Rodman E. Taber

Bacterial endocarditis of the pulmonic valve: Association with atrial septal defect of the ostium secundum type∗

Abstract An unusual case of “right-sided bacterial endocarditis” is reported with a brief review of the literature. Fever, changing heart murmurs over the pulmonic area and scattered pulmonary infiltrates were the main clinical features. At surgery, a large secundum atrial septal defect was found in addition to a large vegetation on the right cusp of the pulmonic valve. The possibility of an acquired stenosis of the pulmonary valve secondary to proliferative bacterial endocarditis is suggested. This could explain the elevated systolic pulmonary valve gradient, in the absence of the typical congenital fusion of the pulmonary cusps.

Treatment of Congenital and Acquired Heart Block with an Implantable Pacemaker

The Chardack-Greatbatch implantable pacemaker has proved a worthwhile device for the management of both congenital and acquired heart block. The procedure used for implantation in 38 patients is described. The most frequent indication for use of the pacemaker is syncope due to heart block. Progressivecardiac enlargement was also an indication for pacemaker implantation in two of four children with congenital heart block. The pacemaker has also been useful in the management of surgically induced heart block and coexisting heart block that accompanies intracardiac lesions, such as aortic stenosis, which require open-heart surgery.Pacemaker failure due to electrode breakage occurred in two patients. In both instances, a replacement unit was successfully used. Three of the 38 patients have subsequently died from causes unrelated to pacemaking while one death resulted from pacemaker failure 12 months after implantation. The remaining 34 patients have remained free from cardiac symptoms during observation periods of 2 to 24 months.

Surgical treatment of anomalies of the coronary arteries

Abstract Many anomalies of the coronary arteries may be corrected by surgical procedures. Those with fistulas into the right side of the heart, atrium, ventricle and pulmonary artery, are most favorable for treatment. Most of these have loud continuous murmurs. 42 cases from the literature are reviewed, and we have added 6 cases. There has been no mortality in any of these operations. In some cases of single coronary artery with fistula, it is feasible to establish a dual coronary circulation with a graft to the aorta. Attempts at the surgical treatment of patients with single coronary arteries which do not have the correct distribution or size to nourish the myocardium have not been palliated by operative procedures. The same can be said of cases with anomalous origin of the left coronary artery from the pulmonary artery, where no collateral connections with the right coronary artery have developed. Cardiac transplantation must be considered for these cases.

Intracardiac Air Aspiration

Abstract Whenever the left heart is opened, the potential exists for systemic air embolization. Aspiration of air as a means of preventing this complication is discussed.