Karl P. Klassen

Diagnosis of Mitral Regurgitation by Cardioangiography

To determine the feasibility of demonstrating mitral regurgitation by injection of contrast media into the left ventricle, percutaneous and subxiphoid left ventricular punctures were carried out in dogs and subsequently in human beings. Contrast media were injected and roentgenographic studies made. The correlation between the roentgenographic and subsequent anatomic findings at operation or autopsy is emphasized. The method appears to be relatively safe if proper safeguards are observed. The results indicate that the method is of value in determining the competence of the mitral valve and relative degree of insufficiency.

Left Atrial and Left Ventricular Sound and Pressure in Mitral Stenosis

Left atrial and left ventricular pressure and sound were recorded at the time of mitral commissurotomy in 18 patients with severe, isolated, noncalcific mitral stenosis and sinus rhythm. Catheter tip micromanometers were used, and in eight studies, two equisensitive micromanometers were employed to examine pressure crossover relationships. Analysis of the left atrial and left ventricular sound and pressure crossover relationships is presented; viewed in the perspective provided by cineangiographic studies and surgical observations, a unifying concept of the auscultatory events in mitral stenosis is proposed.Beginning with left ventricular pressure rise, the left ventricle drives the mitral complex through its ascent (or eversion) phase toward the left atrium, clearing the anterior leaflet from the left ventricular outflow tract. The ascent (eversion) terminates abruptly at the first heart sound (S1). Following systole, left ventricular and left atrial pressure fall together after v peak, during and after pressure crossover, until the point where left atrial pressure fall ceases abruptly (opening snap notch), left atrial pressure exceeding that in the left ventricle, and the mitral opening snap occurs. During this interval, the mitral valve complex descends or inverts toward the left ventricle and terminates abruptly with the mitral opening snap. Thus, the mitral opening snap may be considered as the reciprocal of the delayed, accentuated S1, in noncalcific mitral stenosis in sinus rhythm.

Vascular Malformation Overlying the Pulmonary Artery Simulating a Patent Ductus Arteriosus

An arteriovenous fistula with aneurysmal dilatation involving branches of both coronary vessels and the pulmonary artery is discussed. The malformation was limited to the main pulmonary artery and presented a small left-to-right shunt without symptoms. Ligation of the supplying vessels resulted in the disappearance of a murmur typical of a patent ductus arteriosus.

Pulmonary arteriovenous fistula

Abstract 1. 1. Five patients with pulmonary arteriovenous fistulas have been presented and discussed. 2. 2. Routine roentgenograms of the chest have permitted early recognition and treatment of asymptomatic pulmonary arteriovenous fistula. 3. 3. One patient with malignant pulmonary arteriovenous fistulas is presented to illustrate the rare progressive form of this disease producing death. 4. 4. The presence of cutaneous or mucosal telangiectasias should alert the physician to the possibility of Rendu-Osler-Weber disease and the presence of hereditary pulmonary anteriovenous fistula. 5. 5. Bilateral simultaneous angiocardiogram should be carried out preoperatively to determine the nature and extent of the arteriovenous fistula. 6. 6. Pulmonary resection should be conservative enough to preserve as much functioning lung tissue as possible and radical enough to eradicate the disease.

The left atrial pressure pulse of mitral stenosis in sinus rhythm

Abstract The left atrial pressure pulse of isolated, severe mitral stenosis (sinus rhythm, noncalcified valve) is compared with the normal left atrial pressure pulse (indirect, esophageal); the left atrial sound and pressure relations are described in both groups. Micromanometers mounted on cardiac catheters and nasogastric tubes were used for recording. The left atrial pressure pulse of noncalcified mitral stenosis in sinus rhythm differs from the normal in several important respects. Fusion of the a - c waves in mitral stenosis reflects the overlap of atrial contraction with initial ventricular contraction. The delayed left atrial a wave peak is consistent with prolonged atrial systole. The c wave occurs during the ascent or eversion phase of the mitral complex and terminates abruptly with the initial vibrations of the delayed, accentuated first heart sound. The initial y descent reflects descent or inversion of the mitral complex toward the ventricle and terminates abruptly at the opening snap notch with the mitral opening snap occurring before mitral valve diastolic flow.

Open pulmonary biopsy compared with needle biopsy in infants and children

Summary Twenty-three children had open pulmonary biopsy. A diagnosis was made in all cases and the only complication was one mild wound infection. In comparison, in a group of 24 patients having needle biopsy, a diagnosis was obtained in only 60% of the cases. Complications occurred in 24% of these patients; one was serious enough to require thoracotomy. It is concluded that open pulmonary biopsy is indicated for all patients with diffuse and persistent pulmonary abnormalities with the possible exception of those in whom an acute inflammatory disease is suspected. The main disadvantages of needle biopsy in infants and children appear to be the paucity of material obtained and the high complication rate.