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Pulmonary embolism is one of the common complications of aortocoronary artery graft surgery. During one year period, 22 patients had documented evidence of pulmonary embolism out of 231 patients who were operated. There were four deaths and all confirmed by autopsy. Clinical signs of phlebitis were absent in many cases of pulmonary embolism. Elastic stockings were not effective to prevent phlebitis. Heparin did not prevent deaths in all four patients. Heparin therapy and aggressive caval interruption by Modin-Uddin umbrella has eliminated deaths in the last 450 cases.

A patient with type I dissection of the thoracic aorta inadvertently had a Swan-Ganz catheter sutured to the right atrium during surgical repair of the dissection. A method for its removal using percutaneous passage of a No. 15 scalpel blade is described. The hazards of Swan-Ganz catheters are explored, and the changing roles of nonsurgical interventional procedures are discussed.

DUODENAL obstruction produced by a preduodenal portal vein is rarely seen in clinical medicine. We have encountered reports or references in the literature of the occurrence of a portal vein passing anterior to the duodenum in nine patients. 2' 5,6,8,10,11 This vein apparently produced duodenal obstruction in two of these patients. We recently encountered a patient in whom duodenal obstruction of this etiology produced severe symptoms. In addition, the presence of pneumatosis cystoides intestinalis was recognized by x-ray examination preoperatively; it disappeared after surgical relief of the duodenal obstruction. Case ReportA ten-year-old girl was hospitalized in May, 1959, because of repeated episodes of abdominal pain and vomiting, increasing in severity and frequency during the previous year. Abdominal distention became persistent and increased in severity.This patient was first seen in our institution in 1951 when, at the age of 28 months, studies showed the presence of a complicated congen-tal heart lesion. In 1955, cardiac catheterization studies showed an interventricular septal defect with pulmonary hypertension and right to left shunting at the ventricular level.Examination of the patient at the time of current admission showed marked growth retardation and recent weight loss. She was pale and weak and weighed 46 pounds. The abdomen was severely distended. Additional findings on physical examination included auricular fibrillation, clubbed nails, and umbilical and left inguinal hemiae. Roentgenographic studies showed tremendous dilatation of the stomach and first portion of the duodenum (Fig. 1). Pneumatosis cystoides intestinalis was present in the distal small intestine which was located in the right upper quadrant of the abdomen.