Biomedical subjects
Publications and source records attributed to M Redonnet.
The authors report the case of a 30-year old man who suffered spontaneous rupture of the right subclavian artery. Treatment consisted of carotid-axillary graft since the fragility of the vessel precluded direct suture. The clinical symptoms, together with histological and ultrastructural examinations led to a diagnosis of Ehlers-Danlos syndrome with purely arterial manifestations.
The authors report their experience with pre-operative percutaneous balloon counterpulsation in 75 patients considered to be at high operative risk for coronary artery surgery, mainly because of unstable angina refractory to maximum medical therapy. The criteria to define high surgical risk are reported. The results and the vascular risk in relation to this technique are estimated. Two patients died during the operation, 12 died during the early postoperative phase without any improvement following intra-aortic balloon pumping. The rate and severity of complications of percutaneous insertion of intra-aortic balloon counterpulsation are low and seem to be related to pre-existing arteriosclerosis. The stabilizing effect of this pre-operative insertion on angina, refractory to medical treatment, seems to be justifiable in patients presenting one of the defined criteria.
The authors report three cases of endocarditis after replacement of the aortic valve and the ascending aorta by Bentall's method. This complication, rare in published series, is a serious possible complication during medium and long term follow-up. Its treatment consist of early complete removal of prosthetic material under suitable antibiotic therapy.
Four patients with aneurysms of the membranous ventricular septum were operated either because of complications or for associated malformations. The authors describe the anatomical, radiological and, above all, the echocardiographic and angiographic features of this malformation. Surgical management is necessary in complicated cases or when there are associated congenital malformations. The information provided by echocardiography in the diagnosis and follow-up of ventricular septal defects indicates that this malformation is not as rare as was previously thought.
Organic hypoglycemia occurs in pancreatic and mesenchymal tumors. Thirty percent of extrapancreatic tumors are intrathoracic. A patient with hypoglycemic pleural mesothelioma was treated by surgical excision without recurrence five years after surgery. The mechanisms of hypoglycemia are not clearly established. The recurrence of hypoglycemia is a good sign of tumor recurrence.
Spontaneous incomplete non traumatic rupture of the ascending aorta is rare but life-threatening; it may well remain unnoticed until emergency surgery becomes necessary. Its possibility should be considered in all patients presenting signs of tamponade, chest pain or aortic regurgitation, and it must be diagnosed by appropriate procedures.
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From 1974 to 1984, 46 patients underwent emergency surgery for acute native valve endocarditis. Urgent valve replacement was necessary because of rapid hemodynamic deterioration in 34 (73%), uncontrolled sepsis plus heart failure in 9 (19%), and life-threatening emboli in 3 (7%) patients. At the time of surgery 23 patients (50%) were in NYHA functional class IV, 20 in Class III, and 3 in class II. Streptococcus was the most common organism encountered, followed by staphylococcus. Thirty-four cases presented severe aortic regurgitation, 3 mitral incompetence, 8 mitral plus aortic insufficiency, and one aortic plus tricuspid insufficiency. Operative mortality rate was 17% (8/46). Most deaths were due to preoperative multiple system deterioration, especially in cases with lesions of both the aortic and mitral valves, and were unrelated to the duration of preoperative antibiotic therapy. The postoperative observation period of long-term survival is from 6 to 102 months (= 44 months). There were 7 late deaths. The actuarial survival, including operative mortality, is 67%. Twenty-two patients are now in NYHA class II, 6 in class III. The duration of postoperative antibiotic treatment (6 weeks in our series) seems to be important for the prevention of reinfection, early surgery is of great benefit; our 31 survivors showed an excellent clinical improvement.
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This study was based on the analysis of 41 cases of infectious endocarditis of native valves operated during the acute phase. Patients with bacteriological cures, prosthetic valve endocarditis and endocarditis on congenital non-valvular lesions were excluded. There were 32 men and 9 women with an average age of 49 years. The valve lesions were aortic incompetence, mitral incompetence, mitro-aortic disease and mitro-tricuspid disease. Fourteen patients had preexisting valvular disease (rhumatic in 12 and congenital in 2 cases). These patients were in an advanced clinical state at the time of operation: 23 Class IV, 16 Class III and 2 Class II operated for systemic embolism. The surgical indications were severe cardiac failure in 30 cases, systemic embolism in 2 cases and persistance of septicaemia with worsening cardiac function in 9 cases. The causal organism was isolated from blood cultures in 34 cases (83%) and from the excised valve in 13 cases. The early postoperative mortality during the first month was 5 patients (3 cases of aortic incompetence associated with mitral incompetence and 2 cases of aortic incompetence alone). Death was caused in most cases by irreversible cardiac failure related to the advanced preoperative cardiac failure. All the other patients were followed up for 1 to 102 months (average 44 months). There were 7 late postoperative deaths. The mortality rate was 3.4% per patient year including patients undergoing chronic haemodialysis. The actuarial survival was 79% at 78 months excluding the operative mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
We report a case of spontaneous incomplete rupture of the first segment of the ascending aorta presenting as aortic incompetence and acute tamponade confirmed by preoperative angiography in a 57 year old hypertensive woman. This patient underwent emergency conservative surgery with good results at 8 months' follow-up. This rare pathology occurs in the same terrain as dissection of the aorta. The diagnosis should be suspected not only when chest pain and/or aortic incompetence are associated or not with acute tamponade, contrasting with a normal electrocardiogram, but also in atypical presentations which necessitate angiography in multiple incidences in order not to miss the diagnostic signs which are often invisible in the standard projections. When there are no complications, this condition may pass undiagnosed. However, in most cases, it leads to acute tamponade due to intrapericardial rupture or to an aortic aneurysm or aortic incompetence. The latter complications are usually associated with severe regurgitation requiring surgical correction, which in some cases may be conservative.
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The authors report and discuss the rare case of a female patient age 55 years, with a atherosclerotic stenosis of the aortic isthmus with hypertension. The lesion was resected using partial veno arterial bypass with a dacron graft, literature on this case is reviewed.