Continuous murmur in tetralogy of Fallot and pulmonary atresia

134

College

ventricular

septal

defect

creased

(less

vascular

resistance.

with

than

5

had

normal

units)

Conversely,

ventricular

septal

or slightly

estimated the

estimated

monary

vascular

resistance

was found

or severely

elevated

(7 to 18 units).

from

did

not

operation

ventricular septal

differ

significantly

to postoperative

septal

defect-mean

defect-mean

5.2 yr.).

degree

of left ventricular

valve

pressure

the

4.6 yr.,

period

tract

(no

had some

or pulmonary

stenosis

clude

observations

palliative

and

pertinent later

curence

septal

of complete

cava-left

defect

in 1 child,

obstruction

pulmonary

with transpcsition

National

F.A.c.c.,

There

(b) the oc-

of the inferior

artery

in-

closure

hypoxia.

To

exists

of

adenosine

was

phosphate

stroke

work

followed

(LVEDP)

and (c) the role

values obtained

\vere:

of the great arteries

in infants

and ventricular

Combined

Estrogen

on

Serum in

genesis

BENJAMIN M.

M.D.,

JAIN,

M.D.,

Michael

Chicago,

Large

Levels

of patients

(C/P)

ratios.

were

of estrogen in order

show

that

antiatherogenic

even

at low doses.

mine,

feminization

onary

protection

markedly

and

neither

and

cockerels obtaining

A transient

increase

initial

rise

hypoxia

in LV

end-diAverage

;ZTP CP (~moles/gm.)

4.0 5.8 11.6 23.8

4.60 4.48 4.60 4.65

12.2 10.4 9.0 6.0

was

in

action

of

was still feminizing atherosclerosis coronary

preserved.

thoracic

aorta

were protected

nor against

action

cholestyra-

Both

while

corwere

in the doses given However,

cholestyramine diet-induced The

the hyper-

possibility

in man is being

of

presented.

depressed.

failure

function

of myocardial

energy

Murmur

Pulmonary

Atresia,

M.D., PATRICK A.

in

hypoxic

phosphate

and

of Fallot

W.

pulmonary

atresia

murmur are

(those

Blalock

A

significant

indicated,

determined

the precise

M.D.,

Minn.

a continuous

associated

of Fallot

or ventricular

AMERICAN

JOURNAL

defect

and aortography.

seen by us can be categorized

THE

anastomoses is

of which can be

Patients

septal defect

the similar

with congenital

Potts

by angiocardiography

OWINCS

Rochester, and

nature

and

RAHIMTOOLA,

have and

of

KIRKL.IS,

defect

occasionally

with

excluded).

thereby

of Fallot septal

some

stores.

~x.B., F.A.c.c.,

JOHN

tetralogy

of ventricular

was not in

depression

Tetralogy

ONGLEY,

final in all

by a depression

Mayo Clinic and Mayo Foundation, with

store.

SHAHBUDIN H.

M.D.

the

developed

that

high energy

KINCAID,

ATP.

is not initiated

Continuous

Patients

fall in

was unatrected

first

it is concluded

myocardidl

W.

even with severe

a significant

Since

the secondary

when

condition

hypercholes-

protective.

with

atherogenesis.

with slightly

atherogenesis

Progynon@

feminizing

a similar

of giving

failure

for contraction,

CP,

animals,

and,

reduced

always

dogs and

in mean ATP, early

in 10 of 18 dogs, and with late failure

source

depressed

cholesterol-oil

the desirable

was

energy

the side effects

In combination was

and

in

With

CP occurred CP

Cholestyramine,

Premarin”

given in combination

cholesteremia

cho-

of cholestyramine

to avoid

on

decreased.

in serum

the feasibility

to preserve

and

terolemia

failure.

disturbances.

performed

to invrstigate

at the same time, each. Results

was no change

heart

when given in large doses,

but it may cause gastrointestinal

dosages

There

resin, lowers serum cholesterol

levels in man and animals

combination

SAVITRI Medical

are beneficial

also cause a reduction

a bile acid sequestering

fed cockerels

of

LVEDP (mm.

11.5 15.8 13.4 10.2

with myocardial

doses of estrogens

lesterol/phospholipid

Experiments

Control Hypoxia Early failure Severe failure

RUTH

and

as

Ill.

feminizing They

Hospital

were obtained

Hg)

Athero-

KAPLIN, M.D. and

18 sym-

measurement

during

Treat-

and

Cockerels,

Reese

in the long term prognosis infarction.

Cholestyramine

Cholesterol-Oil-Fed

PICK,

Center,

and

Cholesterol

Sr: after

and fall in LVSW.

LVSW (gin.-M.)

causal

(ATP)

by a progressive

astolic pressure

a

triphosphate

(CP).

vena

pressure

for

(LVSW)

perduring

and propranolol).

biopsies

occurred

creatine

in LV

(LV)

high

two phenomena.

(hexamethonium

failure

concentrations

depressed

with Sol0 Or, 94y,

blockade

the

whether

these

Md.

both

mechanical

are

determine

between

left ventricular

and

the

A.

M.D.,

Bethesda, that

and

in

PI:TER

M.D., CH-\RLES

Institute,

agreement stores

Stores

Failure,

BRAUhWALD.

of the myocardium

connection

Serial

COVELL,

Heart

phosphate

formance

Phosphate Heart

EUGENE

is general

energy severe

W.

and

defect.

ment

when

surgery

of spontaneous

atria1 graft in 3 children,

of restricting septal

to the problems

corrective

(a) the demonstration

of a ventricular

was

M.D.

myocardial

of initial

low

CRID~EY,

pathetic

was low in this

group. Additional

Energy Hypoxic

dogs were respired

demonstrated,

resistance

High Induced,

E. POOL, M.D., JAMES

two

ventricular

Six children

or

vascular

in

mod-

These

catheterization

outflow

gradient

and the pulmonary

pul-

to be

Myocardial Acutely

in 13 of 18 children

defect,

erately groups

in-

pulmonary

News

as tetralogy

with pulmonary OF CARDIOLOGY

College atresia

and

(patent

(1)

large

ductus

collateral

from

aorta,

artery

fistula)

pulmonary

massive

monary

arteries,

magnitude artery

related

of

performed

in

planned The

in all cases. In the case both

flow

largely

to variations

through

3 of the

the

have

of surgery

been

is related

must include

aortopulmonary

measures

Mitral

Institute,

Thrombosis

replacement,

130

orifice

patients

before

and

death.

operated

clots

patient

mitral

patient

with after

necropsy,

or predominant mitral an

mal- or nearly into

the muscular of the ball

obstruction

ventricular

“low

cardiac

both

the

atria1

thrombosis

Starr-Edwards modated

atria1

valve

figuration,

must

placement

de-

infarction.

At

to have

nor-

septum

cavities.

valve,

prevented

full

diastole,

and

emptying

output

resulted.

syndrome”

Since and

left

from this mechanism, accom-

or a valve of different

be utilized

when

in a patient

mitral

a con-

valve

re-

with mitral stenosis

and a small left ventricle. Utility

of

Diagnosis, Hope

Medical

Calibrated, by

plotting

VOLUME

RODBARD,

Center, timed the

Duarte,

arterial

1966

in

Cardiovascular

M.D., F.A.c.c.,City of Calif.

upstrokes

instantaneous

17, JANUARY

diagnosed

less than prolonged ventricular

were obtained

stenosis,

was as

in three such suband

QKs

stenosis,

to the reduction

resulted

QKn

QKs

in

was delayed.

was

in output;

normal

QK,,.

These and other data indicate has utility

to

QK

septal defect with left to right shunt,

morecording

In QKn

that sphyg-

in cardiovascular

diagnosis.

The Significance of Minor Electrocardiographic Wave

Changes.

cants

for

A Mortality

Insurance,

F.A.c.c., LEON of the United

States,

A mortality

study

cants

for insurance

Society

whose

was a low, mitted

flat,

Va,

lowed-up

found

notched,

the

remainder

degree

There

was a total

The deaths,

aggregate was

changes

with changes leads VrV,.

549

could

be fol-

per cent of the

insurable

of 4,788 mortality,

persons

approximately

sub-

period

risks in all other than

in leads with

respects,

abnormalities

of

the electrocardiogram. exposure

years

with

an

time of 9.2 yr.

only

in mortality

this

Seventy-five

had

in other

exposure

T wave 20,000

during

1962.

1946-

abnormality

; 518 of the patients

minor average

the period

diphasic

were standard

appli-

Life Assurance

during

or VS. Among

through

applicants

among

Equitable

electrocardiographic

Vs,

S.

Society

N. Y.

conducted

States

M.D.,

RICHARD

Life Assurance

electrocardiograms

cases were

and

was

to The

only

and

New York,

of the United

1953,

RODSTEIN,

M.S.

Equitable

T

Study of 518 Appli-

MANUEL

WOLLOCH,

GUBNER, M.D., The

wave

sphygmomanometer

was

was associated

of QKn

In mitral

in proportion

QKn

as subaortic

aortic

valve replacement

correction

epi-

data were observed

as 0.32 set, and

values.

sec.

of exercise,

infarction,

in shortening

control

set;

0.32

arteriosclerosis

severe

to as much

resulted

f

early QKn. Myocardial

such as myocardial In

at

the QK

was 0.01

was 0.29

Generalized

QKs.

subjects

obtained

at catheterization

with an abnormally

jects

(QKn)

Similar

associated

delayed

800

or aortic regurgitation,

stenosis.

with

arterial upstrokes

subjects,

outputs

muscular

overweight

Sphygmorecording SIMON

administration,

in 7 patients

than tracings

(QKs)

stroke

the

4,000

In normal pressure

augmented

I, II, Vs,

protruded

of small size and easily

is necessary

1

ventricular

may result

by the ventricle,

In

thrombosis

left ventricular

during

to left

stenosis.

were found

the cage of the prosthetic

descent

were

regurgitation,

mitral

normal-sized

of proevident

patients

myocardial

7 of the patients

of

postoperatively

regurgitation,

acute

8

valves

were

developed

the

in

manifestations

upon for predominant

veloped

occluded

output of the

pure

mitral

mitral

half

had

In each,

which

cardiac

Although

the

surgical

valve

following

postoperatively

6 of the 8 in whom thrombi had

C. ROB-

and prosthetic

Starr-Edwards

In each

reduced

The

M.D., National

complication

in whom

In

of

than

on more

beats as cuff [from the elec-

onset

to direct

pressure

late as 0.50 set;

Md.

developed

were inserted. gressively

WILLIAM

G. MORROW,

of the left atrium early

at diastolic

at systolic

disease,

Surgical

of the large

Replacement:

Syndrome,

Bethesda,

is a recognized mitral

arteries.

interval

was delayed

Valvular

Small Left Ventricle

valve

to the

and Left Atria1 Thrombosis

ERTS, M.D. and ANDREW Heart

is

connection.

Low Cardiac Output Following

and

surgery.

for control

catheterization.

QK

the

means similar

cardiac

nephrine

after

primarily

by this

interval

More

and QKs were shortened.

successfully

studied

died

size of the right and left pulmonary technic

in the

aortopulmonary

has

19 patients

Five

atresia,

in the size of the pul-

Operation

in 3 others.

feasibility

and of pulmonary

to

sound].

were essentially

has demonstrated

the QK

Q

(K)

derived

of right or left (or both)

variation

connection.

artery-pulmonary

study

of Fallot

is considerable

fell, against

Korotkoff

the cause of the murmur there

of each of a series of successive

trocardiographic

coronary

Special

of severe tetralogy

pressure pressure

origin of left or right pulmonary

or (2) stenosis

artery.

connection

aortopulmonary

or

connection,

artery

aortopulmonary

arteriosus,

News

based

slightly

above

who

showed

twice normal. was found confined

on a total normal

a mortality

No significant

of 33

except

difference

between

those with minor

to leads

I and II, and

in both leads I and

II

in

ratio T

those

and one or more of