Robert G. Fish

Carotid Sinus Nerve Stimulation Treatment of Angina Refractory to Other Surgical Procedures

Abstract Carotid sinus nerve (CSN) stimulators were inserted in 13 patients with intractable angina pectoris following surgical procedures to increase myocardial blood flow and relieve their angina. In all patients the CSN stimulation assisted to some degree in relieving angina. In some, a variation of the stimulation level and pattern was necessary to relieve chest pain. Digitalis, diuretics, long-acting vasodilators, and occasionally narcotics, beta-adrenergic-receptor blocking agents, and nitroglycerin were necessary to control angina. The CSN stimulator is a useful adjunct to drug therapy in controlling angina pectoris. In 10 patients square-wave electromagnetic flow probe measurements showed a 21% decrease in bilateral common carotid artery blood flow during CSN stimulation. One of 3 patients with asymptomatic carotid arteriosclerotic plagues sustained a transient cerebrovascular accident following stimulator implantation. CSN stimulators are not recommended for patients with signs or symptoms of cerebrovascular disease because of the danger of cerebral embolization and reduction in cerebral blood flow during stimulation.

Left atrial pressure pulses in the presence of myxoma.

Findings of transbronchial left heart catheterization in the presence of an atrial myxoma and a normal mitral valve are presented. The genesis and possible significance of unusual differences in contour between high and low left atrial pressure pulses are discussed.

Coexistent Addison's disease and North American blastomycosis

Abstract The clinical course of a patient with proved systemic blastomycosis, in whom Addisons disease developed, is reported. Since the incidence of involvement at autopsy of the adrenals with blastomycosis is appreciable (between 5 and 10 per cent) this possibility should be considered in patients with systemic blastomycosis whether they are symptomatic or not, and appropriate studies undertaken to evaluate the adequacy of adrenal cortical function.

Aortic Valve Surgery Using the Magovern Prosthesis

he Magovern sutureless aortic valve prosthesis* [l] was devised in an attempt to simplify the technique of insertion and to T shorten the perfusion time required for successful aortic valve replacement. Whether or not it is worthwhile will depend on observations regarding mortality, morbidity, and long-term results in a significant number of cases. This report concerns our experience with 24 patients in whom Magovern prostheses were employed. All patients were evaluated preoperatively with left heart pressures and cineangiocardiography. Twelve patients had mixed aortic valve lesions. Stenosis was predominant in 15. Calcification was severe in 14. Nine patients had pure aortic insufficiency. Two patients were found to have luetic aortitis, and another had cystic medial necrosis with aneurysmal aortic dilatation. All patients had severe impairment of cardiac function. Four patients had undergone previous aortic valve surgery. One had had a transventricular dilatation of the aortic valve six years earlier. Sculpturing procedures had been performed in two patients, and a fourth patient had a Bahnson leaflet replacement for a destroyed aortic valve leaflet. One patient also had a simultaneous StarrEdwards mitral valve replacement.

A Double-Needle Technic for Transbronchial Left Heart Catheterization

CONTINUING progress in the surgical management of rheumatic mitral vascular disease makes accurate preoperative appraisal of mitral valvular function mandatory. left heart catheterization studies have therefore become essential in many cases. Unlike the posterior transthoracie approach to the left side of the heart, transbronchial left heart catheterization has been limited to a singleneedle technic. Although Colvez et al.1 have described a single-needle method for recording simultaneous left atrial and ventricular pressure pulses, we have felt that if a second needle could be safely introduced into the left atrium by the transbronchial route, more accurate as well as additional studies could be obtained. This has led to a modification of the standard Morrow transbronchial needle2 and a modification of the technic of transbronehial left heart catheterization which is described. Description of Needle and Technic The original Morrow needle has been modified by attaching 6 metal guides to the left side of the shaft (fig. 1). An accessory 18-gage thin-walled needle, 55 cm. long, is inserted through these guides. The guides were constructed so that the accessory needle and the Morrow needle are parallel but 4 mm. apart at their distal ends. The entire assembly passes easily through a standard 8-mm. Broyles bronchoseope. The depth to which the accessory needle is inserted into the left atrium is limited to the same depth as the Morrow needle by a needle stop that impinges against the bronchoseope. Initially a polyvinyl catheter is placed in the ascending aorta by means of percutaneous, retrog,rade catheterization of the right brachial artery. The Morrow needle is then passed transbronchiallv into the left atrium with the accessory needle in the withdrawn position. After left atrial pressure has been recorded, a polyethylene or polyvinyl catheter is passed into the left ventricle through