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Letters to the editor

Towards a regional network of respiratory medicine

Dear Sir,

Modern medicine is at a stage when very little can be achieved if working in isolation. This is true for individual departments, but it is also true for individual physicians who still wish to practice in isolation. David M. Eddy, a physician, mathematician, and healthcare analyst, who has done seminal work in mathematical modeling of diseases, clinical practice guidelines, and was the first to publish the term "evidence based"(1) summarized very nicely the current state of affairs: "the complexity of modern medicine exceeds the capacity of the unaided expert mind".

Pulmonary arterial hypertension in cavo-pulmonary shunts

Dear Editor,

The bidirectional Gleen shunting (an anastomosis between the superior vena cava and the right pulmonary artery) and the Fontan procedure (an operation that results in the flow of systemic venous blood to the lungs without passing through a ventricle) are done to treat several complex cyanotic congenital heart abnormalities such as tricuspid atresia, pulmonary atresia with intact ventricular septum, hypoplastic left heart syndrome, and double-inlet ventricle. Pathophysiology of the Fontan circulation leads to an obligatory systemic venous hypertension in which the superior and inferior vena cava and the mean pulmonary artery pressure are equal and generally in the range of 10 to 20 mmHg, 2 to 4 times that of normal.