Alvin J. Gordon

The Hemodynamics of the Left Side of the Heart as Studied by Simultaneous Left Atrial, Left Ventricular, and Aortic Pressures; Particular Reference to Mitral Stenosis

At operation the hemodynamics of the left side of the heart were studied in six patients without mitral stenosis, and in eight patients with mitral stenosis, by means of simultaneous needle puncture of the left atrium, left ventricle, and aorta. This technic permits analysis of the various phases of the cardiac cycle in normal subjects and in patients with mitral stenosis. The fundamental hemodynamic expression of mitral stenosis is the presence of an elevated left atrioventricular filling pressure sure gradient, which ranged from 4 to 20 mm. Hg, and after valvulotomy fell in relation to the adequacy of the procedure.

Radiofrequency-controlled catheter pacemaker. Clinical application.

THE transvenous endocardial electrode catheter1 and the radiofrequency induction assembly2 have been used for cardiac pacing with success over the past seven years. The catheter electrode has prove...

Patent Ductus Arteriosus with Reversal of Flow

SHOULD closure of a patent ductus arteriosus with reversal of flow be attempted? If so, how can the high surgical mortality hitherto reported1 2 3 be reduced? An attempt is made to answer these questions on the basis of a case of this syndrome in which records were available from the age of ten years to death during operation at the age of twenty-five. Case Report In 1938 a 10-year-old girl came under the observation of Dr. Ernst Boas. We are indebted to him for the findings presented below. At the age of six months an enlarged heart had been found on .xa0.xa0.

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.

Left Ventricular Angiocardiography in the Study of Ventricular Septal Defects

Ventricular septal defect is reported to be the most common congenital cardiac anomaly (1). In many cases, the presence of such a defect can be recognized on the basis of clinical findings alone. The clinical and hemodynamic changes produced by septal defects vary considerably, however, depending upon their size and location. Moreover, the diagnosis may be obscured by the presence of associated cardiac malformations. Experience with 65 cases has demonstrated that left ventricular angiocardiography is a valuable adjunct in the study of ventricular septal defects both as an aid to diagnosis and in planning treatment. Ventricular defects with left-to-right shunts in excess of 25 per cent of the systemic blood flow are readily apparent from oxygen studies obtained during right heart catheterization. Smaller shunts require more sensitive technics for their detection, such as dye dilution (2), hydrogen (3), and isotope (4) studies. With left-sided angiocardiography, both small and large defects can be consisten...

Simultaneous Pressure Pulses in the Human Left Atrium, Ventricle and Aorta Preliminary Communication

Pressure pulses from the human heart have been recorded at operation by simultaneous needle puncture of the left atrium, left ventricle and aorta. Superimposed tracings on equal ordinate scales were obtained, thus simplifying the analysis of hemodynamic events. Preliminary observations are presented from cardiologically normal controls and patients with mitral stenosis before and after commissurotomy.

Visualization of the coronary circulation during angiocardiography.

Abstract The coronary arteries and the coronary sinus may occasionally be identified in the films taken during routine angiocardiography in man. The arteries are seen mainly in children, in whom the aorta and its branches are usually more clearly outlined. In adults, the coronary sinus is sometimes filled in retrograde fashion from the right auricle.

Aorticopulmonary septal defect: Diagnosis and report of case successfully treated∗

Abstract Aorticopulmonary septal defect is a rare congenital anomaly which is difficult to diagnose. The prognosis is poor if treatment is not instituted and, therefore, surgery should not be delayed but should be performed as soon as is feasible. Transection with or without the aid of hypothermia or pump oxygenator is the treatment of choice. A successful case is presented.

Tricuspid stenosis: Report of a case, with hemodynamic studies at tricuspid commissurotomy

Abstract A case of uncomplicated tricuspid stenosis, probably rheumatic in origin, is described. The case afforded a rare opportunity to study the clinical and hemodynamic effects of pure tricuspid stenosis. The diagnosis was suggested by signs and symptoms of right atrial hypertrophy, as well as by a presystolic murmur heard over a wide area. The cardiac catheter failed to enter the right ventricle but a giant A wave was present in the right atrial pressure pulse. Hemodynamic studies on the operating table before valvulotomy disclosed a mean atrioventricular filling pressure gradient of 6 mm. Hg. After valvulotomy the gradient fell to 1 mm. Hg. Comparison with similar data obtained in patients with mitral stenosis disclosed considerably higher preoperative gradients.

Left atrial pulmonary capillary, and oesophageal balloon pressure tracings in mitral valve disease.

In selecting patients for mitral valvotomy, the exclusion of mitral insufficiency by common clinical methods has proven unreliable. We endeavoured to determine whether preoperative pulmonary capillary pressures and tracings taken by means of a balloon in the aesophagus at the left atrial level would be of value in the diagnosis of mitral insufficiency. Pressure pulses were also obtained directly from the left atrium at operation; their characteristics in mitral stenosis and mitral insufficiency were studied, and they were correlated with the P.C. and oesophageal balloon tracings, since the latter two are of value only in so far as they reflect hemodynamic events within the left atrium. To accomplish these aims, we set out to obtain all three types of tracing in each of a series of 30 patients who were operated upon for the relief of mitral stenosis. We relied upon the surgeons finger to detect insufficiency. Both the size of the mitral orifice and the presence of a regurgitant jet were taken into consideration (Wynn et al., 1952). These criteria may be inadequate but must serve until better ones are devised.