"Left heart" radiopotassium-dilution curves were carried out in 9 patients with rheumatic mitral valvular disease. From the curves, blood flow, circulation times, and "left heart" and aortic volumes were calculated. When this technic is used along with "left heart" pressure measurements, it appears to have a satisfactory reliability in demonstrating abnormalities of flow, volume, and mitral valve function. In theory, its proper application permits complete quantitation of these parameters.IN SOME patients having long standing rheumatic heart disease routine clinical studies are inadequate either in establishing the existence or in evaluating the severity of stenosis or insufficiency of the mitral valve. Yet corrective surgical treatment makes evaluation of mitral valve function a matter of considerable importance. The surgical procedure, the surgical mortality, and the prognosis covering postoperative improvement are all influenced to some extent by the nature of the lesion present.A number of specialized diagnostic procedures have been employed to improve diagnosis and quantify approximately the degree of the abnormalities present. Among these are angiocardiography,' measurement of pulmonary arterial "wedge" pressure,' ballistocardiography,3 and direct measurement of "left heart" pressure.4 Yet, mistaken evaluations are still occasionally made or corroborative evidence is desired, particularly with respect to the amount of insufficiency present. It was considered that indicator-dilution curves made by injections of an indicator into the left heart and aortic root could be used to provide additional and perhaps better information on blood flow, valve function, and also on left heart volume.
A technic is described for determining mean circulation time, cardiac output, and central blood volume by use of graded dosages of sodium dehydrocholate (Decholin) administered into a peripheral vein. The indicator-dilution curves derived by the technic were compared with radiopotassium-dilution curves These concepts were tested experimentally by (1) determination indirectly of the blood concentrations of Decholin associated with the appearance and disappearance of the bitter taste, (2) determination of these times of onset and offset of taste following injections of 3 graded doses of Decholin, (3) construction of Decholin-dilution curves from the data on circulation times and blood concentrations at taste threshold, and finally (4) comparison of the results obtained from these curves with results obtained from radiopotassium-dilution studies carried out simultaneously. Comparisons of curve contour, cardiac output, central blood volume, and mean circulation time were made in 12 patients with and without cardiovascular disease. The correlation between the isotope and Decholin results was surprisingly good and indicates that the Decholin method is capable of providing more information than has been obtained in the past.
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