MALFORMATION OF PULMONIC VALVES; TWO 
INSTEAD OF THREE* 
REPORTED BY H. C. HAND, M.D. 
In the number of this Jottrnal for March, 1873, was reported, 
by Dr. D. W. Hand, a death from ether. In the account of the 
autopsy the following description was given of the Heart. 
"Weight, seven and one-half ounces; muscular tissue normal; 
valves normal, except that in place of three leaflets at the 
mouth of the pulmonary artery there are only two, which, how- 
ever, seem sufficient for their purpose. " 
By the aid of the accompanying plate it is now hoped to 
make plain exactly in what the mal-formation consists. The 
depth of each of the two valves of the orifice of the pulmonary 
artery is equal to one half of an inch ; but their lengths are un 
equal, being for one, one and two-fifth inches, and for the other, 
one and four-fifth inches. The smaller one varies little from a 
normal valve except that its corpus Arantii is not sharply de- 
fined, its lunulae are indistinguishable from the general surface 
of the valve, and its free edge is studded with a few small, hard 
papillations ; the simis of Valsalva is natural in size and appear- 
ance. 
In the larger valve there is no distinct corpus Arantii, but a 
diffused thickening of the edge of the valve a little to one side 
of'its middle point: Lunulae, none. Sinuses of Valsalva, two, 
one somewhat larger than the other. They are seperated by a 
bridle of fibrous tissue which binds the arterial wall and the 
valve together and extends some two lines upwards from the 
base of the latter as a prominent, and almost cartilaginous, 
point; from this point strengthening fasciculi of fibrous tissue 
radiate to all parts of the valve. 
♦From The Northwestern Medical and Surgical Journal for July1 Malformation of Pulmonic Valves. 
Figure I shows the pulmonary artery and right ventricle laid 
open exhibiting the ventricular aspect of the valves. 
Figure II is a view of the heart from above with the valves 
stretched open, and shows the two sinuses of Valsalva behind 
the large valves, with the fibrous band forming the partition be- 
tween them. 
I desire to express my indebtedness to my friend, R. O. 
Sweeny, Esq., for the very accurate drawings of this beautiful 
specimen. 
The question arising as to the origin of this mal-formation 
I must express my opinion in favor of its congenital nature, for 
the following reasons. 
All the other valves of the heart are perfectly smooth and 
natural showing no evidence of endo-carditis, as would in all 
probability have been the case if the large valve had been pro- 
duced by the agglutination of the opposed surfaces of two 
valves, with the subsequent absorption of the redundant parts; 
moreover the right side of the heart is but little prone to take 
on endocardial inflammation. Lastly, if this large valve had 
originated in inflammatory fusion of two others, other eviden- 
ces of the inflammation woald have been left in roughness 
and irregularities of its surfaces and edge, which nowhere exists. 
St. Paul, Minn. April ist. 1873. ^4. J. FteidfLifli. St. PauL.