The Symmetrical Liver

THE YOUNG INFANT with cyanotic congenital cardiac disease presents an acute and difficult diagnostic problem. The anomalies responsible for eyanosis in some such infants are now curable surgically while, on the other hand, there remains a group of eyanotic newborn infants in whom the congenital cardiac anomalies are so complex that no surgical procedures for their correction have yet been devised. A method for early separation of these two groups of patients, that is, operable and inoperable, would be of value. Among the so-called inoperable group of patients are individuals with asplenia and congenital cardiac disease, since in these the cardiac anomalies are of such a complex nature that they usually defy surgical correction.' Among a group of cases of asplenia with congenital cardiac diseases the pathologic manifestations include persistent truncus arteriosus, transposition of the great vessels, pulmonary atresia or stenosis, common atrioventricular canal, anomalies of pulmonary veins, and cor biloculare. Moreover, several of these complex malformations usually coexist in the same patient. Visceral symmetry is common also. One step in the direction of separating by clinical means the operable from the inoperable group is to determine whether the spleen is absent. Evidence favoring asplenia includes certain changes in the peripheral blood and findings of visceral symmetry.