[Mechanical disinsertion of valve prostheses].
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Biomedical subjects
Publications and source records attributed to J Guerinon.
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Between May 1963 and December 1976, 889 patients underwent single valve aortic replacement by prosthesis. Hospital (30 day) mortality fell, with an exponential decrease (r = 0.94, p less than 0.01) to 4 per cent in 1976. Early risk factors are studied, taking into account the changes affecting them respectively over the time period considered. The average age of the patients increased but did not significantly affect operative mortality. Cardio-thoracic ratio, sex and the duration of extracorporeal circulation had little or no prognostic value. Only classification in class IV of the N.Y.H.A. and the type of valvular disease (severe incompetence) were of clearly pejorative significance. Most deaths occurred early in a context of signs of poor cardiac output, severe disturbances of ventricular rhythym, visceral (digestive) syndromes and/or thrombotic complications. They were characterised at autopsy by sub-endocardial haemorrhagic lesions. The prevalence of these lesions and that of early deaths appeared to decrease with techniques for myocardial protection during the operation.
10 cases of anomalous position of the great vessels are reported. They include 8 cases of d-transpositions, 1 of 1-transposition and 1 anatomically corrected malposition. These cases have in common the combination of a ventricular septal defect with a pulmonary stenosis. The anatomical study (6 of 10 cases) made it possible to describe the type of the VSD (related to a defect of development and/or alinement of parietal on the septal band) and of the pulmonary pathway stenosis. Blalock's anastomosis has made it possible to obtain an improvement in 6 patients. 4 operations of complete cure were undertaken in d-transpositions: 2 Mustard's operations ending in death. 2 operations according to Rastelli's principles with one death and one good result. The case of anatomically corrected malposition died after an attempt at complete cure, in view of a left ventricular hypoplasia. The indication for the type of complete cure was discussed in relation with the anatomical data.
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The authors report a case of constrictive pericarditis complicating an apparently stable sero-negative rhumatoïd arthritis, a rarely described pathological association. The patient had a serious polyserositis due to an extremely marked and inflammatory pericardial constriction. The rhumatoïd origin was confirmed by pericardial effusion, histological and immunofluorescent studies. The inflammatory pericardial process rendered pericardiectomy virtually impossible and resulted in a fatal outcome.
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