bluuebunny/crossref_metadata_2025_split huggingface dataset:
Congenital Communication of a Coronary Artery with a Cardiac Chamber or the Pulmonary Trunk ("Coronary Artery Fistula")
Authors: NEUFELD HENRY N. , LESTER RICHARD G. , ADAMS PAUL , ANDERSON RAY C. , LILLEHEI C. WALTON , EDWARDS JESSE E. 
Published: June 2012

Anatomic, clinical, hemodynamic, and roentgenographic findings in six patients with congenital communication of a coronary artery with a cardiac chamber or the pulmonary trunk are presented. The literature is reviewed.
A coronary artery may communicate anomalously, with any of the cardiac chambers, more commonly with those on the right side. In the six cases presented, the right coronary artery communicated with the right atrium in one case and with the right ventricle in another. The left coronary artery communicated with the right atrium and right ventricle in one case each, and with the pulmonary trunk in two cases.
The most striking feature observed clinically was a continuous murmur. If a continous murmur is localized in an area atypical for patent ductus arteriosus, the diagnosis should be suspected. Conventional roentgenographic and electrocardiographic studies yielded no specific diagnostic features. The results of cardiac catheterization may reveal a left-to-right shunt, but they are diagnostically useful only when correlated with clinical findings.
The only precise method of demonstrating the abnormality is by means of selective aortography performed by injecting medium into the very origin of the aorta.
Cure is possible by surgical interruption of the fistulous tract.
Coagulation Tests and Platelet Economy in Atherosclerotic and Control Subjects
Authors: MURPHY E. A. , MUSTARD J. F. 
Published: June 2012

Blood coagulation was studied in 31 atherosclerotic male subjects and in 44 control male subjects.
The mean platelet adhesive index was significantly greater in the atherosclerotic group and the plasma thromboplastin time was significantly shorter. These two tests are measures of the activity of the early stages of coagulation. The other in vitro tests of coagulation showed no significant differences.

At present, platelet consumption is probably the only available measure of the activity of the early stages of coagulation in vivo. Platelet survival and daily turnover was accordingly determined with DFP
32
. Mean platelet survival was shorter and mean platelet turnover was greater in the atherosclerotic group.

Division of the groups according to family history of atherosclerosis proved important. The most clearly separated groups were the atherosclerotic group with a positive history and the controls with a negative history. The remaining two subgroups are much more alike. This was true of both in vitro and in vivo tests.
Despite the high experimental error, the in vivo tests correlate well with the in vitro tests of the early stages of clotting though poorly with tests of the later stages. It is concluded that differences exist between atherosclerotic and control subjects in the early stages of coagulation, and that in vitro tests are satisfactory indices of this difference. In their present form, none of these tests is suitable for diagnostic or prognostic purposes in the individual.
External Electrical Termination of Supraventricular Arrhythmias in Congenital Heart Disease
Authors: PAUL MILTON H. , MILLER ROBERT A. 
Published: June 2012

Persistent supraventricular arrhythmias of the flutter or fibrillation-flutter type have been terminated by elective external electric countershock in three patients after drug therapy had been unsuccessful.
It is suggested that this technic is a relatively safe and effective treatment for supraventricular as well as ventricular arrhythmias when anti-arrhythmic drugs have proved ineffective.
Analysis of the Normal and Abnormal Vectorcardiogram in Its Own Reference Frame
Authors: PIPBERGER HUBERT V. , CARTER THOMAS N. , Pipberger Hanna A. 
Published: June 2012

Vectorcardiograms from 296 patients with a variety of ECG abnormalities were compared with normal standards obtained from 249 subjects without evidence of heart disease. A reference frame based on the spatial orientation of QRS loops rather than on conventional plane projections was used. Burger's polar vector and Schellong's QRS plane form the main parameters of such a reference frame. Spatial QRS orientation is defined by one term, the polar vector, which is perpendicular to the QRS plane. The direction of this vector can be determined through rotation of the QRS loop into its principal plane by means of a VCG lead resolver. Further analysis of QRS in its principal plane then becomes independent of inter-individual variability in spatial QRS direction. Separation between normal and abnormal was used as an indicator for the diagnostic quality of various measurements. Two corrected orthogonal lead systems designed by Schmitt and Frank were used for the study. These systems did not differ appreciably in the extent of normal ranges nor in the discrimination between normal and abnormal.
The polar vector appeared as the best indicator for abnormalities. In 65 per cent of the pathologic cases this parameter was found outside normal limits. Measurements derived from the contour and principal axes of QRS planes improved the recognition rate for abnormalities. Ratios expressing the degree of QRS planarity, however, contributed little to diagnostic accuracy. The QRS-T angle obtained in the QRS plane improved the recognition rate mainly in the series with ventricular hypertrophies. It could be demonstrated that without evaluation of time and voltage criteria between 85 and 100 per cent of all pathologic records could be recognized as abnormal when the vectorcardiograms were analyzed in their own reference frame. Thus, it appeared that this method of analysis has a considerable diagnostic potential and compares favorably with those used more commonly in clinical electrocardiography and vectorcardiography.
Acute Pulmonary Edema of Altitude
Authors: FRED HERBERT L. , SCHMIDT ALEXANDER M. , BATES TALCOTT , HECHT HANS H. 
Published: June 2012

Three separate episodes of acute pulmonary edema are described that developed in two otherwise healthy individuals during heavy exertion at high altitudes. Detailed physical examination and laboratory studies failed to demonstrate pulmonary infection or cardiac disease. Data obtained by cardiac catheterization during one of these episodes revealed elevation of the pulmonary artery pressure and a normal left atrial pressure.
This syndrome appears to be the consequence of pulmonary vascular obstruction distal to the capillary bed, presumably in the pulmonary veins. It is brought about by exposure of susceptible individuals to high altitudes, and is completely reversed by oxygen administration.
Effects of Chlorothiazide on Renal Hemodynamics
Authors: VILLARREAL HERMAN , REVOLLO ANDRÉS , EXAIRE JOSÉ EMILIO , LARRONDO FRANCISCO 
Published: June 2012

A comparative study was made of the acute effect of chlorothiazide upon renal hemodynamics in eight normotensive subjects and 10 patients with early essential hypertension.
It was observed that blood pressure remained unchanged in normotensive subjects but was significantly reduced in hypertensive patients. Glomerular filtration rate was decreased similarly in both groups, whereas renal plasma flow was not modified in either. Osmotic clearance increased in all subjects, free water clearance diminished in normotensive (overhydrated) subjects, whereas in the hypertensive (not overhydrated) patients free water reabsorption increased.
It is concluded that chlorothiazide reduces blood pressure in hypertensive patients but not in normotensive persons; that the kidney reacts in the same fashion in normotensive and hypertensive subjects under the action of the drug; and that the alterations in renal function observed with its use in hypertensive subjects are probably unrelated to changes in blood pressure.
The Diagnosis of Bilateral Stenosis of the Primary Pulmonary Artery Branches Based on Characteristic Pulmonary Trunk Pressure Curves
Authors: AGUSTSSON M. H. , ARCILLA R. A. , GASUL B. M. , BICOFF J. P. , NASSIF S. I. , LENDRUM B. L. 
Published: June 2012

The cardiac catheterization and angiocardiographic findings in 12 cases with bilateral stenosis of the primary pulmonary artery branches are described. Characteristic pressure tracings were consistently obtained from the main pulmonary trunk in all cases. These typical curves were reproduced in animal experiments. Associated lesions with left-to-right shunts and mild pulmonary valvular stenosis did not alter the characteristics of the curves. An attempt is made to explain these hemodynamic phenomena.
These tracings obtained from the main pulmonary trunk appear to us to be diagnostic of bilateral stenosis of the main pulmonary arteries even if, as frequently happens, one is unable to enter both pulmonary artery branches during cardiac catheterization or to demonstrate definitely the stenosis of both pulmonary arteries by angiocardiography.
Electrocardiogram and Spatial Vectorcardiogram of Localized Myocardial Hypertrophy
Authors: BURCH GEORGE E. , DEPASQUALE NICHOLAS P. 
Published: June 2012

Diagnostic electrocardiographic and vectorcardiographic manifestations of localized hypertrophy of the posterobasal portion of the left ventricle and of localized hypertrophy of the crista supraventricularis have been described. Recognition of the fact that only a portion of the myocardium may undergo hypertrophy is important in understanding certain types of electrocardiographic and spatial vectorcardiographic patterns.
Several types of localized myocardial hypertrophy for which no characteristic electrocardiographic or spatial vectorcardiographic patterns have been described were also discussed. There is a need for further study of this problem, and, in particular, for detailed correlation of the necropsy data with the electrocardiogram and the vectorcardiogram.
Congenital Stenosis of Individual Pulmonary Veins
Authors: SHONE JOHN D. , AMPLATZ KURT , ANDERSON RAY C. , ADAMS PAUL , EDWARDS JESSE E. 
Published: June 2012

The case is reported of an infant with congenital stenosis of each of the four individual pulmonary veins near the left atrium. The characteristic features were failure to thrive, increasing cyanosis and dyspnea, and death in congestive cardiac failure at 7 months of age. A precordial systolic murmur and an early systolic ejection click were heard; the sounds over the base of the heart were diminished in intensity. Roentgenograms of the thorax revealed a heart of normal size with fullness of the main pulmonary artery segment and increased pulmonary vascular markings that had the reticulated appearance associated with pulmonary venous engorgement. Electrocardiography showed right axis deviation, right atrial enlargement, and a pattern of right ventricular systolic overload. Cardiac catheterization demonstrated increased right atrial pressure and markedly elevated right ventricular and pulmonary arterial pressures. Angiocardiographic studies revealed a right-to-left shunt at atrial level, enlargement of the right ventricle, and enlarged and tortuous pulmonary arteries. In the late films the left atrium appeared normal in size, but the pulmonary veins were tortuous and there was evidence of constriction of the pulmonary veins at the veno-atrial junctions, associated with delay in the passage of opaque material from the pulmonary veins to the left atrium.
It is suggested that the definitive diagnosis most likely is to be made by a selective angiocardiogram performed from the main pulmonary artery.
It would appear feasible, at least in theory, to obtain complete surgical correction of this anomaly.
The Natural History of Atherosclerosis
Authors: VASTESAEGER MARCEL M. , DELCOURT R. 
Published: June 2012

In order to complete the fragmentary knowledge of the natural history of atherosclerosis, the authors examined the coronary arteries of 403 captive and 146 wild vertebrates living in freedom, as well as the aortas of 134 of them. In 88 of the captive animals and in 51 of the free individuals, lipidogram, total cholesterol, beta-cholesterol and cholesterol/phospholipid ratio were also determined.
In this material, spontaneous atherosclerosis always developed in arteries already impaired by intimal sclerosis, and intimal sclerosis seems to be a basic condition for spontaneous atherogenesis.
Lipid deposits were found in the intima of 29 per cent of the examined aortas, but coronary atherosclerosis was present in only 2 per cent of the captive specimens. The discovery of coronary atherosclerosis in free tunny fishes, caught in the Bay of Biscay, brings proof that atherosclerosis is neither the privilege of warm-blooded vertebrates nor a consequence of captivity.
Unfortunately, the material collected does not permit even a rough estimate of the influence of captivity on the development of atherosclerosis. It was observed in any case that captivity significantly alters some aspects of the lipidic metabolism in animals, and especially the beta-lipoprotein levels as well as the beta-cholesterol fraction.
Spontaneous atherosclerosis may develop in fishes living in their natural habitat, feeding on a diet rich in unsaturated fats; in captive birds whose dietary fats are mostly unsaturated (crane, tree duck, pelican); and in wild mammals whose diet is free of animal fats, in freedom as well as in captivity (deer, camel, tapir).
The Two-Step Exercise Electrocardiogram
Authors: FRIEDBERG CHARLES K. , JAFFE HARRY L. , PORDY LEON , CHESKY KENNETH 
Published: June 2012

A double-blind study was made to evaluate the two-step exercise electrocardiographic test (Master) as a means of differentiating between anginal and nonanginal chest pain in 100 consecutive patients.
A high percentage of false-positive results in nonanginal cases and a number of false negatives in anginal cases greatly impaired the usefulness of the test for this purpose.
When Master's criterion of an ST depression of 0.5 mm. or more was employed, there were 39 per cent false positives and 12 per cent false negatives.
Stricter criteria progressively diminished the number of false positives, but resulted in increasing numbers of false negatives. Even if 1 mm. or more of ST depression was required, there were 8 per cent false positives and 43 per cent false negatives. There were no false positives only when the ST segment was depressed 2 mm. or more.
Although an ischemic type of ST depression may be more significant for angina pectoris than the J type, in our series ischemic ST depressions also occurred more frequently than the J type in false-positive tests in nonanginal patients.
The new criteria of Master and Rosenfeld were not more satisfactory than the previous criteria recommended.
There are relatively few cases in which an objective two-step test is necessary to aid in the differentiation of anginal and nonanginal pain, since an unequivocal diagnosis of angina pectoris or nonanginal pain was made in 86 per cent of cases independently by at least two observers, on the basis of a single interview, and since this percentage could undoubtedly have been increased by further interviews concerning the effect of effort and of nitroglycerin.
Insofar as confirmation of a clinical diagnosis of angina pectoris by an objective exercise test is desirable, an ST-segment depression of at least 1 mm. usually offers such confirmation. However, this degree of ST-segment depression is often absent in unequivocal cases of angina pectoris and conversely may be occasionally present in patients with nonanginal pain.
Accessory Valvular Tissue Causing Subpulmonary Stenosis in Corrected Transposition of Great Vessels
Authors: LEVY MORRIS J. , LILLEHEI C. WALTON , ELLIOTT LARRY P. , CAREY LEWIS S. , ADAMS PAUL , EDWARDS JESSE E. 
Published: June 2012

This study reveals three cases of corrected transposition (one with total situs inversus) where an accessory flap or umbrella-like formation of the venous atrioventricular valve presented into the outflow tract of the venous ventricle causing severe subpulmonary stenosis.
In one case the ventricular septum was intact, while in each of the other two, a ventricular septal defect lay below the obstruction. The latter combination effected a right-to-left shunt at ventricular level.
These cases are important because they portray anatomic details of a condition which, although uncommon, is potentially curable. Clinical identification of the subpulmonary stenosis appears best to be accomplished by selective angiocardiography at the level of the venous ventricle.
Reflected Ultrasound in the Assessment of Mitral Valve Disease
Authors: JOYNER CLAUDE R. , REID JOHN M. , BOND JAMES P. 
Published: June 2012

An ultrasound beam directed into a medium of uniform acoustical impedance will travel in a straight line, but a portion of the waves will be reflected at the interface of a medium of different acoustical impedance. A time-distance curve of motion has been obtained from the heart by recording the echoes returned to a send-receive ultrasound transducer applied in the third, fourth, or fifth left interspace. A characteristic curve having two anterior peaks during each cardiac cycle was obtained in the 25 normal patients studied. One peak follows the P wave of the electrocardiogram and is not seen in atrial fibrillation. The other peak of motion toward the anterior chest is followed by rapid regression posteriorly during ventricular diastole. The velocity of the motion was 85 to 160 mm./sec. in normal subjects. In contrast, the records from 90 patients with mitral stenosis demonstrated a distinctive, abnormal pattern having a plateautype configuration with a velocity of posterior motion of only 2 to 35 mm./sec. The configuration of the curve changed toward normal after successful mitral valvulotomy but none of the 35 patients who were studied before and after surgery has developed a calculated postoperative velocity exceeding 70 mm./sec.
Twelve patients with "pure" mitral regurgitation have had records similar to the normal, with velocities in or above the normal range. None of the 135 other patients studied, representing a variety of conditions, demonstrated a curve of the type found in mitral stenosis.
A Vascular Abnormality in Hypertension
Authors: CONWAY JAMES 
Published: June 2012

Forearm blood flow measurements have been made at rest and after 8 to 10 minutes arterial occlusion in 50 normal and 131 untreated hypertensive subjects. The latter group comprised 91 with essential hypertension; 11 with chronic renal disease (nephritis or pyelonephritis); 21 with renovascular disease; and eight with primary aldosteronism.
The resting blood flow increased with the rising pressure in patients with mild hypertension but there was a significant increase in the resting resistance in the more severe cases. The average minimal resistance obtained during reactive hyperemia was greater in hypertensive (3.1 SE 1.0 units) than in normal subjects (2.0 SE 0.07 units). This abnormality was related to the level of blood pressure but not to the duration of the disease.
Patients with renovascular disease or aldosteronism presented the same vascular fault as the more common causes of hypertension.
Evidence is presented to show that the reactive hyperemia produced maximal dilatation of the forearm vasculature, and acute elevation in pressure in normotensive or acute depression of pressure in hypertensive subjects did not influence the level of resistance achieved by reactive hyperemia.
It is concluded that the blood vessels themselves are abnormal in hypertension and that this abnormality may not be related to the activity of vascular smooth muscle.
Pulmonary Stenosis
Authors: SCHERLIS LEONARD , KOENKER ROLF J. , LEE YU-CHEN 
Published: June 2012

The electrocardiographic, vectorcardiographic, and right heart catheterization data of 100 patients with isolated or complicated pulmonary stenosis were analyzed.
All but two patients had normal sinus rhythm. One patient, age 62, had atrial fibrillation; the other, age 8, had the Wolff-Parkin-son-White syndrome.
In isolated pulmonary stenosis, P-wave enlargement was far more frequently seen in those patients with right ventricular systolic pressures above 100 mm. Hg as compared to those with pressures less than 100 mm. Hg. This relationship was not observed in patients with complicated pulmonary stenosis.

The incidence of rsR' in V
1
, QRS widening, and the vectorcardiographic evidence of conduction delay was significantly lower in pulmonary stenosis, isolated or complicated, when compared to atrial septal defects alone. There was one instance of terminal conduction delay of the right bundle-branch block type and one diffuse slowing of the QRS sÊ loop in the present series.

The correlation between the amplitude of the R wave in V
1
and right ventricular systolic pressure was better in the group of isolated pulmonary stenosis as compared to the groups complicated by interatrial communications or ventricular septal defects.

The average right ventricular systolic pressures in patients with type 3 right ventricular hypertrophy was significantly higher than those with either type 1 or type 2 right ventricular hypertrophy on the basis of vectorcardiographic criteria discussed. In the presence of pulmonary stenosis, the electrocardiographic and vectorcardiographic evidence of left ventricular hypertrophy or combined ventricular hypertrophy suggests coexisting lesions such as ventricular septal defect with left-to-right shunts. However, it was not possible to differentiate between isolated pulmonary stenosis and pulmonary stenosis complicated by interatrial communication by either electrocardiograms or vectorcardiograms.
The vectorcardiographic features of combined ventricular hypertrophy are discussed.
Digital Hemodynamics in the Normotensive and Hypertensive States
Authors: CALIVA FRANCIS S. , NAPODANO RUDOLPH J. , LYONS RICHARD H. 
Published: June 2012

By use of the technic of rheoplethysmography, it has been demonstrated that the small veins and venules participate in the over-all increase in peripheral resistance in hypertension.
An arbitrary grading of the degree of venomotor tone in hypertension has been established.