A case of ectopia cordis

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C ONGENITAL ectopia cordis may be found in one of several forms. The heart may be displaced to almost any part of the mediastinum or abdomen, or it may be entirely outside of the body. The condition has been conveniently divided into internal and external form depending on the location of the heart. Mrs. H. M., white, went into labor on the night of January 12, 1932, being admitted to Jefferson Hospital on the following morning. She had a pulmonary tuberculosis in early life, which apparently had become quiescent. No history of abnormalities, tither on her own or the husband’s side could be obta.ined. During the second month of pregnancy, she had attempted an abortion by means of quinine and castor oil. Physical examination was grossly negative. Urine and blood pressure were repeatedly normal, and the Wassermann and the Kahn tests were negative. Labor pains were not severe, until late afternoon, when rectal examination revealed the head low in the pelvis, the cervix being dilated about two’ and a half inches. About 10 :00 P.M. the nurse reported that the patient vomited with each pain. Upon examination, nothing significant to account for the vomiting could be found, but it was thought possibly adhesions might have developed in some way between the bowel and the fundus of the uterus, contractions of the latter causing tugging on the bowel. The pulse, respirations, and temperature were normal. At 11:OO P.M. the cervix was completely dilated. The patient still vomited with the strong pains. The head, however, seemed to be in the same position as it was four hours earlier. At 11:55 the head delivered spontaneously, but when an attempt was made to deliver the anterior shoulder, abnormal resistance was felt. After it had passed under the symphysis the thorax and abdomen could not be delivered, beyond the umbilicus. At this time, a dark blue mass was noted in the region of the cord, which was manipulated through the dilated cervix. Beyond this mass, could be felt the taut umbilical cord, which was clamped inside the uterine cavity, following which the child was delivered. The placenta was expressed, intact, about five minutes later, by Crede’s method, being normal in appearance and weighing 450 gm. The umbilical cord, however, was extremely short, measuring but 10 em. The cervix and perineum were lacerated. The mother’s convalescence was uneventful, and she was discharged from the hospital on the fourteenth day after delivery. Upon delivery, the child cried, breathed promptly and normally, and the skin was pink in color. Upon the anterior chest wall, in the midline above the epigastrium, was a bluish, pulsating mass about the size of a lemon, readily recognized as the heart, protruding through an opening in the anterior chest wall due to the absence of the gladiolus. The manubrium sterni and the ensiform process were present. Further examination disclosed a craniorachischisis, a club foot (left), bilateral cleft palate, facial hemiatrophy. The child weighed 3 kg. and was 51 cm. in length, appeared active and took several bottle feedings. The heart stopped beating at one time, the injection of a few drops of adrenalin into the muscle causing it to again beat vigorously. Death occurred in twenty-eight and a half hours. Motion pictures, x-rays, and electrocardiographic studies were made. The latter, reported by Dr. Boss V. Patterson, showed a pulse rate of 150 per minute, with some