Summary:Myocardial perforations with a central venous catheter are m in adults (67 cases published since 1968). These accidents are fatal in more than two-thirds of the cases owing to confusion caused by misleading symptoms which suggest pulmonary embolism. The perforation is generally localized in the right atrium (29 cases), less frequently in the right ventricle (1 8 cases). The superior vena cava is rarely affected (3 cases). The site of the perforation was not found in the other published cases. Clinical symptoms are signs of tamponade with disorders of cardiac hythm. An enlargement of the cardiac shadow and an abnormal position of the catheter, buckled or openly intrapericardial, make the diagnosis radiologically.Echocardiography provides some information, but this is often too late for practical application. The diagnosis is made with right catheterization when it shows an equalization of the diastolic pressures. This allows the patient to be watched closely following the pericardial tap, after which a surgical approach may be indicated and perfonned. Prevention of these iatrogenic accidents must be systematic and strictly controlled for.
This study is a review of the main aspects of arterial pathology of the lower extremities. It appears that some coincidences can be correlated with abnormal ities of embryonic development. Many diseases of lower arteries, such as per sistent sciatic artery, trapped popliteal artery, Leriche Fontaine aneurysmal dystrophy and hypoplasia of the tibial vessels, can be explained by an embyrolo gic link. These possible mechanisms, rare in the upper arteries, can also be found in anomalies of the renovascular system. It seems necessary to take into account this problem, first to avoid associated lesions of the same type on the contraolateral limb and in order to obtain a better surgical correction.
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