Henry T. Bahnson

Association of Aortic Valvular Disease and Cystic Medial Necrosis of the Ascending Aorta Report of Four Instances

In 4 patients with aortic stenosis and regurgitation, progressive dilatation of the ascending aorta and dissecting aneurysm developed. Cystic medial necrosis was discovered histologically. It is suggested that the change in the aorta is secondary to hemodynamic stresses imposed by the disease at the aortic valve.

Negative P Waves in Lead I in Dextroversion: Differential Diagnosis from Mirror-Image Dextrocardia With a Report of a Successful Closure of a Ventricular Septal Defect in a Patient with Dextroversion Associated with Agenesis of the Right Lung

The electrocardiographic differentiation of dextroversion from mirror-image dextrocardia has frequently been based on the configuration of the P waves in lead I, the assumption being that P waves are upright in dextroversion and inverted in mirror-image dextrocardia. A patient is presented with inverted P waves in lead I in whom an electrocardiographic diagnosis of dextroversion was made based on the analysis of the unipolar leads. This diagnosis was confirmed at surgery when a ventricular septal defect was successfully repaired. The Sodi-Pallares method of analysis of the precordial leads is valuable in determining whether the left ventricle lies anteriorly and to the left as in dextroversion or posteriorly and to the right as in mirror-image dextrocardia. Because of the frequency of unusual atrial rhythms in patients with right-lying hearts, the configuration of the P waves is often unreliable. When there is a discrepancy between the result of analysis of atrial activation and that of ventricular activation, the latter should be used in determining whether dextroversion or mirror-image dextrocardia is present.

Tetralogy of Fallot: Report of case with total correction at 54 years of age

A s the risks of cardiac surgery decrease, new categories of patients can be added to the list of those for whom surgery is indicated. Congenital defects can be corrected before symptoms develop and before irreversible changes occur in the myocardium or pulmonary vasculature. The entire concept of the inoperable lesion or the inoperable situation must be subject to constant review. This is especially true in the case of patients with congenital heart disease who have reached middle age and have, therefore, in many cases, already attained an age in excess of their life expectancy. The surgical risk in the middle-aged patient is increased because of age and associated cardiovascular disease, such as atherosclerosis, as well as by the presence of noncardiac disease. This report documents the case of a 54-year-old man with tetralogy of Fallot in whom the lesions were totally corrected surgically by the use of cardiopulmonary bypass, with good result.

Transseptal left heart catheterization in the pediatric age group

Transseptal left heart catheterization has been carried out in 20 patients ranging in age from 18 months to 16 years. The left atrium was entered in 85 per cent and the left ventricle in 70 per cent of these patients. No complications occurred, and adequate hemodynamic measurements were obtained in the basal state. This technique appears to be superior to that of left ventricular apical puncture.

Intracardiac surgery performed with cardiopulmonary bypass.

The conduct of cardiopulmonary bypass and the apparatus in use at The Johns Hopkins Hospital are described, including some recent improvements in technic. Some 450 operations in which the pump-oxygenator has been used are summarized briefly, with reference to the types of lesion treated, the indications for operation, fundamentals of treatment, and survival rates.