Erosion of Superior Vena Caval Stent into Trachea, An Unusual Cause of Hemoptysis

In a study to examine the basis of rate-related changes in the electrocardiographic P wave we found a multicentric rather than unifocal origin of the atrial depolarization wave in dogs. Three to five pacemakers, or origin points, were distributed over a 30- to 40-mm area compared to the 11-mm size of the sinus node. Two or three of the sites could excite simultaneously, or one specific site would dominate excitation. Each separate origin point dominated excitation within a specific range of heart rates, and on reaching either the upper or lower limits of this range, a new focus abruptly dominated and initiated the atrial wave front. We have obtained evidence to suggest that these findings may be explained by a widely distributed atrial pacemaker complex. The spatial distribution of this system exceeded the dimensions of the canine sinus node by a factor of three to four times. The pacemaker centers, although distributed, were consistently located at specific positions along the superior vena caval-right atrial junction. Also, each separate pacemaker site appeared functionally differentiated to generate a specific range of heart rates. We propose that in addition to the sinus node there are other specialized atrial pacemaker centers, and that this specialization, including the differentiated response and coordination, is conferred by focal receptor characteristics and their inputs.

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Fiberoptic Stylet Laryngoscope and Sitting Position for Tracheal Intubation in Acute Superior Vena Caval Syndrome

Anesthesia & Analgesia ◽

10.1213/00000539-198402000-00014 ◽

1984 ◽

Vol 63 (2) ◽

pp. 161???162 ◽

Cited By ~ 8

Author(s):

Harvey M. Shapiro ◽

Theodore J. Sanford ◽

Ann L. Schaldach

Keyword(s):

Tracheal Intubation ◽

Superior Vena ◽

Sitting Position ◽

Superior Vena Caval ◽

Superior Vena Caval Syndrome

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Superior Vena Caval Obstruction Presenting as Acute Laryngotracheobronchitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947408300620 ◽

1974 ◽

Vol 83 (6) ◽

pp. 829-832 ◽

Cited By ~ 1

Author(s):

Donald B. Hawkins ◽

Victor G. Mikity ◽

Charles R. Battaglia

Keyword(s):

Respiratory Distress ◽

Superior Vena ◽

Vena Cava ◽

Ventriculoatrial Shunt ◽

Superior Vena Caval ◽

Severe Respiratory Distress ◽

Airway Symptoms ◽

Flow Through ◽

Superior Vena Caval Obstruction ◽

Collateral Vessels

A two-year-old child was hospitalized with a diagnosis of laryngotracheo-bronchitis. His airway symptoms, however, were the presenting manifestations of superior vena caval thrombosis around a ventriculoatrial shunt. Subglottic edema obstructed his airway initially; this was relieved by tracheostomy. Later, progressive tracheobronchial compression from the dilated superior vena cava and its collateral vessels almost proved fatal. Removal of the shunt allowed blood to flow through the thrombus. This relieved the patient's severe respiratory distress within hours.

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