Malcolm C. McCord

Isolated Valvular Pulmonic Stenosis Clinical and Physiologic Response to Open Valvuloplasty

The preoperative and postoperative clinical and physiologic data are presented in 10 patients with isolated valvular pulmonic stenosis. The valvulotomy was performed in five patients by the generally accepted blind ventricular approach, while in the remaining five patients the valvular surgery was accomplished by a direct pulmonary arterial approach. The physiologic data revealed uniform obliteration of the systolic pressure gradient from the right ventricle to the pulmonary artery in the patients operated by the direct technic in striking contrast to the inadequate and variable relief of stenosis by the transventricular approach.

Electrocardiographic Changes During Hypothermia and Circulatory Occlusion

An analysis of the electrocardiograms from 25 patients during reduction of body temperature and total occlusion of circulation reveals marked abnormalities in conduction and rhythmicity. Hypothermia thermia was accompanied by slowing of the heart rate, depression of intracardiac conductivity, and by inhibition of the normal centers of impulse formation with resultant atrial arrhythmias. Circulatory occlusion during hypothermia was associated with a high incidence of ventricular arrhythmias. Changes noted in electric activity of the myocardium tended to return to normal with release of occlusion and warming of the patient.

Atrial Septal Defect: Clinical and Physiologic Response to Complete Closure in Five Patients

Complete surgical closure of an atrial septal defect was accomplished under direct vision in five patients. Postoperative catheterization studies demonstrated complete obliteration of the previously existing left-to-right shunt and a reduction of the pulmonary artery blood pressure in all patients. The clinical and hemodynamic status returned to normal limits with but few exceptions.

The hemodynamic pattern in tricuspid valve disease.

Abstract 1. 1. The pressure curves from the right atrium in four patients with tricuspid regurgitation are presented. 2. 2. A pattern of severe organic tricuspid regurgitation is shown which is characterized by “ventricularization” of the right atrial pressure curve. 3. 3. The characteristics of the pressure curves aiding in differentiating organic from functional tricuspid regurgitation are discussed.

Complications following infundibular resection in Fallot's tetralogy.

Two patients are presented to demonstrate complications that may arise following infundibular resection in patients with the tetralogy of Fallot. An aneurysm of the infundibular chamber developed in one patient following removal of the infundibular stenosis. A left to right blood flow at the ventricular level occurred postoperatively in a second patient with marked cardiac enlargement and left ventricular hypertrophy.

Tricuspid stenosis: Clinical and physiologic evaluation☆

Abstract The patients presented at this time demonstrate that the association of mitral stenosis with tricuspid valve disease represents an operable state. Thoughtful consideration of the history and careful physical examination will usually indicate the presence of tricuspid disease. Hemodynamic studies in such patients, with attention to the atrioventricular pressure gradient in early diastole, will aid in arriving at a decision regarding the operability of the tricuspid lesion. The operative mortality and morbidity are high in this type of patient but the probability of improvement warrants operative therapy.