Connolly, Daniel C.

Hemodynamic progression of valvular aortic stenosis was studied in 54 patients who had serial cardiac catheterizations. There were 47 men and 7 women with a mean age of 61.2 years. The time interval between studies was 4.4 years (range, 0.4‐12.2). Associated coronary artery disease was present in 37 patients (69%). The initial mean aortic valve area (Hakki's formula) was 1.26 cm 2 (range, 0.66‐2.85), and the aortic valve area at last follow‐up was 0.77 cm 2 (range, 0.29‐1.95), with mean reduction of 0.49 cm 2 . The mean peak systolic gradient increased from 23.3 ± 15.1 mm Hg at initial study to 52.6 ± 27.5 mm Hg at last study, a mean increase of 29.3 ± 23.6 mm Hg. Patients with no or mild left ventricular impairment and no or mild coronary artery disease are more likely to have progression than patients with more severe left ventricular impairment or coronary artery disease (P < 0.05). Aortic valve replacement for progressive aortic stenosis was required at a later date after coronary artery bypass grafting in a small group of nine patients. In this small group, there was a high intraoperative mortality of 33%.

The incidence and prevalence of diabetes mellitus in residents of Rochester, Minnesota, for 25 years (1945 to 1970) were determined from available medical records. The over-all incidence rate for diabetes is 133 new cases per 100,000 population per year (age-adjusted to 1970 U.S. white population). The rate increased with age for both men and women and was higher among men over 30 years of age. The average annual incidence rates per five-year period for juvenile-onset diabetes mellitus were low and variable and showed little change. Polyuria, polydipsia, glycosuria, lean habitus, loss of weight, and high levels of fasting hyperglycemia at initial diagnosis occurred more frequently in younger than in older patients. The peak incidence in 1960 through 1964 and the decrease in the following five years may be a reflection of the introduction of the AutoAnalyzer method for blood glucose in 1958. The average annual incidence rates for 1955 through 1959 and 1965 through 1969 were essentially the same. The over-all prevalence for diabetes mellitus is 1.6 per cent, with a higher rate among men than among women over 40 years of age; among school children the rate is 0.1 per cent. Survivorship in the diabetic population is lower than that in the general population. The leading cause of death was coronary heart disease, the death rate from it being higher than for the general population.

In 12 patients with atrial septal defect or anomalous pulmonary venous connection, pulmonary vein wedge mean pressure uniformly exceeded mean pressure in the left atrium or pulmonary vein and with one exception was less than mean pressure in the pulmonary artery. There was a positive correlation between pulmonary arteriolar resistance and the difference in pressure between pulmonary artery and pulmonary vein wedge position. The oxygen saturation of blood, withdrawn from the pulmonary vein wedge position, uniformly exceeded that of left atrial and usually also that of pulmonary vein blood.

Persistent pericardial effusion in the absence of obvious preceding or concurrent disease presents a baffling problem. In such cases chylopericardium, cholesterol pericarditis, lupus erythematosus, malignant disease, myxedema, severe anemia, and scleroderma, must be considered. Six cases are reported with large effusions present for from 1 to 11 years. The diagnostic measures to be used, the results of histologic examination, and the effects of surgery on the clinical course are discussed.

Analysis of accumulated experience with the repair of atrial septal defect in 119 adults has revealed several factors determinable preoperatively that appear to have a strong influence on the operative risk. These factors are related to the presence of pulmonary vascular disease or heart failure and contribute importantly to the selection of patients for operation.

Obstruction to pulmonary blood flow may occur in the pulmonic valve, in the infundibulum or in both. Cardiac catheterization aids in the determination of the site of obstruction. Criteria for the differentiation at operation of valvular and infundibular pulmonic stenosis are enumerated, and the usefulness of accurate pressure tracings during operation is emphasized. The accurate identification of the site or sites of obstruction to pulmonary blood flow is essential to proper surgical management. A correctly selected operation must be carried out in as complete a manner as possible.