Myocardial revascularization by autogenous vein graft between aorta and myocardium

College conduction

defect,

was known

to have complete

Two The

patients

first,

neurologic

pigmentosa. which

She

and an intraventricular mittent

bigeminal

The second

rhythm

the characteristic and

atypical

block

defect.

retinitis

unit radius also had

Imagine

findings,

center.

Complete

heart

17 yr. and she had

Stokes-

Adams

attacks

since age 21 yr. These

became

ciently

severe

to warrant

implantation

pacemaker

at age 23. She is the second complete

heart

pacemaker

block

case of this disorder

suggested

lipoidosis.

the

Subsequent

large quantities

disease

workers

of phytanic

may have

and serum

of some of these patients.

usual

neurologic

syndrome

presenting

of unknown The

with

Statistical

Treatment

M.D.,

HENRY

AGUSTI,

M.D.,

Western

Then

of

Angular

ROMBERG, M.D. and

Reserve

in

Arithmetic Mean

Adjusted Mean*

171” 165’ 261’

93O 350° 261’

Frontal Sagittal Horizon. * Obtained away

the prevalent (x,

P).

about

at its

some direc-

the center of gravity direction the disc

is de-

tips.

the further

The

the center

points will be from the center is found as follows:

direction

A measure

put X1 =

is toward

from the center

d = Vkz

of gravity:

the center

d of the precision

chi-square

and values

3.0 furnish

of x2 larger of the

than

observations

of

of the

of the disc

+ Y2. For large

N, X2 = Nd2 is approximately

at

distributed,

the

evidence

of

5(y0 level

of

significance. An example

Cleve-

of the 0.03

of differences methods

sec. vector

in the mean

angle

is seen in the following to N premature

infants

for data

at 24

hours of age.

Prevalent Direction 158O lo 262’

by adding of fixed amount

has

of the YJ plane.

prevalent

is the distance

clustering

, .4N the arithmetic

.

on

disc

sinA,,

three different of N angles Al,

l‘he

on a fulcrum

in which

of gravity

=

to the center

REGULO

University,

, 4N may

disc.

cluster

The

of the sample

observations

defects

Data

A,.

at the origin

the degree of clustering,

gravity

Ohio.

In a sample

x

Y

d

N

- .20 .89 .13

.08 .Ol - .91

22 .90 .92

46 48 48

to each angular observation,

so as to keep the majority

X”

2.3 38.6 40.6

of the observations

from o”.

mean A = resent

(A, +

the direction

cluster, the

in

angles

the inade-

and the results

, XN = cosAr;, YN = sinAN,?% = (X, + . . + X,)/N, u = (Y1 + . Y,)/N.

JEROME LIEBMAN, M.D., THOMAS

DOWNS,

+

be considered

above,

of a circular

as the direction

The center

kidney,

conduction

The

and center

cosA,, Y1

etiology.

Vectorcardiography,

land,

should cardiac

by Do\vns and

of the disc.

to a

un-

the prev-

observations,

as points with unit Fveights situated

If the observations

of gravity

by

This

adapted

the disc to be balanced

greater

demonstrated

acid in the liver,

urine

patients

fined

with

be due

unique.

the

does not have

tion, then the disc will tip toward

implantation.

Refsum

of

analyses

of the observations.

suffi-

and the first to be treated

has been method

the circumference

An inter-

neurologic

pigmentosa.

at age

are

be considered

was also noted.

features,

This

for estimating

precision

of the linear

obtained

electro-

left axis deviation

a 26 year old woman,

facial

developed

an abnormal

conduction

patient,

quacies

and

analysis,

is described.

and atypical

method

direction

a circular

have been studied. had the character-

marked

appropriate

alent

findings

had

showed

An

\vho died suddenly

heart block.

old woman,

features,

cardiogram

1 patient

with this disorder

a 28 year

istic facial retinitis

but

129

News

and

. . + A,)/N about

the sample

. + (AN dispersion

which

dispersion

among

-

angles

mean A. Vectorcardiographers of the inadequacies

the angles

variance

A)2]/(N

of the

is often used to repS2 =

is taken to be 0’. VOLUME 17, JANUARY 1966

to

C.

WALTON

M.

FERLIC, M.D.

University

about

Club Heart

the

arithmetic

have long been aware

observations,

values of K and S2 depend

Between

Graft

1) is used to indicate

of these measures the

-

Revascularization

Vein

A)2

tend

[(A,

Myocardial

greatly

when since

there then

is the

on which direction

LILLEHEI, and

arteriography involvement

Medical

cluding these

successful extensively

direct

Minn.

artery disease,

documented

arteries,

thereby

attacks.

involved

M.D.,

Center and Variety

by coronary

has repeatedly

RANDOLPH

QUATTLEBAUM,

Minneapolis,

of main

Myocardium,

F.A.c.c.,

M.D.,

In patients incapacitated

Autogenous

and

FRANK

of Minnesota Hospital,

by

Aorta

However,

hearts,

extensive

usually

the

pre-

even

in

arterioles,

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