Richard S. Goodwin

Mild mitral regurgitation. Its characterization by intracardiac phonocardiography and pharmacologic responses.

Abstract Fifteen patients with apical or peri-apical systolic murmurs without accompanying conventional roentgenologic or electrocardiographic evidence of cardiac enlargement were studied. All were shown to have mild mitral regurgitation. Investigative technics included intracardiac, esophageal and external phonocardiography coupled with pharmacologic responses and left ventricular angiography. The murmurs were of high frequency and low intensity. Their configuration varied from pansystolic to entirely late systolic. Typical responses to phenylephrine and amyl nitrite are reported. The value of transseptal intracardiac phonocardiography in making this diagnosis is emphasized. Intracardiac recordings suggest that the position of the regurgitant jet in relation to the chest wall is a factor in the configuration of the murmur as appreciated externally. Evidence is presented that associated mid- to late systolic clicks and whoops are mitral valvular in origin. Despite the evident longevity of patients with mild mitral regurgitation, arrhythmia, embolization and endocarditis may occur.

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.

Sail Sound in Ebstein's Anomaly of the Tricuspid Valve

Ebsteins anomaly represents an anatomic, pathologic, and physiologic spectrum. There have been few hemodynamic correlates for the observed auscultatory events. Multiple components of the first sound and “ejection’ sounds are frequently described.Cardiac catheterization, intracardiac sound-pressure studies (Telco), and cineangiograms were performed in three patients with Ebsteins anomaly who had a prominent early systolic sound.The right ventricular pressure pulse was abnormal in all; an initial delta-wave configuration, followed by a more rapid pressure rise, produced a prolonged rise to peak pressure. The right ventricular pressure pulse is not that of a conduction defect alone; rather it suggests that the altered pattern of ventricular contraction and abnormal leaflet placement are contributing factors.The early systolic sound was recorded in the atrialized right ventricle or right ventricle in all. It occurred just after the peak of the c wave in the atrialized right ventricle. In the right ventricle the sound occurred at the point where initial slow delta portion of right ventricular pressure pulse gave rise to rapid upstroke. The early systolic sound most likely occurs when the large, sail-like tricuspid valve reaches the limit of systolic excursion. The sound has been designated as the “sail sound,’ and may be the most specific auscultatory event in Ebsteins anomaly.

Measurement of the Cardiac Output in Dogs by a Conductivity Method after Single Intravenous Injections of Autogenous Plasma

Equations are developed for the estimation of cardiac output from hematocrit dilution, using the continuously recorded conductivity of whole blood drawn from an artery through a conductivity cell, after a single intravenous injection of autogenous plasma. The equipment used is described, the results are compared with those of simultaneously performed measurements of dye dilution and the advantages of the method are discussed.

Intracardiac sound and pressure events in man

Abstract Described herein are intracardiac sound and pressure events recorded in 105 patients with organic heart disease by means of an intracardiac micromanometer at right heart catheterization. Sound-pressure relationships are defined in patients with selected congenital and acquired cardiac diseases. Pressure pulse recordings of high quality with simultaneous isolation and localization of specific sound events provide investigative and diagnostic information. Renewal of interest in the origin, transmission and clinical correlation of the classic auscultatory events are accompaniments of intracardiac sound-pressure studies.

Continuous murmurs associated with shunts in the acyanotic adult: An anatomic classification

A continuous murmur may be precisely localized within a cardiac chamber or great vessel with intracardiac sound-pressure sensitive devices. Intracardiac sound studies were performed in eighteen acyanotic adults who had continuous murmurs associated with shunts. The continuous murmur was localized to the site at which the fistula or communication terminated or emptied in fifteen patients. This information has been translated to the precordial auscultatory areas (designated on the basis of sound or murmur localization by intracardiac phonocardiography) and forms the basis for an anatomic classification for continuous murmurs associated with shunts in acyanotic adults.

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.

A Saline Conductivity Method for Detection of Cardiac Shunts by Indicator-Dilution Technic

A new method for cardiovascular shunt detection is described using the indicator-dilution principle applied to blood conductivity changes produced by 5 per cent saline. It possesses these distinct advantages over the Evans blue technic: (1) an unlimited number of determinations can be made without an increasing blood dye background or bluish discoloration of the patient, (2) oximetric determination of blood oxygen saturation is not interferred with, and (3) a simple modification of the carrier amplifiers of commonly used recording systems supplies most of the necessary instrumentation.

Intracardiac Phonocardiography in the Differential Diagnosis of Continuous Murmurs.

Excerpt Intracardiac sound and pressure are of both investigative and diagnostic significance in the evaluation of heart sounds and murmurs. The understanding of the basic mechanisms of continuous ...

Therapy of Symptomatic Complete Heart Block in Man: Epicardial Versus Endocardial Pacemakers.

Excerpt Permanent endocardial pacemaker offers an alternative approach to epicardial pacemaker implantation in the elderly patient with symptomatic complete heart block. This report compares the cl...