There is a remarkable remnant of primitive fibres persisting at the sino-auricular junction in all mammalian hearts. These fibres are in close connection with the vagus and sympathetic nerves, and have a special arterial supply; in them the dominating rhythm of the heart is believed to normally arise. Keith and Flack, 1907.
In 1866 Ebstein described an uncommon congenital abnormality in which the tricuspid valve was situated below its normal site, thus reducing the size of the functioning right ventricle. Since then, many examples have been recorded, some with " patent foramen ovale," and others without it; the most recent was by Kerwin (1955), who described a case diagnosed during life. In Abbott's series of 16 examples of Ebstein's anomaly, the oldest survived to 56 years. The present case is believed to be the longest survival yet recorded, and was a woman of 79 who succumbed to suppurative cholangitis.Case Report A woman, aged 79, was admitted to the West Middlesex Hospital in October, 1954, with a diagnosis of obstructive jaundice. She had been well until two days before admission, and had never complained of shortness of breath or of swelling of the ankles, though a relative said that the patient did go blue on undue effort, particularly in cold weather.
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