SummaryAn investigation was carried out of the diagnostic value of hepato-jugular reflux in patients with heart failure.The effect of abdominal compression on superior vena cava pressure was assessed in patients with and without heart failure. In four of the six patients without congestive cardiac failure, during compression, whether applied in the right hypochondrium or left iliac fossa, there was a significant rise in vena cava pressure. A similar response was also observed in three patients with congestive heart failure.Hepato-jugular reflex is not a reliable sign ofincipient heart failure.RONDOT (1898) These measurements were made with the patient lying flat or reclining at 30 degrees. The zero reference point was taken at the mid-axillary line in the fourth intercostal space. Six children and young patients had a general anaesthetic. The remaining five were sedated with intravenous valium and were instructed to breathe freely and not to resist when the pressure was applied on the abdomen. In six patients the cardiac lesion was congenital and in two rheumatic; three had ischaemic heart disease.Patients were divided into two categories. The first group of six patients had no evidence of heart failure and end-diastolic pressures in the right ventricle and the mean central venous pressures were normal. Similarly, the mean pulmonary wedge pressure (indirect left ventricular diastolic pressure) was not elevated (Group I).In the second group of five patients, three had physical signs of congestive cardiac failure and raised central venous pressure (Group IIA). In two patients, there was clinical evidence of early left ventricular failure and raised pulmonary wedge pressure (Group IIB).
ResultsGroup I (six patients without congestive cardiac failure): The mean central venous pressure was 2-5 mmHg. During compression in the right hypochondrium or left iliac fossa, there was a steep rise in both free and mean pressures (3-5 mmHg) in four patients. After the initial steep rise (Fig. 1), there was a slight fall, and the level dropped to control levels after release of compression. Two patients in this group had additional measurements -there was an increase in the right ventricular enddiastolic pressure (Fig. 2), free and mean pulmonary artery and wedge pressures and left atrial pressure (Fig. 3). There was a slight and probably not significant rise in the systemic arterial pressure. During compression in four patients, distension and engorgement of the external jugular veins was noted.Group IIA (three patients with congestive heart failure): The mean central venous pressure varied from 8 to 12 mmHg and rose by an average mean of 5-5 (4-7 mmHg). The right ventricular, pulmonary artery and wedge pressure responses were similar to that noted in normal patients (Group I).
A patient with a congenital defect of the pericardium with herniation of the greater omentum within the pericardial cavity is described; the condition was recognized during life. The value of echocardiography as a diagnostic tool is emphasized. Successful surgical treatment was carried out.
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