ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

The acute hemodynamic effects of 0.50 to 0.75 mg. ouabain were studied in six patients with valvular aortic stenosis and in four patients with idiopathic hypertrophic subaortic stenosis. Left atrial and left ventricular pressures were determined by means of transseptal left heart catheterization and cardiac output was measured by the indicator-dilution technic. In the patients with valvular aortic stenosis, ouabain either improved left ventricular function or had no discernible effect on it, but in no patient was left ventricular function depressed. Left ventricular end-diastolic pressure fell slightly or remained unchanged, while cardiac output rose in two of four patients. In the patients with hypertrophic subaortic stenosis, the left ventricular end-diastolic pressure and mean left atrial pressure rose significantly following ouabain administration; cardiac output either fell or remained unchanged and the systolic pressure gradient between the left ventricle and the brachial artery rose. These actions of ouabain in hypertrophic subaortic stenosis are considered to result from a sustained increase in left ventricular contractile force that increased the obstruction produced by the muscular outflow tract.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

A technic for obtaining radiocardiograms has been described and a method of analysis of the curves presented.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

The method of quantitative radiocardiography has been applied to the study of cardiac output, right ventricular and pulmonary blood volume in cardiovascular normals, emphysematous subjects, and patients with various types of heart disease.The values of blood flow obtained by means of this technic have been compared with those measured simultaneously by the direct Fick method. A linear correlation has been demonstrated between QRIHSAand QFick, with a regression coefficient of 1.0395 ± 0.0566, when appropriate correction has been made for the contribution of activity in the paracardiac tissues.The principle of the measurement of right ventricular rate of emptying from the fractional decay rate of the precordial counting during the passage of the indicator through the right heart has been validated. The right ventricle behaves essentially as a mixing chamber; a constant fraction of its volume is ejected with each systole. The variability of the emptying rate does not exceed the limits expected on the grounds of statistics of radioactive measurements in normal and in cardiac patients. The significance of the variability observed in emphysematous patients has been discussed.The measured ventricular rates of emptying are reproducible in repeated curves recorded after injection of RIHSA or dissolved Kr85; are little affected by change of the position of the tip of the injecting catheter; or by small changes in the position of the collimator.The right ventricular end-diastolic and residual volumes have been found to average 221 ± 50 ml. and 128 ± 34 ml. respectively, in 18 normal subjects.The calculated pulmonary blood volume in 18 normal subjects averages 313 ± 58 ml./M.2The significance of this value and the possible extreme range of error resulting from the method have been assessed.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

Of 141 patients with abdominal aortic aneurysms diagnosed at the Mayo Clinic from 1950 through 1959 who were not operated on, follow-up information was obtained from 137 patients (97.1 per cent). Of those followed 1 year or more, 87.6 per cent survived 1 year or more; 52.5 per cent survived 3 years, and 36.4 per cent survived 5 years after diagnosis. These results indicate that the prognosis of abdominal aortic aneurysm in this selected group of patients was somewhat better than that previously reported.The prognosis and survival of patients who had a history of associated cardiovascular disease at the time of diagnosis of aneurysm is distinctly less good than those of patients who had no such history. Of those with such a history, 75.0 per cent survived 1 year, 33.3 per cent survived 3 years, and 20.0 per cent survived 5 years. Of those without such a history 95.7 per cent survived 1 year, 63.2 per cent survived 3 years, and 50.0 per cent survived 5 years.Patients with abdominal aortic aneurysms and associated cardiovascular diseases are more likely to die of cardiovascular complications other than ruptured aneurysms. Patients with abdominal aortic aneurysms who have no evidence of associated cardiovascular disease are more likely to die from a ruptured aneurysm than from anything else.It would appear that small asymptomatic abdominal aortic aneurysms in patients with associated cardiovascular disease may be carefully observed until signs of expansion of the aneurysm or symptoms from the aneurysm appear.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

The report consists of five patients with chronic postinfarct left ventricular aneurysms. The age distribution was between 47 and 63 years. The time lapse between the initial infarct and the appearance of the left ventricular aneurysm was 2 weeks to 2 years. The time interval between the initial infarct and surgery was 5 months to 6 years. Less than adequate bedrest following the infarct, multiple infarcts, and systemic hypertension were other factors present in this group. Right heart catheterization was performed in two patients and showed reduced cardiac output and elevated pulmonary pressures in one. The electrocardiograms were consistent with extensive old myocardial infarction and ventricular aneurysm. The diagnosis was suggested by electrocardiograms and roentgenography, supported by kymography, and confirmed by angiography.The world literature on surgically treated patients with ventricular aneurysms is briefly reviewed with emphasis on the varied surgical approaches to the problem in the past. The method of complete excision with ventriculoplasty during cardiopulmonary bypass was used in all our patients during the past 4 years. The anatomic distribution of the ventricular aneurysm as well as the histopathology of the resected specimen is described.All patients survived the operation, and were observed from 6 months to 40 months after operation. There have been no late deaths to date, and all patients have been rehabilitated. Postoperative catheterization studies have confirmed the clinical improvements observed.More attention should be given to this relatively common complication after infarct because excision under temporary heart-lung bypass is a safe and feasible approach.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

Preoperative and postoperative data on 44 patients with endocardial defect, 32 with the incomplete and 12 with the Complete form are presented. Nineteen per cent of the incomplete form died with per cent of the deaths occurring early and 9.5 per cent late. The mortality rate for the complete form was 75 per cent.Late follow-up results were evaluated in 28 patients 1 to 2½ years following surgery. Catheterization data in nine of 10 and clinical observations in 18 indicated no residual shunt. One patient showed questionable evidence of a left-to-right shunt by cardiac catheterization. Evidence of mitral regurgitation was present in seven (25 per cent) of the survivors. Short chordae attaching the closed cleft margin of the mitral leaflet to the ventricular septum rendered the valve incompetent in nine of 12 autopsied specimens. Surgical exploration of the underside of the cleft margins for such chordae is recommended. No evidence of residual tricuspid regurgitation was found.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

Among 13,314 necropsies following death from neoplastic and nonneoplastic diseases performed at the Mayo Clinic from 1942 through 1958, 189 cases of secondary malignant lesions of the pericardium were demonstrated, an incidence of 1.42 per cent. Carcinoma of the lung and breast, the lymphomas, and leukemia constituted the large majority of the primary malignant lesions that caused the pericardial metastasis. Fifty-five of the 189 patients were adjudged to have had some impairment of cardiac function as a consequence of the pericardial metastasis and the following conclusions concern this group.1. In 47 patients (86 per cent), the lesions were either the immediate or a contributory cause of death.2. The most common mechanism whereby metastatic lesions in the pericardium interfered with cardiac function was by the development of pericardial effusion. Next in frequency was effusion combined with myocardial invasion and then cardiac constriction by tumor. Combinations of these processes with malignant encroachment on the great vessels and with invasion of coronary veins were the other mechanisms noted. Involvement of coronary arteries and the cardiac nerve supply was not noted.3. Pericardial fluid was significant in causing tamponade in 31 cases. The fluid was frankly hemorrhagic in a small minority of these cases although fibrinous pericarditis was present in 45 (82 per cent) of the group. Pleural effusion was present in 48 (92 per cent) of 52 cases and was usually bilateral. Ascites was present in 22 (50 per cent) of 44 cases; the quantity was usually rather small.4. Only one patient had metastasis to the pericardium without metastasis to other thoracic structures; exclusive of patients with leukemia, 43 (92 per cent) of 47 patients had extrathoracic metastatic lesions.5. Dyspnea, cough, pleural effusion, hepatomegaly, and thoracic pain were the most commonly recorded signs and symptoms that might be related to the pericardial lesions. However, more specific signs and symptoms directing attention to pericardial or cardiac involvement were not commonly recorded.6. The diagnosis of pericardial metastatic disease was suspected or established in only 16 (29 per cent) of the 55 patients, although 34 (62 per cent) either received treatment for congestive heart failure or were given roentgen therapy to mediastinal structures.7. Of the 27 patients whose electrocardiograms were available, 25 had T-wave abnormalities, 22 had low QRS voltage, and 15 showed sinus tachycardia.8. Thoracic roentgenograms, made on 53 patients, supplied clues to the diagnosis of pericardial malignancy in 28.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID

摘要:

The pressor and pulse rate responses to three standardized noxious stimuli were determined in groups of hypertensive patients receiving reserpine and chlorothiazide, alone and in combination. Although the drugs caused a significant decline in resting blood pressure, they failed to diminish the actual magnitude of the elevations in pressure and heart rate resulting from either physical or psychological stimuli. The possible physiological interpretations and the therapeutic implications of these data have been pointed out.

ISSN:0009-7322    

出版商:OVID    

年代:1962

数据来源: OVID