- Email: [email protected]
Topical Cooling of the Right Atrium
CORRESPONDENCE
Intraaortic Balloon Entrapment To the Editor: Reference is made to the article relating to intraaortic balloon entrapment by Milgalter and associates [l]. During the past 12 years we have also encountered several instances of balloon retention due to the formation of clot within the confines of the balloon. As an alternative to deliberate and secondary surgical intervention, we have opted to employ intraluminal streptokinase clot dissolution in conjunction with heparinized saline flushing as the sole mode of treatment. Success was enjoyed in every instance. Although the exciting mechanism was a minuscule balloon perforation, as cited, hematological assessment of the patients failed to demonstrate any systemic alterations whatsoever consequent to this regimen. In three instances, retention was at the aortoiliac level and not just at the femoral level. As such, this treatment was especially important in these patients because it avoided the need for retroperitoneal as well as groinal extractional surgery. Cary J . Lambert, M.D.
5310 Forest Lane, Suite 102 Dallas, T X 7524.4
Reference 1. Milgalter E, Mosseri M, Uretzky G, Romanoff H: Intraaortic balloon entrapment: a complication of balloon perforation. Ann Thorac Surg 42:697, 1986
known "toxicity." It is disturbing that the authors have not reviewed the literature thoroughly. In this instance, they did not acknowledge the pioneering work of Hellerstein and colleagues [2] in 1950, or our similar work that was reported in 1980 [3]. We have now proceeded to clinical evaluation of our thermode.
Victor Parsonnet, M . D . Newark Cardiovascular 6 Thoracic Surgery Group Department of Thoracic 6 Cardiovascular Surgery Newark Beth Israel Medical Center 201 Lyons Ave Newark, N ] 07112 References 1. Higashidate M, Takanashi Y, Fujiwara T, Imai Y: A new method to induce topical cooling of the right atrium for treatment of supraventricular tachyarrhythmia: an experimental study. Ann Thorac Surg 43:313, 1987 2. Hellerstein HK, Liebow IM: Factors influencing the T wave of the electrocardiogram. I. Effects of heating and cooling the endocardium and the epicardium. Am Heart J 39:35, 1950 3. Parsonnet V, Driller J, Hudson P, et al: An experimental method for thermal control of heart rate: work in progress. PACE 3:562, 1980
Reply To the Editor:
I want to thank Dr. Lambert for his interesting remarks. This mode of "conservative" treatment of balloon entrapment after perforation and intraluminal clot formation seems most appealing, especially in view of the fact that no systemic fibrinolytic effects could be detected and surgical intervention is not needed for balloon removal. To the best of my knowledge, this therapeutic option was not described previously. May I add one word of caution: as the inner side of the balloon is not sterile, infusion of streptokinase followed by heparinized saline flushing might cause intraarterial instillation of nonsterile contents through the perforation in the balloon.
We thank Dr. Parsonnet for his comments on our article. We recognize his and his colleagues' pioneering efforts in the field of thermal control of heart rate 111. By a n involuntary mistake, we did not include any mention of the article he refers to. In this article, experimental results showed that the sinus rate can be controlled within a clinically useful range using topical cooling probes (thermodes). The fact that the heart rate decreases as the temperature declines has been confirmed [Z,31. We showed experimentally that both atrial dysrhythmia induced by aconitine and sinus tachycardia induced by isoproterenol hydrochloride were suppressed by our extractable device of topical cooling of the right atrium. The purpose of our article was to stress that our device of topical cooling of the right atrium was effective in suppressing the atrial dysrhythmia as well as sinus tachycardia.
Eli Milgalter, M.D.
Masafumi Higashidate, M.D.
Cardiothoracic Surgery Department Hadassnh University Hospital p.0.b. 12 000 il-91 120 Jerusalem, Israel
Department of Pediatric Cardiovascular Surgery The Heart Institute of japan Tokyo Women's Medical College 8-1 Kawada-cho, Shinjuku-ku Tokyo, 162 Japan
Reply To the Editor:
References
Topical Cooling of the Right Atrium To the Editor: In a recent issue of The Annals, Higashidate and associates [ l ] described a system of topical cooling of the right atrium for the prevention of supraventricular arrhythmias. Topical cooling may prove to be an ideal nonpharmacological method of controlling supraventricular arrhythmias because there is no
446 Ann Thorac Surg 4 4 4 6 , Oct 1987
Parsonnet V, Driller J, Hudson P, et al: An experimental method for thermal control of heart rate: work in progress. PACE 3:562, 1980 Popovic V, Popovic P: Hypothermia in biology and in medicine. New York, Grune & Stratton, 1974 Marshall JM: Effects of low temperatures on transmembrane potentials of single fibers of the rabbit atrium. Circ Res 5:664, 1957
Intraaortic Balloon Entrapment To the Editor: Reference is made to the article relating to intraaortic balloon entrapment by Milgalter and associates [l]. During the past 12 years we have also encountered several instances of balloon retention due to the formation of clot within the confines of the balloon. As an alternative to deliberate and secondary surgical intervention, we have opted to employ intraluminal streptokinase clot dissolution in conjunction with heparinized saline flushing as the sole mode of treatment. Success was enjoyed in every instance. Although the exciting mechanism was a minuscule balloon perforation, as cited, hematological assessment of the patients failed to demonstrate any systemic alterations whatsoever consequent to this regimen. In three instances, retention was at the aortoiliac level and not just at the femoral level. As such, this treatment was especially important in these patients because it avoided the need for retroperitoneal as well as groinal extractional surgery. Cary J . Lambert, M.D.
5310 Forest Lane, Suite 102 Dallas, T X 7524.4
Reference 1. Milgalter E, Mosseri M, Uretzky G, Romanoff H: Intraaortic balloon entrapment: a complication of balloon perforation. Ann Thorac Surg 42:697, 1986
known "toxicity." It is disturbing that the authors have not reviewed the literature thoroughly. In this instance, they did not acknowledge the pioneering work of Hellerstein and colleagues [2] in 1950, or our similar work that was reported in 1980 [3]. We have now proceeded to clinical evaluation of our thermode.
Victor Parsonnet, M . D . Newark Cardiovascular 6 Thoracic Surgery Group Department of Thoracic 6 Cardiovascular Surgery Newark Beth Israel Medical Center 201 Lyons Ave Newark, N ] 07112 References 1. Higashidate M, Takanashi Y, Fujiwara T, Imai Y: A new method to induce topical cooling of the right atrium for treatment of supraventricular tachyarrhythmia: an experimental study. Ann Thorac Surg 43:313, 1987 2. Hellerstein HK, Liebow IM: Factors influencing the T wave of the electrocardiogram. I. Effects of heating and cooling the endocardium and the epicardium. Am Heart J 39:35, 1950 3. Parsonnet V, Driller J, Hudson P, et al: An experimental method for thermal control of heart rate: work in progress. PACE 3:562, 1980
Reply To the Editor:
I want to thank Dr. Lambert for his interesting remarks. This mode of "conservative" treatment of balloon entrapment after perforation and intraluminal clot formation seems most appealing, especially in view of the fact that no systemic fibrinolytic effects could be detected and surgical intervention is not needed for balloon removal. To the best of my knowledge, this therapeutic option was not described previously. May I add one word of caution: as the inner side of the balloon is not sterile, infusion of streptokinase followed by heparinized saline flushing might cause intraarterial instillation of nonsterile contents through the perforation in the balloon.
We thank Dr. Parsonnet for his comments on our article. We recognize his and his colleagues' pioneering efforts in the field of thermal control of heart rate 111. By a n involuntary mistake, we did not include any mention of the article he refers to. In this article, experimental results showed that the sinus rate can be controlled within a clinically useful range using topical cooling probes (thermodes). The fact that the heart rate decreases as the temperature declines has been confirmed [Z,31. We showed experimentally that both atrial dysrhythmia induced by aconitine and sinus tachycardia induced by isoproterenol hydrochloride were suppressed by our extractable device of topical cooling of the right atrium. The purpose of our article was to stress that our device of topical cooling of the right atrium was effective in suppressing the atrial dysrhythmia as well as sinus tachycardia.
Eli Milgalter, M.D.
Masafumi Higashidate, M.D.
Cardiothoracic Surgery Department Hadassnh University Hospital p.0.b. 12 000 il-91 120 Jerusalem, Israel
Department of Pediatric Cardiovascular Surgery The Heart Institute of japan Tokyo Women's Medical College 8-1 Kawada-cho, Shinjuku-ku Tokyo, 162 Japan
Reply To the Editor:
References
Topical Cooling of the Right Atrium To the Editor: In a recent issue of The Annals, Higashidate and associates [ l ] described a system of topical cooling of the right atrium for the prevention of supraventricular arrhythmias. Topical cooling may prove to be an ideal nonpharmacological method of controlling supraventricular arrhythmias because there is no
446 Ann Thorac Surg 4 4 4 6 , Oct 1987
Parsonnet V, Driller J, Hudson P, et al: An experimental method for thermal control of heart rate: work in progress. PACE 3:562, 1980 Popovic V, Popovic P: Hypothermia in biology and in medicine. New York, Grune & Stratton, 1974 Marshall JM: Effects of low temperatures on transmembrane potentials of single fibers of the rabbit atrium. Circ Res 5:664, 1957