Intractable angina. Treatment and prognosis

College capillaries

and sinllsoids

of the myocardium

are fire

of disease. For artery

patients

with

advanced

occlusive

disease,

a revascularization

two criteria

bring

in neck arterialized

blood

immediutely to the ischemic

step forward However,

clinical several length

experience

areas.

of utilizing

this

than

urements,

and

size

frequent

of objective myocardial

by angiography, of

injections,

by coronary

date,

advanced

4 patients

upon.

tively

; autopsy

that

patient

died

causes.

occurred

10

The

be suspected

even earlier

artery

are very may

normal

rrvascularization

procedures

be

(8) Stenosis

found.

(9)

leaflets

may

pressure

changes

across the pulmonic

of Cardiac and

Function

M.D.. University

been

oper-

postopera-

posterior

infarct (shunt

two

previous

relief)

have had

of

RICHARD

Minnesota

Cardiac

function

may be maintained

by the combination baric oxygen

in the nonperfused

changes

metabolism

in oxidative a short

time.

function

can be retained

arrest.

10 canine

(3 Five

York,

Downstate

Sixteen

Medical

infants

with

due to maternal cardiac

Center,

rubella

and

performed at

Our

recognized

of congestive

study

led

points

: (1) There

Autopsy

was

ligation

Three

with

operatively.

demonstration

have

ductus

lesions.

previously

not

(2) All of those arteriosus.

Nine

for severe

additional

A good correlation

heart

lesions

the age of onset of heart failure

than

Nine

required

(3) ‘I‘he onset of heart failure

the tirst 2 wk. of life)

first month).

the

is a very high incidence

of the ductus significant

but were studied

(11 of 16).

faillu-e had a patent

gical

to

which

heart failure

of the 11 had additional

(during

causes.

had

studies.

in 5. Two of the infants who died of cardio-

of the following

in heart

Fourteen

angiographic

causes were not catheterized

autopsv.

been

N. Y.

malformations

were studied.

catheterization

of New

Brooklyn,

cardiovascular

Six died, 3 of noncardiovascular vascular

University

sur-

failure.

died

post-

kvas earlier

usual

(after

the

was found

between

and the birth

weight.

atmospheres). control

hours jvith nitrogen were preserved atmosphere. and Hearts atm.)

nitrogen

ventricular

hearts lvere preserved hearts

were

preserved

under

failed

to resume

hyperbaric beat.

environment

co-

and nitrogen but

(3 atm.)

ventricular findings

hypothermia

1

hearts

at 37“ C.

fibrillation indicate

(1

only

beat. Control

are maintained

under

forceful.

fibrillation.

These

and function

a

revascularization.

nitrogen

either

at 1

with hypothermia

after

a \\-eakventricular

stored

as

for 24

at 37’ C.. and 5 hearts

\vith hypothermia ventricular

heart resumed

coordinated

served

preserved

resumed

beat

if per-

(2’ C.) and hyperbaric

All 10 hearts preserved

showed

viability

(3 atm.)

to determine

after prolonged

Ten

hearts

arrest

and rapid

for 24 hours at 2’ C. in nitrogen

hyperbaric

ordinated

and hyperCardiac

with loss of viability

In an attempt

controls.

E. KARLSON, M.D. and

School,

for 42 hours

leads to severe

nitrogen

M.D., KARL

heart.

heart

cardiac

LILLEHEI,

of low temperature

in the nonsupported within

C.

Medical

Minn.

PREECHA VICHIT-

SHIRLEY KAUFFMAN, M.D., State

with GARY

DIETZMAN, M.D. and

observa-

M.D., RAMON ROD-

RIQUEZ-TORRES,

in Vitro

Nitrogen,

LYONS, M.D., WILLIAM G. MANAX, M.D., RONALD

JOSHUA LYNFIELD,

YAO,

ab-

valve.

H.

Neonatal Heart Failure Following Rubella in Utero, M.D., F.A.c.c.,

of the

without

W.

shunts

iods of anoxic

ALICE C.

be found

Hyperbaric

for 24 hours with hypothermia

M.D.,

of a systemic

Thickening

upon

improvement.

BANDIIA,

(7)

of the main pulmonary

microspheres, direct

without

weeks and may

from the auscultatory

valve

Preservation

(1 with

liga-

stenosis

and it may be progressive.

common.

also

ductal

branch

as three

degrees of hypoplasia

pulmonic

artery

non-

at the atria1

from

preoperatively

3

as early

from

shunt

following

pulmonary

in

due to the

and tachypnea

in some patients

artery

failure

complicated

in 4 infants

was demonstrated

the onset of

of heart

(5) A left to right

tion. (6) Peripheral

Hypothermia

12 hours

days

other

be more

level disappeared

meas-

have

a large

diagnosis

of hepatomegaly

cardiac

flowmeter

and

Lveight. the earlier

The

findings

all \vith angina decubitus and

indicated

anterior).

dramatic

presence

These

injected

by arteriography

One

had

was

may

Minneapolis,

disease

ated

these infants

tunnels.

dependency

ligations,

(4)

Varying

involve-

blood

the birth

failure.

has

tion at autopsy. To

lower

and

measurements,

vein to shunt

into

distribution

acetate

small

200 dogs has established

an autogenous

dogs were studied

mam-

Vineberg.

disease.

by a variety

directly

of

viz.,

(1)

A significant

with this operation

limitations;

in more

the feasibility,

induced

must

low risk:

operation

of this vessel.

Experience

vinyl

lvith

blood and 12) distribute

ment by atherosclerotic

aorta

operation

to be effective

implantation

indicated

the

coronary

in this regard has been the internal

artery

limited

The heart

fulfill

mary

News

or a

that

cell

in an anaerobic and

hyperbaric

and

Prognosis,

nitrogen. Intractable

Angina.

Treatment

ARTHUR M.

MASTER,

M.D., F.A.C.C. and

JAFFE, The spond and

New York, majority

of patients

satisfactorily are

able

HARRY L.

N. Y. with angina

to ordinary

to lead

productive

medical lives

pectoris

re-

supervision over

many

THE AMERICANJOURNAL OF CARDIOLOGY

College years.

There

with

is, nevertheless,

intractable

angina

a hard

pain

very

often

at rest as well as on effort.

40

frequently

nitroglycerin

during

tablets

even slight exertion historical,

tabulated.

daily

normal ually

or, if normal,

each

RS-T

a carefully

10 to tolerate

depression

supervised

who could

achieve

patient

this often

measure

proved

oxidase review

inhibitor

Hypertrophy

cardial Infarction,

Both

right

on

to be active but

this

reactions.

operations

recom-

Observations

on the Current

or “true

can induce

hypertrophy

posterior”

literature

tempt

to

study was undertaken.

differentiate

Vectorcardiograms system

PBMI. autopsy,

were

in 203

Of

the

these

cases

RVH

SMITH,

by and

30 were

10 had autopsy, or serial

Of minal

measurements

most helpful: rightward

only in 6% 355’

(169 of 203)

horizontal and

and in only 11%

Mean

frontal

75’

and 210” in 727,

VOLUME

vector

between

350°

following of the ter-

0.5 mv. in PBMI or exceeded but

(2) The direc-

axis was located (73 of 85)

axis

The

eventual

between

(146 of 203) of cases of RVH,

in the

(4) The horizontal

and 60’

17, JANUARY 1966

in 81%

0.04

second

plane

Hospital,

role of surgery

obstructive

lesions

uncertain.

However,

raphy

Santa

Monica,

through

it is possible

constructive

procedure

arterial right

main

of the origin arteries, left

coronary,

The

major

tine

films

type

artery,

of the branches

presentation

postoperative

obstruction

or circumflex

of this

these

in-

two thirds

(2)

descending small

purpose

with

patterns

including

demonstrating

re-

revascularization

These

disease

pat-

a direct

the proximal

coronary

of the anterior

and (3) extensive

the

gether

within

disease

to either

or indirect

of

remains

cinearteriog-

certain

implantation.

(1) obstruction

arteries

selective

to establish

may be amenable

through

in the treatment

in the coronary

terns which

vessel

of

disease.

‘s to show patterns

to-

films which

illustrate

the

which

been

accom-

is 100

patients

of revascularization

The

case

studied

material

by

in-

was lo-

(69 of 85) of

of this

selective

disease has

procedures. have

internal

mammary

of these; patients year

there

MILLER,

and Medical

Center,

Chicago,

of our studies

we became

of various

accomplished,

radiographically ium sulfate

grossly

visible (e.g.,

and PAH)

JAIN, Reese

Ill.

from the pericardial

and cholografin) inulin

Michael

in the mode

the pathways

visible

of

Sac in

of the lymphatics

interested

substances

Removal SAVITRI

M.D.,

M.D.,

In order to determine

(e.g.,

The

of re-

procedures.

Pericardial

LEVIN,

In the course

able

the

Seven

degree

BERTRAM

the heart,

is

deaths.

the

Function:

J.

20

graft,

more than one

by these various

from

years

or a combination

4 operative

illustrating

ALBERT

and

three

vein patch

arteriograms

produced

Substances

Hospital

moval

been

of Pericardial

the Dog,

for revasculariza-

past

implantation

have

have had repeat

Various M.D.

the

had endarterectomy,

postoperatively

Studies

cinearteriography,

candidates

During

patients

study

coronary

26 of whom were judged tion

be-

of cases of

was situated

John’s

JOHN

M.D.,

and RODNEY

M.D.

Calif.

vascularization

(25 of 203) of cases of RVH.

plane

but in only 1 case of PBMI. stantaneous

the

of cases of RVH,

plane

90” in 86%

(3)

cated

48 had classic

It equalled

(5 of 85) of cases of PBMI.

of mean

PBMI,

of by

or surgery.

magnitude

average

(p = 0.001).

1.0 mv. in 83% tion

85 cases

electrocardiographic made,

(1) The

deflection

and 1.7 in RVH

tween

Frank

or both.

several

proved

atthe

confirmed

catheterization

Of the cases of PBMI, enzyme

the

Saint

in

JAMES

Disease,

plished.

precordium.

conditions,

history

with

and

(PBMI)

no outright

two

of RVH

120 by cardiac

changes,

(RVH)

recorded

cases,

Hos-

Mass.

infarction

records

present

Myo-

Brigham

Boston,

tall R waves over the right

the available

lead

Bent

infarc-

Role of Surgery

Heart

H. DAVIS, M.D., PETER G. GAAL,

clude

BetweenRight

School,

ventricular

posterobasal Since

Medical

myocardial

(276 of 288) of cases.

M.D., JACK A. CANNON,

S. MATHUR, M.D. and

HAROLD D. LEVINE, M.D., Peter pital and Harvard

it was

ventricular

A. MCEACHEN,

Patients

and Posterobasal

VIRENDRA

posterobasal

tion in 96%

of the Ventricular

from

right

us-

mended indicates a need for controlled evaluation.

VectorcardiographicDifferentiation

differentiate

of Ischemic

only significant

has untoward

of the numerous

hypertrophy

and physician

to be iproniazid,

of the first two parameters

to correctly

the Treatment

2-step

of pain.

The

(47 of 203) of cases

ab-

depends

were able

long period.

By the synthesis possible

T.

cause

but in only 237,

and the features

usually

angina

between

individual

over a surprisingly

A critical

was

cases of PBMI, of RVH.

hours,

cannot

laboratory

intractable

cooperation

in avoiding

monoamine

24

require

and ‘ipostexercise.”

in treating

effective

and

marked

after

test, “monitored” complete

and

electrocardiogram

developed

Success

entire

They

has been followed

clinical

The

the

to experience

or emotion.

A series of such patients salient

core of patients

who continue

News

sac.

by which removal (e.g.,

India

micropulverized and

of

of re-

chemically

materials

ink), bartrace-

were instilled