. The practice of pediatrics. ), with the extra demand upon the organthat this age necessitates, results in failure of compensation and dilata-tion, followed by the usual train of symptoms peculiar to right heartfailure. 376 THE PRACTICE OF PEDIATRICS A girl with congenital heart disease developed several attacks of angina andcyanosis at the thirtieth month. This continued at rather infrequent intervals for ayear, when she died in an attack. Pathology.—The initial and chief lesion in the majority of cases isat the pulmonary orifice, and is supposedly due to a fetal endocarditiswhich causes a s
. The practice of pediatrics. ), with the extra demand upon the organthat this age necessitates, results in failure of compensation and dilata-tion, followed by the usual train of symptoms peculiar to right heartfailure. 376 THE PRACTICE OF PEDIATRICS A girl with congenital heart disease developed several attacks of angina andcyanosis at the thirtieth month. This continued at rather infrequent intervals for ayear, when she died in an attack. Pathology.—The initial and chief lesion in the majority of cases isat the pulmonary orifice, and is supposedly due to a fetal endocarditiswhich causes a stenosis at this orifice, which in time, through inter-ference with the blood-current, prevents a closure of the auricular orventricular septum. Cases are occasionally seen, however, in which the defect in one orother of the septa exists without atresia or stenosis at the pulmonaryorifice. Patent ductus arteriosus is rare. Its presence is usually associatedwith other defects, such as pulmonary obstruction and septum Fig. 48.—Clubbed fingers in congenital heart disease. Changes in the great vessels are occasionally encountered. Thus,the aorta may have its origin from the right ventricle, and the pulmonaryartery from the left ventricle. Cardiac Enlargement.—Enlargement of the heart is the rule in con-genital cases. Usually the right heart will be found particularly in-volved. The above conditions represent some of the more common abnormali-ties. One who has observed many autopsies upon children has hadabundant opportunity to verify the above statements and to see otherabnormalities which are of academic interest only. Classification of Lesions.—It is a hopeless task to attempt to classifya congenital lesion according to the nature, maximum intensity, ortransmission of the murmur. I have seen this attempted time and again,the autopsy showing results that were not flattering to the diagnosticacumen of the examiner. CONGENITAL HEART DISEASE 377 Diagnosis in Infants
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