bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variant Hemodynamic Patterns in Mitral Stenosis
Authors: CARMAN G. H. , LANGE R. L. 
Published: June 2012

Of a total group of 86, 11 cases of proved significant mitral stenosis with cardiovascular hemodynamic data are presented.
Four had normal pulmonary wedge and pulmonary artery pressures at rest and low cardiac index at rest and after mild exercise. It is postulated that such persons respond to mitral valve obstruction primarily by lowering cardiac output.
The cardiac index in seven was normal at rest and after mild exercise. Thus there was no evidence that alteration of blood flow had occurred in response to the lesion. The values for pulmonary arteriolar resistance in three of these were qualitatively normal when flow was increased. These are considered to be examples of absent or inadequate changes in pulmonary vascular reactivity.
The existence in a significant percentage of patients with mitral stenosis of a low cardiac output with normal resting pulmonary, arteriolar, and wedge pressures, or normal cardiac output despite elevation of these pressures infers that potent flow-regulating factors tors can operate independently of the obstructive lesion.
Measurement of Mitral Regurgitation in Man from Simultaneous Atrial and Arterial Dilution Curves after Ventricular Injection
Authors: LEVINSON GILBERT E. , STEIN SAMUEL W. , CARLETON RICHARD A. , ABELMANN WALTER H. 
Published: June 2012

Measurements of forward and regurgitant flow were obtained in 16 patients with rheumatic disease of the mitral valve by means of simultaneous systemic arterial and left atrial dilution curves after injection of Evans-blue dye into the left ventricle. The results indicate that satisfactory measurements of forward flow may be obtained with injections into the left ventricle and that the calculated regurgitant flow has a good correlation with the severity of mitral insufficiency, as estimated clinically and surgically. The mean and range of regurgitant flow, expressed as a per cent of estimated total left ventricular output, for patients with pure mitral stenosis, predominant stenosis with mild to moderate insufficiency, and predominant or pure insufficiency, were 6 per cent (0 to 11), 21 per cent (8 to 39), and 58 per cent (28 to 82), respectively.
Eight studies in six patients, however, gave results that were either mathematically absurd, physiologically incredible, in conflict with diagnostic evidence, or otherwise suspect. Moreover, in the seven patients in whom satisfactory duplicate studies were obtained, the reproducibility of results was poor: the mean absolute difference in successive measurements was 17 per cent of total left ventricular output and the coefficient of variation was 23 per cent of an observation.
It is suggested that the principal source of error lies in unrepresentative sampling from the left atrium in the presence of incomplete mixing of indicator with blood in the cardiac chambers. In some patients, an additional and possibly appreciable error may arise from the existence of an enhanced pulmonary collateral blood flow, which provides an alternative short pathway from the left ventricle to the left atrium.
It is concluded that, with conventional sampling technics, this theoretically sound approach is too capricious to be a dependable quantitative method.
Surgical Anatomy of the Coronary Artery Distribution in Congenital Heart Disease
Authors: REEMTSMA KEITH , LONGENECKER CHARLES G. , CREECH OSCAR 
Published: June 2012

Distribution of major coronary arteries was studied in 154 congenitally malformed hearts and 24 normal hearts.
The artery to the atrioventricular node constantly arose in the area of the coronary sinus from either the right or left coronary artery. In specimens with ostium primum malformations, this artery coursed immediately beneath the inferior (dorso-caudad) rim of the defect.
Anomalous distribution of the coronary arteries in the region of the right ventricular outflow tract poses a serious problem in openheart surgery. The two most frequent variants were anomalous anterior descending artery arising from the right coronary, and single right coronary artery with the left coronary branch passing across the right ventricular outflow tract.
Such anomalies occur most frequently in transposition complexes and tetralogy with extreme dextroposition of the aorta. Fatalities have been reported following division of these vessels.
Although some anomalies of the coronary vessels may be recognized on inspection of the heart at the operating table, a major vessel may lie buried within the myocardium.
The Clinical, Hemodynamic, and Pathologic Diagnosis of Muscular Subvalvular Aortic Stenosis
Authors: MENGES HERMANN , BRANDENBURG ROBERT O. , BROWN ARNOLD L. 
Published: June 2012

Muscular obstruction to left ventricular outflow is a rare but serious occurrence. Eight cases in which this disease was anatomically proved are presented. The commonest symptoms are angina, dyspnea, and palpitations. Not uncommonly a family history of heart disease may be elicited. A systolic murmur along the left sternal border is the most characteristic physical finding, but a normal aortic second sound, the presence of third and fourth heart sounds, splitting of the second sound, and the absence of a diastolic murmur are all helpful clinical guides. Withdrawal pressures from the left ventricle reveal a characteristic infundibular pressure zone. Other hemodynamic findings include an anacrotic notch on the left ventricular pressure tracing, a rapidly ascending bisferious aortic pulse and a small compensatory beat after extrasystoles.
Necropsy specimens reveal a grossly thickened interventricular septum as compared with normal and hypertrophied control hearts. Microscopic alterations are minimal. The etiology remains obscure but familial and developmental factors, either or both, appear to be implicated.
Association of Specific Behavior Pattern in Women with Blood and Cardiovascular Findings
Authors: ROSENMAN RAY H. , FRIEDMAN MEYER 
Published: June 2012

The possible effect of a specific overt behavior pattern upon serum cholesterol levels, blood coagulation, and incidence of arcus senilis and clinical coronary heart disease was studied in two groups of women randomly chosen for study by lay selectors after careful orientation. Women of group A were selected on the sole basis of their habitual exhibition of a behavior pattern (type A) characterized by excessive competitive "drive," ambitiousness, and immersion in "deadlines." Women of group B were selected by lay selectors on the sole basis of their exhibition of entirely opposite behavioral traits (type B). Each group of subjects included a series of nuns respectively exhibiting the type A and B behavior patterns. The women exhibiting pattern A also exhibited markedly higher serum cholesterol levels, often more rapid blood coagulation, three to five times as much arcus senilis, three to seven times more diastolic hypertension, and a four-fold higher incidence of clinical coronary disease. A history of myocardial infarction or angina pectoris only was found in group A. These striking differences were independent of differences in parental incidence of coronary disease, caloric or fat intake, obesity, physical activity, smoking, or "femininity." The strikingly higher incidence of clinical disease in pattern A women also was not found ascribable per se to differences in heredity, obesity, hypertension, caloric or fat intake, smoking, physical activity, blood coagulation, or serum cholesterol levels.
The results closely resemble those previously found in men with similar behavior patterns, and strongly suggest that the type A behavior pattern is itself in some way largely responsible for the observed findings.
Thrombelastographic Studies with a Twenty-Four-Hour Schedule for Subcutaneous Heparin
Authors: ELIOT ROBERT S. , VON KAULLA KURT N. , BLOUNT S. GILBERT 
Published: June 2012

In 55 patients 430 thrombelastographic studies after 305 heparin injections revealed that a more complete and more rapid reduction of the over-all coagulability of the blood is obtained by a subcutaneous injection of 40 per cent heparin once every 24 hours than that obtained with prothrombin-depressing agents. The individual dose, by the thrombelastographic technic, is between 3.5 and 4.5 mg./Kg.
Further clinical studies are indicated with use of simple laboratory control technics, such as recalcification time.
The Identification of Right-to-Left Shunts in the Central Circulation by the Injection of Ether
Authors: FRASER ROBERT S. , ROSSALL RICHARD E. , DVORKIN JOSEPH , VALLE-CAVERO CESAR 
Published: June 2012

A method is described for localizing central right-to-left shunts by means of anesthetic ether injected through a cardiac catheter at various sites during cardiac catheterization.
The presence and location of right-to-left shunts were correctly demonstrated in 42 of 43 patients in whom the diagnosis was later confirmed at operation or autopsy. The instance in which the site was interpreted incorrectly is explained.
Three false-negative results were obtained from the test and reasons for these are also given.
In our view the test is simple, safe, gives accurate results, allows immediate interpretation, and requires no special equipment. It has proved to be a most useful test for preliminary localization of shunts prior to selective angiocardiography.
Results of Surgical Treatment for Congenital Aortic Stenosis
Authors: ELLIS F. HENRY , ONGLEY PATRICK A. , KIRKLIN JOHN W. 
Published: June 2012

Open operation by means of extracorporeal circulation has been used on 47 patients with congenital aortic stenosis at the Mayo Clinic between April 1955 and July 1, 1960; 33 patients had valvular stenosis, 11 had subvalvular stenosis, and three had supravalvular stenosis. The over-all operative mortality rate was 13 per cent; 6 per cent of patients with valvular aortic stenosis died in the hospital.
Severe aortic insufficiency did not develop in any patient operated on for valvular aortic stenosis although a diastolic murmur was present after operation in some. Rarely, however, was the transvalvular gradient completely eliminated by operation although 90 per cent of the surviving patients were either asymptomatic or had definite clinical improvement. Late follow-up hemodynamic studies suggest that a persistent transvalvular gradient may regress in time.
Relief of obstruction caused by subvalvular variety of aortic stenosis is difficult whether stenosis is localized or diffuse. Even in this gruop, however, it has been possible to achieve good results with careful attention to certain technical details.
Patients with congenital aortic stenosis should be operated on before the development of the sequelae of severe left ventricular hypertension.
The Detection of Heart Disease in Children
Authors: MILLER ROBERT A. , SMITH JACQUES , STAMLER JEREMIAH , HAHNEMAN BETTY , PAUL MILTON H. , ABRAMS IRVING , HAIT GERSHON , EDELMAN JOEL , WILLARD JOEL , STEVENS WILLIAM 
Published: June 2012

A mass field trial was accomplished utilizing a heart sounds tape-recording procedure to detect organic heart disease in school children.
The survey involved 35,934 children, with selection of an 8.2 per cent stratified random sample of Chicago elementary public-school children, drawn from eight representative geographic-socioeconomic-racial areas of the city.
Of the total base population, 33,026 (91.9 per cent) were recorded.
A total of 506 children was recalled for direct auscultation, based on suspicious findings on the tape recordings.
Effective detection required that the tapes be interpreted by two specially trained cardiologists.
Of the 506 children scheduled for recall, 492 were actually examined; 85 were evaluated as having probable organic heart disease, and were referred for complete work-up.
Definite organic heart disease was ultimately diagnosed in 64 children, of whom 48 had congenital heart disease and 16 rheumatic heart disease. The prevalence rate of organic heart disease in the stratified random sample was 2 per 1,000, 1.5 for congenital heart disease and 0.5 for rheumatic heart disease.
Of the total cases, 1 per 1,000 were previously unknown; all such cases have been brought under appropriate medical management as a result of their detection.
A special study of the nonrespondents (those not tape recorded) revealed a six-fold higher prevalence rate of organic heart disease in these children, compared with those surveyed.
A census was also made of cardiac children in special schools for the handicapped, in hospitals, or under home care. Based on the data from the sample, the nonrespondent study, and the foregoing census, the over-all prevalence rate of organic heart disease in Chicago elementary public-school children was estimated to be 3.4 per 1,000, 2.1 for congenital heart disease and 1.3 for rheumatic heart disease.
A validity study was accomplished by randomly inserting 34 cases of known organic heart disease among 2,525 children in one school. Thirty-one of these 34 cases (91.2 per cent) were detected; two of the three cases missed had aortic insufficiency with highpitched grade II murmurs.
It is concluded that this tape-recording procedure is a valid, feasible, and efficient method for the detection of organic heart disease in school children.
Glycogen-Storage Disease of the Myocardium with Obstruction to Left Ventricular Outflow
Authors: EHLERS KATHRYN H. , HAGSTROM JACK W. C. , LUKAS DANIEL S. , REDO S. FRANK , ENGLE MARY ALLEN 
Published: June 2012

A case of glycogen-storage disease of the myocardium with the clinical and hemodynamic picture of left ventricular outlet obstruction was presented. The concept of muscular subaortic stenosis is discussed and the diagnostic features are reviewed.
In a survey of the literature 53 cases of cardiac-type glycogen-storage disease were found. The criteria for diagnosis, sex incidence, familial occurrence, symptomatology and physical signs, and laboratory studies including roentgenograms of the chest, electrocardiogram and muscle biopsy are discussed.
Combined Aortic and Pulmonic Stenosis
Authors: NADAS ALEXANDER S. , VAN DER HAUWAERT LUKE , HAUCK ANNA J. , GROSS ROBERT E. 
Published: June 2012

Combined aortic and pulmonic stenosis is a rare lesion. The clinical, hemodynamic, and pathologic findings in four patients are presented. The presence of a forceful left as well as right ventricular impulse (in four patients), the difference in the character of the ejection murmur at the second left as opposed to the second right interspace (in two patients), and a diastolic rumble at the apex (in four patients) were characteristic. The electrocardiogram showed right ventricular hypertrophy in all patients; additional and definite left ventricular hypertrophy was found in one. Radiologically, there was evidence of right ventricular enlargement in all and suggestive left ventricular enlargement in three. Simple valvular stenosis of both valves was found in only one patient, and valvular pulmonary and supravalvular aortic stenosis in another. The two remaining patients, those with corrected transposition of the great arteries, had complicated lesions including a single ventricle in one and small ventricular septal defect in the other.
Attempts at surgical correction were unsuccessful in all cases.
Congenital Mitral Insufficiency with Cleft Posterior Leaflet
Authors: CREECH OSCAR , LEDBETTER MARION K. , REEMTSMA KEITH 
Published: June 2012

A case of congenital mitral insufficiency in a 2-year-old infant is reported. No other intracardiac defect was found, although pressure studies suggested an area of supravalvular aortic stenosis.
Diagnostic studies included combined right and left heart catheterization. Dye-dilution curves confirmed the presence of mitral insufficiency.
The anatomic defect, a cleft posterior leaflet of the mitral valve, was repaired by direct suture of the valve leaflet.
During 18 months of postoperative observation, the child has shown symptomatic improvement and decrease in the size of the left ventricle, although a systolic mitral murmur and left atrial enlargement persist. Residual insufficiency is probably due to short chordae that restrict mobility of the posterior leaflet.
The Heart in Periarteritis Nodosa
Authors: HOLSINGER DONALD R. , OSMUNDSON PHILIP J. , EDWARDS JESSE E. 
Published: June 2012

The records of 66 necropsied cases of periarteritis nodosa in which there was no associated collagen disease were reviewed with reference specifically to the heart.
Clinically, congestive heart failure and its manifestations were the most important cardiac findings. Congestive heart failure developed some time during the illness in 57 per cent of the patients, and 44 per cent died as a direct result of this cardiac condition. Myocardial infarction was diagnosed clinically in only three cases.
The electrocardiogram was abnormal in 35 of 41 cases but was diagnostic of left ventricular hypertrophy in only six cases and of acute myocardial infarction in only three cases; in the other cases the changes were of a nonspecific nature.
Pathologically, 41 of the 66 hearts had evidence of necrotizing arteritis of the coronary arteries; in 39 of these the arteritis had been acute, and in two it had healed. Forty-one of the 66 hearts exhibited myocardial infarcts. Evidence of acute pericarditis was found in 22 hearts; nine of these cases were attributed to uremia, one was due to transmural myocardial infarction, three could not be classified, and the remaining nine were attributed directly to the periarteritis nodosa. Forty-one of the 64 hearts that had been weighed were hypertrophied.
Effect of Acetylcholine on the Pulmonary Circulation in Patients with Chronic Pulmonary Disease
Authors: CHARMS BERNARD L. , GIVERTZ BERNARD , TOSHIHIKO INOUE 
Published: June 2012

Twenty-seven patients with various forms of chronic pulmonary disease have been studied with constant infusion of acetylcholine directly into the pulmonary artery.
Although many showed a slight decrease in pulmonary artery pressure, this was not great and those with the highest pressures showed the least response.
Pulmonary resistances showed similar small changes, if any.
Arterial oxygen saturations did not fall uniformly and in those with the lowest levels, an actual increase was observed.
It is suggested that vasomotor activity is only one of several factors determining pulmonary artery pressure in patients with chronic pulmonary disease and that anatomic or extravascular factors may become primary.
Vasomotor activity seems to be relatively unimportant in the regulation of ventilation/perfusion relationships in patients with far-advanced disease.
Preoperative Diagnosis and Surgical Correction of Supravalvular Mitral Stenosis and Ventricular Septal Defect
Authors: LYNCH M. F. , RYAN N. J. , WILLIAMS G. R. , CAYLER G. G. , RICHARDSON W. R. , CAMPBELL G. S. , TAYBI H. 
Published: June 2012

A child with supravalvular mitral stenosis plus ventricular septal defect is reported in whom the correct diagnosis was suspected clinically, confirmed by cardiac catheterization, and successfully treated surgically. Only eight previous cases of supravalvular mitral stenosis have been reported; five of the eight have had associated ventricular septal defects. None was correctly diagnosed before autopsy or surgery.
Our patient had a murmur and thrill characteristic of a ventricular septal defect. The pertinent clinical findings suggesting concomitant mitral stenosis consisted of a mitral mid-diastolic murmur that was unusually loud for the magnitude of the left-to-right shunt; a presystolic component to the diastolic murmur; marked left atrial enlargement by x-ray with only moderate pulmonary plethora; and electrocardiographic evidence of left atrial hypertrophy and marked pure right ventricular hypertrophy. Right heart catheterization showed labile passive pulmonary hypertension. Left atrial puncture revealed high proximal and low distal pressure.
Surgical correction of both lesions by total cardiac bypass was accomplished through a midline sternal-splitting incision. The supravalvular mitral membrane was excised from the right atrium through an incision in the atrial septum.
Total Anomalous Pulmonary Venous Connection with Severe Pulmonary Venous Obstruction
Authors: HASTREITER ALOIS R. , PAUL MILTON H. , MOLTHAN MARIAN E. , MILLER ROBERT A. 
Published: June 2012

The clinical, physiologic, and anatomic features of a special group of cases of total anomalous, pulmonary venous connection are reviewed.
The occurrence of severe pulmonary venous obstruction in total anomalous pulmonary venous connection produces a characteristic syndrome:
1. Very early onset of dyspnea and heart failure.
2. Considerably more cyanosis than the usual case without obstruction.
3. Typical x-ray showing diffuse hazy lung fields with reticulated appearance without cardiac enlargement.

4. Electrocardiographic evidence of severe right ventricular hypertrophy with a tall R or qR pattern in lead V
1
and reversal of the R/S ratio over the precordium.

5. Physiologic findings of practically normal pulmonary flow, right ventricular and pulmonary arterial pressures greater than systemic, and a marked gradient between the pulmonary arterial "wedge" and right atrial pressures.
6. Rapid deterioration and death in the first weeks or months of life.
The Mode of Action and Use of Chlorothiazide and Related Compounds
Authors: LARAGH JOHN H. 
Published: June 2012

Chlorothiazide acts to inhibit renal tubular reabsorption of electrolytes. Experimental data are presented which indicate that, under various conditions, anion reabsorption is depressed unselectively so that the pre-existing ratio (Cl/HCO
3
) is not changed during chlorothiazide diuresis. The data suggest that chlorothiazide acts primarily to block sodium ion reabsorption.

Chlorothiazide diuresis is potentiated experimentally by KHCO
3
and clinically by acetazoleamide, organomercurials, or spirolactone. The latter two can also operate to block the potassium wastage of chlorothiazide.

Increased potassium excretion caused by chlorothiazide is viewed as a consequence of the activity of the drug in blocking sodium reabsorption proximal to the site of potassium secretion. According to this concept, all chlorothiazide-type compounds will cause potassium depletion in proportion to their capacity to block proximal sodium reabsorption by diverting more sodium distally to the site of potassium secretion.
Unlike mercurial agents, chlorothiazide either depresser or does not change excretion of free water during a water diuresis. These data suggest that chlorothiazide acts both in the proximal and distal portions of the nephron, while mercurial agents may act largely in the proximal tubule.
The different mode of action of chlorothiazide on tubular reabsorption of electrolytes, as compared with other diuretic agents (acetazoleamide, organomercurials, spirolactone), affords evidence that a number of discrete tubular transport mechanisms participate in the regulation of electrolyte and water balance and provide a rational basis for combined use of various types of diuretic agents in treating edematous patients.
The nature of the antihypertensive action of chlorothiazide has not yet been elucidated. The effect may be related to electrolyte and fluid depletion, but evidence for a more direct action on the circulation is reviewed.
Other aspects of the pharmacology of chlorothiazide and its derivatives are considered, and the application of this information in treatment of states of edema or hypertension is discussed.