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Permanent pacemakers were implanted in 40 children aged one day to 17 years. A new technique, necessitating thoracotomy and lumbotomy, is described briefly. Indications were surgical block in 22 (55%) and congenital block in 18 (45%) patients. Five of 40 (12.5%) died. Reoperation was required 4 times: for electrode problems (3), and wound problem (one). No late infection or wire fractures were noted. The time paced ranged from 7 days to 37 months. All of these patients received lithium units.

We report on a wandering bullet embolus to the left pulmonary artery after it had first passed from the right ventricular to the right renal vein via the inferior vena cava. Its presence in the left pulmonary artery was confirmed by pulmonary angiography. Hemorrhage due to the right ventricular wound was controlled by a median sternotomy and the bullet was extracted by left lateral thoracotomy. Intravascular migratory bullets continue to be a surgical curiosity. Clinical diagnosis may present a difficult aspect in emergency practice and angiography is mandatory. The removal of foreign bodies is recommended by the majority of authors.

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