William P. Nelson

Diverticulum of the heart: Part of the syndrome of congenital cardiac and midline thoracic and abdominal defects

Abstract A case of coexistent congenital midline thoracoabdominal and cardiac defects is presented. The cardiac lesions consisted of a large ventricular septal defect and a muscular diverticulum of the left ventricle. Refractory congestive heart failure was controlled by banding of the pulmonary artery, and the muscular diverticulum was resected. Such cases are rare but important since the defects are treatable. The clinical features, diagnosis, prognosis and treatment are discussed.

A Complication of Valve Replacement by a Caged-Lens Prosthesis

Five of 37 patients undergoing valve replacement with a “caged-lens” prosthesis demonstrated intermittent insufficiency of the prosthesis. Four of these patients had mitral valve replacement, three of whom had uncorrected aortic insufficiency. Cineradiography showed tilting of the prosthetic lens and impingement within the cage in an oblique position.

Pulmonary Artery Obstruction and Cor Pulmonale Due to Chronic Fibrous Mediastinitis

Abstract A case of extensive mediastinal fibrosis with the unique complication of pulmonary artery obstruction leading to cor pulmonale is presented.

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.

Massive Pulmonary Arteriovenous Fistula in the Newborn A Correctable Form of "Cyanotic Heart Disease;" An Additional Cause of Cyanosis with Left Axis Deviation

A case of massive pulmonary arteriovenous fistula, diagnosed and treated in the first week of life is reported. A concept of severely altered intrauterine and neonatal pulmonary blood flow is proposed, with consequent left ventricular overload manifested electrocardiographically by left axis deviation and left ventricular preponderance. Consideration of this malformation in seriously ill cyanotic infantswith a radiographic density and these electrocardiographic changes is essential, since this is a surgically curable lesion.

Spontaneous closure of a ventricular septal defect after banding of the pulmonary artery

Abstract A case is presented of spontaneous closure of a ventricular septal defect after surgical banding of the pulmonary artery. The arterial banding was performed to prevent the development of irreversible pulmonary hypertension. Closure of the ventricular defect was unexpected and unprecedented. Mechanisms of spontaneous closure of ventricular septal defects have been reviewed and speculations offered regarding the relation of pulmonary arterial banding to this process.

The Innocent Supraclavicular Arterial Bruit — Utility of Shoulder Maneuvers in Its Recognition

SOCIOECONOMIC considerations, and the availability of satisfactory surgical procedures for the correction of significant cardiovascular lesions, have increased the need for careful clinical assessm...

Potential benefits of a computer ECG interpretation system for primary care physicians in a community hospital.

One hundred fifteen ECGs from a hospital service were interpreted by 2 primary care physicians and 2 expert electrocardiographers. When their interpretations were compared with one another and with the Marquette MAC II ECG Interpretation Program, there was great variability. Computer ECG interpretations appeared to benefit primary care physicians most by providing a backup opinion. This second opinion was also of use to expert electrocardiographers. Additional long-term benefits that may be derived from computer systems include improvement of physician interpretation ability, reduction in interpretation time, and standardization of electrocardiographic nomenclature and criteria. (J Am Bd Fam Pract 1989; 2:17-24.)

Pulmonary stenosis: Cyanosis, interatrial communication and inadequate right ventricular distensibility following pulmonary valvotomy

Abstract Three patients with persistence of clinical venous-arterial admixture after successful valvotomy for severe pulmonary valvular stenosis with intact ventricular septum were studied by serial cardiac catheterization. Hemodynamic data after valvotomy documented the presence of atrial venous-arterial admixture in the absence of pulmonary hypertension, pulmonary stenosis or tricuspid stenosis in all 3 patients. Inadequate right ventricular distensibility was implicated as the cause of the atrial venous-arterial admixture. The secundum atrial septal defect was surgically closed to eliminate the potential hazards of such interatrial communications with significant venousarterial admixture. After closure, the inadequately compliant right ventricle accommodated itself to the reception of the total systemic venous return without residual evidence of right atrial hypertension.

Incomplete differentiation of cardiac valves

Abstract A case of incomplete differentiation of the cardiac valves is presented because of the antemortem demonstration of continuous visualization of the valvular structures on angiograms. We suggest that this angiographie finding in a child with congenital heart disease should raise the possibility of this lesion.