July 16, 2017

Download A Surgeons’ Guide to Cardiac Diagnosis: Part II The Clinical by Donald N. Ross B. Sc., M. B., CH. B., F. R. C. S. (auth.) PDF

By Donald N. Ross B. Sc., M. B., CH. B., F. R. C. S. (auth.)

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Extra info for A Surgeons’ Guide to Cardiac Diagnosis: Part II The Clinical Picture

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Haemodynamics During foetal life the duct acts as a means of by-passing the functionless lungs and it directs unsaturated blood from the foetal heart into the descending aorta beyond the head vessels. At birth the lungs expand and their vascular resistance falls. The duct if it persists then acts as a fistulous leak from the aorta into the low resistance pulmonary bed. Eventually, depending upon the size of the duct and the pulmonary vascular resistance, a shunt of blood will be established from the aorta to the lungs and back to the left atrium and left ventricle.

This combination of a giant a wave, thrill and a right ventricular heave is almost diagnostic of the condition. 30 Pulmonary Stenosis In the absence of a ventricular septal defect the right ventricle has to propel its entire contents through the stenotic orifice. The systolic murmur is consequently of long duration and continues beyond the aortic element of the second heart sound. This is due to the fact that right ventricular ejection continues well after the unobstructed left ventricular ejection phase is complete (fig.

In infants with this condition the left atrium acts more as a channel than a resevoir and is ill-adapted to receive the whole pulmonary venous return from the lungs. Early attempts to cure this condition in infants were described by MUSTARD of Toronto. He anastomosed the common pulmonary venous trunk or persistent left superior vena cava to the left atrial appendage. This manoeuvre was to encourage the drainage of pulmonary venous blood directly into the left atrium. The anastomosis is, however, restricted by the size ofthe left atrial appendage which is likely to be small in infants.

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