CONGENITAL ANOMALIES OF THE HEART. 3S1 



ANATOMICAL APPEARANCES. Congenital deformities of the heart, 

 which are incompatible with life, and which cause children to die either 

 immediately, or else very soon after birth, belong rather to the province 

 of pathological anatomy than to that of special pathology and thera- 

 peutics. Entire absence of the heart, or of one of its chambers, is one 

 of these. In anomalies which permit the continuance of life, even for 

 a short time, we generally find every part of the organ represented, 

 although some portions of it are only rudimentary. In most instances 

 the aorta or the pulmonary artery is stunted, or quite undeveloped. 

 If the pulmonary artery be deficient, the blood pours from the right 

 heart directly into the left, as such cases are always combined with 

 imperfection of the septa. The aorta then supplies the lungs with 

 blood through the dilated bronchial arteries, or through the ductus 

 Botalli, in which it sets up a current counter to the foetal blood-stream. 

 If the aorta be contracted or closed immediately above the opening of 

 the ductus Botalli, it then can only supply the head and upper ex- 

 tremities, while the pulmonary artery conveys blood to the lower half 

 of the body through the ductus Botalli. If the aorta be closed at its 

 origin, the blood which comes to the left heart passes directly through 

 the open septum into the right heart, the pulmonary artery then fur- 

 nishing blood to the whole aortic system. When the septum between 

 the ventricles is imperfect, it may seem as if the aorta and pulmonary 

 arteries sprang from both of them. If the septum stand too far to 

 the right or left, the right or left ventricle will be too large, and both 

 arterial trunks will originate from it, while the stunted ventricle has 

 to discharge its blood into it through the open septum. In very rare 

 instances, the aorta has been found to spring from the right, the pul- 

 monary artery from the left ventricles. There also are anomalies of 

 the veins discharging into the heart, to describe which, however, would 

 carry us too far. 



Insufficience and stenosis of the orifices, and cicatricial strictures of 

 the heart consequent upon foetal endocarditis and myocarditis, differ from 

 those acquired after birth, in that their situation is in the right heart. 

 Valvular disease is more common at the pulmonary valves than at the 

 tricuspid. In these cases, too, the septum is not closed, so that trans- 

 fusion of the blood takes place from one side of the heart to the other. 



Defects may exist in the septa of greater or less extent, but they 

 do not afford complications and results like those just described, which 

 are of far less importance, and, indeed, may be without any material 

 influence whatever upon the circulation, and, hence, are to be regarded 

 as independent, and proceeding from arrested formation due to un- 

 Known causes. In particular, we very often make post-mortem dis- 

 covery of slit-like openings, or even great holes, in the foramen ovale, 



