FOR more than a century physicians' have been aware of the clinical syndrome of postpartal nonvalvular myocardial disease of unknown origin. Sporadically cases have been reported and various etiologic theories proposed, but the relative rarity of this disease and inconsistent and incomplete descriptions have rendered difficult its understanding. Not the least of the problems is the lack of a universally accepted definition of the syndrome.2 There is little wonder that its very existence is disputed.3' 4 This report relates our experience with 15 patients with postpartal heart disease. The presentation is qualified by the fact that the distribution of our patients is probably skewed toward the more seriously ill category, since mild cases may not have been recognized or may not have been referred for hospitalization. Criteria for admission to our study consisted of (1) absence of the history, symptoms, and physical findings of heart disease prior to the puerperium, (2) appearance of signs and symptoms of heart disease between the first and twentieth week of the puerperium, and (3) inability to establish an etiologic basis for the heart disease. The 1week interval between delivery and admission to the study was chosen to eliminate patients who developed mild heart failure during delivery that was not recognized for several days as well as those with possible pre-existing cardiac diseases that became clinically recognizable during pregnancy.

Using 2 pumps specially constructed to simulate the right and left ventricles of the heart of man, it was shown that very small differences in output per stroke of the 2 pumps will result in a significant change in the volume of the "pulmonary" circulatory system and could become "pathophysiologically" im portant with time. These studies demonstrate that both ventricles must be well synchronized and regulated to maintain good health and to prevent dyspnea and other manifestations of CHF. They also indicate the inadequacy of the conven tional methods used for measuring cardiac output in man and the need to mea sure stroke volume or cardiac output of both ventricles separately and simultaneously. It must not be assumed that the cardiac output is always equal for both ventricles even in the presence of myocardial disease. An explanation is introduced for the acute onset of dyspnea associated with angina pectoris and with exercise. Also, the concept that the ventricles fill, at least in part, by "sucking" action is presented, with support from these and other theoretic considerations.

Lumbar sympathetic ganglionitis was found by light microscopy in 2 of 17 (12%) squirrel monkeys (Saimiri sciureus) experimentally infected with Coxsackievirus B4. This finding shows that viruses can cause ganglionitis which, in turn, must cause autonomic nervous system dysfunction. Such viral ganglionitis may explain some diseases, including cardiovascular ones, of poorly understood or unknown etiology which present with manifestations of dysfunction of the sympathetic nervous system.

Congestive heart failure (CHF) is a complex clinical entity which is still little understood pathophysiologically. Unless it is in the intractable state it responds well to therapy. It has been known for many years that the peripheral circulation can be dramatically altered when CHF is progressively and rapidly developing and worsening. As compensation develops, these changes gradu ally return to normal. We have long been studying the digital circulation of patients with CHF and have been impressed with the changes in the behavior of the peripheral blood vessels in these patients.

Mitral valve lesions were produced experimentally in three of nine squirrel monkeys inoculated intravenously or intraperitoneally with coxsackievirus B4 culture fluid. Aortic valve lesion also developed in one of these monkeys. Pathologic changes associated with acute, subacute, and chronic valvulitis noted in these monkeys are described. These studies demonstrate that coxsackievirus B4, a highly infectious agent to man, can produce valvular lesions in a nonhuman primate, the squirrel monkey. It is suggested that since coxsackieviral infection is common in man and since a substantial number of patients with chronic valvular heart disease present with no history of rheumatic fever and/or streptococcal infections, some instances of acute and chronic valvular disease in man generally attributed to rheumatic fever and the streptococcus are the result of viral infections instead of the streptococcus.

Coxsackievirus B4 infection of a spinal sympathetic ganglion of a squirrel monkey is described. Chromatolysis and neuronophagia were extensive. It is suggested that such viral sympathetic ganglial infections may be responsible for dysfunction of organ systems.

Pregnancy normally imposes changes in the cardiovascular system which usually aggravate any associated illness of the cardiovascular system resulting in aditional difficulty with the outcome of the pregnancy. The normal and abnormal changes associated with pregnancy are particularly prominent in the presence of heart disease. There are certain general clinical medical principles which should be considered in pregnancy and some of these are reviewed. Any woman contemplating or planning a pregnancy should be examined carefully for a complete medical inventory including cardiac evaluation prior to pregnancy. Patients with relatively mild heart disease at the time of pregnancy and delivery may experience no serious problems during the pregnancy and the delivery but over the succeeding years the cardiac disease is likely to worsen. Then the mother would suffer from the stresses of rearing a baby and may become incapacitated or die when the child is most in need of a mother. Thus planning and considerations for pregnancy must consider the future years as well as the immediate period of pregnancy. If a patient already has young children it must be judiciously determined whether or not she should undertake the risk of another pregnancy. The physician needs to discuss with the family the many implications risks advantages and potential problems that may ensue if pregnancy were to develop in the presence of the cardiac disease state. Once pregnant the patient should consult her family doctor immediately to evaluate her state of health and cardiac state in order to determine whether or not the pregnancy should be allowed to continue. Methods of managing a patient who is pregnant and suffering from heart disease are dependent upon many factors.

A recombinant human anti-herpes simplex virus monoclonal IgG1antibody and the corresponding Fab and F(ab′)2fragments were tested for efficacy in preventing vaginal transmission of HSV-2 infection in a well-established mouse model for genital herpes. IgG1, Fab, and F(ab′)2were approximately equally protective; vaginal delivery of 1–5 ng provided approximately 50% protection, and vaginal delivery of 400 ng completely protected mice from genital herpes infection (P< 0.001). These results suggest that topical applications of human monoclonal antibodies may be useful in developing new methods for preventing sexually transmitted disease.