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Archive for February, 2016

Answer  : I guess all mechanisms  contribute.Though E appears unlikely,  its backed by evidence (Ref 5)

Balloon pericardiotomy is done as a drainage procedure in recurrent pericardial effusion. It is actually a replication of surgical pericardial window by Interventional cardiologist.The window not only drains the effusion , it also act as a continuous drain. Though the  benefits are real (Pericardial fluid is shunted away from the pericardial space)  the exact mechanism of its benefit is not clear .

By concept , the catheter and  balloon should not cross the pleural space , (As pneumothorax may ensue) but still pleural effusion is a common consequence of this procedure .How is this possible ? One probable explanation is, the pleural space has some hidden communication with pericardial space .The other possibility is that, balloon creates virtual tissue channels  in the para-cardiac spaces of mediastinum .The extra-cardiac lymphatics does the drainage job without true shunting  pericardial space into the pleural space..

There is an article  from Annals of thoracic surgery which specifically   looked  into the  mechanism of benefit of  surgical pericardial window and came to a surprise conclusion, ie, it is not the continuous  drainage that keeps the space dry , rather it is likely the window  somehow obliterates the pericardial space permanently.(Sugimoto 1990,Annals of thoracic surgery )

Future  Innovation  : A technical add-on to  balloon pericarditomy  could be , delivering a covered stent across the pericardial space  into  peritoneal space like a VP shunt done by  Neurosurgeons.(If no body has done this , Can I claim the patency  for this  !)

The procedure

 

percutaneous balloon pericarditomy

Image used from Daniel A. Jones & Ajay K. Jain, Journal of thoracic Oncology , 2011

Risk of procedure

The procedure carries a definite risk especially  if done in an  emergency fashion. The aim of  procedure is two fold one to drain pericardial effusion second to prevent recurrence of effusion  .Since procedure carries  considerable risk  its to be performed  only in malignant effusion that are documented to be recurrent.

Surgical vs Balloon window  and other alternatives

Surgical window  creation is well known procedure , ever since Palacios (Ref 1) in 1991 described this per cutaneous approach as an alternative to surgery has become less popular. The risk of anesthesia and co-morbidity makes balloon pericardiotomy attractive. But surgical window creation still may have a role. A video  assisted pericardiotomy by thoracoscopy is also possible .Another option is injecting sclerosing agents into pericardial space .This time tested simple modality probably requires  more attention.

Need for subsequent pleural tapping

It should be realised this procedure may just  shift the  fluid from pericardium to pleural space. Some of them become significant effusion that requires pleural space drainage.

Concern of risk of dissemination of malignancy

Its a real issue , there has been instances of accelerated death after the procedure. Hence this procedure is a trade-of  between patient comfort and quality of life with a  potential risk of dissemination impacting  the longevity of life .

1.Palacios IF, Tuzcu EM, Ziskind AA, Younger J, Block PC. Percoutaneous balloon pericardial window for patients with malignant pericardial effusion and tamponade. Cathet Cardiovasc Diagn 1991: 22;244-249.

5.

 

 

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The field of cardiology has seen great men over the centuries. Few women have permanently stamped their presence  in that history .Jane Somerville can be termed mother of pediatric cardiology along with Maude Abbott She has a fascinating life history , having  worked  in Royal Brompton  , Imperial  and Guys London.She was mentored  by  pioneers like  Paul wood , Blalock and others .She is primarily interested in the pediatric cardiology especially congenital heart surgeries .The classification  of pulmonary atresia with VSD  goes with her name.

jane somerville

Dr. Jane Somerville : British cardiologist , (b-1933 )

She carries the credit  of  starting  the Pediatric cardiology world congress in 1990 ,is the founder of GUCH (Grown up children with congenital heart disease.) .

Here is a rare  interview  from he  to Dr Robert Califf  for Heart.org. For  those,who like to  have a glimpse of  cardiology in its vintage  times , don’t miss it.Dr Jane addresses the past treasures , explores specific issues of facing pediatric cardiology  and frank expression about the issues of women being a cardiologist  in a man’s world.

 

She has a foundation in her name that helps the children and adults with congenital heart disease.

somerville foundation

Reference

The landmark paper in BHJ 1970

pulmonary atresia

 

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Men are from Mars , and Women are from Venus ” . . . Do you agree ?

Many probably witness the much talked differential behavior among the gender every day. Its argued , men take more risk in life ( often senseless !) , some go to the extreme to suggest Men are Idiots and decorate them with a provocative title MIT (Men Idiot Theory ) (Mcpherson 2011).Risk taking is important in life, but at what cost ? Does women (Who are caring by nature ) help themselves and the society by less risk taking behavior ?

I stumbled upon this rare piece of writing from BMJ which would demand in depth analysis into this gender phenomenon based on evolutionary biology and genetics.

This article concludes, Yes, men . . . indeed tend to take some foolish risks in various life situations that result in potential harm.

Gender difference in medical outcome men are from mars women venus male idiotic theory darwin theory

What is the influence of MIT on medical profession and patient outcome ?

Now , Iam compelled to ask a hypothetical question .Does women medical professionals take less aggressive stance and low risk taking behavior ?

If it’s true, It may have some striking advantage too.

Reference

1.Harris CR, Jenkins M, Glaser D. Gender differences in risk assessment: why do women take fewer risks than men? Judgm Decis Mak2006;1(1): p. 48-63.

2.Eckel CC, Grossman PJ. Men, women and risk aversion: experimental evidence. In: Plott CR, Smith VL, eds. Handbook of experimental economics results. Vol 1. North-Holland, 2008:1061-73.

3.McPherson J. Women are from Venus, men are idiots. Andrews McMeel, 2011

4.Northcutt W. The Darwin Awards: The official Darwin Awards: 180 bizarre true stories of how dumb humans have met their maker. Orion, 2004.

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