In 80 cases of complete right bundle branch block and 21 cases of complete left bundle branch block, a parabolic relationship between QRS duration and the split interval of the second heart sound was established. However, the relationship was not so very close, and the exceptions mainly due to hemodynamic burdens co-exist were not infrequent. Clinical significance of the relationship was discussed and the mechanism of reversed splitting of the second heart sound in complete left bundle branch block was analyzed in a case of alternating QRS duration. At least in this case, the prolongation of isometric contraction had the most important significance to the occurrence of the reversed splitting.

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The heart sounds in 244 cases of bundle branch block observed during the years 1926-1963 were measured in the quantitative symbol phonocardiograms and electrophonocardiograms. Splitting of the first sound occurs rarely in both right and left bundle branch block and is most likely to be detected at the apex. In the QSPcg's. splitting of the second sound occurred in about 40% of Series A (1926-1952) and 80% of Series B (1952-1963) at the left border of the sternum near the fourth inter costal space with the patient in the sitting position. In Series B, auscultation with the patient in the dorsal recumbent posture, splitting was detected in only 60% at this area. The tables depict the frequency of splitting at all areas of auscultation. The left ventricular components of both the first and second sounds are shorter than normal. A first sound of markedly reduced loudness occurs with somewhat increased frequency in left bundle branch block. The range of loudness of the first sound is otherwise normal in both types. The right ventricular component (tricuspid and pulmonic) is a short thud which is rather faint in about twothirds of cases and about half the loudness of a normal first sound in the remaining third. The interval of quiet between the 2 components does not vary with respiration but the loudness of the pulmonic component increases during inspiration and decreases during expiration, sometimes to the point of extinction. Left bundle branch block is strongly suggested when the pulmonic component precedes the aortic. A rare exception occurs when pulmonary arterial pressure is high enough to make the pulmonic component in the case of right bundle branch block louder than the aortic which precedes it. In about a third of cases of right bundle branch block, physiologic splitting of the first sound could be detected which indicates that this type of split does not depend upon asynchronism of the ventricles. In about 20% of cases with satisfactory electrophonocardiograms, splitting was absent although it was detected by clinical auscultation in the sitting postion. This probably results from the fact that during clinical auscultation the pulmonic component of the second sound became inaudible in about 30% of cases when the position was changed from sitting to dorsal recumbent. The electrophonocardiograms were recorded in this latter posture. The absence of splitting in any posture in some instances is due to the faintness of the right ventricular components of the first and second sounds. In others, it may be due to the fact that the electrocardiogram may present the pattern of bundle branch block but the mechanical events may not be correspondingly asynchronous.

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(1) Five patients with the ruptured aneurysm of the aortic sinus were presented. They were all male and 27, 18, 14, 32 and 31 years of age, respectively. Four of them were treated surgically with success, but one patient died due to the progressive congestive heart failure before surgery.
(2) Operative findings revealed the aneurysm of the aortic sinus ruptured to the right ventricle in 3 cases and ruptured to the right atrium in 1 case. The additional ventricular septal defect adjacent to the aneurysm was associated with in each case in the former. Autopsy of the succumbed case was refused.
(3) Operative procedures were performed in all cases through the right-sided heart and their symptoms completely subsided. Neither recurrence of aneurysm nor residual aortic insufficiency could be demonstrated in followup.
(4) Etiologic mechanism, pathological anatomy, clinical features, prognosis and surgical treatment of the ruptured aneurysm of the aortic sinus were briefly discussed.

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Effects of electrical stimulation of the mesencephalic pressor area (central gray stratum and adjacent portions) on renin release were studied in the chloralosed dogs.
Renin release was measured by simultaneous collection of arterial and venous blood samples taken by the catheter introduced into renal vein under fluoroscopy.
Mesencephalic stimulation provoked marked increase in renin release. Dorsal portion of mesencephalic pressor area is more effective than ventral portion in inducing renin release.

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Right ventricular isometric systolic tension (IST) was measured with a strain gauge lever system prior to and 25-30 days following surgically induced tricupid insufficiency and pulmonary stenosis (TI and PS), each animal serving as its own control. IST was shown to be markedly reduced (53.7%) in heart failure dogs with TI and PS. This decrease in IST was accompanied by a 26.8% increment in heart rate and a decrease in the rate of myocardial relaxation. These and several other factors were discussed in relation to cardiac reserve and decompensation.

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(1) All available electrocardiograms of 697 cases of consecutive autopsies over the age of 60, including 82 cases of myocardial infarction, were reviewed with respect to the Q and QS patterns classified by the Minnesota code.
(2) Abnormal Q and QS patterns meeting the criteria of the I-1, -2 and -3 classifications were observed in 143 cases or 20.5% of all 697 cases. These patterns appeared in 101 cases or 16.4% of the 615 cases without myocardial infarction, and in 42 cases or 51.2% of the 82 cases with myocardial infarction.
(3) The I-1 classification, especially of the persistent type, showed a high diagnostic reliability for myocardial infarction. The I-2 and the I-3, on the other hand, showed a low diagnostic accuracy regardless of the type of their appearance.

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(1) Frank lead vectorcardiograms of 348 autopsy cases, including 43 cases with myocardial infarction, were reviewed and the results were compared with the pathologic observations.
(2) The correct diagnosis of myocardial infarction was possible in 30 of 43 autopsy-proved cases in the vectorcardiogram. Two of these 30 cases were not diagnosed by the routine electrocardiogram. On the other hand, the vectorcardiogram missed a diagnosis of myocardial infarction in none of the 28 cases of autopsy-proved myocardial infarction diagnosed by routine electrocardiography.
(3) The overdiagnosis of myocardial infarction in the vectorcardiography was made in 11 of 305 cases without extensive myocardial fibrosis at later autopsy. Nine of these 11 cases were misdiagnosed as anterior infarction, while the remaining 2 were misinterpreted as inferior infarction.
(4) The necessity of considering the possibility of overdiagnosis of myocardial infarction in reading vectorcardiograms was pointed out, although the present observations suggest the superior sensitivity of vectorcardiography to routine electrocardiography.

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The analyses and description of the preoperative and postoperative vectorcardiogram (Frank lead system) in 28 patients with persistent common atrioventricular canal were presented.
(1) QRS loop in the frontal plane showed characteristic pattern, but not in the horizontal plane.
(2) In the group associated with pulmonary stenosis, the maximum vector was situated in the right superior quadrant in the frontal plane, and in the right posterior quadrant in the horizontal plane.
(3) In the same group, almost all T loop in the horizontal plane was inscribed in a counterclockwise fashion.
(4) Left axis deviation may be brought about by not only anomalous conduction pathway but also left ventricular overload.

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A case of 17-year-old Japanese girl with Takayasu's disease or arteritis associated with elongated coarctation was reported. In addition to ordinary ophthalmoscopic examination, fluorescein retinal angiography revealed severe ischemia in the eye, suggesting imminent blindness. Aortography disclosed occluded left carotid and subclavian artery, stenosed right innominate artery and elongated coarctation in the descending aorta.
Prosthetic bypass graft between thoracic and abdominal aorta with a branch to the left carotid bifurcation was placed. After surgery ocular manifestations disappeared and pedal arteries regained strong pulsation.
Vascular surgery should be considered in patients with Takayasu's arteritis in whom steroid therapy failed.
Ophthalmoscopical examination is useful in determination of operative indication.
Cerebral blood flow was maintained by systemic hypertension due to coarctation of aorta. Corrective measure in the vessels to the brain should be performed first.

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In the present case, tumors originated from endocardium just under the ulmonary valve orifice. They were polypoid and extended along the pulmonary trunk to the right and left pulmonary arteries, and metastasized to the left ventricle and left adrenal. Histologically, they consisted of fibromyxoma, fibromyxosarcoma, and liposarcoma. Finally, the patient died from acute cardiac tamponade caused by the bleeding from the left ventricular metastatic lesion.

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