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The AJC in November 1962
The AJCin November 1962 WILLIAM C. ROBERTS, MD
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he AJC in November 1962 contained 15 articles including 7 clinical studies, 2 experimental reports, 3 reviews, 1 historic study and 2 case reports. This piece will comment on 9 articles. Levy and Lilleheil from Minneapolis, Minnesota, in the lead article described clinical and operative findings in 10 patients aged 4 to 24 years [median 8) with left ventricular to right atria1 canal. Nine had systolic precordial thrills, and all 10 had harsh holosystolic murmurs, grade 3 to 5/6. Seven had complete or incomplete right bundle branch block. All had big hearts by radiogram, and in 7, the right atrium was clearly enlarged. Right atria1 pressures were increased in 5 patients. The pulmonary arterial systolic pressure was >60 mm Hg in only 2 patients. The pulmonary to systemic flow ratio ranged from 1.3 to 5.2:1. In only 3 patients was the preoperative diagnosis of the location of the shunt correct. At operation, the right atria1 wall was pulsatile and the cavity enlarged in all 10 patients. The defect was located in the membraneous part of the ventricular septum and ranged from 4 to 40 mm in diameter. In each patient, .the defect was closed by multiple interrupted mattress sutures. The youngest child (6 weeks] died the day after operation; a second died 3 years after operation. The other 8 patients were asymptomatic 6 to 42 months after operation. Coehlo and associates2 from Lisbon, Portugal, described angiographic features of valvular pulmonic stenosis with intact ventricular septum in 21 patients: (1) dome-shaped deformity in 12 patients; (2) diaphragm-shaped in 4, and (3) irregular deformity of cusps causing a winding trajectory of the contrast medium in 5 patients. The illustrations of the angiograms with injections into the right ventricle are superb. Castellanos and associates3 from Miami, Florida, described electrocardiographic findings in 5 patients with preexcitation (Wolff-Parkinson-White) syndrome associated with bundle branch block, right in 3 patients and left in 2. The authors demonstrated that the premature ventricular depolarization occurred in the cardiac ventricle with the intact bundle branch. Hultgren4 from Palo Alto, California, described systolic venous pulsations accompanied by a loud single sound in the neck and in the groin in 2 patients with severe tricuspid valve regurgitation. Pressure tracings disclosed that the sounds occurred at the moment of rapid rise in pressure in the underlying vein. In the groin, the sound lagged behind the onset of rise in femoral arterial pressure indicating that the sound arose in the vein and not in the artery. Hultgren termed the systolic sounds in tricuspid regurgitation
“venous pistol shot sounds” and showed how they could be differentiated from the more frequently encountered pistol shot sounds of arterial origin. Wasserburger and Corliss5 from Madison, Wisconsin, gave 179 patients with inverted T waves on electrocardiogram 5 g potassium citrate and 5 g potassium bicarbonate in 30 ml of water 90 minutes after the noon meal and recorded electrocardiograms 30, 60 and 90 minutes after the potassium ingestion. In the 60 patients with functionally inverted (anxiety-induced) T waves, the T waves reverted to normal in 90 minutes after ingestion of potassium. Inverted T waves of organic origin (myocardial infarction] in 119 patients, however, were unaltered by ingestion of the potassium solution. The authors regarded the potassium administration as potentially dangerous, particularly in patients with acute ischemic episodes, and cautioned that good renal function was a prerequisite for the test. Pool and associate@ from Denver, Colorado, described findings in 4 patients with unilateral absence of the right or left main pulinonary artery and summarized findings in 94 previously reported cases of this anomaly. Lev and associates7 from Chicago, Illinois, provided a detailed classification for congenital cardiovascular anomalies, including the number of their 1,081 hearts studied in each category. Neufeld and associates8described necropsy findings in a .&yea&old boy with supravalvular aortic stenosis resulting from uniform narrowing of the entire ascending and transverse aorta and associated with severe thickening of the walls of the epicardial coronary arteries, a finding the authors attributed to severe elevation of systolic pressure in the coronary arteries since the coronary ostia were proximal to the supravalvular obstruction. Levine and associates,gincluding the present AJC editor, described the occurrence of,acute aortic regurgitation secondary to blunt chest trauma and reviewed previous reports on this subject.
1. Levy M, Lillehei CW. Left ventricular-bight atrial canal. Ten cases treated sureicalh. Am 1 Cardiol 1962:10:623-633. 2. EoehG E, de’Paiva E, Nunes A, Tavares V. Angiocardiographic studies of valvular malformations in pulmonary stenosis. Relationihip to physiologic alterations. Am J Cardiol 1962;10:634-642. 3. Castellanos A, Mayer JW, Lemberg L. The electrbcardiogram and vectorcardiogram in Wolff-Parkinson-White syndrome associated with bundle branch block. Am J Cardiol 1962;20:657-666. 4. Hultgren HN. Venous pistol shot sounds. Am J Cardiol 1962;10:667-672. 5. Wasserburger RH, Corliss RJ. Value of oral potassium salts in differentiation of functional and organic T wave chdnges. Am J Cardioll962;10:673-687. 6. Pool PE, Vogel JHK, Blount SG Jr. Congenital unilateral absence of a pulmonary artery. The importance of flow in pulmonary hypertension. Am J Cardiol 1962;10:706-732. 7. Lev M, Paul MH, Miller RA. A classification of congenital heart disease based on the pathologic complex. Am [ Cardiol 1962;1&733-737. 8. Neufeld HN, Wagenvoort CA, Ongley PA, Edwards JE. Hypoplasia of ascending aorta. An unusual form of supravalvular aortic stenosis with special reference to IocaIized coronary cirterial hypertension. Am J Cardiol 1962;lO: 746-751. 9. Levine RJ, Roberts WC, Morrow AG. Traumatic aortic regurgitation. Am \ Cardiol 1962;10:752-763.
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he AJC in November 1962 contained 15 articles including 7 clinical studies, 2 experimental reports, 3 reviews, 1 historic study and 2 case reports. This piece will comment on 9 articles. Levy and Lilleheil from Minneapolis, Minnesota, in the lead article described clinical and operative findings in 10 patients aged 4 to 24 years [median 8) with left ventricular to right atria1 canal. Nine had systolic precordial thrills, and all 10 had harsh holosystolic murmurs, grade 3 to 5/6. Seven had complete or incomplete right bundle branch block. All had big hearts by radiogram, and in 7, the right atrium was clearly enlarged. Right atria1 pressures were increased in 5 patients. The pulmonary arterial systolic pressure was >60 mm Hg in only 2 patients. The pulmonary to systemic flow ratio ranged from 1.3 to 5.2:1. In only 3 patients was the preoperative diagnosis of the location of the shunt correct. At operation, the right atria1 wall was pulsatile and the cavity enlarged in all 10 patients. The defect was located in the membraneous part of the ventricular septum and ranged from 4 to 40 mm in diameter. In each patient, .the defect was closed by multiple interrupted mattress sutures. The youngest child (6 weeks] died the day after operation; a second died 3 years after operation. The other 8 patients were asymptomatic 6 to 42 months after operation. Coehlo and associates2 from Lisbon, Portugal, described angiographic features of valvular pulmonic stenosis with intact ventricular septum in 21 patients: (1) dome-shaped deformity in 12 patients; (2) diaphragm-shaped in 4, and (3) irregular deformity of cusps causing a winding trajectory of the contrast medium in 5 patients. The illustrations of the angiograms with injections into the right ventricle are superb. Castellanos and associates3 from Miami, Florida, described electrocardiographic findings in 5 patients with preexcitation (Wolff-Parkinson-White) syndrome associated with bundle branch block, right in 3 patients and left in 2. The authors demonstrated that the premature ventricular depolarization occurred in the cardiac ventricle with the intact bundle branch. Hultgren4 from Palo Alto, California, described systolic venous pulsations accompanied by a loud single sound in the neck and in the groin in 2 patients with severe tricuspid valve regurgitation. Pressure tracings disclosed that the sounds occurred at the moment of rapid rise in pressure in the underlying vein. In the groin, the sound lagged behind the onset of rise in femoral arterial pressure indicating that the sound arose in the vein and not in the artery. Hultgren termed the systolic sounds in tricuspid regurgitation
“venous pistol shot sounds” and showed how they could be differentiated from the more frequently encountered pistol shot sounds of arterial origin. Wasserburger and Corliss5 from Madison, Wisconsin, gave 179 patients with inverted T waves on electrocardiogram 5 g potassium citrate and 5 g potassium bicarbonate in 30 ml of water 90 minutes after the noon meal and recorded electrocardiograms 30, 60 and 90 minutes after the potassium ingestion. In the 60 patients with functionally inverted (anxiety-induced) T waves, the T waves reverted to normal in 90 minutes after ingestion of potassium. Inverted T waves of organic origin (myocardial infarction] in 119 patients, however, were unaltered by ingestion of the potassium solution. The authors regarded the potassium administration as potentially dangerous, particularly in patients with acute ischemic episodes, and cautioned that good renal function was a prerequisite for the test. Pool and associate@ from Denver, Colorado, described findings in 4 patients with unilateral absence of the right or left main pulinonary artery and summarized findings in 94 previously reported cases of this anomaly. Lev and associates7 from Chicago, Illinois, provided a detailed classification for congenital cardiovascular anomalies, including the number of their 1,081 hearts studied in each category. Neufeld and associates8described necropsy findings in a .&yea&old boy with supravalvular aortic stenosis resulting from uniform narrowing of the entire ascending and transverse aorta and associated with severe thickening of the walls of the epicardial coronary arteries, a finding the authors attributed to severe elevation of systolic pressure in the coronary arteries since the coronary ostia were proximal to the supravalvular obstruction. Levine and associates,gincluding the present AJC editor, described the occurrence of,acute aortic regurgitation secondary to blunt chest trauma and reviewed previous reports on this subject.
1. Levy M, Lillehei CW. Left ventricular-bight atrial canal. Ten cases treated sureicalh. Am 1 Cardiol 1962:10:623-633. 2. EoehG E, de’Paiva E, Nunes A, Tavares V. Angiocardiographic studies of valvular malformations in pulmonary stenosis. Relationihip to physiologic alterations. Am J Cardiol 1962;10:634-642. 3. Castellanos A, Mayer JW, Lemberg L. The electrbcardiogram and vectorcardiogram in Wolff-Parkinson-White syndrome associated with bundle branch block. Am J Cardiol 1962;20:657-666. 4. Hultgren HN. Venous pistol shot sounds. Am J Cardiol 1962;10:667-672. 5. Wasserburger RH, Corliss RJ. Value of oral potassium salts in differentiation of functional and organic T wave chdnges. Am J Cardioll962;10:673-687. 6. Pool PE, Vogel JHK, Blount SG Jr. Congenital unilateral absence of a pulmonary artery. The importance of flow in pulmonary hypertension. Am J Cardiol 1962;10:706-732. 7. Lev M, Paul MH, Miller RA. A classification of congenital heart disease based on the pathologic complex. Am [ Cardiol 1962;1&733-737. 8. Neufeld HN, Wagenvoort CA, Ongley PA, Edwards JE. Hypoplasia of ascending aorta. An unusual form of supravalvular aortic stenosis with special reference to IocaIized coronary cirterial hypertension. Am J Cardiol 1962;lO: 746-751. 9. Levine RJ, Roberts WC, Morrow AG. Traumatic aortic regurgitation. Am \ Cardiol 1962;10:752-763.
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