ISSN:0009-7322    

出版商:OVID    

年代:1966

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1966

数据来源: OVID

摘要:

Twelve patients with angina pectoris manifested an ability to adapt to exercise during treadmill stress testing with electrocardiographic monitoring. Three patterns of adaptation were seen. Nine subjects had the ability to continue walking after the onset of angina with eventual disappearance or lessening of anginal pain and the associated ischemic ST-segment depression; anginal pain and ST depression began to diminish during a steady state of blood pressure and heart rate in those cases in which these factors were measured. Four subjects were able to continue walking for long periods of time during a state of angina and ischemic ST depression. Three subjects demonstrated an increase in exercise capacity after being warmed up by a preceding bout of exercise-induced angina; blood pressures and heart rates during the initial, “warming-up” effort tended to be higher than those during the early stages of the second effort. In three subjects more than one of these patterns of adaptation were demonstrated. Five of the subjects showed striking subjective and objective improvement in exercise tolerance while on a program of regular walking exercise.Selective coronary cineangiography was performed in eight of these patients and two patterns of coronary disease were seen: (1) occlusion of a major coronary vessel with good collateral channels circumventing the obstruction; (2) strategically placed, proximal, stenotic lesions in major coronary vessels without frank occlusion and without discernible collateral development.Some diagnostic and therapeutic implications of these findings are discussed.

ISSN:0009-7322    

出版商:OVID    

年代:1966

数据来源: OVID

摘要:

Three cases of endocardial fibroelastosis with vectorcardiographic findings suggestive of an anterior myocardial infarct are presented. It had been previously reported that such vectorcardiographic features were diagnostic of anomalous origin of the left coronary artery. We conclude that the two diseases cannot be differentiated on the basis of electrocardiography or vectorcardiography alone.Two of the cases presented were in identical twins; serial scalar electrocardiograms and vectorcardiograms were obtained during the development and progression of endocardial fibroelastosis.

ISSN:0009-7322    

出版商:OVID    

年代:1966

数据来源: OVID

摘要:

The clinical and pathologic findings in three patients with bacterial infection at the sites of prosthetic aortic valves are described. Each presented typical clinical features of acute bacterial endocarditis followed by the sudden development of severe and ultimately fatal aortic regurgitation. Pathologically the infectious process was characterized by extensive necrosis of the aortic annulus, disruption of the aortic wall, and the formation of abscesses in the periaortic tissues. In two patients the prosthetic valve was partially detached from the annulus, whereas in the other it was totally dislodged and impacted in the aortic arch shortly before death. In all, secondary operative intervention would have been fruitless because of the extent of the infection and the character of the tissue at the aortic root. In one patient fatal staphylococcal endocarditis followed dental extractions despite penicillin prophylaxis. A more comprehensive antibiotic regimen for patients with prosthetic cardiac valves is suggested.

ISSN:0009-7322    

出版商:OVID    

年代:1966

数据来源: OVID

摘要:

Indices have been developed that provide an improved means for evaluation of the degrees of severity of mitral stenosis and regurgitation. The severity of anatomic mitral valve disease found at surgery or autopsy was considered to be the determinant of the state of the valve. An index of the time for the diastolic atrioventricular pressure gradient to fall to half its value multiplied by 100 and divided by the cardiac index was shown to be comparable to the severity of anatomic stenosis. This index ranged from 5.7 to 10 in mitral stenosis, 0.4 to 0.8 in normal subjects, and 0.6 to 2.0 in patients with predominant mitral regurgitation.Mitral regurgitation was estimated by an index of the rate of the atrial pressure rise during ventricular systole in mm. Hg/0.02 second multiplied by 10, and divided by the cardiac index. In predominant mitral regurgitation, this index ranged from 8.0 to 15; in mitral stenosis these values were 3.7 to 6.3, and normal subjects had an index varying from 2.5 to 3.7.Both indices were significantly elevated in patients in whom stenosis and regurgitation were present at surgery. Mitral stenosis complicated by a mild degree of regurgitation gave significantly elevated stenotic indices, while the regurgitation indices were normal or slightly elevated. These indices facilitate the evaluation of either mitral stenosis or regurgitation even when both processes are present together.The significance of these indices in the evaluation of the degree of invalidism in patients with valvular disease is also discussed.

ISSN:0009-7322    

出版商:OVID    

年代:1966

数据来源: OVID

摘要:

Thirty-five cases of congenital heart disease were investigated for the frequency and size of intercoronary anastomoses. Studies of control hearts showed normal intercoronary anastomoses to range to 74 &mgr; in diameter. In those congenital hearts not subjected to surgical procedures, the anastomoses did not differ in size from the control group, even in the presence of anemia, cardiac hypertrophy, and cyanosis. However, the mean age of the cyanotic group was significantly less than the acyanotic group. Even though the size and frequency of the anastomoses were significantly increased in the operated group, surgical trauma alone was an unlikely stimulus, since the size and frequency of anastomoses in those dying within 48 hours of operation and in those surviving for more than 5 weeks were similar. There was also a significant increase in the frequency and size of the intercoronary anastomoses in cases greater than 5 years of age, implying that intercoronary communications in congenital heart disease increase in size with increasing age.

ISSN:0009-7322    

出版商:OVID    

年代:1966

数据来源: OVID

摘要:

A microscopic study of the lungs of 106 patients with transposition of the great vessels has revealed early and severe hypertensive alterations in the pulmonary arteries. These striking changes, associated in almost all instances with normal pulmonary veins, indicate a state of high resistance of the arterial bed.Pulmonary arterial damage was, in general, most advanced in the patients with a large ventricular septal defect, but in spite of this these were the patients who lived longest. It seemed obvious, therefore, that their relatively favorable course was due to a greater beneficial than damaging effect of the ventricular septal defect.Consideration of these findings in the light of known physiologic data has led to a clarification of the physiologic variations of the transposition circulation. Using the recognized physiologic definitions of flows and shunts the transposition circulation is characterized by a diminished effective flow and a bidirectional but predominantly left-to-right shunt. The effect of a large intracardiac communication is to increase the effective flow and tolessen the shunts. With increasing size of the intracardiac communication the spectrum is completed when the circulatory characteristics of a single ventricle are reached in which the anatomic position of the great vessels becomes physiologically insignificant.The effect of a common systolic ejectile force in patients with a large ventricular septal defect will be similar in the transposition circulation and in the normal circulation. Three physiologic states are possible which depend upon the relative magnitude of the systemic and pulmonary resistances.The early appearance and malignant nature of the hypertensive alterations in the pulmonary arteries of patients with transposition of the great vessels suggest that the impact upon the lungs of high blood flow and pressure is aggravated by arterial vasoconstriction. This may be initiated by anoxia and a lowered blood pH. Elevation of pulmonary venous pressure and the increased viscosity of the blood due to polycythemia may add to the damage.Prominence of the bronchial arteries noted in the lung sections suggests that an expanded bronchial circulation augments the effective flow in these patients. If the bronchial venous drainage leads to systemic veins, the bronchial circulation could act as an accessory pulmonary circulation and could improve the effective flow without having to cross the already overloaded intracardiac communications.The anatomic findings and physiologic considerations reported in this study reveal several aspects of the early and severely damaging cardiopulmonary effect of transposition of the great vessels and indicate an urgent necessity of surgical therapy in early life.

ISSN:0009-7322    

出版商:OVID    

年代:1966

数据来源: OVID

摘要:

Introduction of a cardiac catheter into the pulmonary artery from the right heart is not possible in a substantial proportion of patients with transposition of the great vessels. It is necessary to obtain the pulmonary artery pressure and oxygen saturation value to evaluate the degree of pulmonary stenosis and the pulmonary vascular resistance. Twenty-three patients are described in whom this was accomplished by percutaneous suprasternal puncture. There was no mortality and there were no significant complications. The technique appears to be safe and reliable.

ISSN:0009-7322    

出版商:OVID    

年代:1966

数据来源: OVID

摘要:

The response elicited by exercise on pulmonary pressure, cardiac output, and arterial oxygen saturation in 35 lifetime residents of high altitude has been studied at high altitude (14,900 feet above sea level), and 22 residents of low altitude have been studied at sea level. A procedure combining cardiac catheterization, arterial cannulation, and spirometry was carried out. The exercise was moderate and was performed in supine position using a bicycle ergometer, the work load being 300 kg-m/min/m,2and the average increase of the oxygen uptake being 4.7 times at sea level and 4.8 times at high altitude.Both at sea level and at high altitude the cardiac output augmented during exercise proportionally to the increase in oxygen uptake, and thus followed the pattern of response described by other authors. The cardiac output as well as the oxygen intake, for the magnitude of exertion performed in this study, was almost the same at sea level and at high altitude. The cardiac output rose during exercise almost exclusively as a result of an increase in the heart rate, with the stroke volume remaining practically constant.Despite similar increase in cardiac output, the response of pulmonary pressure was smaller for sea-level subjects than for the high-altitude subjects. Increments of mean pulmonary pressure of nearly 50% and 100% were observed on exercise at sea level and at high altitude, respectively.During exercise the arterial oxygen saturation did not change in the sea-level studies, but decreased significantly in the high-altitude studies. The decrement observed in high-altitude residents is related to a fall in arterial pO2which at resting conditions is placed on the steep part of the oxygen dissociation curve.

ISSN:0009-7322    

出版商:OVID    

年代:1966

数据来源: OVID