Hemodynamic responses to the infusion of isoproterenol were studied in 21 patients using right and left heart catheterization. With the measurement of intracardiac pressure, the left ventricular volume was caluculated by the radioisotope dilution method of external monitoring. The patients were divided into four groups: 6 cases of mitral stenosis, 6 cases of mitral stenosis and aortic regurgitation, 5 cases of mitral and/or aortic regurgitation, and 4 cases of idiopathic cardiomegaly.
During the infusion of isoproterenol heart rate, cardiac index, mean systolic ejection rate and left ventricular minute work increased, and peripheral vascular resistance, stroke index and left ventricular stroke work decreased. Systemic blood pressure did not change. Left ventricular enddiastolic pressure and volume decreased with the increase in circumferential shortening rate.
In those with mitral stenosis, pulmonary and left atrial pressure increased markedly, resulting in an increase in the pressure gradient between the left atrium and ventricle. In those with mitral stenosis and aortic regurgitation, the elevation of pulmonary and left atrial pressure occurred less markedly than in those with mitral stenosis. Pressure changes in those with mitral and/or aortic regurgitation were not marked, and cardiac index decreased in 3 of 5 cases. In those with idiopathic cardiomegaly one case showed marked systolic pressure gradient at the outflow tract of the left ventricle during the infusion.
These hemodynamic effects are attributed to the strong positive chronotropic and inotropic action of isoproterenol as well as to the reduction of peripheral vascular resistance.

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We have established two formulae for analysis of left atrial pressure pulse, to provide indices called the pressure and time factors.
In mitral stenosis, the pressure factor is low and the time factor is high, while in mitral insufficiency, these are reversed.
When the pressure factor is found to be less than 50 and the time factor is more than 30, the patient probably has pure mitral stenosis. When the pressure factor is over 100 and the time factor is less than 20, mitral insufficiency is the probable diagnosis. In the intermediate group, i.e. when the pressure factor is less than 80 and the time factor more than 25 we consider pure mitral stenosis or mitral stenosis with regurgitation.

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The thyroid murmur was analyzed in respect to the various characteristics of the murmur per se, the changing aspects in the diseased state as well as the process of the therapy, and finally the pathogenesis by angiography and cast preparations of the thyroid.
1. The thyroid murmur was recorded in 37 out of 39 cases of hyperthyroidism and it was often continuous murmur with systolic accentuation. The murmur was best recorded at the isthmus of the gland, and the murmur over the right lobe was significantly louder in many cases. The reason of this localization was discussed, based on the anatomy of the vessels.
2. The intensity and duration of the murmur were well correlated with the severity of the signs and symptoms in the individual case. Thus it is concluded that the routine phonography of the thyroid gland has an important diagnostic value in the assessment of the diseased state as well as the objective judgement of the treatment.
3. Investigated by the angiography and cast preparations, the most probable origin of the thyroid murmur was mainly in the region of the arterio-venous and arterio-arterial anastomoses. The accessory importance of the other conditions, such as hyperkinetic state and the compression of the artery by the congestion of the gland, was also discussed.

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For coronary arteriography there are two methods available: semiselective filling and selective filling of the coronary arteries. Patients with various cardiovascular diseases were investigated by Paulin's semiselective method. Some illustrations are shown and the correlation between the results of coronary arteriograms and ECG signs are reported. The semiselective method offers reliable results in the verification of coronary artery disease.

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A clinicopathological study was made on a total of 6 cases of cardiac rupture following myocardial infarction, which was found among 50 cases of recent myocardial infarction with the incidence of 16%. Five out of 6 were women, age ranged from 68 to 88 with an average of 77 years old, and 5 cases showed a previous history of hypertension. In 3 cases both old and fresh myocardial infarctions were documented by electrocardiograms. Pathological examination showed the mixture of old scar or fibrosis and fresh myocardial infarction in all cases. Cardiac rupture occurred at the border of the old and fresh myocardial lesions presumed by increased strain at the junction area. Bizarre electrocardiogram at the time of cardiac rupture was shown in one of the cases, which was thought as extraordinarily rare.

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10% saline solution was infused in the dogs by constant infusion and single injection, and the changes in plasma Na concentration and urinary Na excretion rate were followed. The responses of animal to the two types of saline loading were analyzed in terms of a single capacitive system and a two compartment model. The two compartment model was con-structed by one extracellular and another intracellular compartments connected by leak at the cellular membrane and Na pump at the same site and by modulation of renal reabsorption of Na by the intracellular Na concentration. In the dog kidney, the experimental results were accounted for better by the threshold theory of the Na reabsorption than by the constant fractional reabsorption theory. Advantages and incompletenesses in the present model were discussed.

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Effects of experimental ventricular pacing on ventricular function were studied on 5 anesthetized dogs. The heart was stimulated by bipolar electrodes placed at the right atrial appendage and the epicardium at the apex or base of the left ventricle. Cineangiocardiographic analysis of the left ventricle was made and the sequential change in the shape of the left ventricle during ventricular contraction was compared among each of three stimulation sites.
A systolic expansion of the localized area of electrical stimulation was observed during stimulation at the base as well as at the apex of the left ventricle, but not during right atrial stimulation, and it was consistently reproducible in any given experiment. Correlation of individual cine frames to simultaneously recorded ventricular pressures revealed that the bulge developing in mid-systole reached its maximum size at the end of the ventricular ejection period and disappeared during the period of isovolumic relaxation of the ventricle.

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An autopsied case of quadrivalvular heart disease was described, in which pulmonary regurgitation due to possible bicuspid valve was predominant and tricuspid stenosis, mitral stenosis, and aortic stenosis with insufficiency coexisted. The patient was 47, and finally 53 years old female with long-term history of cough due to bronchial compression by the enormously dilated pulmonary artery. Clinical examination revealed massive pulmonary regurgitation, which was further substantiated by right heart catheterization and cineangiocardiography. The phonocardiograms and the reference tracings suggested the co-existence of tricuspid stenosis, aortic stenosis with regurgitation and mitral stenosis. Cardiac catheterization, intracardiac phonocardiography and angiocardiography also favored to the diagnosis of organic tricuspid stenosis. However, the ignorance of the presence of such an unusual combination misled to the precise antemortem diagnosis.
Discussion was made on the rarity of quadrivalvular heart disease, and the pathogenesis of this unusual pulmonary regurgitation was analyzed based on the autopsy finding and the history as well as the clinical manifestation. Finally, combination of the murmurs of organic and relative tricuspid stenosis was presented to explain the acoustical findings of the present case.

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A case of calcified patent ductus arteriosus was reported. The ductus was successfully divided under normothermic occlusion of the descending aorta utilizing cerebrospinal fluid drainage.
When calcification of the ductus is suspected radiologically, surgical manipulation should be performed with stand-by of cardiopulmonary bypass.

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