Exposure of the heart in the course of chest surgery affords a means of faithfully recording pressure pulses in the four chambers of the heart and in the large vessels of human subjects. This study in 13 individuals without any clinical evidence of cardiovascular disease, is concerned with the time relationship between electric and mechanical events and with the temporal sequence and respective characteristics of similar phases of the cardiac cycle in both sides of the heart. The results obtained by permutation of simultaneous pressure recordings confirm the classical observations made in dogs.

Time Relationship of Dynamic Events in the Cardiac Chambers, Pulmonary Artery and Aorta in Man

To study the usefulness of large V waves in pulmonary capillary wedge tracings in establishing the diagnosis of mitral regurgitation, data on 1,021 consecutive cardiac catheterizations were reviewed. Wedge tracings were obtained by Swan-Ganz catheterization in 208 patients, usually because of suspected valve disease. One hundred two patients had no trace of mitral regurgitation angiographically, 69 had mild to moderate and 37 had severe regurgitation. V waves were graded as trivial (less than 5), intermediate (5 to 10) or large (10 or more mm Hg above mean wedge pressure). Of 50 patients with large V waves, 18 (36 percent) had no or trace mitral regurgitation; these included 5 with mitral stenosis, 3 with a mitral valve prosthesis, 4 with coronary disease and congestive failure, 2 with aortic valve disease and congestive failure and 2 with a ventricular septal defect. Of 37 patients with severe mitral regurgitation, 16 (43 percent) had large and 12 (32 percent) had trivial V waves. Thus, mitral regurgitation is the most common cause of large V waves; however, large V waves are neither highly sensitive nor specific for severe regurgitation. Increased left atrial compliance may be associated with trivial V waves in the presence of severe regurgitation. Mitral obstruction, congestive heart failure and ventricular septal defect may all be associated with large V waves in the absence of significant mitral regurgitation.

Limitations of pulmonary wedge V waves in diagnosing mitral regurgitation

Hemodynamic consequences of atrial fibrillation at constant ventricular rates

Pulmonary venous flow patterns by transesophageal pulsed Doppler echocardiography: Relation to parameters of left ventricular systolic and diastolic function

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Circulatory Consequences of Changes in Cardiac Rhythm Produced in Patients by Transthoracic Direct-Current Shock

Pressure pulses were obtained under direct vision, in the left atrium of subjects without clinical evidence of cardiac disease and in patients with mitral valvular disease, after exposure of their hearts during the course of surgical intervention. It was found that the c wave is produced by valvular closure and the subsequent fall of pressure during early ventricular systole (x wave) is related to atrial relaxation. Evidence is presented that mitral incompetence cannot be determined from direct atrial recordings, unless the Degrees of insufficiency is of great magnitude.

Jay L. Ankeney

Papers

An Analysis of Normal and Abnormal Left Atrial Pressure Pulse in Man