bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rupture of the Infarcted Interventricular Septum
Authors: BOICOURT ORVILLE W. , RITZMANN LEONARD W. , CHASE JOHN D. , STARR ALBERT , MCCORD COLIN W. 
Published: June 2012

Successful surgical closure of a ruptured interventricular septum following myocardial infarction is reported. The patient developed the loud pansystolic parasternal murmur characteristic of septal perforation, and cardiac catheterization confirmed an unusually large left-to-right shunt. The patient's course was not the typical rapid deterioration with shock or intractable heart failure, but when myocardial insufficiency developed insidiously 5 weeks postinfarction, surgical closure with a Teflon patch was accomplished during cardiac bypass.
Since early death ensues so frequently, surgical repair has been attempted in only a small number of instances; this patient is one of the very few with successful closure and long-term survival. The pathology, clinical course, and cardiac catheterization data of this entity are reviewed from previously reported cases.
Psychological Factors and Heart Disease
Authors: FISHER STANLEY H. 
Published: June 2012

A number of studies have revealed that perceived emotional stress can produce various transient cardiovascular responses. The reactions may include changes in heart rate and cardiac output. They may include abnormalities in heart rhythm, changes in blood pressure, peripheral resistance, blood viscosity, blood clotting time, and serum cholesterol levels. A hypothesis suggested by the findings which requires further research follows: If these cardiovascular responses were sustained for a period of time, they would ultimately influence the onset or course of coronary artery disease. These studies also suggest that emotional tension at one's work may place an additional strain on an already diseased heart.
In patients whose cardiovascular system is already impaired, investigators have traced the sequence from emotional upset to heart disease. Since the reported evidence has been based on cardiac subjects, it is still possible that "gradual increase in tension" is perceived only after illness occurs, but not necessarily perceived as stressful before beart disease. Owing to the lack of prospective studies in which the life stress factors are studied prior to heart disease, emotion as a cause or contributory factor to heart disease has not been fully accepted. These studies suggest that certain personality traits may be common to certain forms of heart disease. Most of this evidence has been observed from time-consuming, detailed personality analysis, and the evidence depends on studies of relatively few patients and poor or no controls.
It is important to note that these studies on personality type and heart disease were conducted after heart disorders developed. This raises the question of whether the reported personality characteristics preceded or followed the heart disease. The investigations to date assume that the personality structure occurred before the appearance of the heart disease, but before we can answer this question, a longitudinal study of the personality of individuals prior to cardiovascular disease would be necessary.
Intercoronary Anastomotic Channels and Sudden Unexpected Death from Advanced Coronary Atherosclerosis
Authors: SPAIN DAVID M. , BRADESS VICTORIA A. , IRAL PEDRO , CRUZ ANTONIA 
Published: June 2012

Within the limits of the technic in this study, intercoronary anastomotic channels over 40 µ in diameter were unrelated to age and the degree of coronary atherosclerosis.
Intercoronary anastomotic channels over 40 µ in diameter with one exception were found only in the presence of myocardial infarcts.
Those persons who died suddenly and unexpectedly with advanced coronary atherosclerosis did not reveal any evidence of intercoronary anastomoses over 40 microns in diameter. This may be a possible factor in the inability of such individuals to survive a severe initial attack of myocardial ischemia.
The Use of Isoproterenol (Isuprel) in the Evaluation of Congenital Cardiac Defects
Authors: MOSS ARTHUR J. , DUFFIE EDWARD R. 
Published: June 2012

Isoproterenol was infused intravenously at a rate of 0.03 to 0.07 µg. per Kg. per minute in 38 patients undergoing cardiac catheterization to evaluate the routine postoperative condition of 19 patients and to support or confirm the clinical diagnosis in 19 others.
A steady response was obtained in 2 to 4 minutes, and no toxic effects were observed. During the infusion the heart rate increased an average of 55 per cent; the respiratory rate, 23 per cent. The right atrial pressure fell. In general the pulmonary and systemic arterial pressures also decreased. Limited observations on the cardiac output confirmed the previously reported increase. Ten patients developed a significant systolic gradient between the right ventricle and pulmonary artery (greater than 20 mm. Hg) during the infusion. Four of these were postoperative patients, three of whom were considered completely corrected prior to infusion of the isoproterenol. Four patients with aortic stenosis were studied, and the systolic gradient increased in three (80, 93, and 145 per cent).
The results indicate that infusion of isoproterenol is a safe, practical, and effective means of simulating exercise in infants and children. Used in addition to the customary cardiac catheterization studies, it is of distinct value in appraising congenital cardiac defects.
Optimum Criteria for the Diagnosis of Ventricular Septal Defect from Measurements of Blood Oxygen Saturation
Authors: GRAYZEL JOSEPH , JAMESON A. GREGORY , Seed Mary , Webster Jean B. 
Published: June 2012

A combination of physical findings, x-ray films and fluoroscopy, electrocardiography, vectorcardiography, cardiac catheterization including oxygen analysis, indicator-dilution curves, and selective angiocardiography was employed to evaluate 259 consecutive patients undergoing right heart catheterization. All patients were classified on the basis of existing shunts. The present report concerns 63 patients with no shunts and 70 patients with a left-to-right shunt through a ventricular septal defect alone.

A method employing oxygen analysis of right heart blood was evaluated as an isolated diagnostic technic. Blood specimens were obtained in rapid sequence during withdrawal of the catheter from the pulmonary arteries. Spectrophotometric measurements of blood oxygen saturation were appropriately grouped. The difference in means between the right ventricular outflow tract and right atrium was standardized with the estimated standard deviation and the statistical significance determined from the
t
-distribution.

Reliability was defined as the probability of correctly excluding a shunt when none exists. Sensitivity was defined as the probability of diagnosing an existing shunt. By use of the 1-per cent level of signfiicance as critical the method employed was 98.4 per cent reliable and 97.1 per cent sensitive.
Sequential sampling is of vital importance. The value of larger numbers of specimens is illustrated, and the relationship of sensitivity and reliability to the size of the shunt and the number of blood specimens analyzed is illustrated.
The reliability and sensitivity of our method and criteria appear superior to previous criteria currently in use.
Pulmonary Function in Adults with Intracardiac Septal Defect
Authors: WOOLF C. R. 
Published: June 2012

Pulmonary function has been assessed in 45 patients with atrial or ventricular septal defect. Moderate and severe dyspnea occurred almost exclusively in patients with high pulmonary artery pressure irrespective of whether this was due to high pulmonary blood flow or high pulmonary vascular resistance.
Evidence is presented suggesting that this raised pulmonary artery pressure causes lung damage shown by a low compliance and high nonelastic resistance. These findings suggest an abnormal alveolar-capillary membrane and an abnormality of ventilation-perfusion relationships, which in turn cause a relatively low pulmonary diffusing capacity requiring excessive hyperventilation on exercise to maintain oxygen requriments. In patients with moderate or severe dyspnea, the abnormally high minute volume of ventilation during mild exertion is associated with a high work of breathing, the dual abnormality separating them from patients with only slight dyspnea on exertion.
Venous Obstruction of the Upper Extremity Caused by a Malformed Valve of the Subclavian Vein
Authors: CUCCI C. E. , BOTTINO C. G. , CIAMPA V. 
Published: June 2012

A 39-year-old laborer with a venous obstruction of the left upper extremity was studied by selective phlebography. Surgery revealed that the obstruction was caused by an anomalous venous valve, diaphragm-like, at the middle third of the subclavian vein. The removal of the anomalous valve resulted in complete relief of the obstruction.
This is the only known case of venous obstruction caused bv a malformed valve.
The authors suggest that the term "primary venous obstruction" of the upper extremity be used instead of "traumatic thrombosis" or "Paget-Schroetter" syndrome, in cases in which the etiology has not been ascertained.
Detection and Quantitation of Intracardiac Left-to-Right Shunts by an Oximetric Inert Gas Technic
Authors: WOOD ROBERT C. , MARSHALL HIRAM W. , WOOD EARL H. 
Published: June 2012

A method is described for detecting and quantitating small left-to-right shunts by recording continuously and simultaneously the changes in blood oxygen saturation at a systemic artery and at selected sites in the right heart chambers or great vessels produced by a few breaths of an inert gas such as helium or nitrogen.
The advantages of this technic for detecting and quantitating left-to-right shunts are (1) the same instrument, namely, the cuvette oximeter, used to determine blood oxygen saturation and indicator-dilution curves in conjunction with routine diagnostic catheterization procedures, also is used to record the inert gas curves, (2) only one right heart catheter is needed, (3) the method is relatively simple, (4) the shunt can be quantitated, and (5) shunts of less than 10 per cent of pulmonary flow can be detected.
It is concluded that the technic is of considerable practical value as a means of excluding the presence of or demonstrating and determining the magnitude of small left-to-right shunts.
Recognition of Anterior Wall Infarction in Patients with Left Ventricular Hypertrophy
Authors: HUGENHOLTZ PAUL G. , RYAN THOMAS J. , WOERNER THOMAS , LEVINE HAROLD D. 
Published: June 2012

Horizontal plane projections of vectorcardiograms registered by the Frank lead system were analyzed in 36 patients with left ventricular hypertrophy and in 24 with left ventricular hypertrophy and associated anterior wall infarction. All were studied at autopsy. The 0.01-, 0.02-, 0.03-second, and maximum QRS vectors were compared with similar measurements in 60 control subjects previously reported. New criteria for the vector-cardiographic diagnosis of left ventricular hypertrophy have been outlined. Close agreement with earlier reported groups of patients with anteroseptal and anterolateral infarction was found, and findings by others in patients with left ventricular hypertrophy were confirmed.
The direction of the 0.02-second QRS vector allowed the separation of the infarct group from the left ventricular hypertrophy group and from the normal, whereas the direction of the 0.03-second and maximum QRS vectors separated left ventricular hypertrophy from the normal. The magnitude of the maximum QRS vector is another highly reliable indicator of left ventricular hypertrophy and also serves to separate this group from those with associated anterior wall infarct. The influence of associated right ventricular hypertrophy or posterobasal infarction on left ventricular hypertrophy has been discussed.

The accuracy of this technic of vectorcardiographic differentiation between left ventricular hypertrophy on the one hand and left ventricular hypertrophy with anterior infarction on the other in every instance was confirmed at autopsy. In all 12 patients whose electrocardiograms presented the dilemma of QS or rS complexes in leads V
1
to V
3
of the standard precordial electrocardiogram, the vectorcardiographic diagnosis was confirmed at autopsy. The Frank vectorcardiogram is a sensitive and reliable method to recognize left ventricular hypertrophy and may prove to be a useful adjunct to the ordinary electrocardiogram in cases where the electrocardiographic diagnosis is questionable.
Hemodynamic Effects of Isoproterenol Infusion in Patients with Normal and Diseased Mitral Valves
Authors: WHALEN ROBERT E. , COHEN ALLAN I. , SUMNER ROBERT G. , MCINTOSH HENRY D. 
Published: June 2012

Hemodynamic effects of isoproterenol infusion were studied in 26 patients with and without mitral valve disease undergoing combined right and left heart catheterization. The heart rate and cardiac output rose while the left ventricular end-diastolic pressure, pulmonary vascular resistance, and total peripheral resistance fell, regardless of the status of the mitral valve. Infusion produced little change in the mean arterial blood pressure and the diastolic filling period per minute.
While the mean left atrial and pulmonary artery pressures fell in patients with normal or insufficient valves, these pressures rose in patients with mitral stenosis. Stroke volume tended to rise in all patients but those with mitral stenosis. In patients with combined mitral stenosis and insufficiency the insufficiency appeared to modify the hemodynamic response associated with mitral stenosis.
The presence of a lowered end-diastolic pressure in the left ventricle and an increased pressure in the left atrium in patients with stenosis suggests that isoproterenol has a direct or reflex effect on the left ventricle during diastole.
Physiologic Studies Following Surgical Correction of Ventricular Septal Defect
Authors: THEYE RICHARD A. , KIRKLIN JOHN W. 
Published: June 2012

Sixteen patients were studied immediately and for 3 days following surgical closure of ventricular septal defect. In eight patients with absent or mild pulmonary vascular disease, convalescence was uneventful and only small deviations from normal in cardiac output, blood gas levels, and acid-base profile were observed. The remaining eight patients had pre-existing moderate or severe pulmonary vascular disease. Values for cardiac output were abnormally low at some time in the postoperative period in all but two of these eight patients.
Failure to survive was clearly related to a low cardiac output in four of the five nonsurvivors. Reduction in cardiac output observed in this group of patients is believed to be based in major part on the pre-existing increased resistance to blood flow through the pulmonary vascular bed and also to impaired right ventricular function following operation. No evidence was obtained to suggest that major changes in pulmonary vascular resistance occurred in the immediate postoperative period in patients with moderate or severe pulmonary vascular disease following closure of ventricular septal defect. Right ventricular function following atriotomy or transverse ventriculotomy was less impaired than after vertical ventriculotomy.
Surgical Treatment of High Pressure Patent Ductus Arteriosus
Authors: TSUJI HAROLD , SHAPIRO MORSE , MAGIDSON OSCAR , DUNNE EDWARD , DYKSTRA PETER , KAY JEROME HAROLD 
Published: June 2012

Thirteen patients with high pressure patent ductus arteriosus were operated upon. There was no operative mortality in this group. Twelve patients have shown remarkable clinical improvement, and there was a decrease in the pulmonary arterial pressure at the time of recatheterization in 11 of these patients restudied. One patient developed severe pulmonary hypertension and died six and one-half years after operation.
The pulmonary arterial systolic pressure dropped minimally in two patients, despite marked clinical improvement. Both patients had associated lesions: a large ventricular septal defect in one and severe congenital aortic stenosis in the other. Both patients are to be operated upon.
All patients with a predominant left-to-right shunt and a patent ductus arteriosus should have division of the patent ductus arteriosus. If a concomitant lesion requiring open-heart operation, such as a ventricular septal defect or aortic stenosis, is present, it should be corrected at a later date.
Experimental Experience With a Micromodule Pacemaker Receiver Sutured Directly to the Left Ventricle
Authors: STOECKLE HARRY , SCHUDER JOHN C. 
Published: June 2012

It has been demonstrated that it is possible to transmit sufficient energy to pace a heart by means of inductive coupling between an external coil and a very small pacemaker receiver attached directly to the left ventricle. By the use of such a method in dogs, it has been found that the energy requirements for pacing are not dependent upon the total duration of pacing, but rather depend upon the tissue reaction occurring around the electrodes or pins. Electrode erosion, on the other hand, is related to the pacing process and dependent upon electrode material.
The operative implantation of this module is simpler than the other systems presently employed. However, the selection of suitable persons for wearing this unit has not been determined.
Collateral Circulation and Survival Related to Gradual Occlusion of the Right Coronary Artery in the Pig
Authors: LUMB GEORGE D. , HARDY LAWRENCE B. 
Published: June 2012

Studies of survival following ligation and gradual occlusion of the right coronary artery 5 mm. from its ostium have been made in 95 pigs. The pig was selected for the experiments because its coronary artery distribution closely resembles that of the human.
Gradual occlusion was produced by constrictors made of a hygroscopic plastic. Survival following gradual occlusion is considered to be due to the development of collateral circulation.
Comparisons of survival have been made in untreated animals and in animals treated with an orally administered, long-acting nitrate (pentaerythritol tetranitrate). Increased survival in the animals which received medication is thought to be due to the drug's acting as an aid to collateral circulation.
Transatrial Approach to Total Correction of Tetralogy of Fallot
Authors: HUDSPETH ALLEN S. , CORDELL A. ROBERT , JOHNSTON FRANK R. 
Published: June 2012

A transatrial approach to total correction of the tetralogy of Fallot is presented which utilizes: (1) anteroposterior incision of the right atrium near the right atrioventricular groove; (2) circumferential detachment of the septal leaflet of the tricuspid valve near the annulus; (3) pulmonary arteriotomy with valvuloplasty, if necessary; (4) retrograde displacement and resection of the stenosed infundibulum through the right atrium; (5) closure of the ventricular septal defect; (6) closure of the incision in the tricuspid valve; and (7) closure of the atriotomy.
Clinical application to 10 consecutive patients, varying from acyanotia to severely cyanotic, has confirmed the advantages and simplicity of this method. Coronary arterial division, ventriculotomy, and external enlargement of the pulmonary outflow tract have been unnecessary. Relief of pulmonary stenosis has been adequate in each instance. The ventricular septal defect has been well exposed in each patient, and its closure has presented no special problem.
There have been no complications associated with the method, and postoperative cardiac function has been good. Operative as well as clinical features of the method are still under investigation; however, experience thus far has led to its establishment as a routine for total correction of the tetralogy of Fallot in this clinic.
The Need for Systemic-Pulmonary Artery Shunts in the Surgical Management of Tetralogy of Fallot
Authors: HARRIS PAUL D. , BERNHARD WILLIAM F. , GROSS ROBERT E. , NADAS ALEXANDER S. 
Published: June 2012

When managing infants and small children with severe enough symptoms to require operative intervention, there can be no doubt that the establishment of a shunt is highly efficacious. Total repair can be contemplated some years later. If technically feasible, a shunt of the Blalock-Taussig type is the desired form of procedure. When dealing with very small infants, a Potts anastomosis has a higher probability of remaining patent and is therefore more desirable, even though it might be more difficult to obliterate at the second operation.
In older or larger children with the pink tetralogy, total correction in one stage can be advised with an acceptably low mortality rate. However, in older subjects with severe cyanosis, it is now our policy in nearly all cases to employ a two-stage attack in the form of a preliminary systemic-pulmonary arterial shunt, proceeding with complete correction some years later.
An Evaluation of Total Correction of Tetralogy of Fallot
Authors: MALM JAMES R. , BOWMAN FREDERICK O. , JAMESON A. GREGORY , ELLIS KENT , GRIFFITHS SYLVIA P. , BLUMENTHAL SIDNEY 
Published: June 2012

Forty-one consecutive patients, ranging in age from 41/2 to 27 years, were operated upon for complete repair of tetralogy of Fallot without an operative mortality. Postoperative catheterization of 25 patients permitted objective evaluation of the results which were, by the criteria adopted, excellent in 16 patients, good in 5, and poor in 4, including the 2 late deaths.
Surgical experience has shown the necessity for extensive resection of the right ventricular outflow tract. Prosthetic patches are considered necessary for closure of most of the ventricular septal defects encountered, but are infrequently needed for reconstruction of the right ventricular outflow tract. Its use is indicated in certain patients with hypoplasia of the pulmonary annulus or artery.
Age has been an important factor in patient selection. It is suggested that symptomatic patients under five years of age may benefit from a systemic-to-pulmonary arterial anastomosis before definitive correction is undertaken later in childhood.
Serum Tocopherol, Cholesterol, and Triglyceride in Coronary Heart Disease
Authors: NIKKILÄ ESKO A. , PELKONEN RISTO 
Published: June 2012

The plasma tocopherol, cholesterol, and triglyceride were estimated in 175 male survivors of myocardial infarction and in control subjects. The control subjects comprised 214 blood donors (without healthy control) and 70 healthy persons. The coronary group derived from two sources: Group I had had myocardial infarction 4 to 6 weeks before the study; group II was composed of persons who had experienced a myocardial infarction 6 to 30 months before the study.
A tocopherol-loading test with 2 Gm. of tocopherol acetate was performed in 101 coronary subjects and in 34 control subjects. The 24-hour plasma tocopherol was estimated after the tocopherol load.
Ninety per cent of the young control subjects (20 to 35 years of age) had plasma to-copoherol below 15 mg./L., cholesterol below 290 mg./per 100 ml., triglyceride below 140 mg./100 ml., and 24-hour tocopherol below 24 mg./L. In reference to these concentrations, 53 per cent of the whole coronary group had an elevated plasma tocopherol level, 62 per cent had an elevated serum cholesterol level, and 56 per cent showed hypertriglyceridemia. The 24-hour plasma tocopherol level in normal subjects was exceeded by 77 per cent of the subjects with coronary heart disease.
The mean lipid levels were all slightly higher in group I (recent cases) than in group II (old cases). The difference was significant, however, only for triglycerides.
The whole coronary group was divided according to age in two subgroups (age below and over 50). No significant difference existed in the two groups.
The regression analyses of the lipids showed that none of the lipid measurements appeared to be fully independent variables. A highly significant regression was present for cholesterol versus tocopherol. The relationship between triglyceride and tocopherol was not so striking, although the regression was significant also here except the coronary group II.