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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    j riatious which occur in this respect are ex- tremely marked, rendering the degree of malformation very far indeed more salient ;i in some cases than in others ; and espe- cially as it is found that such variations produce considerable difference in the state ©f the circulation, and distinctly affect the i viablity of the individuals who suffer from these malformations. Still it appears preferable to arrange the cases according to the degree of abnormal ' oommunication which is observed to exist in the several instances, premising that the I modes in which the large vessels are found j to be given off from the heart, in cases of t arctation of the pulmonary orifice, are as follow::— I 1. The aorta arising from the right ven- tricle, the narrowed wifice of the pulmonary , artery being situated to its left, and ante- I riorly. The septum of the ventricles pierced I by a rounded opening, which may either be I confined to the upper portion of the par- tition, or be so extremely wide as to leave I tlie ventricles separated merely by a slightly devated falx. t 2. The aorta, originating behind the pul- : monary artery, nearly midway between the ventricles, and above the ventricular septum, which terminates by a crescentic margin below the ostium of the vessel; thus leaving an aperture of greater or less size through which both ventricles communicate alike 'vith the aiteries and with each other. 3- The narrowed pulmonary artery and tiie aorta arising, as usual, from the right and left ventricles, wither without a rounded aperture in the ventricular septum. Although by far the larger proportion of instances in which these malformations occur e congenital, it occasionally becomes a • atter of difficulty to decide whether many, if not the whole, of the abnormal appear- ances are not the results of comparatively recent disease. In the cases of the first and second orders, just described, such a doubt cannot for an instant be maintained; a s'ngle glance will shew that the principal 1 sions are congenital, although morbid changes of later date may have been su- peradded ; but with regard to the third class, it is often by no means easy to decide;—in -uch cases an opinion can only be founded upon a m'nute examination of the struc- rurcs, and a knowledge of the duration and :haracter of the symptoms during life. The following arrangements of parts have leen observed in cases where the orifice of the 'ulmonary artery was congenitally nar- owed. (1.) The pulmonary circulation upplied by enlarged bronchial arteries. '■i.) The auricular and ventricular septa perfect; the ductus arteriosus remainin u rraanently open. (3.) The foramen ovale l.nd arterial duct permanently open; the ventricular septum being complete. (4.) The arterial duct and ventricular septum pervious; the foramen ovale perfectly ob- literated. (5,) The arterial duct closed, the ventricular and auricular septa perforated. (6.) The ventricular septum, only, incom- plete. '(7.) Patency of the foramen ovale only. (8.) Entire absence of any unnatural communication either between the cavities of the heart or its great vessels. A collection of examples of each of these kinds of mal- formation will furnish some interesting data illustrative of the pathology of the circulation. (1.) T/ie 2}ii'lmonary orifice contracted— the lungs supplied by enlarged bronchial arti2ries. Reference has been already made to a class of cases where—the ostium of the pul- monary artery beingcongenitally occluded,— the supply of blood to the lungs is in part or wholly furnished by dilated bronchial arteries, arising from the descending thora- cic aorta. The following case proves that a similar arrangement may obtain where the entrance of the pulmonary artery is merely extremely narrowed. It is, however, the only well-marked instance of the kind with which I am acquainted. M. Jacobson describes* the heart of a boy who died with morbus caeruleus, and in whom the aorta, which was considerably enlarged, was given off from the right ventricle. The pulmonarg artery was not more than one-fourth the size of the aorta, its ostium being greatly contracted by thickening of its valves. But, to compen- sate for this, the bronchial arteries were very much enlarged ; three of these vessels passed off from the right and left sides of the aorta to the lungs, and a branch was distributed to either lung from the pericar- dial artery. A large opening existed in the septum of the ventricles; the foramen ovale was almost closed. II.—JVithpalencij of the auricular and ven- tricular septa and ductus arteriosus. We have observed that, in by far the larger proportion of instances of uon-de- delopment or congenital occlusion, of the pulmonary orifice, the arterial duct remains permanently open throughout the life of the mdiyidual; still, such an arrangement does not invariably obtain, even in those extreme mstances ; and, in cases where children are born with groat narrowing of the pulmonary ostium, it may be stated, as a general rule, that the obstruction to thecirculation thus pro- duced (however extreme it may be) is usually not sufficiently great to determine the per- manency of the arterial duct. This is pro- * Meckel, Archiv. fiii- i'hysiologic, B. ii.