An unusual type of annular, subvalvular left ventricular aneurysm has recently been described in Nigerians by Robertson and Jackson (1960) and Abrahams et al. (1962). A search revealed reports of similar cardiac aneurysms of unknown etiology (Corvisart, 1813;Hunter and Benson, 1933;Berlin and Hallen, 1938;Burn, Hollander, and Crawford, 1943;Higginson and Keeley, 1951;Brink and Barnard, 1954;Clearkin and Bunje, 1955; Lurie, 1960). With one possible exception (Martin, 1946) all the cases hitherto described have been Negroes. The modes of presentation have been diverse. Congestive cardiac failure, pulmonary cedema, or sudden death from pericardial tamponade following rupture of an aneurysm have been reported frequently. Other cases have been asymptomatic, and an abnormal radiological cardiac outline has led to their detection. A large proportion ofthese patients have, had murmurs ofmitral incompetence, and the regurgitation has been confirmed by angiocardiograms in some. Necropsy has revealed stretching and dilatation of the mitral ring produced by these aneurysms due to their extension in an annular fashion around the valve ring. In the majority of patients the electrocardiogram has shown surprisingly little abnormality even in the presence of multiple large aneurysms. Generalized low voltage, slight S-T segment depression with flat or inverted T waves in the limb leads and left ventricular chest leads were usually recorded (Abrahams et al., 1962). This paper describes two further patients with subvalvular aneurysms, one of whom is a European. The electrocardiogram in both patients suggested myocardial infarction. In the second patient interesting auscultatory features were present, which have not previously been described in association with these cardiac aneurysms. (Fig. 1). 184 on 12 May 2018 by guest. Protected by copyright.
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