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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Markus K. Heinemann Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Heinemann, M. K. Search for Related Content PubMed Articles by Heinemann, M. K. Related Collections Congenital - acyanotic Related Article

Ann Thorac Surg 2001;72:438-439
© 2001 The Society of Thoracic Surgeons

Invited commentary

^a Professor of Pediatric Cardiac Surgery, Mainz University Hospital, Langenbeckstr 1, #505, 55131 Mainz, Germany

e-mail: heinemann{at}uni-mainz.de

This retrospective analysis is highly provocative. The paper takes us back to the old days before computed tomography and magnetic resonance imaging. Emphasizing the value of a plain barium swallow for diagnosing the anatomy of vascular compression malformations, the authors remind us that sometimes very little can be gained from these new techniques, if one has competently explored more basic diagnostic procedures beforehand. The point of reconsidering the basics before embarking on a technological overkill with a sick baby definitely has its merits. The diagnosticians, however, have to be sufficiently familiar with these old techniques, which, in our times, can by no means be taken for guaranteed.

Legal reasons seem to force us to perform more and more investigations to rule out even very unlikely constellations. The risks of these must be weighed against potential and often only theoretical benefits. As the authors point out correctly, "definitive intraoperative delineation of anatomy" remains the gold standard, and therefore the surgeon will always remain the ultimate diagnostician. Echocardiography, on the other hand, is even less invasive than a barium swallow and should, from the pediatric cardiac surgeon’s point of view, be performed in all patients with aortic arch anomalies, because the therapeutic approach may change radically in the presence of associated intracardiac anomalies. As Robert Frost observed in his poem The Secret Sits: "We dance round in a ring and suppose, but the secret sits in the middle and knows." (in: A Witness Tree, Henry Holt, New York, 1942) This is particularly true for the entity of vascular rings, slings, and things.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Markus K. Heinemann Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Heinemann, M. K. Search for Related Content PubMed Articles by Heinemann, M. K. Related Collections Congenital - acyanotic Related Article