Protein-losing gastroenteropathy and cardiac diseases

Abstract

1) Nine cases (21 per cent) of 43 cases of constrictive perecarditis showed severe hypoproteinemia under 5.0 Gm. per 100 ml., while only one case with such hypoproteinemia was encountered among congestive failure of the other cardiac diseases with high venous pressure over 150mm. saline. This special case was a postoperative teralogy of Fallot accidentally associated with tricuspid and pulmonary insufficiency. 2) Isotope studies on cases with hypoproteinemia under 5.0 Gm. per 100ml. of serum protein (5 cases of idiopathic hypoproteinemia and 3 cases of cardiac diseases) showed definite evidence of protein loss into the gastrointestinal tract. 3) Comparing the venous pressure and duration of signs of venous congestion, among group with hypoproteinemia under 5.0 Gm. per 100 ml., the other group of constrictive pericarditis, and cases with congestive failure associated with tricuspid insufficiency, the important role of hemodynamic abnormalities on severe hypoproteinemia was confirmed. At the same time, it was pointed out that venous congestion is not a sufficient factor but one of necessary factors to explain the hypoproteinemia in individual cases. 4) Preliminary experimental study designed to clarify causal relationship of venous congestion to abnormality of abdominal lymphatic system and protein loss into the gut was reported. 5) A case of constrictive pericarditis whose clinical findings showed some special features inherent to those of idiopathic hypoproteinemia due to protein losing enteropathy, was described, and some clnical statistics concerning some possible factors other than hemodynamic abnormalities were presented.