1. Volume 33, Issue 5, Pages 513-532 (May 1958)
Differentiation of the Causes of Pulmonary Hypertension in Rheumatic Heart Disease by Simultaneous Right and Left Heart Catheterization 
PHILIP SAMET, M.D., F.C.C.P., WILLIAM H. BERNSTEIN, M.D., ROBERT S. LITWAK, M.D. 
Diseases of the Chest 
Volume 33, Issue 5, Pages (May 1958)
DOI: /chest
Copyright © 1958 American College of Chest Physicians Terms and Conditions

2. FIGURE 1
Pulmonary artery, right ventricle and brachial artery pressure curves in R. R. before surgery. The resting pulmonary hypertension is further increased during exercise. Paper speed 25 mm. per second.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

3. FIGURE 2
Left heart exercise curves in R. R. pre-operatively. The mean diastolic left atrial-left ventricular gradient is 24 mm. Hg. Paper speed is 75 mm. per second.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

4. FIGURE 3
Post-operative right heart catheterization data in R. R. Mild pulmonary hypertension is present only during exercise. Study performed October 24, 1956.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

5. FIGURE 4
One month after surgery the resting mean diastolic left atrial—left ventricular gradient is 3 mm. Hg. at rest. (R. R.) Study performed October 24, 1956.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

6. FIGURE 5
During exercise the gradient rises to 6 mm. Hg. Study performed October 24, 1956.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

7. FIGURE 6
Right heart Catheterization data in D. D., pre-operatively. There is marked pulmonary hypertension at rest with a further increase during exercise.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

8. FIGURE 7
Pre-operative left heart catheterization data in the same patient. The left atrial hypertension and mean diastolic left atrial—left ventricular pressure gradient is readily noted.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

9. Figure 8 Operating room pre-commissurotomy pressures in D. D.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

10. Figure 9
Operating room post-commissurotomy pressures in D. D. The marked decrease in the diastolic gradient is readily seen.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

11. FIGURE 10
Right heart curves in D. D. one month after surgery. There has been a decrease in the level of pulmonary artery pressure at rest and exercise, but marked pulmonary hypertension persists.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

12. FIGURE 11
Left heart catheterization data in D. D. one month after commissurotomy. The diastolic gradient is 1 mm. Hg. at rest and 4 mm. Hg. during exercise. The left ventricular end-diastolic pressure is normal throughout.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

13. FIG. 12
Ten months after surgery a further fall in pulmonary artery pressure is noted in D. D
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

14. FIG. 13
Right and left heart curves in D. D., at rest supine ten months after commissurotomy. The resting gradient is 1 mm. Hg
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

15. FIG. 14 The exercise gradient is 3 mm. Hg., D. D.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

16. FIG. 15
Left heart catheterization curves (prone) in S. B., pre-operatively. There is no evidence of mitral insufficiency
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

17. FIG. 16
One month after commissurotomy. The diastolic gradient has been reduced to 3 mm. Hg., prone position. The left atrial curve is suggestive of mitral insufficiency.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

18. FIG. 17
Left heart curves one year after surgery in S. B. A mean diastolic atrioventricular gradient has reappeared.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

19. FIGURE 18
Severe aortic stenosis in S. M. The left atrial mean and left ventricular end-diastolic pressures are markedly elevated.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

20. FIG. 19
Pulmonary “capillary” pressure in E.C. The mean pressure is 12 mm. Hg., at the upper limit of normal.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

21. FIG. 20
There is an obvious significant mean diastolic left atrial—left ventricular gradient. Tight mitral stenosis was found at surgery.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions

22. FIGURE 21
The mean diastolic atrio-ventricular gradient supine is plotted on the abcissa; the prone gradient is on the ordinate. The deviation from the 46° line of identity is to be noted.
Diseases of the Chest  , DOI: ( /chest )
Copyright © 1958 American College of Chest Physicians Terms and Conditions