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February 25, 2017
19th Century Antoine Louis Jules Pigeaux

Antoine Louis Jules Pigeaux (1807-?)

Traite pratique des maladies du coeur. Paris, J. Rouvier, 1839.

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Antoine Louis Jules Pigeaux was a French physician and studied at the University of Paris. He published an important monograph, "Traite pratique des maladies du coeur," in 1839. In the first section, Pigeaux described the anatomy, physiology and  "general pathology" of the heart. In the second section, he discussed in detail diseases of the heart including pericarditis, valvular lesions, cardiac trauma, congenital malformations, and myocardial disorders.

Regarding valvular pathology, Pigeaux described in detail ossification (calcification) of the left-sided valves. He was of the opinion that the process of inflammation was the primary cause of these valvular disorders. He also mentioned that acute rheumatism was recognized with an increasing frequency as the primary etiology of valvular heart disease. Pigeaux discussed the significance of age in the ossification of cardiac valves and reported that the latter condition was diagnosed more commonly in elderly patients.

Pigeaux described cardiac valve vegetations and their potential role in aortic or mitral obstruction. He recognized that the etiology of these vegetations remained unknown.

He placed a great emphasis on physical diagnosis of valvular disorders using mediate auscultation. His explanations of abnormal cardiac sounds and murmur were similar to those of Laennec and he did not have any original contributions in that regard.

Pigeaux's work was one of the first textbooks in cardiology which included a distinct chapter on "Valvular insufficiency." He mentioned that "a greater attention was paid to this type of valvular disease during a recent period" and gave credit to the work of Bouillaud and Corrigan.

An interesting section of this chapter is Pigeaux's attempt to classify the etiologies of valvular regurgitation and he distinguished three different types, each including a variety of valvular lesions:

* Congenital:

- Incomplete development of valve leaflets
- Annular dilatation
- Leaflet agenesis
- Bicuspid valve in the aortic position
- Short chordae in the mitral and tricuspid positions

* Trauma:

- Chordae rupture
- Leaflet tear (complete or incomplete)

* Valvular retraction and shortening secondary to the deposit of calcification (sels calcaires)

Pigeaux postulated that the congenital etiology was more commonly observed at the semilunar valves whereas the traumatic etiology was predominant at the auriculo-ventricular valves.

Pigeaux described in detail the symptoms of mitral regurgitation including dyspnea, agitation, and asphyxia in the acute setting. He also commented extensively on the sign of jugular vein pulsation, first described by Lancisi, in the presence of mitral regurgitation.

Pigeaux mentioned that most valvular insufficiencies were well-tolerated clinically for a long-period of time at the exception of traumatic etiology. He indicated that some patients were alive 10 to 15 years after the initial diagnosis. He also discussed the treatment of this condition, although at his time, there was little to offer to relieve the suffering of these patients.

The entire Pigeaux's chapter on "Valvular insufficiency" is depicted here.

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Jean Baptiste Bouillaud Sulpice Antoine Fauvel