674 



HANDBOOK OF PHYSIOLOGY 



CIRCULATION I 



was due to an inadequate compensation from the 

 pulmonary or systemic venous bed, which cannot 

 increase the pressure filling the ventricle as easily 

 as the ventricular muscle can increase its force and 

 empty the ventricles in the presence of slight aortic 

 or pulmonary disease. These findings agree well with 

 the observation that patients with even slight mitral 

 stenosis have a lower renal blood flow and react more 

 to the stress of exercise than do patients with slight 

 aortic disease or normals. They also provide a physi- 



ological background to the well-known clinical ex- 

 perience that a patient with aortic valvular disease 

 may have a long active life without symptoms until 

 signs of myocardial failure appear, after which the 

 congestive failure rapidly develops and leads to a 

 fatal termination within a few months. This pattern 

 is quite different from the course in mitral disease 

 where signs of failure develop slowly and congestive 

 heart failure may be present for many years before 

 death. 



REFERENCES 



1. Allison, P. R. and R. J. Linden. The bronchoscopic 

 measurement of left auricular pressure. Circulation 7 : 699, 



'953- '5- 



2. Andersson, T. Electrokymographic examinations in 

 mitral valve disease. Acta Radiol, Suppl. 106, 1953. 



3. Ankenev, J. L. Further experimental evidence that pul- 

 monary capillary pressures do not reflect cyclic changes 16. 

 in left atrial pressure. Circulation Res. 1 : 58, 1953. 



4. Ankeney, J. L. Interrelations of pulmonary arterial, 

 "capillary" and left atrial pressures under experimental '7- 

 conditions. Am. J. Physiol. 169: 40, 1952. 



5. Ankenev, J. L., A. P. Fishman, and H. W. Fritts, Jr. 



An analysis of normal and abnormal left atrial pressure '8. 



pulse in man. Circulation Res. 4: 95, 1956. 

 6 Araujo, J. and D. S. LLrK.'\s. Interrelationships among 

 pulmonary "capillary" pressure, blood flow and valve 

 size in mitral stenosis. The limited regulatory effects of '9- 



the pulmonary vascular resistance. J. Clin. Invest. 31 ; 

 1 082, 1952. 20. 



7. Arvidsson, H. .Angiocardiographic obser\ations in mitral 

 disease. Acta radial. Suppl. 158, 1958. 



8. Bajec, D. F., N. C. Birkhead, S. A. Carter, and E. H. 2I- 

 Wood. Localization and estimation of severity of regurgi- 

 tant Aow at the pulmonary and tricuspid valves. Proc. 



Staff. Meet. Mayo Clin. 33: 459, 1958. 22. 



g. Ball, J. D., H. Kopelman, and A. C. Witham. Circula- 

 tory changes in mitral stenosis at rest and on exercise. 

 Brit. Heart J. 14:363, 1952. 



10. Baroer, A. C, F. p. Muldowney, and M. R. Liebo- 



wiTZ. Role of the kidney in the pathogenesis of congestive 23. 



heart failure. Circulation 20: 273, 1959. 



11. Barger, a. C, B. B. Roe, and G. S. Richardson. 

 Relation of valvular lesions and of exercise to auricular 

 pressure, viorV. tolerance and to development of chronic, 

 congestive failure in dogs. Am. J. Physiol. 169: 384, 1952. 24. 



12. Barger, A. C, R. S. Ross, and H. L. Price. Reduced 

 sodium excretion in dogs with mild valvular lesions of the 

 heart and in dogs with congestive failure. Am. J. Physiol. 

 180: 249, 1955. 



13. Bayliss, R. I. S., N. J. Etherridge, and .\ L. H'iman. 

 Pulmonary hypertension in mitral stenosis. Lancet 259' 25. 



899. 1950 



14. Becker, D. L., H. B. Burchell, and J. E. Edwards. 

 Pathology of the pulmonary vascular tree. II. The occur- 



rence in mitral insufficiency of occlusive pulmonary 

 vascular lesions. Circulation 3: 230, 1951. 

 Berglund, E. The function of the ventricles of the heart. 

 Studies on the relation between diastolic filling and ven- 

 tricular work in the anesthetized dog. Acta Physiol. 

 Scandinav. Suppl. 119: i, 1955. 



BjORK, V. O. Direct pressure measurement in the left 

 atrium, the left ventricle and the aorta. Acta chir. Scandi- 

 nav., 107; fasc. 5, 1954. 



BjORK, V. O., W. S. Bl.\kemore, and G. Malmstrom. 

 Left ventricular pressure measurement in man. A new 

 method. Am. Heart J. 48: 197, 1954. 



Bjork, V. O. AND H. LoDiN. Left heart catheterization 

 with selective left atrial and ventricular angiocardiography 

 in the diagnosis of mitral and aortic vahular disease. 

 Progr. Cardiovasc. Dis. 2 : 116, 1 959. 



Bjork, V. O. and G. Malmstrom. Left heart catheteriza- 

 tion. Circulation Res. 2: 424, 1954. 



Bjork, V. O. and G. Malstrom. The diastolic pressure 

 gradient between the left atrium and the left ventricle in 

 cases of mitral stenosis. Am. Heart J. 58: 486, 1959. 

 Bjork, V. O., G. Malmstrom, and L. G. Uggla. Left 

 auricular pressure measurements in man. Ann. Surg. 138: 

 718, 1953. 



Blakemore, VV. S., T. G. Schnabel, Jr., P. T. Kuo, 

 H. L. Conn, Jr., S. B. Langfeld, D. F. Heiman, and 

 H. WosKE. Diagnostic and physiologic measurements 

 using left heart catheterization. J. Thoracic Surg. 34; 436, 



1957- 



Bloomfield, R., H. Lauson, A. Cournand, E. S. Breed, 

 and D. W. Rich.ards. Recording of right heart pressures 

 in normal subjects and in patients with chronic pulmonary 

 disease and various type of cardio-circulatory diseases. 

 J. Clin. Invest. 25: 639, 1946. 



Borden, C. W., R. V. Ebert, R. H. Wilson, and H. S. 

 Wells. Studies of the pulmonary circulation. II. The 

 circulation time from the pulmonary artery to the femoral 

 artery and the quantity of blood in the lungs in patients 

 with mitral stenosis and in patients with left ventricular 

 failure. J. Clin. Invest. 28: 1138, 1949. 

 Borst, H. G., M. McGregor, J. L. Whittenberger, 

 AND E. Berglund. Influence of pulmonary arterial and 

 left atrial pressures on pulmonary vascular resistance. 

 Circulation Res. 4: 393, 1956. 



