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

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 Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    the circulation, of which dropsy is the most frequent and the most dangerous consequence. Nor does he seem to suspect that incomplete closure of the tricuspid orifice and consequent regur- gitation through it, is the real and only impediment to the circulation in those cases where the heart is dilated and hypertrophied in an equable manner through its whole extent. Case I.—A married lady, set. 29, had not enjoyed good health since an attack of rheumatic fever in early youth. She had for four months suffered from dyspnoea, during which time she con- stantly expectorated clear mucus, sometimes mixed with dark blood, and had occasional attacks of severe pain in both sides, with fever. She could not lie flat; her urine was not coagu- lable by heat. In about a month after this her legs began to swell, and a slight bellows sound was heard over the presecordial region, with the first sound of the heart, when she was hur- ried or excited. The veins of the neck, which had always been rather full, now became much swollen, and pulsated strongly. The oedema of the legs increased, ascites appeared, and she died, the subject of extensive ana- sarca, three months after my first visit. Autopsy. — There was considerable serous effusion in both sides of the chest and in the abdomen. Some patches of circumscribed pulmonary apoplexy were seen in the lungs. The heart was more than twice the size of the fist, being hypertrophied and dilated throughout. Two flaps of the tricuspid valve acted imperfectly, one being partially, and the other entirely adherent to the right ventricle. The tricuspid foramen was greatly dilated, and its circumference measured five inches and a half. An immense trans- parent coagulum, of the consistence of jelly, was lying in it, extending into both the auricle and the ventricle. The other organs were healthy. Case II. —Sarah Richards, set. 14, pigeon-breasted; had rheumatic fever twelve months since, with very severe pain under the left breast, and distress- ing dyspnoea. When examined, com- plained of great dyspnoea, and occasional severe pain in the prrecordial region ; the urine was not coagulable by heat. On the left side, the chest sounded dull from the second rib downwards. A purring thrill was felt under the left mamma. At the same spot bellows sound was constantly heard, and for some distance around it. In two months’ time the veins of the neck were observed to fluctuate ob- scurely. In another fortnight the ankles and legs became oedematous, ascites soon followed, and in three months from my first visit she died extensively anasarcous. Autopsy.—A large quantity of clear lemon-coloured fluid was found in the abdomen, about a pint in each pleural sac, and three ounces in the pericardium. The lower part of each lung was slightly carnified; they were otherwise healthy. The heart was dilated to nearly double its natural size; the walls re- taining their usual thickness. The valves were not thickened, but a part of the tricuspid valves was glued down to the side of the right ventricle, thereby preventing the closure of the foramen, the circumference of which measured four inches and a quarter. The other organs were healthy. Remarks on Cases I. and II.— The hypertrophy and dilatation of the heart in Case I., in all probability re- sulted from an attack of pericarditis and endocarditis during rheumatic, fever — a result which Andral and others have shewn to be by no means uncommon. The intimate adhesion of one of the tricuspid valves to the right ventricle may also have taken place at the same time ; but when we recollect that this fever took place in early youth, it is hardly possible to believe that incompleteness of the tricuspid valves could have existed for so long a period without giving rise to more serious consequences. The hypertro- phy of both ventricles accounts for the strong pulsations observed in the j ugular veins. The manner in which their appearance and increase was followed by dropsical effusion cannot but lead to the belief that it depended on the dila- tation and consequent incompleteness and regurgitation through the tricuspid foramen. In Case II. nearly the same pheno- mena were observable, with this dif- ference, that there was only obscure fluctuation and not pulsation observable in the veins of the neck, and this be- cause the ventricle was not hypertro- phied. I may here remark that Mr. Baynliam has given me the particulars of a case