small residual shunts. LVD, however, persisted after operation, which may reflect underlying myocardial pathology unrelated to the ASD.
Operative closure of ASD, therefore, is recommended for disabled patients over 35, even if they have moderate pulmonary hypertension or congestive heart failure.
Permanent Pacing of the Left Atrium for Treatment of WPW Tachycardia
Authors: PRESTON T. A. , KIRSH MARVIN M. 
Published: June 2012

A patient with WPW paroxysmal tachycardia was treated with a permanent artificial pacemaker, with the electrodes attached to the left atrium. The pacemaker is turned off at all times except when the patient activates it by holding a magnet over the implanted power unit. Random atrial pacing at a rate of 108/min has always terminated the tachycardia within 1 min, and usually within 10 sec.
Left atrial pacing produced WPW type A QRS complexes, whereas regular sinus rhythm and right atrial pacing resulted in more normal QRS complexes. The distinct difference in the QRS complexes suggests preferential conduction through an abnormal pathway during left atrial pacing.
Abnormal Left Ventricular Contraction in Patients with Mitral Stenosis
Authors: HELLER STANLEY J. , CARLETON RICHARD A. 
Published: June 2012

Twenty-five patients with pure mitral stenosis and nine normal subjects were studied by selective left ventricular cineangiocardiography. Left ventricular volumes were measured at end systole, throughout diastole, and at end diastole. Although filling curves showed that the left ventricles filled slowly in patients with mitral stenosis, normal end-diastolic volumes were attained provided diastole lasted 400 msec. Despite normal end-diastolic volumes, end-systolic volumes were significantly larger (
P
< 0.0005) in the patients with mitral stenosis (av=64.6 ml) than in normal subjects (30.8 ml). Correspondingly, left ventricular ejection fractions were significantly lower (
P
< 0.0005) in the patients with mitral stenosis (55.7%) than in the normal subjects (76.7%).

Qualitative analysis of the cineangiocardiograms demonstrated that 20 patients with mitral stenosis had distortion, immobility, and rigidity of the posterobasal area of the left ventricle.
It is hypothesized that a rigid "mitral complex" immobilizes the posterobasal area of the left ventricle in patients with mitral stenosis, thereby impairing left ventricular contraction, and that this impairment is an important factor in the reduced cardiac output of these patients.
Left Ventricular Pressure-Volume Alterations and Regional Disorders of Contraction During Myocardial Ischemia Induced by Atrial Pacing
Authors: DWYER EDWARD M. 
Published: June 2012

Left ventricular function, pressure-volume relationships, and wall motion were studied by sequential cineventriculography during acute myocardial ischemia, induced by atrial pacing, in 10 subjects. Observations made in this group were contrasted to data obtained during atrial pacing in a smaller normal group.
An acute alteration in the pressure-volume relation occurred in five subjects during ischemia with an elevation of the left ventricular end-diastolic pressure, associated with a declining end-diastolic volume.
A deterioration in ventricular function, as manifested by a rightward shift of the ventricular function curve, was also observed in eight of the angina group. A more severe instance of myocardial failure was seen in one patient, who, during angina, demonstrated a marked increase of both left ventricular end-diastolic pressure and end-diastolic volume.
Asynergy of left ventricular contraction occurred acutely during angina and was usually manifested by regional akinesis or hypokinesis. Diminished wall motion was often found in more than one region, reflecting multiple vessel involvement. We were generally able to correlate the dynamc alteration in wall motion with deteriorating ventricular function.