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C Planché

Publications and source records attributed to C Planché.

At least 19 recordsLinked to original sources
PubMed2005

[Surgical repair of atrial septal defect in 1011 consecutive patients].

The immediate postoperative complications of 1011 consecutive patients undergoing surgical repair of atrial septal defects between 1980 and 1998 at Marie Lannelongue Hospital were analysedwith the ultimate objective of comparing their incidence with that of percutaneous closure. Five patients died (0.49%) of low cardiac output (N=3), pulmonary oedema (N=1) or pulmonary hypertension (N=1). A total of 356 patients (35.2%) had 448 postoperative complications. There were 77% minor and 23% major complications. The minor complications included arrhythmias and conduction defects (N=130), respiratory complications (N=90) and pericardial effusions (N=64). The main major complications were cardiac failure (N=27), cardiac tamponade (N=13), neurological complications (N=8) and reoperation (N=28). Of the survivors, 95.6% of patients were discharged from hospital with no residual problem and 41 (4.4%) had sequellae: arrhythmias (N=29, including one pacemaker implantation), neurological complications (N=4), acquired mitral regurgitation (N=2), phrenic nerve paralysis (N=1) and minimal residual shunt (N=10). Factors correlated with surgical morbidity were age, the severity of pulmonary hypertension, the type of atrial septal defect (less morbidity with ostium secundum defects), the presence of associated malformations, the surgical approach (less morbidity with the right postero-lateral thoracic approach). This study demonstrated the incompressible risk of open heart cardiac surgery. It will form a basis for a comparative study of the two modern methods of treating atrial septal defect: surgical and percutaneous closure.

Adolescent↗
PubMed2004

Additional pulmonary blood flow has no adverse effect on outcome after TCPC.

BACKGROUND: Use of additional sources of pulmonary blood flow (APBF) with bidirectional cavopulmonary anastomosis (BDG) and total cavopulmonary connection (TCPC) remains controversial. We have therefore assessed the effects of APBF on BDG and TCPC outcome. METHODS: From 1996 to 2000, 106 patients underwent BDG, either isolated (group 1, n = 54), or with APBF via pulmonary artery (PA) (group 2, n = 30), or Blalock-Taussig shunt (BTS) (group 3, n = 22) with 28 patients completed by TCPC. RESULTS: After BDG low output syndrome was more frequent in group 2 and less in 3 ( p = 0.01), whereas superior cava syndrome was again more common in group 2 and less in groups 1 and 3 ( p < 0.05) than expected. Mortality and complications were similar after TCPC in all groups. Oxygen saturation (SaO (2)) was lower without than with APBF ( p < 0.002) after BDG and in group 3 than in group 2 after TCPC ( p < 0.05). Repeated measures ANOVA showed no effect of APBF on SaO (2), PA pressures, fractional shortening, end-diastolic pressure and AV-valve function. CONCLUSIONS: Early after BDG, APBF via PA presents different difficulties than APBF via BTS. However, BDG and TCPC outcomes are not affected by the presence or absence of APBF.

Adolescent↗
PubMed2004

[A rare form of aortic arch anomaly: left aortic and right descending aortic arch].

Among aortic arch anomalies, the circumflex aortic variety, involving left aortic and right descending aortic arch, is a rare situation. Two children were recently sent to the CCML for signs of tracheobronchial compression leading to the discovery of this anomaly. The younger child, aged 2 months, had been intubated since birth, and angiography presented a constrictive form of the disorder due to the presence of a small arterial canal linking the pulmonary tree to an aberrant right subclavian artery arising from a voluminous Kommerel diverticulum. Removal of the obstacle was achieved by section of the arterial channel approached via a right posterior thoracotomy. The second patient, aged 7 years, had chronic bronchopneumonia with severe obstructive syndrome. Multislice CT investigation with three-dimensional reconstruction showed obstruction at two levels: the first concerned the lower part of the trachea related to the posterior transverse segment of the aortic arch; the more severe second obstruction was due to a vascular pinch formed by the descending aorta and the right pulmonary artery. Improvement in functional signs with time reported by the parents had led to temporisation in this case. In adults this anomaly is often a fortuitous finding during radiological investigations performed for slight functional signs. In all cases of aortic anomalies and associated lesions, the importance of precise and thorough investigation using modern radiological techniques must be stressed.

Aorta, Thoracic↗
PubMed2003

[Neonatal cardiac transplantation. Long-term results].

The pioneering work of Bailey since 1985 has made cardiac transplantation an effective treatment of left heart hypoplasia in the neonatal period. At the Marie-Lannelongue surgical centre, 5 neonates with hypoplastic left hearts or an equivalent cardiac malformation, underwent cardiac transplantation between 1993 and 1998. There were no operative deaths. At the end of the follow-up, all children were treated with cyclosporine, without steroids. One child died of a secondary acute rejection resistant to treatment 7 years after the transplantation, 1 has a severe coronary problem 13 years after the transplantation, and three children (including the diseased child) have psychomotor development abnormalities. These results and those of the literature together with the psychological problems encountered by the children and their families, do not incite in the pursuit of the neonatal transplantation program until the introduction of new drugs for the treatment of chronic rejection which should prevent the programmed death of these children.

Aortic Coarctation↗
PubMed2002

[Three-dimensional multislice CT scanner: value in patients with pulmonary atresia with septal defect].

The aim of this study was to evaluate the interest of multislice CT scanning using three-dimensional reconstructions for pre- or postoperative management of patients with pulmonary atresia with ventricular septal defect. Twenty-one consecutive patients (median age: 8 months, median weight: 5.6 kg) with pulmonary atresia with ventricular septal defect were explored by multislice CT. Standard protocol consisted in one helical thoracic acquisition, associated with an injection of 2 to 3 mL/kg of iodinated contrast medium at a flow rate from 0.5 to 1 mL/s. Three-dimensionnal reconstructions were systematically performed. Before operation, status and size of central pulmonary arteries, major aorto-pulmonary collateral arteries, and associated anomalies were analyzed. In 13 operated patients, the permeability of palliative anastomosis and postoperative anatomical changes were studied. The status of central pulmonary arteries was assessed in all cases and the sizes found were in agreement to surgical findings. Main aorto-pulmonary collateral arteries were depicted and their relative position to central airways was assessed. Various associated anomalies were found: right aortic arch, anomalous coronary artery, abnormal pulmonary venous return, left superior vena cava. The anastomosis and the surgical connections (unifocalization, complete repair) were clearly analyzed. The multislice CT with three-dimensional reconstructions is a complementary imaging technique, reliable, useful to pre-operative management and postoperative follow-up of patients with pulmonary atresia with ventricular septal defect.

Adolescent↗
PubMed2002

[Interarterial and intramural coronary trajectoris: anatomic aspects and surgical implications].

Among the coronary trajectory anomalies found not only in congenital cardiopathies but also in otherwise normal hearts, the terms intramural and interarterial are still used in an ambiguous fashion too frequently. Study of the embryonic development of the coronaries allows a better understanding of the possibility of such a trajectory, (existence of the periarterial sheath). Certain anatomical factors favour the existence of an intramural coronary trajectory, the coronary always being tangential to the aorta in this case: paracommissural ostium, ostium situated too high, departure of the coronary at an acute angle, and ostium in the form of a slit. However, interarterial and intramural are not synonyms. In the case of a coronary trajectory tangential to the aorta, three anatomical and histological situations are possible: free trajectory, with the aorta and the coronary each having its own media and its own adventitia; adherent trajectory, with two separate media covered by a common adventitia: and true intramural trajectory, with fusion of the media without interposition of adventitia. These three situations have different surgical implications in the case of coronary reposition.

Anthropometry↗
PubMed2002

[Surgical treatment ot congenital heart disease].

Congenital heart disease is a heterogeneous group of intra- and extra-cardiac abnormalities of very variable prognosis, which have been classified according to their structural and functional consequences. The functional abnormalities are mainly centered on variations of pulmonary arterial flow that can generally be managed by simple palliative procedures. The extra-cardiac abnormalities affect preferentially the aorta. They may be embryonic vascular remnants responsible for tracheo-bronchial compression or obstructive lesions which are amenable to different types of vascular reconstruction procedures. These anomalies may be isolated or form part of a more complex malformative syndrome. Complete repair may be possible using techniques adapted to the main structural abnormalities of the cardiac architecture: reconstruction of the atrial or ventricular septa, restoration of the ventricular outflow tracts and redirection of blood flow within the atria. Among the therapeutic motivations developed for complete repair over the last decade, reconstruction of the pulmonary arteries by unifocalisation and Ross' procedure for left ventricular outflow tract abnormalities deserve special mention; in addition, a major therapeutic principle has been established for repair of ventriculoatrial malposition and discordance: the re-connection of the aorta with the left ventricle.

Aorta↗
PubMed2001

Surgical management and indication of left ventricular retraining in arterial switch for transposition of the great arteries with intact ventricular septum.

OBJECTIVE: Arterial switch is the operation of reference for the surgical treatment of transposition of the great arteries. In cases of late referral, perinatal complications or early left ventricular (LV) dysfunction, the one stage arterial switch is contra indicated. Anatomical repair remains possible in these patients following a LV retraining. METHODS: From January 1992 to January 2000, a LV retraining was attempted in 22 patients with transposition of the great arteries with intact ventricular septum (TGA IVS), whereas 470 direct arterial switch and 2 Senning were performed. Indication for LV retraining was based on a combination of factors including: an age older than 3 weeks, a "banana shape" aspect of the inter-ventricular septum and mainly a LV mass <35G/m(2). RESULTS: The mean age at LV retraining was 3.2 months ranging from 9 days to 8 months. Usually conducted by sterntomy, it associated a loose PA banding with a LV/RV at 65% with a systemico-pulmonary shunt. The first stage was associated with frequent LV dysfunction and the LV retraining was discontinued in two patients in favor of one Senning and one early switch followed by ECMO. One patient died at first stage from a mediastinitis. Nineteen patients underwent a second stage arterial switch that was performed when the LV mass had reached 50 G/m(2) after a mean delay of 10 days, ranging from 5 days to 6 weeks. After a mean follow up of 25 months, there was one non-cardiac late death. The 17 patients followed and leaving with an arterial switch are in NYHA class I, with a mean LV shortening fraction of 39%. CONCLUSIONS: Arterial switch following LV retraining in TGA IVS is a satisfactory option. The inferior limit of 35 G/m(2) adopted, to indicate LV retraining, seems a safe landmark. The quality of the myocardium generated and the respective roles played by the LV afterload, LV wall shear stress, LV inflow and outflow to induce the LV remodeling remain under debate.

Child↗
PubMed2001

Fibroma and inflammatory myofibroblastic tumor of the heart.

Cardiac fibroma and inflammatory myofibroblastic tumor (IMT) of the heart are rare lesions occurring in young patients and having pathologic similarities. We compared the morphologic and immunohistochemical features of seven cardiac fibromas, including one biopsied at birth and removed 4 years later, and two IMTs of the heart diagnosed at Marie Lannelongue Surgical Center (Le Plessis Robinson, France) between 1980 and 1999. Cardiac fibromas occurred in five females and two males and were surgically biopsied (n = 2) or removed (n = 6) between the ages of 8 days to 31 years (mean 7 +/- 12 years). Inflammatory myofibroblastic tumors were removed in two male patients, aged 13 weeks and 1 year, both alive and well 9 months and 5 years after surgery, respectively. Fibromas were ventricular lesions measuring 3 to 10 cm (mean, 5.7 +/- 2.2 cm). They contained entrapped myocytes and wavy elastic fibers. Three cases contained calcifications. Spindle cells were monomorphic. Their nucleus had a thin chromatin without nucleolus. Mitoses and extramedullary hematopoiesis were only observed in fibromas from patients younger than 5 months (n = 5) while prominent collagen fibrosis was present in fibromas from patients older than 4 years (n = 3). Inflammatory myofibroblastic tumors were endocardial lesions measuring 2 and 2.5 cm. They were covered by fibrin. Spindle cells were larger than in fibromas. Their nucleus had obvious nucleoli. They were associated with numerous inflammatory cells in a variable amount of myxoid background. Occasional mitoses and foci of necrosis were present. Spindle cells in both fibromas and IMTs strongly expressed smooth-muscle actin and were negative for desmin, CD34, S-100 protein, and p53. Our study shows that IMT must be considered in the differential diagnosis of cardiac fibroma especially in cases of inflammatory syndrome, location outside the ventricular myocardium, or multinodular lesions. Morphologic analysis permits the correct diagnosis, while immunochemistry shows a myofibroblastic differentiation in both lesions.

Adult↗
PubMed2001

Biventricular repair of transposition of the great arteries and unbalanced ventricles.

BACKGROUND: It is well established that the arterial switch operation is the surgical procedure of choice in patients with transposition of the great arteries and balanced ventricular anatomy. The surgical approach of choice in patients with transposition but unbalanced ventricular size is unknown. OBJECTIVES: Since the beginning of the arterial switch operation program, patients with transposition of the great arteries and unbalanced ventricles underwent biventricular repair by means of the arterial switch operation and repair of any associated lesions, either through a single or staged surgical procedure. The aim of this retrospective study is to analyze whether this approach can be proposed to such patients. METHODS: Forty-four patients with transposition of the great arteries and unbalanced ventricles underwent this surgical approach since 1984. Two groups were defined: group I had transposition with a dominant right ventricle (n = 28), and group II had transposition with a dominant left ventricle (n = 16). In group I the median age and weight at the arterial switch operation were 8.5 days (range, 5-70 days) and 3.1 kg (range, 1.5-3.7 kg), respectively. The median end-diastolic left ventricular volume, mass, and long-axis ratio were 15 mL/m2 (range, 11-16 mL/m2), 31.5 g/m2 (range, 20-66 g/m2), and 0.85 (range, 0.9-0.7), respectively. The mitral valve diameter was slightly hypoplastic, with a median z value of -1.22 (range, -0.3 to 3.7). In group 2 the median age and weight at the arterial switch operation were 42 days (range, 8 days-15 years) and 3.5 kg (range, 2.8-35 kg), respectively. Associated lesions in this group were coarctation in 9 and single (n = 12) or multiple (n = 4) ventricular septal defects. The median long-axis ratio and tricuspid z value were 0.6 (range, 0.3-0.8) and -0.9 (range, -0.5 to 3.3), respectively. In this group 9 patients had a single-stage procedure with fenestrated ventricular defect patches, atrial septal defect patches, or both; 7 patients underwent the staged approach. RESULTS: In group I there was 1 early death from sepsis after weaning from postoperative extracorporeal membrane oxygenation. Three patients had severe pulmonary hypertension, one of whom died 1 year later. All survivors demonstrated, at discharge from the hospital, equilibrated ventricular size, with a median left ventricular end-diastolic volume of 25 mL/m2 (range, 21-30 mL/m2). In group II there were 2 early and 1 late deaths. All early deaths occurred in patients without voluntary residual intracardiac shunts. Median early postoperative long-axis ratio and tricuspid z value were 0.8 (range, 0.7-1) and -0.2 (range, 0.74 to 1.2), respectively. CONCLUSION: This study demonstrates that the arterial switch operation in patients with transposition of the great arteries and unbalanced ventricles remains a good surgical option.

Cardiac Surgical Procedures↗
PubMed2001

[Enlarging angioplasty of the aortic arch with an pulmonary artery autograft patch. Interest in a single-stage repair of the syndrome of coarctation and interruption of the aortic arch].

Single stage repair of syndromes of coarctation and interruption of the aortic arch is a routine procedure in many surgical centres with good immediate results. The classical technique of aortic repair is based on the principles of Crafoord's extended resection anastomosis. Recoarctation is not an unusual long-term complication. A technique of enlarging angioplasty of the aorta using a patch of pulmonary artery has been developed and used in 22 neonates with obstruction of the aortic arch associated with ventricular septal defect with an average age and body weight of 15 days and 2.9 Kg respectively. The ventricular septal defect was closed surgically during the same procedure. Total circulatory arrest was not used in these children and all had aortic repairs with selective cerebral perfusion with moderate hypothermia (28-30 degrees C). This technique was used without any procedure-related early morbidity. No early or late deaths were observed in this series. Two patients were reoperated during the first year after the initial procedure: one for residual ventricular septal defect and the other for supraventricular pulmonary stenosis. Two patients, one of whom was reoperated, developed supraventricular pulmonary stenosis with a gradient of over 60 mmHg. These stenoses were observed in the first cases operated and were essentially due to the technique of pulmonary artery reconstruction. Over a median follow-up period of 10 months, no recoarctations were observed: the Doppler ultrasound study showed an isolated mean systolic gradient of 6 +/- 12 mmHg. The authors conclude that angioplasty of the aortic arch with an enlarging patch of pulmonary artery autograft during single stage surgery of syndromes of coarctation and interruption of the aortic arch provides a harmonious and durable repair of the aortic arch.

Anastomosis, Surgical↗
PubMed2001

[Ross mitral procedure for massive congenital mitral insufficiency].

The authors report the case of a 4 month old North African baby with massive congenital mitral insufficiency associated with a coarctation of the aorta. The surgical treatment consisted in correction of the coarctation followed, several days later, by a Ross mitral procedure after failure of mitral reconstructive surgery. The postoperative course required circulatory assistance for 4 days and the child returned to his family two months after surgery. Control echocardiography before hospital discharge showed good function of the pulmonary autograft in the mitral position with no regurgitation but slight stenosis with a mean transvalvular pressure gradient of 4 mmHg. This procedure may be used in certain cases as an alternative to mitral valve replacement.

Aortic Coarctation↗
PubMed2000

Congenital mitral stenosis with or without associated defects: An evolving surgical strategy.

BACKGROUND: Congenital mitral stenosis (CMS) remains a surgical challenge, particularly when it is associated with other heart defects. As in other groups of heart defects, there is a trend toward early single-stage complete repair, but the optimal surgical approach remains unanswered. METHODS AND RESULTS: This study was designed to analyze the evolution of surgical strategies in patients with CMS and associated defects through single-stage and staged repair. Between 1980 and 1999, 72 children were operated on for congenital heart defects, including CMS. Preoperative transmitral gradient was 12.6+/-7 mm Hg. Preoperatively, all the patients were NYHA class III to IV. Thirteen patients had an isolated CMS; in 59, it was associated with other heart defects, mainly ventricular septal defect (n=28) or multilevel left ventricular obstruction (n=41). In this group of patients, 33 had a staged approach, and 26 had a single-stage approach. Early mortality was 12.5% (9 patients). There were no deaths in the isolated CMS and single-stage repair groups. Logistic regression revealed that early mortality was influenced by association with left ventricular outflow tract obstruction (P:<0.001) and by use of a staged approach (P:<0.01). There was no late mortality in isolated CMS; there were 2 late deaths in the group of single-stage repair and 6 late deaths in the staged approach group (P:<0.01). Reoperation was required in 24 patients, mainly for residual mitral valve dysfunction or residual left ventricular outflow tract obstruction. Including the reoperations, 10 patients received a prosthetic mitral valve. At 15 years after surgery, survival was 69.6+/-7.5%, freedom from reoperation was 70.8+/-6.3%, and freedom from mitral valve replacement was 69+/-6%. CONCLUSIONS: Surgery for isolated CMS gives excellent early and long-term results. In patients with associated heart defects, a single-stage operation seems superior to a staged approach. Mitral valve replacement in this category of patients should be reserved as a salvage procedure.

Adolescent↗
PubMed2000

Systemic pulmonary shunts in neonates: early clinical outcome and choice of surgical approach.

BACKGROUND: Systemic pulmonary shunt remains a major strategy for the palliation of cyanotic lesions in neonates despite the associated morbidity and mortality. METHODS: Between March 1993 and December 1998, 79 systemic pulmonary shunts were performed in 75 neonates with cyanosis and severely reduced pulmonary blood flow. The mean age was 11.5 days and the mean weight, 3 kg. All neonates were dependent on duct flow and prostaglandin E1 infusion for adequate oxygenation. RESULTS: The systemic pulmonary shunt was performed through a right thoracotomy in 36 patients, left thoracotomy in 6, and median sternotomy in 33 patients. The 30-day mortality was 3 patients (4%). Univariate and logistic regression analyses revealed a weight less than 2 kg (p = 0.039) and preoperative mechanical ventilation (p = 0.008), to be predictors of early mortality, whereas pulmonary hypoplasia (p = 0.55), diagnostic group (p = 0.79), shunt size (p = 0.2), and surgical approach (p = 0.5) were not. There were seven episodes of shunt-related complications that required early intervention. CONCLUSIONS: Systemic pulmonary shunt remains an effective palliative measure in cyanotic neonates despite specific complications. Both low weight and preoperative ventilation represent significant risk factors for early mortality.

Alprostadil↗
PubMed2000

Transaortic closure of residual intramural ventricular septal defect.

BACKGROUND: Residual intramural ventricular septal defect is an unusual cause of left-to-right shunt after biventricular repair of conotruncal anomalies. It results from the insertion of the patch within the trabeculated right ventricular free wall related to the ventriculoinfundibular fold creating a communication through the intertrabeculated spaces to the right ventricular cavity. This complication often leads to unsuccessful reoperations unless the exact mechanism of the shunt has been identified. METHODS AND RESULTS: Five patients presented with residual intramural ventricular septal defects. Three had double outlet right ventricle, one pulmonary atresia with ventricular septal defect, and one tetralogy of Fallot. One patient was unsuccessfully reoperated on for closure of the residual ventricular septal defect through the right ventricular approach. The surgical treatment, which consisted of patch closure of the residual intramural ventricular septal defect through aortotomy, was successful in 3 patients. In the 2 remaining patients the hemodynamically insignificant residual intramural ventricular septal defect remained untouched. No mortality or morbidity occurred. CONCLUSIONS: Residual intramural ventricular septal defect should be suspected in presence of a residual ventricular septal defect after biventricular repair of conotruncal anomalies. It is not accessible through either atriotomy or right ventriculotomy. The transaortic approach allows an easy treatment of this rare complication.

Child↗
PubMed2000

Congenital division of the left atrium: the influence of associated congenital lesions on the timing and mode of presentation.

PURPOSE OF STUDY: Congenital division of an atrium is commonly associated with other cardiac malformations, which may influence presentation. BASIC METHODS: Cases diagnosed at our institution between 1980 and 1997 were reviewed, to determine whether associated lesions influence presentation. PRINCIPLE FINDINGS: 52 patients were diagnosed with atrial division (49 left, 3 right), mean age 4.8 yr. Patients could be divided according to age at diagnosis. Group 1: 32 patients aged < or = 1 yr. 14 patients had associated cardiac malformations other than atrial septal defect (ASD). Presentation was with pulmonary oedema. Group 2: 20 patients > 1 yr. 5 patients had associated major malformations other than ASD. Commonest presentation--isolated shortness of breath. Fifty patients underwent membrane resection and correction of associated anomalies (4% mortality). At follow-up (mean 12 yr) all patients were in NYHA class I or II. CONCLUSIONS: Patients with division of the atrium present early in infancy and with more severe symptoms when associated with other cardiac malformations.

Abnormalities, Multiple↗