A case of tricuspid and mitral stenosis in which physical signs of pulmonary arterial reflux were present / by Sir Dyce Duckworth.

  • Duckworth Dyce, Sir, 1840-1928.
Date:
[1888]
Catalogue details

Licence: Public Domain Mark

Credit: A case of tricuspid and mitral stenosis in which physical signs of pulmonary arterial reflux were present / by Sir Dyce Duckworth. 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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    catarrh tartrate of sodium draught was ordered. The sputa became bloody, apparently indicating pulmonary embolism. At this time the signs of reflux through the pulmonary artery disappeared. Death occurred on November 8. The body was examined next day. The heart extended considerably across the mesial line. The apex was 2 inches beyond the line of left nipple. The heart was much enlarged and weighed 24 oz. Wall of right ven- tricle firm and somewhat thickened. Cavity of right ventricle much dilated, especially at the conus arteriosus. Tricuspid orifice markedly stenosed, barely admitting two fingers. Edges of the valve thickened and somewhat roughened. Pulmonary valves not definitely diseased. Corpora Arantii apparently larger than usual. Left auricle much dilated and rather thick. Mitral orifice, button-hole contraction, barely admitting little finger. Chordae tendineae much thickened. Left ventricle decidedly hypertrophied. Aortic valves doubt- fully thickened. Pulmonary artery dilated. No ante-mortem clots. On the right lung was some recent inflammatory lymph at the base in front. In right lower lobe a patch of consolida- tion, size of a small orange, red hepatization. Rest of lung much congested. Left lung much engorged. No infarcts found in branches of pulmonary artery. A good deal of clear fluid in abdomen. Liver nutmeg,with increased growth of connective tissue. Spleen and kidneys small, hard, and engorged. The points of interest in the case relate to its etiology, and to two of the physical signs observed during life. The fre- quent occurrence of mitral stenosis in women without history of rheumatic antecedents is well recognised. The mitral affection may have supervened on scarlet fever. In many of these cases, however, I believe that rheumatic valvulitis is often the starting-point, the articular symptoms being slight and unrecognised in early life. The suspicion of tricuspid stenosis was verified by the disease of that valve discovered after death. Had life been prolonged, it is not unlikely that further involvement of this valve would have occurred. Tri- cuspid stenosis is hardly recognised during life; when it occurs there is usually accompanying mitral stenosis. The pulmonary reflux must have been due to the dilatation of the pulmonary artery, which entailed insufiiciency of its valves. When the blood-pressure became low this sign disappeared. It is open to comment that signs of increased pulmonary