Paul Winchell

Persistent left superior vena cava, fibrous remnant of the right superior vena cava and ventricular septal defect☆

Abstract We have reported a case of persistent left superior vena cava associated with a nonfunctional right superior vena cava. Twenty-nine cases of this venous pattern with anatomic study were found in the literature. Among these, as in the case here reported, only 3 showed an anatomic vestige, in the form of an atretic cord, of the right superior vena cava. In our case a ventricular septal defect was also present, which yielded certain features like those in origin of both great vessels from the right ventricle. The venous anomalies yielded an unusual course of the catheter during cardiac catheterization. These anomalies were identified by venous angiocardiography.

Myotonia atrophica and cyanosis.

IN 1909, Steinert described a familial, chronic, slowly progressive disease characterized by visual and glandular disturbances combined with muscular atrophy. This has been called myotonia atrophic...

Ventricular septal defect with aortic incompetence simulating patent ductus arteriosus

Abstract 1.1. High ventricular septal defect with downward displacement of an aortic cusp can closely simulate a patent ductus arteriosus. 2.2. Catheterization studies are very helpful in reaching a tentative diagnosis. 3.3. The differential diagnosis includes aneurysm of the sinus of Valsalva with rupture into the right ventricle, any communication between the pulmonary artery and aorta plus pulmonary valvular insufficiency, and simple ventricular septal defect with acquired aortic insufficiency. 4.4. The most common complications of this lesion include pulmonary hypertension, congestive heart failure and bacterial endocarditis. 5.5. This lesion may be a surgically correctible disease in the near future.

POST PARTAL HEART DISEASE—A SYNDROME?

Excerpt Heart failure developing abruptly during the last month of pregnancy or within a few weeks following delivery has been observed in the absence of any known preexisting cardiac lesion. The c...

Pulmonary valvular stenosis with intact ventricular septum: Results of the brock type valvulotomy

Abstract 1.1. In a group of twenty patients studied before and after the Brock valvulotomy, the average preoperative right ventricular systolic pressure was 116 mm. Hg, the average postoperative value 56 mm. Hg. Excluding five cases in which no significant change occurred, the average preoperative value was 123 and the postoperative value 43 mm. Hg. The five failures might be ascribed to the presence of undetected infundibular pulmonary stenosis or to the possibility that the valvulotome slipped through a fibrous valve without making an incision. 2.2. In a group of seven patients with right to left shunt at the atrial level, the average preoperative right ventricular systolic pressure was 143 mm. Hg and the postoperative 45 mm. Hg. In addition the hemoglobin dropped from 20.0 to 15.3 gm. per cent and the arterial oxygen saturation rose from 75 to 89 per cent. 3.3. Vigorous dilatation of the valve following incision with the valvulotome is deemed to be an important determinant of a successful operative procedure.

The Effect of Amytal on the Cardiac Output and Peripheral Resistance of Man

Measurements of cardiac output and intra-arterial pressure on 5 normal young men and 5 hypertensive patients before and during sedation with Amytal demonstrated a decreased cardiac output and an increased peripheral resistance during the period of sedation. It is concluded that the theoretic basis for the use of Amytal sedation as a device for selection of hypertensive patients for sympathectomy is not valid.

Some physiologic features of atrial septal defect; observations in 38 adult patients.

Abstract 1. (1) Thirty-eight adult patients with atrial septal defect have been studied before operation, and 20 have been restudied postoperatively. 2. (2) Of the group, two had significant mitral valve disease and two were of the ostium primum type although they could not be separated from the secundum defects by their hemodynamic findings. 3. (3) The major physiologic findings before operation were: (a) marked increase in pulmonary blood flow; (b) normal systemic blood flow; (c) mild elevation of pulmonary artery pressure; (d) lower than normal total pulmonary vascular resistance; (e) increased right ventricular pressure work; (f) normal systemic arterial blood oxygen saturation. 4. (4) Surgical correction of the atrial septal defect resulted in a reversion of the physiologic abnormalities towards or to normal. 5. (5) “Relative” pulmonary stenosis may be present in the face of marked increases in the pulmonary blood flow. 6. (6) The genesis of pulmonary hypertension in certain cases is not totally understood but may be related to: (a) pulmonary arteriolar sclerosis; (b) residual fetal pulmonary hypertension; (c) associated mitral valve disease; (d) “spasm” of the pulmonary arterioles.

PREPONDERANT LEFT-TO-RIGHT FLOW THROUGH A VENTRICULAR SEPTAL DEFECT IN THE PRESENCE OF PULMONARY STENOSIS

Excerpt Until recently there have been few reported cases of a left-to-right shunt through a ventricular septal defect in the presence of pulmonary stenosis. There are now available several papers ...

ALVEOLAR-CAPILLARY DIFFUSION DEFECT: A CASE REPORT

Excerpt A group of chronic pulmonary diseases showing diffuse thickening of the alveolar septa has been shown to result in impairment of alveolar-capillary diffusion.1The usual example of the syndr...