Studies in cardiac pathology . y hypothetic grounds, and is veryquestionable. From the anatomic standpoint four varieties are recognized:(a) buttonhole; (6) funnel-shaped; (c) vegetative; (d) cystic(due to valvular aneurism).- The mitral orifice in men averages mm., in mm. in circumference. The mitral and tricuspid valvesshow the greatest difference in size when the sexes are compared,a fact which probably has some bearing on the preponderance ofstenosis of these orifices in women. It has been shown that the large, freely movable anteriormitral leaflet has a somewhat differen
Studies in cardiac pathology . y hypothetic grounds, and is veryquestionable. From the anatomic standpoint four varieties are recognized:(a) buttonhole; (6) funnel-shaped; (c) vegetative; (d) cystic(due to valvular aneurism).- The mitral orifice in men averages mm., in mm. in circumference. The mitral and tricuspid valvesshow the greatest difference in size when the sexes are compared,a fact which probably has some bearing on the preponderance ofstenosis of these orifices in women. It has been shown that the large, freely movable anteriormitral leaflet has a somewhat different function from the small,relatively fixed, posterior leaflet, in that the former, in additionto preventing regurgitation into the auricle during ventricularsystole, actually forms, together with the interventricular septum,a channel which helps to conduct the ventricular contents into Bard; Semaine M6d., 1906, No. 20. Lepine: Provence Medic, xx, No. 2. Cecone:Riforma Medic, July 27, 1908. = Cruveilhier: Anat. Path., ii, 66 STUDIES IN CARDIAC PATHOLOGY the aorta ^ (the Stromrinne [flume] of Oesterreich-). It hasthus a double function, and pathologic alterations in its structurehave a double result. In this connection Beitzler ? considers thewhite spots frequently to be found on the ventricular surfaceof the anterior mitral leaflet as mechanical and not inflammatoryin origin, due to conditions similar to those which are active inthe production of aortic sclerosis. Looked at, then, from thestandpoint of physiology, this surface of the anterior leaflet isreally a part of the aorta. The fact that this leaflet is so muchoftener diseased than the others has also been explained as dueto greater tension when closed (Sibson), a smaller line of contactduring closure, greater tendinous traction, greater ,—favoring embolic processes. It should also be borne in mind thatthe anatomic relationship of the mitral, tricuspid, and aorticvalves is a very intimate one. (See Fig
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