Dryden P. Morse

Control of Recurrent Tachycardia of Wolff-Parkinson-White Syndrome by Surgical Ligature of the A-V Bundle

In a patient with WPW, type A, pharmacological therapy and radioactive iodine failed to control the disabling, life-threatening arrhythmia. Surgical ligation of the A-V bundle was undertaken in view of the rapidly deteriorating clinical course. Failure to identify A-V block after several sutures were placed in the A-V junction and subsequent activation of the ventricles in a heart with known A-V block demonstrates that the accessory A-V bundles may completely activate the ventricles. Complete elimination of the recurrent tachycardias after A-V ligation suggests that the normal A-V transmission system may be a crucial link in the circus pathway of WPW tachycardia.

Transtelephonic monitoring of 25,919 implanted pacemakers.

In order to evaluate the behavior of lithium‐powered cardiac pacemakers, a database 25,919 lithium‐powered pacing systems including 23,517 single and 2,402 dual chambered pacemaker generators were followed in 21,750 patients. Of this group, 11,319 were currently active in addition to 7,560 who died, as well as 2,871 patients who terminated their follow‐up service prior to the end‐of‐life of the pacemaker system. A total of 23,517 single chambered pacemakers were followed for 719,173 months of pacing. The mean time to explant for generator malfunctions was 42 months and for all pacing system malfunctions it was 38 months compared to 31.9 months and 28.6 months, respectively, for the 2,402 dual chambered units that were observed for 38,718 months. In the single chambered units, the most frequent reason for explant was battery exhaustion (37% of explants) followed by lead problems (26%) compared to 49% and 12%, respectively, for the dual chambered units. The incidence rates, defined as a transtelephonic test result, required physician decision for action or clarification of the pacing mode or program parameters and showed a high incidence rate immediately post‐implant; thereafter, there was a relatively trauble‐free period until the 36th month when capture, sensing, and battery problems began to occur at a steady rate reaching 4% at the end of 48 months. Similarly, for dual chambered units, an 8% incidence rate was seen within the first 3 months, followed by a quiescent period until the 28th month when the incidence rate jumped to 16%. An analysis of 28 series of pacemakers, manufactured by 10 different pacemaker companies in which projected longevity data was available, indicated that an average of only 63% of the projected longevity of the units was realized for single chambered pacemakers. It is concluded that the actual longevity of single chambered units is less than the projected one originally stated and the present data derived from cumulative survival of dual chambered pacemakers does not suggest a brighter outlook, but rather portends an even higher frequency of pacemaker incidence and failure rate.

Recurrent Wolff-Parkinson-White tachycardia in an infant: successful treatment by a radio-frequency pacemaker.

Abstract A 5 week old infant was successfully treated with use of a radio-frequency pacemaker to terminate recurrent Wolff-Parkinson-White tachycardia. In this instance temporary electronic pacing and later implantation of a permanent pacemaker was lifesaving. The mechanism for termination of Wolff-Parkinson-White tachycardia by pacemaker stimulation is reviewed. This method may have application in any type of recurrent tachycardia in infants as well as adults.

Guide to prosthetic cardiac valves

This book contains 10 chapters. Some of the chapter titles are: The development of artificial heart valves: Introduction and historical perspective; The radiology of prosthetic heart valves; The evaluation of patients for prosthetic valve implantation; Pathology of cardiac valve replacement; and Bioengineering of mechanical and biological heart valve substitutes.

The Bjork-Shiley Prosthesis: A Significant Advance in Aortic Valve Replacement

Abstract Replacement of the aortic valve with the new tilting-disc Bjork-Shiley prosthesis was performed in 133 patients during the period May, 1970, to September, 1971. Thirty-two of these had simultaneous implantation of a Beall mitral valve prosthesis. None of the 13 early deaths (9.8%) or 7 late deaths (5.2%) were attributable to malfunction of the prosthesis or embolic complications. Objective evidence of improvement was noted by cardiac catheterization and treadmill exercise tests following operation. Clinical improvement was found in 97% of the survivors during the three to nineteen months of follow-up.

The accomplishments of open heart surgery: The status of 35 patients 18 to 36 months following the operation∗☆

Abstract A review of our early experiences with 35 patients who had successful open heart surgery with the aid of the pump oxygenator, and who are now alive more than 18 months after surgery, is presented. Excellent grades of improvement persist in 34. These preliminaryresults have been encouraging, and have served as the impetus for the development of advanced techniques. The scope of the field of effective treatment, the facility and capability of the surgeon, and the safety of the patient have all shown constant improvement.

Postoperative left ventriculo-bronchial fistula.

From the Department of Thoracic-Cardiovascular Surgery Hahnemann Medical College Philadelphia, Pennsylvania. Reprint Requests: Modesto M. Peralta, Jr., M.D., 3070 Mayfield Road, Cleveland, Ohio 44118 Idiopathic hypertrophic subaortic stenosis is a rare congenital cardiac anomaly characterized by gross hypertrophy of the left ventricle and inter-ventricular septum, which encroaches upon the outflow tract of the aorta so that it becomes self obstructive. The disease is manifested by angina pectoris, effort syncope and congestive heart failure. The diagnosis is proven by withdrawal pressure recordings demonstrating a substantial systolic pressure gradient well below the aortic valve. Left heart angiocardiography will also show the subvalvular stenosis.

Comprehensive Evaluation of Cardiac Pacemakers.

Excerpt At present, permanent cardiac pacemakers are electively replaced after 18 months. Some generators have failed earlier, and thus far no foolproof system can predict impending failure. A new ...

A Nylon Cloth Oxygenator for Extracorporeal Circulation.

Summary Two experimental oxygenators employing nylon cloth for filming and oxygenating blood have been described. Preliminary tests show that this type of oxygenator has a high comparative efficiency.