Citations

While there are many anatomic varieties of congenital malformations of the heart and great vessels, most may be divided, from a functional point of view, into 3 types: (1) communication between the ventricles or between the aorta and pulmonary arteries, (2) anomalous drainage of pulmonary venous blood into the right atrium, and (3) obstruction to pulmonary venous flow. In each of these categories the responses of the pulmonary vascular tree have to be considered in understanding the altered dynamics. Depending on the type and degree of response in the pulmonary vascular bed, there may be a varying functional picture among patients having the same anatomic or functionally comparable malformation.

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.

This conference has been concerned with a case of primary systemic amyloidosis in which death occurred in the course of severe, congestive heart failure. Major emphasis has been attached to the diagnostic problems which were posed by a patient so afflicted. If comments regarding treatment have been of limited extent, so have been the results of treatment when applied.

The degree of coronary atherosclerosis in 49 hearts obtained from bilaterally oophorectomized women was compared with the degree of sclerosis in 600 hearts from women and in 600 hearts from men of comparable ages. On the average the degree of coronary sclerosis in the bilaterally oophorectomized women was greater than in control women but less than in control men.

This reappraisal of the electrocardiographic manifestations of infarction of the lateral wall of the left ventricle is based on data acquired by simple and conventional technics. Categories of cases have been determined by the age of the infarct and the distribution of the lesion with respect to the circumference of the left ventricular wall and its epicardial and endocardial boundaries. Significant data have been presented in the form of illustrative diagrams and reproductions. The results do not establish a simple pattern common to all cases of infarction of the lateral wall; they do illustrate the varied yet limited electrocardiographic consequences of such lesions.

Knowledge of the structural changes in the commissures, cusps, and chordae tendineae is important to the understanding of the pathologic physiology of mitral stenosis and its surgical correction. Study of 70 hearts with mitral stenosis disclosed that a frequent cause of the obstruction was commissural fusion or shortening of the chordae tendineae or both. In a small percentage of hearts, mitral stenosis appeared to result principally from rigidity of the valvular leaflets. Measurements of the various components of the mitral valve in normal hearts have been given in a previous paper. In this communication, comparable measurements for these structures in 50 hearts with mitral stenosis are presented.

In a necropsy study of 50 cases of ventricular septal defects, the anatomic position and relations of ventricular septal defects, the causes of and ages at death, and association of ventricular septal defects with other cardiovascular malformations were determined. The present availability of surgical closure of ventricular septal defects makes this information of practical significance.

Albuminuria may be an integral part of the picture of congestive heart failure. Of 161 patients in whom the histologic renal findings were considered to be either normal or to be of such a nature as not to be responsible in themselves for albuminuria, and in whom clinically obvious causes for albuminuria had been eliminated, 141, or 88 per cent, had albuminuria. The incidence of albuminuria was about equal among the various types of heart disease when heart failure existed. A trend existed for the grade of albuminuria to parallel the grade of heart failure. Based on a study of 21 patients, there seemed to be a correlation between the grade of albuminuria and the group of hypertension, according to funduscopic examination. No correlation was found between the grade of albuminuria on one hand and the systolic or diastolic values for blood pressure, the known duration of elevated blood pressure, the grades of hematuria or the values for blood urea on the other hand. Among the 161 patients with heart failure in our group 1 (kidneys either normal or containing lesions not judged to be causes for albuminuria), there was no predominant renal lesion associated with any one cardiac lesion.

Administration of a moderately large or large dose of cortisone to dogs having acute myocardial infarctions inhibited slightly the rate of removal of necrotic muscle fibers in these animals as compared with untreated animals. Delay was appreciable at four and six days after production of the infarct in animals receiving 2.5 mg. of cortisone per kilogram of body weight and at 4, 6, 12 and 21 days in animals receiving 10 mg. per kilogram. At all other periods up to essentially complete healing of the infarcts as defined at 60 days, no appreciable differences existed between treated and untreated animals.