Pulmonic regurgitation historical perspective: Difference between revisions

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{{Pulmonic regurgitation}}
{{Pulmonic regurgitation}}
{{CMG}}{{AE}} {{AKI}}, {{AA}}
{{CMG}}{{AE}} {{AKI}}, {{AA}}, {{JA}}


==Overview==
==Overview==
The [[pulmonary valve]] and its function of allowing [[blood]] to the [[lungs]] for nourishment was first described by Hippocrates. Erasistratus, mentioned the involvement of the [[pulmonary valve]] in the unidirectional flow. Realdo Colombo described the pulmonary circulation for the first time.
[[Pulmonic regurgitation]] murmur was first described as [[Graham-Steell murmur]] by Dr. Graham Steel in 1888. Before that  The [[pulmonary valve]] and its function of allowing [[blood]] to the [[lungs]] for nourishment was first described by Hippocrates. Ibn Nafis then described the [[pulmonary circulation]]. Mondino drew a sketch of the [[pulmonary valves|pulmonic valve]]. In 1888 an early blowing [[diastolic murmur]] due to [[pulmonary hypertension]] was described by Graham-steel, known as Graham-steel murmur. Techniques were then developed to diagnose [[pulmonary valve]] regurgitation via the dye method and [[cardiac catheterization]].


==Historical perspective==
==Historical perspective==
*The [[pulmonary valve]] and its function of allowing blood to the [[lungs]] for nourishment was first described by [[Hippocrates]].<ref name="ParaskevasKoutsouflianiotis2017">{{cite journal|last1=Paraskevas|first1=G.|last2=Koutsouflianiotis|first2=K.|last3=Iliou|first3=K.|title=The first descriptions of various anatomical structures and embryological remnants of the heart: A systematic overview|journal=International Journal of Cardiology|volume=227|year=2017|pages=674–690|issn=01675273|doi=10.1016/j.ijcard.2016.10.077}}</ref>
===Discovery===
*Erasistratus, mentioned the involvement of the [[pulmonary valve]] in the unidirectional flow.<ref name="ParaskevasKoutsouflianiotis2017">{{cite journal|last1=Paraskevas|first1=G.|last2=Koutsouflianiotis|first2=K.|last3=Iliou|first3=K.|title=The first descriptions of various anatomical structures and embryological remnants of the heart: A systematic overview|journal=International Journal of Cardiology|volume=227|year=2017|pages=674–690|issn=01675273|doi=10.1016/j.ijcard.2016.10.077}}</ref>
*The concept that the cusps of [[pulmonary valve]] have the texture different than the [[ventricles]] was first described by the father of medicine, [[Hippocrates]] (460-377 B.C). The scientist first described that the function of the [[pulmonary valve]] is to avoid backflow of blood to the [[ventricles]], ensuring one-way flow through the heart.<ref>{{cite book | last = Craik | first = Elizabeth | title = The 'Hippocratic' corpus : content and context | publisher = Routledge | location = Milton Park, Abingdon, Oxon New York, NY | year = 2015 | isbn = 978-1138021716 }}</ref>
*Galen described the membranes of the [[valves]] and named them as "[[semilunar]]".<ref name="ParaskevasKoutsouflianiotis2017">{{cite journal|last1=Paraskevas|first1=G.|last2=Koutsouflianiotis|first2=K.|last3=Iliou|first3=K.|title=The first descriptions of various anatomical structures and embryological remnants of the heart: A systematic overview|journal=International Journal of Cardiology|volume=227|year=2017|pages=674–690|issn=01675273|doi=10.1016/j.ijcard.2016.10.077}}</ref>
*[[Pulmonary circulation]] was first described by Ibn Nafis (1210-1288 AD). The book was forgotten until 1924 when the manuscript No.62243 titled ''Commentary on the anatomy of the Canon of Avicenna'' was found in Germany.<ref name="pmid21042463">{{cite journal| author=Akmal M, Zulkifle M, Ansari A| title=Ibn nafis - a forgotten genius in the discovery of pulmonary blood circulation. | journal=Heart Views | year= 2010 | volume= 11 | issue= 1 | pages= 26-30 | pmid=21042463 | doi= | pmc=2964710 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21042463  }} </ref>
*Mondino de Luzzi designed the sketch of the [[pulmonary valves]] in the anatomical position for the first time.<ref name="ParaskevasKoutsouflianiotis2017">{{cite journal|last1=Paraskevas|first1=G.|last2=Koutsouflianiotis|first2=K.|last3=Iliou|first3=K.|title=The first descriptions of various anatomical structures and embryological remnants of the heart: A systematic overview|journal=International Journal of Cardiology|volume=227|year=2017|pages=674–690|issn=01675273|doi=10.1016/j.ijcard.2016.10.077}}</ref>
*The first ever sketch design  of the [[pulmonary valves]] in their anatomical position was published in a 1541 publication ''Anatomia Mundini, Ad Vetustis''. It was the work of Mondino de Luzzi (1270 A.D -1326 A.D) an Italian physician, [[anatomy|anatomist]], and professor of surgery in Bologna. He is also known as the ''Restorer of anatomy''. His work also includes describing the course of [[pulmonary artery]] (vena arterialis) and [[pulmonary vein]] (arteria venalis).<ref name="pmid24577827">{{cite journal| author=Mavrodi A, Paraskevas G| title=Mondino de Luzzi: a luminous figure in the darkness of the Middle Ages. | journal=Croat Med J | year= 2014 | volume= 55 | issue= 1 | pages= 50-3 | pmid=24577827 | doi=10.3325/cmj.2014.55.50 | pmc=3944418 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24577827  }} </ref><ref name="ParaskevasKoutsouflianiotis2017">{{cite journal|last1=Paraskevas|first1=G.|last2=Koutsouflianiotis|first2=K.|last3=Iliou|first3=K.|title=The first descriptions of various anatomical structures and embryological remnants of the heart: A systematic overview|journal=International Journal of Cardiology|volume=227|year=2017|pages=674–690|issn=01675273|doi=10.1016/j.ijcard.2016.10.077}}</ref>
*Realdo Colombo described the [[pulmonary circulation]] for the first time.<ref name="ParaskevasKoutsouflianiotis2017">{{cite journal|last1=Paraskevas|first1=G.|last2=Koutsouflianiotis|first2=K.|last3=Iliou|first3=K.|title=The first descriptions of various anatomical structures and embryological remnants of the heart: A systematic overview|journal=International Journal of Cardiology|volume=227|year=2017|pages=674–690|issn=01675273|doi=10.1016/j.ijcard.2016.10.077}}</ref>
[[File:Mondino Dei Luzzi 1541 Heart.jpg|thumb|600x600px|One of the first pictoral representations of the heart anatomy from Mondino Dei Luzzi's Anatomia Mundini, Ad Vetustis, 1541. He described [[pulmonary artery]], [[pulmonary vein]], [[pleura]] and [[lungs]] in this picture.  http://hos.ou.edu/galleries//03Medieval/MondinoDeiLuzzi/1541/, Public Domain, https://commons.wikimedia.org/w/index.php?curid=26991959|center]]
*'''[[Graham-Steell murmur]]''': In 1888, Dr. Graham Steel first described the pulmonic regurgitation [[murmur]] in his two publications in ''Manchester Medical Chronicle''. He attributed an early blowing [[diastolic murmur]] over and below the [[Pulmonary valve|pulmonic area]] to the longstanding [[blood pressure|pressure]] in the [[pulmonary artery]], independet of any disease or deformity of the [[valves]]. The [[murmur]] due to [[pulmonary hypertension]] has since been named after the person himself, Graham Steel murmur.<ref name="pmid2023159">{{cite journal| author=Fraser AG, Weston CF| title=The Graham Steell murmur: eponymous serendipity? | journal=J R Coll Physicians Lond | year= 1991 | volume= 25 | issue= 1 | pages= 66-70 | pmid=2023159 | doi= | pmc=5377079 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2023159  }} </ref><ref name="pmid14242430">{{cite journal| author=| title=GRAHAM STEELL (1851-1942)--GRAHAM STEELL MURMUR. | journal=JAMA | year= 1965 | volume= 191 | issue=  | pages= 671 | pmid=14242430 | doi= | pmc= | url= }} </ref>  
 
*Due to the transient, soft nature of the murmur and and resemblance with [[aortic regurgitation]], the need to illustrate the regurgitation by another method arose. In 1958, Wanzer et al. first described the use of [[Evans blue]] dye to diagnose the pulmonic valve regurgitation.<ref name="pmid13783078">{{cite journal| author=WANZER Sh, CUDKOWICZ L, DALEY R| title=[Diagnosis of pulmonary regurgitation by a dye method]. | journal=Br Heart J | year= 1960 | volume= 22 | issue= | pages= 720-2 | pmid=13783078 | doi=10.1136/hrt.22.5.720 | pmc=1017718 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13783078  }} </ref> In 1959, Collins et al. used cardiogreen dye and radioactive [[krypton]] (Kr85) to demonstrate the regurge.<ref name="CollinsBraunwald1959">{{cite journal|last1=Collins|first1=N. Perryman|last2=Braunwald|first2=Eugene|last3=Morrow|first3=Andrew G.|title=Detection of Pulmonic and Tricuspid Valvular Regurgitation by Means of Indicator Solutions|journal=Circulation|volume=20|issue=4|year=1959|pages=561–568|issn=0009-7322|doi=10.1161/01.CIR.20.4.561}}</ref>
*Pulmonic regurgitation [[murmur]] was first described by Dr. Graham Steel in 1888. ''[[Graham-Steell murmur]]'' (named after himself) was described in his two publications in ''Manchester Medical Chronicle''. He attributed an early blowing [[diastolic murmur]] over and below the [[Pulmonary valve|pulmonic area]] to the longstanding [[blood pressure|pressure]] in the [[pulmonary artery]], independet of any disease or deformity of the [[valves]]. The [[murmur]] due to [[pulmonary hypertension]] has since been named after the person himself, Graham Steel murmur.<ref name="pmid2023159">{{cite journal| author=Fraser AG, Weston CF| title=The Graham Steell murmur: eponymous serendipity? | journal=J R Coll Physicians Lond | year= 1991 | volume= 25 | issue= 1 | pages= 66-70 | pmid=2023159 | doi= | pmc=5377079 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2023159  }} </ref><ref name="pmid14242430">{{cite journal| author=| title=GRAHAM STEELL (1851-1942)--GRAHAM STEELL MURMUR. | journal=JAMA | year= 1965 | volume= 191 | issue=  | pages= 671 | pmid=14242430 | doi= | pmc= | url= }} </ref>
*The term "[[semilunar]]" was first used by Galen in 1968 while describing the membranes of the [[valves]] in his book ''De Usu Partium'', Volume 1.<ref name="ParaskevasKoutsouflianiotis2017">{{cite journal|last1=Paraskevas|first1=G.|last2=Koutsouflianiotis|first2=K.|last3=Iliou|first3=K.|title=The first descriptions of various anatomical structures and embryological remnants of the heart: A systematic overview|journal=International Journal of Cardiology|volume=227|year=2017|pages=674–690|issn=01675273|doi=10.1016/j.ijcard.2016.10.077}}</ref>
 
===Landmark Events in the Development of Diagnosis and Treatment Strategies===
*It was long thought that pulmonic regurg can not be [[diagnosis|diagnosed]] during the life-time of a [[patient]]. In 1956, Ralph F. Morton and Thomas N Stern presented a case of isolated nonsurgical [[pulmonic regurgitation]] during the life, suggested by the [[physical exam]], [[phonocardiography]], and [[fluoroscopy]]. It was definitively diagnosed by [[cardiac catheterization]].<ref name="MortonStern1956">{{cite journal|last1=Morton|first1=Ralph F.|last2=Stern|first2=Thomas N.|title=Isolated Pulmonic Valvular Regurgitation|journal=Circulation|volume=14|issue=6|year=1956|pages=1069–1072|issn=0009-7322|doi=10.1161/01.CIR.14.6.1069}}</ref>
*Due to the transient, soft nature of the [[murmur]] and and resemblance with [[aortic regurgitation]], the need to illustrate the regurgitation by another method arose. In 1958, Wanzer et al. first described the use of [[Evans blue]] dye to diagnose the pulmonic valve regurgitation.<ref name="pmid13783078">{{cite journal| author=WANZER Sh, CUDKOWICZ L, DALEY R| title=[Diagnosis of pulmonary regurgitation by a dye method]. | journal=Br Heart J | year= 1960 | volume= 22 | issue=  | pages= 720-2 | pmid=13783078 | doi=10.1136/hrt.22.5.720 | pmc=1017718 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13783078  }} </ref> In 1959, Collins et al. used cardiogreen dye and radioactive [[krypton]] (Kr85) to demonstrate the regurg.<ref name="CollinsBraunwald1959">{{cite journal|last1=Collins|first1=N. Perryman|last2=Braunwald|first2=Eugene|last3=Morrow|first3=Andrew G.|title=Detection of Pulmonic and Tricuspid Valvular Regurgitation by Means of Indicator Solutions|journal=Circulation|volume=20|issue=4|year=1959|pages=561–568|issn=0009-7322|doi=10.1161/01.CIR.20.4.561}}</ref>
*In 1952, Charles A. Hufnagel implanted the first artificial [[heart valve]] (caged ball valve, [[mitral valve]]) among 10 [[patients]]. The implant was a long-term success.<ref>{{Cite web|url=http://www.j-pcs.org/article.asp?issn=2395-5414;year=2015;volume=1;issue=3;spage=289;epage=293;aulast=Rajashekar|title=Development of mechanical heart valves - an inspiring tale|last=Rajashekar|website=www.j-pcs.org|access-date=2019-02-05}}</ref>
*In 2000, Bonhoeffer et al. reported a first bovine (sheep) transcatheter [[pulmonic valve]] repair (tPVR). Abovine [[jugular vein|jugular venous]] valve was sewn inside a platinum-iridium [[stent]] and then hand-crimped onto a [[balloon catheter]]. The device insertion via [[internal jugular]] approach was a success with subsequent explantation of the [[stents]].<ref name="pmid10942752">{{cite journal |vauthors=Bonhoeffer P, Boudjemline Y, Saliba Z, Hausse AO, Aggoun Y, Bonnet D, Sidi D, Kachaner J |title=Transcatheter implantation of a bovine valve in pulmonary position: a lamb study |journal=Circulation |volume=102 |issue=7 |pages=813–6 |date=August 2000 |pmid=10942752 |doi=10.1161/01.cir.102.7.813 |url=}}</ref>
*In 2000, two months following the initial trial among sheep, again Bonhoeffer et al. reported the first ever successful [[percutaneous]] replacement of [[pulmonary valve]] in the [[RV]] to [[PA]] prosthetic conduit via right [[femoral vein]]. The recipient 12-year-old male [[patient]] with [[pulmonary atresia]] and [[ventricular septal defect|VSD]] had valve dysfunction post [[implant]] at the age of 4 years.<ref name="pmid11052583">{{cite journal |vauthors=Bonhoeffer P, Boudjemline Y, Saliba Z, Merckx J, Aggoun Y, Bonnet D, Acar P, Le Bidois J, Sidi D, Kachaner J |title=Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction |journal=Lancet |volume=356 |issue=9239 |pages=1403–5 |date=October 2000 |pmid=11052583 |doi=10.1016/S0140-6736(00)02844-0 |url=}}</ref>
 
===Impact on Cultural History===
No significant impact of [[PR]] discovery and treatment on cultural history has been reported. There were no outbreaks associated with [[PR]] reported in history.
 
===Famous Cases===
*Shaun White is an American professional snowboarder. The three-time Olympic champion suffered from [[TOF]] and has undergone three separate [[Tetralogy of fallot surgical techniques|repair surgeries]] during hs childhood.<ref name="urlShaun White - Olympic | United States of America">{{cite web |url=https://www.olympic.org/shaun-white |title=Shaun White - Olympic &#124; United States of America |format= |work= |accessdate=}}</ref><ref name="urlWinter Olympics 2018: Shaun Whites heart condition inspires an army of loyal fans - CBSSports.com">{{cite web |url=https://www.cbssports.com/olympics/news/winter-olympics-2018-shaun-whites-heart-condition-inspires-an-army-of-loyal-fans/#:~:text=White%20suffers%20from%20a%20heart,the%20middle%20of%20his%20chest. |title=Winter Olympics 2018: Shaun White's heart condition inspires an army of loyal fans - CBSSports.com |format= |work= |accessdate=}}</ref>
*Jennie Garth, a Hollywood actress mentioned having a heart condition saying: “I have a leaky valve. She also said "I can feel a little weird fluttering."<ref name="url6 Celebrities Who Prove Heart Disease Can Hit Anybody">{{cite web |url=https://totalnewswire.com/celebrities-with-heart-problems/ |title=6 Celebrities Who Prove Heart Disease Can Hit Anybody |format= |work= |accessdate=}}</ref><ref name="urlwww.youtube.com">{{cite web |url=https://www.youtube.com/watch?v=Gg0u4luUidc |title=www.youtube.com |format= |work= |accessdate=}}</ref> Some literature mentions the actress having [[mitral regurgitation]] but it is not clear whether the [[Regurgitation (circulation)|valvular insufficiency]] involves [[pulmonic regurgitation|pulmonic]] or [[Mitral regurgitation|mitral]] valves.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 21:09, 7 August 2020

Pulmonic regurgitation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differential diagnosis

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X-Ray

Echocardiography

Cardiac MRI

Severity Assessment

Treatment

Medical Therapy

Surgical therapy

Follow up

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2], Aysha Anwar, M.B.B.S[3], Javaria Anwer M.D.[4]

Overview

Pulmonic regurgitation murmur was first described as Graham-Steell murmur by Dr. Graham Steel in 1888. Before that The pulmonary valve and its function of allowing blood to the lungs for nourishment was first described by Hippocrates. Ibn Nafis then described the pulmonary circulation. Mondino drew a sketch of the pulmonic valve. In 1888 an early blowing diastolic murmur due to pulmonary hypertension was described by Graham-steel, known as Graham-steel murmur. Techniques were then developed to diagnose pulmonary valve regurgitation via the dye method and cardiac catheterization.

Historical perspective

Discovery

  • The concept that the cusps of pulmonary valve have the texture different than the ventricles was first described by the father of medicine, Hippocrates (460-377 B.C). The scientist first described that the function of the pulmonary valve is to avoid backflow of blood to the ventricles, ensuring one-way flow through the heart.[1]
  • Pulmonary circulation was first described by Ibn Nafis (1210-1288 AD). The book was forgotten until 1924 when the manuscript No.62243 titled Commentary on the anatomy of the Canon of Avicenna was found in Germany.[2]
  • The first ever sketch design of the pulmonary valves in their anatomical position was published in a 1541 publication Anatomia Mundini, Ad Vetustis. It was the work of Mondino de Luzzi (1270 A.D -1326 A.D) an Italian physician, anatomist, and professor of surgery in Bologna. He is also known as the Restorer of anatomy. His work also includes describing the course of pulmonary artery (vena arterialis) and pulmonary vein (arteria venalis).[3][4]
One of the first pictoral representations of the heart anatomy from Mondino Dei Luzzi's Anatomia Mundini, Ad Vetustis, 1541. He described pulmonary artery, pulmonary vein, pleura and lungs in this picture. http://hos.ou.edu/galleries//03Medieval/MondinoDeiLuzzi/1541/, Public Domain, https://commons.wikimedia.org/w/index.php?curid=26991959

Landmark Events in the Development of Diagnosis and Treatment Strategies

Impact on Cultural History

No significant impact of PR discovery and treatment on cultural history has been reported. There were no outbreaks associated with PR reported in history.

Famous Cases

  • Shaun White is an American professional snowboarder. The three-time Olympic champion suffered from TOF and has undergone three separate repair surgeries during hs childhood.[13][14]
  • Jennie Garth, a Hollywood actress mentioned having a heart condition saying: “I have a leaky valve. She also said "I can feel a little weird fluttering."[15][16] Some literature mentions the actress having mitral regurgitation but it is not clear whether the valvular insufficiency involves pulmonic or mitral valves.

References

  1. Craik, Elizabeth (2015). The 'Hippocratic' corpus : content and context. Milton Park, Abingdon, Oxon New York, NY: Routledge. ISBN 978-1138021716.
  2. Akmal M, Zulkifle M, Ansari A (2010). "Ibn nafis - a forgotten genius in the discovery of pulmonary blood circulation". Heart Views. 11 (1): 26–30. PMC 2964710. PMID 21042463.
  3. Mavrodi A, Paraskevas G (2014). "Mondino de Luzzi: a luminous figure in the darkness of the Middle Ages". Croat Med J. 55 (1): 50–3. doi:10.3325/cmj.2014.55.50. PMC 3944418. PMID 24577827.
  4. 4.0 4.1 Paraskevas, G.; Koutsouflianiotis, K.; Iliou, K. (2017). "The first descriptions of various anatomical structures and embryological remnants of the heart: A systematic overview". International Journal of Cardiology. 227: 674–690. doi:10.1016/j.ijcard.2016.10.077. ISSN 0167-5273.
  5. Fraser AG, Weston CF (1991). "The Graham Steell murmur: eponymous serendipity?". J R Coll Physicians Lond. 25 (1): 66–70. PMC 5377079. PMID 2023159.
  6. "GRAHAM STEELL (1851-1942)--GRAHAM STEELL MURMUR". JAMA. 191: 671. 1965. PMID 14242430.
  7. Morton, Ralph F.; Stern, Thomas N. (1956). "Isolated Pulmonic Valvular Regurgitation". Circulation. 14 (6): 1069–1072. doi:10.1161/01.CIR.14.6.1069. ISSN 0009-7322.
  8. WANZER Sh, CUDKOWICZ L, DALEY R (1960). "[Diagnosis of pulmonary regurgitation by a dye method]". Br Heart J. 22: 720–2. doi:10.1136/hrt.22.5.720. PMC 1017718. PMID 13783078.
  9. Collins, N. Perryman; Braunwald, Eugene; Morrow, Andrew G. (1959). "Detection of Pulmonic and Tricuspid Valvular Regurgitation by Means of Indicator Solutions". Circulation. 20 (4): 561–568. doi:10.1161/01.CIR.20.4.561. ISSN 0009-7322.
  10. Rajashekar. "Development of mechanical heart valves - an inspiring tale". www.j-pcs.org. Retrieved 2019-02-05.
  11. Bonhoeffer P, Boudjemline Y, Saliba Z, Hausse AO, Aggoun Y, Bonnet D, Sidi D, Kachaner J (August 2000). "Transcatheter implantation of a bovine valve in pulmonary position: a lamb study". Circulation. 102 (7): 813–6. doi:10.1161/01.cir.102.7.813. PMID 10942752.
  12. Bonhoeffer P, Boudjemline Y, Saliba Z, Merckx J, Aggoun Y, Bonnet D, Acar P, Le Bidois J, Sidi D, Kachaner J (October 2000). "Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction". Lancet. 356 (9239): 1403–5. doi:10.1016/S0140-6736(00)02844-0. PMID 11052583.
  13. "Shaun White - Olympic | United States of America".
  14. "Winter Olympics 2018: Shaun White's heart condition inspires an army of loyal fans - CBSSports.com".
  15. "6 Celebrities Who Prove Heart Disease Can Hit Anybody".
  16. "www.youtube.com".