Oscar Magidson

Geometric and functional abnormalities of the left ventricle with a chronic localized noncontractile area.

Abstract Thirty-one patients with coronary artery disease, 25 of whom had a chronic localized noncontractile area in the anteroapical region of the left ventricle, were studied at rest by means of left heart catheterization, left cineventriculography and selective coronary arteriography. The left ventricular volume, stroke volume, ejection fraction, left ventricular end-diastolic pressure, cardiac output and the surface area of the noncontractile area were measured. The patients with a noncontractile area were classified in 4 groups according to the size of the noncontractile area relative to the end-diastolic left ventricular surface area. The relative size of the non-contractile area ranged from 5 to 47 percent. Six patients with uncomplicated coronary artery disease comprised the control group. The critical size of the noncontractile area beyond which significant functional derangement occurred appeared to be 20 to 30 percent of the left ventricular internal surface area. The end-diastolic volume increased significantly and the ejection fraction was reduced to less than half of normal when the regional noncontractile area was larger than the critical size. Neither the cardiac output nor the left ventricular end-diastolic pressure correlated closely with size of the noncontractile area. In contrast, the ejection fraction was a more sensitive indicator and correlated well with the extent of regional contraction abnormality. In this study, double vessel disease was most common, followed by single vessel disease. Obstruction of the left anterior descending coronary artery was significant in the formation of anteroapical noncontractile regions.

The surgical treatment of mitral insufficiency and combined mitral stenosis and insufficiency using the heart-lung machine

Abstract Open heart surgery now offers a method for correction of mitral insufficiency. The technic consists of posteromedial annuloplasty. The details of the operation are important in that only the annulus of the mural leaflet should be narrowed and not the annulus of the aortic leaflet. In retrospect in only three of the fortytwo patients would the use of a plastic valve be indicated. The surgical mortality was 15 per cent and the patients with good or excellent results comprised 86 per cent of the living patients.

Ruptured aortic sinus aneurysms

Abstract 1. Seven new cases of ruptured aortic sinus aneurysm are presented. All the patients were submitted to open-heart surgery, with one operative death. 2. The characteristic continuous murmur of this lesion is discussed, and the possibility of distinguishing right ventricular from right atrial perforations is noted. In the 2 patients with fistulas into the right atrium the murmur was localized to the xiphisternum and the area immediately laterally, without radiation higher into the chest. The murmurs in the patients with right ventricular fistulas were heard over the second to fifth left intercostal spaces. None had a predominant radiation of the murmur above the second intercostal space, as is common in patent ductus arteriosus. 3. The difficulty in determining the time of rupture of the aneurysm in these patients is stressed, and in one case the fistula may have been congenital. 4. The condition is amenable to operation, and most cases should be curable.

Effect of premarin on survival in men with myocardial infarction.

Conclusion The incidence of deaths due to arteriosclerotic heart disease is being compared in men recovered from myocardial infarction and treated 75 days or more with either Premarin or no estrogen (control), allocation of treatments being randomized. Survival rate in those receiving Premarin is significantly higher than in controls.

Pulmonary stenosis with left to right shunt

Abstract 1.1. A series of cases exhibiting the combination of pulmonary stenosis and a defect permitting a left to right shunt is described. The series includes examples of the combination of pulmonary stenosis with atrial septal defect, transposed pulmonary veins and ventricular septal defect, respectively. 2.2. The clinical features of the cases were in general those of mild or moderate pulmonary stenosis. It is thought that electrocardiographic and radiologic findings may suggest the presence of an accompanying septal defect. 3.3. Atrial septal defect with left to right shunt occurred in the presence of mild or moderate pulmonary stenosis and a normal left to right atrial pressure gradient. These findings are contrasted with those in pulmonary stenosis with right to left shunts. 4.4. A shunt through transposed pulmonary veins may occur in the presence of severe pulmonary stenosis. 5.5. Cases of ventricular septal defect and pulmonary stenosis appeared to fall into two groups; those with slight to moderate elevation of right ventricular pressure and those in which the right ventricular and systemic pressures were similar. 6.6. The surgical implications of these combined lesions are discussed.

EFFECTS OF LONG-TERM ESTROGEN THERAPY ON SERUM CHOLESTEROL AND PHOSPHOLIPIDS IN MEN WITH MYOCARDIAL INFARCTION

Excerpt It has been well established1-8that administration of estrogen to men or women with myocardial infarction tends to raise the serum phospholipids and to lower the serum cholesterol and the c...

Correction of congenital ventricular septal defect in a patient with previous surgically produced pulmonary artery stenosis

Abstract A report is given of a patient with a large ventricular septal defect, in whom the creation of an artificial pulmonary artery stenosis at the age of twenty months reversed severe heart failure and allowed her to live a reasonably normal life for the subsequent five years. At the age of eight years, cardiac failure once again presented a threat and the patient was completely cured by definitive open heart surgery. The creation of a pulmonary artery stenosis may be considered in tiny infants with this condition who are under fifteen pounds and who are in circulatory failure because of increased pulmonary blood flow associated with diminished systemic blood flow.

The electrical impedance cardiogram in health and disease

Abstract 1. 1. The electrical impedance cardiogram (ICG) records continuous changes in heart shape throughout the cardiac cycle. It can be recorded on any direct writing electrocardiograph. 2. 2. Certain electrical impedance cardiograms closely resembled mechanical displacement recordings of heart motion (apexcardiograms), indicating a related origin. 3. 3. Tracings from normal subjects resembled each other, but tracings from patients with known cardiac deformities differed from the normal. 4. 4. Atrial activity was recorded selectively. 5. 5. Paradoxical bulges of the left ventricle produced characteristic abnormalities in impedance cardiograms. 6. 6. The impedance cardiogram can be used to analyze dynamic dysfunctions of the heart.

Surgical Treatment of High Pressure Patent Ductus Arteriosus

Thirteen patients with high pressure patent ductus arteriosus were operated upon. There was no operative mortality in this group. Twelve patients have shown remarkable clinical improvement, and there was a decrease in the pulmonary arterial pressure at the time of recatheterization in 11 of these patients restudied. One patient developed severe pulmonary hypertension and died six and one-half years after operation.The pulmonary arterial systolic pressure dropped minimally in two patients, despite marked clinical improvement. Both patients had associated lesions: a large ventricular septal defect in one and severe congenital aortic stenosis in the other. Both patients are to be operated upon.All patients with a predominant left-to-right shunt and a patent ductus arteriosus should have division of the patent ductus arteriosus. If a concomitant lesion requiring open-heart operation, such as a ventricular septal defect or aortic stenosis, is present, it should be corrected at a later date.

Effect of Estrogens on Interlipid Relations in Men with Myocardial Infarction.

Conclusions 1. A total of 223 men recovered from myocardial infarction were allocated to treatment groups and serum cholesterol and phospholipids determined (I) before and (II) following 6 months of uninterrupted treatment with No estrogen, Premarin, Lynoral or Anvene. 2. The abnormality in interlipid relationships characteristic of men with clinical atherosclerosis was unaltered in the subjects receiving Premarin, but this abnormality was abolished by treatment with Lynoral. 3. There is no necessary correlation between the feminizing, lipid-altering and outcome-altering effects of estrogen therapy in men with myocardial infarction.