1) Spectral phonocardiography was studied by the use of Sound-spectrograph. 2) Spectral phonocardiography gives better frequency analysis than the ordinary phonocardiography and the use of amplitude display gives better expression of variation in amplitude. 3) The use of ear-like characteristics for the preamplifier gives better recording than the flat characteristic used by McKusick. 4) Using the characteristics of spectral phonocardiography, frequency distribution of heart sounds and murmurs, especially their variation according to auscultatory area, was studied. Noise similar to heart murmur was experimentally produced and some considerations were made on the origination mechanism of heart murmurs.

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In 124 subjects consisting of normal controls and patients with various diseases, 203 determinations of cardiac output were performed by precordial dilution technic using I¹³¹ labeled human serum albumin. 1) Our standard technic was determined to direct the scintillation detector toward the apex of the heart from the left lateral to see the left heart predominantly and to take a blood specimen for calibration 5 minutes after the RISA injection, since the values obtained under these conditions revealed the best approximation to those obtained by direct arterial sampling method. 2) The values determined by our standard technic demonstrated a satisfactory reproducibility and a reasonable agreement with those determined by Fick method. Superiority of the digital type recording to the conventional analog ratemeter recording was described. 3) Orthostatic decrease in cardiac output was more marked in patients with neurocirculatory asthenia and in those with hyperthyroidism than in control cases. 4) After lifting the legs in recumbent position, cardiac output decreased in some patients with heart disease, while it remained unchanged in control cases and slightly increased in patients with hyperthyroidism. 5) Aminophylline increased the cardiac output in patients with heart failure, but not in control cases and in patients with compensated heart disease. Cedilanid increased the cardiac output in one patient with heart failure but no significant changes were found in the other patients and in control cases within a relatively short period of observation.

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1. The procedure of direct percutaneous left heart puncture is mentioned. 2. Cases of mitral valvular disease are classified by a circulatory dynamical analysis of the superimposed pattern of left atrial and left ventricular pressure curves. 3. Cases of aortic valvular disease are classified by a circulatory dynamical analysis of the superimposed pattern of left ventricular and ascending aortic pressure curves. 4. True lung blood volume, left atrial blood volume and left ventricular blood volume are calculated by an original method.

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From the experiences with "transseptal left heart catheterization" in 40 patients, this method has been proven to be relatively simple and safty in techniques. Therefore, the procedure can be carried out by any physician trained in the usual techniques of right heart catheterization. As the Brockenbrough method has had advantages over the Ross method in techniques and applications, the author would like to recommend the use of the Brockenbrough method hereafter. In this report, clinical application of this method to dilution method was demonstrated with relation to left atrial pressure. Further application of this method to the hemodynamic study will contribute to clarify the pathologic physiology of the left-sided heart disease.

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1) The method of estimating the average contact time through simultaneous measurements on the red cell component of the apparent pulmonary diffusing capacity and the effective pulmonary blood flow. 2) The physiological basis of the present method was introduced. 3) The average contact time in cases of normal healthy was ranged between 0.3-0.5 sec and that in cases of any cardiopulmonary diseases had revealed various degree of restriction. 4) The average contact time has been studied in relation with any haemodynamic factors of the pulmonary circulation and some physiological significance of the average contact time was reported. 5) As for the cause of the restriction of the average contact time, the authors have pointed out the following items : such as a) increase in cardiac output, b) decrease in effective pulmonary capillary beds, c) decrease in pulmonary blood volume, etc. 6) The importance and necessity of further investigations to give any definite conclusion on the physiological mechanism to cause any restriction of the average contact time was emphasized.

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A double lumen catheter was employed to examine the hemodynamics of the right heart. Also, the factors which cause pulmonary hypertension in anoxia were determined. The relation between the heart sound and the intersecting point of the ventricular and arterial pressure curves were that the second sound and the closing point of the pressure curve coincide well, but the first sound did not coincide well with the opening point of the curve probably because interference of sounds due to blood flow, myocardial vibration etc. When the pulmonary artery pressure rises (this includes the condition during induced anoxia) the effective expulsion time of the right ventricle shortens and the ventricle is forced to expell a certain amount of blood within a short time. In cases with no obstruction in blood flow, the pressure difference between the systolic right ventricular and pulmonary pressures decreases as the mean pulmonary arterial pressure rises. Thus, in combination with the fact noted in the above section, the right ventricle is placed in a state of an increased pressure load. When this state becomes more severe, the possible occurrence of right ventricular insufficiency can be predicted. This paper was made possible with the cooperation of Drs. Shinji WATANABE, H. YOSHINAKA, K. YAZU, R. YAZIMA, K. NARIYAMA, K. ASAKUMA, I. SUEMITSU, Shigeki WATANABE and T. OKUl.

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I would like to conclude that Grishman's system is more sensitive to RVH and Kimura's system is more sensitive to LVH, because Grishman's system has its electrode on the right side of chest and Kimura's has on the left side. In spite of the difference of lead system, QRS vectors deviate to right anterior direction in RVH and to left posterior superior in LVH. These deviations are the essential change accompanied with ventricular hypertrophy. Application of these facts to the aid of electrocardiographic diagnosis for ventricular hypertrophy makes diagnosis better. Kimura's pattern criteria is based theoritically o these spatial deviation of QRS vector and has not voltage factor which is easily affected by the thickness or deformity of chest wall and location of heart in thorax, etc. Therefore it is possible to pick up LVH by Kimura's criteria among the negative cases by voltage criteria and we think it is desirable to use both voltage and pattern criteria.

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ECG and VCG diagnosis has still various difficulties. In order to overcome these difficulties, following studies were attempted : 1) Various combinations of height of the waves recorded by Frank's orthogonal leads were compared as index for left ventricular hypertrophy. R_X/R_Y was most useful to differentiate LVH from normal and had larger positivity than some other criteria presented by various authors. On the one hand, R_X+ S_Y + S_Z was thought to be a better index for degree of LVH. 2) Differential curves of the second order of coronary T wave is considerably differed from that of usual negative T wave. Differences are also observed in the differential curve of the first order between the RS-T elevation in myocardial infarction and non-specific elevation. The differential curves are useful for objective recognition of shape of the waves. 3) Statistical diagnosis of disease by ECG findings was attempted by using Bayes' theorem without referring to other clinical data. Calculation with electronic computor showed fairly correct answers in various actual cases. Some of the results are indicated.

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The principle and method of ECG- and VCG reconstruction were outlined. The reconstructed VCGs of a normal and some hypothetical case of L.B.B.B., R.B.B.B., antero-lateral infarction and posterior infarction were comparatively demonstrated with the clinical cases of those VCGs respectively, and a good agreement in configuration was found between them. Four different lead systems, Grishman's, Frank's, the SVEC III, and the P III lead systems were examined with the lead vector of their three standard leads on the torso of a Japanese having a normal constitution by means of the torso model experiment. The three, Frank's, the SVEC III, and the P III lead systems were very close to each other in their componental lead vectors. In minor aspect, however, there was a noticeable difference in the Z axis component between Frank's and the SVEC III lead systems. The Z axis component in the former system was observed to become greater than that in the latter system as the location of the test dipole approached the sternum. The characteristic difference in the Z axis component between each system was also observed with some instantaneous vectors of reconstructed VCGs and clinical VCGs.

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