bluuebunny/crossref_metadata_2025_split huggingface dataset:
Conversion of Supraventricular Tachyeardias with Rapid Atrial Stimulation
Authors: VERGARA GEORGE S. , HILDNER FRANK J. , SCHOENFELD CLYDE B. , JAVIER ROGER P. , COHEN LAWRENCE S. , SAMET PHILIP 
Published: June 2012

Rapid atrial stimulation (RAS) is a technic useful for converting the rapid ventricular response of atrial tachycardia, atrial flutter, or junctional tachycardia to a slower ventricular rate with normal sinus rhythm or atrial fibrillation. It is particularly useful when alternate methods such as DC cardioversion, carotid sinus massage, and drug therapy are either ineffective or undesirable. It is safe in patients with digitalis intoxication, does not require general anesthesia, documents atrial rhythm, and can be used repetitively without cumulative effects.
RAS was performed 129 times in 87 patients (45 males; 42 females) whose ages ranged from 33 to 90 years (mean 67 years). There were no major complications. Overall, including both initial and repeat attempts, RAS successfully converted supraventricular tachycardia in 71% of cases and failed in 29%.
Hemodynamic Data and Angiographic Findings after Mustard Repair for Complete Transposition of the Great Arteries
Authors: RODRIGUEZ-FERNANDEZ HECTOR L. , KELLY DAVID T. , COLLADO AGUSTIN , HALLER J. ALEX , KROVETZ L. JEROME , ROWE RICHARD D. 
Published: June 2012

Eleven childrern with uncomplicated transposition of the great arteries repaired by the Mustard procedure were studied by atrial pacing, cardiac catheterization, and cineangiography. Nine had persistent postoperative ectopic cardiac rhythms. Atrial pacing in five suggested sinus node damage in four and A-V junctional conduction tissue damage in one.
In seven children dye-dilution curves indicated small right-to-left shunts. In all seven superior vena cava cineangiograms showed leaks in the baffle at the superior atrial junction. In the other 10, sequential pressures in the superior vena cava, physiologic right atrium, and inferior vena cava showed no evidence of obstruction to systemic venous return. The three complications related to placement of the atrial baffle seemed to be due in large part to technical difficulties in suturing the baffle in the vulnerable sinus node region.
There were no differences in the postoperative hemodynamics between the five patients repaired at a younger age because of severe cyanosis and the five larger children who had been repaired electively. Our results support the aim for early surgical correction in uncomplicated transposition of the great arteries.
Use of Sublingual Nitroglycerin in Congestive Failure following Acute Myocardial Infarction
Authors: GOLD HERMAN K. , LEINBACH ROBERT C. , SANDERS CHARLES A. 
Published: June 2012

The effect of 0.3 mg sublingual nitroglycerin (NTG) was evaluated by hemodynamic measurements and precordial S-T-segment mapping in 17 patients following acute myocardial infarction.
In all cases NTG produced a prompt reduction in mean pulmonary capillary wedge pressure (PCW) from an average of 19 ± 2 to 14 ± 1 mm Hg associated with a small fall in mean arterial pressure from a mean of 85 ± 4 to 82 ± 4 mm Hg. No significant change in heart rate occurred.
In patients without left ventricular failure (PCW 3-12 mm Hg) cardiac output (CO) fell 9%. By contrast, in patients with moderate left ventricular failure (PCW 13-22 mm Hg) CO rose 18%. In three patients with refractory left ventricular failure (PCW 25-31 mm Hg) CO rose 25%. Two of these patients were treated with repetitive NTG doses in addition to previously ineffective diuretic therapy with resolution of resistant pulmonary edema. No significant changes in the magnitude of S-T-segment elevations were noted.
NTG may have a special role in the management of acutely ill patients with myocardial infarction in whom pulmonary edema does not respond to conventional therapy.
Echocardiography in the Normal Neonate
Authors: SOLINGER ROBERT , ELBL FRANCISCO , MINHAS KAREEM 
Published: June 2012

Utilizing the atrioventricular and semilunar valves as ultrasonic landmarks, a simple reproducible technic is described for the ultrasonic evaluation of the heart and its great vessels in the normal neonate. The importance of the clinical application of this method is discussed.
Echocardiographic studies were performed on 240 normal newborns. Qualitative assessment was made of the interrelationships of the pulmonary, aortic, tricuspid, and mitral valves, and of interventricular septal motion. Quantitative norms were obtained for the following parameters: amplitude of motion of anterior leaflets of tricuspid and mitral valves, anteroposterior diameter of the ventricular and left atrial cavities, thickness of ventricular walls and interventricular septum, outside diameter of aortic and pulmonary roots, and interaortic and interpulmonary cusp distances.
Prognosis of Surgically Corrected Coarctation of the Aorta
Authors: MARON BARRY J. , HUMPHRIES J. O'NEAL , ROWE RICHARD D. , MELLITS E. DAVID 
Published: June 2012

A long-term retrospective analysis of 248 patients, 11-25 years after surgical correction of coarctation of the aorta, revealed a high incidence of premature cardiovascular disease. Twelve percent of patients with follow-up have died. It is suggested that premature death in patients with adequate surgical repair may be related to the duration of preoperative hypertension. Fifty-nine patients were evaluated on a standard hospital protocol. Seventy-eight percent had evidence of cardiovascular disease and over 40% had no change or had increased blood pressure over the preoperative value.
These data emphasize the importance of early diagnosis and treatment for patients with coarctation of the aorta as well as the need for close postoperative follow-up.
Correlation of the Antemortem Coronary Arteriogram and the Postmortem Specimen
Authors: VLODAVER ZEEV , FRECH ROBERT , VAN TASSEL ROBERT A. , EDWARDS JESSE E. 
Published: June 2012

Correlative studies were carried out on the coronary arteriograms made during diagnostic procedures and on the specimens obtained at necropsy in 10 cases of coronary heart disease. Of the 134 segments of coronary arteries available for both studies, 44 (33%) were given false-negative arteriographic diagnosis of obstructive atherosclerosis.
Factors which may underlie this discrepancy include (1) radiographic technic, (2) projection used, (3) a slitlike lumen adjacent to the atheroma, (4) comparison of severely obstructed segments involved but less severely obstructed, and (5) misinterpretation from the specimen of obstruction present in life.
Absence of Anatomic Origin from Heart of Pulmonary Arterial Supply
Authors: EDWARDS JESSE E. , MCGOON DWIGHT C. 
Published: June 2012

Among certain patients with cardiovascular malformations, a common phenomenon is a ventricular septal defect and absence of anatomic origin of the pulmonary arterial supply from the heart. In this situation, true pulmonary arteries may be present or absent. In the latter case, the pulmonary arterial supply comes through bronchial arteries. When true pulmonary arteries are present, the left and right pulmonary arteries either may be in continuity at their origins (confluence) or they may arise from separate sites (nonconfluence).
When confluence is present, the two pulmonary arteries may arise either from an atretic pulmonary trunk or from certain forms of persistent truncus arteriosus. Pulmonary atresia may be localized to the proximal end of the pulmonary trunk or diffuse in this vessel. When nonconfluence is present, each pulmonary artery arises separately from one of three possible sources as follows: (1) a form of persistent truncus arteriosus, (2) through ducti arteriosi from the aortic arch system, or (3) through bronchial arteries from the descending aorta.
Assessment of Ventricular Function after Acute Myocardial Infarction by Plasma Volume Expansion
Authors: LOEB HENRY S. , RAHIMTOOLA SHAHBUDIN H. , ROSEN KENNETH M. , SINNO M. ZIAD , CHUQUIMIA RUBEN , GUNNAR ROLF M. 
Published: June 2012

In order to see if changes in preload could be used to help assess left ventricular function, 24 patients with uncomplicated acute myocardial infarction (AMI) received plasma volume expansion (PVE). In eight patients (group A) cardiac index (CI) increased by 20% or more, and in 16 patients (group B) CI increased by less than 20% or decreased. By plotting left ventricular stroke-work index (LVSWI) against left ventricular end-diastolic pressure (LVEDP) before and after PVE, the ventricular function curves upon which the heart was operating could be assessed. In group A patients the values moved upward and to the right, while in group B the values during PVE moved horizontally or downward and to the right suggesting that at rest these hearts were operating at the peak of their function curves.
Patients in group B had a higher incidence of anterior infarction and a lower control mean arterial pressure than patients in group A, but other clinical and control hemodynamic values did not differ between the two groups. Follow-up data suggest that patients in group B may have had a higher mortality within the first 6 months following AMI.
Changing preload by PVE appears to be a safe and potentially useful means of assessing ventricular function following AMI and deserves further study.
Immediate and Remote Prognostic Significance of Fascicular Block during Acute Myocardial Infarction
Authors: WAUGH ROBERT A. , WAGNER GALEN S. , HANEY THOMAS L. , ROSATI ROBERT A. , MORRIS JAMES J. 
Published: June 2012

The electrocardiograms of 538 patients with acute myocardial infarction were searched to identify all instances of atrioventricular (A-V) and intraventricular (I-V) conduction disturbances. Data concerning mode of therapy and clinical complications were obtained by review of the record. These variables were then analyzed for significance in relation to the development of type II A-V block acutely and syncope or sudden death during the first year of follow-up.
The most accurate predictor for both these events was the status of A-V conduction in combination with the status of I-V conduction. At highest risk (50%) for type II progression were patients with acute adjacent fascicular block plus P-R prolongation, i.e., left anterior hemiblock plus right bundle-branch block (RBBB), or left bundle-branch block (LBBB), or patients with acute nonadjacent fascicular block, i.e., RBBB plus left posterior hemiblock or alternating bundle-branch block. The nonpaced survivors from this same group, plus any other patients with transient type II progression, were also at high risk (45%) for syncope or sudden death in follow-up. No syncope or sudden death has occurred in seven patients with type II progression discharged with a pacemaker. All other patients were at lower risk for these acute and chronic complications.
Thus, the electrocardiogram in acute myocardial infarction can identify a high-risk group for acute type II progression in whom prophylactic pacer insertion may be beneficial. Similarly, the electrocardiogram can identify a high-risk group for syncope or sudden death in follow-up and implicates progression to higher degrees of A-V block as an important pathophysiologic mechanism.The possible role of permanent pacemaker therapy in preventing syncope or sudden death in this high-risk group is also suggested.
Newer Aspects of Echocardiography
Authors: FEIGENBAUM HARVEY 
Published: June 2012

The recent increase in interest in echocardiography is partially due to the feasibility of using this technic to evaluate left ventricular performance in a noninvasive manner. It has been demonstrated that one can obtain an internal dimension of the left ventricular cavity and that this dimension is closely related to the corresponding volumes in uniformly contracting ventricles. Thus in patients with valvular heart disease, congenital heart disease, or cardiomyopathy, echocardiography provides an excellent noninvasive means of estimating diastolic volume, systolic volume, stroke volume, ejection fraction, and mean rate of circumferential shortening. In patients with segmental left ventricular disease, such as with coronary artery disease, these dimensions may not be true reflectors of the corresponding volumes. In such ventricles one probably should use echocardiography to evaluate the motion of individual segments of the chamber. To evaluate overall left ventricular function, one could use the mitral valve echoes to estimate mitral valve flow and left ventricular diastolic pressure. Echocardiography also provides a method of measuring wall thickness of the posterior left ventricular wall and the interventricular septum.
Many echocardiographic technics for the diagnosis of congenital heart disease have recently been described. Most of these technics obviously need further substantiation; however, the size of the list is impressive and makes one feel that even the more complicated forms of congenital heart disease may be unraveled with echocardiography. The use of a strip-chart recorder has greatly improved and broadened the echocardiographic examination. Besides making the examination technically easier, it provides a means of appreciating the interrelationship of many cardiac echoes.
A critical problem facing echocardiographly is the maintenance of high-quality examinations. Unfortunately the examination is not easy, and it requires a well-trained, highly skilled individual. The acceptance of the technic by the clinician has produced a demand which exceeds the available manpower to do adequate echocardiography. As a result much of the echocardiography being done is totally inadequate. The technic is still new and relatively unproven, and it cannot tolerate much abuse by people not well trained. One possible safeguard to the maintenance of high-quality echocardiography is for clinicians to be familiar with what a good echocardiogram looks like. The difficulty with echocardiography is mainly in doing the examination. not necessarily in the interpretation. Thus if the technical quality can be maintained, there is no doubt that echocardiography will play an increasingly important role in clinical cardiology.
Symptomatic Atrial Septal Defect in Infancy
Authors: HUNT CARL E. , LUCAS RUSSELL V. 
Published: June 2012

Atrial septal defect of the ostium secundum variety (ASD) is uncommonly diagnosed in infancy and rarely results in congestive heart failure (CHF). Eleven patients with uncomplicated ASD who developed CHF between 6 days and 13 months of age are presented.
The diagnosis of ASD was documented by cardiac catheterization in all 11 patients. Left-to-right shunt ranged from 52 to 80%. Right ventricular pressure was near systemic levels in two patients and at least somewhat elevated in the other nine. Total pulmonary resistance (TPR) was within normal limits in all 11. No left ventricular obstructive lesions were found. Although one patient had unusual thickening of the left ventricular myocardium, and the left ventricular cavity was enlarged in two other cases, no specific abnormality in left or right ventricular function could be defined.
Spontaneous closure of the ASD did not occur in any of our patients. Since spontaneous closure even of a large ASD can occur, however, it seems advisable to defer elective surgical closure until after 2 years of age if successful medical management can be achieved. In those patients in whom early surgery is not necessary, the clinical course usually becomes that of a typical ASD by age 2 years.
Clinical Course of Patients with Normal, and Slightly or Moderately Abnormal Coronary Arteriograms
Authors: BRUSCHKE ALBERT V. G. , PROUDFIT WILLIAM L. , SONES F. MASON 
Published: June 2012

In a series of 500 patients who had normal coronary arteriograms or narrowings < 50% of the lumen diameter the subsequent clinical course was studied. The minimum follow-up period was 5 years. In 342 patients with entirely normal coronary arteriograms there were only two (0.6%) presumed cardiac deaths and three (0.9%) acute myocardial infarctions within 5 years; both incidences are about half the expected rates in the average unselected population of the United States matched by sex and age. In 101 patients with mild abnomalities (<30% narrowing of the lumen diameter) the prognosis was less good than in the normal group but still better than in the average population. In 57 patients with moderate abnormalities (30 to less than 50% narrowing) there were three (5.3%) presumed cardiac deaths and two (3.5%) myocardial infarctions within 5 years; both incidences are higher than in the average population. Serial arteriograms were made in 20 cases and showed progression of the disease in the majority of cases with moderate narrowings, but progression or development of narrowings in only one of the cases with normal arteries or mild narrowings. Other determinants included in this study appeared to have limited predictive value regarding the clinical course.
It is concluded that the coronary arteriogram contains major predictive information. Normal findings indicate an excellent prognosis regardless of other diagnostic parameters; moderate abnormalities indicate the early phase of an essentially progressive disease.
Echocardiographic Detection of Regional Myocardial Infarction
Authors: KERBER RICHARD E. , ABBOUD FRANCOIS M. 
Published: June 2012

Posterior wall velocities have been advanced as a useful technic for the assessment of left ventricular function. To evaluate the echocardiographic effects of regional myocardial infarction on posterior wall motion (PWM), measurements were obtained in 22 open-chest dogs. Coronary artery ligation produced infarction of the apex in 11 dogs (group I) and the posterior wall in 11 dogs (group II). Echoes were thus received from noninfarcted myocardium in group I and from infarcted myocardium in group II. Postinfarct recordings in group I showed no significant changes in posterior wall velocities or excursion. In contrast, group II showed striking changes in the contour of PWM with a large initial posterior displacement (aneurysmal bulging) during isometric contraction, followed by a slow anterior movement during ventricular ejection and then a rapid anterior recoil motion during isometric relaxation. Mean posterior wall velocity fell from 31 ±
se
3 mm/sec preinfarct to 13 ± 4 postinfarct (
P
< 0.01); from 33 ± 4 to 21 ± 5 mm/sec during atrial pacing pre- and postinfarction (
P
< 0.05); from 30 ± 3 to 18 ± 3 mm/sec during volume loading with dextran 20 ml/kg (
P
< 0.01); and from 32 ± 4 to 5 ± 2 mm/sec during aortic constriction (
P
< 0.01). Corresponding reductions in posterior wall systolic excursion were observed.

Simultaneous hemodynamic measurements revealed moderate depression of ventricular performance in group II, but there was no significant correlation between the changes in hemodynamic parameters and echocardiographic velocities following infarction.
We conclude that the marked changes in PWM following posterior infarction were due to echocardiographic detection of dyskinesis in the infarcted area rather than to generalized changes in ventricular function. Posterior wall velocities are not a reliable index of left ventricular performance when localized dyskinesis, as indicated by abnormal PWM, is present.
Effect of Digitalis on Atrioventricular Conduction and Circus-Movement Tachycardias in Patients with Wolff-Parkinson-White Syndrome
Authors: WELLENS HEIN J. , DURRER DIRK 
Published: June 2012

During regular driving of the right atrium using the single-test stimulus method, atrioventricular conduction and initiation of tachycardias were studied in six patients with the Wolff-Parkinson-White syndrome (W-P-W), before and 45 min after the administration of ouabain (0.75-1.5 mg into the right atrium).
Following ouabain (1) all patients showed shortening of the refractory period of their anomalous pathway; (2) at least five of them showed lengthening of the refractory period of the A-V nodal-His pathway; and (3) all patients showed prolongation of the A-V nodal transmission time (prolongation of the A-H interval). In four patients who suffered from circus-movement tachycardias these changes resulted in two patients in marked shortening of the range of premature beat intervals during which a tachycardia could be initiated and complete inability to initiate a tachycardia in the other two. These results suggest that digitalis can be of prophylactive value in patients with the Wolff-Parkinson-White syndrome and circus-movement tachycardias.
Reduced Red Cell 2,3-Diphosphoglycerate and Adenosine Triphosphate, Hypophosphatemia, and Increased Hemoglobin-Oxygen Affinity after Cardiac Surgery
Authors: YOUNG JERALD A. , LICHTMAN MARSHALL A. , COHEN JULES , Murphy Marion 
Published: June 2012

Serum inorganic phosphorous was decreased significantly on the third postoperative day following cardiac surgery in 18 patients initially studied. Reduced plasma inorganic phosphate has been shown to cause a reduced concentration of red cell organic phosphates, an important determinant of hemoglobin-oxygen affinity. Therefore, 10 consecutive patients were studied to determine if reduced 2,3-diphosphoglycerate (DPG) and adenosine triphosphate (ATP) concentration and increased hemoglobin-oxygen affinity accompanied the fall in serum inorganic phosphate concentration.
A significant fall in 2,3-DPG and an increase in hemoglobin-oxygen affinity was present in red cells of patients studied on the first postoperative day. A reduction in red cell ATP was also present and persisted for 5 days during which time red cell 2,3-DPG returned to levels which were in excess of preoperative values. The reduction in serum inorganic phosphorous followed the reduction in red cell 2,3-DPG and correlated with the reduction in ATP. The latter changes may indicate the diversion of glucose and more specifically 1,3-DPG into the Rapoport-Leubering pathway away from ATP generation at the phosphoglycerate kinase step and the utilization of plasma inorganic phosphate for 2,3-DPG resynthesis. Neither the transfusion of stored blood nor the effect of cardiopulmonary bypass fully explained the reduction in red cell 2,3-DPG and the inefficiency of hemoglobin function postoperatively. Further studies in postsurgical patients are needed to clarify the cause of the changes observed since they are potentially deleterious, especially in the subject with compromised cardiovascular and pulmonary function.
Aneurysms of the Thoracic Aorta Complicating Coarctation
Authors: EDWARDS JESSE E. 
Published: June 2012

Coarctation of the aorta may become complicated by aortic aneurysms involving either the proximal or distal compartment of the vessel. Such aneurysms principally are consequences either of hypertension or of bacterial infection. The aneurysms in either compartment may be of the classical dissecting or saccular types. Saccular aneurysm may result from infection or laceration of the aorta without intramedial dissection of blood.
In the ascending aorta, an additional basis for aneurysm is aortic stenosis, the latter either being congenital, or more commonly, acquired calcific in a congenital bicuspid valve.