bluuebunny/crossref_metadata_2025_split huggingface dataset:
Masked Infundibular Pulmonary Obstruction in Ventricular Septal Defect with Pulmonary Hypertension
Authors: VOGEL JOHN H. K. , BLOUNT S. GILBERT 
Published: June 2012

Recent observations have suggested that infundibular pulmonary obstruction may exist in association with a ventricular septal defect and pulmonary hypertension but not be apparent because of greater obstruction in the pulmonary arterial bed which "masks" the more proximal infundibular obstruction. Following the administration of the pulmonary vasodilator tolazoline to patients with a ventricular septal defect and pulmonary hypertension, pullback tracings have revealed infundibular obstruction where none was apparent in control studies.
An analysis of the catheterization findings in those patients with a ventricular septal defect and pulmonary hypertension revealed 32 subjects who had received and responded to tolazoline. Twenty-seven of these patients had gradients after tolazoline ranging from 8 to 73 mm. Hg.
The findings suggest that in the presence of pulmonary hypertension, infundibular obstruction is present from birth and continues to develop, becoming apparent or "unmasked" by virtue of a reduction (acutely with drugs or slowly by delayed maturation) in pulmonary vascular resistance.
Electrocardiographic Findings Among the Adult Population of a Total Natural Community, Tecumseh, Michigan
Authors: OSTRANDER L. D. , BRANDT RALPH L. , KJELSBERG MARCUS O. , EPSTEIN FREDERICK H. 
Published: June 2012

Electrocardiograms were recorded from 2,449 men and 2,689 women past 16 years of age, 85 per cent of the adult population of Tecumseh, Michigan. The tracings were classified according to the system of Blackburn and associates and the various categories are tabulated and discussed.
Abnormal Q waves and certain "nonspecific" changes such as left axis deviation, high-amplitude R waves, ST-segment depression, T-wave inversion, first-degree atrioventricular block, complete intraventricular block, and arrhythmias increased in frequency with age. Hypertension and hyperglycemia occurred with significant frequency among persons with some of these changes. It seems likely that such "nonspecific" electrocardiographic abnormalities are frequently signs of coronary or hypertensive heart disease.
The mean amplitudes of QRS complexes of men less than 50 years of age were greater than those of women. Such sex differences should be taken into account in the interpretation of clinical electrocardiograms.
Further examinations and surveillance of the participants of this study are expected to clarify the significance of the electrocardiographic features discussed and the relationships between such features and other physiologic variables.
The Thoracic Duct
Authors: RABINOVITZ ADOLPH J. , SAPHIR OTTO 
Published: June 2012

In a search for atheromata, multiple sections of thoracic ducts from 119 autopsied individuals, varying in age from newborns to 91 years, were studied histologically with various stains, including fat stains on frozen sections of 84 different ducts.
No atheromata were found. Changes in the wall of the duct apparently related to aging included increasing density, minimal intimal fibrosis, degenerative changes in the internal elastic plate, and the appearance of occasional microscopic fibrous polypoid projections into the lumen.
Although fat was demonstrated with ease in the wall of the duct and did not appear to be related to the intimal fibrosis, it appeared to be passing through the wall of the vessel without exciting either inflammatory reaction or fibrosis.
The findings in the thoracic duct were evaluated with respect to the conventionally accepted definitions of atherosclerosis and phlebosclerosis. It was concluded that the sclerotic changes found in the thoracic duct are more like phlebosclerosis and unlike atherosclerosis in that they bear no relationship to lipid infiltration and reaction thereto. The term "lymphatic sclerosis" was suggested for the condition.
The common presence of lipid in the wall of the thoracic duct without reaction and without true atheroma formation indicates that factors beyond mere lipid infiltration of vascular walls must play an important role in the pathogenesis of atherosclerosis.
Termination of Left Superior Vena Cava in Left Atrium, Atrial Septal Defect, and Absence of Coronary Sinus
Authors: RAGHIB GUNAY , RUTTENBERG HERBERT D. , ANDERSON RAY C. , AMPLATZ KURT , ADAMS PAUL , EDWARDS JESSE E. 
Published: June 2012

Eight cases of termination of the left superior vena cava in the left atrium are reviewed pathologically and clinically.
In three of the five patients who died, pathologic examination revealed three anomalies which, together, are considered to form a developmental complex. The anomalies are (1) termination of the left superior vena cava in the left atrium, (2) absence of the coronary sinus, and (3) an atrial septal defect lying in the postero-inferior angle of the atrial septum. In the two remaining fatal cases, the aforementioned anomalies were associated with persistent common atrioventricular canal. In this situation, the atrial septal defect of the latter malformation was confluent with the atrial septal defect of the anomalous complex described.
The coexistence of three anomalies-the left superior vena cava terminating in the left atrium, absent coronary sinus, and atrial septal defect-is considered to result from a single developmental abnormality. This takes the form of failure of complete formation of the left atriovenous fold, that fold which normally develops along the left side of the junction of the sinus venosus and the atrial portion of the heart.
Clinically, features of increased pulmonary blood flow, coupled with duskiness of the skin, were the significant abnormalities.
When cardiac catheterization was attempted through a right-sided vein, the data revealed a left-to-right shunt at atrial level, while levels of arterial oxygen desaturation were present.
Except in cases with coexistent ventricular septal defect, pulmonary hypertension was absent.
In each of the four patients in whom cardiac catheterization was performed through a left antecubital vein, the catheter was advanced into the left superior vena cava, left atrium, and left ventricle. This was substantiated by angiocardiography in three of the four patients. In our experience, angiocardiography was the most reliable procedure to substantiate the termination of the left superior vena cava in the left atrium.
The present study suggests that, in the absence of pulmonary hypertension, a left-to-right transatrial shunt associated with systemic arterial oxygen desaturation may indicate the presence of a persistent left superior vena cava terminating in the left atrium. Moreover, an atrial septal defect identified surgically as lying in the postero-inferior angle of the atrial septum should suggest that an additional anomaly may be present in the form of termination of the left superior vena cava in the left atrium.
Value of Chlorthalidone Plus Reserpine in Moderately Severe and Severe Hypertension
Authors: FINNERTY FRANK A. , KAKAVIATOS NIKOS , CHUPKOVICH VICTOR 
Published: June 2012

One hundred nine patients with moderately severe hypertension and 12 patients with severe hypertension received the combination of 50 mg. of chlorthalidone plus 0.25 mg. of reserpine combined in a single tablet (Regroton) administered once daily for an average duration of 2 years.
The ease of administration (one tablet daily), the effectiveness (78-per cent good response), the lack of development of drug resistance over a 2-year period, and the small incidence of side effects would seem to make the combination of 50 mg. of chlorthalidone plus 0.25 mg. of reserpine the ideal treatment for most patients with hypertension. If a more rapid reduction in arterial pressure is indicated, as in patients with severe hypertension, or if a satisfactory therapeutic response has not been observed in 3 to 4 months in patients with moderately severe hypertension, suboptimal doses of other antihypertensive agents may be added.
Multiple Muscular Ventricular Septal Defects
Authors: FRIEDMAN WILLIAM F. , MEHRIZI ALI , PUSCH ALLEN L. 
Published: June 2012

Defects in the muscular portion of the interventricular septum are frequently multiple. Although their incidence is significant, scant attention has been paid them as a distinct entity. This report concerns seven patients with multiple muscular ventricular septal defects seen between 1956 and 1962. The patients ranged in age from 4 months to 9 years; five were less than 2 years old. Symptoms and signs of growth retardation, failure to thrive, and marked cardiac decompensation were present in each case. Electrocardiographic evidence of combined ventricular hypertrophy and incomplete right bundle-branch block was noted in each instance. Right heart catheterization demonstrated marked pulmonary hypertension of the high-flow, low-resistance type. These routine studies could not distinguish multiple muscular ventricular septal defects from the more usual membranous septal defect. All patients had cardiac surgery. There was one survivor. In three instances difficulty in identifying all of the multiple fenestrations prevented complete surgical repair. Postmortem examination was done in six patients. The sievelike appearance of the muscular ventricular septum was the most striking gross finding in the majority of the cases. Histologic analysis of the pulmonary vascular structural alterations did not reveal marked changes in any of the cases.
In contrast to the widespread belief that most isolated muscular septal defects are innocuous, these seven examples of multiple muscular defects were associated with a picture of severe heart disease. Every effort should be made to diagnose the lesion prior to surgery. Recognition of the multiple nature of the defect is a necessary preliminary to successful therapy. It is hoped that preoperative left heart angiocardiography will successfully demonstrate the multiple lesions.
Ventricular Response in Atrial Fibrillation
Authors: LANGENDORF RICHARD , PICK ALFRED , KATZ LOUIS N. 
Published: June 2012

The ventricular response in atrial fibrillation is determined by the long refractory period of the AV junction. Since an atrial impulse is always available for transmission to the ventricles, a regular ventricular rhythm would be expected, the rate of which would reflect the duration of a stable junctional refractory phase. The irregularity of the ventricular action associated with atrial fibrillation, therefore, indicates changes of refractoriness of the AV junctional tissues from cycle to cycle. This can best be attributed to varying degrees of penetration of "blocked" atrial impulses into parts of the AV junction, and to the effect of such concealed conduction on the propagation of subsequent impulses.
The following facts are pointed out and illustrated as evidence of concealed AV and VA conduction during atrial fibrillation: (a) Occurrence of a "compensatory pause" following a ventricular premature systole. (b) Failure of an AV nodal escape to appear at the expected time due to concealed discharge of a subsidiary AV nodal pacemaker by a penetrating atrial impulse. (c) Acceleration of the ventricular rate when atrial fibrillation changes to flutter (elimination of concealed conduction with slowing of the atria). (d) A tendency for two or more long cycles to occur in succession (each containing one or more concealed responses).
The reasons for the variations of the refractory period at different levels of the AV junction as a result of concealed conduction are analyzed. Their complex interplay may readily account for the over-all irregularity of the ventricular response associated with atrial fibrillation.
Postinfarction Ventricular Septal Defect
Authors: BARNARD PIETER M. , KENNEDY JOHN H. 
Published: June 2012

A series of four patients who died following rupture of the ventricular septum due to myocardial infarction has been reported. One of these died of hemorrhage due to a defective clotting mechanism 8 hours after successful surgical repair.
The 13 cases of surgical repair of postinfarction ventricular septal defect reported by other authors are reviewed.
The time interval is important and preferably 3 to 6 months should elapse following myocardial infarction before surgery is undertaken.
Surgery should be considered in every patient diagnosed as having an acute septal rupture following myocardial infarction who fails to respond to vigorous medical treatment.
Combined Ventricular Hypertrophy
Authors: MUSTER ALEXANDER J. , PAUL MILTON H. 
Published: June 2012

An attempt has been made to uncover the vectorcardiographic spectrum of combined ventricular hypertrophy by studying a group of 82 patients with cyanotic tetralogy of Fallot representing right ventricular hypertrophy with normal or less than normal left ventricular muscle mass and 140 patients with tetralogy of Fallot and surgically created systemic-pulmonary shunts representing right ventricular hypertrophy combined with varying degrees of increased left ventricular muscle mass.
An analysis of the spatial orientation of the maximal QRS vectors has demonstrated a continuum of vectorcardiographic patterns. These extend starting with severe right ventricular hypertrophy through a series of ventricular hypertrophy patterns representing right ventricular hypertrophy with progressively increasing left ventricular potentials toward dominant left ventricular hypertrophy patterns of combined ventricular hypertrophy. An estimate of the relative contribution of the two ventricles to a given vectorcardiographic pattern of combined ventricular hypertrophy is possible by analysis of the direction of maximal spatial QRS vectors.
Electrocardiogram after Chloroquine and Emetine
Authors: SANGHVI L. M. , MATHUR B. B. 
Published: June 2012

Electrocardiographic abnormalities have been studied after administration of chloroquine in 25 patients, of emetine in 28 patients, and of emetine and chloroquine in 28 patients.
Abnormalities after chloroquine were less in severity and of shorter duration than after emetine. They were more severe, became maximum later after cessation of emetine therapy, and were much longer in duration after emetine and chloroquine than after emetine. These differences are attributed to combined effects of the two drugs.
Serum potassium levels showed some decrease after antiamebic therapy, the decrease being more after emetine than after chloroquine.
A case is reported in which severe abnormalities and muscular paralysis occurring after emetine and chloroquine were rapidly reversed by oral potassium administration.
Administration of potassium simultaneously with emetine and chloroquine often prevented or delayed the appearance or decreased the severity of abnormalities. Subsequent potassium administration usually reversed the abnormalities except in cases in which they were present before emetine therapy. It is concluded that the abnormalities are functional in nature and not due to organic myocardial damage.
It is suggested that some disturbance of potassium metabolism in the myocardium and skeletal muscles may be the cause of electrocardiographic abnormalities and emetine neuritis, respectively.
The Electrocardiogram during Exercise
Authors: BELLET SAMUEL , MULLER OTTO F. 
Published: June 2012

The electrocardiogram after exercise has proved to be an extremely valuable tool in the diagnosis of coronary artery disease. However, it fails to record the events during the actual period of exercise at the time of the greatest stress on the circulation. Recent technics have enabled us to take the electrocardiogram during the period of exercise. Data presented indicate that the electrocardiogram taken during this period of exercise adds much to the information obtained in the postexercise electrocardiogram; at times, this information may be crucial in determining evidence of abnormalities in the exercise study. The tracings may be solely positive or more markedly positive during the period of exercise. Evidence of such changes would be helpful in diagnosis and in the early termination of the exercise test. It is our belief that the complete electrocardiographic exercise study should include tracings taken both during and after exercise, and the data obtained during both of these periods should be available for evaluation.
Although the complete exercise test adds much to the diagnosis of coronary artery disease, the presence of a normal test does not necessarily exclude this state. Evaluation of the tracing taken during exercise is in its infancy. Much still needs to be done relative to (a) more adequate standardization of the type of exercise to suit the individual subject, (b) improvement of standardization of apparatus, (c) standardization of leads and their placement, and (d) more rigid standardization of criteria for normality and abnormality.
Intracardiac Phonocardiography
Authors: LUISADA ALDO A. , MACCANON DONALD M. , SLODKI SHELDON J. 
Published: June 2012

A new system for recording intracardiac and intravascular sound during routine catheterization is described.
This system is based on the application of a flat, sonar-type, barium titanate microphone at the end of the catheter, so that the vibrations of the blood within the chambers of the heart and vessels are transmitted along the fluid in the catheter, and transduced by the microphone (fluid column transmitted phonocardiogram-FCT phonocardiogram).
Comparative studies between the response of the FCT system and other systems for intracardiac phonocardiography are made in normal dogs and in dogs with experimental aortic lesions. It is demonstrated that the FCT system gives a good response for vibrations between 25 and 400 cycles per second.
Representative phonocardiographic tracings in patients with congenital or acquired heart disease during routine cardiac catheterization are presented.
Cardiovascular Aspects of the Ehlers-Danlos Syndrome
Authors: BOPP PIERRE , HATAM KASSEM , BUSSAT PHILIPPE , GREDER GEORGES , DUCHOSAL PIERRE W. 
Published: June 2012

The case of a 10--year-old boy is reported because of the association of the Ehlers-Danlos syndrome with bifidity of the pulmonary artery and anomaly of the aortic arch.
The cardiovascular aspects of this connective-tissue disorder are reviewed, and the possibility of another common feature with the Marfan syndrome is briefly discussed.
Long-Term Postoperative Follow-Up in Surgery for Congenital Aortic Valvular Stenosis
Authors: THOMSON NORMAN B. , FISHER FRANK C. 
Published: June 2012

Twenty-three children with congenital aortic valvular stenosis have undergone operation prior to November 1964, without a hospital mortality. A 4-week-old infant who died at the induction of anesthesia is not included. There was one late death due to uncontrolled aortic regurgitation. The late death occurred at the time of the second operation for placement of aortic valve prosthesis in another institution.
Thirteen of the 23 patients have an audible postoperative diastolic murmur. In two this murmur was present preoperatively. Eight of the 13 are considered to have mild aortic regurgitation, four moderate, and one severe. Of the 18 patients with competent valves or mild regurgitation, all have normal electrocardiograms. Ten of these 18 patients had electrocardiographic evidence of left ventricular hypertrophy before surgery. Four of the five patients with moderate or severe regurgitation have electrocardiographic evidence of left ventricular hypertrophy. These patients have all been followed from 3 to 5½ years. There is no evidence that the amount of regurgitation has either decreased or increased since surgery. The gradients measured at cardiac catheterization before operation range from 138 to 56 mm. Hg, with an average of 89 mm. Postoperatively, these gradients ranged from 45 to zero, with an average of 27. Pressures measured at the time of operation before and after valvulotomy agree favorably with the pressures measured at the time of cardiac catheterization before and after valvulotomy.
The development of postoperative regurgitation was found to be related to the incision of a rudimentary raphe which made an anatomically bicuspid valve tricuspid. It is also related to the position of the patient in the series, the regurgitation occurring most frequently in the first half of the series. Comparison with another series with a high residual gradient, but a lower incidence of the severity of regurgitation, suggests that the optimal gradient reduction may be purchased at the expense of an unavoidable amount of aortic regurgitation. This aortic regurgitation, however, is not necessarily hemodynamically significant.
Removal of Iatrogenic Foreign Bodies within Cardiac Chambers and Great Vessels
Authors: LILLEHEI C. WALTON , BONNABEAU RAYMOND C. , GROSSLING SERGIO 
Published: June 2012

This paper reports six cases (age range 8 months to 69 years) of iatrogenic foreign bodies lodged within the heart or great vessels. Four cases were produced during left heart catheterization by breakage of a metal stylet, and two after the insertion of a Pudenz valve (for hydrocephalus) which embolized into the right ventricle and pulmonary artery.
In five of these patients, the foreign body was intracardiac (three in the left ventricle and two in the right ventricle and pulmonary artery) and the open-heart surgery was utilized for successful removal. In the sixth patient, the stylet was removed from the innominate artery via a closed procedure. Five of the six patients survived (including the youngest and oldest) and their postoperative course was uneventful. The one death followed removal of the right-left atrial foreign body and total aortic valve replacement for calcific stenosis, and failure appeared related to the basic disease rather than to the foreign body.
Such complications have rarely been reported in the literature. The high ratio of success, if treatment is prompt before the formation of clots (which is rapid), needs full appreciation, and emphasis is given to the benefits of prompt surgery for removal.
The Origin of an Immediate Diastolic Murmur in Atrioventricular Defects
Authors: SOMERVILLE JANE , RESNEKOV LEON 
Published: June 2012

The origin of an audible immediate diastolic murmur in 10 of 22 patients with atrioventricular defects was investigated by intracardiac phonocardiography. It was shown to arise at the site of the atrial septal defect, and all other possible causes of such a murmur were excluded.
The production of the murmur depended on the combination of mitral regurgitation and an atrial septal defect of such a size as to permit an interatrial pressure gradient in early diastole.
Salt Loading in Hypertension due to Renal Artery Stenosis
Authors: LOWE HAROLD M. , SINGELYN MICHAEL 
Published: June 2012

Acute salt loading was performed in three groups of patients, a normal group, a group with essential hypertension, and a group with hypertension due to renal arterial stenosis.
Patients with hypertension due to renal arterial stenosis were found to excrete an acute salt load in a qualitatively and quantitatively similar manner to normal individuals, in marked contrast to the exaggerated natriuretic response of individuals with essential hypertension.
Of measures in which significant differences were found, the test urine volume, per cent of administered sodium excreted, and the ratios of clearance of sodium in the test and baseline periods yielded a clear separation of patients with essential renal hypertension.
The results of this study indicate that acute salt loading in hypertensive patients may have diagnostic and prognostic value.
The test procedure is simple, rapid, free from morbidity, and requires a minimum of laboratory analyses.