Chrurgie des anevrismes de l'aorte acsendante

Evaluation of the short and middle term morbidity and mortality rate of ascending aortic aneurysm surgery. Material and methods: It is a retrospective study of 21 ascending aortic aneurysm patients operated between May 1996 and may 2003. The interventions were of Bentall's type in 11 cases [4-25], Carbrol's in 6 cases [6-28%] and Weath's type in 4 cases [19%]. A total of 21 patients-16 males and 5 females- average age of 45 years +/- 8-12 [15-68]. Four patients [19%] had acute complicated discecting aneurysm. Two patients [5-9%] had MARFAN'S syndrome. Sixteen patients [57 +/- 6,3%] had aortic regurge grade II to IV. Seventeen patients [81%] had NYHA'S functional class II-III. Average aneurysmal diameter was 57 mm +/- 6,3 [48-80mm]. Operative mortality rate was nil. Hospitalisation period was 19 +/- 4 days [16-40 days]. Three patients had complete atrioventricular heart block. Lately 2 patients died as a result of thromoembolic accidents. The ascending aortic aneurysm surgery can be achieved with immediate results similar to surgical aortic valve replacement. The mode of surgery and necessity of a long course of anticoagulant treatment affect the middle and long term prognosis

Remplacement valvulaire aortique associe au pontage cronaire

The progress achieved in the cardiac surgery and resuscitation fields allowed an enlargement of surgical indications to invalue inoperable patients. A typical example is the association of aortic valve stenosis with coronary stenosis in elder patients. The authors report a series of 6 male patients who underwent an aortic valve replacement associated with coronary artery bypass grafting [CABG] at the cardioc surgery department "B", between May 1996 and May 2003. The average age was 64,5 years [52-74]. All of them had a significant and symptomatic aortic valve stenosis. One patient had left ventricular dysfunction. All the patients had a stable hemodynamic status in the preoperative period. Five patients benefited from bioprosthesis valve, while the 6th patient had a mechanical one. The mean number of bypass was 2,1 per patient. The mean time of aortic cross clamp was 97min. Hospital mortality was nil. One patient developed acute renal insufficiency, while an other suffered from myocardial infarction and pulmonary infection. The aortic valvular replacement associated with CABG is a highly risk surgery. The operative indications that give best prognosis depend on the age factor [less than 70 years] and timing factor of surgery [suitable timing]

Surgical treatment of hemorrhagic complications of duodenal ulcer

Haemorrhage complicating duodenal ulcer is relatively rare compared with other complications of duodenal ulcer. Inspite of this fact, haemorrhage of duodenal ulcer is responsible for high rate mortality of complicated duodenal ulcer. The mortality rate is related to: severity of bleeding, recurrency, and also advanced age great help in the identification of the chracteristics and types of the ulceratives lesions showing the tendency of recurrent bleeding, hence, a more active attitude will be adopted rapidly as the risk of mortality is higher in these cases when recurrent massive bleeding arrives. In this study carride on 85 cases of haemorrhage complicating duodenal ulcer: 48 patients are operated upon, 45 with trunkal vagotomy with or without local hemostatic mesures, 3 cases of supraselective vagotomy were than. Mortality rate in this group was 10% [8 patients out of 85] 5 deaths happend before any intervention, other 2 deaths during surgical operation and related to massive or recurrency haemorrhage. The recurrent haemorrhage arrived for 2 patients after trunkal vagotomy was responsible of death for these two cases. According to this study, and also to other recent publications, we found that the Weinberg operation is the operation of choice, but the good results published recently by certain groups using supraselective vagotomy, obtained also in our group [3 cases] are encouragely to substitued trunkal vagotomy by this technic