Studies in cardiac pathology . ased contractile tension, and in the insufficiencies by increasedsystolic output. As a corollary, to compensate an obstructionhypertrophy is required, but to compensate an insufficiencj^, bothhypertrophy and dilatation must exist (Moritz).^ As theresult of mitral insufficiencj, pressure in the aorta falls, in the pul-monary veins and in the arteries it rises, wherefore the amount ofblood in the greater circulation diminishes; in the lesser, systolic output of the left ventricle increases, that of theright decreases. Distinct dilatation of the right
Studies in cardiac pathology . ased contractile tension, and in the insufficiencies by increasedsystolic output. As a corollary, to compensate an obstructionhypertrophy is required, but to compensate an insufficiencj^, bothhypertrophy and dilatation must exist (Moritz).^ As theresult of mitral insufficiencj, pressure in the aorta falls, in the pul-monary veins and in the arteries it rises, wherefore the amount ofblood in the greater circulation diminishes; in the lesser, systolic output of the left ventricle increases, that of theright decreases. Distinct dilatation of the right ventricle is notthe result of pure mitral insufficiency. Mitral insufficiency leadsto dilatation and hypertrophy of the left ventricle. With increaseof left ventricular systolic output, the aortic pressure may returnto normal and the pulmonic pressure diminish to normal; truecompensation is, therefore, possible. In mitral stenosis the workof the left ventricle decreases. 1 Moritz: Deut. Arch. f. klin. Med., 1899, Ixvi, p. Fig. -Mitral ShowinK vr-ry extensive tissue destruction. The chorda; tendineaj at the central part ofthe valvular margin have been destroyed by ulceration, leaving only short shriveled few vegetations are seen. The ventricular wall is much thickened. (Specimenfrom the Pennsylvania Hospital.) 84 STUDIES IN CARDIAC PATHOLOGY When mitral insufficiency is exj)erimentally produced—bycutting the leaflets or chordee tendinese by means of a knife-hookintroduced through the left auricular appendage—arterial pressurefalls in proportion to the severity of the lesion. Pressure in thepulmonary artery is not much altered; it falls somewhat, withextreme insufficiency, and with slight lesions rises systemic venous pressure too shows but little change. Themost striking alterations occur in the left auricle, in which pressurerises, distention becomes marked, and the pulsation not onlyviolent, but systolic in time. The l
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