Effect of Temperature on Survival of Bacteria in Blood for Transfusion

MEDICAL JOURNAL (Fig. 1), and at necropsy his tricuspid valve was thought to be incompetent as well as stenosed.A similar case, but without proof at necropsy, is reported by Ferrer et al. (1953). Association of Incompetence with StenosisThe development of signs of tricuspid insufficiency in all patients with tricuspid stenosis who developed atrial fibril- lation led us to suppose that the organically stenosed and obstructed valve is probably always incompetent to some degree.The findings of Ferrer et al. (1953), McCord et al. (1954), Whitaker (1955), and Hollman (1956, 1957), in general support this contention.However, Reale et al. (1956) doubt whether a marked systolic wave in the right atrial pulse necessarily indicates tricuspid incompetence, and they suggest that if the atrium is filled and stretched at the time of ventricular systole the regurgitation of even a very small amount of blood might produce a considerable systolic wave.Ten of their 13 cases came to operation, and " significant."regurgitation was detected in only one.A low cardiac output at the time of palpation of the valve, however, may obscure a regurgitant jet.Pantridge and Marshall (1957) reported incompetence in one of two cases of tricuspid stenosis at operation for tricuspid valvotomy.However, the work of Muller and Shillingford (1954) and Korner and Shillingtord (1957) suggests that a large positive systolic wave is in fact associated with a considerable volume of reflux estimated by the dye-dilution technique.Such a wave was regularly seen in our patients with atrial fibrillation, and at necropsy it seemed probable that the valves had been incompetent.The absence of this wave in sinus rhythm may have been partly due to better emptying of the atrium, which is then able to accept a regurgitant flow without conspicuous rise of pressure.We believe, therefore, that incompetence is a very com- mon accompaniment of stenosis, but is not necessarily in- variable.This point has an important bearing on the surgical treatment of tricuspid stenosis, since valvotomy is unlikely to be wholly successful if appreciable incompetence is present, for it may be increased by valvotomy (Hollman, 1956), to the detriment of the patient.At the present time, tricuspid valvotomy is a well-recognized though uncommon operation (