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This is interesting
Volume 79 Nrcmber 5
Fig. 1. Knotted in this patient.
platinum
electrode with Command catheter passed to knot illustrating
The wire was noted to have a figure-eight knot at the distal end when it was removed (Fig. 1). Knotting of flexible wires should be prevented by the use of portable fluoroscopy units at the time of wire passage and by immediate withdrawal of the wire if it should enter the right ventricle. If knotting of the wire does occur the technique described may be of benefit in removing the wire. Joseph F. X. McGamy, M.D.* 60 East
Court
St.
Doylestowlz, Pa. 18901 *Cardiac
Fellow
supported
by Grant
5445.
REFERENCES 1. Vogel, J. H. K., Tabari, K., Averill, K. H., and Blount, S. G., Jr.: A simple method for identi-
technique
for removal
fying P waves in complex arrhythmias, AMER. HEART J. 76:1X& 1964. Sivertssen, E.: Intracavitary electrocardiograms in the diagnosis of arrhythmias, Acta Med. &and. 18155, 1967. Symposium on cardiac pacing and cardioversion, Philadelphia, 1967, The Charles Press, p. 43. Boal, B. H., Keller, B. D., Ascheim, R. S., and Kaltman, A. J.: Complication of intracardiac electrical pacing-knotting together of temporary and permanent electrodes, New Eng. J. Med. 280:650, 1969. Pomfret, D., Polansky, B. J., and Huvos, A.: Dangerous complication of temporary floating pacing electrodes, New Eng. J. Med. 280:651, 1969.
This is interesting
As indicated previously, spontaneous naturally occurring phenomena unfold before us which answer important questions in biology or at least introduce thought-provoking concepts concerning biologic processes and medicine.1 As with the relationship of arterial pressure to coronary arteriosclerosis in aberrant coronary arteries,’ congenital corrected transposition of the great vessels of the heart displays a phenomenon which is interesting. For example, it is a fact that patients with corrected transposition of the ventricles can live a normal lie expectancy.* Thus, the right ventricle can carry
the pressure, volume work, and power loads usually carried by the left ventricle without any difficulty. The right ventricle does hypertrophy to a satisfactory extent, but it still maintains all the morphologic characteristics of a right ventricle. On the other hand, if a patient develops pulmonary hypertension with pressure levels no greater than that normal for the aorta,* the patient develops the manifestation of car pulmonale, usually develops serious difficulties, and even death oan follo&. Therefore, the pressure load on the rirrht ventricle cannot be the most important problem in car pul-
722
Annotations
monale. What is, then? The answer remains: unknown. It may be related to the pulmonary vascular disease, associated respiratory diseases or the abnormally high pressure in the pulmonary arterial system, and the associated factors involved iu the pulmonary hypertension, but it must not be dependent only on the work load of the right ventricle. The coronary circulation to a right ventricle carrying a high pressure load in car pulmonale and a right ventricle carrying a high pressure load in corrected transposition of the ventricles also need consideration. G. E. Burch. M.D. Department of Medicine Tulane Ckiversity School of Medicine 1430 Tulane Ave. New Orleans, La.
REFERENCES 1.
2.
Burch, G. E., and I)ePasquale, N. I’.: The anomalous left coronary artery: An experiment of nature, Amer. J. Med. 37:159, 1964. Lieberson, A. D., Schumacher, K. I<., Childresa, I<. H., and Genovese, P. D.: Corrected transposition of the great vessels in a 73-year-old man, Circulation 39:96, 1969.
Fig. 1. Knotted in this patient.
platinum
electrode with Command catheter passed to knot illustrating
The wire was noted to have a figure-eight knot at the distal end when it was removed (Fig. 1). Knotting of flexible wires should be prevented by the use of portable fluoroscopy units at the time of wire passage and by immediate withdrawal of the wire if it should enter the right ventricle. If knotting of the wire does occur the technique described may be of benefit in removing the wire. Joseph F. X. McGamy, M.D.* 60 East
Court
St.
Doylestowlz, Pa. 18901 *Cardiac
Fellow
supported
by Grant
5445.
REFERENCES 1. Vogel, J. H. K., Tabari, K., Averill, K. H., and Blount, S. G., Jr.: A simple method for identi-
technique
for removal
fying P waves in complex arrhythmias, AMER. HEART J. 76:1X& 1964. Sivertssen, E.: Intracavitary electrocardiograms in the diagnosis of arrhythmias, Acta Med. &and. 18155, 1967. Symposium on cardiac pacing and cardioversion, Philadelphia, 1967, The Charles Press, p. 43. Boal, B. H., Keller, B. D., Ascheim, R. S., and Kaltman, A. J.: Complication of intracardiac electrical pacing-knotting together of temporary and permanent electrodes, New Eng. J. Med. 280:650, 1969. Pomfret, D., Polansky, B. J., and Huvos, A.: Dangerous complication of temporary floating pacing electrodes, New Eng. J. Med. 280:651, 1969.
This is interesting
As indicated previously, spontaneous naturally occurring phenomena unfold before us which answer important questions in biology or at least introduce thought-provoking concepts concerning biologic processes and medicine.1 As with the relationship of arterial pressure to coronary arteriosclerosis in aberrant coronary arteries,’ congenital corrected transposition of the great vessels of the heart displays a phenomenon which is interesting. For example, it is a fact that patients with corrected transposition of the ventricles can live a normal lie expectancy.* Thus, the right ventricle can carry
the pressure, volume work, and power loads usually carried by the left ventricle without any difficulty. The right ventricle does hypertrophy to a satisfactory extent, but it still maintains all the morphologic characteristics of a right ventricle. On the other hand, if a patient develops pulmonary hypertension with pressure levels no greater than that normal for the aorta,* the patient develops the manifestation of car pulmonale, usually develops serious difficulties, and even death oan follo&. Therefore, the pressure load on the rirrht ventricle cannot be the most important problem in car pul-
722
Annotations
monale. What is, then? The answer remains: unknown. It may be related to the pulmonary vascular disease, associated respiratory diseases or the abnormally high pressure in the pulmonary arterial system, and the associated factors involved iu the pulmonary hypertension, but it must not be dependent only on the work load of the right ventricle. The coronary circulation to a right ventricle carrying a high pressure load in car pulmonale and a right ventricle carrying a high pressure load in corrected transposition of the ventricles also need consideration. G. E. Burch. M.D. Department of Medicine Tulane Ckiversity School of Medicine 1430 Tulane Ave. New Orleans, La.
REFERENCES 1.
2.
Burch, G. E., and I)ePasquale, N. I’.: The anomalous left coronary artery: An experiment of nature, Amer. J. Med. 37:159, 1964. Lieberson, A. D., Schumacher, K. I<., Childresa, I<. H., and Genovese, P. D.: Corrected transposition of the great vessels in a 73-year-old man, Circulation 39:96, 1969.