[Determinants factors of hospital morbidity and mortality after reintervention of valve replacement]

Valve surgery involves valvular substitutes that expose to different types of complications that can lead to re subsequent interventions. was to identify the predictors factors of in-hospital morbidity and mortality of re interventions after valve replacement. Retrospective study of 73 consecutive patients who underwent a re valve replacement between 1985 and 2010 in the Cardiovascular Surgical department of La Rabta hospital. The average age at further surgery was 44 years [15-80 years] and sex ratio of 0.87. The average time between interventions was 10 years [3 days -33 years]. Different etiologies were found prosthesis thrombosis [36.9%]. The overall hospital mortality was 36.9%, 11 intraoperative deaths and 16 immediate postoperative deaths. The iterative intervention of valve replacement surgery is increasingly mastered by the surgical team. According to this study, the prognosis depends mainly on the patient preoperatively state, the cause of further surgery and its mode of occurrence

[Transfusion safety: state of the arts]

Blood transfusion is a high risk activity. To evaluate transfusion safety in planned cardiac surgery. This study was conducted in the blood bank of the Rabta Hospital in two phases: a phase to observe transfusion acts followed by corrective actions and a phase to evaluate the impacts of these corrections on the transfusion practices. Characteristics of the potentially transfused patients, the eventually prescribed, dispensed and transfused blood products and transfusion practices were studied. During the observation phase, 70 patients were enrolled, 51 potentially transfused. Weaknesses concerned the mention of phenotype and transfusion history when ordering blood components as well as the double ABO/D group typing, the phenotype and the cross match performing. Final bedside controls were done in a wrong way. The distribution and the blood administration were established respectively for 208 and 232 blood products. The traceability was established for 86 blood products. During the evaluation phase, 30 patients were enrolled, 15 potentially transfused. Improvement was achieved in the transfusion history notification, phenotype and antibodies screen performing and cross matching. Optimisation of blood transfusion can be conceived only with collaboration between the different transfusion structures

[Results of surgical treatment of intracardiac total anomalous pulmonary venous return]

Total anomalous pulmonary venous return [TAPVR] has a rather low incidence [1-3%] of all congenital heart disease. Intracardiac TAPVR represent 25-30% of all TAPVR. To report our results and long-term follow-up of surgical management of intracardiac TAPVR. Retrospective study of 7 patients with intra cardiac TAPVR treated surgically between Mai 1992 and July 2007. The surgical technique has been an intra atrial procedure in all cases. We didn't report any early post-operative death. Early postoperative complications were principally pulmonary infections. We report one death at three months of follow-up caused by laryngeal stenosis. Late follow-up was good for all patients. Good result of surgical treatment of intracardiac TAPVR depends on early diagnosis and adequate surgical technique

[Prosthetic valve endocarditis about 14 cases]

Prosthetic valve endocarditis [PVE] is a serious complication of valve surgery. The aim of this study is to determine the diagnostic and therapeutic management for PVE. It's a retrospective study about 14 cases of PVE operated in the department of cardiovascular surgery of la Rabta hospital between January 1996 and December 2006. In two cases, surgery was performed emergently, in the remnant cases surgery was elective. The coagulase-negative staphylococcus [CNS] is the predominant cause of these PVE. Surgery consisted on seven mitral prosthesis replacements and seven aortic prosthesis replacements. Hospital mortality was 50%. In conclusion attention should he made to prevent endocarditis when possible. In case of PVE, an early diagnosis leads to eavlier application of appropriate therapies and improved outcome

[Split or rupture of the infra renal abdominal aortic aneurysms: indications, treatments and results]

With increasing age of the population and improvement of diagnostic tools, the incidence of abdominal aortic aneurysm [AAA] has been rising steadily. Thus, surgical repair of fissured or ruptured AAA needs a close analysis of the indications and therapeutic strategies. The aim of this study is to define the new criteria for surgical indications. Between 2000 and 2006, 26 consecutive patients with AAA underwent open operations for ruptured AAA in 22 [84%] and fissured AAA in 4 [16%]. The mean age was 59 years [26-S2years] and the predominant aetiology was the atherosclerosis [84%]. Radiological analysis showed a mean AAA diameter of 7,3cm [4-11cm]. The AAA repair was performed with tubular or bifurcated graft in 22 patients [84%], and the AAA exclusion associated to extra-anatomical revascularisation in 4 [16%]. Operative mortality was 23%and late follow up find no recidivant AAA. The high operative mortality rate of patients with complicated AAA is related to the unstable hemodynamic status and surgical difficulties. The finite radiological images description is the best way to find new predictive elements of rupture and indicate surgery even in small AAA

[Substernal goiter: diagnosis and therapeutic problems]

Sudsternal goiter has particular nosological, diagnostic and therapeutic problems. This study is to study the epidemiologic and clinical particularities of this disease and to emphasize on therapeutic problems essentially surgical management. We report a retrospective study about 25 cases of substernal goiter operated in the Rabta hospital between January 1996 and December 2005. The mean age at operation was 61 years and sex-ratio was 0, 5. Patients were almost symptomatic. Surgery was carried by cervicotomy in all but one ease in which sternotomy was necessary. Histological exam didn't find any mailgnity signs in 95.6%of cases. Substernal goiter surgery is more delicat than the cervical one. Accurate diagnosis leads to good surgical results

[Atrial septal defect in adult: usefulness of surgical closure]

The atrial septal defect [ASD] is one of the most common congenital heart diseases in adults. The objective of our study is to determine the value of the surgical closure of ASD in adults. Between January 1990 and December 2006, 87 adult patients underwent surgical closure of ASD. The mean age is 28 years; eighty one patients [93%] were in NYHA class I or II. All patients were operated on with extra corporeal circulation. There were 10% post operative complications, no early or late death. Surgical closure of ASD in adults given good results and in spite of percutaneous procedures progress surgery keeps some specific indications

Late reinterventions after repair of common arteriel trunk

The common arterial trunk is a heart disease in witch a unique arterial trunk, with a unique ventriculo-arterial valve, exits from the ventricular mass and supply directly the coronary, the aortic and also the pulmonary arterial circulations. Its anatomic repair is now possible but necessitates the use of conduit in pulmonary position. To evaluate the incidence and the causes of late reinterventions after repair of common arterial trunk. We retrospectively study the outcome of 17 patients who underwent repair of common arterial trunk between January 1983 and December 2006. The 15 early survivors were followed during a median period of 7 years [range 10 months and 13 years].: Nine reinterventions were necessary in 8 patients. Only one conduit reintervention was necessary in the 8 patients. Freedom from conduit reintervention was 73% at 5 years and 33% at 10 years. Three reinterventions were performed in 2 patients for severe truncal valve incompetence, including repair in 2 cases and replacement in one case. Freedom from truncal valve reintervention was 67% at 10 years. Late reinterventions are inevitable after repair of common arterial trunk. The most common reasons are conduit stenosis and truncal valve incompetence

Paralysie phrenique apres chirurgie pediatrique: interet de la plicature diaphragmatique. A propos de deux cas

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

Peripheral infected aneurysms: report of 15 cases

In this retrospective study we report 15 cases of peripheral infected aneurysms. The sex ratio was 13/2 and the mean age was 23 years. Patients presented with infection mean age was 32 years. Patients presented with infection syndrome in 9 cases, vascular mass in 11 cases and limb ischemiae in 2 instances. Arterial lesion was documented and confirmed by echography, tomodensitametry and angiography. The infection was recognized by different criteria the main one being micro-organism isolation. In 10 cases aneurysm was secondary to bacterial endocarditis, in 4 it was primary and in one case it was related to arterial catheter procedure. Treatment is based on antibiotics and surgical management by removing of infected aneurysm and arterial restauration whenever possible. Arterial floweriest restablishment was done in 10 patients among whom 6 by anatomic procedures 4 by extra-anatomic ones. Hospital morality rate was 13 percent [2/15], all deaths occurred after cardiac surgery for endocarditis. Two patients were readmitted for adjacent spine infection, one month and one and a half respectively after surgery. One young patient required late surgery [aorto-bifemoral bypass] 24 months after initial treatment and one patient died by intro-duodenal rupture of recurrent review allow discussion of clinical, physiopathological and specially therapeutic aspects of infected aneurysm