Citations

Of 141 patients with abdominal aortic aneurysms diagnosed at the Mayo Clinic from 1950 through 1959 who were not operated on, follow-up information was obtained from 137 patients (97.1 per cent). Of those followed 1 year or more, 87.6 per cent survived 1 year or more; 52.5 per cent survived 3 years, and 36.4 per cent survived 5 years after diagnosis. These results indicate that the prognosis of abdominal aortic aneurysm in this selected group of patients was somewhat better than that previously reported. The prognosis and survival of patients who had a history of associated cardiovascular disease at the time of diagnosis of aneurysm is distinctly less good than those of patients who had no such history. Of those with such a history, 75.0 per cent survived 1 year, 33.3 per cent survived 3 years, and 20.0 per cent survived 5 years. Of those without such a history 95.7 per cent survived 1 year, 63.2 per cent survived 3 years, and 50.0 per cent survived 5 years. Patients with abdominal aortic aneurysms and associated cardiovascular diseases are more likely to die of cardiovascular complications other than ruptured aneurysms. Patients with abdominal aortic aneurysms who have no evidence of associated cardiovascular disease are more likely to die from a ruptured aneurysm than from anything else. It would appear that small asymptomatic abdominal aortic aneurysms in patients with associated cardiovascular disease may be carefully observed until signs of expansion of the aneurysm or symptoms from the aneurysm appear.

Closed-chest massage and defibrillation were used successfully in the management of six acute cardiac emergencies occurring in a cardiac catheterization laboratory. A modification of the Kouwenhoven method of closed-chest massage was used in infants and small children. It is concluded that open-chest resuscitation is usually unnecessary during cardiac catheterization.

The records of 66 necropsied cases of periarteritis nodosa in which there was no associated collagen disease were reviewed with reference specifically to the heart. Clinically, congestive heart failure and its manifestations were the most important cardiac findings. Congestive heart failure developed some time during the illness in 57 per cent of the patients, and 44 per cent died as a direct result of this cardiac condition. Myocardial infarction was diagnosed clinically in only three cases. The electrocardiogram was abnormal in 35 of 41 cases but was diagnostic of left ventricular hypertrophy in only six cases and of acute myocardial infarction in only three cases; in the other cases the changes were of a nonspecific nature. Pathologically, 41 of the 66 hearts had evidence of necrotizing arteritis of the coronary arteries; in 39 of these the arteritis had been acute, and in two it had healed. Forty-one of the 66 hearts exhibited myocardial infarcts. Evidence of acute pericarditis was found in 22 hearts; nine of these cases were attributed to uremia, one was due to transmural myocardial infarction, three could not be classified, and the remaining nine were attributed directly to the periarteritis nodosa. Forty-one of the 64 hearts that had been weighed were hypertrophied.

The high rate of necropsy in deaths among permanent residents of Rochester, Minnesota, provided a unique opportunity to study the prevalence of coronary heart disease and the frequency and mode of death resulting from this disease. In this community of approximately 30,000 population, necropsy was done in 73 per cent of all resident deaths during the years 1947 through 1952. Included in this group were 691 necropsies that represented 67 per cent of the 1,026 deaths of persons 20 years of age or older. Coronary heart disease caused death in 221 patients (23 per cent of all necropsies and 32 per cent of all necropsies on adults). These 221 coronary deaths in adults represented 41 per cent of the men and 22 per cent of the women. The coronary deaths were attributed to acute coronary failure (sudden death) in 94 patients (43 per cent), acute myocardial infarction in 87 patients (39 per cent), congestive heart failure in 32 patients (14 per cent) and thromboembolism in eight patients (4 per cent). The 87 patients dying during acute myocardial infarction died of congestive heart failure (30 per cent), myocardial rupture (24 per cent), acute coronary failure (23 per cent), and thromboembolism (14 per cent), with the remaining 9 per cent dying of a combination of acute myocardial infarction and additional serious systemic disease. The greatest number of deaths from coronary heart disease occurred during the seventh decade of life in men and the eighth decade in women. At least one coronary artery exhibited from 25 to 100 per cent obstruction from atherosclerosis in 513 hearts (74 per cent of the adult necropsies). These necropsies, representing two thirds of all deaths in adults in this community, disclosed that significant coronary-artery disease was present in three of four adults and was the cause of death in four of 10 men and two of 10 women.

Open operation by means of extracorporeal circulation has been used on 47 patients with congenital aortic stenosis at the Mayo Clinic between April 1955 and July 1, 1960; 33 patients had valvular stenosis, 11 had subvalvular stenosis, and three had supravalvular stenosis. The over-all operative mortality rate was 13 per cent; 6 per cent of patients with valvular aortic stenosis died in the hospital. Severe aortic insufficiency did not develop in any patient operated on for valvular aortic stenosis although a diastolic murmur was present after operation in some. Rarely, however, was the transvalvular gradient completely eliminated by operation although 90 per cent of the surviving patients were either asymptomatic or had definite clinical improvement. Late follow-up hemodynamic studies suggest that a persistent transvalvular gradient may regress in time. Relief of obstruction caused by subvalvular variety of aortic stenosis is difficult whether stenosis is localized or diffuse. Even in this gruop, however, it has been possible to achieve good results with careful attention to certain technical details. Patients with congenital aortic stenosis should be operated on before the development of the sequelae of severe left ventricular hypertension.

A group of 26 patients who had peripheral occlusive arterial disease of the lower extremity were studied before and after chemical or surgical unilateral lumbar sympathectomy. The temperatures of the gastrocnemius muscle and of the skin of the sural area were determined simultaneously preoperatively and postoperatively. Only patients who had undergone successful unilateral lumbar sympathetic denervation based on the postoperative area of anhidrosis were included. The data were obtained under basal conditions among the 26 patients, and the persons studied were divided into two groups. Group 1 was composed of 17 patients (65 per cent) who had a definite parallel increase of 1.2 C. in the temperature of the gastrocnemius muscle and the skin after unilateral sympathectomy. In group 2 (nine patients or 35 per cent) the temperature of the gastrocnemius muscle and the skin of the sural area was unchanged after unilateral sympathectomy. Since none of these patients were suitable for surgical bypass arterial-grafting procedures and all were in the older age group, not too much could be expected from the standpoint of an increase in temperature. However, when the temperature of the skin after operation increased, the temperature of the gastrocnemius muscle also increased.

A study has been made at the Mayo Clinic of the results of treatment in 28 hypertensive patients receiving thiazide diuretics. The use of these agents produced a significant but very temporary reduction in plasma volume in most patients. The plasma volume reverted to or toward normal after the first week of treatment; therefore, hypovolemia could not explain the prolonged hypotensive effect of these drugs. Administration of thiazide diuretics did not deplete the body of its sodium stores, as measured by isotope studies in five patients on an unrestricted diet. Therapy with thiazides did not produce a persistent increase in urinary aldosterone excretion in the nine patients studied for this possibility.

Two cases presenting complications of popliteal aneurysm requiring amputation have been presented. Dissection of these limbs showed proximal popliteal aneurysms located immediately beyond the adductor magnus tendinous hiatus and, in addition, distal popliteal aneurysms immediately below the arcuate popliteal ligament. Another case is described in which bilateral popliteal aneurysms were located in the distal popliteal artery—that is, immediately below the arcuate popliteal ligament. These findings support the concept that post-stenotic dilation may be one of the causal factors in the pathogenesis not only of proximal but also of distal popliteal aneurysms.