Edward F. Bland

Rheumatic Fever and Rheumatic Heart Disease A Twenty Year Report on 1000 Patients Followed Since Childhood

Herewith is presented an interim report on a long-term study of 1000 patients followed since their childhood rheumatism. The dominant role of rheumatic recurrences and the fatal features are reviewed. The benign nature of uncomplicated chorea is stressed, the disappearance of physical signs of heart disease in some patients is contrasted with the delayed and even remote appearance of valvular deformity in others, and finally, the favorable course to date in the majority of cases is emphasized.

Congenital anomalies of the coronary arteries: Report of an unusual case associated with cardiac hypertrophy

Abstract An instance is recorded, in a male infant dying at the age of three months, of an abnormal origin of the left coronary artery from the pulmonary artery, associated with marked enlargement of the heart (due to hypertrophy and dilatation of the left ventricle), together with extensive degenerative changes in the ventricular wall supplied by the malposed vessel. In view of these findings, it is probable that the paroxysmal attacks of acute discomfort precipitated by exertion and associated with profound vasomotor collapse occurring in this infant were those of angina pectoris. The electrocardiographic picture in our case was similar to that seen in adults with important coronary disease. In the few recorded cases (8 in number in addition to our own) of this rare anomaly a characteristic pathological picture has resulted. Death within the first year has been the rule. Two of the cases have been exceptional. A review of congenital variations in the coronary vessels and a discussion of their embryological background are included. A bibliography is appended.

Systemic arterial embolism in rheumatic heart disease

Abstract Rheumatic heart disease is an important cause of systemic arterial embolism. In 1933, Weiss and Davis 76 published a report on embolic episodes in rheumatic heart disease, using autopsy material as their source of study. Harris and Levine 25 , in 1941, reported on a series of cerebral emboli complicating rheumatic heart disease. In 1950, Bourne 6 published a report on the relationship of exertion to embolism in mitral stenosis. Recent publications (Warren and Linton 75 , Haimovici 23 , and Andrus 3 ) on the general subject and the treatment of arterial embolism emphasized further the importance of rheumatic heart disease as an etiological factor. The considerable progress in the past few years with anticoagulant agents as a protection against embolism and the recent surgical obliteration of the left atrial appendage as a possible focus of thrombus formation in rheumatic heart disease were responsible for the present study. It was undertaken primarily to elucidate the factors favoring intracardiac thrombosis, to ascertain the relative frequency of the atrial appendage as the offending site, and to appraise the results of therapy. The records of 194 patients, including the autopsy findings in thirty-nine patients, were obtained from the Massachusetts General Hospital, the House of the Good Samaritan, and the private practice of two of the authors (E. F. B. and P. D. W.). The period covered was from 1923 to 1950. Patients suffering from bacterial endocarditis have been excluded.

The course of mitral stenosis without surgery: ten- and twenty-year perspectives.

Excerpt A decade has elapsed since the introduction of a successful operation for mitral stenosis, and survival curves for this 10-year period are now available. Surprisingly little factual informa...

Acute nonspecific pericarditis; clinical, laboratory, and follow-up considerations.

Acute nonspecific pericarditis has been recognized with increasing frequency in recent years although there is reason to believe that it was considered distinct from rheumatic pericarditis almost 100 years ago. The authors have been able to secure follow-up information on 50 cases seen between 1930 and 1949. A few have shown persistent electrocardiographic changes, and calcification of the pericardium occurred in 1 case. In general the prognosis appears excellent and we have not observed constrictive pericarditis as a sequela.

Myocardial rupture and hemopericardium associated with anticoagulant therapy; a post-mortem study.

A DISTURBING feature of the occasional case of fatal hemopericardium following anticoagulant therapy for myocardial infarction is the absence of an obvious explanation for the hemorrhage. Heretofor...

A note on coronary occlusion and myocardial infarction found post mortem at the Massachusetts General Hospital during the 20-year period from 1926 to 1945 inclusive.

Excerpt Heart disease as a cause of death in this country today far exceeds all other causes. Coronary heart disease is one of the three most common types of cardiac involvement. Since this is so a...

Declining severity of rheumatic fever. A comparative study of the past four decades.

THE present report concerns the nature and extent of the decline in severity of rheumatic fever in recent years and certain factors that may have been in part responsible. It is based upon the long...

Surgery for Mitral Stenosis A Review of Progress

The renewed interest in surgery for mitral stenosis is reviewed and the progress of the past five years summarized. The present status of the indirect operation (pulmonary-azygos shunt) is discussed, and the notable advances with the direct attack (finger-fracture valvuloplasty and commissurotomy) have been brought up to date (May 1951) by means of a survey of selected centers here and abroad. Detailed information is available on 352 patients who have had an operation on the mitral valve. It is quite likely that the total now approaches 500 cases. The over-all operative mortality has been 15 per cent. Post-operative embolism occurred in 6 per cent. Clinical improvement in the majority has been prompt and striking, and this has been fully supported by catheterization data. An appraisal of the more remote effects must await the passage of time. Those most likely to benefit are patients under the age of 50 with only slight to moderate cardiac enlargement who are nevertheless seriously limited by pulmonary hypertension and congestion. A formidable procedure of this magnitude should be reserved for those in trouble; it has no place in the management of patients with little or no disability.

THE NATURAL HISTORY OF RHEUMATIC FEVER: A 20 YEAR PERSPECTIVE

Excerpt We are presenting at this time a summary of the outstanding features of rheumatic fever, and its consequences in terms of heart disease and longevity. This report is in essence a review of ...