On a case of patent ductus arteriosus with aneurism of the pulmonary artery / by James Foulis.

Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: On a case of patent ductus arteriosus with aneurism of the pulmonary artery / by James Foulis. 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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    niumiiir will be heard accompanying the ventricular systole caused by the rush of blood through tliat orifice into the aorta, and in the same way after the closure of the aortic valve, another murmur would be caused by the rusli of blood back through that orifice during the recoil of the aorta, and this rush back current is the one which gradually causes the dilatation of the pulmonary artery. If, then, we meet with a case in which there is no history of lung disease such as would cause obstruction to the flow of the circula- tion through the lungs, and if on auscultation in the second left intercostal space we find there is a heaving pulsation conmiunicated to the stethoscope with the ventricular systole, and at the same time a loud thrilling murmur is heard with maximum intensity at this very spot, and also heard in lines radiating upwards and outwards from this spot, and if this murmur is followed by another, similar in character, immediately following the closure of the aortic valve, we may fairly conclude that the cause of the aneurismal dilatation of the pulmonary artery, and of the two thrilling murmurs, is a patent ductus arteriosus. These murmurs and the dilatation of the pulmonary artery may exist without any co-existing disease of the pulmonary valve. In fact, I should think that freedom from disease and competency of that valve was a necessary condition for the production of any marked aneurismal dilatation of the pulmonary artery itself. No doubt the valve must sooner or later become incompetent, and then the whole right side of the heart becomes subjected to great extensile pressure, and dilatation results, as was so well observed in the right heart of my patient. I do not believe that the attack of scarlet fever from which my patient suffered six or seven years before she came to consult me had in any way affected the right side of her heart. She was able to do hard work, even to dance, up to within a comparatively short time before I first saw her. We know that even a slight cold jn such a case would be sufficient to throw much pressure on the pulmonary valve, and my belief is that her pulmonary valve began to give way, and became crumpled and diseased as soon as em- bolic plugging of the terminal branches of the pulmonary artery took place. From a careful examination of the aneurism and of the pul- monary valve, I think there can be no doubt that the former existed a long time before the latter began to be diseased and incompetent, and it was only when the latter Ijecame so that the distressing symptoms commenced which ultimately carried off my patient. The mere presence of a patent ductus arteriosus and tlie consequent intermingling of venous and arterial blood does not seem to act very injuriously on the health of the patient. In my patient's case there was very little cyanosis at the first, and all