Complete Closure of the Pulmonary Artery.—Cyanosis.—Dr. Hare
presented a specimen of this malformation, taken from a child who died
at the age of nine months. During life, the limbs were colder than
natural and of a dusky hue. Whenever the child coughed, qr was
moved much, he became distinctly blue. There was nothing unusual
in the conformation of the chest, but close to the left nipple a purring
tremor was detected, and at the apex of the heart a moderately loud sys-
tolic blowing murmur was audible. A post-mortem examination was
made twenty-seven hours after death. There were about two drachms
of fluid in the pericardium. The right auricle was much dilated and
filled with blood. The foramen ovale was patulous, but extremely small.
On cutting into the right ventricle, it was found that the carneae columnae
were fused almost into one mass, so that this part of the right side of
the heart was nearly solid. Towards the base of the ventricle, rudiments
of the tricuspid valves were discernible, hanging into a cavity no larger
than a moderate-sized pea. The pulmonary artery measured rather more
than an inch in circumference at its middle, but the ventricular extremity
terminated in a cul de sac, where there were some minute folds, probably
rudiments of the pulmonary valves. At its upper extremity the vessel
communicated with the aorta in the ductus arteriosus, the orifice of
which was capable of admitting a crow-quill. The right and left pul-
monary arteries were given off from the main trunk as usual. The left
auricle was somewhat contracted, but the remaining structures of the
heart were in their normal state. Dr. Hare remarked, that although
instances of complete closure of the pulmonary artery were not rare, yet
he thought the present specimen was almost unique, as exhibiting so
contracted a foramen ovale in conjunction with that malformation.—
Lond. Med. Times and Gazette.