Biomedical subjects
Publications and source records attributed to Adel Khayati.
Phrenic nerve injury is a recognized and severe complication after cardiac surgery. Diaphragmatic paralysis leads to difficulty of weaning the child from the ventilator surgical plication is an easy and safe procedure that result in early clinical and physiological improvements.
From 1994 and 2003, 46 patients underwent surgical myocardial revascularisation associated to valvular surgery. Surgical indications were for valvular disease in 13 cases (28%), for coronary disease in 16 cases (35%) and associated coronary and valvular disease in 17 cases (37%); Isolated conservative mitral repair was performed in 22 cases (48%); mitral valve replacement in 10 cases (41%), aortic valve replacement in 11 cases (46%) associated mitral and aortic surgery in 3 cases (13%). Intra-aortic balloon pump was used in 4 patients (9%). In the post operative period complete atrio-ventricular heart bloc occurred in 2 cases. For the entire group, 8 deaths (17%) occurred in the hospital, related to low cardiac output in 5 cases (63%). Long term follow up was achieved in a mean period of 18 months. 25 patients (68%) were asymptomatic and one late death occurred after severe heart failure. The predictive factors of hospital mortality were: preoperative ischemic mitral insufficiency. Various large series in the literature have documented operative risk of myocardial revascularisation when combined with valve surgery. In our group the high rate of hospital mortality (17%) explains the difficulties in medical and surgical care of this combined valvular and coronary disease especially in the perioperative period.
The aim of this study is to raise up the effect of surgical thrombectomy among other alternative therapies. This retrospective study reports 6 patients (mean age 63 years) admitted with phlegmasia cerulea dolens. All patients underwent surgical venous thrombectomy associated with infracava filter insertion in 2 cases. One patient died in the early postoperative course. In all other cases we noticed good early and late outcome both on clinical examination and duplex scanning assessment. In conclusion, surgical venous thrombectomy can be considered as a good and efficient procedure in the presence of phlegmasia cerulea dolens in order to relieve ischemia and to prevent whenever possible severe chronic venous disorders. However, fibrinolytic therapy might achieve as good results as surgery. Thus, the latter is to be reserved to very severe veinous ischemia with limb loss threatening where fibrinolytic therapy fails or is contre-indicated.
150 patients had mitral valve repair for mitral valve incompetence. There were 57 males and 93 females with a mean age of 22 years, 39% were less than 15 years of age. 60% of the patients were in Class II NYHA and 40% in Class III and IV. According to Carpentier's classification, isolated type I was present in 18 patients (12%), type II in 98 patients (64%) and type III in 34 cases (24%). Mitral repair included correction of valve prolapse, valvular enlargement with pericardial patch and annuloplasty with semi-rigid ring in 128 cases and PTFE patch along the posterior leaflet in 12 cases. The perioperative mortality rate was 2.6% (4 patients). All patients had early post-operative echocardiography. According to this, mitral regurgitation was absent or tiny in 135 patients (92%), grade II in 10 cases and grade III in 2 cases. It was moderate or important in twelve patients (8%). In the late post-operative period, three patients were lost to follow-up. All the others patients were reoperated upon for mitral dysfunction in a mean time of 37 months. The reason for reoperation was in the majority of the cases the recurrence of mitral regurgitation related to increase of valvular and sub valvular disease. The late mortality rate is 7% (10 patients). Out of 126 reviewed survivors on the long run, 71 patients (56%) are asymptomatic in class I, 53 patients (42%) in class II and 2 patients in class III NYHA. Mitral valvuloplasty is the preferred procedure in mitral insufficiency surgical management. It is associated to a low early mortality and morbidity rate. Despite the need for reoperation in about 10% of the cases in the long follow-up, mitral repair offers a good quality of life without anticoagulant treatment.
Carpentier techniques for valve repair remain our first choice to deal with mitral insufficiency. This case is of a 65 years old woman scheduled for mitral valvuloplasty. Using conventional procedure was prevented by unfavourable anatomic conditions (lack of papillary muscles with chordaes supported by several tiny trabeculations). As an alternative to valve replacement (required in these instances), we performed mitral valvuloplasty according to Alfieri technique. Postoperative outcome was uneventful. Ultrasonographic assessment at 2 months showed competent mitral valve with no residual stenosis. Unless its late results are well defined, this new technique shall be used only in particular cases.