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CASE REPORT BY A RENOWNED ANATOMIST OF UNUSUAL MODESTY
197
TRICUSPID VALVULAR REGURGITATION
gitation by means of indicator solutions, Circulation, 20:561,1959. 13 S K E L T O N , R.B.T., AND CORDAY, E.: Detection of valvular insufficiency by a platinum electrode technique, a preliminary study, Amer. }. Cardiol, 11:373,1963. 14 K O R N E R , P.I., AND SHILLINCFORD, J.P.: The quantitative estimation of valvular incompetence by dye dilution curves, Clin. Sci., 14:553, 1955.
peared when severe failure and dilation occurred in a right ventricle hypertrophied by a severe pressure load imposed over an unusually long period by a severely restricted pulmonary bed. REFERENCES
J.H., AND B U R C H , G.E.: Problems in the diagnosis of cor pulmonale, Amer. Heart J., 66:818, 1963. SALAZAR, E . , AND L E V I N E , H . : Rheumatic tricuspid regurgitation, Amer. J. Med., 3 3 : 1 1 1 , 1 9 6 2 . M I L L E R , O . , AND SHILLINCFORD, J . : Tricuspid incompetence, Brit, Heart}., 16:195, 1954. K O R N E R , P . , AND SHILLINCFORD, J . : The right atrial pulse in congestive heart failure, Brit. Heart }., 1 6 : 4 4 7 ,
1 PHILLIPS, 2 3 4
1 5 C A I R N S , K . B . , KOSTLER, F . E . , BRISTOW, J . D . , L E E S , M . H . , GRISWOLD, H.E.: Problems in the hemodynamic diagnosis of tricuspid insufficiency, Amer. Heart }., 75: 173,1968. 16 R U B E I Z , G.A., NASSER, M.E., AND D A C H E R , I . K . : Study of the right atrial pressure pulse in functional tricuspid insufficiency, Circulation, 30:190,1964. 17 L O T T E N B A C H , C . , AND SHILLINGFORD, J,: Functional tricuspid incompetence in relation to the venous pressure, Brit., Heart J., 19:395, 1957. AND
1954. 5
6
7
8
9
S H E R M A N , W . T . , F E R R E R , M . I . , AND H A R V E Y , R . M . : C o m -
petence of the tricuspid valve in pulmonary heart disease (cor pulmonale), Circulation, 3 1 : 5 1 7 , 1 9 6 5 . P E R L O F F , J . K . : Auscultatory and phonocardiography manifestations of pulmonary hypertension, Progr. Cardiovasc. Dig., 9:303, 1967. A H N , A.J., AND SEGAL, B . L . : Isolated tricuspid insufficiency, clinical features, diagnosis, and management, Progr. Cardiovasc. Dis., 9:166,1966. SEGAL, B . L . , LOCOFF, W., AND M O Y E R , J.H.: The theory and practice of auscultation, Ninth Hahnemann symposium, F. A. Davis, Inc., Philadelphia, 1964. RTVERO CARVALLO, J . M . : Signo para el diagnostico de las insuficiencias tricuspideas, Arch. Inst. Cardiol. Mex.,
1 8 BURCH,
19 20 21 22
16:531,1946.
10 11
S., AND D A V I E S , P.: The electrocardiogram in cor pulmonale, Progr. Cardiovasc. Dis., 9:341, 1967. F R I E D B B I C , C . K . : Diseases of the heart, (5th ed), W . B . Saunders Co., Philadelphia, 1966. ORAM,
1 2 COLLINS,
N.P.,
BRAUNWALD,
E.,
AND
MORROW,
R E P O R T O F
BY
A
R E N O W N E D
U N U S U A L
In an old man, who was of lean habit, and whom I dissected, the pulse had been weak and small, but not intermitting, when, he was brought into the hospital at Padua. The appearances which I observed in the heart are of such nature that I cannot judge them to be unworthy of being communicated to you. As I examined the external surface of the heart, the left coronary artery appeared to have changed into a bony canal, from its very origin to the extent of many fingers breadth, where it embraces the greater part of the basis. And part of the very long branch, also, which it sends down upon the anterior surface of the heart, was already become bony to so great a space, as could be covered by three fingers placed transversely. For which reasons, a passage was opened on both sides, not through a membranous canal, or one which was
CHEST, VOL. 57, NO. 2, FEBRUARY 1970
DEPASQUALE,
N.P.,
AND P H I L L I P S ,
J.H.:
Reprint requests: Dr. Bernard H. Boal, Department of Medicine, New York University School of Medicine, New York City 10016
A.G.:
Detection of pulmonic and tricuspid valvular regur-
C A S E
G.E.,
The syndrome of papillary muscle dysfunction, Amer. Heart J., 75:399, 1968. SEPULVEDA, G . , AND LUKAS, D . S . : The diagnosis of tricuspid insufficiency. Clinical features in 60 cases with associated mitral valve disease, Circulation, 11:552, 1955. RUTESHAUSER, W., Wraz, P . , GARDER, M., AND N U T T I N G , E,: Atriogenic diastolic reflux in patients with atrioventricular block, Circulation, 34:807, 1966. L I T T L E , R.C.: Effect of atrial systole on ventricular pressure and closure of the A-V valves, Amer. J. Physiol, 166:289, 1951. BARGER, A.C., R O E , B . B . , AND RICHARDSON, G.S.: Relation of valvular lesions and of exercise to auricular pressure, work tolerance, and to development of chronic, congestive failure in dogs, Amer. J. Physiol., 169:384, 1952.
A N A T O M I S T
M O D E S T Y
made somewhat hard, here and there, by disjoined bony lamellae, but through a continued bony tube, which for hardness might with justice have been compared with any other hard bone, except that in some places it was less hard; though those were very small, and inconsiderable, and resembled the transverse lines formed by the knots of a slender reed. The heart then being opened, although I saw the tubercles of the valves of the great artery much harder than usual, and almost bony, yet I found nothing bony either in them, or in any other valves, or in that artery near the heart. Morgagni, John Baptist (1682-1771) in Willius, F.A. and Keys, T.E.: Classics of Cardiology, Henry Schuman —Dover Publications, New York, 1941
TRICUSPID VALVULAR REGURGITATION
gitation by means of indicator solutions, Circulation, 20:561,1959. 13 S K E L T O N , R.B.T., AND CORDAY, E.: Detection of valvular insufficiency by a platinum electrode technique, a preliminary study, Amer. }. Cardiol, 11:373,1963. 14 K O R N E R , P.I., AND SHILLINCFORD, J.P.: The quantitative estimation of valvular incompetence by dye dilution curves, Clin. Sci., 14:553, 1955.
peared when severe failure and dilation occurred in a right ventricle hypertrophied by a severe pressure load imposed over an unusually long period by a severely restricted pulmonary bed. REFERENCES
J.H., AND B U R C H , G.E.: Problems in the diagnosis of cor pulmonale, Amer. Heart J., 66:818, 1963. SALAZAR, E . , AND L E V I N E , H . : Rheumatic tricuspid regurgitation, Amer. J. Med., 3 3 : 1 1 1 , 1 9 6 2 . M I L L E R , O . , AND SHILLINCFORD, J . : Tricuspid incompetence, Brit, Heart}., 16:195, 1954. K O R N E R , P . , AND SHILLINCFORD, J . : The right atrial pulse in congestive heart failure, Brit. Heart }., 1 6 : 4 4 7 ,
1 PHILLIPS, 2 3 4
1 5 C A I R N S , K . B . , KOSTLER, F . E . , BRISTOW, J . D . , L E E S , M . H . , GRISWOLD, H.E.: Problems in the hemodynamic diagnosis of tricuspid insufficiency, Amer. Heart }., 75: 173,1968. 16 R U B E I Z , G.A., NASSER, M.E., AND D A C H E R , I . K . : Study of the right atrial pressure pulse in functional tricuspid insufficiency, Circulation, 30:190,1964. 17 L O T T E N B A C H , C . , AND SHILLINGFORD, J,: Functional tricuspid incompetence in relation to the venous pressure, Brit., Heart J., 19:395, 1957. AND
1954. 5
6
7
8
9
S H E R M A N , W . T . , F E R R E R , M . I . , AND H A R V E Y , R . M . : C o m -
petence of the tricuspid valve in pulmonary heart disease (cor pulmonale), Circulation, 3 1 : 5 1 7 , 1 9 6 5 . P E R L O F F , J . K . : Auscultatory and phonocardiography manifestations of pulmonary hypertension, Progr. Cardiovasc. Dig., 9:303, 1967. A H N , A.J., AND SEGAL, B . L . : Isolated tricuspid insufficiency, clinical features, diagnosis, and management, Progr. Cardiovasc. Dis., 9:166,1966. SEGAL, B . L . , LOCOFF, W., AND M O Y E R , J.H.: The theory and practice of auscultation, Ninth Hahnemann symposium, F. A. Davis, Inc., Philadelphia, 1964. RTVERO CARVALLO, J . M . : Signo para el diagnostico de las insuficiencias tricuspideas, Arch. Inst. Cardiol. Mex.,
1 8 BURCH,
19 20 21 22
16:531,1946.
10 11
S., AND D A V I E S , P.: The electrocardiogram in cor pulmonale, Progr. Cardiovasc. Dis., 9:341, 1967. F R I E D B B I C , C . K . : Diseases of the heart, (5th ed), W . B . Saunders Co., Philadelphia, 1966. ORAM,
1 2 COLLINS,
N.P.,
BRAUNWALD,
E.,
AND
MORROW,
R E P O R T O F
BY
A
R E N O W N E D
U N U S U A L
In an old man, who was of lean habit, and whom I dissected, the pulse had been weak and small, but not intermitting, when, he was brought into the hospital at Padua. The appearances which I observed in the heart are of such nature that I cannot judge them to be unworthy of being communicated to you. As I examined the external surface of the heart, the left coronary artery appeared to have changed into a bony canal, from its very origin to the extent of many fingers breadth, where it embraces the greater part of the basis. And part of the very long branch, also, which it sends down upon the anterior surface of the heart, was already become bony to so great a space, as could be covered by three fingers placed transversely. For which reasons, a passage was opened on both sides, not through a membranous canal, or one which was
CHEST, VOL. 57, NO. 2, FEBRUARY 1970
DEPASQUALE,
N.P.,
AND P H I L L I P S ,
J.H.:
Reprint requests: Dr. Bernard H. Boal, Department of Medicine, New York University School of Medicine, New York City 10016
A.G.:
Detection of pulmonic and tricuspid valvular regur-
C A S E
G.E.,
The syndrome of papillary muscle dysfunction, Amer. Heart J., 75:399, 1968. SEPULVEDA, G . , AND LUKAS, D . S . : The diagnosis of tricuspid insufficiency. Clinical features in 60 cases with associated mitral valve disease, Circulation, 11:552, 1955. RUTESHAUSER, W., Wraz, P . , GARDER, M., AND N U T T I N G , E,: Atriogenic diastolic reflux in patients with atrioventricular block, Circulation, 34:807, 1966. L I T T L E , R.C.: Effect of atrial systole on ventricular pressure and closure of the A-V valves, Amer. J. Physiol, 166:289, 1951. BARGER, A.C., R O E , B . B . , AND RICHARDSON, G.S.: Relation of valvular lesions and of exercise to auricular pressure, work tolerance, and to development of chronic, congestive failure in dogs, Amer. J. Physiol., 169:384, 1952.
A N A T O M I S T
M O D E S T Y
made somewhat hard, here and there, by disjoined bony lamellae, but through a continued bony tube, which for hardness might with justice have been compared with any other hard bone, except that in some places it was less hard; though those were very small, and inconsiderable, and resembled the transverse lines formed by the knots of a slender reed. The heart then being opened, although I saw the tubercles of the valves of the great artery much harder than usual, and almost bony, yet I found nothing bony either in them, or in any other valves, or in that artery near the heart. Morgagni, John Baptist (1682-1771) in Willius, F.A. and Keys, T.E.: Classics of Cardiology, Henry Schuman —Dover Publications, New York, 1941