Delicate networks occur in the right side of the heart at three sites: at the entry of the inferior vena cava into the atrium, at the mouth of the coronary sinus, and between the endocardial surfaces of the right ventricle. The first clear account of the fenestrated valve of the inferior vena cava and coronary sinus was by Eustachi (1563, quoted by Franklin 1948. Franklin (1948) has reviewed the historical background of these valves and the theories concerned with their origin and function. Chiari (1879) described networks formed from the valves of the inferior vena cava, and in some cases of the coronary sinus, which showed attachments beyond the usual territories of these valves. These reticular formations are now called Chiari networks. Chiari himself considered them to act as a source of pulmonary emboli. Yater (1929) suggests that they may serve as a filter for emboli arriving at the right atrium from elsewhere in the venous system. This investigation is mainly concerned with the view that the network may act as a short circuit from sinu-atrial node to atrioventricular bundle.Hearts from 300 consecutive necropsies were examined for the presence of networks in the right atrium and in the right ventricle. Of these 260 were from adults, 23 of whom were below the age of fifty; 7 were from children in the first five years of life; and 33 were from stillbirths and neonates. RESULTSIn 58 of all hearts examined, of which 38 were from children of five years or less, no valves were found of either the coronary sinus or the inferior vena cava. In 204 of 260 adult hearts examined the commonest findings were along the lateral border of the coronary sinus and in order of frequency could be divided into: (a) a conspicuous crescentic valve flap often fenestrated, (b) a valve flap that completely covered the orifice of the coronary sinus and was adherent to its medial wall except at one or two points, and (c) a single strand which was present alone in 25, or in association with a fenestrated valve of the inferior vena cava in 9 (Fig. 1). If the inferior sinus septum (Fig. 1) was absent or poorly developed, then the strands were continuous with a fenestrated valve of the inferior vena cava in five cases (Fig. 2).The next most frequent abnormality found in 75 cases was a fenestrated valve of the inferior vena cava (Fig. 1). In four cases the attachments of this valve extended up to the internal orifice of the superior vena cava and inferiorly to the atrioventricular ring near the site, anterior to the coronary sinus, of the atrioventricular node (Fig. 3). Such a valve with these attachments is called the Chiari network (Yater, 1929). Evidence will be presented to support the desirability of distinguishing it from a fenestrated valve of the inferior vena cava without such attachments.The degree of fenestration of the valve of the inferior vena cava was variable. The simplest form was a fleshy crescentic valve with a few holes in its free border (Fig.

A case of complete heart block with paroxysms ofventricular fibrillation, during the last night of her life is reported.Case Report A woman, aged 85, was admitted to Harrogate General Hospital under the care of Mr. Gordon Bailey on May 30, 1950 with vomiting and constipation that had been present for four days. Heart block had been diagnosed by her family doctor three weeks before.Her pulse was irregular, 32 a minute; the blood pressure was 230/90. She vomited repeatedly and gastric suction and intravenous saline were started to combat dehydration.On June 2 her vomiting had ceased; she was seen by Dr. Curtis Bain and a diagnosis of complete heart block with premature ventricular beats was made. The heart was not enlarged, but persistent crepitations were audible at the base of the left lung.On June 4 the patient developed attacks of unconsciousness lasting a few seconds, in which she became pulseless and cyanosed, with tonic and clonic movements of the limbs. The attacks became more frequent and she died on June 9.A cardiogram taken on June 6 showed complete heart block with an auricular rate of 100 and the Q-T time greatly prolonged, 0-72 sec. (Fig. 1). The ventricular rhythm was irregular due to multifocal ectopic beats, the rate being about 36. A short paroxysm of ventricular tachycardia is shown, preceded by an initial premature beat. The latter follows the preceding ventricular complex by an interval of 0t68 sec. and is directed downwards (Fig. 2).FIG. 1.-Complete heart block. Q-T time 072 sec., auricular rate 100.

SummaryThe values for plasmatic and thrombocytic anti-plasmin and anti-UK were determined in normal test persons and in 107 patients with different diseases.In 12 patients with a fresh venous thrombosis the values of these inhibitors were within normal limits.In 6 patients with liver cirrhosis no significantly lowered values were found.Also in patients with different haematological diseases no abnormality was found. A relationship between plasmatic and thrombocytic anti-UK was found.

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