Samuel O. Sapin

The Hemodynamics of the Left Side of the Heart as Studied by Simultaneous Left Atrial, Left Ventricular, and Aortic Pressures; Particular Reference to Mitral Stenosis

At operation the hemodynamics of the left side of the heart were studied in six patients without mitral stenosis, and in eight patients with mitral stenosis, by means of simultaneous needle puncture of the left atrium, left ventricle, and aorta. This technic permits analysis of the various phases of the cardiac cycle in normal subjects and in patients with mitral stenosis. The fundamental hemodynamic expression of mitral stenosis is the presence of an elevated left atrioventricular filling pressure sure gradient, which ranged from 4 to 20 mm. Hg, and after valvulotomy fell in relation to the adequacy of the procedure.

A study of the electrocardiogram and vectorcardiogram in congenital heart disease

Abstract 1.1. The electrocardiograms and spatial vectorcardiograms of 135 patients with congenital heart disease, in whom the diagnosis was well established, were analyzed. Our findings were compared with those of other authors. 2.2. No pathognomonic electrocardiographic or vectorcardiographic pattern is associated with any particular anatomic lesion. 3.3. Both the electrocardiogram and the vectorcardiogram, but particularly the latter, are of considerable aid in the differential diagnosis of the various malformations by indicating the dominant type of ventricular hypertrophy present. 4.4. In general, patients with the tetralogy of Fallot, pulmonic stenosis, interatrial septal defect, and Eisenmengers complex show right ventricular hypertrophy; those with tricuspid atresia, subaortic or aortic stenosis, and coarctation of the aorta show left ventricular hypertrophy, while those with uncomplicated patent ductus arteriosus, interventricular septal defect, and idiopathic dilatation of the pulmonary artery show a normal balance of electrical forces. 5.5. The determination of electrical axis from the standard electrocardiographic leads is found to be of little value in determining the type of ventricular hypertrophy present.

A study of the electrocardiogram and vectorcardiogram in congenital heart disease. III. Electrocardiographic and vectorcardiographic findings in various malformations.

Abstract 1. 1. The electrocardiograms and spatial vectorcardiograms of 135 patients with congenital heart disease, in whom the diagnosis was well established, were analyzed. Our findings were compared with those of other authors. 2. 2. No pathognomonic electrocardiographic or vectorcardiographic pattern is associated with any particular anatomic lesion. 3. 3. Both the electrocardiogram and the vectorcardiogram, but particularly the latter, are of considerable aid in the differential diagnosis of the various malformations by indicating the dominant type of ventricular hypertrophy present. 4. 4. In general, patients with the tetralogy of Fallot, pulmonic stenosis, interatrial septal defect, and Eisenmengers complex show right ventricular hypertrophy; those with tricuspid atresia, subaortic or aortic stenosis, and coarctation of the aorta show left ventricular hypertrophy, while those with uncomplicated patent ductus arteriosus, interventricular septal defect, and idiopathic dilatation of the pulmonary artery show a normal balance of electrical forces. 5. 5. The determination of electrical axis from the standard electrocardiographic leads is found to be of little value in determining the type of ventricular hypertrophy present.

Right Bundle-Branch Block. Hemodynamic, Vectorcardiographic and Electrocardiographic Observations

The time intervals between the onset of ventricular depolarization and of right ventricular contraction were studied in 36 patients, by means of cardiac catheterization, and were correlated with their vectorcardiograms and electrocardiograms. The onset of right ventricular contraction was delayed in six subjects without heart disease but with the electrocardiographic picture of right bundle-branch block. The onset of right ventricular contraction was found to be normal in 10 of 15 patients with right ventricular hypertrophy with the electrocardiographic picture of right bundle branch block. This indicates that this electrocardiographic configuration is not necessarily accompanied by delayed right ventricular contraction.

The use of simultaneous left heart pressure pulse measurements in evaluating the effects of mitral valve surgery

Abstract 1.1. The need for an objective method of measuring the adequacy of mitral valvulotomy by estimating the extent of residual mitral stenosis is emphasized. 2.2. Measurement of the mitral valve filling pressure gradient appears to be the best method of determining the degree of hemodynamically significant mitral stenosis. A method for recording the pressure gradient between the left auricle and the left ventricle at the operating table, by inscribing simultaneous pressure pulses in the left heart, is described. 3.3. The normal filling pressure gradient across the mitral valve approximates zero. The effect of valvulotomy on the elevated pressure gradient in mitral stenosis is to produce a fall of variable degree, depending on the adequacy of the surgical procedure. When this pressure gradient remains high after valvulotomy, relief of the obstruction can be termed inadequate. 4.4. The method is also of value in the differential diagnosis of mitral stenosis, in aiding the surgeon at the operating table to decide whether sufficient manipulation of the valve has been carried out and in determining whether recurrence of obstruction has taken place in patients previously operated upon for mitral stenosis.

Simultaneous Pressure Pulses in the Human Left Atrium, Ventricle and Aorta Preliminary Communication

Pressure pulses from the human heart have been recorded at operation by simultaneous needle puncture of the left atrium, left ventricle and aorta. Superimposed tracings on equal ordinate scales were obtained, thus simplifying the analysis of hemodynamic events. Preliminary observations are presented from cardiologically normal controls and patients with mitral stenosis before and after commissurotomy.

Auricular tachycardia with Wenckebach phenomenon occurring during the course of cardiac catheterization

Abstract 1. 1. A case is presented of rapid auricular rhythm with Wenckebach type of A-V block occurring during the course of cardiac catheterization in a 9-year-old girl with congenital cyanotic heart disease. 2. 2. The aid of intracardiac leads and pressure tracings from the right atrium in establishing the nature of the arrhythmia is demonstrated. 3. 3. The various factors influencing the development of the Wenckebach phenomenon are discussed with particular emphasis on the influence of the autonomic nervous system, auricular rate, hypoxia, and digitalis, and it is seen that attention to all of the factors involved may bring about rapid reversion to normal rhythm.