ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Fourteen cases of severe aortic insufficiency are presented in which an extremely elevated left ventricular pressure exceeded left atrial pressure during diastole. In 13 of the 14 cases there was proof, or strong suggestive evidence, that the aortic insufficiency was sudden in onset. In nine cases the left ventricular pressure equaled aortic pressure by end-diastole. In five cases left ventricular pressure failed to equal aortic pressure by end-diastole. The similarities between the hemodynamics of experimental and clinically occurring sudden severe aortic insufficiency, including possibly the effect of superimposed mitral insufficiency, was at times striking. The clinical picture in these cases was sufficiently distinctive that the abnormal hemodynamics could be predicted and the presence of sudden, severe aortic insufficiency suggested. The absence of the first heart sound at the cardiac apex, the presence of an early diastolic sound and “double diastolic apex beat,” the harshness of the aortic systolic and diastolic murmurs, all served to make auscultatory differentiation of systole and diastole at times extremely difficult. This difficulty in differentiating the phases of the cardiac cycle by auscultation alone was in itself rather characteristic of sudden severe aortic insufficiency. The poor prognosis in these cases makes early recognition mandatory and early surgery advisable.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Postoperative hemodynamic studies have been performed on 11 subjects following replacement of the mitral valve. In eight cases a comparison was made with the preoperative findings.The great improvement in the functional capacity of most patients is reflected in the findings of this study, which indicate a small gradient at rest across the prosthesis and no mitral incompetence. The residual gradient was thought to be due mainly to inadequate orificial size, although delay in reaching the fully open position may also play a part.In two subjects a severely elevated pulmonary vascular resistance fell markedly following the relief of left atrial hypertension.Two patients failed to show sustained clinical and hemodynamic improvement. In one, mild aortic valve disease was present and severe systemic hypertension developed, resulting in death. The influence of these factors is discussed. In the other, the cause for the continuing heart failure with poor left ventricular contractility was undetermined.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Twenty-three children with congenital aortic valvular stenosis have undergone operation prior to November 1964, without a hospital mortality. A 4-week-old infant who died at the induction of anesthesia is not included. There was one late death due to uncontrolled aortic regurgitation. The late death occurred at the time of the second operation for placement of aortic valve prosthesis in another institution.Thirteen of the 23 patients have an audible postoperative diastolic murmur. In two this murmur was present preoperatively. Eight of the 13 are considered to have mild aortic regurgitation, four moderate, and one severe. Of the 18 patients with competent valves or mild regurgitation, all have normal electrocardiograms. Ten of these 18 patients had electrocardiographic evidence of left ventricular hypertrophy before surgery. Four of the five patients with moderate or severe regurgitation have electrocardiographic evidence of left ventricular hypertrophy. These patients have all been followed from 3 to 5½ years. There is no evidence that the amount of regurgitation has either decreased or increased since surgery. The gradients measured at cardiac catheterization before operation range from 138 to 56 mm. Hg, with an average of 89 mm. Postoperatively, these gradients ranged from 45 to zero, with an average of 27. Pressures measured at the time of operation before and after valvulotomy agree favorably with the pressures measured at the time of cardiac catheterization before and after valvulotomy.The development of postoperative regurgitation was found to be related to the incision of a rudimentary raphe which made an anatomically bicuspid valve tricuspid. It is also related to the position of the patient in the series, the regurgitation occurring most frequently in the first half of the series. Comparison with another series with a highresidual gradient, but a lower incidence of the severity of regurgitation, suggests that the optimal gradient reduction may be purchased at the expense of an unavoidable amount of aortic regurgitation. This aortic regurgitation, however, is not necessarily hemodynamically significant.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

Appraisal of the gross and microscopic anatomy of the heart was carried out at necropsy in 12 subjects (six men, six women) with marked chronic obesity. In each case the observed heart weight was considerably greater than that predicted at ideal body weight. Nine of the 12 subjects were found to have increase in left ventricular wall thickness, and two increase in right. The increases in heart weight and ventricular wall thickness were due to muscle hypertrophy involving the left ventricle or both left and right ventricles. Neither isolated nor predominant right ventricular hypertrophy was observed.It has been concluded that myocardial hypertrophy is a more specific and significant anatomic alteration in the hearts of very obese subjects than are the previously reported findings of excess epicardial fat and fatty infiltration of the myocardium. The relationship between chronic augmentation of the work of the heart in these subjects and the development of cardiac hypertrophy has been discussed. The findings in this study have been interpreted as providing further support for the propositions that manifestations of myocardial insufficiency do occur in very obese subjects without evidences of other heart disease, that these manifestations are those of predominant left ventricular or biventricular failure, and that isolated cor pulmonale does not develop in the absence of pulmonary embolization.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

The electrocardiograms before and after operation have been compared in 20 patients undergoing left mastectomy and in 19 patients undergoing right mastectomy.There are highly significant increases in the amplitude of the QRS complexes recorded over the precordium after left mastectomy, except in lead V6.There are highly significant increases in the amplitude of the QRS complexes of leads V3Rand V1after both left and right mastectomy.These data are not completely explained by a diminution of distance between the recording electrode and the myocardium or of electrical resistance following the excision of soft tissue.The possible relationship is suggested between the precordial voltage changes and the altered thoracic volume conductor.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID

摘要:

The effects of sublingual nitroglycerin and inhaled amyl nitrite on the arteriolar and venous beds of the forearm were studied in 11 normal subjects. Forearm blood flow was measured with a strain-gauge plethysmograph, and venous tone was determined both by an acute occlusion technic, and by several equilibration technics. Nitroglycerin reduced systemic arterial pressure, elevated forearm blood flow, lowered forearm vascular resistance and decreased venous tone. Amyl nitrite diminished arterial pressure, elevated forearm blood flow, markedly decreased forearm vascular resistance, but in contrast to nitroglycerin augmented venous tone strikingly. This venoconstriction was abolished or diminished when adrenergic activity was impeded by administration of either guanethidine or reserpine.

ISSN:0009-7322    

出版商:OVID    

年代:1965

数据来源: OVID