Coronary-pulmonary artery shunt with normal origin of coronary arteries

143

Abstracts due ILIS arteriosus of XX

&lrce

1)aticnts.

and

I)rancll

had,

stenosis

X0

mosaic

-1 urner

t,ascular

lesions

These

in X0

stenosis),

data

Turner

repair 13

Turner

although

a

Findings

only

may

1 patient.

the systemic

Interference

ITDALI.,

Several fluence

the

contradictory, individual in

or derived

Twenty-six

groups

doses

were

each

ser\,etl

2 weeks

when

mg./day) chronic

was heart

given.

time

increased

3 patients

in prothrombin

receiving (2,000

definite (al.crage

14.4

sec.)

showed

rise

alcohol

adre-

times

(aver-

mg./day)

(average

4.1

sec.)

mg./day),

10 patients

and

with

neo-

showed

prothrombin

in response

ad-

a question-

5.6 sec.)

in

a

2 patients

showed (1,000

All

prompt

and

had

who

ethyl

(average

mg./day).

mg./day),

patient

(2,000

griscofulvin

test

was ob(800

Only

times

increase

after

(3,000

prothrombin

Only

6 a moderate

and

5 days

or quinidine

during

clofibrate

periods

3 to

hepatomegaly

during

ministration.

m\cin

1

In

Prothrombin

effect

acid

and

in

8 test drugs

week

during

Only

failure

with

fall

two

(8 oz. vodka/day).

:cgc 10 sec.)

warfarin

therapy.

mg./day),

observa-

in this study.

No modifying

in prothrombin

sponded

for

before,

(3,000

ministration

while

incidental

were given

day

to in-

therapy;

receiving

acetylsalicyclic

acetaminophen

A.

inconclusive,

by Fibrometer

administration.

able

from

warfarin

measured

for

drug

J.

reported

has been

volunteers

continued

weekly

been

fixed daily doses served

divided

times

Therapy.

anticoagulant

of 10, these patients

during

ris?

of oral

of the data

a

times

to phenylbutazone

and Potts’

Patients

with

Anastomosis.

M.D.,

‘Tlventy-six Potts’

patients of

D.

Rochester,

anastomosis

velopment VOLUMI’.

G.

~I.D.,

Tetralogy

of

G. VON BERNUTH,

G. RIT-TKR, ~M.D., R. L. FRYE, hlc:Go~~,

twice

in group

were

pulmonary

23> JANUARY 1969

M.D.,

DAVIS,

F.A.c.c.,

M.D.

and

Fallot

M.D.,

D.

W.

H.

D.

C.

Minn.

with

and

formed.

In group

operable

because

operatively

reviewed vascular

of Fallot

in regard disease

and

artery

the

the

1 (7 patients) in

as

the

duration

it was

per-

were considered

PVD,

later.

right

electrocardiogram

2 groups

1 died

segment

was no consistent

1, 4 patients

and

from

isolated

or age at which

of severe

in

a continuous

and

There

4 died

ill-

early

All patients

post-

in group

operation.

Coronary-Pulmonary

Artery

Shunt

Origin

Arteries.

Y.

of

Coronary

AMPLATZ,

With

Normal

WANG, M.D., I(.

and F. L. GOBEL, ~v.D.. Minneapolis,

M.D.

Minn. Shunting lation

of blood

is an unusual

in adults. arteries

With

pulmonary

origin

trunk

from

of

dyspnea

and

tinuous

murmur had

branous

subaortic

teriosus.

There

onstrated detected

fatigue, at

the

coronary

stenosis

artery,

to de-

municating

may be related

the

patent

pulmonary diversion

Two memar-

electrocarAt

cardiac

to be dem-

but

could

be

In 4 patients a

the right

a network

COII-

ductus

was defined had

and

a

border.

the pulmonary

to critical

pain,

lesions:

methods.

both

They

patients

had

findings.

Two

from

with

chest

in all G cases

and 2 had

(PVD)

Two

was too small

of the shunt from

to the

sternal

and

sensitive

angiography.

communicating

6 pa-

artery

characteristic

radiographic

by oximctry

studied

patients

left

no

the shunt

10 years.

congenital

the shunt

the anatomy

past

1 had

Four

were

by more

coronary

the

associated

or

have

12 to 54 years.

asymptomatic.

patients

We

circu-

ischemia

both

the coronary

during

in age from

3 were

onary

the coronary

of myocardial

to detect.

with shunts

ranged had

cause

normal

may be difficult tients

away from

and only a small communication,

communications

tetralogy

pulmonary

in group

between

ranged

had

as frequent

anastomosis

range

were cyanotic,

saturation

2 (3 patients).

difference

cyanosis

murmur

2, 8 patients

on

pa0.15).

(111

saturation

roentgenogram

pul-

I)ctween

1 included

12 patients

I-

a

2-13

0.3

a continuous

oxygen

of Potts’

2 survived

and

oxygen

In group

catheterization

of

12’~IDVAN,

were

0.1

in group

hypertrophy

diographic

(300 mg./day). Evaluation

between

arterial

ventricular

drugs have

course

much

Warfarin

Calif.

common

however, tions.

with

Irvine,

M.D.,

group

arterial

thoracic

group

with

(Rp!Rs)

Aneurysmal

on the

PVD

ratio

in patients

murmur. Drug

Rp,‘Rs

2 groups: of

repair.

to complete

(m) 0.7’]-and

81 to 90 (m 91) and

group.

into

resistance

1.3 [mean

with

prior

evidence

of 76 to 90 (m 84),

(pul-

lesions

divided

with

in 12, a systemic

(coarcta-

phenotype

0.4 and

of completr

catheterization

and were

patients

tients

with

to the cardio-

additional

in either

in

that

to the success

cardiac

monaryisystemic

defects.

syndrome

had

steno-

found

indicate

with regard

and XX

in patients

lesion

its relation

All

l6

artery

and 3 of 4 patients

exists

tion of the aorta)

valve septal

the

and

cvi. in

pulmonary

ventricular

was also

phenotype.

dichotomy

monary

pulmonary

patients

clear-cut

occur

had

Cytologic was found

in addition,

2 had

stenosis);

Pulmonary SY

phenotype

14 of whom

sis (6 ot these

3 XX

I dcxtrocardia.

Turner

by selecti\,e single

vessel

trunk,

2 had

and

left

of vessels trunk.

corcom-

Symptoms

of local coronary

Abstracts 60~ or to the size of shunt relative to total coronary blood flow. Aortic Aneurysms with Aortic Insufficiency: Repair Without Prostheses. W. R. WEBB, M.D., F.A.c.c., W. I. SUGG, M.D., F.A.C.C. and R. R. ECKER, M.D., Dallas, Texas. Aneurysms of the ascending aorta often produce aortic valvular insufficiency because of stretching of the aortic commissural attachments without any abnormalities of the valve leaflets. To avoid the as yet unsolved complications of prosthetic valves which are usually inserted in such instances, we have reefed the ascending aorta to restore the aortic valve to competence. Five consecutive cases of large (8-15 cm.) globular ascending aortic aneurysms with moderate to severe aortic insufficiency have been repaired successfully without valve replacement. Arterial grafts were used in 2, but in the other 3 aortic continuity was restored by end to end anastomoses, since the length of the aorta was increased as well as the Although 2 patients had been circumference. treated for syphilis their specimens, along with those of the other 3, showed cystic medial necrosis without pathologic evidence of syphilis. Followup study has shown all doing well 2 to 6 months postoperatively with no hemodynamic evidence of aortic insufficiency. Only 1 has a diastolic murmur. Full data and aortograms will be presented. This concept of restoration of valvular competence and primary aortic repair extends the practice of utilization of autogenous tissue, whenever possible, as the safest and most practical approach. Hypertension with Defective Aldosterone Stimulation by Sodium Restriction: A New Syndrome. G. H. WILLIAMS, M.D., D. P. LAULER, M.D., R. B. HICKLER, M.D., F.A.C.C. and A. R. CHRISTLIEB, M.D., Boston, Mass. Two Negro patients with hypertension were placed on a diet of 10 mEq. sodium and 100 mEq. potassium and evaluated as part of a study of reninaldosterone mechanisms and essential hypertension. Each failed to achieve sodium balance after 6 to 8 days and each became hyponatremic, azotemic and hyperkalemic. Studies of upright peripheral plasma renin activity (PPRA) and aldosterone secretory rates (ASR’s) were performed. Two liters of normal saline were then infused on each of 2 consecutive days, and the tests for AX’S and PPRA were repeated. ACTH then was given either as 40 units intramuscularly per day or as a continuous infusion of 80 units daily on 2 con-

secutive days. ASR’s and urinary 17-hydroxycorticoids (170HCS) were performed on each day of ACTH stimulation. Results were compared with normal individuals similarly studied. Low Salt’ ASR

Renin hg. %) Case 1 Case 2 N0Illlal subjwts

1500 3050 >700

High Salt ASR kg.1 day)

R&n hg. %) 189

156 >400

250 318 <300

116 220 <225

1stDay ACIYH ASR kg/day) 540 451 >240

The urinary 170HCS increased from 6 to 16 mg. per 24 hr. in the patient given ACTH intramuscularly and from 4 to 49 mg. per 24 hr. in the patient given ACTH intravenously. The data from these 2 patients suggest either a selective defect in aldosterone secretion to a specific stimulus, i.e., angiotensin-n or a defect in the conversion of angiotensin-I into angiotensin-rr. Arterial Sodium Content in Experimental Congestive Heart Failure. R. ZELIS, M.D., C. S. DELEA, H. N. COLEMAN, M.D. and D. T. MASON, M.D., F.A.c.c., Bethesda, Md. Although congestive heart failure (CHF) in man is associated with diminished arteriolar dilator capacity, the mechanism of this physiologic defect has not been elucidated. It was considered that an abnormality of ion and water content of blood vessels in CHF might be responsible for their unusual stiffness. Accordingly, the concentrations of sodium (Naf) and potassium (K+) were determined in samples of aorta (Ao) and femoral arterial branches (FA) from 17 dogs; 6 had ascites due to CHF produced by rapid ventricular pacing [left ventricular end-diastolic pressure (LVED) 26.2 mm. Hg and maximal velocity of myocardial shortening (V,,,) 2.39 circumferences/set.], 4 were paced but had normal dynamics (LVED 8.8 mm. Hg and V,,, 2.98 circumferences/set.), and 7 normal dogs had sham operations or no intervention. In CHF, Ao Na+ was 38.0 % 2.3 mEq./lOO gm. dry weight and FA Na+ 44.2 c 3.2 mEq./lOO gm. These were significantly higher than similar samples taken from the 11 normal dogs [ Na+ 31.9 + 1.6 (0 < 0.05) and 31.9 -+- 1.8 (p < 0.01) mEq./lOO gm., respectively]. Although the water content tended to be higher and Kf tended to be lower in animals with CHF, these values were not significantly different from normal. It is suggested that the increased Na+ in the arterial bed in CHF might be responsible for the diminished responsiveness of THE AMERICAN JOURNALOF CARDIOLOGY