William C. Manion

Nonpenetrating Traumatic Injury of the Aorta

The misconception that nonpenetrating trauma to the heart is relatively rare, is primarily due to the fact that myocardial contusion or traumatic pericardial lesions are usually well tolerated and the clinical findings transient and often difficult to recognize. However, the sequelae of this type of cardiac trauma may be serious. Therefore, a careful evaluation of every traumatized individual for cardiovascular injury is essential if the more serious complications are to be recognized and treated effectively. The most commonly encountered cardiac lesion at necropsy was myocardial rupture of a septum or a chamber wall. Now that surgical therapy is available for certain types of cardiac rupture, early diagnosis is essential. Thrombosis of a major coronary artery as a direct result of nonpenetrating trauma was not found in this study and is considered rare. Nevertheless, a previously diseased heart appears to be more vulnerable to trauma. Under these circumstances, it is often difficult to assess properly the extent to which trauma may aggravate a pre-existent disease.

CORONARY ARTERY ANOMALIES.

Twenty-two selected anomalies of the coronary arteries are related to cases previously reported in the literature. These are presented with simplified drawings and photographs in an attempt to provide a workable understanding of the practical problems such create for both the internist and surgeon.

Left atrial myxoma: Report of a case including hemodynamic, surgical, histologic and histochemical characteristics

Abstract A case of left atrial myxoma is reported. Some newly recognized clinical characteristics of this tumor are emphasized, and hemodynamic and surgical findings are discussed. The hypergammaglobulinemia in this case was shown to be due to a polyclonal elevation of IgA. Tissue culture of the tumor ceils was successful and revealed the presence of fusion giant cells in the cell culture. Electron microscopy suggested that the endothelial or subendocardial reserve cell was the cell of origin.

Anomalous Pulmonary Venous Return

One hundred and thirteen selected anomalous pulmonary venous returns have been well documented anatomically. Twenty-seven variations were seen. With the use of simplified diagrams, these have been correlated with related cases in the literature. Emphasis has been placed on transitional forms with one anomaly shading off into the next, rather than upon a series of neat, compartmentalized, classic types of anomalous pulmonary venous return. It is hoped that the broad anatomic spectrum shown will promote additional understanding and interest.

Incomplete differentiation of the cardiac valves: A report of 197 cases

Abstract Incomplete differentiation of cardiac valves is a relatively common, but infrequently recognized and documented congenital malformation of the cardiac valve involving single, multiple, or all cardiac valves. A total of 197 cases were reviewed. This group comprises 5 per cent of the gross congenital hearts examined at the Armed Forces Institute of Pathology over the past 15 years. In some cases, the only cardiac abnormality was the valvular lesion, but the great majority of cases presented other associated single or multiple congenital cardiac anomalies. The lesion is believed to be caused by varying degrees of incomplete development of the cardiac valves from their embryonic state. An implication of the significance of this entity is indicated by the finding of varying degrees of ischemic myocardial damage associated with aortic valve involvement. This complication is believed to be the result either of coronary hemodynamic disturbance or of local myocardial biochemical imbalance. Clinical awareness of incomplete differentiation of the valve and its possible complications should be stressed because of the obvious hazards of corrective operation in these hearts.

Thoracic Arterial Arch Anomalies

Forty-one well-studied thoracic arterial arch anomalies are related to cases previously reported in the literature and presented with simplified drawings in an attempt to provide a workable understanding of these anomalies.

Benign tumor of the heart causing complete heart block

Abstract A case is presented in which a benign cystic tumor disrupted the continuity of the A-V conducting pathway, resulting in complete heart block. Despite 15 years of stable chronic A-V block, the patient developed ventricular arrhythmias that led to her death. Such tumors, although rare, represent a significant cause of complete heart block and are important because of the implications of pacemaker therapy available today.

Microcirculatory disturbances and human myocardial infarction.

Abstract Thirty-nine cases of thrombotic thrombocytopenic purpura (Moschcowitzs discase) were examined, and the severe, obstructive involvement of the intramyocardial arterial branches was compared to the myocardial condition. In only 4 cases (10.2 per cent) was an occasional microfocal coagulative necrosis present, despite the massive involvement of the intramural branches. The conclusion, therefore, is that the obstructive lesions of the intramyocardial arterial portion cannot be the cause of the so-called “myocardial infarction” without acute occlusion of the main extramural branches.