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LIGATION OF THE PATENT DUCTUS ARTERIOSUS

1945; BMJ; Volume: 7; Issue: 2 Linguagem: Inglês

10.1136/hrt.7.2.95

1468-201X

T. East,

This operation is now being performed to cure patients who have become infected, but also it may be done to remedy a congenital defect, which very considerably reduces the prospects of longevity, and is as well the source of several serious disadvantages.This is an account of the experience provided by thirteen cases, considered from the medical point of view.All the operations were done by Mr. John B. Hunter, F.R.C.S., and Dr. Nosworthy gave the anesthetic. DIAGNOSIS AND PROGNOSISDiagnosis presented no difficulty: the typical murmur, best heard in the second left inter- costal space, starting just after the first sound and persisting into diastole (with the exception of one case where it is doubtful whether it would be heard beyond the second sound), was present in all.This applies to two other cases seen during the same period, who declined operation.Its hollow whizzing character resembles nothing else to my ear.Is not " machinery murmur " a bad expression?I cannot think of any machine causing such a sound.In most a thrill was palpable as well.Sometimes there was a systolic pulsation, and as a rule the pulmonary second sound was loud and the closure palpable.The pulmonary artery was never large enough to cause dullness.The possible presence of another congenital defect, in particular pulmonary stenosis, was always considered but was never suspected.A normal cardiogram, and the absence of its peculiar murmur lower down should exclude pulmonary stenosis.Obviously, if this were present, ligation of the ductus would be undesirable.All the cardiograms were within normal limits.Enlargement of the pulmonary artery in the skiagram may be quite conspicuous, but in this series of thirteen cases it is clear from the outlines shown in the figure that nothing very striking may be noted.In Case 4 the pulmonary artery was largest, and that has a flat curve.Enlargement of the heart was present only in Case 3 and perhaps in Case 2. But in this series the disease was in its early stage, and failure had in no case come on.The blood pressure readings showed no constant abnormality, but an average figure of 120/70 indicated a slightly increased pulse pressure.In some the diastolic pressure tended to be low.Physical examination before operation gave no reliable information as to the size and shape of the ductus.Probably in most cases, until well into adult life, a patent ductus arteriosus may interfere but little with activities.But such a lesion as this is almost certain to be recognized early in life, and in many instances restrictions that are probably unnecessary are imposed.The result is that the patient is well aware that there is something wrong with him, and may become unduly heart-conscious and even neurotic.He will certainly miss a great deal of the best that youth can give.Later on more serious considerations arise.Employment in many walks of life will be hard to obtain.The Services, civil and military, will be closed to him; banks and many firms will not employ him because he is ineligible for staff schemes and pension funds.Life assurance will be denied him.