SUMMARY In 18 immature mongrel dogs (3-4 weeks of age), anesthetized with chloralose and morphine, the hearts were arrested with potassium chloride and excised. After reproducible curves relating pressure and volume in the left ventricle (LV) had been obtained, each LV was fixed by coronary perfusion with glutaraldehyde while pressure was maintained at a predetermined value between 0 and 30 mm Hg. Midwall sarcomere length in the LV free was determined by electron microscopy and was related to fixation pressure and to postfixation volume by silastic casts. Casts also were used to measure ventricular chamber dimensions. Results were compared with previous results for adult dogs. In the immature canine LV, the relation of sarcomere length and pressure is similar to that of the adult dog at physiological pressures. Above IS mm Hg, sarcomeres resist stretch significantly with immature LVs fixed between 15 and 30 mm Hg pressure with an average sarcomere length of 2.21 ± 0.05 fim in contrast to adult sarcomere length of 2.33 ± 0.01 Jim (P < 0.05). In the immature heart, electron microscopy demonstrated reduced cell size and evidence of assembly of immature sarcomeres from myofilaments. Compliance is reduced in the immature canine LV at pressures greater than 5 mm Hg as demonstrated in pressure-volume curves analyzed by exponential curve fitting. Measurements of silastic casts indicate a close geometric similarity between the immature and adult LV. Thus, whereas the ultrastructural limits on performance are similar in the adult and immature canine LV, the latter LV may be better protected against damage from volume overloads. Ore Res 44: 879-691, 1979

We used standard nicroketrode to record action potentials of human right trial fibers obtained during cardiac surgery, and correlated these potential with dinical and preoperative ECG data. Human atrial fibers were classified as follows: Group A (ten patients) had a maximum diastolic potential (MDP) of -71.4 ± 5.1 mV (mea ± SD), and actin potentials that were primarily fast pe These atria were normal or sdghty dilated. In group B (12 patients) MDP was 50.3 ± 5.7 mV; action potentials were slow responses and the atria were moderately to

Twelve patients with cor triatriatum sinistrum were treated over a 28-year period. Their ages ranged from 1 month to 7.5 years. Congestive heart failure was the most common presentation. Cardiac catheterization was performed on six of the 12 patients and a correct diagnosis of cor triatriatum was made on angiography in only four of the six. Of the remaining six patients, three were diagnosed as having cor triatriatum by echocardiography and three by autopsy. Echocardiography is now considered to be the diagnostic modality of choice in our institution. Seven patients were operated on and five died prior to diagnosis or treatment. Associated cardiac anomalies included persistent left superior vena cava, atrial septal defects, coarctation of the aorta, and total anomalous pulmonary venous drainage. A right atrial, transseptal approach to the common pulmonary chamber and excision of the left atrial membrane was found to be the treatment of choice and was used in six of the seven patients operated on. One patient died in the postoperative period. Thus, cor triatriatum sinistrum, a rare and potentially lethal congential cardiac anomaly, can be diagnosed by echocardiography and successfully treated surgically with a low operative mortality.

Medical treatment has a small role in the management of the symptomatic infant with critical aortic stenosis. Surgical intervention offers the only hope of survival; but even then, the reported mortality has been high in the past. At present, improved techniques and surgical results warrant reassessment of this high-risk lesion, and the experience at Columbia Presbyterian Medical Center with 31 infants with critical aortic stenosis is now reviewed.

Coronary artery bypass surgery (CABS) has been shown to reduce angina, as well as to prolong life in some subsets of patients [1–4]. Studies of the postoperative quality of life are now considered important in further justifying the use of this costly procedure.

Fibrin glue derived from pooled human blood is an effective sealant for high-porosity vascular grafts and a valuable topical hemostatic agent in heparinized patients. Use of this agent in the United States is prohibited because of potential transmission of hepatitis B, acquired immunodeficiency syndrome, and other serologically transmitted illnesses. We have developed a cryoprecipitation technique that allows preparation of fibrin glue from single-donor fresh frozen plasma. Use of this agent presumably entails no greater risk of disease transmission than intravenous administration of single-unit fresh frozen plasma. This report describes our early clinical experience with this material. Fibrin glue was used as a sealant for porous woven Dacron tubular prostheses and cardiovascular patches in 19 patients. The fibrin glue sealant has also been employed to control bleeding from needle holes and small anastomotic tears in 22 patients. No patient in this series had a bleeding complication from a suture line or graft treated with fibrin glue. This experience indicates that like fibrin glue from pooled blood, fibrin glue from single-donor plasma is effective as a graft sealant and topical hemostatic agent. Preparation of fibrin glue from single-donor plasma is simple and economical, and may provide cardiothoracic surgeons in the United States with a widely available, valuable hemostatic adjunct.

Fibrin glue is used widely in Europe as a tissue sealant and hemostatic agent. The European glue is prepared commercially from pooled human blood. It is not available in this country because of the risk of transmission of hepatitis B, acquired immune deficiency syndrome, and other blood-transmitted diseases. We describe a cryoprecipitation technique for preparation of fibrin glue from single-donor fresh-frozen plasma. This technique enables the glue to be made in large quantities with no greater risk of disease transmission than with that from the transfusion of single-unit fresh-frozen plasma. We have found that the glue is a useful tool in surgery. By helping to control difficult bleeding, its use can decrease the need for blood transfusions and shorten operating room time. It also is effective as a means to pretreat highly porous vascular prostheses that currently are used infrequently because of bleeding. These porous grafts offer potential advantages in handling, suturing, and long-term patency. This new technique of fibrin glue preparation may make this useful surgical adjunct as readily available in this country as it is in Europe.

In 31 dogs chronically beta blocked with oral propranolol (12 to 14 mg/kg/day), glucagon (20 üg/kg) and combined dopamine (10 üg/kg/min) and isoproterenol (0.2 üg/kg/min) were given intravenously and tested for hemodynamic efficacy. Dogs were divided into four groups. Basal hemodynamics were obtained in Group I (n = 8) without cardiopulmonary bypass. In Group II (n = 8), hemodynamics were studied after 15 minutes of global ischemia during cardiopulmonary bypass. In Group III (n = 8), hemodynamics were studied after regional ischemia produced by ligation of the proximal left anterior descending coronary artery. In Group IV (n = 7), myocardial oxygen consumption and left ventricular mechanics were studied before and after 1 hour of cardiopulmonary bypass. Our results indicate the following: (1) Dopamine-isoproterenol improves hemodynamics in basal, post-global ischemic, and post-regional ischemic states. Glucagon improves hemodynamics either insignificantly or to a lesser extent than dopamine-isoproterenol. Furthermore, glucagon produces a larger increase in heart rate, which is not desirable. (2) Both dopamine-isoproterenol and glucagon increase myocardial oxygen consumption in comparison with control.

A technique is presented for recording four simultaneous electrograms from the heart during operation for cardiac arrhythmias. This technique permits intraoperative maps of cardiac electrical activity to be constructed more rapidly than is possible with single-point mapping, thereby decreasing the risks to the patient and yielding more information about cardiac events.

One hundred consecutive patients who underwent coronary artery bypass surgery at the Columbia-Presbyterian Medical Center from December 1972 through February 1975 were evaluated at surgery and then followed for as long as 4 1/2 years to study their postoperative psychosocial and behavioral course. One patient died during the first 30 days. At 4 1/2 years, 23 patients were reported as deceased, 15 from cardiac causes. The majority of the long-term survivors had substantially less angina and greater exercise capacity; surgery did not increase the number of patients who were employed, but led to substantial improvements in the quality of life, including general pleasure, reduction of anxiety and depression and subjective improvement in job and family roles. Sexual adjustment improved the least; the frequency of sexual relations tended to decrease. Compliance with the medical regimen was relatively good for smoking and exercise, but not for diet or type A behavior, suggesting a need for psychological intervention.

We used standard microelectrode techniques to study the effects of histamine on right atrial tissues from patients undergoing corrective cardiac surgery. In the 10(-6) to 10(-4) M range, histamine increased maximum diastolic potential, action potential amplitude, and automaticity. In some preparations, histamine also induced delayed afterdepolarizations and triggered activity. The potency of histamine in increasing automaticity was about 10 times less than that of epinephrine. Propranolol (2 x 10(-7)M), which abolished the chronotropic effect of epinephrine, did not alter the effect of histamine. Conversely, the effect of histamine but not that of epinephrine was antagonized by cimetidine (3 x 10(-6) to 1 x 10(-5) M). This suggests that H2 receptors mediate the chronotropic effects of histamine on the human heart. The slow channel blocker verapamil (2 x 10(-8) to 2 x 10(-6) M) counteracted the effects of histamine on automaticity, delayed afterdepolarizations, and triggered activity, suggesting that in human atrium histamine may act by increasing slow inward (presumably Ca2+) current. If one considers these arrhythmogenic effects of histamine and the fact that human cardiac tissue contains large amounts of histamine, our experiments lend further support to the concept that histamine release can induce arrhythmias.

We determined the incidence of cardiac arrhythmias in children post cardiac surgery, the cardiac malformations associated with specific arrhythmias and the ECG characteristics of the arrhythmias. Continuous 2-lead ECG's were recorded in 26 consecutive patients (ages 2 mos-13 yrs) during the first 24 hours after open heart surgery. The most frequent non-sinus arrhythmia was atrioventricular junctional tachycardia (JT) which occurred in 9 patients (39%). Ventricular, junctional and atrial premature depolarizations were infrequent (<5 beats/hr in 16 patients) and atrial tachycardia occurred in 1 patient. JT occurred mainly in patients with tetralogy of Fallot (4 of 5) and endocardial cushion defects (3 of 3). Two types of onset of JT were seen, often in the same patient: the first occurred following sinus pauses > the duration of the basic cardiac cycle (i.e., occurring as accelerated junctional escape); the second occurred when sinus tachycardia supplanted normal sinus rhythm and then was overdriven by an accelerated junctional focus. The second type of onset is consistent with reentry or triggered activity; the first, with an automatic focus. Both JT had similar QRS morphologies and axes and appeared unrelated to perioperative medication and acid-base and electrolyte status. The high incidence of JT after open heart surgery is of interest because of its infrequency in the general pediatric population. It may result from surgical manipulation of the AV junction and it appears that more than one mechanism is responsible for its initiation.

HomeCirculation ResearchVol. 47, No. 2Mechanisms for impulse initiation in isolated human atrial fibers. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBMechanisms for impulse initiation in isolated human atrial fibers. L Mary-Rabine, A J Hordof, P DaniloJr, J R Malm and M R Rosen L Mary-RabineL Mary-Rabine , A J HordofA J Hordof , P DaniloJrP DaniloJr , J R MalmJ R Malm and M R RosenM R Rosen Originally published1 Aug 1980https://doi.org/10.1161/01.RES.47.2.267Circulation Research. 1980;47:267–277 eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. 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Kimura S, Bassett A, Kohya T, Kozlovskis P and Myerburg R (1987) Automaticity, triggered activity, and responses to adrenergic stimulation in cat subendocardial Purkinje fibers after healing of myocardial infarction., Circulation, 75:3, (651-660), Online publication date: 1-Mar-1987. Gintant G and Hoffman B (1987) The Role of Local Anesthetic Effects in the Actions of Antiarrhythmic Drugs Local Anesthetics, 10.1007/978-3-642-71110-7_7, (213-251), . Gilmour R and Zipes D (1987) Pathophysiology of Cardiac Arrhythmias Clinical Disorders of Membrane Transport Processes, 10.1007/978-1-4684-1286-4_5, (75-93), . Johnson N, Danilo P, Wit A and Rosen M (1986) Characteristics of initiation and termination of catecholamine-induced triggered activity in atrial fibers of the coronary sinus., Circulation, 74:5, (1168-1179), Online publication date: 1-Nov-1986. Rosenshtraukh L, Urthaler F, Anjukhovsky E, Beloshapko G, Hageman G and James T (1986) Serial production of controlled periods of temporary heart block used to unmask and assess latent ventricular automaticity during experimental acute myocardial ischemia, Journal of the American College of Cardiology, 10.1016/S0735-1097(86)80035-3, 8:1, (95A-103A), Online publication date: 1-Jul-1986. Escande D, Coraboeuf E, Planché C and Lacour-Gayet F (1986) Effects of potassium conductance inhibitors on spontaneous diastolic depolarization and abnormal automaticity in human atrial fibers, Basic Research in Cardiology, 10.1007/BF01907407, 81:3, (244-257), Online publication date: 1-May-1986. Lee Y (1986) Pathophysiological mechanisms of altered transmembrane potentials in diseased human atria, Journal of Electrocardiology, 10.1016/S0022-0736(86)80006-1, 19:1, (41-49), Online publication date: 1-Jan-1986. 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Moak J and Rosen M (1984) Induction and termination of triggered activity by pacing in isolated canine Purkinje fibers., Circulation, 69:1, (149-162), Online publication date: 1-Jan-1984.Brachmann J, Scherlag B, Rosenshtraukh L and Lazzara R (1983) Bradycardia-dependent triggered activity: relevance to drug-induced multiform ventricular tachycardia., Circulation, 68:4, (846-856), Online publication date: 1-Oct-1983. Zipes D, Heger J and Prystowsky E (1983) Pathophysiology of arrhythmias: Clinical electrophysiology, American Heart Journal, 10.1016/0002-8703(83)90004-2, 106:4, (812-828), Online publication date: 1-Oct-1983. Wit A and Rosen M (1983) Pathophysiologic mechanisms of cardiac arrhythmias, American Heart Journal, 10.1016/0002-8703(83)90003-0, 106:4, (798-811), Online publication date: 1-Oct-1983. 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Hemodynamic effects of isoproterenol, dopamine, and epinephrine were studied before and after acute beta-adrenergic blockade in 16 open-chest, anesthetized mongrel dogs. Beta blockade was induced with 1 mg. per kilogram of intravenous propranolol. Cardiac output measurements were obtained by thermal dilution, and pressure recordings were obtained in the right ventricle, pulmonary artery, left atrium, left ventricle, and aorta. Derived parameters included stroke volume, pulmonary and systemic vascular resistances, and peak left ventricular dP/dt. In the presence of propranolol, epinephrine became a lethal drug in large doses and did not increase cardiac output in standard doses. Dopamine, in 25 to 50 mcg. per kilogram per minute doses, increased arterial pressure and systemic resistance; cardiac output was diminished compared with dopamine, 10 mcg. per kilogram per minute, prior to propranolol, as a result of increased resistance and decreased LV contractility. Isoproterenol, 0.6 to 0.9 mcg. per kilogram per minute, 15 to 20 times standard dosages, had moderately positive inotropic effects and increased cardiac output. Left ventricular systolic pressure with isoproterenol after propranolol was reduced when compared with effects of smaller doses prior to propranolol. These observations suggest that none of the catecholamines studied would be optimal for circulatory support in heart failure in the presence of propranolol. The present results define a pharmacologic basis for design of appropriate drug combinations for circulatory support in beta-blocked animals.

Statistical data on surgery for congenital and acquired heart disease in New York City in the 17 years from 1961 through 1977 and in New York State in 1977 document trends in volume and types of operations. The ratio of open heart surgery for congenital versus acquired heart disease of 2:1 in 1961 was reversed to 1:6 by 1977 as the number of procedures for valvular and coronary heart disease increased. The case load for surgery for congenital heart disease using the open heart technique gradually increased until 1974 and then decreased. The number of closed heart operations was relatively constant. Observations suggest a finite number of open and closed heart operations for congenital cardiac malformations; the total of 1,381 cardiac operations in New York State in 1977 may continue to diminish if the decreasing birth rate persists.