CIRCULATIONVOLUME 51

January-June, 1975

No. 1 (January)EDITORIAL:Echocardlographic Examination of the Left Ventricle. Harvey Feigenbaum ............................. 1

SPECIAL ARTICLE:Deep Vein Thrombosis: Detection and Prevention. V. V. Kakkar ...................................... 8

ORIGINAL ARTICLES:Anatomically Corrected Malposition of the Groat Arteries 1S,D,Li. Richard Van Praagh, Robert E. Durnin,

Hubert Jockin, Henry R. Wagner, Michael Korns, Hrair Garabedian, Masahiko Ando, and A. Louis Calder .. 20Transposition of the Great Arteries. Results of Trentment with Early Palliation and Late Intracardiac

Repair. Howard P. Gutgesell and Dan G. McNamara .................................................. 32Ultrastructure of Cristo Suproventricularis Muscle In Patients with Congenital Heart Diseases Associatedwith Right Ventricular Outflow Tract Obstruction. Michael Jones, Victor J. Ferrans, Andrew G. Morrow,and William C. Roberts. ............................................................................ 39

Problems In Recognition of Conduction Disturbances in the His Bundle. Reinier M. Schuilenburg and DirkDurrer ........................................................................................... 68

Analysis of Re-entry Mechanisms In Three Patients with Concealed Wolff-Parkinson-White Syn-drome. Helmut Neuss, Martin Schlepper, and Jochen Thormann ........................................ 75

Echocardlographic Analysis of Mitral Valve Motion After Acute Myocardial Innfrction. Gary A. Bergeron,Michael V. Cohen, Louis E. Teichholz, and Richard Gorlin ............................................. 82

The Echocardiogram of the Anterior Leaflet of the Mitral Valve: Correlation with Hemodynamic andCineroentgenographic Studies in Dogs. Gerald M. Pohost, Robert E. Dinsmore, Joel J. Rubenstein,Dennis D. O'Keefe, R. Nathan Grantham, Hugh E. Scully, Edward A. Beierholm, James W. Frederiksen, Myron L.Weisfeldt, and Willard M. Daggett ........................................... 88

The Echocardlographic Determination of Mitral Valve Opening and Closure: Correlation with Hemo-dynamic Studies In Man. Joel J. Rubenstein, Gerald M. Pohost, Robert E. Dinsmore, and J. Warren Harthorne 98

A Study of the Dynamic Relations Between the Mitral Valve Echogrom and Phasic Mitral Flow. ShlomoLaniado, Edward Yellin, Morris Kotler, Leonard Levy, Jona Stadler, and Reuven Terdiman ..... ............ 104

Systolic Time Intervals by Echocardiography. Miltiadis A. Stefadouros, A. Calhoun Witham, with thetechnical assistance of Frieda Stefadouros ............................................................. 114

Coronary Collateral Function In Patients without Occlusive Coronary Artery Disease. Robert E. Goldstein,Lawrence L. Michaelis, Andrew G. Morrow, and Stephen E. Epstein ....................................... 118

Myocardlal Blood Flow Response to Isometric (Handgrip) and Treadmill Exercise In Coronary ArteryDisease. Danield K. Lowe, Donald A. Rothbaum, Paul L. McHenry, Betty C. Corya, and Suzanne B. Knoebel 126

Intravenous Nitroglycerin In Acute Myocardial inforction. John T. Flaherty, Philip R. Reid, David T. Kelly,Dean R. Taylor, Myron L. Weisfeldt, and Bertram Pitt ................................................ 132

Improvement in Left Ventricular Wall Motion Following Nitroglycerin. John H. McAnulty, Mark T.Hattenhauer, Josef R5sch, Frank E. Kloster, and Shahbudin H. Rahimtoola .............................. 140

Prognosis in Coronary Artery Disese: Angiographic, Hemodynamic and Clinical Factors. Gary W. Burggrafand John 0. Parker . ............................................................................... 146

Mechanism of Normal Splitting of the Second Heart Sound. Edward I. Curtiss, Robert G. Matthews, andJames A. Shaver . ................................................................................... 157

Postural Changes In Left Ventricular and Mitral Valvular Dynamics In the Systolic Click-Late SystolicMurmur Syndrome. Mary E. Fontana, Charles F. Wooley, Richard F. Leighton, and Richard P. Lewis 165

CLINICOPATHOLOGIC CORRELATIONS:Bacterial Endocarditis In Subjects 60 Years of Age and Older. Rudy Thell, Franklin H. Martin, and

Jesse E. Edwards ............................ 174RADIOLOGY:The Abnormal Left Hilum. Timothy A. Lind, Michael J. Pitt, Bertron M. Groves, James E. White, and

Edward Quinn ... ... ... 183Visualization and Measurement of the Main Bronchi by Tomography as an Objective Indicator of

Thoracic Situs in Congenital Heart Disease. John B. Partridge, Olive Scott, Philip B. Deverall, and FergusJ. Macartney ...................................................................................... 188

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CASE REPORT:Return of Normal Conduction after Paroxysmal Heart Block: Report of a Case with Major Discordance of

Electrophysiological and Pathological Findings. Kenneth M. Rosen, Delon Wu, Charles Kanakis, Jr., PabloDenes, Saroja Bharati, and Maurice Lev ............................................................... 197

BOOK REVIEWS ..................................................................... 205NEWS FROM THE AMERICAN HEART ASSOCIATION .......... ........................................ Page 1ABSTRACTS FROM THE U.S.S.R. ....................................... Page 5

No. 2 (February)EDITORIAL:It's Time To Be Practical. Donald S. Fredrickson ...................................... 209SPECIAL ARTICLE:A Letter from Sir James Mackenzie to Dr. Carter Smith, Sr. Carter Smith, Sr., and Mark Silverman ...... 212

ORIGINAL ARTICLES:Thickenings In the Coronary ArteriesinInfancy as an Indication of Genetic-Factorsin Coronary HeartDisease. Erkki Pesonen, Reijo Norio, and Seppo Sarna.... ............................................ 218Famiial Atrioventricular Block: An Autosomal Dominant Trait. Menashe B. Waxman, John D. Catching,Clarence H. Feldorhof, Eugene Downar, Malcolm D. Silver, and Michael M. Abbott .... ................... 226

Demonstration of Sustained Sinus and Atrial Re-entry as a Mechanlsm of Paroxysmal SupraventricularTachycardci. Delon Wu, Fernando Amat-y-Leon, Pablo Denes, Ramesh C. Dhingra, Raymond J. Pietras,and Kenneth M. Rosen....................... 234Electrophyslological ObstrvationsIn Patients with Rate Dependent Bundle Branch Block. Pablo Denes,Delon Wu, Ramesh C. Dhingra, Fernando Amat-y-Leon, Christopher Wyndham, and Kenneth M. Rosen ..... 244

Effect of Digoxin on Atrioventricuhar Conduction: StudiesIn Patients With and Without CardiacAutonomic innervation. D. J. Goodman, R. M. Rossen, D. S. Cannom, A. K. Rider, and D. C. Harrison .. 251Genesis of Higi Frequency Notching ofQRS Complexes in an In Vivo Cardiac Model. Condon R.VanderArk and Ernest W.Reynolds . ................................................................. 257

Mitral Comnmssurotomy versus Replacement: Preoperative Evaluation by Echocardiography. Navin C.Nanda, Raymond Gramiak, Pravin M. Shah, and James A. DeWeese .............. 263

Echocardlogaphy of the Tricuspid ValveIn Congenital Left Ventricular -Right AtrilC nunction.Navin C. Nanda, Raymond Gramiak, and James A. Manning ................. ................ 268Echographic Assessment of Atrial Transport, Mitral Movement, and Ventricular Performance FollowingEectroversion of Stpra-ventricular Arrhythmias. Anthony N. DeMaria, James E. Lies, James F. King,Richard R. Miller, Ezra A. Amsterdam, and Dean T. Mason... ........ 273

Differenthial Diagnoo s of Anomalies of the Great Arteries byRiea-timewinTwo-d nsionalEchocardiog-raphy. Walter L. Henry, Barry J. Maron, James M. Griffith, David R. Redwood, and Stephen E. Epstein ... 283Echocardiographk Obstervaons on the Mechanism of Producton of the Second Heart Sound. PremindraA. N. Chandraratna, Jose M. Lopez, and Lawrence S. Cohen, with the technical assistance of Dale Gindlesperger 292

EchographicD*terminadton of Left Ventricular VolumesIn Pediatric Patients. Richard A. Meyer, JamesStockert, and Samuel Kaplan ..... 297Measurement of Right and Left VentricularSystolic Time Intervlds by Echocrdio'graphy. StephenHirschfeld, Richard Meyer, David C. Schwartz, Joan Korfhagen, and Samuel Kaplan.. .................... 304

A on of Systoli Time Intervals Derived from the Central Aortlc Pressure and from the ExternalCarotidPulse Trcing. Frans Vande Werf, Jan Piessens, Hugo Kesteloot, and Hilaire De Geest.. ......... 310Dynamic Deternmnants of Left Ventricular Diastolk Presswre-olume Relations In Man. William H. Gaasch,James S. Cole, Miguel A. Quinones, and James K. Alexander .......................................... 317

The Apical A Wave versus the Fourth Heart Sound in Assessing the Severity of Aortic Stnosns. Morton A.Kavalier, Janie Stewart, and Morton E. Tavel ..... 324

Cliniccal Use of Sodim Nitroprusside in Chronic c H eartD ises Effectson P eripheraV asularResistance and Venou Tone and on Ventricular Vohume, Pump and Mechanical Performnce. Richard R.Miller, Louis A. Vismara, Robert Zeus, Ezra A. Amsterdam, and Dean T. Mason......................... 328

Transfemoral Plug Cowsure of Patent Ductus Arterlosus: Experionces in 61 Consecutive Cases Treatedwithout Thoracotomy. Kenji Sato, Masaoki Fujino, Takahiro Kozuka, Yasuaki Naito, Soichiro Kitamura,Susumu Nakano, Choken Ohyama, and Yasunaru Kawashima... ....................................... 337

Hnmodynamic Features of Prolapsing and Nonprohpsing Left Atrial Myxona. Ruey J. Sung, Ali R.Ghahramani, Stephen M. Mallon, Stanle y E. Richter, Leonard S. Sommer, Stuart Gottlieb, and Robert J.Myerburg. ................................................................................. 2342

Pulmonary Edemo Relantd to Chanes In Collold Osmotic and Pulmonary Artery Wecdge Pr*esure InPatients after Acute Myocardlal Inforction. Protasio L. da Luz, Herbert Shubin, Max Harry Weil, EdwinJacobson,

andLe in Stein .......................................................................... 350

Platelet SurWviv llme Following Aortlc Valve Replacement. Peter Steele, Hugh Weily, Hywel Davies,George Pappas, and Edward Genton ....................................... 358

Predictive Implications of Stress Testing: Follow-up of 2700 SubJects after Maxhnum TreadilStressT esting. Myrvin H. Ellestad and K. C. Wan .36.....................3............. 33Learned Control of lead Pressure In Patients with High Blood Pressur. Donald A. Kristt and BernardT. Engel ...................................... 370

CLANICOPATHOLOGIC CORRELATIONS:De ubtaneis Mortibus. X. Familial Congenital Heart black. Thomas N. James, Robert C. McKone, and

Allen S. Hudspeth ........... 379

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RADIOLOGY:The Deceptive Aortic Root. Manuel Viamonte, Jr., Manuel Camacho, Donald R. Cahill, Maria Viamonte, and

Kurt Mori . ....................................................................................... 389LETTERS TO THE EDITOR:

First and Second versus Second and Third Exercise Tests. David H. Spodick; John W. Kirklin .... ....... 394Author Corrects Variant Interpretation. J. F. Goodwin ............................................... 395Ultrasound Evaluation of SASM. Nobuyoshi Kawai; A. D. Hagan ........................................ 395Techniques of Measuring Regional Wall Motion. Allan Sniderman, Derek G. F. Marpole, Ernest L. Fallen;

Richard F. Leighton .............. 395Postoperative Myocardial Infarction. Erich Vormittag ................................................. 396Estimating Collateral Circulation. David C. Levin; Robyn J. Carroll, Mario S. Verani, Herman L. Falsetti ... 397

NEWS FROM THE AMERICAN HEART ASSOCIATION .................................................... Page 1

No. 3 (March)EDITORIAL:Optimal Cardiac Care: Achievable? Mary Allen Engle .399

ORIGINAL ARTICLES:Diastolic Murmurs in the Presence of Starr-Edwards Mitral Prosthesis: With Emphasis on the Genesis ofthe Austin Flint Murmur. Richard A. Schaefer, John H. McAnulty, Albert Starr, Shahbudin H. Rahimtoola .. 402

The Course of Acute Myocardial Infarction: Feasibility of Early Discharge of the Uncomplicated Patient.J. Frederick McNeer, Andrew G. Wallace, Galen S. Wagner, C. Frank Starmer, and Robert A. Rosati ....... 410

Relation between Contractile Reserve and Prognosis in Patients with Coronary Artery Disease and aDepressed Ejection Fraction. Peter F. Cohn, Richard Gorlin, Michael V. Herman, Edmund H. Sonnenblick,Howard R. Horn, Lawrence H. Cohn, and John J. Collins, Jr. ........................................... 414

Hemodynamic Effects of Nitroglycerin in Acute Myocardial Infarction: Decrease in Ventricular Preloadat the Expense of Cardiac Output. David 0. Williams, Ezra A. Amsterdam, and Dean T. Mason .... ..... 421

Response of the Left Ventricle in Coronary Artery Disease to Postextrasystolic Potentiation. Robert I.Hamby, Agop Aintablian, B. George Wisoff, and Marvin L. Hartstein ..................................... 428

Acute Subendocardial Myocardial Infarction in Patients. Its Detection by Technetium 99-m StannousPyrophosphate Myocardial Scintigrams. James T. Willerson, Robert W. Parkey, Frederick J. Bonte, Steven L.Myer, and Ernest W. Stokely . ........................................................................ 436

The Effect of Intracoronary Injection of Contrast Medium upon Coronary Blood Flow. Mayer Bassan, WilliamGanz, Harold S. Marcus, and H. J. C. Swan ........................................................... 442

Histopathology of the Conduction System in Sudden Death from Coronary Heart Disease. J. T. Lie .... 446Acute Myocardial Infarction in Toxic Cardiomyopathy Without Coronary Obstruction. Timothy J. Regan, Chia

F. Wu, Allen B. Weisse, Christos B. Moschos, S. Sultan Ahmed, Michael M. Lyons, and Bunyad Haider ...... 453The Omnicardiogram: Study of a Proposed Method for Detecting Coronary Heart Disease in an Asymp-

tomatic Population. C. Paul Nay, William B. Kannel, William P. Castelli, and Patricia M. McNamara ...... 462Vectorcardiographic Diagnosis and Electrocardiographic Correlation in Left Ventricular Asynergy Due toCoronary Artery Disease. 1. Severe Asynergy of the Anterior and Apical Segments. Eliot Young, Peter F.Cohn, Richard Gorlin, Harold D. Levine, and Michael V. Herman ........................................ 467

A Clinical and Follow-up Study of Right and Left Bundle Branch Block. Michael Rotman and John H. Triebwasser 477Comparison of Cardiac Refractory Periods in Children and Adults. Ira W. DuBrow, Elizabeth A. Fisher, Fernando

Amat-y-Leon, Pablo Denes, Delon Wu, Kenneth Rosen, and Alois R. Hastreiter ............................ 485Multiform Ventricular Ectopic Rhythm. Evidence for Multiple Parasystolic Activity. Nabil El-Sherif and Philip

Samet ............................................................................................. 492Echocardiographic Observations on Ventricular Septal Rupture Complicating Acute Myocardial Infarction.

P. A. N. Chandraratna, P. K. Balachandran, P. M. Shah, and M. Hodges ................................. 506Posterior Mitral Leaflet Motion in Mitral Stenosis. Jorge A. Levisman, Abdul S. Abbasi, and Morton Lee Pearce 511Echocardiographic Features of Subpulmonic Obstruction in Dextro-transposition of the Great Vessels.

Navin C. Nanda, Raymond Gramiak, James A. Manning, and Elliot 0. Lipchik ............................ 515Simultaneous Echocardiogrophic - Phonocardiographic Recordings at Rest and During Amyl Nitrite

Administration in Patients with Mitral Valve Prolapse. Roger A. Winkle, Daniel J. Goodman, and RichardL. Popp . .......................................................................................... 522

A Simplified Method for Quantitating Left-to-Right Shunts from Arterial Dilution Curves. Benjamin E.Victorica and Ira H. Gessner . ........................................................................ 530

Acute Effects of Low Doses of Alcohol on Left Ventricular Function Measured by Echocardiography. Cedar E.Delgado, Nicholas J. Fortuin, and Richard S. Ross ................................................ 535

On the Clinical Value of Calibrated Displacement Apexcardiography. Boudewijn Denef, Roger Popeye, HilaireDe Geest, Hugo Kesteloot . ............................................................................ 541

CASE REPORTS:Anomalous Left Coronary Artery from Pulmonary Artery. An Eight Year Angiographic Follow-up afterSaphenous Vein Bypass Graft. Bernard R. Chaitman, Martial G. Bourassa, Jacques Lesperance, and PierreGrondin . .......................................................................................... 552

Premature Pulmonic Valve Opening Following Sinus of Valsalva Aneurysm Rupture into the Right Atrium.Arthur E. Weyman, James C. Dillon, Harvey Feigenbaum, and Sonia Chang ............................... 556

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RADIOLOGY:Results of Routine Preoperative Coronary Angiography in Tetralogy of Fallot. Kenneth E. Fellows, Michael D.

Freed, John F. Keane, Richard Van Praagh, William F. Bernhard, and Aldo C. Castenada ..... .............. 561

CLINICOPATHOLOGIC CORRELATIONS:True and False Left Ventricular Aneurysms: Propensity for the Latter to Rupture. Zeev Vlodaver, John 1. Coe.

and Jesse E. Edwards . ........................................................................... 567

BOOK REVIEWS: . ........................................................................... 573

NEWS FROM AMERICAN HEART ASSOCIATION ............. .......................................... Page 1

N\o. 4 (April)

EDITORIALS:IHSS - HOCM - MSS -- ASH? Pravin M. Shah ......................... ............................ 577

ORIGINAL ARTICLES:A Forty-year Review of Bacterial Endocarditis In Infancy and Childhood. David H. Johnson, Amnon

Rosenthal, and Alexander S. Nadas .................................................................. 581DIastolic Vibration of the Interventricular Septum In Aortic Insufficiency. Geoffrey D. Cope, Joseph A.

Kisslo, Michael L. Johnson, and Sondra Myers . ................................................. 589Echocardiographic Recognition of the Mitral Valve-Posterior Aortic Wall Relationship. Brian L. Strunk,

Stephen B. Guss, Richard E. Hicks, and Morris N. Kotler .594Echocardiographic Features of Total Anomalous Pulmonary Venous Connection. Marc Paquet andHoward Gutgesell .................................................................................. 599

Precursors of Sudden Coronary Death: Factors Related to the Incidence of Sudden Death. William B.Kannel, Joseph T. Doyle, Patricia M. McNamara, Phillip Quickenton, and Tavia Gordon ..... 606

Clinical Mbasurement of Myocardial Infarct Size: Modification of a Method for the Estimation of TotalCreatine Phosphokinase Release after Myocardial Infarction. Robin M. Norris, R. M. L. Whitlock, CaranBarratt-Boyes, and Charles W. Small .. . . . 614

The Effect of Hypoglycemia on Myocardial lschemic Injury During Acute Experimental Coronary ArteryOcclusion. Peter Libby, Peter R. Maroko, and Eugene Braunwald .. ... 621

Persistence of MB Isoenzmye of Creatine Phosphokinase in the Serum after Minor latrogenic CardiacTrauma: Absence of Postmortem Evidence of Myocardial Infarction. Andrew M. Tonkin, Robert M.Lester, C. Earl Guthrow, Charles R. Roe, Donald B. Hackel, and Galen S. Wagner ..... 627

Effects of Nitroglycerin and Nitroglycerin-Methoxamine During Acute Myocardial lschemia in Dogswith Pre-existing Multivessel Coronary Occlusive Disease. Richard W. Myers, James L. Scherer, Richard A.Goldstein, Robert E. Goldstein, Kenneth M. Kent, and Stephen E. Epstein ..... 632

Thaillum-201 for Myocardial Imaging: Relation of Thallium-201 to Regional Myocardial Perfusion.H. William Strauss, Katherine Harrison, James K. Langan, Elliot Lebowitz, and Bertram Pitt .. ... 641

Three Variants of Concealed Bigeminy. Matthew N. Levy, Dale S. Adler, and James R. Levy ... .. 646

Modification of Ventricular Fibrillation Latency Following Coronary Artery Occlusion in the ConsciousPig: The Effects of Psychological Stress and Beta-adrenergic blockade. James E. Skinner, J. T. Lie,and M. L. Entman ..... 656

Primory T Wave Abnormalities Caused by Uniform and Regional Shortening of Ventricular MonophasicAction Potential In Dog. Gernot Autenrieth, Borys Surawicz, Chien Suu Kuo, and Makoto Arita .... . 668

The Evaluation of Left Ventricular Function in Man: A Comparison of Methods. Thomas H. Kreulen, Alfred A.Bove, Michael T. McDonough, Milton J. Sands, and James F. Spann .. ... 677

Echocordiographic Determination of Left Ventricular Stress-Velocity Relations in Man: With Referenceto the Effects of Loading and Contractility. Miguel A. Quinones, William H. Gaasch, James S. Cole,and James K. Alexander ..... 689

Circulatory and Metabolic Effects of Glycerol Infusion in Patients with Recent Cerebral Infarction. JohnStirling Meyer, Yoshifumi Itoh, Shigemichi Okamoto, K. M. A. Welch, Ninan T. Mathew, Erwin 0. Ott,Saburo Sakaki, Yohsuke Miyakawa, Eva Chabi, and Arthur Dale Ericsson ..... 701

Serum Digitoxin Concentrations in Infants and Children. Andrea C. V. Giardina, Kathryn H. Ehlers,John B. Morrison, and Mary Allen Engle .. . .. 713

Augmentation of Myocardial Digoxin Concentration in Hemorrhagic Shock. Brian L. Loyd and Roger R.Taylor ..... 718

The Course of the Conduction System in Single Ventricle with Inverted (L-) Loop and Inverted (L-)Transposition. Saroja Bharati and Maurice Lev .. . . . 723

Congenital Mitral Valve Disease in Transposition of the Great Arteries. Glenn C. Rosenquist, J. Stark,and J. F. N. Taylor ..... 731

Reduced Baroreceptor Sensitivity in Borderline Hypertension. Akira Takeshita, Senichi Tanaka, and MotoomiNakamura ..... 738

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CLINICOPATHOLOGIC CORRELATIONS:De Subitanois Mortibus. XI. Young Girl with Palpitations. Thomas N. James, Ralph J. Marilley, Jr., and

Henry J. L. Marriott ........................................... 743RADIOLOGY:Catheter Positions in Congenital Cardiac Malformations. Richard M. Taketa, David J. Sahn, Allan L.

Simon, Stanley J. Pappelbaum, and William F. Friedman ............................................... 749BOOK REVIEWS: ................................................. 758CORRECTION ................................................. 688NEWS FROM THE AMERICAN HEART ASSOCIATION ................................................. Page 1

AHA Committee Report: A Reporting System on Patients Evaluated for Coronary Artery Disease Page 5

No. 5 (May)EDITORIAL:Role of the Slow Current in Cardiac Electrophysiology. Douglas P. Zipes, H. R. Besch, Jr., and August M.

Watanabe ........................................... 761SPECIAL ARTICLE:Woiff-Parkinson-White Syndrome: The Problem, Evaluation, and Surgical Corroction. John J. Gallagher,

Marcel Gilbert, Robert H. Svenson, Hugh Miller, Will C. Sealy, Jackie Kasell, and Andrew G. Wallace ...... 767ORIGINAL ARTICLES:

Intraventricular Conduction in Man Studied with an Endocardial Electrode Cathoter Mapping Technique.Patients with Normal QRS and Right Bundle Branch Block. John A. Kastor, Bruce N. Goldreyer,E. Neil Moore, James C. Shelburne, and Joel H. Manchester ........................................... 786

Corrected Sinus Node Recovery Time: Experimental Physiologic and Pathologic Determinants. Kul D.Chadda, Vidya S. Banka, Monty M. Bodenheimer, and Richard H. Helfant ............ .. ................. 797

Extracardiac Recordings of His-Purkinje Activity During Conduction Disordors and Junctional Rhythms.Edward J. Berbari, Ralph Lazzara, Nabil El-Sherif, and Benjamin J. Scherlag ........... .. ................ 802

Supernormal Conduction of a Premature Impulse Utilizing the Fast Pathway in a Patient with Dual A-VNodal Pathways. Pablo Denes, C.R.C. Wyndham, Delon Wu, and Kenneth M. Rosen ........ ............ 811

Lack of Sensing by Demand Pacemakers due to Intraventricular Conduction Defocts. Zakauddin Vera, DeanT. Mason, Najam A. Awan, General Hilliard, and Rashid A. Massumi ................................... 815

Echocardiographic Detection of Tricuspid Valve Prolapse. Premindra A. N. Chandraratna, Jose M. Lopez,Jose J. Fernandez, Lawrence S. Cohen, with the technical assistance of D. Gindlesperger ........ ............ 823

Meoasurement of Mitral Orifice Area in Patients with Mitral Valve Disease By Reol-time, Two-dimensionalEchocardiography. Walter L. Henry, James M. Griffity, Lawrence L. Michaelis, Charles L. McIntosh, Andrew G.Morrow, and Stephen E. Epstein ..................................................................... 827

Echocardiographic Manifestations of Flail Aortic Valve Leaflets in Bactorial Endocarditis. TaylorM. Wray ............................................... . 832

Echocardiographic Demonstration of Early Mitral Valve Closure in Severe Aortic Insufficiency: Its ClinicalImplications. Elias H. Botvinick, Nelson B. Schiller, R. Wickramasekaran, Steven C. Klausner, and EdwardGertz .............................................. 836

Variability of Echocardiographic Discontinuity in Double Outlet Right Ventricle and Truncus Arteriosus.James W. French and Richard Popp ....................... ........................ 848

Cardiac Specific Creatine Phosphokinase lsoenzyme in the Diagnosis of Acute Myocardial Infarction.Murray A. Varat and Donald W. Mercer ....................... ........................ 855

Time Course and Zonal Variations of lschemia-induced Myocardial Cationic Electrolyte Derangements.J. T. Lie, Peter C. Pairolero, Keith E. Holley, John T. McCall, Howard K. Thompson, Jr., and JackL. Titus ............................................... 860

Cardiac Performance and Mortality Early after Intracardiac Surgery in Infants and Young Children.Grant V. S. Parr, Eugene H. Blackstone, and John W. Kirklin .......................................... 867

Early Onset of Pulmonary Vascular Obstruction in Patients with Aortopulmonary Transposition andIntact Ventricular Septum. Jeffrey B. Lakier, Paul Stanger, Michael A. Heymann, Julien I. E. Hoffman, andAbraham M. Rudolph ...... ........................................ 875

Right Heart Volume Characteristics in Transposition of the Great Arteries. Thomas P. Graham, Jr.,Gerald F. \twood, Robert J. Boucek, Jr., Robert C. Boerth, and James H. Nelson ........ .. .............. 881

Seven-year Follow-up of Cardiovascular Study and Maximal Exercise Testing of Chinese Men. R. A. Bruce,Y. -1. Pao, N. Ting, B. N. Chiang, Y. -b. Li, S. T. Chiang, E. R. Alexander, R. P. Beasley, and L. D.Fisher ......................................................................................... 890

Nontraumatic Determination of Left Ventricualar Ejection Fraction by Radionuclide Angiocardiography.Heinrich R. Schelbert, John W. Verba, Allen D. Johnson, Gary W. Brock, Naomi P. Alazraki, Frank J. Roseand William L. Ashburn ............................................................................. 902

Alterations in Preload and Ejection Phase Indices of Left Ventricular Performance. Larry S. Rankin,Sally Moos, and William Grossman .................................................................. 910

Plasma Dopamine - - Hydroxylase Activity in Oral Contraceptive Hypertension. Stanley G. Rockson,Richard A. Stone, J. Caulie Gunnells, Saul M. Schanberg, Norman Kirshner, and R. R. Robinson ........... 916

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Radioisotopic Bolus Technique as a Test to Detect Circulatory Deficit Associated with Cerebral Death:142 Studies on 80 Patients Demonstrating the Bedside Use of an Innocuous IV Procedure as anAdjunct in the Diagnosis of Cerebral Death. Julius Korein, Phillip Braunstein, Irvin Kricheff, AbrahamLieberman, and Norman Chase . .............................................................. 924

CLINICOPATHOLOGIC CORRELATIONS:Prosthetic Aortic Valvular Endocarditis. James Madison, Kyuhyun Wang, Fredarick L. Gobel, and Jesse E.

Edwards. .............................................................. 940LETTERS TO THE EDITOR:

Calculating Pulmonary Valve Area. Steven Wolfson; William A. Neal, Russell V. Lucas, Jr., S. Rao, James H.Moller ................................................................ 950

Lidocaine and Heart Rate. Michael A. Nevins ........................................................ 951Surgical Correction of ASH. C. M. Oakley; Stephen E. Epstein, Walter L. Henry, Chester E. Clark, Barry Maron,

David R. Redwood, Andrew G. Morrow .............................................................. 951Concealed Retrograde Conduction in A-V Block. David Shander; Howard S. Friedman; Stafford I. Cohen .. 952

NEWS FROM THE American Heart Association, Including Presidential Address, AHA 47th Scientific Sessions.The Case for Prevention of Coronary Heart Disease .......... .................................... Page 1

Education of Physicians in High Blood Pressure by The Working Group on the Training and Evaluationof Physicians in High Blood Pressure . ............................................................. Page 9

No. 6 (June)

EDITORIAL:Radlolsotopic Studies of the Regional Myocardial Circulation. Paul J. Cannon ...... .................... 955

ORIGINAL ARTICLES:Dose Response Effectiveness of Propranolol for the Treatment of Angina Pectoris. Edwin L. Alderman,

Richard 0. Davies, John J. Crowley, Mario G. Lopes, Jeff Z. Brooker, Joel P. Friedman, Anthony F. Graham,Harvey J. Matlof, and Donald C. Harrison ............................................................ 964

Anonmlous Left Coronary Artery Originating From the Pulmonary Artery: Report on 15 Cases. JosephAskenazi and Alexander S. Nadas ............................................................... 976

The Effects of Right Atrial and Ventricular Pacing on the Auscultatory Findings In Patients with MitralValve Prolapse. William D. Towne, Shahbudin H. Rahimtoola, M. Ziad Sinno, Henry S. Loeb, Kenneth M.Rosen, Rolf M. Gunnar . ........................................... 988

Unusul Examples of Suprventricular Re-entrant Tchycars. Hein J. J. Wellens ..... ............... 997Electrode Catheter Recordings during Maignant Ventricular Arrhythmia Following Experimental AcuteMyocordlal lschmia. Evidence for Re-entry due to Conduction Delay and block In lschemic Myocardlum.Nabil El-Sherif, Benjamin J. Scherlag, and Ralph Lazzara .............................................. 1003

Transient ST-Segment Elevation In Unstable Angina: Clinical and Hemodynamic Significance. Gary D.Plotnick and C. Richard Conti .1015

Double Accessory Pathways In Wolff-Parkinson-White Syndrome. Agustin Castellanos, Abdul S. Agha,Benjamin Befeler, and Robert J. Myerburg ......................................... 1020

Postoperative Left Anterior Hemiblock and Right Bundle Branch Block Following Repair of Te-ralogy ofFallot: Clinical and Etlologic Considerations. Carl N. Steeg, Ehud Krongrad, Farzin Davachi, Frederick 0.Bowman, Jr., James R. Malm, and Welton M. Gersony . ......................................... 1026

Purkinje Repolarizatlon as a Possible Cause of the U Wave in the Electrocardiogram. Yoshio Watanabe 1030Folow-up of Mass Screening for Coronary Risk Factors in 1617 Adults. Wilbert S. Aronow, William H.

Allen, Dominic De Cristofaro, and Suzanne Ungermann ........................ 1038Technetium Stannous Pyrophosphate Myocardial Scintigroms In Patients with Chst Pan of Varying

Etiology. James T. Willerson, Robert W. Parkey, Frederick J. Bonte, Steven L. Meyer, James M. Atkins, andErnest M. Stokely . ........................................... 1046

The Effect of Cold Air Inhalation on Angina Pectoris and Myocardial Oxygen Supply. Mark Hattenhauer andWilliam A. Neill ............................................ 1053

Pathology of Stable and Unstable Angina Pectoris. Richard B. Guthrie, Zeev Vlodaver, Demetre M. Nicoloff,and Jesse E. Edwards . .. ........................................................ ............. 1059

Hemodynamic and Prognostic FRndings In Patients with Trnsmural and Nontransnmura Infrction. PierreRigo, Malcolm Murray, Dean R. Taylor, Myron L. Weisfeldt, H. W. Strauss, and Bertram Pitt ..... ........ 1064

Ventricular Function l-fore and After Direct Revascularization Surgery: A Proposal for an Index ofVascularlzation to Correlate Anglographk and Ventriculogrephic Findings. Jay A. Levine, David J. Bechtel,Peter F. Cohn, Michael V. Herman, Richard Gorlin, Lawrence H. Cohn, and John J. Collins, Jr . ............ 1071

Observations on Bood Vlscosity Changes after Acute Myocordial Inforction. Kung-ming Jan, Shu Chien, andJ. Thomas Bigger, Jr. .............................................................................. 1079

Compentory Changes of the Distal Coronary Vascular Bud During Progressive Coronary Constriction.K. Lance Gould, Kirk Lipscomb, and Cynthia Calvert .................................................. 1085

Influence of Hypertonic Mannitol on Ventricular Performance and Coronary Blood Flow in Ptients.James T. Willerson, George C. Curry, James M. Atkins, Robert Parkey, and Lawrence D. Horwitz .......... 1095

Continuous Recording of Direct Artrlal Pressure in Unrestricted Patients: Its Role in the Dhoss andManagement of High Bood Pressure. William A. Littler, A. John Honour, David J. Pugsley, and Peter Sleight 1101

Return of Elevatd blood Pressure after Wthdrawl of Antihypertensive Drugs. Veterans AdministrationCooperative Study Group on Antihypertensive Agents .................................................. 1107

Splanchnlc Blood Flow In Essential Hypertension and In Hypertensive Patients with Renal Artery Stenosis.Franz H. Messerli, Jacques Genest, Wojciech Nowaczynski, Otto Kuchel, Masanobu Honda, Yves Latour, andGuy Dumont ...................................................................................... 1114

(Continued)

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CONTENTS OF VOLUME 51

Smoking and Fibrinolysis. Lars Janzon and Inga Marie Nilsson ......................................... 1120Great Vessel, Cardiac Chamber, and Wall Growth Patterns In Normal Children. Michael L. Epstein, Stanley

J. Goldberg, Hugh D. Allen, Lee Konecke, and Janice Wood ............................................ 1124Echocardiography of the Intra-atrial Bffle In Dextro-transposition of the Great Vessels. Navin C. Nanda,

Scott Stewart, Raymond Gramiak, and James A. Manning.1130Radionucitde Anglocardlography: Improved Diagnosis and Quantitation of Left-to-Right Shunts UsingAra Ratio Techniques in Children. P. 0. Alderson, R. G. Jost, A. W. Strauss, S. Boonvisut, and J. Markham 1136

The basis for Differences In Ethanol-Induced Myocardial Depression In Normal Sublects. Gerald C. Timmis,Renato G. Ramos, Seymour Gordon, and V. Gangadharan .............................................. 1144

CLINICOPATHOLOGIC CORRELATIONS:Do Subitaneis Mortibus. Xli. Asymmetrical Hypertrophy of the H-ert. Thomas N. James and Thomas K.Marshall .1149

BOOK REVIEWS .1167LETTERS TO THE EDITOR:Nonsurgical Closure of PDA. Jami C. Shakibi, Iraj Aryanpur; W. Porstmann .1170On Prophylactic Pacing. John W. Lister, Arthur J. Gosselin; K. J. Lie, Hein J. Wellens, Reinier M. Schuilenburg,Anton E. Becker and Dirk Durrer .1170

Mid-Systolic AV Closure in IHSS. Joram Glaser; Ronald M. Rossen and Richard L. Popp ............... ........... 1172Two Papers on BBB During Tachycardia. Robert Slama; R. A. J. Spurrell, D. M. Krikler and E. Sowton .... 1172Heparin and Arterial Thrombosis In Children. Donald A. Girod, Roger A. Hurwitz; Michael D. Freed,Amnon Rosenthal and John F. Keane . ............................................................... 1173

NEWS FROM THE AMERICAN HEART ASSOCIATION ................................................... Page 1Report of the Inter-Society Commission for Heart Disease Resources: Optimal Resources for

Ultrasonic Examination of the Heart ................. ............................................ A-iVOLUME AUTHOR INDEX .............................................................................. 1175VOLUME SUBJECT INDEX .............................................................................. 1179

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51 (1)

Print ISSN: 0009-7322. Online ISSN: 1524-4539 Copyright © 1975 American Heart Association, Inc. All rights reserved.

is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231Circulation 1975;51:1-204Circulation. 

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