Henry T. Nichols

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.

Commissurotomy for Rheumatic Aortic Stenosis I. Surgery

As long ago as the middle of 1949 it had been demonstrated by the senior author that any blunt dilating mechanism applied within the stenotic aortic orifice would, upon expansion, force the separation of one or more of the fused commissures. Thus the diminutive valve orifice could be enlarged without the creation of additional insufficiency and with the restoration of such part of the original valve function as the pathologic distortion of the leaflets would permit. In other words the principles and effectiveness of such an aortic commissurotomy would be comparable to those of the similarly named operation for mitral stenosis. It has remained for us finally to develop an instrument and a technic capable of implementing these concepts, and this has at last been accomplished.

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.

Aberrant origin of left coronary artery combined with mitral regurgitation in an adult

Abstract A case of aberrant origin of the left coronary from the pulmonary artery is described in a woman who lived to the age of twenty-six. In addition, severe mitral regurgitation was present due to a dilated and partially calcific mitral valve. The clinical syndrome is reviewed and the causes for the myocardial ischemia outlined. Angiocardiography is helpful in establishing the diagnosis. Electrocardiograms may be considered pathognomonic of the syndrome only in the absence of mitral regurgitation. Surgical treatment still is unsatisfactory.

Partial anomalous pulmonary venous drainage associated with mitral stenosis: Report of a case with surgical correction of both lesions

Abstract 1.1. A case of partial anomalous pulmonary venous drainage into the left innominate vein associated with mitral stenosis is reported. 2.2. Mitral commissurotomy and transplantation of the anomalous vein into the left atrial appendage were successfully performed at one operation. 3.3. A follow-up of one year is presented.

Myxoma of the left atrium simulating restmosis of the mitral valve

Abstract A case of intra-atrial myxoma simulating restenosis of the mitral valve is presented. A past history of mitral commissurotomy and physiologic evidence of obstruction of the mitral valve led to the wrong diagnosis of restenosis of the mitral valve. A pump-oxygenator to bypass the heart during surgery was preferentially used over the closed-heart technique or hypothermia for complete and successful removal of the tumor.

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.