578 The Annals of Thoracic Surgery Vol 21 No 6 June 1976
Prevention of Recurrent Empyema To the Editor:
Pulmonary Valve Ring Size To the Editor:
Dr. Kirsh’s excellent review ”Complications of Pulmonary Resection“ (Ann Thorac Surg 20:215, 1975) prompts me to correct the mistaken impression I may have given in discussions of empyema and bronchopleural fistula at the American Association for Thoracic Surgery meeting in 1971 and the 1973 Society of Thoracic Surgeons meeting (J Thorac CardiovascSurg 62:393, 1971, and Ann Thorac Surg 15:615, 1973). When I advocated reoperation on a wide-open postpneumonectomy fistula in preference to all compromise approaches such as muscle flaps, thoracoplasties, and extensive chest wall resections, it did not come out in my brief discussions that concomitant treatment by closed antibiotic instillation was employed. The 3 patients published then who had bronchial reamputation were meant only to show that any local treatment ”Clagett style” or by simple instillation is condemned to failure while the fistula is open, whereas bronchial closure does prevent recurrence of a chronic empyema.
I write to compliment the article by J. L. Mercer, “Acceptable Size of the Pulmonary Valve Ring in Congenital Cardiac Defects” (Ann Thorac Surg 20:567, 1975). I think Dr. Mercer has made a most useful contribution by tabulating these data. I was impressed by the similarity of his findings and the numerical guides with Hegar dilators that I have used for a number of years as a result of cumulative observations. For a long time, in operating upon patients with tetralogy of Fallot, I noted that if the valve ring would admit a No. 14 Hegar dilator in a small child or a No. 16 in one over 5 years of age, division of the valve ring was necessary in only 10 to 15% of patients, in sharp contrast to the 30 to 50% of patients needing ring division in reports from several groups with a large experience. Hence, my clinical experience has proved Dr. Mercer’s theoretical suggestions to be quite valid.
A . P . Naef, M . D .
Department of Surgery N e w York University School of Medicine 550 First Aue N e w York, NY 10016
Department of Surgery Hapita1 d‘Yverdon 1400 Yverdon, Switzerland
Frank Cole Spencer, M.D.
Prevention of Recurrent Empyema To the Editor:
Pulmonary Valve Ring Size To the Editor:
Dr. Kirsh’s excellent review ”Complications of Pulmonary Resection“ (Ann Thorac Surg 20:215, 1975) prompts me to correct the mistaken impression I may have given in discussions of empyema and bronchopleural fistula at the American Association for Thoracic Surgery meeting in 1971 and the 1973 Society of Thoracic Surgeons meeting (J Thorac CardiovascSurg 62:393, 1971, and Ann Thorac Surg 15:615, 1973). When I advocated reoperation on a wide-open postpneumonectomy fistula in preference to all compromise approaches such as muscle flaps, thoracoplasties, and extensive chest wall resections, it did not come out in my brief discussions that concomitant treatment by closed antibiotic instillation was employed. The 3 patients published then who had bronchial reamputation were meant only to show that any local treatment ”Clagett style” or by simple instillation is condemned to failure while the fistula is open, whereas bronchial closure does prevent recurrence of a chronic empyema.
I write to compliment the article by J. L. Mercer, “Acceptable Size of the Pulmonary Valve Ring in Congenital Cardiac Defects” (Ann Thorac Surg 20:567, 1975). I think Dr. Mercer has made a most useful contribution by tabulating these data. I was impressed by the similarity of his findings and the numerical guides with Hegar dilators that I have used for a number of years as a result of cumulative observations. For a long time, in operating upon patients with tetralogy of Fallot, I noted that if the valve ring would admit a No. 14 Hegar dilator in a small child or a No. 16 in one over 5 years of age, division of the valve ring was necessary in only 10 to 15% of patients, in sharp contrast to the 30 to 50% of patients needing ring division in reports from several groups with a large experience. Hence, my clinical experience has proved Dr. Mercer’s theoretical suggestions to be quite valid.
A . P . Naef, M . D .
Department of Surgery N e w York University School of Medicine 550 First Aue N e w York, NY 10016
Department of Surgery Hapita1 d‘Yverdon 1400 Yverdon, Switzerland
Frank Cole Spencer, M.D.
