Sim P. Dimitroff

The incidence and severity of atherosclerosis in estrogen-treated males, and in females with a hypoestrogenic or a hyperestrogenic state.

Autopsy records of estrogen-treated men, castrated women, and women with breast carcinoma were analyzed with reference to the degree of atherosclerotic disease. Findings were then compared with those in similar groups of men and women whose estrogen supply was considered normal. Results obtained suggest: (1) that the male treated with estrogen has less atherosclerosis than the normal male; (2) that the oophorectomized female has an incidence of severe atherosclerosis approaching that of the male; and (3) that the hyperestrogenic female with breast carcinoma has less atherosclerosis than the normal female.

The electrocardiogram in congenital heart disease and mitral stenosis; a correlation of electrocardiographic patterns with right ventricular pressure, flow, and work.

Abstract 1.1. Mean levels of right ventricular pressure, flow, and work, but particularly mean levels of right ventricular work, are considerably higher in congenital heart disease than in mitral stenosis. 2.2. In congenital heart disease only abnormal electrocardiograms appeared above a mean right ventricular systolic ejection pressure of 30 mm. Hg. In mitral stenosis normal or borderline electrocardiograms appeared frequently up to a mean pressure level of 60 mm. Hg. 3.3. In congenital heart disease almost all electrocardiograms were abnormal above a right ventricular work load of 1 kg. M./min./sq.M. In mitral stenosis, normal electrocardiograms often occurred at work levels above 1 kg. M./min./sq. M. 4.4. In both mitral stenosis and congenital heart disease, the pattern of partial right bundle branch block appeared at almost all levels of right ventricular pressure and work, and thus this pattern appeared to be almost as significant as the classic pattern of right ventricular hypertrophy in the detection of right ventricular hypertension and presumptive right ventricular hypertrophy. 5.5. Gross electrocardiographic differences between congenital heart disease and mitral stenosis were present in all precordial leads; this was most marked in V 3R and V 1 , where the R wave in congenital heart disease was three to four times as tall as the comparable R wave in mitral stenosis. 6.6. In congenital heart disease, the electrocardiogram is remarkably accurate (91 per cent of cases) in the detection of right ventricular hypertrophy. In this disease no definite correlation was present between abnormalities of individual waves such as the height of R or RS ratio over the right precordium and levels of pressure or work. 7.7. The electrocardiogram in mitral stenosis is less diagnostic (51 per cent of cases) in the detection of right ventricular hypertrophy. But when the electrocardiogram is abnormal, a definite correlation is present between the height of R and RS ratios over the right precordium and levels of right ventricular pressure and work. 8.8. These differences in the total electrocardiographic picture suggest fundamental differences in the genesis of right ventricular hypertrophy in the two diseases.

Transposed pulmonary veins; a correlation of clinical and cardiac catheterization data.

Abstract Ten patients with transposed pulmonary veins are described. These include four patients with partial and two with complete pulmonary vein transposition, in whom cardiac catheterization and clinical findings are correlated. The other patients presented (1) pulmonary valvular stenosis accompanied by partial pulmonary vein transposition, (2) a left superior vena cava entering a sinus venosus in common with the hepatic veins, accompanied by anomalous drainage of the right pulmonary veins into the right atrium, and (3) probable tricuspid atresia with partial pulmonary vein transposition (two cases). The diagnosis of anomalous pulmonary vein drainage in these cases was made at cardiac catheterization by roentgen visualization of the catheter in the anomalous vein, by a characteristic pulmonary vein pressure curve and finally by 90 to 95 per cent oxygen saturation in the blood sample from the anomalous vein. Surgical exploration and attempts to correct this anomaly should be reserved for those patients with complete transposition in whom limitation of physical activity is progressive.

Pulmonary stenosis with left to right shunt

Abstract 1.1. A series of cases exhibiting the combination of pulmonary stenosis and a defect permitting a left to right shunt is described. The series includes examples of the combination of pulmonary stenosis with atrial septal defect, transposed pulmonary veins and ventricular septal defect, respectively. 2.2. The clinical features of the cases were in general those of mild or moderate pulmonary stenosis. It is thought that electrocardiographic and radiologic findings may suggest the presence of an accompanying septal defect. 3.3. Atrial septal defect with left to right shunt occurred in the presence of mild or moderate pulmonary stenosis and a normal left to right atrial pressure gradient. These findings are contrasted with those in pulmonary stenosis with right to left shunts. 4.4. A shunt through transposed pulmonary veins may occur in the presence of severe pulmonary stenosis. 5.5. Cases of ventricular septal defect and pulmonary stenosis appeared to fall into two groups; those with slight to moderate elevation of right ventricular pressure and those in which the right ventricular and systemic pressures were similar. 6.6. The surgical implications of these combined lesions are discussed.

Cardiac catheterization in interatrial septal defect

Abstract 1.1. Ten proven and seven presumptive cases with atrial septal defects have been presented. 2.2. The importance of catheterization of the left auricle is emphasized, together with the differential diagnosis of atrial septal defect from transposed pulmonary veins. 3.3. A rise of oxygen content in the right atrium in comparison to the oxygen content of the superior vena cava is not necessarily present in proven atrial septal defects. 4.4. The cause for cyanosis in atrial septal defect lies primarily in the presence of a right to left shunt. 5.5. The direction of shunt is determined by the pressure gradient between the atria during the cardiac cycle. 6.6. Pulmonary vascular disease may contribute to the pulmonary resistance but is not a significant factor in the production of cyanosis.

The Selection and Medical Management of Patients with Mitral Stenosis Treated by Mitral Commissurotomy

The selection of patients for mitral commissurotomy must be made after considering all manifestations of the rheumatic state. A conservative approach is urged and no patients should be operated upon without evidences of increasing pulmonary hypertension and right heart strain. The preparation of the patient, the management of the arrhythmias during surgery and the postoperative care are the full responsibilities of the physician. A team composed of physiologists, cardiologists and surgeons must work together.

CLINICAL EVALUATION OF GITALIN IN THE TREATMENT OF CONGESTIVE HEART FAILURE

Excerpt The cardiac glycoside, gitalin, was first isolated fromDigitalis purpureaby Kraft 40 years ago.1It has been used extensively in Europe, where some investigators believed it to be superior t...

Clinical and cardiac catheterization studies in four cases of Eisenmenger's complex

Abstract 1.1. Four cases of Eisenmengers complex are reported and the results of cardiac catheterization are discussed. Right ventricular hypertrophy, pulmonary hypertension, high ventricular septal defect and overriding of the aorta were demonstrated. 2.2. The practical and theoretic difficulties of demonstrating overriding of the aorta by cardiac catheterization are discussed.

Mercurial diuretics; the replacement of parenteral administration by a new oral preparation in ambulatory patients with chronic congestive heart failure.

Improvement in the usage of an effective therapeutic agent is highly desirable especially when the method of administration is simplified, the total dosage reduced, the toxicity of the drug diminished and the cost of medical care lessened. The replacement of parenteral injections of the mercurial diuretics by an oral preparation in ambulatory patients in chronic congestive heart failure represents a step forward in the management of this type of patient.

The use of oral quinidine and procaine amide as premedications for cardiac catheterization

Abstract This report is concerned with the need for prophylactic measures to reduce the incidence of potentially dangerous arrhythmias induced during cardiac catheterization. The experience of this catheterization team will be presented, and suggestions for increasing the safety of routine cardiac catheterizations will be made.