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Quadricuspid pulmonic valve is a rare congenital anomaly which appears to occur in the absence of other cardiac or systemic anomalies. It predominates in males and tends to be clinically quiescent. The first case of quadricuspid pulmonic valve in a live newborn infant diagnosed by two-dimensional echocardiography is presented here with a review of the literature.

Left atrial pressures were determined by transbronchial puncture in 53 patients with mitral valve disease of proved type, and were analyzed by several methods. Two new methods of analysis, the rate of the y descent divided by the mean left atrial pressure, and the y descent for each 0.1-second interval divided by the mean left atrial pressure afforded the best separation of the patients with mitral insufficiency from those with mitral stenosis requiring a commissurotomy. In the presence of predominant mitral stenosis, however, the severity of accompanying mitral regurgitation could not be assessed.IT HAS been well established that mitral valve disease and experimentally produced mitral valvular lesions alter the contour of the left atrial pressure pulse.'-6 The purpose of this investigation was to evaluate the usefulness of several previously describedl-4 and 3 new methods of analysis of the left atrial pressure in distinguishing patients with predominant mitral insufficiency from those with predominant stenosis. This study is based on the preoperative left atrial pressure curves of 53 patients with mitral valve disease of proved type. MATERIALOf the patients studied, 39 were found at operation to have significant mitral stenosis. In 32 of these patients there was either no palpable regurgitation or a minimal jet considered by the surgeon to be of little functional significance. Seven of the 39 patients with mitral stenosis were found to have, in addition, "significant" mitral insufficiency. This was evidenced by the presence of a regurgitant jet of moderate or severe intensity. The valve orifice in each of the 39 patients with mitral stenosis (including those with combined mitral stenosis and insufficiency) was less than 1 cm. in diameter and a commissurotomy was indicated and performed.Fourteen patients had essentially pure mitral insufficiency. In 7 patients this diagnosis was established at operation or autopsy. The other 7 patients presented classic clinical, roentgenologic, and electrocardiographic findings of mitral insufficiency and at left heart catheterization were shown to have no diastolic gradient across the mitral valve.

Left heart catheterization is proving of increasing importance in the study of a variety of congenital and acquired cardiovascular defects. More than 500 left heart catheterizations have been performed by the transbronchial method without death or serious sequelae. This technic and its usefulness in clinical investigation and in the assessment of valvular heart disease are described.

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