Claude S. Beck

The production of a collateral circulation to the heart

Abstract The heart was given a collateral vascular bed by operation. Almost total occlusion of both coronary arteries was effected with recovery when a collateral vascular bed was present. The significance of these experiments in the treatment of coronary occlusion is discussed.

Venous stasis in the coronary circulation

Abstract The purpose of this article is to record data concerning stasis in the venous circulation of the heart. Any addition to the methods of treating coronary artery disease should be investigated. The available medical methods by drugs and rest are indirect. Perhaps a direct operative method can be evolved which will improve the vascular bed in the heart. Ligation of a major vein and a major artery elsewhere in the circulatory tree has received considerable study. Both clinical and experimental observations support the conclusion that after a major artery to an extremity has been ligated the incidence of ischemic necrosis in the extremity is reduced by ligation also of the major vein. Surgeons accept this as a principle in surgery. According to Halsted, the idea originated with the Russian surgeon Von Oppel,1 in 1908. On the basis of clinical observations Sir George Makins3, 4 became an advocate of vein ligation with the artery. There are now considerable experimental data on this subject. Some of the experimental data are conflicting. In general, however, it appears that the incidence of necrosis is reduced by ligation of the vein with the artery. A brief resume of this experimental work is given.

Production of a Collateral Circulation to the Heart

The experiments recorded in this paper are to a large extent an outgrowth of work done previously. 1 , 2 It was our purpose to destroy the normal coronary circulation and in its place provide an adequate collateral circulatory bed. This study, begun in February, 1932, is based upon 103 dogs in which attempts were made to produce a collateral circulation to the heart. The problem of producing a new blood supply to the heart resolved itself into 2 components, (1) to provide a vascular bed from which blood vessels could grow directly into the myocardium, (2) to reduce the circulation in the myocardium, so that collateral circulation in the adhesions might develop. The operative procedure was one of almost constant evolution. Omitting the details of development the procedure used was as follows: Epicardiectomy∗ was done under ether anesthesia by abrasion and stripping with a special burr. The lining of the parietal pericardium was removed. Silver clips were placed around the major coronary arteries. The lumina of these vessels were reduced in stages at repeated operations over a period of 2 years in some of the animals. The collateral bed established through the pericardial adhesions was injected with a watery suspension of iron ferrocyanide (0.4%). The injection was carried out as follows: The venae cavae and azygos vein were ligated. The right auricle was incised. The aorta was clamped close to the heart and the aorta was incised between heart and clamp. This dissection prevented injection of the heart by way of the aortic coronary ostia and by way of the thebesian vessels. Dye was run into the right carotid artery under gravity pressure. The pressure in the arterial system, as determined from the left carotid artery, was between 100 and 120 mm. mercury.

Revascularization of the Heart A Study of Mortality and Infarcts following Multiple Coronary Artery Ligation

This report on revascularization of the heart is based on work done in this laboratory in the period from Sept. 1, 1949 to Sept. 1, 1951. A brief description of the operation is given. After the operation was done an attempt was made to shift the inflow from the coronary arteries to the graft from the aorta. An attempt was made to occlude all coronary arteries. Four hundred operations were done on 100 dogs. Data on mortality and infarcts are given in this paper.

The production of a collateral circulation to the heart: II. Pathological anatomical study ☆

Abstract On the assumption that thrombotic occlusion of a major coronary artery can be recognized clinically, it is probable that the diagnosis could have been made in life in eighty of these ninety-four patients. Only fourteen patients died as the direct result of the first major coronary occlusion. Of the eighty patients who survived the first occlusion, the question is whether or not they could have been protected against disastrous results from subsequent occlusions by the production of extracardiac coronary collateral circulation. In thirty-seven of these eighty cases, concomitant disease or continued cardiac incompetence rendered the operative risk unjustifiable. The remaining forty-three patients might have been benefited by the production of the additional collateral circulation. With the exception of seven patients, who died of other causes, all died of subsequent attacks of coronary thrombosis. This data, chiefly pathological, derived from this study of ninetyfour cases of major coronary arterial occlusion would indicate that there was a period after the first coronary occlusion in the lives of forty-three individuals when the production of extracardiac coronary collateral circulation might have been feasible and beneficial.

Effect of pentaerythritol tetranitrate, amyl nitrite and alcohol on arterial blood supply to ischemic myocardium

Abstract 1. 1. Treatment of localized myocardial ischemia depends upon addition of arterial blood by way of intercoronary arterial communicacations. 2. 2. Pentaerythritol tetranitrate adds 0.81 cc. per minute to the ischemic circumflex area of the dog heart. 3. 3. Amyl nitrite adds 0.98 cc. per minute to the ischemic circumflex area of the dog heart. 4. 4. Alcohol decreases intercoronary flow by 1.93 cc. per minute. 5. 5. Increased intercoronary flow resulting from drug action is temporary. 6. 6. Addition of 0.81 cc. per minute as produced by pentaerythritol tetranitrate did not reduce mortality or infarct size following test coronary artery ligation in a series of twentyone experiments.

Subdural hematoma hygroma, and hydroma in infants

Summary 1. The various diagnostic criteria for subdural hematoma, hygroma, and hydroma have been briefly reviewed. 2. The various theories of pathogenesis are drawn together into an inclusive review. 3. Twenty-two cases are analyzed from the standpoints of incidence, symptoms, signs, special studies, operative findings, pathology, and results. 4. The diagnostic criteria for chronic subdural hematoma, hygroma, and hydroma have been defined in a mutually exlusive manner. Their diagnostic procedures and individual treatment are mentioned. 5. The significance of birth injuries, neonatal “silent period”, and duration of nonspecific symptoms is emphasized. 6. A definitive surgical treatment for subdural hygroma is described. 7. The relative frequency of hygroma and hydroma is mentioned. 8. The importance of evaluating concurrent intrinsic brain damage prior to operation is emphasized.

LEFT HEART BYPASS IN CARDIAC RESUSCITATION.

Abstract 1. 1. In the presence of ventricular fibrillation, left heart bypass increases systolic and diastolic blood pressures by 20 to 100 mm. Hg and thus augments the blood supply to anoxic tissues. 2. 2. After coronary artery ligation, bypass delays the onset of ventricular fibrillation. 3. 3. Defibrillation is facilitated under conditions of left heart bypass. 4. 4. This evidence supports the use of left heart bypass as an aid in resuscitation from cardiac arrest.

Intercoronary arterial channels produced by chemical agents

V ASCULAR communications between coronaq arteries protect the heart when stenosis or occlusion of these arteries takes place. These channels “ration” the available blood and deliver it to ischemic muscle where it is needed most. Theyhave significant protective value. The Beck operation was designed to produce such intercoronary channels.lP4 One of the methods to produce them consisted of abrasion of the surface of the heart. In some instances abrasion cannot be done because the heart is too irritable. In such cases a substitute method, such as the use of a chemical agent, is desirable. Experiments with \.arious chemical agents arc reported here.

Cerebral birth injury in retrospect

Summary As surgical and medical procedures come under evaluation in therapy of children with mental retardation, convulsive disorders, cerebral spasticity, and behavior problems, the selection of patients for various types of treatment may depend on the etiology of the childs condition. Thus in selecting patients for carotid jugular anastomosis, less benefit should be expected on theoretical grounds for children with congenital cerebral defects or developmental abnormalities of their brains than in those children entirely normal up to the time of cerebral injury either from trauma, anoxia, or infection. Hence, the necessity of better means of determining causative factors in cerebral disturbances. We have reviewed a series of cases, seeking to determine the incidence of birth injuries as a cause of late cerebral disorders. The evidence suggests that birth injuries may be a major factor in their causation. Studied in retrospect, the evidence does not distinguish between cerebral birth injuries due to anoxia and those due to direct trauma. Cortical atrophy revealed in pneumoencephalograms is accepted as presumptive evidence that the brain was injured following complete formation. This finding, together with changes attributable to organic disease in the electroencephalographic tracings, was present in almost all patients with a known history of birth injury and in an unsuspectedly large number of other children in whom the history was obscure. Decreased cerebral blood flow was present in those cases studied in whom gliosis might have followed cerebral injury, but was absent in children with a known developmental defect as exemplified by mongolism. Behavior disorders in children without retardation, spasticity, or convulsions appear to be possible sequelae of milder degrees of cerebral injury at birth. The data suggest that at least one out of five of birth injuries may have been due to preventable causes.