On defective closure of the tricuspid foramen as a frequent cause of dropsy / by Peyton Blakiston.

  • Blakiston, Peyton, 1801-1878.
Date:
[1841]
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Licence: Public Domain Mark

Credit: On defective closure of the tricuspid foramen as a frequent cause of dropsy / by Peyton Blakiston. 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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    very difficult to do, the valves will be stretched, and will measure more than they can do in action. He gives three inches eleven lines as the mean circumference of an undilated tiicuspid foramen. I have been in the habit of removing the apex of the heart and laying open the right auricle, and then raising up the tricuspid valves into their plane of closure, by means of my fingers intro- duced into the right .ventricle. By looking at them from the auricle when in this position, a tolerably accurate idea can be formed of the area they • cover, and whether any and how much space is left uncovered Ijy them, through which the blood can regurgitate. I have then usually gauged the tricuspid foramen by the introduction of the fingers; its ordinaiy size not quite ad- mitting the three first fingers up to their first joint, and then measm-ed the circumference after it has been laid open. I regret that the size of the heart should have been noted in such loose terms. I have lately measured its bulk and capacity, by ascertaining the quantity of fluid it displaces both when full and empty, and hope by this , n\eans to arrive at a more accurate standard of measurement. In the cases which follow, and which I have condensed as much as possible, the heart presented a great variety of morbid appearances ; but one peculiar state was common to them all, and that was the incompleteness of the closure of the tricuspid foramen. In two cases this arose from adhesionofoneormorevalves to the ventricle; in elevenfrom dilatation oftheforamen to such an extentthat the valves could not effect its closure. In most of them the dropsical effusion was preceded by turgesceiice of the jugular veins: in those of them where the heart was not softened or attenuated, it was preceded by pulsations in these vessels. I shall not in this place enter upon the causes which tended to pro- duce dilatation, which will in most of the cases appear tolerably clear. Being anxious to know how far the views in this paper would be borne out by cases recorded by others, I have consulted the work of Bouillaud, who is the only writer on diseases of the heart that has carefully measured its orifices. He gives thirty-four cases of cardiac dropsy, of which the following table gives the analysis :— Analysis of 34 Cases of Cardiac Dropsy, detailed by Bouillaud. Tricuspid foramen dilated and its closure incomplete, with the valves adherent in some .... . 16 Tricuspid valve diseased so as to interfere with its action ... 4 Their chordae tendinise shortened, pro- ducing the same effect ... 2 Concentric hypertrophy of right ven- tricle, with great diminution of cavity 2 Foramen dilated, and valves enlarged, so as to close it . . . .1 Valves and foramen healthy . . 2 No mention of foramen, hut both right auricle and ventricle dilated . • 7 34 In these last seven cases there appears to have been no measurement of the orifices of the heart, but as there was dilatation of both ventricle and auri- cle on the right side, we may con- clude that the foramen between them was also dilated. If this be allowed, it would follow that there were only three cases out of the thirty-four in which thefe was com- plete closure of the tricuspid foramei.. From this it might be supposed that Bouillaud was fully aware of the fre- quency of this pathological state of the heart, and of its intimate relation to dropsy as cause and effect. He simply remarks, however, The dilatation of the orifices of the heart is not less com- mon than that of the cavities them- selves, and he recommends diligent observers not to neglect examining the orifices of the heart in all its organic diseases, for if the dimensions are such that the valves cannot close the orifices, the circulation of the blood through the heart must be more or less seriously disturbed*. Here he stops short, and does not seem to be aware of the extent of ob- struction which is thus so frequently oflPered to the circulation, and that in a majority of cases di-opsy does not come on till the tricuspid valves have become incompetent to close the dilated orifice to which they are attached. Over- looking the fact that contractions of the orifice of the left side are not un- commonly found unaccompanied either by extensive dilatation or by di'opsy, he considers, throughout the M'hole of his work, that these contractions are the main cause of those disturbances to * Paris, 1835, vol. ii. p. 52C.