ALTHOUGH bicuspid venous valves in the internal jugular and subclavian veins at the thoracic inlet in man were identified by sixteenth century anatomists' and are included in modern textbooks of anatomy,2 many physicians are unaware of their existence. The function and competence of these thoracic inlet venous valves have been controversial for several hundred years. In 1628, Harvey wrote, "the edges of the valves in the jugular veins hang downwards, and are so contrived that they prevent blood from rising upwards."3 Nearly 3 centuries later, Mackenzie4 reviewed the evidence and could not reach any firm conclusion about the competence of the internal jugular vein valve. In patients with tricuspid regurgitation, Muller and Shillingford found sudden decreases in systolic pressure (v) waves as the catheter was withdrawn from the superior vena cava past the subclavian vein valves.5 Wood claimed that in tricuspid regurgitation, the venous valves take on the function of the tricuspid valve.6 Keith,7 however, concluded that in man, the internal jugular vein valves were the weakest set of venous valves separating the thorax and abdomen from the extremities because they were the only set of From the Peter

A case report of a 28-year-old woman with malignant fibrous histiocytoma (MFH) of the left atrium is presented, and the six previous reports of this rare cardiac tumor are reviewed. A tendency for malignant fibrous histiocytoma of the heart to occur in the left atrium of young women is suggested; this sarcoma's usual location is in the soft tissue of elderly men. The apparent predilection for the left atrium is unique among cardiac malignancies. Careful pathologic study is necessary to differentiate the uniformly fatal MFH of the heart from the more common benign atrial myxoma. Cancer 59:1026-1031. 1987. ALIGNANT FIBROUS HISTIOCYTOMA (MFH) is one M of the most common soft tissue sarcomas,' but its presentation as a primary cardiac tumor is distinctly unusual. The current case illustrates two important points regarding MFH of the heart: (1) it may be confused clinically and histologically with benign atrial myxoma (BAM), the most common cardiac tumor; and (2) it occurs in a younger, predominantly female population in con-tradistinction to its occurrence in the soft tissue where it is most commonly seen in elderly men.2,3 Case Report A 28-year-old Hispanic woman in her third trimester of pregnancy presented to her obstetrician in September 1983, with a 1-week history of shortness of breath, orthopnea, and cough productive of purulent sputum. She reported increasing fatigue for 2 months. She was markedly dyspneic at rest with blood pressure of 100/70 and a heart rate of 130/minute. The first heart sound was loud, and the second was physiologically split. A short Grade II/VI systolic murmur was heard at the lower left sternal border, and a I/VI diastolic rumble was audible at the apex and lower left sternal border, A gravid uterus of 7 months gestation was noted. The hematocrit was 3190, leukocyte count From the was 12,000/mm3 with a left shift. A few ovalocytes and schis-tocytes were seen on the peripheral smear. Sputum and blood culture showed no growth. A chest x-ray revealed bilateral in-filtrative changes consistent with congestion, although the heart size was within normal limits. An electrocardiogram (ECG) revealed sinus tachycardia. Two-D and M-Mode echocardiography showed the right atrial, right ventricular, and left ventricular cavities to be normal in size. The left atrium was enlarged (4.6 cm); the two-D films revealed a mass in the left atrium which appeared to arise from the posterior wall immediately above the mitral valve. The patient was treated for a time with diuretics, bed rest, and sodium restriction, but because of progressive cardiac de-compensation a caesarian section was performed at 37 weeks gestation. One week later three large atrial tumors were excised via a right anterior thoracotomy, all three attached to the posterior atrial wall. These were pedunculated, their bases separated by normal-appearing endocardium. The tumors were removed at their bases, and adjacent endocardium was resected. Four months later the patient again presented with symptoms of congestive heart failure. An echocar...

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Isolated pulmonic regurgitation was found in a 30-year-old man 5 years after an episode of bacteriologically proved and successfully treated staphylococcal endocarditis. Intracardiac phonocardiography was useful in confirming the diagnosis, and simultaneous intracardiac pressure and sound recording afforded a plausible explanation for the unusual murmur of organic pulmonic insufficiency.

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