bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac Myopathy, Probably of Congenital Origin
Authors: RUTTENBERG HERBERT D. , JUE KENNETH L. , ELLIOTT LARRY P. , ANDERSON RAY C. , EDWARDS JESSE E. 
Published: June 2012

The clinical and pathologic findings are presented in a 1-year-old child with an unusual cardiac myopathy of the left ventricle. [see figure in the PDF file] [see figure in the PDF file] The clinical findings suggested the diagnosis of anomalous origin of the left coronary artery from the pulmonary trunk. These features included insidious onset of cardiac failure in the first year of life, massive cardiomegaly with nearly normal pulmonary vasculature, absence of cyanosis and of a cardiac murmur, and electrocardiographic and vectorcardiographic findings of left ventricular hypertrophy with severe myocardial ischemia or infarction.
[see figure in the PDF file]
Angiocardiograph studies, which did not support this diagnosis, revealed an aneurysmally dilated left ventricle with unusual internal septations and loculations.
The necropsy showed concentric semicircular muscular ridges and grooves in the apical portion of the left ventricle and a peculiar fibrous endocardial network of the same chamber. It is suggested that this process may be congenital in origin.
Cyanosis, Cardiomegaly, and Weak Pulses
Authors: WALKER WELDON J. , MULLINS CHARLES E. , KNOVICK GEORGE C. 
Published: June 2012

An infant was seen at 2 days of age with cardiomegaly, congestive failure, cyanosis, and weak pulses. The primary cardiovascular lesion was a massive arteriovenous fistula between the left subclavian artery and innominate vein.
Review of the literature indicates that most newborn infants with large systemic arteriovenous fistulas leading to congestive failure have been cyanotic. The hemodynamic alterations incident to large experimental systemic arteriovenous fistulas affords an explanation for this cyanosis.
It is suggested that massive systemic arteriovenous fistula in the newborn lowers systemic resistance to a fraction of the high pulmonic resistance present at this age. The right ventricle bears the brunt of the increased cardiac work. Right ventricular failure associated with a marked increase in systemic venous return to the right atrium elevates right atrial pressure above that in the left atrium and almost inevitably leads to cyanosis with right-to-left shunting of blood through the foramen ovale.
Failure to realize that massive systemic arteriovenous fistula in the newborn may present as cyanotic heart disease can cause fatal delay in recognizing this correctable form of heart failure.
Painless Dissecting Aneurysm of the Aorta
Authors: O'DONOVAN T. P. B. , OSMUNDSON PHILIP J. , PAYNE W. SPENCER 
Published: June 2012

A case is reported of a man who had an acute painless dissecting hematoma of the aorta, which was diagnosed clinically in the absence of hypertension or known precipitating cause. The successful surgical treatment is described and illustrated.
The following diagnostic features were stressed in the absence of pain: sudden onset of symptoms, syncope, acute peripheral arterial occlusion, appearance of aortic insufficiency, and finding of bruits over the course of the aorta. The significance of the symptom of pain in the torso and the possible modes of its production in this condition are considered, and it is suggested that pain in dissecting aneurysm may imply a poor prognosis.
Ventricular Septal Defect with Aortic Regurgitation
Authors: NADAS ALEXANDER S. , THILENIUS OTTO G. , LAFARGE C. GRANT , HAUCK ANNA J. 
Published: June 2012

Thirty-four patients with ventricular septal defect and aortic regurgitation, representing less than 5 per cent of our patients with ventricular septal defect, are discussed.
A loud, systolic murmur, characteristic of ventricular septal defect, is noted during infancy, whereas evidences of aortic regurgitation (protodiastolic murmur and wide pulse pressure) does not usually appear until sometime between 2 and 10 years of age.
Clinical and catheterization data indicate that the principal hemodynamic load is aortic regurgitation, whereas the ventricular septal defect does not usually result in a large pulmonary blood flow or high pulmonary arterial pressure. In about 50 per cent of the patients, a significant pressure gradient across the right ventricular outflow tract exists.
Detailed pathologic studies indicate that the ventricular septal defects are high and anterior and encroach to a greater or lesser degree on the membranous bulbar septum. The right coronary cusp is the one most severely involved, and, by its prolapse, causes aortic regurgitation; the noncoronary cusp is always less severely affected. The anatomic basis of the pressure gradient observed across the right ventricular outflow tract is not always clear.
Relationship of the Azygos Venous System to Normal Atrial Situs in Levocardia
Authors: LEACHMAN ROBERT D. , SLOVIS ARNOLD J. 
Published: June 2012

Levocardia with abdominal visceral situs inversus is associated with complex intracardiac malformation and most often with inversion of the atria.
In patients with levocardia, if the azygos venous system replaces the inferior vena cava as the principal or only avenue of venous return from below the diaphragm, the position of the right and left atria may be normal.
Patients with levocardia associated with simple ostium secundum atrial septal defects that were surgically corrected are briefly presented.
Circulatory Dynamics in the Presence of Carotid-Jugular Fistula
Authors: HOLMES THOMAS W. 
Published: June 2012

Two patients are presented, in whom right common carotid artery-internal jugular vein fistula had been patent for 12 years. These cases provide the longest reported follow-up of patients with surgically created carotid-jugular fistulas.
Marked cardiac hypertrophy, a systolic murmur in one patient, and arterial hypertension in the other, proved reversible following repair of the fistulas.
Alterations in circulatory dynamics before and after repair are correlated with established phenomena associated with arteriovenous fistulas of various size, duration, and anatomic location.
The Influence of Respiratory Gas Mixtures on Arterial Pressure and Vascular Reactivity in "Normal" and Hypertensive Dogs
Authors: PAGE IRVINE H. , OLMSTED FREDERICK 
Published: June 2012

The reactivity of the vascular tree to chemical stimuli is of fundamental importance in both hypertension and shock. Refractoriness and hypotension can be elicited by stimuli arising in the sympathetic ganglions as a result of their stimulation by carbon dioxide. "Total" autonomic ganglionectomy thus prevents the appearance of refractoriness and aids in production of the supernormal hypotensive response to carbon dioxide.
Dogs with renal experimental hypertension differ from those with neurogenic hypertension in that they react normally to carbon dioxide and several other vasoactive substances. The neurogenic hypertensives exhibit greatly heightened depressor responses and hence vasomotor activity. The mechanism for refractoriness is intact in both groups of animals and does not appear overactive in either. The neurogenic mechanism for the production of refractoriness is lost in the sympathectomized animal.
Mitral Ball-Valve Prosthesis
Authors: KEZDI PAUL , HEAD LOUIS R. , BUCK BRUCE A. 
Published: June 2012

Flow dynamic studies were performed in a mechanical pulse duplicator with Starr-Edwards ball valves. It was shown that the "effective orifice" of the ball valve is less than the measured orifice of the cage of the valve. The orifice is decreased to 83 per cent of the measured orifice in the smaller and to 89 per cent in the larger valves. These measurements corresponded well with the measurements of the "effective orifice" of the valve implanted in patients who were examined by left and right heart catheterization and left ventricular angiocardiograms several months after placement of the valve.
The closing regurgitation found in early systole in the mechanical system appears to be negligible in patients. Left ventricular angiograms did not show reflux of dye into the left atrium through the valve cage.
The size of the mitral annulus in patients was measured from left ventricular angiograms. The size of the mitral ball valve prosthesis which the mitral annulus will accommodate could be predicted with good accuracy from these measurements.
Arrhythmias Related to Cardioversion
Authors: LEMBERG L. , CASTELLANOS A. , SWENSON J. , GOSSELIN A. 
Published: June 2012

DC countershock abolished 92 of 101 episodes of atrial fibrillation in 86 patients, an incidence of 91 per cent. Supraventricular arrhythmias were not infrequent immediately after countershock. These were transient and did not complicate the procedure nor were they hazardous to the patient. On two occasions a slow atrioventricular nodal rhythm appeared followed by recurrence of atrial fibrillation a few hours later. Sinus node activity did not return in these patients. Ventricular tachycardia, fibrillation, or standstill did not occur in this series.
The following arrhythmias were observed immediately after countershock but prior to the establishment of a regular sinus rhythm: atrioventricular dissociation, 12 times; passive atrioventricular nodal rhythm, five times; atrioventricular nodal tachycardia, five times; atrial flutter or tachycardia, four times.
The conversion of fibrillation to flutter by countershock implies that the effect of the electric current was merely to shorten the length of the circulating wave, a phenomenon that can also be observed in the treatment of atrial fibrillation with quinidine.
Disorders of rhythm, probably having a different mechanism, were also observed after countershock had established a regular sinus pacemaker. In the group not treated with quinidine prior to countershock (74 episodes) atrial extrasystoles were seen 26 times (35 per cent); atrioventricular nodal extrasystoles or escapes, 18 times (24.3 per cent); atrial flutter or tachycardia, six times (8.1 per cent); atrial fibrillation, eight times (18 per cent); atrioventricular nodal tachycardias, twice (2.6 per cent); and a bizarre, multifocal atrial arrhythmia, once (1.3 per cent). The arrhythmias considered to be responsible for the recurrence of atrial fibrillation and also the possible mechanisms involved were discussed.
Pretreatment with quinidine was effective in reducing the incidence of arrhythmias occurring after conversion (27 episodes), atrial extrasystoles six times (22 per cent), atrioventricular nodal extrasystoles or escapes six times (22 per cent); atrial flutter or tachycardia three times (11 per cent); atrial fibrillation once (3.7 per cent); and atrioventricular nodal tachycardia once (3.7 per cent).
Traumatic Tricuspid Insufficiency
Authors: OSBORN JAMES R. , JONES ROBERT C. , JAHNKE EDWARD J. 
Published: June 2012

A patient with isolated traumatic rupture of the anterior papillary muscle of the tricuspid valve is described. This is the second such case in the literature.
Clinical observations, hemodynamic data, and details of surgical treatment are discussed.
The diagnosis should be suspected in any patient who initially develops clinical evidence of tricuspid insufficiency following mechanical trauma to the chest or during the course of endocarditis.
Treatment is directed at the associated primary condition, i.e., severe trauma elsewhere in the body or endocarditis. The indications for open-heart surgery will be a matter for decision in individual cases.
The Actions of Cardiac Glycosides on Heart Muscle Cells
Authors: PAGE ERNEST 
Published: June 2012

In experimental heart muscle preparations cardiac glycosides specifically inhibit the active transport of Na ions out of heart muscle cells. By this action they bring about a net cellular accumulation of Na and, secondarily, a net cellular loss of K and uptake of Cl, cell swelling, and a fall in the electrical potential difference across the resting cell membrane. The site of inhibition appears to be the external surface of the cell membrane and to involve a displacement of K ions from a critical site at this surface. Inhibition of active transport by cardiac glycosides in intact cells has a counterpart in cell membrane fragments, in which the drugs inhibit the Na- and K-activated enzymatic splitting of adenosinetriphosphate.
The contraction-promoting effect of these drugs is not understood, principally because the sequence of events in cellular contraction and its alterations in heart failure have been only incompletely identified. Cellular contraction has been divided for descriptive purposes into three stages, including depolarization, excitation-contraction coupling, and shortening and relaxation of the myofibrils containing the contractile proteins. Neither the inhibition of active ion transport nor the experimental observations on the three stages of the contractile sequence explain the therapeutic effects of cardiac glycosides. Experimental approaches to the question of cardiac glycoside action at the cellular level and to the related problem of heart muscle cell failure are suggested.
Renal Biopsy and Its Clinical Correlation in Toxemia of Pregnancy
Authors: ALTCHEK ALBERT 
Published: June 2012

Through the combination of a renal biopsy technique modified for pregnant women, electron microscopy, and knowledge of fine (ultramicroscopic) glomerular anatomy, the pathology of the renal glomerular lesion of toxemia of pregnancy (preeclampsia-eclampsia) has been defined. The lesion is pathognomonic and consists of swelling of the cytoplasm of the endothelial cell, deposits underneath the basement membrane and within the swollen endothelial cytoplasm, and an increase of intercapillary cells. The lesion reduces the glomerular capillary lumen. It is the most sensitive pathological lesion of toxemia in the body, and is present in all cases of toxemia. Once formed, the lesion persists until evacuation of the uterus, in spite of apparent clinical improvement with therapy.
The lesion accounts for the characteristically decreased glomerular filtration rate in toxemia, and this may be a factor in the formation of edema. Demonstration of the lesion is the only laboratory method that can reliably differentiate toxemia from uncomplicated essential hypertension (preeclampsia may be superimposed on essential hypertension): the presence of the glomerular lesion indicates toxemia, while absence of the lesion indicates that the illness is not due to toxemia. A severe glomerular lesion indicates impending fetal death.
Although renal biopsy is mainly of investigative use in obstetrics, it is a valid diagnostic tool for discovering or dismissing the possibility of chronic renal disease.
Left Ventricular Performance Following Digitalization in Patients with and without Heart Failure
Authors: MURPHY GERALD W. , SCHREINER BERNARD F. , BLEAKLEY PAUL L. , YU PAUL N. 
Published: June 2012

Nine patients, three with left ventricular failure and six with compensated heart disease, were studied by means of right and transseptal left heart catheterization during acute digitalization with acetyl strophanthidin. One of the patients with heart failure and a compensated subject with the Wolff-Parkinson-White syndrome were also studied during supine left leg exercise.
In the decompensated group, digitalization produced a decrease in heart rate and increases in stroke index, stroke work, mean stroke power, mean systolic ejection rate, and the rate of pressure rise in the left ventricle. Left ventricular end-diastolic pressures were markedly lowered after digitalization.
In the compensated group, no significant changes in cardiac index, stroke index, or mean systolic ejection rate were observed. Although there were small increases in stroke work and power and moderate decreases in left ventricular diastolic pressures, the most striking finding was an increase in the rate of rise of left ventricular systolic pressure.
Digitalization produced considerable improvement in the circulatory response to light exercise in a patient with left ventricular failure. Less marked improvement in the exercise response was observed in a patient with normal hemodynamics. After digitalization, left ventricular function points plotted on the stroke work end-diastolic pressure diagram tended to shift upward and to the left in both decompensated and compensated patients. The shift of function points was most prominent in the decompensated group.
This study demonstrates that, in the presence of myocardial failure, acetyl strophanthidin markedly augments left ventricular performance. Furthermore, the data suggest that digitalization also improves left ventricular performance in patients with left ventricular enlargement but no clinical manifestations of heart failure.
The Susceptibility of Dogs with Chronic Impairment of Cardiac Lymph Flow to Staphylococcal Valvular Endocarditis
Authors: MILLER ALBERT J. , PICK RUTH , KLINE IRWIN K. , KATZ LOUIS N. 
Published: June 2012

Nine of 16 dogs (56 per cent) with surgically produced chronic impairment of cardiac lymph flow developed acute endocarditis of the mitral valve or acute myocarditis, or both, after intravenous injections of staphylococci, while none of 10 unoperated control dogs did. The results show that chronic impairment of cardiac lymph flow predisposes to staphylococcal endocarditis and myocarditis.
Impairment of cardiac lymph drainage may be important in explaining certain poorly understood pathologic processes in man. Thus, impaired lymph flow may predispose to bacterial endocarditis, recurrent rheumatic carditis, and myocarditis. It may be one of the alterations which perpetuates chronic inflammatory processes in the heart valves and in the myocardium. Inflammation and fibrosis in turn may predispose to impairment of lymph flow, and the latter in its turn will predispose to further inflammation, infection, and fibrosis. Thus a vicious cycle is established. A hypothesis concerning the role of cardiac lymphatics in infection, inflammation, and fibrosis is outlined. There is great need for careful and detailed observations of disease involvement of the cardiac lymphatic system in man.
The Effect of Beta-Sympathetic Blockade on Arterial Oxygen Saturation in Fallot's Tetralogy
Authors: HONEY MICHAEL , CHAMBERLAIN DOUGLAS A. , HOWARD JANE 
Published: June 2012

In many patients with Fallot's tetralogy, the fall in arterial oxygen saturation that occurs during exercise can be reduced by prior administration of the beta-sympathetic blocking drug, pronethalol. In a few patients there is also a rise in arterial oxygen saturation at rest.
During exercise, increased stimulation of beta-sympathetic receptors in the heart enhances myocardial contractility; this leads to more complete systolic emptying of the right ventricle, and increased systolic obstruction to ejection of blood into the pulmonary circulation by hypertrophied infundibular muscle. It is this dynamic component of the right ventricular outflow tract obstruction that is abolished or reduced by beta-sympathetic blockade. The phenomenon occurs most readily when valve or high infundibular stenosis is associated with infundibular muscle hypertrophy proximal to the organic obstruction, and can sometimes be demonstrated by angiocardiography.
Beta-sympathetic blocking drugs may have a place in the treatment of cyanotic attacks in Fallot's tetralogy, and possibly in the long-term management of the patients in whom total correction has not yet been undertaken.
The Development of Outflow Tract Obstruction of the Left Ventricle in Idiopathic Myocardial Hypertrophy
Authors: TAFUR EMILIO , GUNTHEROTH WARREN G. , BAUM DAVID , BLACKMON JOHN R. 
Published: June 2012

A patient was found to have unexplained left ventricular and septal hypertrophy at age 11, but no pressure gradient across the left ventricular outflow tract. At age 13, there was a mean ejection gradient of 82 mm. Hg. The patient died suddenly 1 month later. This patient demonstrates the development of muscular subaortic stenosis in idiopathic myocardial hypertrophy with obstruction due to increasing muscular hypertrophy.
A second patient with left ventricular hypertrophy secondary to a fixed left ventricular outflow tract obstruction produced by an anomalous insertion of a mitral valve leaflet developed additional obstruction due to septal hypertrophy.
We believe that the cases presented establish that "muscular subaortic stenosis" may be the result of ventricular hypertrophy of different etiologies. A schema is presented to assist classification of muscular subaortic stenosis.
Transluminal Treatment of Arteriosclerotic Obstruction
Authors: DOTTER CHARLES T. , JUDKINS MELVIN P. 
Published: June 2012

The rationale and technic of a new procedure—transluminal recanalization of arterio-sclerotic obstructions—has been described.
Of the 11 extremities treated, six have shown marked improvement (four amputations averted). It is reasonable to assume that with a perfected technic and patients with less advanced disease, the percentage of successful recanalizations would increase.
Early treatment with this technic may well prevent otherwise serious disease, not just prevent amputation of extremities not suitable for definitive surgery. We are satisfied that percutaneous transluminal recanalization is the treatment of choice for many lesions of the femoral and popliteal arteries. We believe this method is ready for application to obstructions up to approximately 10 cm. by those skilled in the use of vascular catheters. No doubt the interest and ingenuity of others will lead to refinements of technic as well as further clarification of the role of this attack on arteriosclerotic obstructions.
Lipid-Binding Capacity of Intimal Globulins in Human Aortic Atherosclerosis
Authors: MATHUR K. S. , SHARMA R. D. , KASHYAP S. K. , SAPRU R. P. 
Published: June 2012

One hundred forty-seven aortas obtained from medicolegal autopsies were studied. According to the extent of involvement of the intimal surface and the types of lesions, aortic atherosclerosis was classified as mild, moderate, and severe. The globulin content of the intima and its lipid-binding, and cholesterol-binding capacity were determined in each specimen.
No relation could be established between the globulin content of aortic intima and the degree of atherosclerosis. A direct correlation was observed, however, between the lipid-binding capacity and the cholesterol-binding capacity of the globulins and the severity of atherosclerosis, suggesting the possibility of a qualitative change in the globulins of the ground substance in atherosclerosis.