Citations

The pulmonary vessels in 2 cases of cor triloculare with subaortic stenosis are compared. Each showed medial hypertrophy of the muscular arteries of the lungs. In 1 case concerning an 8 year old boy this class of vessels showed, in addition, severe intimal fibrosis. The arterioles were normal. It is emphasized that the changes in the pulmonary arteries are similar to those seen in the Eisenmenger complex, in coarctation of the aorta proximal to a patent ductus arteriosus and in the normal fetus. These conditions, though anatomically different from each other and from cor triloculare with subaortic stenosis, are functionally alike in that there is in each a common ventricular ejectile force for the pulmonary and the systemic circulations in the absence of stenosis in the major arterial pathways to the lungs. It is suggested that in cor triloculare biatriatum with subaortic stenosis, the structure of the pulmonary muscular arteries is, and that their function seems, similar to that of the fetus. The changes in the case of the malformation may be considered a carry-over from fetal life.

A clinicopathologic study of 51 cases of mitral stenosis with intracardiac mural thrombi is presented with particular reference to the locations of these thrombi and their relationship to the associated thromboembolic phenomena. In 27 cases the thrombi were present only in the left side of the heart, in 15 cases they were in both sides of the heart, and in 9 cases they were present only in the right atrium. Of 42 cases in which thrombi were located in the left side of the heart, in 20 the thrombi were limited to the left auricular appendage. In the remaining 22 cases in this group the thrombi in the left side of the heart were situated on the main atrial wall, in the auricular appendage and on the main atrial wall together, or in the left ventricle. Systemic arterial emboli occurred frequently regardless of the particular site in the left side of the heart at which the thrombus formed. Of 24 cases in which thrombi were situated in the right side of the heart, in 20 the thrombi were restricted to the right auricular appendage.

Two cases of mitral insufficiency are reported. In 1 case the lesion was produced by rupture of the chordae tendineae of the posterior leaflet of the mitral valve. In the other case it was produced by fibrous adhesion of the posterior leaflet of the mitral valve to the underlying left ventricular wall, which occurred during healing of subacute bacterial endocarditis. Changes occurred in the pulmonary vascular bed which are essentially identical with those found in mitral stenosis.

Congenital insufficiency of the pulmonary valve may result if the valvular cusps develop faultily or fail to develop. It is commonly associated with ventricular septal defect, with or without pulmonary stenosis. Under these conditions a continuous precordial murmur may be present. Less commonly, congenital pulmonary valvular insufficiency may appear as an isolated cardiac malformation.

The relative importance of organic changes and vasoconstrictive influences in the production of increased pulmonary vascular resistance in congenital heart disease is problematic. With use of a grading system previously described, a study was made of the relation between each of the grades of hypertensive pulmonary vascular disease associated with ventricular or atrial septal defects and the change of pulmonary artery blood pressure immediately following closure of the abnormal communications. The immediate reversibility of the pulmonary hypertension varies inversely with the severity of the structural changes.

With use of a previously described system of grading, a study was made of the relation between each of the grades of hypertensive pulmonary vascular disease and the hemodynamic findings in the lesser circulation in 15 cases of atrial septal defect, 19 cases of ventricular septal defect, and 6 cases of patent ductus arteriosus.

This series of papers constituted the second Symposium on Cardiovascular Sound conducted in association with the Scientific Sessions of the American Heart Association. The symposium took place on Friday, October 25, 1957, at the Hotel Sherman in Chicago. The chairman of the morning sessions was Dr. Hans H. Hecht of Salt Lake City; Dr. J. Willis Hurst of Atlanta was chairman for the afternoon sessions. The first symposium was published in Circulation 16 : 270, and 414, 1957. This publication was made possible by a grant-in-aid front the National Heart Institute, U.S. Public Health Service, and by contributions from Mr. Arthur L. Humphries, The Rena and Walter Burke Foundation, Lakeside Laboratories, Burroughs-Welcome Company, and the Wyeth Laboratories.

Among 24 cases of small subendocardial infarctions included in this report are 10 cases of anteroseptal distribution in which the electrocardiogram was characterized by the presence of deeply inverted T waves in some or all of the precordial leads. Two other types of change encountered among the remaining 14 cases are described. Electrocardiographic changes in this group of 24 cases are compared with changes encountered in 5 cases of large and near circumferential acute subendocardial infarction described in part I of this study.

The electrocardiographic consequences of subendocardial infarction will find their most evident and characteristic expression in the acute has of a large lesion. Five cases of this kind are presented here and the associated electrocardiographic changes are described. At what level in the myocardium between the endocardium and epicardium do the electrocardiographic expressions of subendocardial infarction give way to those of transmural infarction Data in 6 cases of large nontransmural infarction are presented for comparison with findings in the 5 cases of subendocardial infarction.