Congenital Anomalies of the Heart 35 



is more frequently found in these cases than any other type of 

 irregularity, but is by no means constant. There seems to be 

 no foundation for the statement, which has been frequently made, 

 that they are particularly subject to pulmonary tuberculosis. 



This anomaly has been of more interest clinically than any 

 other congenital cardiac condition. Various symptoms and phys- 

 ical signs have been suggested as characteristic for the lesion ; it 

 is, I think, generally admitted that the exact diagnosis of the 

 other anomalies which so frequently accompany it is impossible. 

 Its association with other lesions may be seen by reference to the 

 clinical classification in Section XVII. Many of the statistical 

 studies of age at death, etc., are of slight value because they do 

 not take into account the part played by the associated anomalies. 



The frequency relationship of stenosis to atresia has been re- 

 ported as follows : 



Peacock 90 : 29 



Rauchfuss 81 : 33 



Deguise 30 : 4 



Kussmaul 64:26 



Abbott 1 16 : 34 



This Study 158:94 



A. Pulmonary Stenosis 



The narrowing of the pulmonary trunk may involve the oriiice 

 or a part or all of the canal or both. Keith thinks that in 90 per 

 cent, of the cases the right ventricle in its infundibular portion 

 is also involved. I am sure that such an estimate is too high if 

 we are to rely on the published reports in this series. Hyper- 

 trophy and dilatation of the right ventricle occur in many cases, 

 but these conditions are by no means constant. 



As already pointed out, the position of the aortic opening is 

 changed in many cases so that it may open from the right ventricle. 



The same general statements apply equally to atresia of the 

 pulmonary artery, consequently a separate discussion for such 

 cases is not called for. Lists of cases for both stenosis and 

 atresia follow, grouping the cases according to the anatomical 

 position of the lesion. 



