Aaron Himmelstein

Pure congenital pulmonary stenosis and idiopathic congenital dilatation of the pulmonary artery

Abstract 1.1. Sixty-eight cases of pure congenital pulmonary stenosis without abnormal shunts, the diagnosis established at autopsy, have been collected from the literature and the chief clinical and anatomic features are described. 2.2. Eight cases of pure congenital dilatation of the pulmonary artery have been selected from the literature of the last thirty years as being unequivocal examples of that lesion and a summary of the clinical and anatomic features is given. 3.3. Four additional examples of each of these lesions are reported. 4.4. Hemodynamic studies of these eight patients demonstrate the absence of abnormal shunts and the presence of a differential between the systolic pressure in the pulmonary artery and that in the right ventricle. 5.5. A division of these patients into two groups on the basis of the pressure in the right ventricle and the intensity of the pulmonic second sound is proposed. ∗

BLOOD FLOW THROUGH EACH LUNG IN MAN DURING UNILATERAL HYPOXIA

It is well established that pulmonary hypertension may be elicited in man by reducing the oxygen content of the inspired air. The mechanisms involved in this response to acute hypoxia, and the role of the individual segments of the pulmonary vascular tree in effecting this rise in pulmonary arterial pressure, are currently under investigation. In order to further analyze this phenomenon, a method has been developed for the separate measurement of blood flow through each lung in man. This method consists of a combination of (a) bronchospirometry, with each lung breathing a specifically selected oxygen mixture, (b) cardiac catheterization, and (c) arterial cannulation; this makes possible the application of the Fick principle, not only for the measurement of total blood flow, but also of blood flow through each lung. Previous attempts to partition pulmonary blood flow in man have been indirect, and have involved many assumptions (1). It is the purpose of this paper to 1) describe a method based on more direct data, and 2) present the results of studies concerning the effects of unilateral hypoxia upon the pulmonary circulation in man.

Circulatory Effects of Mitral Commissurotomy with Particular Reference to Selection of Patients for Surgery

Of 60 patients with mitral stenosis referred as proper candidates for commissurotomy, less than half (27) proved suitable after further study. One half of these (13) had a good postoperative result as judged not only clinically but by objective physiologic measurements. The latter represent the best criteria for the effects of surgery since subjective impressions may be unreliable. Eight subjects originally advised to undergo surgery would now be rejected inasmuch as myocardial insufficiency and not mitral block was their predominant difficulty. Clinical criteria appear as yet inadequate for the selection of the proper candidate for mitral commissurotomy, as there is no good clinical means of establishing in every instance the presence of pulmonary hypertension which remains the best evidence of a significant degree of mitral block.

The use of simultaneous left heart pressure pulse measurements in evaluating the effects of mitral valve surgery

Abstract 1.1. The need for an objective method of measuring the adequacy of mitral valvulotomy by estimating the extent of residual mitral stenosis is emphasized. 2.2. Measurement of the mitral valve filling pressure gradient appears to be the best method of determining the degree of hemodynamically significant mitral stenosis. A method for recording the pressure gradient between the left auricle and the left ventricle at the operating table, by inscribing simultaneous pressure pulses in the left heart, is described. 3.3. The normal filling pressure gradient across the mitral valve approximates zero. The effect of valvulotomy on the elevated pressure gradient in mitral stenosis is to produce a fall of variable degree, depending on the adequacy of the surgical procedure. When this pressure gradient remains high after valvulotomy, relief of the obstruction can be termed inadequate. 4.4. The method is also of value in the differential diagnosis of mitral stenosis, in aiding the surgeon at the operating table to decide whether sufficient manipulation of the valve has been carried out and in determining whether recurrence of obstruction has taken place in patients previously operated upon for mitral stenosis.

Cardiopulmonary function studies in a patient with ligation of the left pulmonary artery

Abstract A case is reported in which cardiopulmonary function studies were performed on a patient two years after the left pulmonary artery was ligated. Cardiac catheterization revealed normal pressures in the pulmonary artery as well as in the chambers of the right side of the heart. The results of pulmonary function tests were almost completely within normal limits. The only abnormalities found were a slight increase in cardiac index and hyperventilation under all conditions of observation. However, bronchospirometry disclosed a marked Table III Results of Cardiocirculatory Studies NormalObservedPressures in mm. of mercuryPulmonary artery, systolic 2 )3.05 + 0.64.23 limitation of gas exchange in the left lung, with carbon dioxide output limited to a lesser degree than oxygen consumption. These findings are consistent with the assumption that anastomoses from the bronchial artery result in a considerable blood flow through the pulmonary capillary bed of the left lung.

Latent period between electrical and pressure pulse waves corresponding to right auricular systole.

Summary In 8 adult subjects with essentially normal hearts the latent period between the beginning of the electrical P wave and pressure pulse wave corresponding to the right auricular systole averaged 0.11 sec. 2. In one case of a child with a rapid pulse and Tetralogy of Fallot the latent period was much shorter, 0.055 sec. 3. In one case of scleroderma with pulmonary hypertension and partial heart block the latent period was prolonged to 0.17 sec.

A special care unit for the postoperative open cardiotomy patient

Abstract Skillful postoperative management, especially during the critical first twenty-four to thirty-six hours, is essential to the success of open cardiotomy for the surgical correction of cardiac defects. The organization and use of a Special Care Unit for the postoperative open heart patient are described. The problems of immediate postoperative care, such as optimal respiratory function, cardiovasular stability, maintenance of normal body temperature, electrolyte balance and the treatment of any complications arising as the result of operation or perfusion, are discussed. The use of precise monitoring instruments in specific ways to guide the physician in the diagnosis and treatment of the postoperative cardiac patient is presented.

Intravascular and intracardiac pressure recording in man; electrical apparatus compared with the Hamilton manometer.

Summary 1. The Clark Capsule, an electrical pressure pickup device, has been found satisfactory for recording blood pressures from the right heart, pulmonary artery, systemic arteries, pleural and mask pressures in man, when used with a suitable amplification and recording device. 2. The tracings recorded with this apparatus compare closely with those obtained simultaneously with a Hamilton manometer system.