bluuebunny/crossref_metadata_2025_split huggingface dataset:
Potassium-43 Myocardial Perfusion Scanning for the Noninvasive Evaluation of Patients with False-Positive Exercise Tests
Authors: ZARET BARRY L. , STENSON ROBERT E. , MARTIN NEIL D. , STRAUSS H. WILLIAM , WELLS HARRY P. , MCGOWAN RONALD L. , FLAMM M. D. 
Published: June 2012

Twelve patients with false-positive ECG exercise tests presented with ischemic ECG responses (greater than one mm ST segment depression) during graded maximal treadmill exercise testing in the absence of exercise-induced chest pain or clinical coronary heart disease. Coronary arteriography, left ventriculography and hemodynamic evaluation revealed no significant abnormality in these patients. Transmyocardial lactate analysis during atrial pacing revealed a normal extraction (mean 21%) during pacing stress in five patients.
Nine of 12 patients were evaluated with exercise potassium-43 myocardial perfusion imaging whereby the radioactive tracer was administered intravenously during exercise at a time when abnormal ECG changes were present. Myocardial images in these nine patients all showed a normal homogeneous pattern of radioisotope distribution. These results are in direct contrast to findings in patients with coronary heart disease in whom reproducibly demonstrable abnormal regions of decreased potassium-43 accumulation have been noted in myocardial images obtained following injection of the radioactive tracer during exercise. Potassium-43 exercise myocardial perfusion scanning thus appears to be an accurate noninvasive method of assessing patients with suspected false-positive exercise tests and provides a means of increasing the specificity of exercise testing.
The Natural History of the So-Called Aneurysm of the Membranous Ventricular Septum in Childhood
Authors: FREEDOM ROBERT M. , WHITE ROBERT D. , PIERONI DANIEL R. , VARGHESE P. JACOB , KROVETZ L. JEROME , ROWE RICHARD D. 
Published: June 2012

Fifty-six children with isolated membranous ventricular septal defect (VSD) included in the National Natural History Cooperative Study for Congenital Heart Disease were studied at the Johns Hopkins Hospital Center to determine the occurrence and natural history of an associated "aneurysm of the membranous septum" (AMS). These patients represented a wide range of ages and VSD size. Each child was evaluated by two cardiac catheterizations four years apart, with regular clinical examinations in the interval. The diagnosis of AMS was based on angiographic criteria, and as such may encompass several distinct anatomic lesions.
Twenty children had AMS at the first catheterization; all were over age two, and all but one had a pulmonic-to-systemic flow ratio (Qp/Qs) of less than 2.0, with normal intracardiac pressures. Four years later, repeat catheterization revealed only minor changes in Qp/Qs and angiographic appearance of the aneurysms in this group. Twelve new cases of AMS were also demonstrated at the second study; seven of these children underwent a significant diminution in Qp/Qs during the period in which the aneurysm was formed. No cases of spontaneous anatomic closure were observed in the course of our study, nor were there any serious complications which could be attributed to the presence of an aneurysm. Overall, AMS was found in 32 of 56 patients (57%), and in 31 of 44 (70%) of those with a Qp/Qs less than 2.0.
These findings suggest that AMS is common among children with small membranous VSD, and that its course in childhood is usually stable and asymptomatic. Although anatomic closure of the VSD was not observed during this four year study, our data support suggestions that aneurysm formation may play an important role in some cases of spontaneous diminution in the functional size of an associated membranous VSD.
The Syndrome of Systolic Click, Murmur, and Mitral Valve Prolapse-A Cardiomyopathy?
Authors: GULOTTA STEPHEN J. , GULCO LOUIS , PADMANABHAN VELLORE , MILLER STUART 
Published: June 2012

Twenty six patients with systolic clicks, murmurs, and prolapsed mitral valve leaflets were studied because of distressing chest pain or troublesome arrhythmias. Cardiac catheterization revealed normal coronary arteries and a high incidence of left ventricular (LV) dysfunction.
The patients, 20 of whom were women, averaged 41 years of age. Thirteen of the 22 patients experienced chest pain of sufficient severity to warrant hospital admission for suspected acute myocardial infarction. Twenty of 26 had abnormal ECG patterns including sinus bradycardia, 1°, 2°, and 3° block, atrial and ventricular arrhythmias and abnormal ST-T wave vectors. Three had patterns of healed transmural infarctions and five of 16 had positive exercise tests.
LV dysfunction was hemodynamically documented in 20 patients by either elevated LV end diastolic pressure, low resting cardiac index, or inappropriate rise in cardiac index during exercise. In the remaining six, impaired LV dynamics were demonstrated angiographically.
Left ventriculography revealed mitral valve prolapse in all patients, mitral regurgitation in 20, and mild to severe LV hypertrophy in 14 patients. Contractility, determined angiographically, was markedly impaired in 13 patients with marked hypokinesis of the antero-lateral wall of the LV resulting in the appearance of an unusual prominent convexity in this portion of the ventricle in end systole and early diastole. Seven others had similar but less severe impairment of LV contractility.
These results indicate that LV dysfunction, possibly related to a primary myocardial disorder, is a significant component of the syndrome of prolapsed mitral valve leaflet. The findings in the symptomatic patients described in this study cannot be generalized to all patients with this syndrome as our sample excluded patients with mild asymptomatic forms of the disease.
Atrial Septal Defect in Infancy
Authors: TANDON RAJENDRA , EDWARDS JESSE E. 
Published: June 2012

The atrial septum was evaluated in necropsy specimens from subjects who died under the age of one year. Observations indicated that when an atrial septal defect (ASD) was present, there was commonly an associated condition. In the vast majority, the ASD was at the fossa ovalis and took the form of valvular incompetent foramen ovale. The findings strongly support the concept that an ASD at the fossa ovalis found in symptomatic infants is acquired secondary to the effects of an underlying anomaly. Overloading of the left or right atrium appears to be the mechanism resulting in the formation of an acquired ASD.
In infants with various anomalies that cause overloading of the left atrium, such as left-to-right shunts from ventricular septal defect and left-sided inflow obstruction, the incidence of a defect at the fossa ovalis was 18% and 29%, respectively.
A similar type of ASD was found in 31% of the cases with right-sided inflow or outflow obstruction.
Ascending Aorta to Right Pulmonary Artery Anastomosis
Authors: REITMAN MILTON J. , GALIOTO FRANK M. , EL-SAID GALAL M. , COOLEY DENTON A. , HALLMAN GRADY L. , MCNAMARA DAN G. 
Published: June 2012

An intrapericardial ascending aorta-to-right pulmonary artery anastomosis was performed in 123 patients with cyanotic congenital heart disease associated with pulmonary stenosis or atresia during the eight year period from 1964 through 1971. While there were 20 early postoperative deaths (16%), 90% (93 patients) of the 103 survivors were symptomatically improved.
In the postoperative evaluation, 74 patients (72% of the survivors) returned for follow-up examination, which included cardiac catheterization in 57. The anastomosis was nonfunctioning in ten (13.5%) of these 74 patients and in an additional 13 (17.5%) patients, clinically silent right pulmonary artery stenosis was demonstrated angiographically at the anastomosis site. Clinical improvement had been maintained in the 64 patients with an open anastomosis (audible continuous murmur or angiographically demonstrated patency) including the 13 patients with acquired pulmonary stenosis at the operative site. Persistent right pulmonary artery stenosis was demonstrated in nine of the 14 patients who had cardiac catheterization after intracardiac repair of the congenital heart defect and closure of the anastomosis, but this was insignificant in four of these nine.
The ascending aorta-to-right pulmonary artery anastomosis provides symptomatic improvement for most patients with cyanotic congenital heart disease associated with pulmonary stenosis but may produce right pulmonary artery obstruction requiring attention at the time of total intracardiac repair.
Severe Congenital Tricuspid Incompetence in the Neonate
Authors: BARR PETER A. , CELERMAJER JOHN M. , BOWDLER J. DENBY , CARTMILL TIMOTHY B. 
Published: June 2012

Five neonates with congenital tricuspid incompetence due to severe tethering of the tricuspid valve to the right ventricle by abnormal chordal and papillary muscle attachments are described. The abnormality was called tricuspid valvular dysplasia (TVD) if the basal insertion of the valve was normal and the Ebstein malformation if it was displaced into the sinus portion of the ventricle.
In the two infants with isolated TVD and severe tricuspid regurgitation the functional obstruction to right ventricular outflow (ORVO) produced by the high perinatal pulmonary vascular resistance (PVR) made the exclusion of pulmonary atresia difficult, despite selective right ventricular angiocardiography.
In three infants the tricuspid valvular abnormality was associated with organic ORVO; pulmonary atresia in two and critical pulmonary valve stenosis in one. In the two infants with pulmonary atresia and intact ventricular septum (IVS) the severe tricuspid incompetence produced a clinical, radiological and hemodynamic profile which was clearly different from that usually seen in infants with pulmonary atresia and IVS and a normal right ventricular cavity (type 2 of Greenwold).
Coarctation of the Aorta with Congenital Mitral Regurgitation
Authors: FREED MICHAEL D. , KEANE JOHN F. , VAN PRAAGH RICHARD , CASTAÑEDA ALDO R. , BERNHARD WILLIAM F. , NADAS ALEXANDER S. 
Published: June 2012

Among 861 infants and children with coarctation of the aorta examined between 1950 and 1973, inclusive, 18 (2.1%) also had congenital mitral regurgitation (MR).
Resection of the coarctation of the aorta was performed in 16 of these 18 patients (89%). There were three operative deaths early in the series, giving a total mortality rate of 18% since 1950. Over the past decade, mortality in this group has been reduced to zero. Mitral valve replacement was performed following resection of the coarctation in 2/13 patients (13%), both successfully. The follow-up of the 13 postoperative patients and the two who have not undergone surgery has ranged from 5 to 18 years, with a median of nine years. At the last examination, an appreciable pressure gradient persisted between the right arm and the legs in 4/15 patients (27%). Weight remained below the third percentile in none. The clinical picture of congestive heart failure was present in none, but significant cardiomegaly was found radiologically in 11/15 (73%) and the electrocardiogram remained abnormal in 8/15 (53%). Over the period of follow-up, the MR became clinically worse in 4/15 patients (27%), remained unchanged in 7/15 (47%), and improved following resection of the coarctation in 4/15 patients (27%).
The pathologic anatomy of congenital MR associated with coarctation of the aorta was reviewed and classified. Two unique cases were presented — rupture of chordae tendineae and perforation of the posterior leaflet, both apparently congenital. When mitral surgery becomes necessary, an understanding of the pathologic anatomy of congenital MR may well make it possible to avoid mitral valve replacement in selected cases.
The Missing Waveform Information in the Orthogonal Electrocardiogram (Frank Leads)
Authors: KORNREICH F. , BLOCK P. , BRISMEE D. 
Published: June 2012

Nine surface electrocardiograms recorded on the thoracic surface at fixed and identical locations in 412 individuals were found to account for the maximal useful waveform information available in each individual. In other words, nine waveforms were capable of resynthesizing any waveform recorded on their thoracic surface. These nine waveforms were then submitted to multivariate statistical procedures and their diagnostic performance compared to the Frank leads on which the same procedures were applied. Before the data were fed into the computer, all waveforms were time-normalized and divided into eight equal parts, yielding 72 variables and 24 variables for the nine lead system and the Frank leads, respectively, for each individual.
In this paper we attempted to discriminate between normal subjects and patients with documented angina pectoris (typical history and positive coronary angiography); myocardial infarction was excluded in these patients. Only the resting QRS complex was considered. With the 9-lead system, keeping the specificity (true negatives) at 90%, the sensitivity (true positives) is 76%; with the Frank leads, the same specificity yielded a sensitivity of 49%. The repeatability of the results on new independent controls was also found very satisfactory.
The discrimination between patients with angina pectoris on one hand and left ventricular hypertrophy and myocardial infarction on the other hand resulted in a performance level of 89% and 87%, respectively, for the 9-lead system. A good correlation was also found between the extent of the coronary lesions (number of coronary vessels involved) and the fraction of correctly diagnosed patients.
The present study concluded that the retrieval of more complete surface information results in an evident improvement of the diagnostic performance of electrocardiography.
Use of a Combination of Anion and Cation Exchange Resins in the Treatment of Edema and Ascites
Authors: MARTZ B. L. , KOHLSTAEDT K. G. , HELMER O. M. 
Published: June 2012

A mixture of a carboxylic acid type of cation exchange resin and a weakly basic anion exchange resin has been used successfully to control the edema of 42 patients with congestive heart failure and the ascites of 14 patients with cirrhosis of the liver. Approximately one-third of the cation exchanger was supplied in the potassium cycle.
Inclusion of the anion exchange resin resulted in a greater sodium uptake per gram of resin and apparently decreased the incidence of disturbances in acid-base balance in patients with impaired renal function who were treated with resins.
A Method for Evaluating Computer Programs for Electrocardiographic Interpretation
Authors: BAILEY JAMES J. , ITSCOITZ SAMUEL B. , GRAUER LEONARD E. , HIRSHEFELD JOHN W. , HORTON MARTHA R. 
Published: June 2012

A previously described method for evaluating computer programs for electrocardiographic (ECG) interpretation was applied to Version D of the Public Health Service (PHS) program and to the Mayo Clinic program of 1968. Staff cardiologists found agreement with the results of the PHS program in 45.5% of 1150 unselected tracings. Clinically significant disagreements based strictly on application of different criteria occurred in 29%, while disagreements based on program errors were found in 25.5%. The corresponding results for the Mayo Clinic program are: agreement in 47%, disagreements due to criteria differences in 30.9%, and disagreements due to program errors in 22.1%.
Both programs had serious deficiencies, particularly in the diagnostic categories of myocardial infarction and cardiac arrhythmias. PHS program errors resulted primarily from mismeasurements and deficient program logic, while Mayo Clinic program errors more frequently resulted from pattern recognition failures. Neither program appears suitable for routine clinical use at the present time.
Starr-Edwards Mitral Valve Failure Ten Years After Replacement Surgery: Chronic Fibrous Obstruction of the Prosthesis Frustrum Area
Authors: SEYFER ALAN E. , HEYDORN WILLIAM H. , NELSON WILLIAM P. , SPICER MELVIN J. , STREVEY TRACY E. 
Published: June 2012

A case of malfunction of a Starr-Edwards caged-ball mitral prosthesis occurring ten years after implantation is presented. The possibility of late malfunction must be suspected in any patient who redevelops symptoms after valve replacement. Preservation of normal prosthetic opening and closing clicks does not prove that the device is functioning normally. The diagnosis is difficult, with cardiac catheterization and demonstration of mitral obstruction providing the most valuable information. Once the diagnosis of prosthesis obstruction is made, reoperation and replacement is mandatory.
This clinical pattern will be seen with increasing frequency as patients with artificial valves are followed over longer periods of time.
Anomalous Origin of One Pulmonary Artery from the Ascending Aorta
Authors: KEANE JOHN F. , MALTZ DAVID , BERNHARD WILLIAM F. , CORWIN ROBERT D. , NADAS ALEXANDER S. 
Published: June 2012

Six patients with origin of one pulmonary artery from the ascending aorta are presented. Two are alive: a 21-year-old female, unoperated, with bilateral pulmonary vascular obstructive disease (PVO) and a 4-year-old girl who underwent successful correction at age 5 months. In addition, the data are reviewed from previous reports of 44 patients with this anomaly. Among the total of 50 patients, 42 had congestive heart failure in infancy. The right pulmonary artery arose anomalously in 44. A patent ductus arteriosus was present in 38 cases. At cardiac catheterization, pressure in both pulmonary arteries was generally at systemic level and the diagnosis was confirmed by aortography. Histologically, no significant PVO was observed in the majority of 18 infants who died, while significant changes, mainly in the "systemic" lung, were observed in 6 of 10 older children.
Twenty-two patients have been operated on with 13 survivors. Anastomosis of the aberrant pulmonary artery to the main pulmonary artery directly or using a graft has been successful in 12 of 18 children. Corrective tive surgery should be performed as early as possible to prevent PVO.
Complications of Cardiac Catheterization of Neonates, Infants, and Children
Authors: STANGER PAUL , HEYMANN MICHAEL A. , TARNOFF HAROLD , HOFFMAN JULIEN I. E. , RUDOLPH ABRAHAM M. 
Published: June 2012

In order to assess the influence of recent modifications in cardiac catheterization technique and patient management, a prospective study of all complications in a series of 1160 cardiac catheterizations of neonates, infants, and children was performed. Thirty-four major and 136 minor complications were recorded. Fatal complications were rare in all age groups (0.26%); however, postcatheterization deaths not attributable to the procedure were common in critically ill neonates with nonremediable lesions.
Arrhythmias and arterial complications accounted for 78% of all complications. Although the incidence of arrhythmias was high (8.3% of all cases), particularly in infants, almost all responded to simple therapeutic measures. Five arrhythmias resulted in clinical deterioration and two contributed to death.
The incidence of arterial complications varied considerably with the method of arterial entry. Percutaneous catheterization by the sheath method was associated with fewer complications than with the Seldinger technique, arteriotomy, or insertion of a teflon cannula into an exposed artery. Complications were particularly common after brachial arteriotomy in patients with coarctation of the aorta (16.1%).
Complications of contrast media and perforation of the heart were infrequent, each occurring once.

Although the total number of major complications was only moderately less frequent than in patients of comparable age in the Cooperative Study on Cardiac Catheterization,
1
there was a considerable reduction in the most severe complications and deaths. The changes in catheterization technique and patient management that contributed to decreased mortality and morbidity are discussed.
Phenylephrine (Neo-synephrine) Terminated Ventricular Tachycardia
Authors: WAXMAN MENASHE B. , DOWNAR EUGENE , BERMAN NEIL D. , FELDERHOF CLARENCE H. 
Published: June 2012

Five cases of recurrent, wide QRS complex tachycardia which could be terminated with phenylephrine are presented. These cases fulfilled all accepted criteria for ventricular tachycardia. Carotid sinus massage with and without edrophonium hydrochloride had no effect on the ventricular activity but selectively slowed the atrial rate in cases of atrioventricular (A-V) dissociation, or blocked retrograde conduction in cases of A-V association. The mechanism of action of phenylephrine remains unclear.
These cases have many possible implications. Two of the most important are: 1) phenylephrine may be useful in terminating certain cases of ventricular tachycardia; 2) termination of an unknown, regular, wide QRS complex tachycardia by phenylephrine, and possibly other pressors, can no longer be taken as proof of a supraventricular mechanism.
The Effect of Collateral Circulation on Segmental Left Ventricular Contraction
Authors: CARROLL ROBYN J. , VERANI MARIO S. , FALSETTI HERMAN L. 
Published: June 2012

The anatomy of the coronary circulation was correlated with left ventricular segmental contractile motion in 162 patients: 43 with normal coronary arteriograms, 119 with significant (> 75%) obstruction of the right coronary artery and/or left anterior descending coronary artery. Collateral vessels were identified in 69% of the patients with coronary artery disease (82/119). The cases with collaterals were graded poor, fair, or good according to the number of vessels and the quality of opacification. Segmental contractile motion was determined angiographically by the percent shortening of each of the six chords of the left ventricle in the right anterior oblique projection. The range of normal shortening (mean ± one standard deviation) for each chord was established in the 43 normal patients as follows:
[See Equation in PDF File]
Patients were grouped according to the site of coronary artery obstruction and quality of collateral circulation to the area supplied by the obstructed coronary artery. The percent shortening and number of abnormal segments were determined for each patient; there was no consistent difference in segmental contraction between patients with and without collaterals. The quality of collateral vessels did not correlate with either the number of abnormal segments or the percent of chord shortening.
In summary, the development of collateral vessels is not associated with the restoration of normal segmental wall motion in patients with coronary artery disease.
Anomalous Origin of the Left Circumflex Coronary Artery
Authors: PAGE HARRY L. , ENGEL H. JURGEN , CAMPBELL W. BARTON , THOMAS CLARENCE S. 
Published: June 2012

Anomalous origin of the circumflex coronary artery from the proximal right coronary artery or right sinus of Valsalva was recognized in 20 of 2996 patients undergoing selective coronary arteriography (0.67%). The relative frequency of this anomaly demands a high level of anticipation during the performance of selective coronary arteriography to assure that an adequate study has been obtained. Failure to recognize and properly demonstrate the anomaly can be hazardous to patient management.
Two angiographic signs have proved reliable in recognizing the anomalous artery before its selective demonstration. These signs are a profile view of the artery behind the aortic root during left ventriculography (the "aortic root sign") and recognition of absent arterial inflow to a significant area of the posterior lateral left ventricle during selective injections of the main left coronary artery (the "sign of non-perfused myocardium"). These angiographic signs are described and the clinical implications of proper demonstration of the anomalous circumflex coronary artery are discussed.