Henry H. Gale

Pulmonary Angiography and Pulmonary Embolism

In the past twenty-four months we have engaged in a program to encourage the performance of pulmonary angiography in suspected cases of life-threatening pulmonary embolism. Pulmonary embolectomy is performed with or without the aid of the heart lung bypass (1), following clipping (2) or ligation of the inferior vena cava in patients with occlusion of more than 60 per cent of the pulmonary arterial bed. Anticoagulant therapy, with or without inferior vena cava interruption, is administered to patients with lesser obstruction. If pulmonary embolism is excluded, appropriate studies are performed to establish the proper diagnosis, and indicated therapy is instituted. Treatment which may have been directed toward embolism is discontinued. The following cases illustrate the advantages of pulmonary angiography. Case I: A 50-year-old woman in critical condition with the diagnosis of pulmonary embolism was transferred from an outside hospital. Four weeks previously resection of a small bowel hemangioma had been pe...

Transcardiac Membranotomy for Obstruction of the Hepatic Portion of the Inferior Vena Cava

W E HIAVE OBSERVED two women with edema of the lower extremities and lhepatomegaly who received dramatic relief of their symptoms as a restult of surgical procedures. Although the pathological derangement appeared to be different in the two cases, the operative approach to the hepatic portion of the vena cava was the same in 1oth, and involved digital exploration with the finger inserted throuigh an opening in the lov right atrium.

Angiographie Study of the Left Atrium in Mitral Stenosis1

Systemic embolization of left atrial thrombi is a dread complication of mitral stenosis which is particularly likely to occur during and immediately following surgery on the mitral valve. The threat of embolization is confined to patients with atrial fibrillation. Taber and Lam (4) reported from this institution (The Henry Ford Hospital, Detroit) operative or postoperative embolization in only 2 patients of a group of 226 with normal sinus rhythm, compared to 29 operative or postoperative embolizations in 200 patients with atrial fibrillation. In 41 of the 200 patients preoperative embolization was present, and in 11 of these, emboli were noted in the operative or immediate postoperative period. The presence of an atrial thrombus is a contraindication for closed mitral commissurotomy, and unless all patients with fibrillation are to be operated upon by open heart technics the preoperative determination of the presence or absence of thrombi assumes importance. The angiographic demonstration of left atrial ...

Pulmonary angiograms in the management of pulmonary embolism

Abstract Pulmonary angiograms are carried out in all patients suspected of having pulmonary embolism. The decision for treatment is based on (1) the condition of the patient, (2) the pulmonary arterial pressure, and (3) the amount of pulmonary arterial obstruction as shown by angiograms. If the patient has normal vital signs without dyspnea and cyanosis, no elevation of pulmonary arterial pressure, and only a small portion of the pulmonary vascular bed occluded, caval interruption only is indicated. If the vital signs are altered, the pulmonary arterial pressure is elevated, and there is more than 60 per cent occlusion of the pulmonary arterial tree, immediate embolectomy with cardiopulmonary bypass is indicated.