Cor triatriatum: study of 20 cases.

Twenty cases of cor triatriatum are reported. The diagnosis was confirmed by necropsy in 16 cases and at the time of operation in 4. The lesion occurred as an isolated anomaly in 7 cases; in 13, other associated cardiac anomalies were present. Three anatomic types of cor triatriatum were identified in the cases studied at necropsy: diaphragmatic (10 cases), hourglass (3) and tubular (3). The diaphragmatic type was also present in all four cases in which the diagnosis was confirmed at operation. Associated anomalies were found in five cases of the diaphragmatic type and in each case of the hourglass of tubular types. In isolated cor triatriatum the clinical findings were characteristic of pulmonary venous and arterial hypertension. In two cases, one with a communication between the right atrium and the accessory left atrial chamber and one with partial anomalous pulmonary venous connection associated with cor triatriatum, the clinical findings suggested a large left to right shunt with pulmonary arterial hypertension. The clinical findings varied in the cases with associated anomalies, and it was difficult to determine the cause of disturbance of the circulation.     

Comparison of the antibody response to streptococcal cellular and extracellular antigens in acute pharyngitis

The antibody response to the group A carbohydrate moiety of the streptococcal cell wall is of special interest because of its postulated role in the pathogenesis of rheumatic valvulitis. The immune response to this somatic antigen was measured in 159 children with culture-proved group A streptococcal pharyngitis and was compared with that to two extracellular antigens of the Group A streptococcus: streptolysin O and streptococcal DNase B. The data suggest that the maximum anti-A-carbohydrate rise occurs soon after the onset of streptococcal pharyngitis in a fashion similar to the response to some streptococcal extracellular antigens. However, the anti-A-carbohydrate antibody response appeared to be a less sensitive indicator of streptococcal upper respiratory tract infection.     

Hemorrhagic myocardial infarction associated with aortocoronary bypass revascularization.

Experimentally, hemorrhage and extension of myocardial infarction occur commonly when there is reperfusion after coronary artery occlusion. To investigate this hazard in a clinical setting, we compared the histopathologic picture of myocardial infarction in 44 patients who had undergone aortocoronary bypass: 14 (Group I) had myocardial infarction that predated aortocoronary bypass by 1 to 7 days; 13 (Group II) had infarction 1 to 14 days after the surgery; and 17 (Group III) had infarction 15 to 90 days postoperatively. All 44 patients had two or more coronary arteries with luminal narrowing of more than 75 per cent and patent vein grafts to arteries supplying areas of infarction. Hemorrhagic infarcts were present in 57 per cent of patients (eight of 14) in group I and 38 per cent of patients (five of 13) in Group II, contrasting with 6 per cent of patients (one of 17) in Group III (P < 0.005 and P < 0.05, respectively). In hemorrhagic infarcts, the extravasated blood formed irregular intramural dissecting tracts beyond the area of infarction, and foci of myocardial necrosis were present in the border zones. Infarcts affected more than 50 per cent of the left ventricular muscle in 64 per cent of cases of hemorrhagic infarction and in 13 per cent of cases of nonhemorrhagic infarction (P < 0.05). The prevalence of hemorrhagic infarction after revascularization may account for the high mortality of evolving and perioperative myocardial infarction associated with aortocoronary bypass, and this finding militates against wholesale immediate revascularization in patients who have uncomplicated myocardial infarction.