Nonsurgical treatment of membranous obstruction of the inferior vena cava by percutaneous inoue balloon angioplasty

findings have been summarized in a 1. Roti WC, Oluwde 0, Femicola DJ. Comparirecent American Journal of Cardi- son of active infective endocarditis involving a previously stenotic versus a previously nonstenotic aottic ology Symposium.4 valve. Am J Cardiol 1993;71:1082-1088. I hope this information is of use to investigators wishing to use intracoronary Doppler techniques to ex- The Coromwy Dimple plore coronary physiology in paI read with fascination the caseretients in the cardiac catheterization port by Shirani and Roberts1and the laboratory. Morton J. Kern, MD editorial comment by Angelini.2 The St. Louis, Missouri 1 June 1993 possibility also exists, and was not discussedby either protagonist, that the dimple has nothing to do with the coronary arteries! It would be 1. Kern MJ. A simplified method to measure compremature to discard the strong scinay blood flow velocity in patients: validation and entitic evidence of Bogers et al3 on application of a Judkins-style Doppler-tipped angiothe basis of such speculative repgraphic catheter. Am Heart J 199&12@1202-1212. 2. Doucette JW, Cod PD. Payne HM, Flynn AE, Goto resentations. M, Nassi M, Segal J. Validation of a Doppler guide hbWt H.hdWSOll,MD wire for intravascular measurement of comnaty artery

a “standard textbook of electrocardiography” it is a well-known standard book on cardiology. Finally, I did not know that as far back as 1973 Dr. Fletcher had explained this electrocardiographicabnormality. But knowing Ross well, his expertise does not surprise me. Many thanks. Agustin

castelm

MD

Miami, Florida 12July 1993

Nonsurgloal Treatmentof Membranous obstNotionof theInfetiorV8naCavaby -s hue mlfwarty

Ralloon

London,United Kingdom 7 July 1993

I read the report by Chan et al1 on the use of Ring’s bioptome and bal1. Shirsni J, Robeas WC. Coronary ostial dimple (in loon angioplasty for treatment of the posterior aortic sinus) io the absence of other comcomplete membranous obstruction nary arterial abnomulities. Am J Cardio[ 1993;72: 118-119. of the inferior vena cava. My col2. Angelii P. The case of a fascinating dimple (edileaguesin The People’s Republic of torial). Am J Cardiol 1993;72:102-103. 1. Bogers AJJC, Gitteobergerde Gmot AC, DubbelChina and I also had successfulexdam JA, Huysmans HA. The inadequacy of existing periences with nonoperative treattheories on development of the proximal coronary arterment of membranousobstruction of ies and their connexions with the arterial trunks. Int J Cardiol 1988;20: 117-123. the inferior vena cava by percutaneous balloon transluminal angioplasty. We reported our results in 9 Misplaoements involving the Inolti of Revlewer’s such patients in August 1992.* We comments-An hlteredng Gromd (Rl@t l.e@ Electrode used the straight Brockenbrough transseptal needle to puncture the ApprThe article entitled “Recognition membrane and the Inoue balloon I am stunned,but happy, at the in- of Electrocardiographic Electrode catheter for dilation. The Inoue balclusion of the reviewer’s comments Misplacements Involving the loon catheter has several advantages from the Journal of the American Ground (Right Leg) Electrode” by over other balloon cathetersin dilatCollege of Cardiology in your arti- Haisty et al (Am J Cardiol 1993;71: ing membranous obstruction of the cle entitled “Comparison of Active 149&1495) is interesting. The in- inferior vena cava.2 I agree with Infective Endocarditis Involving a vestigator, however, must have been Chan et al’ that percutaneous balPreviously Stenotic Versus a Previ- unaware of our publication on the loon angioplasty is an effective ously Nonstenotic Aortic Valve.“’ same subject entitled “Electrocar- means of treating membranous obEven though the commentswere not diographic Patterns Resulting from struction of the inferior vena cava negative, J Am Co11Cardiol decid- Improper Connections of the Right and is nonsurgical, bllltg 0. v MD ed not to publish. It will be of great Leg (Ground) Cable” by CastelWashington,DC. interest to your readers to publish lanos et al (PACE 1985;8:364-368). 22 July 1993 the reviews from The American A brief description of this error can Journal of Cardiology. Additionally, also be found in Figure 40 of chap- 1. Chan P, Lee C-P, Lee Y-H. Complete membranous why would an editor of a major car- ter 18: The resting electrocardio- obstruction of the inferior vena cava treated successby King’s bioptome and balloon angioplasty. Am diology journal want to publish in gram. In: Hurst JW, Schlant RC, Jfully Cardiol 199372241-243. another journal? Rackley CE, Sonnenblick EH, and 2. Yang X-L, Chen C-R, Cheng TO. Nonoperative 8tOVw1 N. II@%,MD Wagner NK. 7th ed. The Heart. Al- txatment of membranous obstmction of the inferior Washington,D.C. vena cava by percutan~us balloon tmnsluminal angio1 June 1993 though the latter does not qualify as plasty. Am Heart J 1992;124~4Oti12. flow velocity. Circulation 1992:85:1899-1911. 2). Ofili EO, Kern MJ, Labovitz AJ, St Vrain JA, Segal J, Aguirm F, Castello R. Analysis of coronary blood flow velocity dynamics in aogiogmphically normal and stewsed armies before and after endoltial enlargement by angioplasty. J Am CoN Cardi 199321: 308-316. 1. Kem MJ, Anderson HV, eds. A symposium: the clinical applications of the inhacomnary doppler guidewire. flow velocity in patients: understanding blood flow beyond the cornnary stenosis. Am J Cardial 1993;71:1D+36D.

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