摘要:

Correlation of electrocardiographic abnormalities occurring postoperatively with lesions of the conduction system found at autopsy was done in 20 dogs which had received cardiac homografts. The incidence of arrhythmias closely paralleled the severity of rejection injury found within the heart and specifically within the conduction system. Severe pathological changes in the conduction system (grade D) were uniformly associated with arrhythmias. These disturbances, as well as decrease in electrocardiographic voltage, have consistent anatomic correlates in acute rejection of cardiac homografts and are of primary importance in the clinical diagnosis of acute rejection.

ISSN:0009-7322    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

Single ventricle is that condition in which both atrioventricular (A-V) orifices enter a common ventricular sinus, from which the arterial trunks emerge with their coni. The following types of single ventricle were found: (1) with regular (noninverted) transposition in levocardia; (2) with inverted transposition in levocardia; (3) with normal position of arterial trunks in levocardia; (4) in dextrocardia, and (5) in mesocardia. This entity is differentiated from common ventricle which is basically a heart with a large ventricular septal defect. Single ventricle does not include mitral and tricuspid atresia by definition, nor does it include straddling tricuspid orifice, in which two distinct ventricles are present. The concept of single ventricle herein defined differs from de la Cruz and Miller's concept of double-inlet left ventricle which includes straddling tricuspid orifice. Embryologically in single ventricle we are dealing with persistence of the primitive state of the bulboventricular loop, due to a lack of expansion of the atrial canal to the right during the process of absorption of the bulbus.

ISSN:0009-7322    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

Thirty patients with cyanotic heart disease, including Fallot's tetralogy, transposition of the great arteries, and tricuspid atresia had Waterston's anastomosis for gross effort intolerance or cyanotic attacks. The results were good in 28. Spontaneous closure of the anastomosis occurred in one patient. There was a tendency for preferential perfusion of the right lung, and unilateral pulmonary edema occurred in nine patients. Congestive heart failure appeared when the stoma was too large. Surgical technic to avoid kinking of the right pulmonary artery has been modified, and the importance of limiting the size of the anastomosis has been emphasized. Transaortic closure of the anastomosis through the aorta at the time of definitive correction was simple in three patients.

ISSN:0009-7322    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

Two cases are reported in which complete transposition of the great vessels was associated with an unusual form of subpulmonic obstruction. In each case, redundant tricuspid valvular tissue protruded through a ventricular septal defect into the left ventricular outflow tract, producing severe obstruction to the outflow of blood from the left ventricle.The clinical course suggested the presence of left ventricular outflow obstruction. Both patients demonstrated progressive clinical deterioration characterized by increasing cyanosis, respiratory distress, and decrease in intensity of the cardiac murmur. Serial laboratory determinations revealed increasing hemoglobin and decreasing systemic oxygen saturation. The clinical deterioration was relieved only temporarily by atrial balloon septostomy.The angiographic findings appear to be specific for this type of subpulmonic obstruction. In each case, a large asymmetric filling defect was demonstrated at the anterior border of the left ventricular outflow tract below the pulmonic valve.When the clinical and laboratory findings suggest pulmonary or subpulmonary obstruction, careful evaluation of the outflow tract is indicated. If diagnosed clinically, redundant tricuspid tissue could perhaps be resected during a definitive operation, thus relieving the outflow obstruction.

ISSN:0009-7322    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

Four male members of a family are known to have congenital mitral and aortic insufficiency, a fifth male has congenital mitral insufficiency only, and a sixth male had congenital heart disease by history. The involved males comprised all males in three generations of this family. Chromosomal and dermatoglyphic studies of the two living affected males are normal.The involvement of males in this family is best explained on the basis of X-linked recessive inheritance. To our knowledge, this is the first report of possible X-linked inheritance of isolated congenital heart disease.

ISSN:0009-7322    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

A rapid, harmless, noninvasive technic using ultrasound to diagnose intra-atrial mass lesions is described. The technic permits detection of those tumors which pass through the atrioventricular orifice. Two patients with left atrial myxomata and one with a right atrial myxoma were studied with pulsed, reflected ultrasound, cardiac catheterization, and cineangiography. The diagnosis in each case was confirmed at surgery. The ultrasound technic for detecting atrial tumors was based on recording a mass of echoes immediately behind the echoes originating from the mitral or tricuspid valve leaflets. The mass held the leaflet open during diastole, causing abnormal valve motion. In one case of left atrial myxoma, the tumor plop sound, clinically confused with an opening snap, was shown to occur at a different time in the ultrasound cycle than the true opening snap. This examination is simple enough to be considered as a screening examination for the detection or exclusion of this rare but potentially dangerous abnormality.

ISSN:0009-7322    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

The hemodynamic effects of 10 mg of propranolol given intravenously (iv) were studied in 10 patients (group I) with coronary heart disease (CHD). These results were compared with the hemodynamic effects in a similar group of the nine (CHD) patients (group II) who were studied after administration of 0.6 mg of nitroglycerin and then after receiving 10 mg of propranolol iv with a second 0.6-mg dose of nitroglycerin. Measurements were obtained at rest and during exercise: before treatment, after nitroglycerin alone, after propranolol alone, and after nitroglycerin-propranolol in combination. Pretreatment exercise showed a 125% increase in mean pulmonary artery pressure (PAP) to 43 mm Hg and a 163% increase in left ventricular end-diastolic pressure (LVEDP) to 29 mm Hg. Nitroglycerin decreased PAP (−45%) and LVEDP (−66%); as did nitroglycerin-propranolol: PAP (−33%) and LVEDP (−38%). Nitroglycerin reduced tension-time index (TTI) −21%, and increased cardiac index (CI) +17%, heart rate (HR) +10%, left ventricular work index (LVWI) +11%, and left ventricular dp/dt (LV dp/dt) +22%. By contrast, nitroglycerin-propranolol reduced LVWI −14%, LV dp/dt −30%, TTI − 15%, and HR − 13% but did not significantly alter CI from pretreatment.Propranolol increased PAP to 40 mm Hg, did not change LVEDP at 29 mm Hg and decreased stroke index (SI) 16%. Nitroglycerin-propranolol diminished PA and LVED pressure and increased SI 14%. Effects of propranolol alone and of nitroglycerin-propranolol on HR, TTI, and LV dp/dt were not significantly different.Nitroglycerin-propranolol appears to have important advantages over nitroglycerin or propranolol alone. A reduction in HR, TTI, and LV dp/dt, determinants of myocardial oxygen consumption, concurrent with improved left ventricular function, demonstrates a beneficial synergistic hemodynamic action for nitroglycerin combined with propranolol.

ISSN:0009-7322    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

Responses to a multistage treadmill test of maximal exercise were studied in 61 hypertensive patients: 13 had uncomplicated hypertension; 15 had associated retinopathy; 22 had left ventricular hypertrophy; and 11 also had coronary heart disease. Because of significant differences with aging normally, and differences in ages of these subgroups, responses were compared with those of normotensive persons matched for age and sex.With only elevated blood pressure there was no impairment of exercise performance and no increase in S-T segment depression. With ventricular hypertrophy and particularly with retinopathy, maximal exercise duration was shortened. Prevalence of postexertional myocardial ischemia, manifested by S-T segment depression, was increased threefold in those with hypertrophy of the left ventricle.Even greater impairment of exercise duration, maximal heart rate, and systolic pressure was observed in patients with coronary heart disease and hypertension. Prevalence of S-T segment depression was sevenfold greater.This ECG manifestation of myocardial ischemia may represent either an augmented contractile force or a significantly restricted coronary blood supply to limit myocardial perfusion. Differences in duration of exercise and circulatory responses, particularly the product of maximal heart rate and maximal systolic pressure/100, indicate these variations in pathophysiological mechanisms.

ISSN:0009-7322    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

The effects on the pulmonary circulation of breathing 10% CO2for 10 to 20 min were studied in five eucapnic and 11 convalescing hypercapnic patients to recreate the CO2tensions which they had experienced during respiratory failure. Right heart catheterization permitted measurements of pulmonary arterial and wedge pressures and obtaining samples of mixed venous blood. Breathing CO2increased mean pulmonary arterial pressures from 33 to 50 mm Hg (52%); pulmonary arterial wedge pressures were unchanged, and cardiac output increased only 22%. In three hypercapnic and two eucapnic subjects reduction of blood hydrogen ion levels by rapid infusion of 120 to 135 mEq NaHCO3during CO2breathing did not lower pulmonary arterial pressure significantly, nor raise cardiac output. Neither vascular pressures nor cardiac outputs changed during oxygen breathing. Larger increases in cardiac output, which were produced by exercise, raised pulmonary artery pressure only half as much as breathing 10% CO2did. Therefore, pulmonary vascular resistance (PVR) that was elevated to an average of 4.8 mm Hg/L/min at rest while breathing air was increased to 6.5 mm Hg/L/min during CO2breathing (P<0.01). In contrast, PVR was unchanged (4.6 mm Hg/L/min) during exercise. This difference between PVR while breathing CO2and during exercise was statistically significant (P<0.02). Restoration of the pH of the blood toward normal by the infusion of bicarbonate during breathing of CO2raised the pulmonary arterial pressure. The five eucapnic subjects showed similar changes during CO2breathing and exercise, although their base-line values were significantly different. The differences were due, at least in part, to lower Paco2. This evidence suggests that CO2acts on pulmonary arterioles and capillaries that are exposed to alveolar gases to increase the pulmonary vascular impedance.

ISSN:0009-7322    

出版商:OVID    

年代:1969

数据来源: OVID

摘要:

The study consisted of observations on nine male patients with palpable dicrotic as evidenced by cardiomegaly and the presence of prominent atrial and ventricular diastolic gallop sounds. Most of these patients were diagnosed as having primary myocardial disease.The indirect carotid pulse was characterized by a single systolic wave, a low dicrotic notch, and a large dicrotic wave. The direct brachial arterial pressure pulse had a similar configuration with a shortened ejection time index. The hemodynamic data on these patients was characterized by low cardiac output, low stroke volume, elevated pulmonary arterial wedge pressures, and high total systemic resistance. From these observations we conclude that the presence of a marked dicrotic pulse in afebrile patients at rest may indicate severe functional impairment of the myocardium.

ISSN:0009-7322    

出版商:OVID    

年代:1969

数据来源: OVID