Interatrial septal murmurs were investigated by means of intracardiac phonocardiography and hemodynamics.
1) The murmur was detected in 77% of total 31 cases of secundum type ASD.
2) The murmur was localized at the site of septal defect and usually not transmitted widely because of the low intensity. It was essentially continuous, starting from late systole and continuing to diastole, and lowto medium-pitched. The systolic component was dominant at the left side of the septum, whereas the diastolic accentuation was observed at the right side of it. Respiration influenced the intensity and it was usually louder in expiration. Methoxamine intensified the murmur.
3) Hemodynamic study disclosed that the determinant was the interatrial (left-to-right atrial) pressure gradient mainly observed during the phase of v wave. Occasionally, pressure gradient of a waves was present with concomitant atrio-systolic murmur. The significance of the hemodynamic determinant was discussed.
4) The audibility of the interatrial septal murmurs by precordial auscultation depends on several factors which are discussed in detail. Rare instance, in which the murmur appeared in the 3rd left interspace, was demonstrated, and discussion was made on the detection of the murmur and its topographic localization.
5) Other diastolic murmurs, particularly that of relative tricuspid stenosis, were also investigated in order to differentiate from the interatrial septal murmurs.
6) The clinical meaning of the interatrial septal murmurs was mentioned.

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Hemodynamic, morphological and functional observations on the right ventricular outflow tract of tetralogy of Fallot were performed. The classification of the structures of the outflow tract into 3 types (I-localized infundibular hypertrophy, II-valvular stenosis and III-hypoplasia of the pulmonary trunk combined with infundibulovalvular stenosis) might be suitable and practical from the points of hemodynamic and angiocardiographic studies.
Morphological, histochemical and electron microscopic findings obtained in this survey revealed characteristic patterns shown in the dystrophied cardiac muscle structures secondary to possible hypertrophy. During the studies, effects of congenital cyanosis or intracardiac pressure on structures of the outflow tract of tetralogy of Fallot were found to be taken into consideration to locate a position as to hypertrophied or dystrophied muscle. Further investigations are necessitated in these points with more distinct presentations of cardiac nerve innervation.

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Digitalis is an essential drug in the treatment of congestive heart failure and various supraventricular arrhythmias. However, digitalis may produce or aggravate congestive heart failure and almost every known cardiac arrhythmia. A recognition of digitalis-induced arrhythmias is extremely important because cardiac arrhythmias may often indicate digitalis intoxication without any other signs.
One hundred and eighty patients with digitalis intoxication studied by this author were presented. The total incidence of digitalis-induced arrhythmias was 346 episodes. The overall incidence of ventricular arrhythmias was highest (104 patients) and, among these, ventricular premature contractions predominated. The basic rhythm was atrial fibrillation in 87 patients and almost all of these patients showed either nonparoxysmal A-V nodal tachycardia or A-V nodal escape rhythm. This information is extremely important since A-V nodal arrhythmia in the presence of atrial fibrillation are frequently misinterpreted as uncomplicated atrial fibrillation. Frequent occurrence of A-V dissociation with A-V nodal arrhythmias was emphasized. Nineteen patients had atrial tachycardia and A-V conduction disturbances were encountered in 64 patients.
Sudden appearance of rapid or slow heart action during digitalization should make one suspect digitalis toxicity rather than need for increased digitalis. Immediate recognition of digitalis toxicity particularly digitalisinduced arrhythmias and withdrawal of digitalis are essential to minimize the relatively high mortality.

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The characteristic values of renal Na regulatory system were determined during constant infusion experiment of hypertonic saline with and without physiological saline preloading. After physiological saline preloading renal threshold for Na rejection was lowered significantly. Aldosterone could not counteract this lowering of renal Na threshold. It is inferred that Na excretion after elevation of plasma Na concentration is linearly dependent on its concentration under both conditions with and without physiological salin epreloading. This finding is consistent with the single capacitive model of the first report. And aldosterone cannot control augmented overflowing Na rejection induced by conditioning volume and Na preload. This supports the dualistic concept in the renal Na reabsorptive mechanism.

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Prostaglandin E₁ (PGE₁) was infused directly into the left renal artery of anesthetized dogs. In the infused kidney, there occurred increases in sodium and water excretion with increased RPF and decreased E_PAH. Distinctly hypotonic urine was excreted even without solute diuresis in the infused kidney, when control urine and urine in contralateral kidney was hypertonic. Rapid washout of renal medullary urea was also observed in the infused kidney and transitory increase in urea excretion made urea to creatinine clearance ratio more than unity. The effects may have resulted from either hemodynamic effect alone or from both hemodynamic and anti-ADH effect of PGE₁. The present study may seem to support the presence of a direct anti-ADH action of PGE₁ in vivo.

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(1) ABC EGG tracings from proven cases of ASD are presented.
(2) An embryological origin for the EGG pattern is suggested.

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Two patients with calcific aortic stenosis were studied with cardiac catheterization and brachial arterial pulse pressures. The ejection time, first derivative and upstroke time of the brachial artery pressure pulse was compatible with severe aortic stenosis. On cardiac catheterization, only minimal aortic stenosis was found. These cases illustrate the importance of cardiac catheterization as the sole determinant in the final evaluation of aortic stenosis.

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A 74-year-old male is described who demonstrated an intermittent appearance of a right and left bundle branch block with varying P-R intervals. The best explanation of these electrocardiograms is that a bilateral bundle branch block is present. In spite of this conduction defect, the patient remains asymptomatic and has never developed complete heart block.

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Successful resection of an ascending aortic aneurysm under cardiopulmonary bypass associated with auxiliary carotid and coronary perfusion is reported. The advantages of the cardiopulmonary bypass such as the present method in surgery of aneurysms of the ascending aorta and aortic arch are discussed.

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