Congenital Anomalies of the Heart 13 



Langmead (1906), Potter (1906), Horaud (1907), Pal (1907), Scandola 

 (1909), Foggie (1910), Benjamin (1911), Bello-Morales (1912). Forty- 

 cases. 



(b) Heart in the Abdomen. — These cases are frequently classed 

 with the group of ectopia cordis but I have placed them in this 

 class because the ventral body is normally closed, and until we 

 have a clear idea of the etiology it seems proper to assume that 

 other factors than those causing the cleft in the body wall are 

 responsible for the cardiac misplacement. The diaphragm is 

 defective and the heart is situated in the peritoneal cavity. The 

 condition is very rare but should not be difficult to recognize and 

 is apparently not incompatible with long life. The cases re- 

 ported by Deschamps (1778) and Ramel (1778) had both passed 

 the thirty-fifth year; Holt's (1897) case was in a child. 



(c) Diverticulum of the Heart. — In these cases the heart is 

 prolonged as a muscular diverticulum from the left ventricle and 

 extending into the abdomen through a defect in the diaphragm. 

 I know of no suggested explanation of the anomaly except that 

 of Gibert which is to the effect that the condition is a type of 

 early aneurysm of the tip of the ventricle which prevents the 

 complete development of the diaphragm. A diverticulum of the 

 right ventricle, Fennell (1901), but which is well above the dia- 

 phragm, may possibly belong in this group. Following the work 

 of Peacock I have placed these cases among misplacements, 

 although they are probably in no way related etiologically to the 

 cases of malposition of the whole organ. Cases are from 

 O'Bryan (1837), Thaden (1868), Gibert (1883), Arnold (1894), 

 and Kotter-Aeby (1907), Fennell (1901). 



2. External Misplacements 



These cases are generally described under the title ectopia 

 cordis. The heart protrudes through a median fissure in the 

 ventral body wall and comes, in many cases, to lie on the surface 

 of the body. In a few cases the pericardial sac is complete but 

 in the majority the parietal layer is lacking ventrally, its borders 

 being attached to the borders of the body fissure. 



The cause of the misplacement is not known ; the first theory 



