Author + information
- Warren G. Guntheroth, MD, FACC⁎ ()
- ↵⁎University of Washington School of Medicine, Pediatrics (Cardiology), Box 356320, Seattle, Washington 98195-6320
The study by Costanzo et al. (1) confirmed an observation from my medical internship at The Peter Bent Brigham in 1952, but left an unanswered question. Doctor Samuel Levine had admitted a patient with severe edema of the feet and legs who was resistant to mercurial diuretics. (She had been sitting upright in a chair that increased the edema, but as Dr. Levine was fond of reminding us, edema causes fewer symptoms when it is in the legs than in the lungs.) He ordered Southey tubes, for me a novel concept. (The term is still in my medical dictionary: small tubes inserted after local anesthetics, facilitated by small nicks in the skin.) I was not surprised to see the ultrafiltrate drain, but the big surprise was a vigorous, general diuresis that followed with no other interventions. I did not understand the mechanism until I read the report by Costanzo et al. (1) stating that ultrafiltration by veno-venous catheters also produced prolonged benefits due to decreased neurohumeral activity, evidenced by a drop in B-type natriuretic peptide (BNP) levels without worsening renal function.
Costanzo et al. (1) point out the advantages of greater safety and shorter admissions with their treatment. Perhaps a resurrection of the use of Southey tubes would be even less costly and at least as safe, and would be affordable in third-world countries. It is gratifying to learn of this advance made possible by physiologic reasoning, instead of ever-more complicated and expensive technology.
A final comment: there appears to be a tautology in the title of the investigators’ study (1). Doesn’t decompensatedmean the same as heart failure? Why not just “diuretic-resistant heart failure”?
- American College of Cardiology Foundation