William P. Young

Cor triatriatum dexter: Persistent right sinus venosus valve☆

Abstract The usual causes of a large right to left shunt at the atrial level are tricuspid or pulmonary atresia, severe pulmonary stenosis, Ebsteins anomaly or a large atrial septal defect with pulmonary hypertension. We have recently evaluated a patient with a large right atrial membrane which subdivided the right atrium into 2 chambers with the venae cavae and foramen ovale on one side of the web and the coronary sinus and a small tricuspid valve on the other. The presence of this membrane was demonstrated preoperatively by cineangiograms, and it was successfully removed at operation. This unusual entity, cor triatriatum dexter, is discussed and the literature reviewed.

Phasic changes in human right coronary blood flow before and after repair of aortic insufficiency

We have shown previously that acute aortic insufficiency in chronically instrumented dogs reverses the normally high ratio of diastolic to systolic coronary blood flow. Phasic blood flow in the dominant right coronary artery was measured directly with an electromagnetic flow meter during surgery in eight patients with severe aortic insufficiency before and after relacement of the aortic valve. Before the insufficiency was eliminated, right coronary flow average 116 +/- 37 ml./minute and the diastolic to systolic flow ratio was 0.88 +/- 17. Mean arterial blood pressure averaged 106 +/- 17 mm. Hg, heart rate 84 +/- 19 beats/minute, and mean diastolic pressure averaged 67 +/- 10 mm. Hg. After the aortic valve was replaced with an average heart rate of 90 +/- 15 and mean blood pressure of 103 +/- 13 mm. Hg, the average right coronary blood flow increased to 180 +/- 40 ml./minute with a D/S ratio of 2.18 +/- 0.8. In all cases the right coronary blood flow increased after the aortic insufficiency was eliminated surgically. Right coronary flow probably increased because of the improved diastolic perfusion pressure and the change from predominantly systolic to diastolic coronary flow.

Pericardial Tamponade Following Percutaneous Left Ventricular Puncture

A case of pericardial tamponade following percutaneous left ventricular puncture for the assessment of aortic stenosis is presented. Technical factors pertinent to the etiology of the complication are discussed. Emphasis is placed on the fact that current enthusiasm for percutaneous ventricular puncture should be tempered with an awareness of the associated complications that may ensue and require immediate definitive therapy in an environment well equipped for their management.

Development of a carbon-coated, central-hinging, bileaflet valve☆

Between April 1963 and January 1966, 86 patients at the University of Wisconsin Hospital underwent aortic or mitral valve replacement, or both, with a carbon-coated, central-hinging, bileaflet valve. A 25-year follow-up has been obtained on 43 of these patients discharged with an aortic prosthesis, 13 patients discharged with a mitral prosthesis, and 2 patients discharged with double prostheses. The mean implantation time was 7.2 years, 9.0 years, and 9.5 years, respectively. The longest aortic valve implantation time was 24.2 years in a patient who had her bileaflet valve prophylactically replaced, and the longest mitral implantation time is 24 years in a patient who is doing well with her original prosthesis. We are not aware of any patient among the approximately 700 receiving this valve around the world who has developed fatigue-failure of the silicone-impregnated Teflon fabric leaflet. This valve has demonstrated unexpected durability and has provided some design and biomaterial concepts that are used in a number of current prosthetic valves.

Aortic root size in aortic valve disease. Its measurement and significance.

Abstract In 2 subjects who had a very small aortic root the surgical procedure of aortic valve replacement was greatly complicated, and obstruction of the aortic root and coronary arteries led to early death. All aortic valve replacements at the University of Wisconsin Hospital from 1963 through 1969 were reviewed. With use of the known catheter size as a reference, the size of the aortic root was calculated from preoperative cineangiocardiograms and correlated with the measurements made at operation. A significant correlation was found, especially with small aortic roots. It is stressed that the small aortic root should be recognized preoperatively when aortic valve replacement is contemplated.

Evaluation of the Effect of Bilateral Internal-Mammary-Artery Ligation on Cardiac Output and Coronary Blood Flow

THE therapy of angina pectoris has been a very difficult medical and surgical problem, and consequently new therapeutic approaches in this disease are avidly accepted by the lay public as well as t...

A Study of Duroziez's Murmur of Aortic Insufficiency in Man Utilizing an Electromagnetic Flowmeter

Femoral arterial blood flow was recorded with an electromagnetic flowmeter at the time of open heart surgery on subjects with and without aortic insufficiency. The records demonstrated that subjects with severe aortic insufficiency and Duroziezs murmur had a large amount of retrograde flow in the femoral artery. Those subjects without significant aortic insufficiency and no Duroziezs murmur had little or no backflow. When only a moderate amount of aortic insufficiency was present, the correlation was less satisfactory. In some subjects who had femoral backflow, a second recording was made from the femoral artery after the aortic valve had been replaced, and in these instances there was no longer any measurable backflow. Postoperatively these patients did not have Duroziezs murmur.It is concluded that Duroziezs crural murmur in subjects with aortic insufficiency is associated with retrograde diastolic femoral arterial blood flow.

Premature Closure of the Mitral and Tricuspid Valves

Premature closure of an atrioventricular valve was observed in 80 of a group of 519 subjects catheterized for aortic insufficiency (AI) or mitral insufficiency (MI), or both. Sole premature mitral closure (PMC) was present in nine subjects, sole premature tricuspid closure (PTC) in 40, and combined PMC and PTC in 31. Clinically PMC was associated with a first sound that was soft or absent in 75% and an atrial contraction sound in 50% of the subjects with dominant aortic insufficiency. PMC or PTC, or both, were verified at surgery in three subjects and were produced experimentally in intact dogs by acute AI. The presence of PMC and PTC appears related to the severity and chronicity of valvular disease.

A Follow-up Study of Aortic Valve Homografts for Two to Four and One-Half Years

Abstract Fifty-two patients underwent replacement of the aortic valve with a homograft and were followed for two to four and one-half years. There was no intraoperative mortality; 3 patients died in the immediate postoperative period and 7 patients died after discharge from the hospital. The results are very favorable when compared with the results in patients who have undergone replacement with aortic valve prostheses and have been followed at least two years. Patients with aortic homografts have been spared the problems of anticoagulants, and no emboli have been recognized. Eighteen of 42 survivors now have diastolic murmurs that are not hemodynamically significant. Neither diastolic murmurs that have been present continually nor those that have appeared late have been associated with deterioration of the patients state, and all patients remain normally active with very few taking any medication. The homografts have proved to be excellent aortic valve replacements, and their continued use is justified.

Preoperative and Postoperative Hemodynamic Data in Patients with a Prosthetic Hinged-Leaflet Aortic Valve

SINCE APRIL, 1963, 32 patients at the University of Wisconsin Hospitals have had surgery for aortic valvular disease with the placement of a new type of prosthetic leaflet valve. All patients selected for surgery were extremely ill and were deteriorating in spite of good medical management. Thirty-one of the patients had preoperative cardiac catheterization, and to date, the first 20 consecutive surviving patients have returned one to six months postoperatively for follow-up catheterization. The purpose of this report is to present in detail the results of these preoperative and postoperative catheterizations and also to discuss some of the possible advantages of a hinged-leaflet valve when compared with prostheses using the cusp and caged-ball design. The design and construction of the hingedleaflet prosthesis and the method of operative insertion have been described in detail previously.1 Briefly, this prosthesis consists of a rigid housing with a central cross strut for the anchoring of a hinged leaflet (fig. 1). The leaflet is constructed of a relatively heavy piece of Teflon fabric with a second lamina of fabric being applied in all but the hinging area of the leaflet. The construction of the leaflet is completed with the encasement of the Teflon fabric in silicone rubber by means of a pressure molding process. There is a Teflon felt suture ring incorporated in the