Citations

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.

Seven cases of patent ductus arteriosus with pulmonary hypertension and reversal of the usual direction of flow are described. Breathing of a low oxygen mixture either initiated or increased the reversed shunt, and breathing 100 per cent oxygen produced the reverse effect. Differences in oxygen saturation and dye-dilution curves recorded simultaneously from the radial and femoral arteries have allowed calculation of differences in the proportion of shunted blood flowing in these arteries and demonstrate that retrograde movement of blood in the aortic arch may occur.

Use of cuvette and earpiece oximeters facilitates the recording of the immediate dilution pattern of the dye T-1824 (Evans blue) in the arterial blood. In patients with venoarterial shunts the pattern of the dilution curves differs from normal. Quantitative analysis of such curves from patients with cyanotic congenital heart disease has been undertaken to establish the proportion of blood which bypassed the pulmonary circulation. The results obtained have been compared with estimates of the volume of the shunt from cardiac catheterization data and related to the arterial oxygen saturation.

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.

The electrocardiographic findings were analyzed in 15 patients found at the time of necropsy to have deposits of amyloid in the heart. Although 12 of the 15 tracings were regarded as abnormal, changes which could be held to be specific to cardiac amyloidosis have not been defined. The most common alterations encountered were auricular fibrillation, QRS complexes and T waves of low amplitude in the standard limb leads, and impaired auriculoventricular conduction.

This study was undertaken to ascertain whether coarctation of the aorta produces permanent hemodynamic abnormalities that may persist despite resection and end-to-end anastomosis. The results of studies in 10 patients 4 to 7 years after operation are compared to those obtained before and immediately after operation. The most significant finding was continued decrease in residual coarctation, in addition to dramatic immediate postoperative improvement in the degree of circulatory impairment.

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.