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October 18, 1965


Author Affiliations

From the Cardiovascular Clinical Research Center, Hospital of the University of Pennsylvania; the Children's Hospital of Philadelphia; and the departments of medicine, pediatrics, radiology, and surgery, School of Medicine, University of Pennsylvania, Philadelphia. Dr. Helwig is now with the Cardiovascular Section, Germantown Dispensary and Hospital, Philadelphia.

JAMA. 1965;194(3):253-254. doi:10.1001/jama.1965.03090160031008

Pleurectomy was used to stimulate systemic-pulmonary anastomoses as a palliative treatment for patients with cyanotic congenital heart disease with pulmonary hypertension. To our knowledge, the successful application of this principle, suggested to us by Bernice Wedum, MD, has not heretofore been reported.

Patients with pulmonary hypertension associated with a right-to-left shunt within the heart have systemic hypoxia due to the combination of a decreased effective pulmonary blood flow secondary to the mechanical pulmonary-arteriolar block and the effects of the right-to-left shunt itself. As a result of pulmonary arteriolar obliterative changes, the pulmonary resistance is equal to or greater than the systemic resistance. In effect, multiple peripheral "pulmonary stenoses" exist.

In 1949, Barrett and Daley1 described pleurectomy as a method for increasing the pulmonary blood flow in patients with cyanotic congenital heart disease with a decreased pulmonary blood flow and low pulmonary-artery pressures. They demonstrated the development of large, effective