[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

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