Percutaneous balloon valvotomy for combined rheumatic mitral and aortic stenosis

Balloon dilatation of the mitral valve is an established modality of treating patients with mitral stenosis. However, there is limited experience for simultaneous dilatation of combined mitral and aortic stenosis report our experience in percutaneous balloon valvotomy for combined mitral and aortic rheumatic stenosis. we describe a case of a 33 years old woman who successfully balloon valvotomy for rheumatic mitral and aortic stenosis via the transseptal anterog ade approach using Inoue balloon for mitral valve and retrograde approach single balloon for aortic valve. Double valve balloon valvotomy is feasible and safe in selected patients with combined mitral and aortic rheumatic stenosis

[Anaesthetic security: evolution of ideas]

The concept of risk has not clear neither in the media nor in the medical field. It appears important to us to bring details relating some definitions in the field of anaesthesia safety. This work aims to clarify the concepts of safety, of risk in a medical activity like the Anaesthesia. A search was carried Out on Medline with the following key words: Risk anaesthetic, anaesthetic Safety, anaesthetic mortality. The definitions of risk, of acceptable risk taking account of social and economic considerations are brought in this text. The ways to evaluate safety and the methods to achieve it was developed. The indicator of quality more used to evaluate safety is anaesthetic mortality. Many difficulties exist with the interpretation of data on mortality. The standards of care are normally established according to the degree of necessary safety. Concurrently to these standards exist certainly the human error which is a phenomenon towards which must direct all the efforts of improvement of safety but more especially the errors of system which are found regularly in the analysis of accidents and incident. The identification of the failures is the mandatory step to achieve safety

[Anomalous origin of coronary arteries from the aorta]

The authors report the series of 9 patients [6 male and 3 female, aged from 32 to 64 years] with anomalous origin of coronary arteries from the aorta discovered at coronary arteriography. In 4 cases, the circumflex artery aries from the right coronary sinus and in 5 cases, the right coronary artery arises from the left coronary sinus. Severe atherosclerotic coronary disease was discovered in 5 cases. We conclude that aberrant coronary origin from the aorta is a rare congenital anomalous discovered usually at coronary angiography and certain patients with this anomalous can develop severe myocardial ischemia especially when a vessel runs between the aorta and pulmonary artery

Fistules coronaires multiples dans la cavite ventriculaire gauche. A propos d'un cas

The authors report the case of a patient with multiple coronary artery-left ventricular fistulae discovered in coronary angiography for exertional angina

Resultat a 20 ans d'une reparation complete d'une tetralogie de fallot chez une femme de 50 ans

The authors report the case of a woman operated at 50 years of age for a tetralogy of Fallot with a good late result

Retrecissement valvulaire aortique congenital avec dysfonction ventriculaire gauche: effet de la dilatation percutanee

Two girls aged 6 ans 1 5 years with severe congenital valvular aortic stenosis and left ventricular [LV] dysfunction underwent successful balloon aortic valvotomy [BAV]. Both patients had severe symptoms at the time of initial evaluation. The electrocardiograms showed LV hypertrophy and cardiac enlargement [cardiothoracic ratio 0,7 and 0,65] was evident in the chest roentgenograms. Immediately after BAV, the aortic valve peak-to-peak gradients decreased from 60 to 8 mmHg and 120 to 30 mmHg respectively, the LV end-diastolic pressures decreased from 47 to 13 mmHg and 40 to 15 mmHg, the LV ejection fractions improved from 40 to 65% in the second girl. On follow-up [30 and 36 ms respectively], both patients were asymptomatic with normalization of LV function and without a change in the residual gradient a cross the aortic valve

effet immediat de l'atrioseptostomie de Rashkind sur la saturation systemique dans la transposition des gros vaisseaux

The purpose of this prospective study is to analyse the immediate effect of Rashkind's atrioseptostomy on systemic saturation in transposition of the great arteries [TGA]. Thirteen neonates and infants [10 males and 3 females] with TCIA underwent balloon atrial septostomy [BAS] at a median age of 20 days [range 2 ans 60 days]. The mean atrial septal defect diameter apter BAS was 6.5 +/- 1.1 mm. The right ventricular saturation increased from 37 +/- 17% to 67 +/- 13% [p<0.001]. there was no correlation between the atrial septal defect diameter and the increase of systemic saturation aiter BAS

Analyses des connaissances attitudes et pratiques du personnel soignant face aux accidents d'exposition au sang en chirurgie generale

In order to assess the degree of knowledge, attitudes and the personnel's practices exercising in a service of general surgery of the hospital Charles Nicolle of Tunis, concerning blood exposure accidents, we did a transverse survey during the month of January of the year 2002. A questionnaire has been addressed to 114 people while using the technique of the direct interview. The middle age of investigated is 35,7 years. The sex ratio is 0,7. Only the 2/3 declare have been vaccinated against the B hepatitis. The results show a good knowledge of the exposure risk to a communicable disease by blood [95,6%], but less good for the risk of contamination by the three viruses HBV, HCV and HIV. The resheathing of needles, considered like gesture to risk, is underestimated by 71,2% of investigated. the majority of investigated declare to know universal precaution principles [85,8%]. However, to the maximum 4 measures only on the 1 0 advisable have been mentioned by investigated. The conduct to hold in case of blood exposure accident seems insufficientiy known by our sample- It is represented, in 78,8% of cases, in the application of disinfectants Betadin' type or alcohol Iodized, whereas the practice of 0 serology to the patient source is ignored completely. 75% of investigated having had a blood exposure accident lasting the last 12 months [n = 44] didn't declare their blood exposure accident and only 11,4% declare to have undergone cares. Actions of information and Formation, to the intention of the whole of the personnel of the service, on risks incurred by the nursing, gestures and procedures to risk, the universal precaution respect, the conduct to hold in case of a blood exposure accident, the interest of the declaration and the interest of the vaccination against the B hepatitis, are primordial

Facteurs predictifs de morbidite et de mortalite de la chirurgie du vieillard

The aim of the study was to determine prognostic factors of post operative morbidity and mortality for patients aged 80 years and older. We compared two groups of patients aged 80 and over operated to determine predictive factors of morbidity and mortality group of patients who presented post operative complication within 30 days after surgery and group of patients without any complication. Comparison of the two groups for global morbidity using univariate analysis showed only one prognostic factor: surgery of diabetic foot [p = 0.034]. Predictive factors of mortality according to univariate analysis were: pre-operative shock [p = 0.001], abdominal wall pathology [p = 0.027], gastric or duodenal ulcer diseases [p= 0.011] and global morbidity [p = 0.006]. After logistic regression, only pre-operative shock was an independent predictive factor of mortality [p = 0.0023]. Risk for morbidity after surgery in the elderly 80 years and over is linked with type of surgery and not with soil. Likewise, risk for mortality is linked with advanced stage of disease that is presence of pre-operative shock and not with soil

Evoluation after 5 years ago of percutaneous pulmonary valvulotomy report

47 patients aged from 2 to 59 years affected by valvular congenital or mixed pulmonary stenosis including three fallot trilogies and one patient with right congestive cardiac failure are treated by percutaneous pulmonary valvulotomy between October 1986 and December 1990. All patients have been controlled with a mean follow-up of 6.5 +/- 1.1 years. The total gradient rate between pulmonary artery and right ventricule decrease from 112 +/- 55 mm Hg to 20 +/- 8 mm Hg on the last control with disappearance of infundibular inflammation and their auricular shunt in all the concerned cases. We observe the degression of right cardiac failure symptoms with disappearance of tricuspid insufficiency in the cases of advanced pulmonary stenosis with right ventricular dysfunction. Percutaneous pulmonary valvulotomie by its simplicity and inocuity, its long term efficiency is a good method of treatment of pure valvular or mixed pulmonary stenosis

Percutaneous mitral commissurotomy report of a new simplified method

We report a new simplified method of mitral dilatation done on 146 patients. The technique use the lnoue balloon with progressive diameters under ultrasonographic control, avoiding the arterial part of the dilatation. The population include 9 pregnant women, 13 children, 13 with restenosis and closed heart and 12 restenosis after dilatation. Mean age is 32 +/- 16 years [9 to 72] and sex ratio 3.7 [114 F/32 M]. Three groups are individualized according to histopathologic exam of metal struclure, group [26 percent] concern good indication and III [32 percent] bad indication for this technique, group II [42 percent] contain intermediate indications. Commissurolomy increase the mean mitral square for 0.2 to 1.9 +/- cm'. We observe 3 cases of chirurgical mitral insufficiency needing remplacement recuited for 2 patients from the group III. Mean fluoroscopic exposition time is 5.2 +/- 3.3 mn and procedure duration 18 +/- 11 mn. Hospitalisation duration is one day for 95 percent of the patients. This method remaining simple, efficient and safe permit a gain in time of 70 percent with a good confort for patient and a return to work on the 4th day

[Study of incidence of nosocomial infection in a general surgery service]

Nosocomiol infection incidence and its cost were studied. We have identified 61 infected patients and 75 infectious episodes, is an incidence of 9,4% infected for 100 hospitalized by trimester. Operative site infections are the most frequent [60%], operative site infection [9,1%], inferior respiratory ways infections [2,2%]. Incriminated germs are represented essentially by negative gram Bacillus [77,3%] with predominance of enterobacterias [59%]. Invasive technique usage, surgery types and contamination classes have been identified as risk factors of nosocomial infection occurrence. The supplementary stay duration estimated by simple comparison between infected group and non-infected one is 9,3% days, responsible of an over cost of 336 TD by infected patient and 273 TD by infectious episode. The curative antibiotic costs have been estimated at 70 TD by infected patient being equivalent to two hospitalization days and to 57 TD by infectious episode