CHEST

ii

VOLUME

I NUMBER

71

3 I

MARCH,

involved,

EDITORIALS

1977 drainage

a significantly

Drainage

Pulmonary and Mitral Stenosis

A Possible

Explanafion

Partial

Hemodynamic

T

wo

but

have

anomalous

or acquired

draining

lung

reflects

reflected

right

age was from the normal pulmonary to the In the two cases

pressure, right veins

lung

atrial Galley there

those

pressure.

the

lung.

twice that in all three

the

gradient

sure

and

nary

arterial

They

pullback rior vena

pressure

is via atrium

veins

the

lung. add

atrial one

information a gradient

or superior

hemodyriamic drainage from in size

vena

mean

for

additional

of

from the left pulmonary cava. This, we believe,

normal

pulmo-

heretofore

and

cava.

intrapulmonary

resistance

sides.

It seems

the

venous

and the

with exercise. opportunity

conduit

such

determinations

*Department

of

Critical

T

of

and

equal

also

on

the

intrapulwith

needs it will

exerto be be nec-

from

the

left

both at rest and diameter

be

publish Frank

obtained

and of

at

their

rest

results.

Dammann,

Martha

Pediatrics,

Jr., M.D.#{176}

A. Carpenter,

University

of

on in several

When lung, it

M.D.#{176}

of

Va

Virginia.

Cardiac

right is 311

on the

was

of the

dial

infarction

salient

which

general patient

agreement after

is feasible

held

in

December

features

an and

by

the

International

was

and

Evaluation

sponsored of the

November

tion

“Critical

Rehabilitation,” Rehabilitation

Cardiology,

Of

clinician. There

meeting

Cardiac

Council Israel,

lung

equal

pulthe

We hope the next team that has to study such a patient will make

he scientific

sized

left

should

right Thus,

that

in pressure

the pres-

Rehabilitation

veins to the supeis the key to the

the

was

remain

drop

Evaluation

ciety

the

atrial

to the mean 19 mm Hg. to us

drop to

Charlottesville,

the

Hg

vein right

at rest

and

avail-

10 mm

into

close of

the

the

LeGalley

et al, if the

to the

should

to measure

across

pulmonary

reasonable

resistance

on

length When

is very pressure

to that

drop in pressure along conduit of the left lung

is added

sure, the result monary wedge

right

resistance output

in pressure

left

I.

item

not

patterns. the right

the

cava

follows the

Unfortunately,

pulmonary veins to the right atrium with exercise. Data about length

pres-

mean

drop

by LeGalley

from

vena

essary

lung

arterial and

Hg

Le-

left

which

entering

cise; however, this is a point which determined. To prove our hypothesis,

was carried out, rise in resistance

lung

draining left and associates

two

of

of the

the increase.

left

patient

vein

before

not measure the of this drainage

10 mm

monary

a ver-

reflecting

pulmonary

right

right

measured

also

two

drain-

joining

lung

resistance

and

difference in the there is anomalous

In

left atrial pressure

left innominate pressures ap-

exercise parallel

mean

for the

hemodynamic

pressure.

of the right lung throughout. patients was calculated using

between wedge

anomalously LeGalley able.

right in

The

abnor-

abnormal

veins

Furthermore

left

remained Resistance

of

the

et al, when graded was a significant and

across

exercise,

should

superior

one,

et al appearing in this drainage was from

pulmonary

from

the

atrial

which, in turn, joined the pulmonary arterial wedge

proximated

In

or superior vena cava. reported in the literature,

left

Left

with

vessel

of

through one or more in size and length)

( normal

the

tical vein

partial

associated

from

the

by LeGalley 400 ), abnormal

vein.

is stenosis.

right

right atrium previously

via

a

the elevated where wedge

and in the report issue ( see page lung

return

pressure

it approximates In every instance

atrial

occurs

during exercise. In the case reported

pat-

when

mitral

wedge

the other, pressure.

directly

hemodvnamic

a single

course

This vessel offers a significant flow. With the increase in cardiac

et al did the length

venous

arterial

left

Inferesfing

documented

pulmonary

pulmonary

Some

distinct,

been

congenital

mally

for

atrium. blood

Findings

different,

terns

with

Venous

Anomalous

is via

longer

1975,

of importance that

early

uncomplicated safe

and

SoTel

Aviv, emphato

the

mohilizamyocar-

that

there

is

no evidence myocardial early

of increased complications infarction associated with

ambulation

of

patients.

The

physical

activity

but

these

appropriately

low-level goals.

identified They

programs as having

are

designed

which

commonly

myocardial

occur

infarction.

in the

in the

hospital

sible

and

additional

tioii

of

an

earlier

benefits

( ie,

complications

gina,

early

vised

early

of

myocardial

return

acute

are

involve

the

favor-

dysrhythmias,

allowing

Pos-

earlier

deteceffort

)

during

ansuper-

appropriate

the of

in the

with

of

exercise

coronary

not coronary

work

and

and

decrease

on

lateral which

and

physical

factor

coronary

cardiac creased

function collateral

)

( ie,

of

the

heart

rate

to

any

given

workload.

the

symptoms

trocardiographic both appear.

318

the

heart

to perform the critical

)

no of

be

of

life

the

implement ideal

the

the re-

style.

The

for

post-

programs

rehabilitation education

actual

program

the plan involves

to rapid

include of the

trainpatient

and psychosocial and vocational initiation and coordination efforts are the responsibility

counthese of the

of

he may utilize personnel to

rehabilitative

processes.

of rehabilitation

The

is incorporated

into

of care during the initial hospitalization, the patient’s family and social environment

and

system, physician

continues in community

or

in the office facilities

of or

for

oxygen

of angina

pectoris

of the Council

on Rehabilitation

of the International

the

col-

ob-

cardiovascular in

due to related

an into the

not are blood This and

or the

O

nce

is the least

we

the

are

part

The

work

enables

the

standards pills

before at which

moral

elecor

et al,4 and

has

been of

and

from

for

in the

for

indispensability

uncontrolled

apfor

objective

as-

controlled generated by acceptable

of Barry

et al,3

Guinn,5

whose

and

increasing

of by and

getting

no

acceptability

ethical

a burgeoning

elsewhere.6

need

Years

application

results

of Mathur

ical trials of all treatments, ical.7 Indeed, even some results

finally

in the

summarized

mystique”7

is evident

future.

into

campaign

are

be for

Cushmgl

is being channelled what it accomplishes

notably

of Takaro

the

met by well-designed naked numerators

studies

denominators,

into wholesale

determined

uncontrolled

“surgical

Trials

of the work.

plunge

industry,

sessment2 is being clinical trials. Thus,

re-

backing

headlong

bypass

whom.

the

ischemia particularly

part

again

after

reduces

ST-T

Clinical

like to see the day when somebody would surgeon somewhere who had no hands,

coronary

pressure

activity product

of Confrofled

the procedure finally propriate studies of to

native

Triumph

Surgery

Harvey

socio-

alter

Bypass

the operative

improvement

changes of myocardial Other peripheral effects,

EDITORIALS

M.D.#{176}

of Cardiology; Professor of Medicine ( Cardiology), University School of Medicine; and Director, Cardiac Grady Memorial Hospital.

Aortocoronary

emo-

circulation

the

more physical rate-pressure

Member

I would appointed

data at present an angiographi-

The

and

K. Wenger,

Atlanta

Emerging

decreased

of the

are primarily circulation but

sponse

on

near-normal,

patient’s primary physician, although the services of a variety of health-care

factors;

an improved

collateral

disease. training

risk and

progression

muting

patient reaching

family, The rehabilitative

often

as increased

( exercise

coronary

of physical

physical

in physical for physical

coronary such

There are development than

effects

demand

or

components

Society Emory Clinics,

to generate the indirect beneficial

at times

activity

other

structive

to

or retarding ( because this

self-confidence

demonstrable

any

a normal,

and

a

disease),

performance;

in other

and

circulation2 relate the

cally

approach for its

status.

Does

arresting process

effects,

frustration;

economic

appear

approach is his

Nanette

patient

of

include an increase of the capacity

psychologic stability

fear

the rehabilitative infarctional patient

myocardial infarctional ing for physical activity,

cardiac

or the

coronary

cardiocirculatory

an associated tional

also

of

sudden

prescription

for its effect atherosclerotic

of

beneficial

of

the

These effects an enhancement

fitness;

and

evidence

area demands a research needed information ), but effects.

oxygen,

secondary

prevention

patient

warrant

activity

the

( ie,

infarction

clinical

data

in

disease

postinfarctional

other

current the

role

myocardial

death

of

both.

Regarding recurrent

to

of

as a support the private

therapy

to be instituted. prevention

The goal postmyocardial

seling.

for early a decrease of the stay to work.

extraction

important.

important

with

there

increased

turn

effects assoduring bed and depres-

programs including the cost,

dysfunction

ambulation,

limited,

patient

Furthermore,

able economic implications mobilization of such patients, in the duration, and therefore

of

to decrease

the deleterious or “deconditioning” ciated with prolonged immobilization rest, and they decrease both the anxiety sion

acute for

selected

in-hospital

were

important,

of programs

longer

That

the

permit

operations

lower than

realization8

for

of the

of controlled

din-

surgical as well as medwho persist in presenting series

have

been

CHEST, 71: 3, MARCH,

made 1977