ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

A series of 80 reoperations for mitral stenosis in 79 patients is reported and analyzed.The most important causes of deterioration after valvuloplasty for mitral stenosis are inadequate initial operation, restenosis, and mitral insufficiency. Generally more than one of these factors pertain.An adequate mitral valvuloplasty requires the complete opening of both the anterior and posteromedial commissures and the mobilization of the chordae tendineae from each other and from the wall of the ventricle.The advantages and limitations of closed reoperation, open reoperation, the right-sided approach, and the use of the transventricular valvulotome are reviewed.More complete correction of stenosis with mobilization of posteromedial, anterior, and subvalvular chordae is emphasized. This is attained by operating from both the ventral and dorsal aspects of the patient through a left posterolateral thoracotomy incision.An Ivalon operating tunnel sutured to the left atrial wall at reoperation makes it possible to carry out the more extensive valvuloplasty at reoperations.A lower operative mortality, better longterm results, and fewer instances of deterioration are anticipated when this concept of improved valvuloplasty is effected initially.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

The technic of banding the pulmonary artery is described.Twenty infants with intractable cardiac failure secondary to interventricular septal defects have had banding with one operative and one late death.The operation is palliative, and definitive surgery probably must be done when the child is 3 to 5 years of age.Banding the pulmonary artery is a relatively safe procedure but the mortality of banding plus ventricular closure and unbanding remains to be evaluated.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

A precordial scanning technic and its application in the detection of left-to-right cardiac shunts in 75 patients are described. I131-labeled Diodrast was injected into an antecubital vein, its concentration in the central circulation was metered by means of a scintillation detector, and the time-concentration curve were recorded directly. In patients with left-to-right shunts these curves were modified in a characteristic fashion; the build-up time was normal, but the disappearance of isotope from the central circulation was slow. The product of the build-up time and disappearance rate was generally lower than in patients without cardiac shunts. The clinical value of this simple technic in detecting or excluding the presence of left-to-right shunts is discussed.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

A collected series of 5 patients with Marfan's syndrome is reported in whom S-T depression and T-wave inversion in electrocardiographic leads II, III, and aVFwere associated with necropsy-proved deformity of the mitral valve.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

Function tests of the individual kidneys have been performed during mannitol diuresis and vasopressin infusion in hypertensive patients with essential hypertension, pyelonephritis, and occlusive lesions of one or both main renal arteries or their primary branches.In patients with essential hypertension, glomerular filtration rate and renal plasma flow on the two sides, though depressed, were practically equal, as were urine flow, water, solute, and sodium excretions.Pyelonephritis and branch arterial lesions alike depressed urine flow, glomerular filtration rate, and renal plasma flow in the affected or more-affected kidneys; water, total solute, and sodium excretions were in proportion to glomerular filtration rate. These findings indicate a decrease in numbers of functioning nephrons without a qualitative change in function of those remaining.Occlusive lesion of one main renal artery decreased glomerular filtration rate and renal plasma flow on the affected side; urine flow was relatively more depressed than filtration rate, urinary osmolality was higher, and urinary sodium concentration was sharply decreased, as was the excreted fraction of the filtered sodium load.Bilateral occlusive main arterial lesions sometimes had effects similar to those of unilateral lesions in the sense of greater functional deficits on the more-affected sides. However their functional patterns were not consistent.The enhanced renal sodium reabsorption observed in patients with unilateral and bilateral main renal artery diseases could not be explained solely by decreases in filtered sodium load; this suggests that decreases in intrarenal arterial pressure also affect sodium excretion.Changes in renal functions caused by arterial disease depend on the site of the lesion and not on the pressor mechanism it may evoke.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

The present study presents pertinent clinical and pathologic findings in 20 cases of ruptured mitral chordae tendineae encountered at the Mayo Clinic between 1934 and 1958 inclusive. Mitral insufficiency results from the rupture of chordae tendineae, the severity being related to the number of chordae ruptured. The resulting heart disease may be severe and may progress to cardiac decompensation and death. Bacterial endocarditis was the major etiologic factor in rupture of the chordae tendineae in this study.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

The role of the physical state of plasma as a determinant of oxygen availability to the myocardium has been investigated during the course of alimentary lipemia. After the development of substantial plasma lactescence, the coronary blood flow (nitrous oxide method) and myocardial oxygen consumption were assessed in 7 normal human subjects and repeated after heparin-induced lipolysis. The lipemic state was further contrasted with a control fasting group, comparable in age and sex.The mean coronary blood flow for 15 fasting controls was 83 ml. per 100 Gm. of left ventricle per minute with a myocardial oxygen extraction of 11.04 volumes per cent, and a myocardial oxygen consumption of 9.0 ml. per 100 Gm. of left ventricle per minute. By contrast, the mean coronary blood flow during maximal lipemia in the 7 subjects fed cream was 20 per cent below normal, with a value of 67 ml. per 100 Gm. per minute (p=< 0.01). As the extraction of oxygen was not significantly affected, the calculated myocardial oxygen consumption was proportionately reduced to 7.02 ml. per 100 Gm. per minute (p=< 0.01). A failure of the anticipated oxygen extraction increment in the face of coronary blood flow reduction suggests an impediment of blood-tissue oxygen transport during lipemia.After the administration of 60 mg. of heparin to the 7 lipemic subjects, a 65 per cent decline in plasma lactescence was observed by 45 minutes, when the coronary blood flow and myocardial oxygen consumption were elevated to 87 ml. per 100 Gm. per minute (p=< 0.05) respectively. Thus, the reduced coronary flow and myocardial oxygen consumption were restored in each instance to normal levels during the process of plasma clearing. There were no associated systemic hemodynamic changes to account for such increments. These heparin effects appear dependent on the lipemia-clearing property, for no alteration in coronary dynamics was found in 6 additional patients in whom this activity was not manifest after the same heparin dosage.The residual lactescence after post-heparin lipolysis was associated with no significant deviation of coronary dynamics from the normal. That a concentration-dependent phenomenon is operative, was confirmed in a separate group of patients in whom low lactescence values developed in the course of alimentary lipemia without affecting myocardial oxygen consumption.The relevance of the lipemic state, per se, to the pathophysiology of myocardial ischemia appears to depend upon the establishment of an oxygen gradient within the myocardium, presumably through altered pressure-flow relationships produced by lipemic blood within a pathologic vessel.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID

摘要:

The amount of mitral regurgitation was estimated in 50 patients by an indicator-dilution technic and by the usual clinical, catheterization, operative, and autopsy criteria. There was a good correlation between the two estimates. Patients with significant mitral regurgitation (grade 2 or grade 3) had, with one exception,QR/QFratios above 0.41. There were at least two instances where the calculatedQR/QFwas almost certainly falsely high. It seems likely that these discrepancies are related to the presence of an unusually large volume between the pulmonary artery and the femoral artery.

ISSN:0009-7322    

出版商:OVID    

年代:1961

数据来源: OVID