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Nishimura RA, Abel MD, Housmans PR, Warnes CA, Tajik AJ. Mitral flow velocity curves as a function of different loading conditions: evaluation by intraoperative transesophageal Doppler echocardiography. J Am Soc Echocardiogr 1989; 2:79-87. [PMID: 2629864 DOI: 10.1016/s0894-7317(89)80068-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Transesophageal pulsed wave Doppler echocardiography was performed intraoperatively on 10 patients undergoing coronary artery bypass operation. Mitral flow velocity curves and hemodynamic values were recorded during control conditions and intravenous infusion of (1) nitroglycerin, (2) phenylephrine, and (3) fluids. During nitroglycerin infusion blood pressure and wedge pressure decreased, peak filling velocity decreased, and deceleration time increased compared with control values. During infusion of phenylephrine blood pressure increased, there was a trend toward a decrease in peak filling velocity, and deceleration time increased. During infusion of fluids wedge pressure increased, deceleration time decreased, and peak filling velocity increased. Mitral flow velocity curves are therefore altered by changes in hemodynamic loading conditions.
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Warnes CA, Somerville J. Transposition of the great arteries: late results in adolescents and adults after the Mustard procedure. Heart 1987; 58:148-55. [PMID: 3620254 PMCID: PMC1277294 DOI: 10.1136/hrt.58.2.148] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A selected group of 18 patients aged 15-27 years with transposition of the great arteries and a previous Mustard procedure were evaluated to determine their functional ability and clinical state. Arrhythmias were common, occurring at some time in 16/18 (89%). Arrhythmia was serious in four; two of them required pacing and two had cardiac arrests, one resulting in death. Seven (41%) had right ventricular dysfunction; this was progressive in three. Tricuspid regurgitation was present in seven (41%); it occurred in patients with normal and reduced right ventricular ejection fractions. Regurgitation became progressively worse as the right ventricle dilated. Left ventricular function was well preserved in most patients. Fourteen (82%) of this pioneer group were leading normal lives (ability index 1 or 2). Although these results are acceptable concern remains about the probability of deteriorating right ventricular function.
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178
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Warnes CA, Somerville J. Tricuspid atresia with transposition of the great arteries in adolescents and adults: current state and late complications. BRITISH HEART JOURNAL 1987; 57:543-7. [PMID: 3620231 PMCID: PMC1277224 DOI: 10.1136/hrt.57.6.543] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The outcome was reviewed in 17 patients aged 15-40 years with tricuspid atresia and transposed great arteries selected by survival beyond age 14 years. Only five lead normal lives (ability index 1 or 2); the rest are dead or disabled. Arrhythmias occurred in seven. Maintenance of sinus rhythm is important because incessant atrial arrhythmias cause serious symptomatic deterioration. Pulmonary vascular disease and subaortic stenosis were important determinants of late mortality and morbidity. Because the mortality associated with the Fontan operation was high in these patients it should be performed with impeccable surgical technique and only in those who fulfil all the selection criteria for the operation. A shunt is the preferred option when any of the criteria are not met.
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Barbour DJ, Warnes CA, Roberts WC. Cardiac findings associated with sudden death secondary to atherosclerotic coronary artery disease: comparison of patients with and those without previous angina pectoris and/or healed myocardial infarction. Circulation 1987; 75:II9-11. [PMID: 3815791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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180
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Warnes CA, Somerville J. Tricuspid atresia in adolescents and adults: current state and late complications. BRITISH HEART JOURNAL 1986; 56:535-43. [PMID: 3801245 PMCID: PMC1216401 DOI: 10.1136/hrt.56.6.535] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty nine patients aged 15-35 years (mean 23) with tricuspid atresia and normally related great arteries were studied; 20 are alive. Ten patients who had had a Fontan operation (group 1) were compared with 10 patients with palliative shunts (9) or no surgery (1) (group 2). Patients were graded according to their ability to lead a normal life (ability index). Patients in group 1 tended to have a better ability index, a greater exercise capacity, and fewer social and extracardiac problems than those in group 2. The mean left ventricular ejection fraction measured by radionuclide angiography was the same in both groups. Arrhythmias were equally common in both groups; they appear to be age related and they occur independently of left ventricular function.
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181
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Warnes CA, Roberts WC. Morphologic findings in sudden coronary death: a comparison of those with and those without previous symptoms of myocardial ischemia. Cardiol Clin 1986; 4:607-15. [PMID: 3779721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In this article, the amount and distribution of coronary arterial narrowing by atherosclerotic plaque at necropsy are described in 70 victims of sudden coronary death. Of 3484 5-mm segments examined from the four major coronary arteries, 950 (27 per cent) were narrowed 76 to 100 per cent in cross-sectional area by atherosclerotic plaque; 1127 (32 per cent) were narrowed 51 to 75 per cent; 689 (20 per cent) were narrowed 26 to 50 per cent; and 718 (21 per cent) were narrowed 0 to 25 per cent. More extensive severe narrowing occurred in the proximal halves compared with the distal halves of the left anterior descending and left circumflex coronary arteries. Comparison between the 31 previously symptomatic victims (either angina pectoris and/or a clinical acute myocardial infarction) and the 39 victims who had previously been asymptomatic disclosed a significantly higher mean percentage of severely narrowed 5-mm segments and a lower mean percentage of minimally narrowed segments in the symptomatic group.
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Warnes CA, Roberts WC. Morphologic Findings in Sudden Coronary Death: A Comparison of Those With and Those Without Previous Symptoms of Myocardial Ischemia. Cardiol Clin 1986. [DOI: 10.1016/s0733-8651(18)30579-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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183
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184
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185
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Warnes CA, Maron BJ, Roberts WC. Massive cardiac ventricular scarring in first-degree relatives with hypertrophic cardiomyopathy. Am J Cardiol 1984; 54:1377-9. [PMID: 6542306 DOI: 10.1016/s0002-9149(84)80108-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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186
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Warnes CA, Maron BJ, Jones M, Roberts WC. Asymptomatic sinus of Valsalva aneurysm causing right ventricular outflow obstruction before and after rupture. Am J Cardiol 1984; 54:1383-4. [PMID: 6507321 DOI: 10.1016/s0002-9149(84)80111-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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187
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Warnes CA, Roberts WC. Sudden coronary death: comparison of patients with to those without coronary thrombus at necropsy. Am J Cardiol 1984; 54:1206-11. [PMID: 6507291 DOI: 10.1016/s0002-9149(84)80068-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Among 70 victims of sudden coronary death (SCD), certain clinical and morphologic findings in the 13 with a coronary thrombus are compared with the findings in 57 victims without a coronary thrombus. The 13 with a thrombus were younger than those without (mean age 43 vs 51 years, p less than 0.02); had a lower mean percent of cross-sectional area (XSA) narrowing by plaque at the site of maximal coronary stenosis (89% vs 95%, p less than 0.01); and had a higher mean percent of 5-mm segments of the 4 major epicardial coronary arteries minimally narrowed (0 to 25% in XSA) by plaque (27% vs 19%, p less than 0.001). No differences occurred in the 2 groups with regard to sex, previous angina pectoris or clinical acute myocardial infarction, healed myocardial infarction at necropsy, mean heart weight, number of major coronary arteries narrowed 76 to 100% in XSA by atherosclerotic plaque, or the mean percent of 5-mm segments of the 4 major epicardial coronary arteries narrowed 76 to 100% in XSA by atherosclerotic plaque. Thus, coronary thrombi are infrequent in victims of SCD, and when observed, their significance is uncertain because victims of SCD without coronary thrombi have similar amounts of severe coronary narrowing.
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Warnes CA, Roberts WC. The heart in massive (more than 300 pounds or 136 kilograms) obesity: analysis of 12 patients studied at necropsy. Am J Cardiol 1984; 54:1087-91. [PMID: 6496330 DOI: 10.1016/s0002-9149(84)80149-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Observations are described in 12 massively obese patients (5 women, 7 men), aged 25 to 59 years (mean 37), who weighed 312 to more than 500 pounds (mean 381). Seven patients had had systemic hypertension, 4 hypersomnia or sleep apnea, 2 diabetes mellitus, and 1 patient symptomatic coronary artery disease. Five patients died suddenly from undetermined causes, 2 from right-sided congestive heart failure, 1 patient from acute myocardial infarction; 1 from aortic dissection; 1 from intracerebral hemorrhage; 1 from a drug overdose, and 1 soon after an ileal bypass. The heart weight was increased in all 12 patients. The heart weight to body weight ratio expressed as a percent ranged from 0.22 to 0.61 (mean 0.37) (normal for men 0.42 to 0.46 [mean 0.43], normal for women 0.38 to 0.46 [mean 0.40]). The left ventricular cavity was dilated in 11 patients and the right ventricular cavity in all 12. Only 2 patients (aged 42 and 59 years) had 1 or more major epicardial coronary arteries narrowed greater than 75% in cross-sectional area by atherosclerotic plaque, 1 of whom had no symptoms of myocardial ischemia. Of 664 five-millimeter segments from the 4 major epicardial coronary arteries from 11 patients (mean 60 per patient), 431 (65%) were narrowed 0 to 25% in XSA, 143 (21%) were narrowed 26 to 50%, 73 (11%) were narrowed 51 to 75%, and 17 (3%) were narrowed 76 to 100%.(ABSTRACT TRUNCATED AT 250 WORDS)
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Warnes CA, Shugoll GI, Wallace RB, Roberts WC. Atrioventricular septal defect (primum atrial septal defect) with prolonged survival (despite severe mitral regurgitation and pulmonary hypertension) and associated cardiac calcification (mitral anulus, coronary artery and pulmonary trunk). Am J Cardiol 1984; 54:689-91. [PMID: 6475802 DOI: 10.1016/0002-9149(84)90284-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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190
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Warnes CA, Roberts WC. Comparison at necropsy by age group of amount and distribution of narrowing by atherosclerotic plaque in 2995 five-mm long segments of 240 major coronary arteries in 60 men aged 31 to 70 years with sudden coronary death. Am Heart J 1984; 108:431-5. [PMID: 6475707 DOI: 10.1016/0002-8703(84)90404-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A comparison of the amount and distribution of coronary arterial narrowing by atherosclerotic plaque at necropsy is described in each of four decades (31 to 70 years) of 60 male victims of sudden coronary death (SCD). Of 2995 five-mm segments examined (mena 50 per patient) of the four major (left main [LM], left anterior descending [LAD], left circumflex [LC], and right) coronary arteries, no significant differences were observed in the mean percent of 5 mm long segments narrowed severely (76% to 100% in cross-sectional area [XSA]) in each decade: 33% in the five patients aged 31 to 40 years, 29% in the 27 patients aged 41 to 50 years, 26% in the 18 patients aged 51 to 60 years, and 30% in the 10 patients aged 61 to 70 years. The mean percent of 5 mm segments severely narrowed was significantly (p less than 0.05) greater in the proximal halves than in the distal halves of the LAD, LC, and right coronary arteries in only the two older decades. The mean percent of 5 mm segments minimally (0% to 25%) narrowed, however, was significantly higher in the younger than in the older decades. Thus, as groups, both young and old victims of SCD have similar amounts of severe coronary narrowing, but the younger victims have a greater proportion of their major coronary arteries minimally narrowed.
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192
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Warnes CA, Roberts WC. Sudden coronary death: relation of amount and distribution of coronary narrowing at necropsy to previous symptoms of myocardial ischemia, left ventricular scarring and heart weight. Am J Cardiol 1984; 54:65-73. [PMID: 6234790 DOI: 10.1016/0002-9149(84)90305-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The amount and distribution of coronary arterial narrowing by atherosclerotic plaque at necropsy is described in 70 victims, aged 22 to 81 years (mean 50), of sudden coronary death. Of 3,484 five-millimeter segments examined (mean 50 per patient) from the 4 major (left main, left anterior descending, left circumflex and right) coronary arteries, 950 (27%) were narrowed 76 to 100% in cross-sectional area (XSA), 1,127 (32%), 51 to 75%; 689 (20%), 26 to 50%; and 718 (21%), 0 to 25%. More extensive severe narrowing occurred in the proximal than in the distal halves of the left anterior descending, left circumflex and right coronary arteries. Comparison between the 31 previously symptomatic victims (angina pectoris or a clinical acute myocardial infarction or both) with the 39 victims who had previously been asymptomatic disclosed a significantly higher mean percent of severely narrowed (76 to 100% XSA) 5-mm segments (30 vs 25%, p less than 0.005) and lower mean percent of minimally narrowed (0 to 25% XSA) segments in the symptomatic group (15 vs 25%, p less than 0.001). Comparison of the 31 patients who had a healed myocardial infarction at necropsy with the 39 patients who did not disclosed a higher mean percent of 5-mm segments narrowed 76 to 100% in XSA (33 vs 24%, p less than 0.001) and a lower mean percent of segments narrowed minimally in those with a left ventricular scar (13 vs 26%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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193
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Roberts WC, Warnes CA. The AJC in December 1958. Am J Cardiol 1983; 52:1355. [PMID: 6359853 DOI: 10.1016/0002-9149(83)90602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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194
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Warnes CA, McIntosh CL, Roberts WC. Wear of the metallic studs on the composite seat of the 2320 Starr-Edwards aortic valve and its clinical consequences. Am J Cardiol 1983; 52:1062-5. [PMID: 6637825 DOI: 10.1016/0002-9149(83)90533-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The 2320 Starr-Edwards aortic valve has a composite seat with metallic studs that protrude through the cloth. Certain clinical and morphologic findings are described in 6 patients who had this prosthesis in situ for 50 to 144 months (mean 92). Considerable disruption of the cloth covering both struts and base, and varying degrees of wear of the metallic studs that line the luminal side of the prosthetic ring occurred in each. Excessive stud wear resulted in severe disruption of the cloth lining the interior of the prosthetic ring. Cloth disruption may be associated with hemolytic anemia, embolic consequences, or both. Of our 6 patients, 4 had severe hemolytic anemia, 4 had neurologic events compatible with emboli and 1 died suddenly. Stud wear as observed in the 2320 series Starr-Edwards prosthesis also may occur in the models 2310 and 2400 prostheses, which have the same composite seat.
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195
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Warnes CA, Roberts WC. The AJC in November 1958. Am J Cardiol 1983. [DOI: 10.1016/0002-9149(83)90549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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196
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Warnes CA, Kishel JC, Roberts WC. Fatal cardiac arrest during cardiac catheterization for angina pectoris. A marker of quadruple vessel disease. Chest 1983; 84:631-2. [PMID: 6628017 DOI: 10.1378/chest.84.5.631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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197
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Warnes CA, Roberts WC. The AJC in October 1958. Am J Cardiol 1983. [DOI: 10.1016/0002-9149(83)90438-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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198
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Warnes CA, Roberts WC. The AJC in September 1958. Am J Cardiol 1983. [DOI: 10.1016/0002-9149(83)90044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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199
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Warnes CA, Roberts WC. The AJC in June 1958. Am J Cardiol 1983. [DOI: 10.1016/0002-9149(83)90230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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200
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Warnes CA, Harris PC, Fritts HW. Effect of elevating the wrist on the radial pulse in aortic regurgitation: Corrigan revisited. Am J Cardiol 1983; 51:1551-3. [PMID: 6846191 DOI: 10.1016/0002-9149(83)90675-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Five patients with severe aortic regurgitation had their intraarterial radial pulse recorded simultaneously with the external radial artery deflection of the other wrist. Recordings were made with the arms horizontal and repeated after elevation of the wrists, until the arms were vertical. Elevating the arm of a patient with aortic regurgitation increased the pulsation recorded over the radial artery, lowered mean intraarterial pressure, and reduced the pulse pressure. The results suggest that elevation increases the compliance of the arterial wall, primarily by moving the artery to a lower position on its pressure-volume curve. The same changes occurred in 5 normal subjects but were less pronounced.
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