i,~d. J. Pod., 23: 23, 1956

SOCIETY P R O C E E D I N G S

INDIAN PEDIATRIC S O C I E T Y

CLINICAL MEETING

[July, 1955] Calcutta

DIAGNOSIS OF C O N G E N I T A L H E A R T DISEASE

Under the Chairmanship of DR. J. C. BANERJEE, a lecture on the Diagnosis of Congenital Heart Disease" was given by DR. H, K. BosE,

Cardiologist to the National Medical College, Calcutta. The speaker emphasized the practical approach to this condition and

discussed the ways and means of diagnosing congenital heart disease at the bedside. He dealt briefly with all the important types of congenital cardiac abmormalities. Regarding patent ~luctus ajcteriosus he stated that there were two types, the very witle bore type and the narrow. TKe former may not be associated with a murmur but the latter always is. Radiological findings, E.C.G. changes and clinical signs and symptoms were necessary to diagnose this condition. Where hypertension occurred in a child <me should always palpate the peripheral pul~e to eliminate coarctation of the aorta. He stated that clinical diagnosis was difficult in such cases as patent truncus, trans- portation of the great vessels, tricuspid atresia etc. The speaker said that only 350/0 of cyanotic cases were diagnosable at the bedside; 50% by means of electrocardiography and 70-720./0 of acyanotic cases at the bedside.

DISCUSSION

DR. LANE disagreed with the speaker's ~gur e of 35%. He said that much could be done at the, bedside by careful clinical observation. Few diagnoses were made at present by angiocardiography and most cases were being diagnosed by the bedside in the large hospitals abroad. Due, therefore, to great advances in clinical methods, mechanical aids to diagnosis can be dispensed with. X ' ray and angiocardiography were certainly of great help, but he was certain that ona should be able to make more diagnoses at the bedside.

Df~ H. B. BosE in reply stated that because bedside experience in foreign hospitals had been based on findings obtained from laborator,y and mechanical aids such as catheterization and angiocardiography, therefore bedside diagnosis in these countries had become a comparatively easy matte.*. In this country where cardiologists have not had much experience with mecha0ical methods bedside diagnosis was somewhat difficult.

DR. B, C. SINGHA then outli~ed some of his experiences with these conditidns. His discussion highlighted certain points relating to septal defects, patent ductus arteriosus, Fallot's Tetralogy etc. He stated among

24 Indian Journal of Pediatrics

other things that in patent ductus~arteriosus there was only one murmur during the first five }Tear~ of life and that the second sound was not much accentuated. A diamond-shaped murmur occurred, but since the pulmonary artery ascended, the murmur fn~y show a reversion and ma~/disappear. He reported .seeing cases following the Blalock,Taussig anastomosis; but the patients were r~ot relieved_and were returning with co~aplications. He also made 'b r i e f reference to the new syndrome--Fallot 's Trilogy which was difficult to diagnose. He concluded by stating that mechanical aids and appliances were important. PAUL WOOD was gradually changing over to clinical diagnosis of these conditions and the time might come when ap- pliances will be dispensed w~th after knowledge had been gained by means of mechanical~ aids.

DR. J. C, BANENEE , Chairman, summing up said that due to lack 0f diagnostic facilities in this country diagnosis of congenital heart disease was a difficult matter. Knowledge of this disease can advance only after postmortem findings and other diagnostic methods were available for confirmation. The problem Here was that doctors were left at a certain stage and were not atJle to proceed any further. However, with the recent work being done on cardiac surgery in this country, mo~e knowledge may be gained about congenital heart disease. He then thanked the speaker for drawing the attention o~ ~ the profession to the way inwhichbedsidediagnosis of congenital h~zart disease may be made.