Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3702_Библиотеки_им_академика_М_И_Перельмана

“heart murmur.” During childhood he had occasional dizzy spells. At age 18years, he was rejected from the Armed Services and later failed several insurance examinations because of the murmur. He worked as a professional gambler, married and had 3 chil­dren. At age 38years (1958), dyspnea with hemoptysis appeared. Examination disclosed central cyanosis, a short systolic and a long, loud diastolic precordial murmur, loudest in the third left intercostal space. The blood hemoglobin was 22 g/dl and the hematocrit was 62%. An electrocardiogram showed right ventricular strain. The first of 3 cardiac catheterizations was performed at this time (Table 1). By age 41years (1961), he was more dyspneic and cyanotic, and had chronic lethargy, and a second cardiac catheter­ization was performed (Table 1). Aradiograph showed cardiac enlargement with large pulmonary arteries (Figure 1). By age 51years, the diastolic murmur of pulmonary regurgitation was loud (grade 4/6). In addition, a grade 1/6 murmur of tricuspid regur­gitation was heard. Athird cardiac catheterization was performed (TableI). Although not physically active, he continued to support himself and his family through gambling. In the last 2 months of life signs of severe tricuspid regurgitation developed, and his condition deteriorated rapidly. He died in October1983.