Leonard Leight

Subvalvular pulmonary stenosis due to constriction of the right ventricular outflow tract by a pericardial band

Abstract An unusual case of a patient with subvalvular pulmonary stenosis due to a constricting pericardial band is presented. Sixteen years after purulent pericarditis and partial pericardiectomy this patient again had evidence of constrictive pericarditis. Cardiac catheterization demonstrated a large systolic pressure gradient across the right ventricular outflow tract. A calcified ring was noted on the roentgenogram in the atrioventricular groove. Surgical division of this calcified constricting band abolished the pressure gradient and relieved the work of the heart. There was marked improvement in the patients clinical course following operation. The necessity of careful excision of the pericardium in the atrioventricular groove during pericardiectomy is again stressed.

The effect of intravenous potassium on myocardial contractility and cardiac dynamics

Abstract The inotropic and hemodynamic effect of acutely administered potassium has been studied in the open chest dog by utilizing the strain gauge arch. In both digitalized and nondigitalized dogs, potassium did not significantly alter the right ventricular contractility or cardiac dynamics. The effect of potassium on automaticity was manifested by bradycardia, and the effect on conductivity by fatal arrhythmia. Long term depletion of body potassium in 1 dog and short term depletion in 3 dogs did not alter the inotropic response to acetyl strophanthidin.

Pulmonary Artery Stenosis

Although the number of cases of stenosis of a branch or branches of the pulmonary artery reported in the literature is small, this congenital lesion is being recognized with increasing frequency. This report is a description of 2 cases seen within 1 year. Both cases were studied by means of cardiac catheterization and angiocardiography. In both there were complicating congenital heart lesions.

The conduction system in rheumatoid arthritis with complete atrioventricular block

Abstract Rheumatoid arthritis, of the peripheral type, or the ankylosing spondylitis type, with complete atrioventricular (A-V) block 1–11 or other conduction disturbances 12–18 has been sporadically reported. Very few conduction system studies have been done in these cases. 3, 7–9, 17, 18 The present report deals with a comprehensive serial section study of the conduction system in a case of the peripheral type of rheumatoid arthritis with complete A-V block.

Mitral regurgitation and intramyocardial injection resulting from left heart catheterization

Abstract The incidence of mitral regurgitation and intramyocardial injection of contrast material during left heart catheterization in normal dogs has been investigated, comparing the transseptal with the retrograde aortic approach. A transseptal catheter passed through the mitral valve into the left ventricle almost always caused some regurgitation during injection of contrast material, even in the absence of premature ventricular contractions. There was a 33 per cent incidence of intramyocardial injection when the transseptal catheter was employed. Retrograde aortic catheterization was associated at times with minimal mitral regurgitation when premature ventricular contractions occurred during injection, but significant mitral regurgitation was never produced. In the absence of premature contractions, regurgitation did not occur. Intramyocardial injection of contrast material was not observed in this series when the retrograde aortic catheter was employed.

Pulmonary hypertensive effects of bretylium tosylate in the dog

Abstract A sympathetic-blocking agent, bretylium tosylate, was given intravenously in large dosage to 15 anesthetized mongrel dogs with closed chests. This drug caused a significant increase in mean pulmonary arterial pressure, total pulmonary vascular resistance, and pulmonary arteriolar resistance. Pulmonary blood volume did not change significantly. These changes are compatible with constriction of a small segment of the pulmonary vascular bed, such as the arterioles.

Electrocardiographic changes following diaphragmatic inspiration.

The effect of inspiration on a standard electrocardiogram is recorded infrequently, and the less routine use of the method of diaphragmatic inspiration yields interesting and, as yet, perplexing findings. Various cardiac arrhythmiasl-’3 and abolition of left and right bundle-branch block following deep inspiration have been reported. 4-6 In 1964, Lin7 reported the first case of intermittent right bundle-branch block induced by diaphragmatic inspiration. To our knowledge no other investigator has reported electrocardiographic alterations by this inspiratory maneuver which produces maximal diaphragmatic stimulation. This study reports the rather frequent and variable effect of sustained diaphragmatic inspiration on 160 electrocardio-

COARCTATION OF THE AORTA ASSOCIATED WITH AORTIC STENOSIS AND A PATENT DUCTUS ARTERIOSUS.

Abstract A 14 year old girl with congenital aortic stenosis, coarctation of the aorta and patent ductus arteriosus is presented. Serial catheterization data demonstrated the relief of severe pulmonary hypertension after division of the patent ductus and resection of the coarctation. Further x-ray and electrocardiographic improvement followed open heart repair of the aortic stenosis. The response of the patient to the staged surgical approach as outlined was gratifying. A possible explanation of her improvement following the initial surgery is given.

The relation of the aortic root to the ventricular septum in tetralogy of fallot

Abstract Three cases of clinically classic tetralogy of Fallot are presented in which angiocardiographic studies demonstrated no overriding of the aorta. These studies indicate that many cases of tetralogy of Fallot should be considered as a type of ventricular septal defect with pulmonic stenosis, in which overriding of the aorta is of no functional or surgical importance.