. Diseases of the heart and arterial system; Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. all, may be retracted, curled, or shrivelled,so as to permit a free regurgitation. Old vegetations on the ven-tricular surface may interfere with their complete apposition. Inshort, the conditions parallel those found in mitral insiifiiciency,with exception of the influence of contraction of the chordae ten-dinese and papillary muscles. Acute incompetence may occur during ulcerative endocarditisby the perforation of one of the valve-cusps. V
. Diseases of the heart and arterial system; Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. all, may be retracted, curled, or shrivelled,so as to permit a free regurgitation. Old vegetations on the ven-tricular surface may interfere with their complete apposition. Inshort, the conditions parallel those found in mitral insiifiiciency,with exception of the influence of contraction of the chordae ten-dinese and papillary muscles. Acute incompetence may occur during ulcerative endocarditisby the perforation of one of the valve-cusps. Very rarely a cuspmay rupture during violent muscular exercise. The aortic semi-lunar valve is one of the most delicate structures in the body, andyet one of the strongest, sustaining as it does the Avhole blood-pressure of the systemic circulation. It is hence extremely un-likely that muscular exertion could be severe enough to raiseblood-prcBsure to a height sufficient to rupture a healthy in such cases the valve has been weakened either by de-generation or inflammation. As in mitral disease, regurgitation is often combined with278. AORTIC REGUEGITATION, WITH CALCIFIED VEGETATION THAT SWUNGIN BLOOD CURRENT. CAUSING ATHEROMA OF ENDOCARDIUM ANDOF INTIMA OF AORTA. AORTIC REGURGITATION 279 some degree of stenosis, but regurgitation may occur without nar-rowing, and occasionally, in consequence of dilatation of the ven-tricle, even with stretching, of the aortic ring. That such en-largement of the ring, leading to relative insufficiency, could takeplace, was long doubted, owing to the great strength of the annulusiibrosus, but so many instances of the kind have been observedthat there is no longer any room for doubt. The first effect on the heart is dilatation of the left is due to the impact on its inner surface of the regurgitantstream,which in very free regurgitation re-enters with nearly theforce with which it was driven out of the ventricle. Such
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