CLINICOPATHOLOGICAL CONFERENCEA 51-YEAR-OLD MAN WITH PALPITAT10N, SHORT BREATH,CYANOSIS AND SUFFOCATION

A 51-year-old man was admitted to ourhospital on January 23, 1985 because of pal-pitation and short breath for 40 years. Hewas well until 7 years of age. Then he devel-oped symptoms ofpalpitation and shortbreath with cyanosisafter exercises. Relief ofthe symptoms would be achieved by squat-ting for a while or taking a few minutes' rest.Later, his growth was retarded. In 1960 hedeveloped clubbing fingers. In 1965 whenhospitalized for tonsillectomy, he was sus-pected of having "congenital heart disease"with ventricular septal defect, stenosis of thepulmonary artery and Eisenmengerissyndrome in question. In 1966, cardiaccatheterization was performed, showing that the partial pressure of blood oxygen was l.85 vol%, higher in the right ventricle than in theleft auricle. This means there exists a left toright shunt and the magnitude of shunt is24.0% of the pulmonary circulation. The blood oxygen saturation in the f'emoral arteryis a little bit low (93.5%). The hemoglubinconcentration is (180g/l). Bilateral shunt could not be excluded.Since August 1969, he began to be very often troubled by nocturnaldyspnea, cough and chest distress. These symptoms could be abated by the treatmentof aminophytlline. In 1976, ultrason- ocardiography revealed ventricular septal de- fect and aortic insufficiency. In May 1984. he had high fever for several days and was sus-pected of having "bacterial endocarditisu.The fever subsided with antibiotic therapy fora few db.ys. Twenty days before thishosptalization he had chest distress, shortbreath, palpitation, cyanosis, nocturnaldyspnea and paroxysmal precordial pain af-ter getting cold.