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ATS Training Programs in Respiratory Disease
630
TIKOFF AND WILSON
diffuse lIlt'dial arkrial hypprtrophy were noted microscopically. along with mild cardiac cirrhosis and centrilohular hepatic nt.'Crosis. Otht'f findings included a larJ.!e. actin' duodt:'nal ulcN.
Discesslo:" Pre\'ious studies ha\'e indicated that the a\'erage life expectancy from birth of patients with atrial septal defect lies hetween .'3(j and :39 years.~··H Ilowever. there have heen many reported instances of patients with large atrial septal defects Ii\'ing past 60 years of age including two octogenarians. a." Our 9.5-year-old patient demo.nstrates once again that this lesioll is compatihle with marked longevity. \Vhy this patient lived so IOllg is an interesting question. It has heen pointed out that heart failure and pulmonary vascular disease are two complications of atrial septal defect which are commonly seen in adults with atrial septal defect and ach-ersely affect prognosis.H.i \Vhile the cause of the heart failure in atdal septal defect cannot he delineated in all cases. it has heen suggested that in the majority of instances. an additional process. such as mitral illsufficiency or systemic hypertension. is present.i-~ It has heen further suggested that such an additional lesion. even if mild. may be superimposed on a postulated "hypoplastic" left ventricle and precipitate the presence of heart failure or aggravate its progression.i.I< In this light. our patient never had systemic hypertension or mitral insufficiency. Thus, the ahsence of these predisposing factors as well as the relatively mild degree of coronary artery disease and myocardial scarring (while also contributing to her cardiac failure). may plausibly help explain her relath'ely benign course. Pulmonary vascular disease with pulmolIary hypertensioll is also known to complica te the course of
suggests that she did indeed have pulmonary hypertension. Howe\"(.:>r, it apparently was never severe enough, to result in detectahle cyallosis. 7 ." or in thromhosis of the pulmonary vasculature. i \\'e contend that her longevity may he plausihly explained in part hy the late onset and henign nature of her heart failure as well as her mild pulmonary vascular disease. :\ddellClum: Since this articlt, ww, suhmitted for puhlication.
a reference to an atrial septal defect in a HO-yt'ar-old patit'nt has been pointed out to us (Zan'r AG. :\adas AS: atrial septal defect-secundum t)"lX'. Circulation 31-:32 (Suppl III): 24. 196.5 l. REFERE:"CES
2
,3 4 .'5
(i 7
Fi.<;dll'r J\1. \\'ilson \\'It Theilen EO: Hl'cognition of congenital heart di.wase in the fifth to eighth decades of lift'. Circulation 2.5: 821. IH62 Cooll'Y DA, Hallman GL, Hamman AS: Congenital cardiovascular anomalit's in adults: Results of surgical trt'atment in 167 patients over agl' 3.1. Arnl'r J Cardiol 17: .30.3. 19(j6 Ellis FR. Greaves \1. Hecht HH: Congenital heart disease in old age. Interauricular st'ptal defect with mitral and tricuspid valvulitis. An1l'r Heart J 40: 154, 19.'50 Rodstein \1. Zeman FD. Gerher IE: Atrial septal defect in the aged. Circulation 23: 66.5. 1961 Ro{'sler II: Interatrial septal lll·fect. Arch Int \Ied .'54: :3:39. 19:34 Calliphd I \1. :\eill C. Suzl1lan S: The prngnosi<; of atrial septal defect. Brit \Ied J I: 1.375, HJ57 Dexter L: Atrial septal dl·fl'ct. Brit Hl'art J 18: 209. l~r:56
S Tiko(f G. Schmidt A\1. Kukla H. et al: Heart failurt' in atrial septal defect. AlIll'r J \Ied 39: 5.3.1. 19(i.1 9 \\'ood P: Discussion of: The cause of the continupd It'ftto-right shunt in A.S.D. when the right atrial prpssurt' is high. Brit Heart J 20: 26M. H):')8 10 \Iarkman P, Howitt C. Wade EG: :\trial septal defect in tl\l' middle-aJ.!ed and dderly. ()uart J \Il'd .34: 409, 1965 Ikprint requests: Dr. Tikoff..'50 :\orth \Iedkal Drive. Salt Lake City 84112.
ATS Training Programs in Respiratory Disease The American Thoracic Societv. medical section of the ~ational Tuhen.'ulosis amI Resl)iratory Disease Association. has allllotlllced puhlication of the fifth edition of a listing of training programs ill respiratory disease. including pediatric prograuls. The booklet contains such informatioll as: institution. chief of service or program director: pr<>vious training required; allnllal stipend;
typt.' of experi('IJ('e offered: illpatiellt aud outpatient admissions per yt>ar. The' listin~ carries no implication of approval hy the ATS and is pmely faetual as supplied hy those in charge of the programs. A copy of the hooklet may he ohtained hy writill~: Anwriean Thoracic Society. Divisioll of \Iedical Education. 17 -to Broadwa\'. ~ew York City 10019. .
CHEST, VOL. 58, NO.6, DECEMBER 1970
TIKOFF AND WILSON
diffuse lIlt'dial arkrial hypprtrophy were noted microscopically. along with mild cardiac cirrhosis and centrilohular hepatic nt.'Crosis. Otht'f findings included a larJ.!e. actin' duodt:'nal ulcN.
Discesslo:" Pre\'ious studies ha\'e indicated that the a\'erage life expectancy from birth of patients with atrial septal defect lies hetween .'3(j and :39 years.~··H Ilowever. there have heen many reported instances of patients with large atrial septal defects Ii\'ing past 60 years of age including two octogenarians. a." Our 9.5-year-old patient demo.nstrates once again that this lesioll is compatihle with marked longevity. \Vhy this patient lived so IOllg is an interesting question. It has heen pointed out that heart failure and pulmonary vascular disease are two complications of atrial septal defect which are commonly seen in adults with atrial septal defect and ach-ersely affect prognosis.H.i \Vhile the cause of the heart failure in atdal septal defect cannot he delineated in all cases. it has heen suggested that in the majority of instances. an additional process. such as mitral illsufficiency or systemic hypertension. is present.i-~ It has heen further suggested that such an additional lesion. even if mild. may be superimposed on a postulated "hypoplastic" left ventricle and precipitate the presence of heart failure or aggravate its progression.i.I< In this light. our patient never had systemic hypertension or mitral insufficiency. Thus, the ahsence of these predisposing factors as well as the relatively mild degree of coronary artery disease and myocardial scarring (while also contributing to her cardiac failure). may plausibly help explain her relath'ely benign course. Pulmonary vascular disease with pulmolIary hypertensioll is also known to complica te the course of
suggests that she did indeed have pulmonary hypertension. Howe\"(.:>r, it apparently was never severe enough, to result in detectahle cyallosis. 7 ." or in thromhosis of the pulmonary vasculature. i \\'e contend that her longevity may he plausihly explained in part hy the late onset and henign nature of her heart failure as well as her mild pulmonary vascular disease. :\ddellClum: Since this articlt, ww, suhmitted for puhlication.
a reference to an atrial septal defect in a HO-yt'ar-old patit'nt has been pointed out to us (Zan'r AG. :\adas AS: atrial septal defect-secundum t)"lX'. Circulation 31-:32 (Suppl III): 24. 196.5 l. REFERE:"CES
2
,3 4 .'5
(i 7
Fi.<;dll'r J\1. \\'ilson \\'It Theilen EO: Hl'cognition of congenital heart di.wase in the fifth to eighth decades of lift'. Circulation 2.5: 821. IH62 Cooll'Y DA, Hallman GL, Hamman AS: Congenital cardiovascular anomalit's in adults: Results of surgical trt'atment in 167 patients over agl' 3.1. Arnl'r J Cardiol 17: .30.3. 19(j6 Ellis FR. Greaves \1. Hecht HH: Congenital heart disease in old age. Interauricular st'ptal defect with mitral and tricuspid valvulitis. An1l'r Heart J 40: 154, 19.'50 Rodstein \1. Zeman FD. Gerher IE: Atrial septal defect in the aged. Circulation 23: 66.5. 1961 Ro{'sler II: Interatrial septal lll·fect. Arch Int \Ied .'54: :3:39. 19:34 Calliphd I \1. :\eill C. Suzl1lan S: The prngnosi<; of atrial septal defect. Brit \Ied J I: 1.375, HJ57 Dexter L: Atrial septal dl·fl'ct. Brit Hl'art J 18: 209. l~r:56
S Tiko(f G. Schmidt A\1. Kukla H. et al: Heart failurt' in atrial septal defect. AlIll'r J \Ied 39: 5.3.1. 19(i.1 9 \\'ood P: Discussion of: The cause of the continupd It'ftto-right shunt in A.S.D. when the right atrial prpssurt' is high. Brit Heart J 20: 26M. H):')8 10 \Iarkman P, Howitt C. Wade EG: :\trial septal defect in tl\l' middle-aJ.!ed and dderly. ()uart J \Il'd .34: 409, 1965 Ikprint requests: Dr. Tikoff..'50 :\orth \Iedkal Drive. Salt Lake City 84112.
ATS Training Programs in Respiratory Disease The American Thoracic Societv. medical section of the ~ational Tuhen.'ulosis amI Resl)iratory Disease Association. has allllotlllced puhlication of the fifth edition of a listing of training programs ill respiratory disease. including pediatric prograuls. The booklet contains such informatioll as: institution. chief of service or program director: pr<>vious training required; allnllal stipend;
typt.' of experi('IJ('e offered: illpatiellt aud outpatient admissions per yt>ar. The' listin~ carries no implication of approval hy the ATS and is pmely faetual as supplied hy those in charge of the programs. A copy of the hooklet may he ohtained hy writill~: Anwriean Thoracic Society. Divisioll of \Iedical Education. 17 -to Broadwa\'. ~ew York City 10019. .
CHEST, VOL. 58, NO.6, DECEMBER 1970