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D Metras

Publications and source records attributed to D Metras.

At least 91 records · Page 5Linked to original sources
PubMed1983

[Open-heart surgery in tropical Africa. Results and peculiar problems of the 1st 300 cases of extracorporeal circulation performed in Abidjan].

The authors report on their experience of 300 open-heart operations performed in Abidjan for cardiac valve disease (149 cases), congenital cardiopathy (100 cases), endomyocardial fibrosis (40 cases) and other lesions. The operational method involved haemodilution, hypothermia, aortic clamping and cardioplegia. The death rate was 13.3%, mostly due to the severity of the condition prior to surgery. A number of specific points are discussed, including haemodilution without blood perfusions, surgery in patients with sickle-cell anaemia, cardiac valve surgery in children and surgery of endomyocardial fibrosis.

Adolescent↗
PubMed1983

Left endomyocardial fibrosis with severe mitral insufficiency; the case for mitral valve repair. A report of 4 cases.

Left ventricular endomyocardial fibrosis accompanied by severe mitral insufficiency occurring in 4 adolescent African patients is reported. Mitral valve repair was successfully performed in all 4 cases including annuloplasty in 3 and chordal shortening in one. Short-term follow-up of up to 10 months indicated substantial clinical improvement and decrease of the cardiothoracic ratio in all. It is emphasized that mitral valve repair appears to be the method of choice in treating mitral incompetence in the localized form of endomyocardial fibrosis, where endocardiectomy is not required in the area of the papillary muscles.

Adolescent↗
PubMed1983

Endomyocardial fibrosis masquerading as rheumatic mitral incompetence. A report of six surgical cases.

This report presents six cases (among 43 surgical cases) of left ventricular EMF presenting as pure mitral insufficiency without any echocardiographic or hemodynamic signs of left ventricular EMF (except apical diverticulum in two cases). Five of these cases were diagnosed at operation, and the sixth was diagnosed on the basis of a characteristic right ventricular angiogram. At operation a fibrotic lesion localized to the level of the anteropapillary muscle, with severe mitral insufficiency, was found. Five patients underwent successful mitral valve replacement and one a successful conservative mitral valve procedure. Postoperative angiograms, done in two patients, showed a normal contour of the left ventricle. A review of the literature did not reveal any previous descriptions of this type of limited left ventricular EMF, mimicking rheumatic mitral insufficiency. In our surgical experience, we have encountered three types of left ventricular EMF: obliterative, extensive, and limited. We emphasize EMF as a possible cause of mitral insufficiency in African children.

Adolescent↗
PubMed1982

Endomyocardial fibrosis: early and late results of surgery in 20 patients.

Twenty patients with endomyocardial fibrosis (EMF), the largest series reported to date, were operated upon between June, 1978, and June, 1980. Eleven were male and nine female, ranging in age from 6 to 23 years (mean 13.3 years). There were seven cases of right ventricular (RVEMF), six of left ventricular (LVEMF), and seven cases of bilateral EMF. All patients underwent endocardiectomy and atrioventricular valve replacement with a xenograft. Four patients had an additional valvular annuloplasty. There were four postoperative deaths (all bilateral EMF): two from low cardiac output and one each from hepatic failure and cerebral malaria. There was one late death from serum hepatitis. The other patients had a relatively difficult postoperative course, but none of the 20 patients atrioventricular block. The longest follow-up of the 15 survivors is 28 months (mean 16.7 months). All patients are symptom free. Three take digitalis and/or diuretics. Ten have been recatheterized from 6 months to 1 year after operation. Intracardiac pressures, the ventricular cineangiogram, liver, and heart size returned to normal in patients with LVEMF; in RVEMF, despite clinical improvement, most of these parameters remained abnormal. Of special interest were (1) our recognitions of an early type of LVEMF and (2) our surgical preservation of a thin juxta-annular rim of fibrosis in the right ventricle to avoid atrioventricular block. Operation is indicated in all patients with LVEMF, despite greater risk. Early intervention is advised in RVEMF to avoid irreversible liver damage and cardiac enlargement.

Adolescent↗
PubMed1981

[Arterial thrombosis of the femoro-popliteal axis. An exceptional case of vascular complication by exostosis (author's transl)].

The authors report an exceptional case of arterial thrombosis of the femoro-popliteal axis, caused by a bony exostosis of the femur. It was a man of 48 years, presenting with sub-acute ischemia of the left lower limb. The different examinations showed an extensive femoro-popliteal artery thrombosis centered by a bony exostosis of the inferior third of the femur. The patient was successfully operated upon with resection of the exostosis and saphenous vein femoro-popliteal by-pass. A review of the literature shows the rarity of vascular complication of exostosis and particularly of thrombosis, previously reported only 4 times. An explanation of the mechanism involves the repeated trauma on the artery in this narrow region and the possibility of superimposed atheroma.

Arteriosclerosis↗
PubMed1980

[Surgical treatment of interventricular communication with aortic insufficiency. Apropos of 5 cases].

The results of surgery on five patients aged between 4 and 14 years old with ventricular septal defect (VSD) and aortic incompetence (AI) are reported. Four of the five patients had massive AI, the diastolic blood pressure being 0 in 3 cases. All patients underwent catheterisation and angiography. In 1 case, an aneurysm of the sinus of Valsalva bulging into the infundibulum was detected. At operation, 3 infra-cristal, 1 supra cristal and 1 unclassified VSD were observed. Prolapse of the aortic cusps was present in three cases, and in two cases these lesions were complicated by infective endocarditis. Three patients were managed by a slightly modified version of Trusler's aortic valvuloplasty, and the two patients with endocarditis underwent aortic valve replacement. The VSD was closed by Dacron patch in 3 cases and directly in 2 cases. The immediate postoperative period was complicated in one case by haemorrage due to anticoagulant therapy causing tamponade and paraplegia. In the other four cases, there were no complications. The results of valvuloplasty were good with complete regression of the diastolic murmur. The medium-term results were good, with a maximum follow-up period of 21 months. One of the patients with an aortic valve prosthesis has minimal AI, probably due to a paravalvular leak. A number of points are discussed with respect to this small series of patients: anatomy, techniques, indications. The modified Trusler's valvuloplasty is recommended, even in cases of severe AI.

Adolescent↗
PubMed1977

[Monitoring of the pulmonary artery pressure after open heart surgery (author's transl)].

A monitoring technic of recording the pulmonary artery pressure and cardiac output after cardiac surgery (valvular prothesis or aortocoronary bypass) is described. This monitoring is realised by introduction of catheter into pulmonary infundibulum during surgery, emerging through a cutaneous incision. This method was applied to 60 patients with two accidents at the beginning of the procedure. The technic's indications and cares are discussed.

Blood Pressure↗
PubMed1976

[Inidications for multivalve prostheses].

The authors consider that the indications for surgery should take into account three unknowns: the natural history of the valvulopathies, our incomplete state of knowledge about the outcome in operated cases, and surgical progress, which may transform the whole subject in a short time. They emphasize the seriousness of the disorders in which mitral incompetence is associated with aortic stenosis and/or incompetence; such cases justify earlier surgery. By contrast, some cases of aortic incompetence, when associated with a predominant mitral valve lesion, may not constitute an indication for valve replacement. Tricuspid annuloplasty is a noteworthy advance which provides a simple answer to some of the problems.

Aortic Valve↗