CASE HISTORY

This patient was admitted for and died of a carcinoma of head of pancreas and the heart lesion was an incidental finding on routine examination. There was an indefinite history of slight dyspnoea on exertion but there were no other cardiac symptoms. On examination he was found to have a loud rough apical systolic murmur and a thrill. The heart was enlarged to percussion and X-ray showed enlargement of the heart and pulmonary arteries. Cardiac catheter studies showed evidence of a widely patent auricular septum. He died as a result of his pancreatic carcinoma

PATHOLOGY

Heart 185mmx130mmx80mm. The heart which weighed 475 grams has been mounted to show the septa, the right ventricle being to the front. The latter is greatly hypertrophied and dilated and forms the cardiac apex. The left ventricle is of normal size. The right auricle is both hypertrophied and dilated but the left auricle is of normal size. There is a large hole in the position of the foramen ovale, measuring 3x3.5cm, partly closed by a sickle shaped membrane on its posterior border. The main pulmonary artery is dilated and has a circumference of 14cm.