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

  • Norman Chevers
Date:
1851
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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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    I have now endeavoured to trace out, by means of a classified series of fifty-fivedetailed cases, the several forms in which congenital narrowing of the pulmonary orifice is wont to occur; detailing the various modifications of the lesion from its most complicated form, in which the arterial impediment, becoming established at a period when the heart is still in the condition of a single auri.le and ventricle, prevents the develop- ment of the cardiac septa, and determines the permanence of the arterial duct, until we arrive at the simplest condition in which the malformation can possibly occur; i. e. as a defect which is confined to the pulmonary ostium, and which has been produced at so late a period as to have no influence what- ever in preventing the other portions of the heart and its appendages from attaining their full and normal development. I should have been content with illustrating each species of the lesion by merely one or two examples, had it not been for the sin- gular fact, that nearly every instance of this kind of malformation has been found to present certain marked peculiarities which in a striking degree distinguish it from all the other recorded instances to which it is allied ; in fact, it appears that scarcely any two cases of this kind perfectly agree : the history of each appears to develope some new feature in cardiac ])athology, and to afford some additional insight into the inexhaustible resources by which nature is prepared to enable the central organ of the circulation to adapt itself to those vicissitudes which are so liable to affect it during the progress of its development. I shall reserve the discussion of many important points connected with the history of the above lesions until I arrive at the consideration of the morbus cseruleus, and the diagnosis, prognosis, and treatment of diseases originating in the pulmonary artery. Absence of the sigmoid valves. In many of the cases of narrowing of the pulmonary ostium which have been already cited, the valvular apparatus at the origin of the vessel presented scarcely the faintest re- semblance to the natural arrangement of the sygmoid curtains, the development of the valves being especially incomplete in those cases where the imperfect state of the ven- tricular septum, and other extremely defec- tive conditions of the heart and its vessels, proved that the arterial lesion had occurred during the earlier periods of intra-uterine life. In the larger proportion of these in- stances, however, there existed some form or other of imperfect valvular a))paratus, which must have proved more or less efficient in guarding the vessel against reflux ; and, in one only—that observed by Dr. Crampton, (p. 457)—was the vessel entirely destitute of a valvular apparatus: a similar defect was also observed in the following case, which has been recorded by Dr. Favell.* The subject of this extraordinary malfor- mation was a boy, setat. 8 years, who died of cerebral irritation. During his illness his pulse was always slow, not exceeding 70 in the minute : the boy was well developed. On placing the ear below the left nipple there was a loud souffle, and it was stated that, if the boy was much excited, or had taken active exercise, his countenance be- came blue. On examination after death, the heart was found to be of normal size; but, on opening the right auricle, the fora- men ovale was seen completely unclosed, and capable of allowing the passage of the little finger. There was no communication be- tween the right auricle and the correspond- ing ventricle, so that the whole of the blood must have passed through the foramen ovale. In the left ventricle, immediately behind the mitral valve, there was a large aperture through the septum which opened into the commencement of the pulmonary artery : this vessel had no valves. The right ventricle would scarcely contain a small walnut. This case is extremely interesting when compared with the example by Dr. Black- more (cited at p. 749). Here we observe a singular adaptation of parts by which the immediate ill effects of the primary lesion,— complete occlusion of the right auriculo- ventricular orifice,—were averted : in Dr. Blackmore's case was displayed a still more extraordinary alteration in the course of the circulation consequent upon non- development or early occlusion of the left auriculo-ventricular opening. The faulty condition of the pulmonary artery in either case, although apparently secondary to the other cardiac lesions, was evidently the prin- cipal cause of the lividity of surface, and symptoms of cardiac obstruction, from which the patients suffered. It will be noticed that, both in this case and in that related by Dr. Crampton, the valveless pul- monary artery communicated directly with a small muscular cavity which in reaUty merely formed an appendix to the ventricle from which the vessel received its supply of blood : it is probable that this arrangement of parts in some degree compensated for the absence of a valvular apparatus, by prevent- ing the refluent blood from being imme- diately thrown back into the ventricle from which it had been propelled. It is to be regretted that it has not been stated whether the bruit which was heard in both of these cases was synchronous with the diastole or the systole of the heart. There can be little * Provincial Med. and Surg. Journal, vol. iii. p. 440.