Pulmonary stenosis with normal aortic root.

Pulmonary stenosis has alw"ays attracted more attention than other forms of congenital heart disease. This was true even in the eighteenth and nineteenth centuries, when the approach to the whole subject was mainly aitatomical, and for that reason academic. In recent years the surgical treatment of pulmonary stenosis has inevitably aroused further interest and has underlined the need for more detailed clinical and physiological studies. Despite this stimulus, there exists today much uncertainty about pulmonary stenosis: disagreement about nomenclature and a proper classification, ignorance of its true incidence, failure to appreciate the great difference between mild and severe cases, unfamiliarity with several of its variations, and, above all, a consistent neglct of physical signs, have all contributed to the confusion. In this paper we present 71 cases of pulmonary stenosis, occurring either as an isolated lesion or combined with certain other congenital cardiac defects, but excluding the tetralogy of Fallot. Cardiac catheterization was carried out in 55 cases, including all doubtful instances. The diagnosis was further confirmed at necropsy in five and at operation in ten. In all cases great emphasis was placed on careful history taking, detailed physical examination, and comprehensive electrocardiography and radiography. From these studies at least five clear-cut syndromes have emerged, which may be diagnosed at the bedside with a high degree of accuracy. Special techniques are now rarely necessary for practical purposes.