Citations

The possibility of sympathetic vasoconstrictor control of blood flow to active muscles was studied in dogs during graded exercise by comparing the blood flow in the normal with that in the Sympathectomized hind limb. Blood flow was measured by electromagnetic flow transducers around each external iliac artery, or inferred from the oxygen saturation of blood samples from the common iliac veins. The dogs either ran for successive periods of 3 minutes at 5.5 km/hr and grades of 0, 7, 14, 21, and 28% or ran each level of exercise separately. Unilateral lumbar sympathectomy (L-2 through L-7) was performed when the flow transducers were implanted or later by a snare technique. The latter allowed observations during exercise as early as 4 hours after sympathectomy. The magnitude of limb blood flow during exercise and the decline of exercise hyperemia were similar in the normal and the sympathectomized limb, as were the changes in the oxygen saturation of limb venous blood. However, electric stimulation of the lumbar sympathetic chain at the L-5 level in the conscious dog by a chronically implanted electrode reduced limb blood flow at all levels of exercise, the maximal flow of 1,000 ml/min was almost halved.

In anesthetized dogs, the vasoconstrictor nerves to the vessels of the hind limb left the spinal cord in the anterior spinal nerve roots from T-10 through L-4 levels. Maximal vasoconstrictor responses occurred on stimulation of the T-12, T-13, and L-l roots; none occurred on stimulation of roots caudal to L-4. The nerves first entered the lumbar paravertebral chain at or above L-1; the last point of entry was at the L-4, L-5 level. No fibers left the lumbar chain at L-1, L-2, and L-3 levels. The first point of exit was at L-4, and nerves continued to leave as far distal as S-1, The most caudal point examined. The maximal response to stimulation of the lumbar chain was at the L-4, L-5 level. With a single exception, the responses to electric stimulation of the anterior spinal nerve roots, lumbar chain, or sympathetic ganglia were confined to the vessels of the ipsilateral limb. In 22 dogs with unilateral sympathectomy (L-2 through L-7), changes in hind-limb vascular resistance were induced reflexly or by electric stimulation of the anterior spinal roots. The results indicated that sympathetic control of the resistance vessels of the hind limb was still absent 77 days after sympathectomy.

It has been suggested that the pressor effect of hypertonic solutions of sodium chloride on the Pulmonary circulation results from spasm of the pulmonary veins at their junction with the left atrium. These studies demonstrate that the increased resistance in the pulmonary vessels develops upstream to this site and that it may result primarily from mechanical blockage of vessels by clumped erythrocytes rather than from vasoconstriction.

Application of hemodialysis to dogs has been complicated by an acute reaction consisting of hypotension, bradycardia and respiratory depression followed by instability and a mortality rate of about 30 per cent. This reaction appears to be a response to homologous blood used to fill the dialyzers. Sensitization occurs in survivors, and accentuated reactions with marked hemolysis are noted on subsequent challenge. Cross matching the donor and recipient bloods has not permitted an adequate determination of compatibility under the conditions of hemodialysis. Satisfactory hemodialysis may be accomplished in dogs by using autogenous blood or blood substitutes to fill the dialyzers.

Preferential right-to-left shunting of inferior vena caval blood and left-to-right shunting of right-lung blood has been demonstrated to occur in experimental atrial septal defects in dogs as in the congenital defects in human beings. Existence of these preferential shunts proves that uniform mixing of blood does not occur in either atrium.

The possibility of measuring pulmonary blood flow in patients with central arteriovenous shunts utilizing the initial portion of indicator-dilution curves was explored in 16 patients by comparing these values for pulmonary blood flow with determinations by the direct Fick method. A good correlation between Fick and indicator-dilution values was obtained, and no systematic differences were demonstrated. The standard deviation of the differences between Fick and dye values was in the order of 20 to 25 per cent.

Central (aortic or subclavian), brachial, radial and femoral pressure pulses were recorded simultaneously in 12 healthy subjects during conditions of rest, exercise and 70 degree head-up tilt. Peripheral systolic pressure at rest uniformly exceeded the central systolic pressure generated by the same heartbeat. The average radial pulse pressure was 146, 146 and 165 per cent of central pulse pressure during rest, exercise and tilt while radial mean pressures were 94, 93 and 98 per cent of central mean pressures respectively. Summation of the incident pulse wave with reflected waves from the periphery and resonance effects in the peripheral arterial systems may produce these changes in pressure and contour.

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.

Relationships between artefacts in recorded intracardiac pulses and the dynamic response and susceptibility of catheter-manometer systems to artefacts caused by motion of the catheter were investigated. Sine-wave motions of the catheter, resembling motion frequently seen when the catheter is in the pulmonary artery, produce sine-wave pressure variations with peak-to-peak amplitudes of 10 mm. Hg. Square-wave motions (impacts) produce high-frequency pressure variations, greatest (10 to 200 mm. Hg) when directed along the axis and much less when perpendicular to the axis of the catheter. High-fidelity records of pressure by conventional cardiac catheter-manometer systems are most unlikely when such catheters are threaded through the beating heart.

Background —Left ventricular ejection fraction (LVEF) is a recognized determinant of survival in patients with coronary artery disease. In major trials comparing surgical and percutaneous revascularization approaches, the long-term effect of the coronary revascularization strategy on LVEF has not been reported. Methods and Results —In the NHLBI-sponsored Bypass and Angioplasty Revascularization Investigation (BARI) randomized trial comparing angioplasty and bypass surgery as initial treatment strategies, 1220 (75%) of the 1617 surviving randomized patients had their EF measured by radionuclide ventriculography 5 years after study entry. For the total study group, the 5-year EF in the CABG group (n=623) was 55.8±12.3, compared with 55.7±12.7 in PTCA group (n=597, P =0.82). There was no significant difference in measured EF between the CABG group and the PTCA group within multiple subgroups determined by the presence or absence of diabetes, 3-vessel disease, complete revascularization, or prior myocardial infarction. In a multiple linear regression model developed to predict 5-year EF, treatment assignment to PTCA or CABG was not significant ( P =0.95). If an EF of 0 was imputed for patients who were dead and missing EF data, however, there was a higher EF in the CABG group ( P =0.0018) among diabetic patients only. Conclusions —In the BARI randomized trial, initial treatment assignment to angioplasty was not associated with any difference in long-term ventricular function compared with initial treatment assignment to surgery. These results apply, however, only to patients who were alive at 5 years.