Many factors may affect the interventricular septal motion. This study measures the effect of pericardiectomy on septal motion in 9 patients who were evaluated 1 week to 58 months after pericardiectomy. Echocardiography was performed with the patient in recumbent position with the special care to record motion of the muscular septum and not that of the aorta. No patient had left bundle branch block, angina, myocardial infarction, pericardial effusion or right ventricular volume overload. Septal motion was paradoxical in 7, normal in 1 and could not be evaluated in 1 patient. The mean value of the right ventricular internal dimension was normal. Two of 9 patients had technically satisfactory echocardiograms preoperatively. Septal motion was normal in both, and both developed paradoxical septal motion postoperatively. We conclude that paradoxical septal motion follows pericardiectomy, but in contrast with other causes of this finding right ventricular internal dimension remains normal.

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The sequences of myocardial excitation in the cases of human LBBB have been studied by the surface mapping technique. Analysis of the surface map patterns of 12 subjects has enabled 4 different types to be described.
It is suggested that Type I represents a complete LBBB in the presence of an intact right bundle branch, while Types II and III show different degrees of conduction defect in the right bundle branch, too. The left ventricular activation of these 3 types has a similar pathway in phases II and III which is determined by orientation of the main subepicardial muscle layer coursing through the apex and terminating in the anterobasal region.
The terminal anterobasal activation in the cases of LBBB has not only theoretical, but clinical significance, since in the presence of anteroseptal myocardial infarction the signs of necrosis must be hidden not in the early, but in the terminal parts of the QRS complex of conventional ECG.
The lack of terminal anterior positivity of surface maps in the case of LBBB may be indicative of chronic anterior myocardial infarction.

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Indirect systolic time intervals corrected for heart rate were measured at rest, during, and immediately after the isometric handgrip exercise in 70 patients with progressive muscular dystrophy, and these were compared with the values of normal subjects. Those with dystrophy included 47 patients with Duchenne type, 19 with limb girdle type, and 4 with facioscapulohumeral type, and each type was subdivided into 2 groups by the severity of the skeletal muscle involvement: 1) mild group, included patients who were still able to walk, 2) severe group, included those who were restricted to wheel chair or confined to bed.
Over a half of the patients of the severe Duchenne type group had a longer pre-ejection period (PEP), shorter left ventricular ejection time (LVET), and larger PEP/LVET ratio at rest than the normal group. Increased PEP/LVET ratio during and after isometric handgrip exercise was observed in the severe group of Duchenne type. The patients with limb girdle type and facioscapulohumeral type showed no signifificant difference in values of the systolic time intervals at rest and during hangrip exercise compared with the normal subjects. The measurements of resting and exercise systolic time intervals may be useful for clinical recognition of latent left ventricular functional impairement in subjects with progressive muscular dystrophy.

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Hemodynamic responses to intramuscular injection of 5 to 10mg (average 8.5mg) of chlorpromazine were assessed in 10 patients with acute left-sided heart failure (treated group). Left ventricular filling pressure, blood pressure, heart rate, and cardiac index were measured before the injection and for 6 hours thereafter. In 8 patients with heart failure, the same hemodynamic monitoring was performed without the injection of chlorpromazine (control group).
In treated group significant reduction of left ventricular filling pressure was observed at 5min after the injection of chlorpromazine. Left ventricular filling pressure showed a peak reduction from an average of 27.2 to 18.8mmHg (-30.8%, p<0.001) at 15min, and a significant reduction persisted for 6 hours. At 15min, mean blood pressure was reduced slightly (101 to 92mmHg, -9.0%, p<0.05) and cardiac index tended to increase slightly (2.11 to 2.28L/min/M², +7.8%, NS). Heart rate was unchanged. Relief of symptoms of pulmonary congestion was also observed within 15min. Improvement of symptoms of pulmonary congestion was more prominent particularly in 3 patients who had severe dyspnea and stridor. In control group, left ventricular filling pressure, blood pressure, and heart rate showed no significant change over 6 hours.
The present study suggested that intramuscular injection of chlorpromazine at the dosage of 5 to 10mg showed rapid and marked clinical improvement without significant side effects and therefore its use may be indicated in patients with acute left-sided heart failure, especially in paroxysmal episodes.

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This is a report on the anatomical findings of 6 cases of typical Ebstein's anomaly found in a review of 1300 autopsy specimens. In addition 2 cases with pulmonary atresia and 1 with atresia of the malformed tricuspid valve showing morphologically similar anomalies were found, as well as 29 cases with tricuspid valvular dysplasia (21 of them coexisting with pulmonary atresia with intact ventricular septum).
The right ventricle was divided, in each case, in 2 parts separated by the abnormal valvular leaflets. The infundibular septum was very hypoplastic, its antero-medial prolongation forming a morphologically abnormal band superimposed upon the right side of the interventricular septum, ending inferiorly at the base of the anterior papillary muscle. The interventricular septum was thinner than normal, and so was the right ventricular free wall.
A constant finding was a superiorly placed valvular orifice, limited by anterior and septal leaflets. In three cases an apical orifice was found, limited by the septal and posterior leaflets and by a zone of the posterior wall of the right ventricle with no recognizable leaflet insertion.
The leaflets were rather easily identified. The anterior leaflet was demarcated by the 2 commissures of the superior orifice. The septal leaflet attached to the septum along an oblique line. The posterior leaflet, the least differentiated, inserted in the annulus, with its inferior border adherent to the ventricular muscular wall, forming a blind cavity in which chordae tendineae in different stages of development were found.
Microscopic findings included: myocytolysis, substitution of muscle fibers by connective tissue with some small scars, a great deal of capillaries and disorganization of muscle bundles, none of them being constant.

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Using a quantitative microscopic technique, we quantitated right and left ventricular interstitial tissue space vs. myocardial fiber space in 4 groups of autopsied hearts: 1) 5 normal hearts; 2) 5 hearts from infants _??_2 years old with tetralogy of Fallot; 3) 10 hearts from children 21/2-13 years old with tetralogy of Fallot, and 4) 5 hearts from adult patients _??_20 years old with tetralogy of Fallot. The proportions of interstitial tissue and myocardial fiber were quantitated using planimetry of the projected photomicrographs.
The proportion of interstitial tissue in Group II was similar to that in Group I, except for a mild increase of interstitial tissue in left ventricular apex of Group II. The proportion of interstitial tissue was significantly increased in Groups III and IV when compared with normal controls (p<0.001). When Groups II and III were compared, a significant increase of interstitial tissue in right ventricle (p<0.05) and left ventricular body (p<0.01) was noted in the latter group. And finally a comparison of Groups III and IV showed that although there was no difference between their right ventricles, and left ventricular apices, however the left ventricular body of Group III contained significantly more interstitial tissue and less myocardial fiber (p<0.001). It is thus demonstrated that up to 2 years of age both right and left ventricles of patients with tetralogy of Fallot were comparable to normals as far the proportion of myocardial fiber and interstitial tissue space were concerned.
After this age the proportion of interstitial tissue increases dramatically up to 13 years of age, In patients older than 13 years, the left ventricular myocardial fiber is further reduced with increasing interstitial tissue. Thus the anatomic correlate of myocardial dysfunction documented in older subjects with tetralogy of Fallot before and following total correction, consists of ever increasing interstitial tissue and loss of myocardial fiber, most probably due to persistent and chronic hypoxia. Total correction of tetralogy of Fallot prior to the age of 2, may prevent or halt the progression of such irreversible myocardial damage.

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The present communication deals with the observations made during the study of 140 hearts (138 from medico-legal postmortems and 2 from post-natal deaths). The formalin fixed heart was dissected to separate non-muscular portion (NMP), right ventricle (RV), and left ventricle with septum (LV+S).
The weights of the different components of the adult heart were affected by sex and body built and not by age or body length. In most of the hearts the total weight varied from 180 to 320Gm, the weight of RV, from 40 to 80Gm, and LV+S, from 100 to 180Gm. NMP was neither affected by age nor by ventricular weight. The coefficient of correlation between the heart weight and NMP was 0.93. Heart weight in Gm could be represented as equaled to 38.89+4.09 NMP.
LV+S/RV ratio ranged from 1.64-3.84: 1 in males and 1.73-3.1: 1 in females, average being 2.52: 1 and 2.44: 1 respectively. No correlation between the weights of RV and LV+S was found. An attempt has been made to lay down the criterion for normal heart and for ventricular hypertrophy. The importance of total heart weight, weights of ventricles and the ratio in assessment of cardiac hypertrophy is discussed.

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A possible effectiveness of atropine on variant form of angina pectoris was investigated using the left circumflex coronary arterial strips of dogs. Acetylcholine 10^-5-10^-3Gm/ml dose-dependently constricted the isolated arterial strips during potassium-contracture in 6 cases, and repetitive applications of acetylcholine could produce the similar contractions to the control. In 18 strips atropine 10^-6Gm/ml significantly depressed the contractions of coronary arteries induced by acetylcholine 10^-5-10^-3Gm/ml. In 5 arterial strips atropine 10^-6Gm/ml significantly inhibited norepinephrine-induced responses of these arteries, and by 10^-5Gm/ml further suppression of these responses was obtained. The results suggest that atropine may suppress the contractile responses of the coronary artery induced by acetylcholine and norepinephrine through a muscarinic-receptor blocking action and simultaneously partly through an adrenergic alpha-receptor blocking action.

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A small electromagnetic flowprobe was chronically implanted in circumflex branch of left coronary artery of mongrel dogs. Diltiazem, 100μg/Kg, was injected in a basilic vein of the unanesthetized dogs. The changes in phasic coronary flow as well as hemodynamics including aortic pressure (AP), heart rate (HR), and myocardial oxygen extraction ratio (OER) were in estigated. The increasing rates of total coronary flow (TCF) 5, 10, and 20min after the injection of the drug were 90%, 65%, and 40% respectively, Total coronary vascular resistence (TCVR) was inversly proportional to TCF, resulting in a significant decrease after injection. Five min after the drug administration, OER markedly decreased to the level of -45% of control value. The changes in aortic pressure (AP) and heart rate (HR) were unremarkable.
In clinical investigation, coronary atrery narrowings (spasms) observed by cine coronary arteriography in a patient with a variant form of angina pectoris were completely dilated after intravenous injection of Diltiazem.
In conclusion, Diltiazem exerted a powerful and long-acting vasodilator action on coronary vasculature. Although AP and HR showed unremarkable changes after the injection of the drug, OER decreased significantly. Results obtained suggest that Diltiazem can reduce myocardial oxyge consumption and OER and that the decrease in OER is attributed to not only the peripheral hemodynamic effect of the drug but also probable consequence of the direct action on the myocardium.

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The echocardiographic, scintigraphic, angiocardiographic and autopsy correlations in a patient with left ventricular pseudoaneurysm are presented. Interruption of the echo of the left ventricular wall and radioisotope image of pseudoaneurysm and its communication channel are demonstrated for the first time. The striking similarity of the radioisotope image to the angiographic image is noted.

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