Herbert E. Griswold

Influence of Aortocoronary Bypass Surgery on Left Ventricular Performance

Abstract Quantitative analysis of left ventricular cineangiocardiograms was performed before and after aortocoronary-vein-bypass operations for angina pectoris in 14 selected patients. Eight patients with anatomically successful results had a decrease in left ventricular end-systolic volume, and an increase in ejection fraction and the rate of circumferential fiber shortening at the ventricular equator. In two, improvement in the motion of akinetic regions of the ventricular wall was found. Six other patients had anatomically unsatisfactory results, usually because of occlusion of the graft. Ejection fraction and fiber-shortening rate fell in these, and the end-systolic volume was higher after operation. End-diastolic volume was similar in both groups and was not consistently altered by operation. In patients without severe depression of ventricular performance, ventricular function improved when the operation was technically successful. Deterioration of function accompanied graft occlusion.

Aortic Replacement Clinical Experience with a Semirigid Ball-Valve Prosthesis

A ball-valve prosthesis for aortic replacement has been described which, while it is similar to the mitral ball valve in terms of materials and construction, is quite different in sewing margin and internal geometry. Implantation is greatly facilitated by the flexibility of the prosthesis in terms of external diameter, and by the availability of a full set of varying sizes for obtaining a proper fit. Widening of the aortic root by patch grafting has not been necessary. Long-term survival has been achieved in the dog, and early clinical results are most promising.While the selection of the ideal aortic valvular replacement must await further experience with all types of prostheses, continued evaluation of the ball valve in the aortic position, in carefully chosen patients, is indicated.

The Role of Left Atrial Transport in Aortic and Mitral Stenosis

The relationship of left atrial contraction to ventricular filling was studied in 24 patients. Eight patients had aortic stenosis, eight had mitral stenosis, and eight others served as a control group. All had normal sinus rhythm. Cineangiocardiographic volumetric determinations of the left ventricle were done throughout the cardiac cycle, and the rate of left ventricular filling before and during left atrial contraction was calculated.In the group with aortic stenosis 39% of the left ventricular stroke volume entered the ventricle during left atrial contraction; in the group with mitral stenosis 24% was contributed during left atrial contraction, and in the control patients, 26%.The rate of left ventricular filling more than doubled during left atrial contraction in aortic stenosis, while no consistent change in the rate of filling occurred during left atrial contraction in mitral stenosis and in the control group.The character of the resistance to left ventricular filling in aortic stenosis and mitral stenosis is discussed. An important contribution by left atrial contraction to left ventricular performance in aortic stenosis is suggested.

Red Blood Cell Survival in Patients with Aortic Valvular Disease and Ball-Valve Prostheses

Red blood cell survival was determined in patients with aortic valvular disease, postoperative patients with aortic valvular ball-valve prostheses and postoperative patients with multiple ball-valve prostheses. The red blood cell survival was reduced in the majority of patients in each group when compared with the red blood cell survival from a normal control group.A detailed analysis of the survival curves suggested that in many patients there was more than one population of red blood cells. The first population displayed rapid random destruction. This population was not present in normal persons in the control group. The second population showed the usual decline in radioactivity due to random destruction and loss of the red cell label due to elution. The shortened red blood cell survival in some patients was due to a large percentage of the first population of randomly destroyed red blood cells, in other patients to an accelerated rate of destruction of the usual single population of cells while others had a combination of the two mechanisms.A mechanism of mechanical hemolysis due to increased intracardiac turbulence was suggested as a cause for the shortened survival. When the turbulence was increased by a leak around the aortic or mitral valve prosthesis the red blood cell survival was found to be further decreased. In some cases this reduction in survival was enough to produce hemolytic anemia.The Coombs antiglobulin test was positive in three patients. The suggestion was made that the development of autoantibodies to red blood cells was secondary to increased destruction of red blood cells.

Problems in the hemodynamic diagnosis of tricuspid insufficiency

Abstract The dependability of RVA in the evaluation of TI was studied in 141 patients with congenital or rheumatic disease. In patients over age 10, angiocardiography revealed TI in 13 and was negative in 27. Eight with positive RVA had cardiac operation and TI was confirmed in seven; three not having been operated upon were probably false positives. Six with negative RVA had an operation and no TI was detected. In 20 per cent of 95 younger patients, RVA revealed TI, often believed catheter induced. RA pressure criteria commonly employed in the hemodynamic diagnosis of TI were tested. RA pressure level and contour were analyzed in 27 cases proved negative for TI by RVA and in seven proved positive by operation. An X descent shallower than Y correlated better with atrial fibrillation than with TI; X deeper than Y correlated better with sinus rhythm than with tricuspid competence. RVA can exclude TI but yields false positive studies. RA pressure contour is believed not to have the usually accepted significance.

The Failure of Hemodynamic Improvement After Valve Replacement Surgery: Etiology, Diagnosis, and Treatment

Excerpt Although most patients who have prosthetic replacement of diseased heart valves have significant symptomatic improvement after surgery, it has become apparent that a small percentage either...

Phonocardiographic Diagnosis of Aortic Ball Variance

Fatty infiltration causing changes in the silastic poppet of the Model 1000 series Starr-Edwards aortic valve prostheses (ball variance) has been detected with increasing frequency and can result in sudden death. Phonocardiograms were recorded on 12 patients with ball variance confirmed by operation and of 31 controls. Ten of the 12 patients with ball variance were distinguished from the controls by an aortic opening sound (AO) less than half as intense as the aortic closure sound (AC) at the second right intercostal space (AO/AC ratio less than 0.5). Both AO and AC were decreased in two patients with ball variance, with the loss of the characteristic high frequency and amplitude of these sounds. The only patient having a diminished AO/AC ratio (0.42) without ball variance at reoperation had a clot extending over the aortic valve struts. The phonocardiographic findings have been the most reliable objective evidence of ball variance in patients with Starr-Edwards aortic prosthesis of the Model 1000 series.

Clinical and hemodynamic results of peritoneal dialysis for severe cardiac failure

Abstract A total of 16 patients with heart disease of various types underwent peritoneal dialysis for severe and often intractable, cardiac failure. The average amount of fluid removed was 6 liters. Most patients had immediate improvement of symptoms and signs of fluid overload, 12 entered periods of remission, and four were improved enough to undergo corrective surgery, with survival of three. An average weight loss of 6 kilograms occurred during dialysis and 4 kilograms more in the next 2 weeks. Serum sodium and chloride levels were depressed initially and returned toward normal in most patients. The average predialysis sodium and chloride levels were 126 and 86 mEq. per liter, increasing to 136 and 97, respectively. Total blood volume (TBV) was greatly expanded beforehand and decreased with therapy in all 9 patients so studied. The average decrease was from 139 to 109 ml. per kilogram. Cardiac index (CI) was low in all and increased significantly in 6 of 8 patients so studied, the average changing from 1.4 to 1.9 L. per minute per square meter. The decrease in TBV, increase in CI, and sustained clinical improvement were closely associated. There were no definite complications, although in one instance, excessive vascular volume depletion may have contributed to hypotension, oliguria, and death. It is concluded that hypertonic peritoneal dialysis is an effective method for the treatment of severe heart failure with sodium dilution.

Aortic Ball Variance: Diagnosis and Treatment

Abstract Increased incidences of acute valvular malfunction and of death due to changes in the silicone poppet of cardiac valve prostheses have been noted. Of the 47 long-term survivors of aortic r...

Left Ventricular Volume Measurements in Man by Thermodilution

A safe, rapid method for estimating left ventricular volume in man during the course of hemodynamic studies should prove helpful in the assessment of cardiac disease and useful in physiological research. It is the purpose of this report to present left ventricular volume measurements in man that were obtained by an indicator dilution method which employs cold as the indicator. This circulatory indicator has been studied by several workers (1-4) and has been used for left ventricular volume determinations in animals previously (5-10). The method employed was adapted from those used by Rapaport and his co-workers for left ventricular volume measurements in the dog (7) and right ventricular studies in man (11).