Thirty-three patients with pure mitral stenosis were studied by radiocardiography and cardiac catheterization to assess changes in blood flow and the distribution of circulating blood. Radiocardiograms were analyzed by Kuwahara's model using an analog computer. The volumes of the right heart, lung, left heart and the rest of the whole circulatory system were obtained, as well as the cardiac output and the circulating blood volume (BV). Stroke index (SI) showed a tendency to decrease with diminished mitral valve area (MVA). In the presence of atrial fibrillation SI was 28% smaller than that of patients with sinus rhythm. The contribution of atrial contraction to the flow was inferred to be larger than in the normal hemodynamic state. A rough linear correlation was found between mean right heart volume (RHV) and mean pulmonary arterial pressure (PA_m) (r=+0.69). The relationship between RHV and MVA was smaller than 1 cm². Increase in mean left heart volume (LHV) was found but was not so prominent as that in RHV. The ratio of RHV to LHV showed a good linear correlation with PA_m (r=+0.81). Significant increase in pulmonary blood volume (PBV) was found. Multiple regression analysis revealed that in the group with lower pulmonary arteriolar resistance (PAR < 250 dynes·sec·cm^-5) the major determinants of PBV were BV and mean intravascular pressure (Pi). In the group with higher PAR (PAR&ges;250) determinants were BV and PAR, while Pi was not important. These findings suggest a decreased distensibility of the pulmonary vascular bed in patients with pulmonary hypertension. The present study revealed that severe mitral stenosis with pulmonary hypertension is associated with decreased pulmonary vascular distensibility, and that the sustained pressure load on the right ventricle leads to dilatation of the right chambers of the heart and to right ventricular failure.

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The forces acting on IVS were analyzed to delineate reciprocal effects of the two ventricles on the ventricular function as a whole. The resultant force (F_T) was dependent on the LV pressure but independent on the RV pressure. But the composite forces (F₁ and F₂) of F_T were affected by the LV and RV pressures. In a normal heart F₁ increased with increasing LV and/or RV pressures. But in F₂ increase occurred only with increasing RV pressure. In the LV pressure increase occurred only when the RV pressure was 10 mmHg and decrease did when the RV pressure was 50 mmHg, while stable at 30 mmHg. Directions of both the forces (F₁ and F₂) diverged as the RV pressure increased and the LV pressure decreased. When FRV was hypertrophic, increases of the magnitudes of the forces were decreased when the pressures of the LV and RV were higher. The angle between the forces was also decreased so that the efficiency of the forces was risen. When a portion of the ventricles lost its contractility, F_T increased, particularly, when FLV lost its contractility. But these increases seemed to well be within range of compensation.

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M-mode scan echocardiographic studies of the mitral valve were performed in order to investigate structural architecture of the diseased mitral valve. Structural lesion of the mitral valve was assessed by the echo-pattern change, an increase in number or thickness of the diastolic mitral echo complex. The echo-pattern was classified into 4 grades according to number or thickness of the mitral echoes. The echo-pattern grade correlated with the degree of the structural lesion of 21 surgically excised mitral valves. Clinically, the echo-pattern grade was compared with subsequent operative procedure in 56 cases with pure or predominant mitral stenosis (42 open commissurotomy, 14 valve replacement). Grade I or grade II echo-pattern was a good indicator for mitral commissurotomy. Grade IV pattern was a reliable criterion for valve replacement. Mitral valve replacement should be also considered in cases with grade III pattern, 38 percent of whom underwent valve replacement. C-E amplitude of the mitral valve was not a useful parameter in assessing the surgical procedure. Thus, the echo-pattern obtained by M-mode scan technique appeared to be of valve in planning the surgical approach for patients with pure or predominant mitral stenosis.

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Thirteen patients with aortic regurgitation (AR) and 13 with mitral regurgitation (MR) were compared quantitatively from the standpoint of their vectorcardiograms (VCG). Vectorcardiographic parameters were also compared with left ventricular angiographic parameters. The QR time interval was longer and the magnitude of the spatial maximum QRS vector was larger in the AR group, but these differences were thought to be attributed to the differences in length of the left ventricular long axis and the left ventricular end diastolic volume (LVEDV). In the AR group, the ratio of the width to the long axis of the QRS loop in the horizontal plane correlated well with the length of the left ventricular long axis and the angle made by the axis from the middle of the aortic valve to the left ventricular apex and the horizontal axis in the lateral view of the angiogram. In the MR group, these correlations were poor.

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The effect of glucagon on the renal hemodynamics in the dog was examined by comparing its effect with that of secretin, a peptide with which glucagon shares a similar chemical structure. An intrarenal infusion of glucagon resulted in increases of RBF and GFR. GFR rose by approximately the same order of magnitude of RBF. The increase in GFR depended on the selective dilation of the afferent arteriole and a consequent rise in the transcapillary pressure difference. On the other hand, secretin infusion produced highly significant and proportional decreases in both afferent and efferent arteriolar resistance, resulting in no change in GFR. A superimposition of acetylcholine to glucagon decreased GFR even though RBF increased significantly. Glucagon infusion did not affect the permeability of glomerular capillary and the distribution of cortical blood flow. These findings indicate that the effect of glucagon on GFR depended on the selective dilation of afferent arteriole, and that as a result of its dilation the net filtration pressure increased without any change in permeability of glomerular capillary and a redistribution of filtration.

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The contrast media used contains 10-40 mg/dl of EDTA2Na as stabilizer, and its effect on cardiac contraction during selective coronary angiography was studied experimentally. When EDTA2Na was added to the blood, the Ca⁺⁺ was almost completely chelated at levels of more than 80 mg/dl. EDTA2Na was added to 10ml of blood at varying concentrations and injected into the LAD artery of laboratory dogs, and the changes related to the concentration were observed in regard to the left ventricular pressure, max.dp/dt/ P, cardiac output, contraction in the LAD area and the LCF area, and ECG. There was observed no marked reduction in the LAD area was marked. When the concentration was over 60 mg/dl, paradoxical systolic expansion began to appear. Depending on the concentration of EDTA2Na, the QT interval was prolonged and the ventricular extra systole increased in frequency; ventricular fibrillation occurred in 16% of the dogs at 60 mg/dl, in 68% at 80 mg/dl and in all the dogs at 100 mg/dl. This study demonstrates that the administration of EDTA2Na produces significant transient changes in ECG and cardiovascular function and that it is one of the factors involved in these changes observed during selective coronary angiography with angiographic agents containing EDTA2Na.

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An adult renal transplant recipient was complicated with cryptococcal lung granuloma and meningitis. Treatment with the antifungal agents, 5-fluorocytocin and clotrimazole had to be discontinued due to side effects. Whereas, the intrathecal administration of amphotericin B proved effective for meningitis but intravenously it induced acute tubular necrosis to the transplanted kidney. Inorder to cure the persistant fungal lung granulomas in renal transplant patients early surgical excision seems to be essential. C'est un cas adulte d'un transplante renal complique par la cryptococcose granulomateuse pulmonaire et meningique, qui a ete ulterieurement traitee avec succes par l'excision partielle d'un poumon. Traitement avec des agents anti-fongique, 5-fluorocytocine et clotrimazole, a ete force d'arreter a cause des effects secondaires nefasts. Alors, l'administration intra-thecale d'amphotericine B a ete trouvee efficase pour meningite, mais ensuite, puand elle a ete donne par la route intra-veneuse, elle a provoque necrose tubulaire aique du rein greffe. Pour obtenir la guerison du granulome pulmonaire fongueux persistant chez les transplantes renaux, une intervention chirurgicale precoce semble indispensable.

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We reported on the autopsy of a 35-year-old man who had mixed levocardia with situs inversus including atrial inversion, transpostition of the great vessels, and other complex cardiac malformations. Levocardia was discussed.

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A case of Fabry's with pulmonary regurgitation is reported, and the cause of valvular involvement, the electrophysiological mechanism of the short PR interval, and the usefulness of the endomyocardial biopsy method in an attempt to establish the diagnosis in Fabry's disease have been discussed.

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In sick sins syndrome, a sinus arrest is induced by a marked decrease in the automaticity of the sinus node, and a sino-atrial block is also induced by a conduction disturbance of impulse in the region of the sinus node. Consequently, it is not rare that a long cardiac asystole occurs in sick sinus syndrome. In most of these cases, however, an escape beat originated from the atiroventricular junction appears and prevents Adams-Stokes' attack accompanying the cardiac asystole. It is clear, therefore that the automaticity of the A-V junction plays quite an important role in these cases. Studies on the automaticity of the A-V junction, however, have not intensively been carried out. Then the author experimentally treated dogs' hearts so as to beat with A-V junctional rhythm and evaluated the automaticity of the A-V junction on the bases of the following parameters : (1) the spontaneous heart rate of each dog and (2) the degree of overdrive suppression upon each dog. Furthermore, to clarify functioning of the autonomic nerve in the automaticity of the A-V junction, agents for blocking the vagus or the sympathetic nerve were examined for effect upon the parameters. Method : 1. Preparation of dogs with A-V junctional rhythm and control dogs with sinus rhythm. A total of 26 adult mongrel dogs were used. Under anesthesia by intravenous injection with 30mg/kg of pentobarbital, the chest was opened through a midline incision, and a pericardial cradle was made. Then, an electric coagulator was used to induce thermal coagulation at the sinus node region (about one-third of the whole right atrium.) Twenty-two dogs out of twenty-six succeeded in displaying A-V juctional rhythm on the electrocardiogram. A-V junctional rhythm was judged from the following criteria in limb lead electrocardiograms : (1) there was no P wave which would precede QRS complexes, (2) QRS complexes showed essentially the same wave patterns as those presented at the time of sinus rhythm, and (3) the cardiac beats were regular.

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As a noninvasive method to determine the location and the extant of myocardial infarction, a body surface isopotential map is expected to have some advantages over a conventional electrocardiogram (ECG) or a vectorcardiogram, because of its greater number of leads points. We examined 15 cases with myocardial infarction by the body surface isopotential map, and the results were analyzed in correlation with ECG and the coronary angiographic findings (CAG). Material and Methods : The clinical material consisted of 15 patients with old myocardial infarction. The diagnosis was based upon clinical hictories, physical and laboratory findings, and abnormal Q waves in ECG. The abnormal Q and QS patterns were classified according to the criteria of AHA committee report. All cases had significant (90% decrease in diameter) obstructions in one of the major coronary arterise. In 10 cases, the obstructions were located in the anterior decsending branch of the left coronary artery (LAD), and in the remaining 5 cases, the obstructive lesions were in the right coronary arteries (RCA). Body surface isopotential maps (MAP) were constructed of unipolar lead ECG recordings from 85 lead points over the chest surface. Data were computer-processed and the potentials were plotted as sopotential maps at 1.5 msec intervals the QRS deflection. Results : The cases with LAD obstructions were classified into following three groups according to their sites of obstructions in LAD; group A whose obstructions were located in the proximal portion of LAD, group B whose obstructive sites were in the middle portion of LAD and group C in which obstructions were in the apical portion of LAD. Each group had its own characteristic map pattern. Five cases with RCA obstructions also showed a characteristic pattern.

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