CASE HISTORY

The child was born 3.2.1938 and was cyanosed at birth. It remained so ever since. The cyanosis was slightly relieved by CO2 and O2. Crying made cyanosis worse, fontanelles tense. 7.2.38: a slight systolic murmur was first heard over the chest. A diagnosis of congenital morbus cordis was made and the child transferred. It developed a staphylocooccal conjunctivitis and thrush in its mouth, but both of these cleared up. RBC 6,600,000 Hb 13, WBC 9,700. 16.2.38: systolic murmur quite definite, lungs normal. 27.2.38: slight convulsion with extreme cyanosis; after this the child continued extremely cyanosed until death.

PATHOLOGY

Heart 120mmx140mmx70mm. The heart and lungs are mounted together and the heart has been opened to expose the cavities of the ventricles. The aorta, which in all other respects appears normal, is arising from the right ventricle. The pulmonary artery is arising from the left ventricle. The venous return from the lungs and from the systemic circulation is normal. The two circulations, pulmonary and systemic are therefore dissociated, the only communication being via the ductus arteriosus which is still patent and is marked by a blue glass rod. The heart as a whole is rather globular in shape and the right ventricle is thicker than the left. The foramen ovale was patent but this cannot be seen in the specimen.