lO0 Pulmonary Artery wiih Two Valves.

AI~T. VI.--Pubnonary Artery with Two Valves2 By ARTHUR WYh'NE FOOT, M.D., F.K.Q.C.P. ; Physician to the Meath Hospital ; Professor of Medicine, Royal College of Surgeons.

I WISH to lay before the Academy the heart of a man, aged fitty- nine, which presents the very rare anomaly of two sigmoid valvr in the pulmonary artery. Inasmuch as the heart exhibited other pathological features it is not assumed or pretended that tile deformity in question had anything to do with the man's death. He had long suffered from incompetence of the aortic valves, and from a great degree of calcification of the ascending portion of the arch of the aorta ; the left ventricle was very much hypertrophied. The immediate cause of death was a sudden attack of diffuse bronchitis, to which he succumbed after a few days' illness, on the occasion of his admission for the third time to the Meath Hospital. On his two previous visits he had presented in a marked degree the physical signs of aortic regurgitation.

The pulmonary artery had been happily opened in the line of junction of the two valves which were of equal size, both of them much broader and deeper than usual, and of such dimensions that t h e pair were as competent to close the orifice of the artery as three of the usual size would have been. From the absence of hypertrophy of the right ventricle it would also appear that the want os the third valve had not given rise to regurgitation. The corpora Arantii were small, but the slight thickenings which, between the fingers, could be felt in their situations, were each placed mesially in the free edge of the valves ; there was no trace of a ridge on the pulmonary side of the valve, nor of a raphe visible when the valve segments were held against the light, nor of a rudimentary septum at the bottom of the pouches. These points are of importance to attend to in reference to the question of con- genital or acquired malformation.

The man from whom the heart was taken had enjoyed good health till about four years before his death. He entered the army at seventeen, and served in it for twenty-one years; he never had rheumatism, nor had he received any strain about the chest other than that incidental to the accoutrements in use when he joined the service.

By a strange coincidence the only other case of a similar forma-

a Read in the Section of Pathology in the Royal Academy of Medicine in Ireland, on F.riday, Ma~ 4, 1888.

By DR. A. W. FooT. 101

tion which I can find recorded in Ireland was one which was met with by Graves, in the Meath IIospital, ill the year 1841. I t is mentioned in his " Clinical Lectures," Vol. ]I., p. 180, and an earlier account of it is to be found in tlle Dublin Medical Jour~ml, Vol. XX., p. 409. It was met with in a man, aged sixty-six, who died with pneumonia, pericardial effusion, and endocardit[s of the pulmonary valves--which proved to be but two in number. Speaking of his case, Graves observes " the pl'esent is, as far as I can ascertain, the only specimen in which this peculiarity has been, observed." In 1851 Dr. Peacock collected statistics upon the mal- formations of the aortic and puhnonary valves. He found that among forty-one cases of defect in the number of the valves, in nine the malformation existed at the pulmonic orifice, and in thirty two at the aortic.

I t has been suggested that the existence of two in place of three valves, in either the puhnonary artery or the aorta, is due to disease and not to congenital malformation, the disease being so situated as to separate from the wall of the artery the conterminous attachments of two valves, which then, when thrown into one, con. stitute a single deformed valve, the result of the union of the two segments. Lapse of time would tend to obliterate the traces of the initial disease.

I am led to believe that in the present case we have to do with a congenital formation, from the equality in size of the valves, the mesial position of the corpora Arantii, the absence of any ridge on the arterial side of the valve, or of any rudimentary frenual at the bottom of the valve pocket.

The research which this case led to enables me to affirm two propositions, viz. :--(1) That numerical irregularities in the semi- lunar valves are more often observed in the aorta than in the pulmonary artery; and (`2) that defect in the number of valve segments is more rare than excess.

It should be observed that in this case there was no other mal- formation in the heart, for Dr. Peacock has pointed out (Path. Soc. Trans., Lond., Vol. III. , p. '294) that defect in the number of the pneumonic valves is generally attended with other serious malfor- mations which interfere with the natural development of other parts of the heart, and consequently, from the tendency to early death, is usually found in young persons.