Collection of facts illustrative of the morbid conditions of the pulmonary artery / by Norman Chevers, M.D.

  • Norman Chevers
Date:
1851
Catalogue details

Licence: Public Domain Mark

Credit: Collection of facts illustrative of the morbid conditions of the pulmonary artery / by Norman Chevers, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    occluded by a dense membrane of fibrous structure. Immediately above this partition a narrow passage (the ascending portion of the pulmonary artery) extended upwards to the back of the aorta, where it divided into two branches; one of these appears to have passed to tlie right lung, and the other is again subdivided into two. I believe that the lower of these went to the left lung, and that the upper received blood from some aortic branch. The arterial ligament passed directly from the upper and inferior part of the ascending aorta to the point of diver- gence of the two main pulmonary branches. In the portion of the aorta which remained, there were not any vessels which could have conveyed blood to this rudimentary pul- monary artery, but this must, in all proba- bihty, have been supplied by branches aris- ing either from some of the large vessels of the arch, or from some part of the descend- ing thoracic aorta. That the supply was re- ceived from the latter source is rendered extremely improbable by the fact that, im- mediately distal to the left subclavian artery, the tissues of the aorta were considerably thinner and weaker than they were a short distance above this point, rendering it pro- bable that a somewhat diminished current of blood passed through the descending part of the main artery. Two or three of the ori- fices of the superior aortic intercostal arte- ries were left attached to the vessel, (which had been divided obliquely immediately an- terior to the origin of the left subclavian) : these were of the natural size: hence the further improbability that the pulmonary artery received any supply from the aorta below its arch. The origins of the brachio- cephalic and left carotid arteries appeared of the ordinary dimensions, and did not seem to have been capable of admitting more than the usual quantity of blood. The left sub- clavian had been severed, and therefore it was impossible to judge of either its dimen- sions or its course, but the obliterated state of the arterial duct, the undilated condition of the brachio-cephalic, left carotid, and in- tercostal arteries, and the thinness of the coats of the descending aorta, appear to render it a perfectly fair conjecture that the pulmonary artery could not have received its supply of blood from any other source than the left subclavian. Whatever uncertainty may attach to the manner in which the pulmonary artery was supplied with blood in this remarkable case, its detail afl'ords one or two extremely in- teresting facts—as shewing for how long a time an individual may survive, although suffering from so extreme a malformation, and as proving that the natural closure both of the arterial duct and the ovalian foramen may be effected, even in a case where there is complete occlusion of the pulmonary ostium. The heart is preserved in the Museum of St. George's Hospital. The following case, by M. Bigger,* affords a rare example of absence of the pulmonary artery, the lungs being supplied by a supernumerary vessel from the arch of the aorta. An infant which, from the fifth day after birth, had been affected with cya- nosis, died at the age of 5^^ months, of con- vulsions and dyspnoea. The left ventricle and auricle of the heart were found to be much smaller than the right. The foramen ovale was still patent. The pulmonary veins were much contracted, but no traces of the [true ?] pulmonary arteries could be detected. The aorta arose from the septum of the two ventricles, and commu- nicated with both. A considerable arterial branch, about the size of the arteria in- nominata, was given off from the arch of the aorta, and was distributed to the lungs. In January 1842, Mr. G. Smith de- tailed, at the Westminster Medical Society, the case of an infant which attracted atten- tion soon after its birth by the dark colour of its skin. It, however, went on pretty well, and appeared in good health, except that it was subject to attacks of crying, with shortness of breath, at which time the blue- ness of the surface was very much increased. It died suddenly at the age of eight months. The body .was plump and fat. The heart was large, the right auricle and ventricle were of great extent, and composed the greater portion of the organ ; the right ven- tricle was more muscular than natural, and the left had the small proportions proper to the right. The pulmonary artery was want- ing, with the exception of what appeared to be the small rudiment of one going in a direction towards the ductus arteriosus. The aorta, which was very large, arose from both ventricles, the ventricular septum being in- complete. The vessels branched off from the arch of the aorta as usual; but, in addi- tion to these, there was an artery about the size of the subclavian arising from the under surface of the arch. This shortly divided into two branches, which were distributed one to each lung. There were three or four small pulmonary veins, which passed to the left auricle. The foramen ovale was open sufficiently to admit a goose-quill in an oblique direction.f As the precise spot from which the super- numerary branch ai-ose in the two cases just quoted is not mentioned, and as no re- ference to the arterial duct is made in either, it would be difficult to judge whether the * Wochenschrift fur die Gcsnninite Hcil- kunde, 1839, No. 36; nnii Kdinburgh Med. and Surgical Journnl, vol. Iv. p. 25, t Vancct, Jan. IStli, 1842.