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

  • Chevers, Norman, 1818-1886.
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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    cavity (the right ventricle), furnished with the diminutive rudiment of a tricuspid valve. The right auricle communicates with the left by a large foramen ovale, guarded by a remarkably formed sigmoid valve which opens just above the left auriculo-ventricular orifice. The ovalian valve must have per- mitted a free passage of blood from right to left, but must have been efficient, or nearly so, in the contrary direction. The left ventricle, which is capacious, and communi- cates freely with the left auricle, is partially separated about its centre—above by a membranous expansion, and below by a net- work of pectinated bands, A large aorta arises from the back part of the left ventricle. Above the point of obliteration, the pulmo- nary artery is rather small, but it has evidently received a supply of blood—it is uncertain from what source, as the arch and its vessels have been removed. Just at the point where the pulmonary artery is divided, the orifice of the ductus arteriosus is seen apparently partially closed. This heart, notwithstanding its complicated form, is essentially single; and, in this respect, cor- responds with those in the two cases already detailed. It is probable that, in the whole of the above instances, obliteration of the pulmo- nary orifice occurred at a period of intra- uterine life, when the communication be- tween the ventricles had been entirely or nearly closed by the septum, under which circumstances the right ventricle, destitute of an outlet, and reduced to the condition of an inefficient cul de sac, became contracted and almost impervious. This is the only class of cases with which I am acquainted where—the pulmonary orifice being congeni- tally imperforate—a free communication between the ventricles does not exist. This condition of heart appears to be incompatible with a prolonged duration of extra-uterine life. Mr. Hodgson's case was published in the London Medical Review. The heart has also been described by Dr. Farre. The foramen ovale was widely open. Some of the fibres were wanting in the ventricular septum, and the lining membrane of the left ventricle had three foramina, giving it a cribriform appeai'ance. In the place of the pulmonary artery there was an impervious filament leading to a very large ductus arteriosus, which might be traced from the aorta into two pulmonary branches. The trunk was much larger than an ordinary ductus arteriosus, but smaller than a pul- monary artery. The child hved seven days. Two similar specimens are referred to by Farre, as contained in Mr. Langstaff's museum,—one from a still-born infant, the other from a child who lived 6 months. In this case there was a considerable per- foration of the septum of the ventricles, but it was nearly closed by the fibres which almost filled up the right ventricle. The same author makes slight allusion to two other specimens. A remarkable case, showing how com- pletely the development of the ventricular and auricular septa may be prevented, when occlusion of the pulmonary orifice occurs at a very early period of intra-uterine life, is related by Dr. J. Mauran,* A female child, set. 10§ months, of small stature and exceed- ingly emaciated, suffered from frequent at- tacks of difficult and almost totally suspended respiration, immediately succeeded by a livid and purple appearance extending over the whole surface. The heart was found to be single, having but one auricle and one ventricle, communicating by a very large and free foramen, guarded by a tricuspid valve. The aorta and pulmonary artery arose from the common ventricle, but the latter vessel was perfectly impervious at its origin. The ductus arteriosus occupied nearly the usual position, and was open, and hence the pxilmonary artery received its sup- ply. The auricle was very large; into its posterior part were inserted the two cavae and the right pulmonary vein (there were only two), the left having an insertion ante- riorly near the origin of the pulmonary artery. The parietes of the ventricle were unusually thick and strong. Dr. F. Ramsbotham observed a very similar condition of parts in a child 6 months old. The heart was single, con- sisting of one auricle and one ventricle ; it was turned to the right side, and the ductus arteriosus seemed to supply the place of the pulmonary artery. The pulmonary veins of the left lung terminated in the left subclavian vein—that of the right lung passed through the diaphragm and terminated in the vena portarum. Inhere appeared to be an at- tempt to form a pulmonary artery and veinf. The following instances represent the con- dition of parts which is most frequently observed in cases of this description, viz., the partial division of the heart by an im- perfect ventricular septum—the aorta origi- nating either from the right ventri'^le, or from a point immediately over the septum, mid-way between the two ventricles. Dr. Farre relatesj the case of a female infant, set. 4 weeks, where the ventricular septum was perforated; the aorta arose from * Philadelphia Journ. of Med. and Physical Sciences, vol. xiv., p. 253. t So stated in the original account; but, as the course of the pulmonary veins is distinctly men- tioned, this allusion is obscure: it probably refers to a rudiment of the fourth pulnionnry vein, only one being- described as passing from the right lung.—Medical and Physical Journ. vol Ixi. p. 548. % Pathological Researches, p. 27.