bluuebunny/crossref_metadata_2025_split huggingface dataset:
A-V Nodal Reentrance
Authors: ROSEN KENNETH M. 
Published: June 2012

Electrophysiologic studies were performed in a patient with type B preexcitation and recurrent paroxysmal supraventricular tachycardia (PSVT). Atrial pacing at rates of 80/min and faster produced QRS normalization suggesting failure of the anomalous pathway. At a paced rate of 120/min, Wenckebach periods proximal to the His bundle as well as episodes of PSVT were noted. These episodes all occurred when a critical P-H interval of 300 msec was achieved. PSVT was also induced by coupled atrial pacing. At coupling intervals of 800-530 msec, anomalous pathway conduction was intact. At coupling intervals of 520 msec or shorter, QRS normalization occurred. At intervals of 480-280 msec, PSVT was induced. The P-H interval of the coupled beat inducing PSVT was always between 300 and 350 msec. Intraatrial recording revealed atrial echoes following each QRS of the PSVT.
In summary, critical A-V nodal delay appeared necessary for induction of PSVT. This delay was achieved either by coupled pacing or during pacing-induced Wenckebach periods. The PSVT occurred at rates at which the anomalous pathway would seem to be inoperative. These findings strongly support A-V nodal reentry as the mechanism of PSVT in this patient without participation of the anomalous pathway. In this patient and other patients with similar fiindngs, surgical ablation of the anomalous pathway would probably not be useful in prevention of recurrent PSVT.
Echocardiographic Determination of Mitral Disc Valve Excursion
Authors: JOHNSON MICHAEL L. , HOLMES JOSEPH H. , PATON BRUCE C. 
Published: June 2012

Disc excursion and opening and closing velocities of prosthetic disc valves can be measured accurately by diagnostic echocardiography. The ultrasound beam is projected along the longitudinal axis of the valve and the echoes arising from the struts, disc, and suture ring are displayed on the oscilloscope. Twenty-four patients with normally functioning mitral Beall valves of various sizes and three patients with prosthetic valve dysfunction (one Beall, two Kay-Shiley) were studied. Table 1 lists the disc excursions with standard deviations of Beall valves measured by ultrasound.
The 0.06-0.09 cm difference in excursion between models no. 103 and no. 104 valves was detected by ultrasound without prior knowledge of change in design of the valve and demonstrates the extreme accuracy of this technic. The opening and closing disc velocity averaged 22 cm/sec and 40 cm/sec, respectively.
Decrease in expected disc excursion and abnormal motion patterns were found in three patients with prosthetic dysfunction secondary to thrombus formation, and verified at operation. With continuous changes in valve designs it is important to obtain a baseline excursion and motion pattern for each patient immediately postoperatively.
Echocardiography is a useful, noninvasive, reproducible technic for accurate assessment of prosthetic mitral disc valve movement.
Cardiac Malformations Associated with Down's Syndrome
Authors: TANDON RAJENDRA , EDWARDS JESSE E. 
Published: June 2012

A review of 55 specimens with congenital heart disease from subjects with Down's syndrome (Mongolism) showed a variety of malformations. For each case a major anomaly was identified and, when present, additional anomalies were recorded.
The three leading types of major anomalies, in order of decreasing frequency, were (1) persistent common atrioventricular canal (60%), isolated ventricular septal defect (29%), and tetralogy of Fallot either alone or in association with persistent common atrioventricular canal (14.5%).
Of the additional anomalies, the most common took the form either of an atrial septal defect at the fossa ovalis (50%) or patent ductus arteriosus (47%).
Exercise Stress Testing in Evaluation of Aortocoronary Bypass Surgery
Authors: BARTEL ALAN G. , BEHAR VICTOR S. , PETER ROBERT H. , ORGAIN EDWARD S. , KONG YIHONG 
Published: June 2012

Graded exercise treadmill tests (ET) were performed on 123 patients who had undergone aortocoronary bypass surgery. All had angina preoperatively (preop) and 77% were in Class III or IV for angina. Postoperatively (postop), 68% were free of angina. Eighty-three patients had ST-segment changes of 0.1 mV or greater during stress preop (positive), 38 of which (46%) converted to electrocardiographically negative postop. Among the 30 patients (36%) remaining positive during stress postop, 19 (63%) were angina free despite ST-segment depression during stress. Among the 17 patients with negative ET preop, there were no conversions to positive postop. Twenty-three patients had undetermined ET preop; 13 remained undetermined postop, 4 were positive and 6 were negative. Patients experiencing a perioperative myocardial infarction more frequently had a negative postop ET. Among 27 selected patients undergoing postop angiography, there was good correlation between relief of symptoms and successful myocardial revascularization.
This study demonstrates that dramatic improvement in angina after aortocoronary bypass surgery can be objectively substantiated in most patients. Subjective symptoms of angina are frequently absent during myocardial ischemia postop, emphasizing the importance of exercise testing in objective evaluation of surgical results.
New Arteriographic and Surgical Techniques for Vertebral Arteriopathies
Authors: WESOLOWSKI S. ADAM , GILLIE EDWARD , MCMAHON JAMES D. , SANTOS DELFIN S. , CALI J. ROBERT , UCHIDA HATSUZO 
Published: June 2012

Vertebral arterial insufficiency syndromes are being diagnosed with greater frequency, and would appear to be at least as common as carotid disease in causing cerebrovascular insufficiency. Carotid lesions are nearly always arteriosclerotic, but vertebral obstructions are caused at least as frequently by nonarteriosclerotic lesions, including tortuosity with kink and external bands, slings, bony compression, and congenital aberrations.
A method of cerebral arteriography has been standardized and a new radiographic sign of comparative opacification times of the intracranial carotid and basilar arteries has been tested as a pathognomonic sign of vertebral-basilar arterial insufficiency.
The concept of the innominate-subclavian-vertebral complex as a single surgical geometric unit has allowed the development of a graded surgical approach of arteriolysis, endarterectomy, and resection and anastomosis in managing 97% of obstructive vertebral arteriopathies.
A new surgical operation of distal subclavian resection and anastomosis to correct vertebral and/or subclavian arterial tortuosity with kinking has proven helpful in ablating symptoms of vertebral-basilar arterial insufficiency.
Tetralogy of Fallot with Absent Pulmonary Valve
Authors: STAFFORD EDWARD G. , MAIR DOUGLAS D. , MCGOON DWIGHT C. , DANIELSON GORDON K. 
Published: June 2012

From 1957 through 1971, 18 patients whose ages ranged from 10 months to 18 years underwent surgical correction of tetralogy of Fallot with absent pulmonary valve. All patients had associated pulmonary arterial aneurysms; in two the left pulmonary artery also was absent. Right middle lobectomy had been performed previously on one patient for lobar emphysema; seven other patients had recurrent pulmonary infections.
The ventricular septal defect was closed with a patch in 12 patients and by direct suture in 6. Concomitant infundibular resection was done in all. In four the narrow pulmonary valve annulus was enlarged with an outflow patch, and multiple radial incisions were made in the valve annulus in seven others. The pulmonary arterial aneurysms were not resected in any patients.
There were three hopsital deaths (17%) and two late deaths. Complete heart block developed intraoperatively in three patients, all operated on prior to 1963, contributing to the early death of one patient and to the late deaths of the other two.
In a follow-up of all 13 survivors at 8 months to 15 years (median 6 years), results were excellent and equal to those of patients who have undergone repair of tetralogy of Fallot with pulmonary valve.
Lethal Postoperative Infections Following Cardiac Surgery
Authors: ENGELMAN RICHARD M. , CHASE RANDOLPH M. , BOYD ARTHUR D. , REED GEORGE E. 
Published: June 2012

Seventeen of 1,494 patients (1.1%) succumbed to infection following open-heart operations at New York University Hospital between January, 1968 and December, 1971. All but two of these patients had Starr-Edwards ball-valve prostheses inserted. One had repair of a tetralogy of Fallot, and one had aortic commissurotomy and a double coronary bypass graft. The sites of infection were pulmonary (15 patients), urinary tract (14), mediastinum or pleura (10), and blood (15). Pulmonary infection appeared as the source of endocarditis in 13 patients and as a source of pleural or mediastinal infection in nine. Candida species infection was directly responsible for the deaths of 10 of the 17 patients, being the sole organism isolated in 5 of the 10.
Predisposing factors to infection were preoperative bacterial endocarditis 2 patients, prolonged cardiopulmonary bypass (>3½ hours) 6 patients, a "low output" state following operation 12 patients, postoperative cerebral dysfunction 6 patients, and postoperative disseminated intravascular coagulation 4 patients.
The debilitated state of the patients, multiple sites of infection, degree of tissue destruction, and the variety and resistance of the organisms involved all combined to produce treatment failure. Removal of the infected valvular prosthesis coupled with antimicrobial therapy is considered the treatment of choice in instances of bacterial endocarditis when chemotherapy fails and in all cases of established fungal endocarditis.
Development of Subaortic Stenosis After Pulmonary Artery Banding
Authors: FREED MICHAEL D. , ROSENTHAL AMNON , PLAUTH WILLIAM H. , NADAS ALEXANDER S. 
Published: June 2012

Palliation of children with large ventricular septal defects (VSD) by pulmonary artery banding (PAB) is associated with a variety of unfavorable sequelae. We document another possible complication of PAB, the development of subaortic stenosis, which occurred in 4 of 40 infants with large VSD and PAB. Prior to surgery all had congestive heart failure, cardiomegaly, pulmonary plethora, and biventricular or right ventricular hypertrophy on electrocardiogram. At cardiac catheterization all had large VSD with pulmonary artery hypertension. No gradient between left ventricle and systemic artery was demonstrated. PAB was followed by improvement in all four children. Repeat catheterization at 4 to 11 years of age revealed that they had developed a significant (30 to 100 mm Hg) gradient across the left ventricular outflow tract.
Although the etiology of the subaortic stenosis is not known, it is felt that the hypertrophied and possibly leftward deviated conal septum was impinging on the left ventricular outflow tract in three of the four.
Since the subaortic stenosis was not suspected prior to the second catheterization, we feel that preoperative evaluation of children with VSD and PAB should include evaluation of the left ventricular outflow tract to be certain that no obstruction is present.
Intra-aortic Balloon Pump Assist for Cardiogenic Shock After Cardiopulmonary Bypass
Authors: BUCKLEY MORTIMER J. , CRAVER JOSEPH M. , GOLD HERMAN K. , MUNDTH ELDRED D. , DAGGETT WILLARD M. , AUSTEN W. GERALD 
Published: June 2012

Intra-aortic balloon pump assist (IABP) was applied to 26 patients who could not be with-drawn from total cardiopulmonary bypass (CB) subsequent to elective surgery for multiple cardiac procedures. Eighty-eight per cent were able to separate from CB with IABP and were assisted for 36 to 168 hours. Seventeen were withdrawn from the balloon. Eleven (42%) are hospital survivors. Ten (38%) are alive at the time of this report.
IABP was most effective when applied early to patients who had recognizable acute ischemic injury to the myocardium at the time of operation and/or presence of hypertrophied left ventricular myocardium with small chamber volume. Support in these conditions gave 50% survival. Poorest results were in patients with either extensive acute infarction or severe chronic irreversible myocardial damage.
Detection of Left Ventricular Asynergy by Echocardiography
Authors: JACOBS JAMIE J. , FEIGENBAUM HARVEY , CORYA BETTY C. , PHILLIPS JOHN F. , Black Mary Jo , Chang Sonia , Haine Charles L. 
Published: June 2012

The purpose of this study was to determnie if echocardiography could detect left ventricular asynergy. Forty-eight patients underwent selective coronary arteriography and cineventriculography for the evaluation of chest pain. Four patients were studied twice: three before and after myocardial revascularization and one before and after an intervening myocardial infarction. Echocardiographic M-mode scans were registered on a strip chart as the left ventricle was scanned with an ultrasonic beam from the aortic root to the region of the posterior papillary muscle approximately 18 hrs prior to the catheterization studies.
Ten of the forty-eight patients had no evidence of coronary artery disease. All ten patients had normal ventriculograms in right anterior oblique projection and their echocardiographic scans showed all areas of the left ventricular posterior wall endocardium to move anteriorly 0.9-1.4 cm (mean 1.2 cm) and all parts of the left side of the interventricular septum to move posteriorly 0.3-0.8 cm (mean 0.5 cm) during systole. The 38 patients with significant obstructive coronary artery disease had a total of 42 studies; 25 of these studies showed left ventricular asynergy on the ventriculogram taken in right anterior oblique. The echocardiograms associated with all but one of these studies demonstrating left ventricular asynergy had abnormal motion of some part of the interventricular septum and/or left ventricular posterior wall. Seventeen studies in patients with significant coronary artery disease did not exhibit left ventricular asynergy on the ventriculogram but eight of these studies were associated with distinctly abnormal echocardiograms.
None of the ten patients with significant coronary artery disease and normal echocardiograms had evidence of transmural infarction on their electrocardiograms. Echocardiographic abnormalities correlated with the anatomic area predicted by the myocardial infarction pattern on the electrocardiogram in 18 of 20 patients.
All patients demonstrating abnormal echographic interventricular septal motion had a significant obstructive lesion in the left anterior descending coronary artery. In the absence of significant involvement of the left anterior descending coronary artery, echographically recorded interventricular septal motion was invariably normal. On the other hand, eight patients had significant obstruction in their left anterior descending coronary artery and their echographic interventricular septal motion was normal.
The results of this correlative study indicate that M-mode echocardiographic scans can detect left ventricular asynergy and may possibly predict regional myocardial involvement in coronary artery disease.
Echocardiography in Truncus Arteriosus
Authors: CHUNG KYUNG J. , ALEXSON CHLOE G. , MANNING JAMES A. , GRAMIAK RAYMOND 
Published: June 2012

Nine patients with a clinical presentation suggestive of truncus arteriosus were examined by echocardiography. Subsequent intracardiac studies including cardiac catheterization and angiocardiography divided this group into five patients with truncus arteriosus and four patients with other congenital heart diseases. In all patients with proven truncus arteriosus, it was possible to identify only one semilunar valve with a large truncal vessel overriding the ventricular septum. In none of these patients could a second semilunar valve be found.
This study indicates that echocardiography may provide a direct, yet noninvasive method to exclude the diagnosis of truncus arteriosus by finding the pulmonic valve. However, the diagnosis of truncus arteriosus is not tenable when based solely on the inability to demonstrate the pulmonic valve. The importance of the clinical application of this method is discussed.
Influence of the Sympathetic System on the Pacemaker Suppression Which Follows Overdrive
Authors: PLIAM MICHAEL B. , KRELLENSTEIN DANIEL J. , VASSALLE MARIO , BROOKS CHANDLER McC. 
Published: June 2012

When ventricular pacemakers are electrically stimulated at a fast rate, the cessation of the drive is followed by a temporary suppression of automaticity ("overdrive suppression"). The role of the sympathetic system in the regulation of this overdrive suppression was studied and the following results obtained: 1) Hypotension induced during overdrive by amyl nitrite inhalation caused a shortening of the pause which follows the drive. 2) Bilateral resection of the stellate ganglia led to the opposite effect. 3) Maximal stellate ganglion stimulation halved the pause duration. 4) Norepinephrine infusion accelerated the idioventricular rate and shortened the pause. 5) Beta adrenergic blockade decreased the idioventricular rate and prolonged the pause.
It is concluded that the tonic sympathetic discharge not only controls the basal idioventricular rate but also plays a regulatory role in the suppression of idioventricular automaticity which follows overdrive. This regulatory role can be dissociated from changes in idioventricular rate prior to overdrive.
Reproducibility of a Multi-Stage Near Maximal Treadmill Test for Exercise Tolerance in Angina Pectoris
Authors: SMOKLER PAUL E. , MACALPIN REX N. , ALVARO ANTHONY , KATTUS ALBERT A. 
Published: June 2012

A retrospective analysis was made of the reproducibility of a treadmill exercise tolerance test performed on patients with angina pectoris to an end point of moderately severe (3+) angina. One hundred and forty tests (70 pairs) in 63 patients were found to meet criteria for inclusion in the study. In 30 patients a comparison of the first test the patient had ever had with a subsequent test revealed a significantly poorer performance on the first test; mean differences ± one standard error of the mean between the first test and the subsequent tests were 0.90 ± 0.20 min of walking from the start of the test to the onset of angina, 2.3 ± 0.33 total min of walking, and 5.8 ± 0.86 "exercise units" attained at the end point of "3+" angina. In 40 patients a comparison of two tests, neither of which was the patients' first test, revealed no significant differences in performance; mean differences between the two tests were 0.20 ± 0.23 min of walking at the onset of angina, 0.11 ± 0.07 min of walking and 0.18 ± 0.15 exercise units attained at the end point of "3+" angina. There were no significant differences in maximum heart rates attained between any of the tests.
In using treadmill testing to quantitate exercise capacity in angina pectoris, the first test is likely to yield a poorer performance than subsequent ones. Tests subsequent to the first are highly reproducible when a specifically defined symptomatic end point of moderately severe intensity is employed.
An Analysis of 35 Cases of the Complete Form of Persistent Common Atrioventricular Canal
Authors: TENCKHOFF LORE , STAMM STANLEY J. 
Published: June 2012

Thirty-five hearts with the complete form of persistent common atrioventricular canal were classified according to the morphology of the common anterior leaflet. The ratio of specimens with a free-floating undivided common anterior leaflet (Type I) to those with a divided common anterior leaflet attached to the septum (Type II) was 1:2. Type I cases had a high incidence of other cardiac (90 percent) and noncardiac (80 percent) malformations. These were primarily conotruncal anomalies (80 percent), left ventricular outflow obstructions (66 percent), aortic arch hypoplasia (30 percent), and abnormalities of organ position or symmetry including the polysplenia and asplenia syndromes. In contrast, Type II canals exhibited a high incidence of Down's syndrome (40 percent), other cardiac and noncardiac anomalies being less common. The associated anomalies suggest that Type I lesions reflect an earlier interference during embryogenesis than Type II lesions.
A clockwise QRS loop and a normal or right axis on the electrocardiogram in four cases were associated with a left ventricular inflow tract of normal length, suggesting that conduction system displacement and a deficient base of the heart may be interrelated.
Postmortem double contrast radiography confirmed the angiographic differences between Type I and II lesions, and in Type I lesions clarified the alterations in the angiographic profile occurring with variations in the fullness of the common anterior leaflet.
Marantic Valvular Vegetations
Authors: WALLER BRUCE F. , KNAPP WILLIAM S. , EDWARDS JESSE E. 
Published: June 2012

Marantic valvular vegetations represent one form of vegetative nonbacterial endocarditis. While any of the cardiac valves may be involved, the mitral valve and/or aortic valve are the most common sites at which this process occurs. Underlying disease of a chronic nature is usually identifiable somewhere in the body, with malignant tumors collectively representing the most common underlying condition. Systemic arterial occlusion, usually multiple when present, may antedate the identification of an underlying malignant tumor.
The gross nature of the vegetations requires histologic distinction from metastatic lesions of valves and from bacterial endocarditis. In some instances, the latter process may originate upon marantic vegetations.
Epicardial Mapping in a Variant of Type A Wolff-Parkinson-White Syndrome
Authors: NEUTZE JOHN M. , KERR ALAN R. , WHITLOCK RALPH M. L. 
Published: June 2012

Electrocardiographic and epicardial mapping studies are reported in a child with an atrial septal defect and a variant of type A Wolff-Parkinson-White (WPW) syndrome. The vectorcardiogram suggested a posterior area of early activation and this was confirmed by epicardial mapping studies. Premature activation apparently occurred from a site near the endocardium of the basal region of the left ventricle and surgical interruption could not be planned on the basis of data provided by epicardial mapping.
The role of vectorcardiography in assessing patients with the WPW syndrome is discussed.
The Role of Glucagon Hypersecretion in the Pathogenesis of Hyperglycemia Following Acute Myocardial Infarction
Authors: LANIADO SHLOMO , SEGAL PESACH , ESRIG BARRY 
Published: June 2012

In a group of nondiabetic patients, postinfarction hyperglycemia was found to be closely associated with high levels of plasma immunoreactive glucagon (IRG).
It is proposed that, in certain cases, hyperglycemia following acute myocardial infarction may be related to a temporary and uninhibited rise in plasma glucagon levels, probably stimulated by the major stress of acute myocardial infarction.
Doppler Echocardiography
Authors: JOHNSON STEVE L. , BAKER DONALD W. , LUTE ROBERT A. , DODGE HAROLD T. 
Published: June 2012

A range-gated pulsed Doppler flowmeter has recently been developed that measures the average velocity of blood flow within a small tear-drop shaped (4 mm by 2 mm) sample volume. Unlike the continuous wave Doppler, the distance from the transducer face to the sampling site can be continuously varied by a range adjustment knob.
Twenty patients with cardiac murmurs were evaluated in a noninvasive laboratory by brief cardiac physical examination, abbreviated phonocardiogram, complete echocardiogram, and localization of the murmurs by Doppler echocardiography. The localization depends on the detection of turbulent flow or jets at the sampling site. The murmurs included the diastolic rumble of mitral stenosis, mitral regurgitation, the murmur of left ventricular outflow tract obstruction, aortic stenosis, aortic insufficiency, diastolic rumble of tricuspid stenosis, augmented right ventricular filling sound in atrial septal defects, pulmonic stenosis, pulmonic insufficiency, and high velocity flow through the obstruction in ccarctation of the aorta.