Case of aneurism of the ascending aorta opening into the right auricle : fatty degeneration of the muscular substance of the heart / by Thomas Bevill Peacock.

  • Thomas Bevill Peacock
Date:
[1844]
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Credit: Case of aneurism of the ascending aorta opening into the right auricle : fatty degeneration of the muscular substance of the heart / by Thomas Bevill Peacock. 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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    of being removed, and retained the form of the pouch when sepa- rated from the other tunics. In two or three other cases I have dissected aneurismal tumours of considerable size, consisting, like that described in this paper, of expansions of the arterial tunics; and I believe that aneurisms of the aorta, throughout its course, originate, in the largest proportion of cases, in sacculated dilata- tions of the coats. It rarely occurs, that in the larger tumours, the internal tunics can be traced throughout the sacs.1 ^ 2. The portion of the ascending aorta above the attachment of the right and posterior semi-lunar valves,—where in this case the aneur- ism originated,—would appear to be less liable to this affection than that near the attachment of the right and left valves; often an- eurismal sacs observed by Mr Thurnam in these situations, one only arose from the former, and eight from the latter point. From Mr Thurnam's researches it also appears, that the cavities of aortic aneurisms more frequently form communications with the right ventricle, than with the right auricle; of the cases which he has referred to, eight are examples of the former, and two only of the latter kind. The greater frequency of communications with the right ventricle is owing to the situation of that cavity, —in close contact with the left and right sinuses of Valsalva, and the points of attachment of the corresponding valves,—exposing it to the pres- sure of aneurisms in each of these situations; while the auricle is in contact with a much smaller portion of the origin of the aorta. Dur- ing the time that I conducted the dissections of the Royal Infirmary, a case in which an aneurism of the ascending aorta had opened into the right ventricle, fell under my notice.2 In this instance, the aneu- rism arose from the anterior and left side of the aorta, about half an inch above the attachment of the semi-lunar valves. The aperture, the size of half-a-crown, and bounded by firm and projecting edges, opened into a large sac, extending above to the level of the arch, and burrowing below into the base of the right ventricle. The septum between the cavity of the latter and the aneurism, was so thin as to be perfectly diaphanous, and in the centre had given way, leaving an aperture of sufficient size to allow the point of the little finger to be passed through. 3. This case affords us no assistance in what is at present a great desideratum, viz. the physical diagnosis of communications be- tween the aorta and right cavities of the heart. There can be no doubt that the symptoms under which the patient laboured during the short time he was under notice before his death, were 1 It is extremely improbable that the external coat of the aorta can alone sustain a column of blood extravasated between it and the middle tunic, as supposed by Scarpa. See experiments illustrative of the mode of formation of dissecting aneurisms, by the author, in the number of the London and Edinburgh Monthly Journal for October 1843. 2 For full particulars of the symptoms attending this case during life, and the morbid appearances, see a Clinical Lecture by Dr Henderson in the London and Edinburgh Monthly Journal for May 18-13.