John Parkinson

Right-Sided Aortic Arch (Situs inversus arcus aortae)

Right-sided aortic arch is a congenital malformation of the aorta due to an abnormal evolution of the embryonic arterial arches. Two anatomical varieties are recognised. It may be an isolated anomaly or may be combined with congenital malformation of the heart, especially with Fallots tetralogy. Eleven cases of right-sided aortic arch are described and their radiological features are discussed and portrayed.

EARLY DIAGNOSIS OF RHEUMATIC VALVULAR DISEASE IN RECRUITS.

During the world war of 1939-45 the call for men for the armed forces made the medical examination of potential recruits an important field of medical service, and many were rejected for heart disease. The major problem for cardiologists was to detect the presence of rheumatic heart disease when it was early and symptomless, a stage not seen except incidentally in peacetime practice. It might at first be thought that with the advent of peace the importance of very early diagnosis would quickly fall. But it is becoming evident that in economic and. labour conditions after this war, comparable medical examinations will be multiplied and that in time few employees will be accepted without them. From 1940 to 1945, 2500 men suspected of cardiac abnormalities were referred to one of us (J. P.) by medical boards. Among them were found 609 cases of early rheumatic heart disease, of which only a quarter had symptoms, and those slight. Only 264 had mitral valvular disease, a low proportion due to the fact that mitral stenosis is more easily identified by medical boards than aortic incompetence, and that those with mitral disease more often get symptoms at an earlier age and, therefore, come under medical observation. It is on the analysis and study of these 609 together with a limited survey of the literature, that this paper is mainly based. Table I shows the relative incidence of various cardiovascular defects. Cases of effort syndrome (neuro-circulatory asthenia) were not included.