. The diseases of children : medical and surgical. ndocarditis may also occur after birth, and still furtherdeform or pucker the valves. In such cases, if there is marked obstructionat the aortic valves, the ductus arteriosus may remain open, and some of the D D 402 Diseases of the Circulatory System blood may pass, as it does during fcetal life, from the pulmonary artery intothe aorta, without passing through the lungs ; the left ventricle becomeshypertrophied. When the stenosis is only moderate, life may be prolongedfor many years. Stenosis of the mitral valves may also occur. Transposition
. The diseases of children : medical and surgical. ndocarditis may also occur after birth, and still furtherdeform or pucker the valves. In such cases, if there is marked obstructionat the aortic valves, the ductus arteriosus may remain open, and some of the D D 402 Diseases of the Circulatory System blood may pass, as it does during fcetal life, from the pulmonary artery intothe aorta, without passing through the lungs ; the left ventricle becomeshypertrophied. When the stenosis is only moderate, life may be prolongedfor many years. Stenosis of the mitral valves may also occur. Transposition of the Aorta and Pulmonary Artery.—This curiousmalformation is not uncommon ; the foramen ovale and ventricular septumremain open. Lite is rarely prolonged for more than a few months ; thereis much cyanosis, but no bruit is present. A diagnosis during life is hardlypossible. Of the many other malformations or arrests of development, suchas a heart consisting of single auricle and ventricle, or a three-chamberedheart, it is unnecessary to Fig. 77. —Same heart as fig. 76. Right ventricle opened, a, aorta arising from both ventricles ;b, pulmonary artery, valves adherent, only admits a large probe ; c, incomplete interventricularseptum ; d, tricuspid valves. Diseases of the Pericardium In a few cases a congenital absence of the pericardium or some defectin the pericardium has been recorded. In some cases a hernia or diver-ticulum has been present ; these congenital defects are of little practicalinterest. Pericarditis Etiology.—In children, as in adults, the most important association ofpericarditis is with rheumatism, acute or subacute, as it arises more oftenduring a rheumatic attack than under any other condition. An exception tothis however occurs, for in children under three years of age rheumatism isan uncommon ailment, and pericarditis when present is most frequently theresult of an extension of the inflammation from a pleuro-pneumonia. orempyema or arises in
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