Stanley Gibson

Transposition of viscera in siblings

Summary Transposition of the viscera has a general incidence of approximately0.014 per cent. Over 1,000 cases have been reported in the literature. Ten per cent of these cases have occurred in families, including thirty-seven sibships in addition to twelve miscellaneous relationships. We have added two additional sibships involving brothers in each instance. Complete situs inversus was present in 3 of the children, 2 of whom had severe congenital malformations of the heart.

Accidental hanging with recovery

Summary Two cases in children of accidental hanging with recovery have been reported. The symptoms and signs found in our cases and in other cases reported in the literature have been enumerated. The clinical pattern has shown striking uniformity.

Rheumatic heart disease in childhood

Summary A clinical and postmortem study of seventy-three children with rheumatic heart disease has revealed the following: 1. Predisposing causes of the rheumatic infection, such as sore throats, chronic tonsillar infection, growing pains, and scarlet fever, were encountered with less frequence than was anticipated. 2. Chorea occurred in 26 per cent and joint pains in 68 per cent. 3. The first bout of carditis proved fatal in 40 per cent. 4. Pericardial friction was heard in 48 per cent. 5. Pericarditis was found on postmortem examination in 85 per cent. In no instance was a large amount of fluid present in the pericardial sac. 6. Auricular fibrillation was infrequent, occurred in the older patients, and was usually a terminal event. 7. Nodules were found in 37 per cent. 8. Average duration of life was longest when the attack began with chorea, less prolonged when joint pains initiated the infection, and shortest when the invasion of the heart itself was the only evidence of rheumatism. 9. The total duration of the rheumatic infection was less than three months in 27 per cent.

A case of congenital heart disease: Truncus aorticus solitarius, single ventricle, and aberrant coronary drainage into the common ventricle☆☆☆

Abstract A case of congenital heart disease is presented in which a truncus aorticus solitarius was diagnosed because the only vessel leaving the base of the heart was identified as the aorta by angiocardiography. The presence of a functional single ventricle was diagnosed on the basis of the close agreement of oxygen contents in samples obtained from various points in the ventricle and from the peripheral artery. The existence of an aberrant vein draining the myocardium and opening into the common ventricle was indicated by (a) continuous pressure tracings, and (b) the low oxygen content of blood samples taken from this channel. Angiocardiography demonstrated that the pulmonary circulation was via the truncus aorticus solitarius, the descending portion of which gave rise to a large artery supplying the left lung. It is assumed that the right lung received its circulation via small bronchial arteries. The presence of only mild cyanosis at rest, the fluoroscopic contour of the heart and the absence of murmurs are important signs in the clinical diagnosis of a single ventricle. A large vessel from the base of the heart and a visible aortic knob in the posteroanterior position on fluoroscopy in a child indicates the possibility of a truncus. In this patient, the calculated flow through the pulmonary circuit is equal to that through the systemic circuit. The cardiac output from the common ventricle equals that expected from two separate ventricles. However, the heart, working against a single high pressure circuit, has to develop a much higher potential energy than under normal anatomical circumstances. The kinetic energy of this heart is not much increased, mainly because of the large calibre of the single outlet channel. This case is unique in that a review of the literature has failed to reveal any reports of aberrant myocardial venous drainage such as that described above.