bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Signs in Compressive Cardiac Disorders
Authors: LANGE RAMON L. , BOTTICELLI JAMES T. , TSAGARIS THEOFILOS J. , WALKER JOHN A. , GANI MUKHTAR , BUSTAMANTE RODRIGO A. 
Published: June 2012

Thirty patients with primary cardiac compression due to constrictive pericarditis, lax effusion, or cardiac tamponade and an additional seven patients with spurious evidence of cardiac compression or with pericardial effusion playing an unimportant role in the circulatory disorder were studied. Rather stringently defined physical findings were sought which might allow discrimination between cardiac disorders. The following conclusions are drawn from the results.
1. Constrictive pericarditis is associated with venous and auscultatory phenomena which do not allow separation from other forms of heart disease causing congestive heart failure. Kussmaul's sign is present in less than 40%; pulsus paradoxus as classically defined is rare.
2. In lax pericardial effusion, Kussmaul's sign and Friedreich's sign, along with third heart sounds, are not present. Pulsus paradoxus is inconstant with tranquil breathing but is regularly induced by deep inspiration. There is inspiratory decrease in venous pressure and pericardial pressure. Cardiac index is normal and venous pressure is less than 12 mm Hg. Circulatory distress is not apparent.
3. Tamponade induces signs of circulatory distress and is regularly characterized by pulsus paradoxus but Friedreich's sign, a third heart sound, as well as Kussmaul's venous sign, are absent. The venous pressure exceeds 12 mm Hg. There is an inspiratory decrease in venous pressure and pericardial pressure. The low cardiac index is usually relieved by tap. When aortic stenosis is present, respiratory variation in left ventricular systolic pressure may not be reflected by clinical pulsus paradoxus.
4. Spurious signs of cardiac compression may be due to (1) respiratory disease, (2) severe myocardial disease and incidental effusion, or (3) obesity. In the respiratory disease pulsus paradoxus, normal cardiac index, low venous pressure, and venous and pericardial-pressure decrease with inspiration are present. The second group does not show pulsus paradoxus and the elevated venous pressure, diastolic dip, and third heart sounds are due to heart failure. Obesity may cause pulsus paradoxus and increased peripheral venous pressure, which does not reflect central venous pressure. These findings seem related to inspiratory collapse of extrathoracic vessels.
Pulmonary Venous and Arterial Hypertension due to Chronic Fibrous Mediastinitis
Authors: BOTTICELLI JAMES T. , SCHLUETER DONALD P. , LANGE RAMON L. 
Published: June 2012

A patient with chronic fibrous mediastinitis presented with bronchial, superior vena caval, and pulmonary venous obstruction, pulmonary hypertension, and pulmonary fibrosis. Pulmonary venous obstruction was confirmed at surgery and explains the hemodynamic findings of elevated pulmonary artery and pulmonary wedge pressures despite low left atrial pressure. Pulmonary function studies showed marked alterations in ventilation-distribution, diffusion, work of breathing, and fixed airway resistance.
It is concluded that the pulmonary arterial hypertension was due, in large part, to the pulmonary venous hypertension caused by pulmonary venous obstruction. Unsuccessful surgical intervention has been followed by 10 months of observation during which aldosterone inhibition together with use of chlorothiazide has prevented recurrence of heart failure and pleural effusion.
The relationship between the physiological abnormalities and the patient's symptoms is discussed along with the possible relationship between pulmonary venous obstruction and pulmonary fibrosis.
The Diastolic Murmur of Atrial Septal Defects as Detected by Intracardiac Phonocardiography
Authors: WENNEVOLD ALF 
Published: June 2012

Intracardiac phonocardiography was performed in 18 patients with the secundum type of atrial septal defect.
In eight patients a delayed diastolic murmur was recorded in the inflow tract of the right ventricle and was probably due to the increased flow through the tricuspid valve; the murmur was audible at external auscultation in five of the patients.
In 13 patients a diastolic murmur was recorded in the right atrium; eight patients had an early diastolic murmur, two patients had a delayed diastolic murmur, and the remaining three patients had both kinds of murmurs.
The early diastolic murmur did not correspond in time to the murmur found in the right ventricle and was probably due to the flow through the defect. The delayed diastolic murmur could be due either to the flow through the tricuspid valve or through the defect. None of the atrial diastolic murmurs were audible at external auscultation.
The Syndrome of Familial Defects of Heart and Upper Extremities (Holt-Oram Syndrome)
Authors: MASSUMI R. A. , NUTTER D. O. 
Published: June 2012

Two families with familial defects of the heart and upper extremities and two sporadic cases of skeletal anomalies of the same type are reported.
In the most complete and prototypal form the syndrome consists of a secundum atrial septal defect of moderate size and the so-called radial defect of the upper extremities. However, less complete forms exhibiting cardiac anomalies alone, skeletal defects alone, or a combination of certain features of both, have been observed. Formes frustes undoubtedly occur.
The mode of inheritance seems to be autosomal dominant and of a high degree of penetrance.
Chromosome studies have suggested an abnormality in the pair 16.
Study of palm and sole prints have shown the abnormalities to be secondary to musculoskeletal defects and not likely to be genetically determined.
The syndrome is probably much more common than is realized. Identification of cases leading to the affected families depends upon awareness of pediatricians and orthopedists of its existence and inclusion of a careful examination of the upper extremities in all instances of atrial septal defect.
Infarction of Papillary Muscles and Mitral Insufficiency Associated with Congenital Aortic Stenosis
Authors: MOLLER JAMES H. , NAKIB AHMAD , EDWARDS JESSE E. 
Published: June 2012

Study of the papillary muscles in 11 infants dying in the first year of life with congenital aortic stenosis and normal coronary arteries demonstrated infarction of the left ventricular papillary muscles in each. Lesions were more extensive in the posteromedial than in the anterolateral papillary muscle.
Infarction of papillary muscles is considered the basis for the common occurrence of mitral insufficiency in symptomatic infants with congenital aortic stenosis. Congenital aortic stenosis, infarction of left ventricular papillary muscles, and mitral insufficiency are so interrelated as to constitute a syndrome.
Action of Bradykinin on Human Pulmonary Circulation
Authors: DE FREITAS FLAVIO M. , FARACO EDUARDO Z. , DE AZEVEDO DECIO F. , LEWIN ISAAC 
Published: June 2012

Twenty-one patients with pulmonary hypertension secondary to rheumatic mitral valve disease were submitted to right and left heart catheterization and received a continuous intravenous infusion of synthetic bradykinin (average dose, 0.98 µg/kg/min).
The drug elicited an appreciable fall of the systemic vascular resistance simultaneously with a decrease of the mean systemic arterial pressure and an increase of the cardiac output in all cases. The rise in cardiac output derived mainly from an increase in heart rate, since the modifications of the stroke volume were generally of low magnitude.
In the pulmonary circulation, the increase in blood flow was coincident with a rise of the mean arterial and venous (left atrial) pressures in 19 and all patients, respectively. The pulmonary vascular resistance fell in 19 patients, but no appreciable modifications were noted in pulmonary blood volume.
The changes in the lesser circulation were interpreted as expressing secondary effects, either mechanical or reflex, consequent to the action of bradykinin on the systemic vessels and heart rather than a direct effect of the drug on the pulmonary vessels.
The Medial Wall of the Right Atrium
Authors: WALMSLEY ROBERT , WATSON HAMISH 
Published: June 2012

The correct orientation of the heart in situ has been stressed and the anatomic relationships of the medial wall of the right atrium have been described and illustrated.
Each atrium lies behind and to the right of its corresponding ventricle and, as the plane of the septa is angled at approximately 45° to the median plane, the right atrium lies as much in front of the left atrium as alongside it.

The area of overlap between the atria is small in both the anteroposterior and lateral views and the interatrial septum, which constitutes
only
the posterior half of the medial wall of the right atrium, is most accessible in the right anterior oblique projection.

The anterior half of the medial wall of the right atrium is closely related from above downward to the first part of the aorta including the aortic valve, and to the left ventricular outflow tract through the membranous part of the interventricular septum. The right coronary artery and the right ventricular outflow tract are also important anterior relations.

Transverse sections of the thorax in all age groups have shown that only one aortic valve cusp is truly anterior and it is suggested that the terms
anterior,
and
right
and
left posterior
should be used to designate the cusps and sinuses of the aortic valve.
The Anatomy of the Atrioventricular Conduction System in Ventricular Septal Defect and Tetralogy of Fallot: Correlations with the Electrocardiogram and Vectorcardiogram
Authors: FELDT ROBERT H. , DUSHANE JAMES W. , TITUS JACK L. 
Published: June 2012

The atrioventricular conduction system was studied by a technique of selected serial histological sections in examples of tetralogy of Fallot and ventricular septal defect to correlate the anatomic findings observed with the electrophysiological findings as manifested by the vectorcardiographic pattern. Eight hearts were studied; two examples of each anomaly had electrocardiographic and VCG patterns in the frontal plane similar to A-V canal defects and two examples of each had ECG and VCG patterns usually associated with these lesions.
Of the four examples of tetralogy, the two examples with VCG patterns similar to the A-V canal pattern differed from the other examples in that the distance between the A-V node and the origin of left bundle branching was shorter and the fibers destined to become the right bundle branch took an elongated course. The VSD examples offered less striking differences. A short distance from the A-V node to the onset of left bundle branching was seen in both examples with VCG patterns similar to the A-V canal pattern, but one example of VSD with a representative VCG pattern had a similar anatomic configuration. When measurement ratios were compared, the right bundle took its origin at a relatively greater distance from the A-V node in the examples with VCG patterns similar to the A-V canal pattern.
The anatomic configuration of those examples of tetralogy and VSD with VCG patterns similar to the A-V canal pattern was such that relatively early conduction to the left bundle branch system could occur.
Role of the Phonocardiogram in Evaluation of the Severity of Mitral Stenosis and Detection of Associated Valvular Lesions
Authors: SURAWICZ BORYS , MERCER CHARLES , CHLEBUS HENRYK , REEVES JOHN T. , SPENCER FRANK C. 
Published: June 2012

The phonocardiogram was correlated with hemodynamic measurements and with the results of surgical exploration in 141 patients with pure or dominant mitral stenosis. The study revealed the following results:
1. A diastolic murmur at the apex was absent in only two of 141 patients.
[see figure in the PDf file]
2. The opening snap (OS) was absent in 29% of all patients and in 10% of patients with pure mitral stenosis and noncalcified mitral valve. The most important single factor contributing to the absence of an OS was calcification of the mitral valve. Other factors included young age and associated aortic stenosis or mitral insufficiency.

3. There was no significant correlation between the (Q-1)-(2-OS) interval (PCG index) and the diastolic pressure gradient across mitral valve at rest. The correlation between the PCG index and the calculated mitral valve area (MVA), and the diastolic pressure gradient across the mitral valve during exercise was significant (
P
<0.05).

4. The PCG index correctly predicted whether the MVA was smaller or greater than 1.2 cm
2
in 85% of patients with pure mitral stenosis but in only 57% of patients with associated lesions. The MVA was less than 1.2 cm
2
in 36 of 39 patients with pure mitral stenosis in whom the PCG index ranged from +2 to +6. Of 42 operated patients with pure mitral stenosis, the PCG estimate was correct in 36. The PCG index did not underestimate MVA in any of the operated patients.

5. In a group of patients with the same left atrial (LA) pressure, the 2-OS interval was longer in patients with low cardiac output. The relation between the 2-OS interval and the cardiac output could explain in part the lack of correlation between LA pressure and 2-OS interval and the smaller number of correct estimates of MVA made by the 2-OS interval as compared to the Q-1 interval and the PCG index.
6. There was no significant correlation between the amplitude of the first sound at the apex and the severity of mitral stenosis. Several patients with associated mitral insufficiency had a first sound of high amplitude.

7. There was no significant correlation between the amplitude of the sound of pulmonary valve closure (P
2
) and the pulmonary artery pressure. P
2
amplitude was significantly greater in slender patients.

8. An apical systolic murmur was recorded in 48% of patients with pure mitral stenosis. The longer the murmur, the greater was the likelihood of associated mitral insufficiency. A pansystolic murmur at the apex usually indicated an associated mitral or tricuspid insufficiency.
Serial Electrocardiographic Findings in a Prospective Epidemiological Study
Authors: OSTRANDER LEON D. 
Published: June 2012

The prevalence of classified electrocardiographic items among the adult population of Tecumseh, Michigan, during two examinations approximately 4 years apart is reported. Changes in the prevalence rates of certain items are probably due to reader differences, the effect of prior ingestion of glucose in the first series of examinations, and possibly the treatment of abnormalities detected during the first examinations.
Among the cohort of 3,745 persons who had classified electrocardiograms on both examinations, the Q and QS items were relatively stable, the more marked ST and T items were less stable, and the minor ST or T classifications were extremely variable. Still, 31% of persons whose second electrocardiogram revealed codable Q or QS items for the first time had classified ST-segment or T-wave items in their previous electrocardiogram and another 9% had nonspecific QRS abnormalities, either high amplitude R waves or left axis deviation.
The Minnesota code is a useful system for the classification of large numbers of electrocardiograms, but for accurate identification of new events, tracings exhibiting category I, IV, or V items must be examined serially.
An Epidemiological Assessment of Bundle-Branch Block
Authors: EDMANDS ROBERT E. 
Published: June 2012

Complete bundle-branch block was found in 57 of 1,560 (3.7%) electrocardiograms routinely recorded on members of a retirement community. Of this number, 19 were identified as left bundle-branch block (LBBB), while 38 fulfilled the criteria for right bundlebranch block (RBBB).
Individuals with LBBB were found to have cardiomegaly more frequently than did individuals with normal electrocardiograms. Individuals with RBBB, regarded as a homogeneous group, also demonstrated a greater prevalence of cardiomegaly than did the control group, but the difference from normals was less striking than in the case of LBBB. Neither LBBB nor RBBB was significantly associated with hypertension, as defined in the text.
When the common, uncomplicated RBBB was regarded as a separate entity, the prevalences of hypertension and cardiomegaly were indistinguishable from those of a control group with normal electrocardiograms. The RBBB variant, regarded as a possible manifestation of left ventricular disease secondary to hypertrophy or myocardial infarction, was found to be frequently associated with hypertension, cardiomegaly, and the need for digitalis therapy. RBBB with left axis deviation, regarded as a complication of the common RBBB due to left ventricular hypertrophy or myocardial infarction, was similarly associated with a high prevalence of cardiovascular disease. None of the 38 cases of RBBB fulfilled the criteria for classic RBBB.
It is suggested, therefore, that the chronic uncomplicated RBBB in the adult may indeed bear a less ominous portent than has previously been ascribed to it. This is suggested only in relation to the parameters evaluated, however; prospective evaluation is clearly necessary to assess the validity of such an inference.
Detection of Small Ventricular Septal Defects
Authors: CRAENEN JO , MOORE DOUGLAS , HOHN ARNO R. , LAMBERT EDWARD C. 
Published: June 2012

The value of selective left ventricular cineangiography in the detection of small ventricular septal defects was assessed in 23 patients in whom no shunt was detected by blood oxygen saturation change. A comparison was made with selective indocyaninegreen indicator-dilution curves in 10 of these patients. A ventricular septal defect was demonstrated by both methods in 10. However, in one case, the indicator curve showed a left-to-right shunt whereas selective left ventricular cineangiography failed to demonstrate it. Conversely, in two other cases, selective left ventricular cineangiography demonstrated a small ventricular septal defect while a normal curve was obtained by indicator-dilution technique.
Comparing our experience with cineangiography with that of others, using hydrogen ion and indocyanine-green indicator-dilution techniques for the detection of small left-to-right intracardiac shunts, it seems there is little difference in the sensitivity of the three methods. Each is capable of detecting ventricular septal defects which cause left-to-right shunts too small to produce measurable blood oxygen saturation variations.
Studies on Anomalous Collateral Systemic-Pulmonary Circulation
Authors: TAMMELING G. J. , NIEVEEN J. , SLUITER H. J. 
Published: June 2012

The circulatory status of four patients with anomalous systemic-pulmonary circulations has been studied by bronchospirometry, cardiac catheterization, angiography, and dye-dilution techniques. In three of these patients the affected lung was smaller than normal, and bronchography showed no abnormalities. On the affected side angiography failed to show filling of the pulmonary artery, and the oxygen uptake appeared to be zero or minimal. In two of the patients bronchospirometry revealed an effective collateral circulation, whereas the dye-dilution curves were almost normal. In the other patient there was anatomic evidence of both transpleural systemic-pulmonary arterial communication and occlusive disease of the pulmonary veins. Here the dye-dilution curves revealed considerable shunting of blood, whereas no effective collateral circulation could be demonstrated. The fourth patient has extensive unilateral bronchiectasis and illustrates the condition wherein neither pulmonary nor systemic blood flows through the pulmonary capillary bed.
The pathogenesis of the various pathways of collateral circulation is discussed, as well as some methodological and technical problems.
Cardiac Volume in Normal Children and Adolescents
Authors: NGHIEM QUANG X. , SCHREIBER MELVYN H. , HARRIS LEONARD C. 
Published: June 2012

Cardiac volume was determined by a simplified Rohrer-Kahlstorf method in 305 healthy children and adolescents. The ages ranged from birth to 19 years. Height and weight were comparable with normal growth standards. Race, sex, age, height, weight, and body surface area were studied for their value in predicting cardiac volume. Cardiac volume was different in males and females (
p
< 0.005) and was more closely predicted by weight than by body surface area. In this study body weight has been used as a single predictor of cardiac volume for both sexes. Normal values are presented and the limitations of the technique discussed.

Serial cardiac volume plotted against weight and cardiothoracic ratio plotted against time were correlated with the clinical course in 27 children with pure rheumatic mitral insufficiency. Cardiac volume was found to be superior to the cardiothoracic ratio in reflecting the severity and prognosis of mitral insufficiency. After the cardiac volume had reached a level of 1,100 to 1,300 ml, the course was progressively downhill in 10 adolescents in the absence of evidence of rheumatic activity in most cases.
That the course of rheumatic mitral insufficiency is essentially volume-dependent is a phenomenon of great interest which may be used to assess the severity of mitral regurgitation and its future course.
"Demand" and Internal Mammary Artery Implantation
Authors: MALETTE WILLIAM G. , SCHNEIDER BARRY , TAIT IVAN B. 
Published: June 2012

The results with internal mammary artery implantation in the myocardium after chronic, slow constriction of the left anterior descending coronary artery did not differ from the same implantation done with a normal coronary system. Patency rates, flow through the implanted vessel, cineangiographic appearances, and anatomical patterns were the same in both groups. Pulse pressure patterns were variable.
We conclude that ischemic demand in this preparation has little to do with final flow rate, anatomical collateral pattern, or patency. The reason for this lack of correlation is still obscure.
Surgical Significance of Angiographic Patterns in Coronary Arterial Disease
Authors: DIETHRICH EDWARD B. , LIDDICOAT JOHN E. , KINARD SAMUEL A. , GARRETT H. EDWARD , LEWIS JOHN M. , DEBAKEY MICHAEL E. 
Published: June 2012

A review of 313 selective cine coronary arteriograms performed in patients with angina pectoris is presented. Classification of coronary arterial disease by location and severity of stenosis has established certain patterns of disease. Significant disease (greater than 75% stenosis of at least one major vessel) occurred in 270 of 313 (89%) patients. Significant single-vessel disease occurred in only 58 of 270 (23%) patients, while the occurrence of significant multiple-vessel disease was: double, 110 of 270 (40%) patients; triple, 78 of 270 (29%) patients; and quadruple, 24 of 270 (9%) patients. The distribution in 191 arterial occlusions was: right coronary, 101 of 191 (53%); anterior descending, 64 of 191 (33%); and circumflex, 26 of 191 (14%). Anterior and anterior-lateral myocardial ischemia occurred in 80 of 270 (29%) patients, isolated posterior myocardial ischemia in 46 of 270 (18%) patients, and equal anterior and posterior ischemia in 144 of 270 (53%) cases. The angiographic studies were correlated with clinical history and electrocardiographic findings.
The frequency of severe posterior myocardial ischemia, either alone or in conjunction with severe anterior ischemia, indicates the need for selective posterior or total myocardial ischemia, either alone or in conjunction of patients are to benefit from myocardial revascularization.