TUESDAY AFTERNOON, APRIL 23, 1968

2:00 P.M. Executive Session (Limited to Active and Senior Members)

Ballrooms 1 and 2

3:00 P.M. Scientific Session: REGULAR PROGRAM

Ballrooms 1 and 2

Address by the President

Paul C. Samson, Piedmont, California

"The Compleat Thoracic Surgeon"

Address by Special Guest Speaker

Professor Christiaan N. Barnard

University of Cape Town Medical School

Observatory, Cape Town, South Africa

"Experience with Human Heart Transplantation"

28. The Coronary Arteriographic Pattern in Complete Heart Block

Frank begg,* George J. Magovern, William J. Gushing,*

Edward M. Kent, and Don L. Fisher,* Pittsburgh, Pa.

Since January 1965 we have performed selective cine-coronary arteriography (Sones technique) on over 1,200 patients and this has provided an opportunity to review the coronary pattern to date on 25 patients with complete heart block requiring a permanent pacemaker. The clinical data and the angiographic pattern has not confirmed the long accepted view that the etiology of complete heart block is due to or associated with significant coronary atherosclerosis. All of the patients studied to date have had a permanent pacemaker in place for two weeks to 18 months. A dominant right coronary circulation was demonstrated in all, and the A-V nodal branch has been present in 90% of the patients studied. The septal perforator branches of the anterior descending branch of the left coronary artery have been shown in all. Although the majority of patients are in the 70-80 years age group, a similar pattern was present in one patient known to have complete block_ since age 14. The significance of this observation in relation to etiology, treatment and prognosis will be discussed and the angiographic technique and pattern demonstrated.

29. Surgical Aspects of Long-Term Electrical Stimulation of the Heart

Howard A. Frank, Paul M. Zoll,* and Arthur J. Linenthal,*

Boston, Mass.

Work from many sources during the past decade has established the feasibility and usefulness of long-term electrical stimulation of the heart. Disagreement exists, however, with regard to surgical, physiologic, electrical, and mechanical aspects of the many systems proposed. In this communication we shall report our experience with 182 patients treated during the period July 1960 through November 1967 by a totally implanted, battery-powered, fixed-rate pacemaker system, with impulse source connected by conducting wires to electrodes implanted surgically into the ventricular myocardium. Case selection, the effectiveness of control of Stokes-Adams disease and congestive heart failure, and the morbidity and mortality, surgical and non-surgical, will be presented, as well as measurements of stimulus threshold at intervals up to 7 years after implantation, an analysis of the electrical and mechanical performance of the pacemaker system, a description of technics for primary implantation, for pacemaker replacement, and for recognition and correction of system flaws, and for the management of sepsis. These data will be applied to a discussion of current issues: transvenous vs. intramyocardial electrodes, and fixed rate vs. variable rate, atrial-coupled, and "demand" pacemaking.

30. Continuous Positive Pressure Breathing (CPPB) in Adult Respiratory Distress Syndrome

D. G. Ashbaugh,* T. L. Petty,* D. B. Bigelow,* and T. Harris,*

Denver, Colo.

Sponsored by William R. Waddell

The syndrome of adult respiratory distress has been previously described and is characterized by the rather sudden onset of dyspnea, tachypnea, hypoxemia and loss of lung compliance. Pathological examination of the lungs suggests that the site of the pulmonary lesion is the alveolar capillary membrane. This lesion is characterized by interstitial edema, capillary congestion and leakage of red blood cells and plasma into the alveolus. Massive atelectasis characterizes the terminal stages of the syndrome and is probably due to inactivation of surfactant. These findings suggest that ventilation and oxygenation are impaired by a massive increase in pulmonary blood volume, pulmonary edema and loss of alveolar stability. Mortality with conventional respiratory support remains extremely high. Continuous positive pressure breathing (CPPB) implies the maintenance of positive pressure throughout the respiratory cycle and has theoretical advantages in the prevention of alveolar collapse and the reduction of intra-alveolar edema. The maintenance of effective CPPB requires absolute control of respiration. Hyperventilation alone frequently fails to control respiration in these patients and curare may be needed to maintain effective CPPB. Only 2 of 7 patients survived with conventional respiratory support, but 7 of 10 survived with CPPB support. Clinical biochemical and pathologic data will be presented to define the syndrome and to support the hypothesis that CPPB is effective treatment.

*By Invitation

TUESDAY EVENING, APRIL 23, 1968

7:00 P.M. Reception

Ballroom 2

8:00 P.M. Dinner and Dancing

Ballroom 1

Attendance limited to Members of the Association and their ladies, Invited Speakers and their ladies, Invited Guests and their ladies

Dinner dress preferred