William S. Blakemore

Ventricular aneurysmectomy for the treatment of recurrent ventricular tachyarrhythmia

Abstract Resection of a left ventricular aneurysm led to termination of lifethreatening paroxysmal ventricular tachycardia in 2 patients. Preoperative cardiac catheterization and cineangiocardiography are essential for visualization of the aneurysm and mural thrombus. Our living patient has survived over 58 months after aneurysmectomy without recurrence of tachyarrhythmias and is receiving no medication. It is suggested that aneurysmectomy, preferably on an elective basis, may be indicated in the management of recurrent tachyarrhythmias even in the absence of congestive heart failure and systemic embolization.

A later stage of anomalous coronary circulation with origin of the left coronary artery from the pulmonary artery. Coronary artery steal.

A 45-year-old woman with angina pectoris, beginning at the age of 16 and progressing to produce incapacitation, was found to have an anomalous left coronary artery arising from the pulmonary artery. Because of the severity of symptoms and progression of disability, the anomalous artery was ligated at its origin from the pulmonary artery. Pressure in the left coronary system increased from 35/10 to 105/30 mm Hg. Since operation the patient has been relieved of her symptoms. There was no evidence of increased myocardial ischemia after ligation. This indicates that operative treatment of this anomaly can be carried out successfully in the older age group. It is also suggested that a fourth stage of progression of this anomaly occurs in which there is an exaggeration of the intercoronary communications between the right and left coronary systems. This produces such a large arteriovenous shunt that blood flow to the myocardium is again reduced, resulting in a “coronary steal syndrome.”

Mechanical Ventricular Assistance in Man

Mechanical cardiac massage by a pneumatic device which fits over the ventricles of the heart was studied in six patients with cardiac arrest who failed to respond to conventional means of resuscitation. Adequate arterial blood pressure, full peripheral pulses, respiratory efforts, small reactive pupils, reasonable cardiac output, and a low venous pressure were obtained for as long as four hours. In a 48-year-old patient ventricular fibrillation did not respond to external or internal massage and defibrillation in 35 minutes, and there was no ECG activity. With this instrument the circulation was supported for an hour (blood pressure 135/50). Defibrillation was then possible, and the patient survived for six days, dying of her primary disease process, which was unrelated to the heart. These studies are being continued and indicate that this approach may be helpful for cardiac resuscitation, for prolonged circulatory support, and for maintaining the circulation in potential donors for organ transplantation.

Ventricular arrhythmias in a patient with artificial pacemakers

Abstract The case of a patient is reported whose implanted pacemaker manifested different mal-functions, including the development of ventricular premature beats, tachycardia and fibrillation. The ventricular premature beats were satisfactorily controlled when the catheter pacemaker was turned off and the heart was paced only by the internal pacemaker. Successful emergency treatment of ventricular fibrillation included immediate cardiac massage, division of the internal pacemaker leads and external defibrillation. The cardiac rhythm was restored with the aid of a catheter pacemaker.

The adrenal cortex in hypertension: cause and effect.

Abstract Cushings syndrome, primary hyperaldo-steronism, congenital adrenal hyperplasia and Addisons disease are adrenal dysfunctional diseases usually associated with abnormal blood pressure levels. Adrenal regeneration hypertension and desoxycorticosterone hypertension represent experimentally induced adrenal dysfunction states in which hypertension occurs. Renal-adrenal relationships may result in the production of hypertension and secondary hyperaldosteronism in some patients. Adrenalectomy and subdiaphragmatic sympathectomy performed in 171 severely hypertensive patients have resulted in an excellent or good blood pressure response in 82 per cent of 105 survivors observed from 3 to 11 years after treatment.