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RUPTURED CHORDAE TENDINEAE
Volume 48. No. Octoher 19(,~
·1
POLYCYTHEMIC STATES
l'oxyde de carbone varie directement avec la concentration d'hemoglobine. Ce rapport entre capacite de diffusion et concentration de l'hcmoglobine est independant du taux de diffusion de l'oxyde de carbone avant phlebotomie. ZUSAMMENFASSUNG
Bei verschiedenen polycythaemischen Zustanden wurden Beobachtungen der Diffusionskapazitat vor und nach einemAderla{l durchgefuhrt. Personen mit einer unbehandelten Polycythaemia vera besitzen eine hohe Diffusionskapazitat. Die Phlebotomie fuhrt bei allen Formen der Polycythaemie zu einer Verminderung der Diffusionskapazitiit. Unsere Ergebnisse zeigen, da{3 die Diffusionskapazitat der Lungen fur CO sich direkt mit der Hamoglobinkonzentration andert. Dieser Zusammenhang zwischen der Diffusionskapazitat und der Hamoglobinkonzentration ist unabhangig von dem Ausma{l der DLCO vor dem Aderla{l.
2 3
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5
6
REFERENCES RANKIN, J., McNEILL, R. S. AND FORSTER, R. E.: "The Effect of Anemia on the Alveolarcapillary Exchange of Carbon Monoxide in Man," /. Clin. Invest., 40: 1323, 1961. HARROP, G. A., JR. AND HEATH, E. H.: "Pul_ monary Gas Diffusion in Polycythemia Vera," /. Clint Invest., 4:531, 1927. FORSTER, R. E.: "Exchange of Gases Between Alveolar Air and Pulmonary Capillary Blood: Pulmonary Diffusing Capacity," Phyciol. Rev. 37:391,1957. RATTO, 0., BRISCOE, W. A. MORTON, J. W. AND COMROE, J. H., JR.: "Anoxemia Secondary to Polycythemia and Polycythemia Secondary to Anoxemia," Am. /. Med., 19:958, 1955. BURGESS, J. H. AND BISHOP, J. M.: "Pul_ monary Diffusing Capacity and Its Subdivisions in Polycythemia Vera," /. Clin. Invest., 42: 997, 1963. BEIERWALTES, W. H., JOHNSON, P. C. AND SOLARI, A.: Clinical Use of Radioisotopes, W. B. Saunders Company, Philadelphia, 1957.
7 HUFF, R. L., HENNESSY, T. G., AUSTIN, R. E., GARCIA, J. F., ROBERTS, B. M. AND LAWRANCE, J. H.: "Plasma and Red Cell Iron Turnover in Normal Subjects and Patients Having Various Hematopoietic Disorders," /. Clin. Invest., 29: 1041, 1950. 8 KORY, R. C., CALLAHAN, R., BoREN, H. G. AND SVNER, J. C.: "The Veterans Administration-Army Cooperative Study of Pulmonary Function. I. Clinical Spirometry in Normal Men," Am. /. Med., 30:243,1961. 9 MENEELY, G. R., BALL, O. T., KORY, R. C., CALLAWAY, J. J., MERRILL, J. M., MABE, R. E., ROEHM, D. C. AND KALTREIDER, N. L.: "A Simplified C los e d C i rc u it Helium Dilution Method for the Determination of the Residual Volume of the Lungs," Am. /. Med., 28:824, 1960. 10 COMROE, J. H., JR. AND FOWLER, W. S.: "Lung Function Studies. VI. Detection of Uneven Alveolar Ventilation During a Single Breath of Oxygen," Am. ]. Med., 10:408, 1951. 11 VAN SLYKE, D. D. AND NEIL, J. M.: "Determination of Gases in Blood and Other Solutions by Vacuum Extraction and Manometric Measurement," /. Bioi. Chern., 61 :523, 1924. 12 OGILVIE, C. M., FORSTER, R. E., BLAKEMORE, W. S. AND MORTON, J. W.: "A Standardized Breath Holding Technique for the Clinical Measurement of the Diffusing Capacity of the Lung for Carbon Monoxide," ]. Clin. Invest., 36: 1, 1957. 13 BURROWS, B., KASIK, J. E., NIDEN, A. H. AND BARCLAY, W. R.: "Clinical Usefulness of the Single Breath Pulmonary Diffusing Capacity Test," Am. Rev. Resp. Dis., 84: 789, 1961. 14 ROUGHTON, F. W. J. AND FORSTER, R. E.: "Relative Importance of Diffusion and Chemical Reaction Rates in Determining Rate of Exchange of Gases in the Human Lung, with Special Reference to True Diffusing Capacity of Pulmonary Membrane and Volume of Blood in the Lung Capillaries," /. Appl. Physiol., 11: 290, 1957. For reprints, please write Dr. Hans Weill, 1430 Tulane Avenue, New Orleans.
RUPTURED CHORDAE TENDINEAE Fifteen cases of severe mitral regurgitation se~ ondary to ruptured chordae tendlneae have been reviewed. eight of whom under\vent open-heart surgery. Three patients are llvlng at this time with two being markedly Improved. Progressive deterioration within the year following onset of dlfflculty or sudden worsening of previous cardiac symptoms characterized the usual clinical course. The apical systolic murmur, always loud, was conspicuously harsh and radiated to the base of the heart, simulating aortic stenosis when
the mural cusp was ruptured. Although strongl)' suggesting the diagnosis, the sudden onset of an apical systolic murmur could be documented In only three Instances. The presence of a small left atrium radiographically with tall left atrial "v" waves and marked reflux of contrast material into a paradoxically pulsating left atrium also pointed to the correct diagnosis.
C. A., SCANNELL, J. G.. HARTHORNE, J. W. AND W. G.: "Severe Mitral Regurgitation Secondary to Ruptured Chordae Tendineae," eire"J"lion, 31 :506, 1965.
SANDERS, AUSTEN,
·1
POLYCYTHEMIC STATES
l'oxyde de carbone varie directement avec la concentration d'hemoglobine. Ce rapport entre capacite de diffusion et concentration de l'hcmoglobine est independant du taux de diffusion de l'oxyde de carbone avant phlebotomie. ZUSAMMENFASSUNG
Bei verschiedenen polycythaemischen Zustanden wurden Beobachtungen der Diffusionskapazitat vor und nach einemAderla{l durchgefuhrt. Personen mit einer unbehandelten Polycythaemia vera besitzen eine hohe Diffusionskapazitat. Die Phlebotomie fuhrt bei allen Formen der Polycythaemie zu einer Verminderung der Diffusionskapazitiit. Unsere Ergebnisse zeigen, da{3 die Diffusionskapazitat der Lungen fur CO sich direkt mit der Hamoglobinkonzentration andert. Dieser Zusammenhang zwischen der Diffusionskapazitat und der Hamoglobinkonzentration ist unabhangig von dem Ausma{l der DLCO vor dem Aderla{l.
2 3
4
5
6
REFERENCES RANKIN, J., McNEILL, R. S. AND FORSTER, R. E.: "The Effect of Anemia on the Alveolarcapillary Exchange of Carbon Monoxide in Man," /. Clin. Invest., 40: 1323, 1961. HARROP, G. A., JR. AND HEATH, E. H.: "Pul_ monary Gas Diffusion in Polycythemia Vera," /. Clint Invest., 4:531, 1927. FORSTER, R. E.: "Exchange of Gases Between Alveolar Air and Pulmonary Capillary Blood: Pulmonary Diffusing Capacity," Phyciol. Rev. 37:391,1957. RATTO, 0., BRISCOE, W. A. MORTON, J. W. AND COMROE, J. H., JR.: "Anoxemia Secondary to Polycythemia and Polycythemia Secondary to Anoxemia," Am. /. Med., 19:958, 1955. BURGESS, J. H. AND BISHOP, J. M.: "Pul_ monary Diffusing Capacity and Its Subdivisions in Polycythemia Vera," /. Clin. Invest., 42: 997, 1963. BEIERWALTES, W. H., JOHNSON, P. C. AND SOLARI, A.: Clinical Use of Radioisotopes, W. B. Saunders Company, Philadelphia, 1957.
7 HUFF, R. L., HENNESSY, T. G., AUSTIN, R. E., GARCIA, J. F., ROBERTS, B. M. AND LAWRANCE, J. H.: "Plasma and Red Cell Iron Turnover in Normal Subjects and Patients Having Various Hematopoietic Disorders," /. Clin. Invest., 29: 1041, 1950. 8 KORY, R. C., CALLAHAN, R., BoREN, H. G. AND SVNER, J. C.: "The Veterans Administration-Army Cooperative Study of Pulmonary Function. I. Clinical Spirometry in Normal Men," Am. /. Med., 30:243,1961. 9 MENEELY, G. R., BALL, O. T., KORY, R. C., CALLAWAY, J. J., MERRILL, J. M., MABE, R. E., ROEHM, D. C. AND KALTREIDER, N. L.: "A Simplified C los e d C i rc u it Helium Dilution Method for the Determination of the Residual Volume of the Lungs," Am. /. Med., 28:824, 1960. 10 COMROE, J. H., JR. AND FOWLER, W. S.: "Lung Function Studies. VI. Detection of Uneven Alveolar Ventilation During a Single Breath of Oxygen," Am. ]. Med., 10:408, 1951. 11 VAN SLYKE, D. D. AND NEIL, J. M.: "Determination of Gases in Blood and Other Solutions by Vacuum Extraction and Manometric Measurement," /. Bioi. Chern., 61 :523, 1924. 12 OGILVIE, C. M., FORSTER, R. E., BLAKEMORE, W. S. AND MORTON, J. W.: "A Standardized Breath Holding Technique for the Clinical Measurement of the Diffusing Capacity of the Lung for Carbon Monoxide," ]. Clin. Invest., 36: 1, 1957. 13 BURROWS, B., KASIK, J. E., NIDEN, A. H. AND BARCLAY, W. R.: "Clinical Usefulness of the Single Breath Pulmonary Diffusing Capacity Test," Am. Rev. Resp. Dis., 84: 789, 1961. 14 ROUGHTON, F. W. J. AND FORSTER, R. E.: "Relative Importance of Diffusion and Chemical Reaction Rates in Determining Rate of Exchange of Gases in the Human Lung, with Special Reference to True Diffusing Capacity of Pulmonary Membrane and Volume of Blood in the Lung Capillaries," /. Appl. Physiol., 11: 290, 1957. For reprints, please write Dr. Hans Weill, 1430 Tulane Avenue, New Orleans.
RUPTURED CHORDAE TENDINEAE Fifteen cases of severe mitral regurgitation se~ ondary to ruptured chordae tendlneae have been reviewed. eight of whom under\vent open-heart surgery. Three patients are llvlng at this time with two being markedly Improved. Progressive deterioration within the year following onset of dlfflculty or sudden worsening of previous cardiac symptoms characterized the usual clinical course. The apical systolic murmur, always loud, was conspicuously harsh and radiated to the base of the heart, simulating aortic stenosis when
the mural cusp was ruptured. Although strongl)' suggesting the diagnosis, the sudden onset of an apical systolic murmur could be documented In only three Instances. The presence of a small left atrium radiographically with tall left atrial "v" waves and marked reflux of contrast material into a paradoxically pulsating left atrium also pointed to the correct diagnosis.
C. A., SCANNELL, J. G.. HARTHORNE, J. W. AND W. G.: "Severe Mitral Regurgitation Secondary to Ruptured Chordae Tendineae," eire"J"lion, 31 :506, 1965.
SANDERS, AUSTEN,