[Abnormal origin of the left coronary artery from the pulmonary artery. Diagnostic contribution of ultrasonographic technique]. / Naissance anormale de la coronaire gauche a partir de l'artère pulmonaire. Apport diagnostique des techniques échographiques.

We report a case of abnormal origin of the left coronary artery from the pulmonary artery trunk. The original features of this case were its discovery in a young pregnant woman, the normality of basal left ventricular function and the electrocardiogram, the diagnosis by transoesophaegeal echocardiography, and the demonstration of severe myocardial ischaemia by stress echocardiography.

[Decompensated valvular disease and coarctation. One-stage repair using a median approach with an ascending aorta-abdominal aorta shunt]. / Valvulopathie décompensée et coarctation. Cure en un temps par voie médiane avec dérivation aorte ascendante-aorte abdominale.

The tactical decision in patients with decompensated valvular disease associated with a severe stenosis of the aortic isthmus is always difficult. One stage surgical repair using two separate approaches is a long and high risk procedure. It would seem more logical and safer to treat the lesions in two stages a few weeks apart, the severest lesion being managed first. In the two cases reported. The isthmic stenoses and valvular lesions were of the same severity and made both classical techniques impracticable. Therefore the patients underwent a single stage procedure by a median approach associating valve replacement under cardiopulmonary bypass (mitral and tricuspid in one and aortic in the other case) and an ascending aorta-abdominal aorta dacron conduit. The present postoperative survival periods are 30 and 9 months. The functional result was good (Class 1 and 0) and postoperative angiography has shown the montage to be working satisfactorily. This technique is exceptional but may be useful in borderline cases with decompensated valvular disease and severe isthmic stenosis.

[Decompensated cardiac valve disease associated with tight aortic stenosis. Surgical cure in one stage (author's transl)]. / Valvulopathie décompensée associée à une sténose isthmique serrée. Cure chirurgicale en un temps.

The authors report on 2 cases of severe cardiac valve disease associated with tight stenosis of the aortic isthmus for which the standard techniques could not be safely applied owing to patients' poor condition. Inserting by the median route a dacron tube between the ascending aorta and the subdiaphragmatic descending aorta immediately after heart valve replacement under extracorporeal circulation in our experience proved a simple and safe technique.

[Painless ST elevation with syncope. Diagnosis by continuous electrocardiography]. / Sus-décalages indolores de ST avec syncopes. Diagnostic par l'enregistrement électrocardiographique continu.

The aetiology of syncope in a 53 year old man was discovered on continuous ambulatory electrocardiography. A ventricular arrhythmia associated with ST elevation was recorded. It proved resistant to medical therapy and a double aorto-coronary bypass graft was performed. Post-operative Holter monitoring showed surgery to have been effective.

[Anesthesia-recovery from aorto-coronary bypass surgery (100 recent cases)]. / L'anesthésie-réanimation des pontages aorto-coronariens (a propos des 100 derniers opérés).

The authors report their experience of anaesthesia and postoperative recovery in cases of myocardial revascularisation surgery. On the basis of their last 100 bypass operations, they define the problems encountered according to the operative indications, previous treatment and the surgical technique, and attempt to provide answers to these problems. The difficulties (arrhythmias, myocardial ischaemia, hypertensive crises) occurred during the first 48 hours. They then consider the most current problem, that of the preoperative treatment of these patients (nitroglycerine, beta-blockers, amiodarone). They conclude that, paradoxically, in this type of surgery the operative risk is low as long as the indication for surgery is valid and myocardial protection effective.

[Crenelation of Beall's prostheses in mitral position: apropos of 21 reoperated cases]. / Le crénelage des prothèses de Beall en position mitrale. A propos de 21 réinterventions.

The authors report their experience of 21 revision operations for malfunction of the Beall Surgitool 104 prosthesis used in the mitral position. The incidence and uniformity of the disorders found in the prostheses suggest that these changes are produced inevitably usually during the fourth year. The disc becomes kinked, the mountings eroded, and the teflon ring torn. The clinical features are the onset of heart failure, anaemia, or a thrombo-embolic episode. These three findings may occur individually or in association. The authors do not advise systematic revision surgery, but conclude that close follow-up is essential in the case of all patients who have had a Beall prosthesis. Early signs of failure should be revealed by clinical examination, the level of LDH, and by phonocardiogram and echocardiogram studies. Leaving aside thrombo-embolic episodes and severe anaemia which themselves constitute indications for revision surgery, the decision to replace the damaged prosthesis should be taken as soon as the first signs of cardiac failure are detected.

[Direct action of extracorporeal circulation on platelets and coagulation factors]. / Action directe de la circulation extra-corporelle sur les plaquettes et les facteurs de coagulation

Concerning a study carried out in 250 patients, the authors confirm the classical notions concerning the fall in platelets, fibrinogenesis, factor II, XII AT3 and plasminogen during ECC. A more precise study of platelet levels shows important variations depending on the patients, whereas the length of time of ECC, the degree of importance of aspiration the first minutes of ECC, appear to be aggravating factors. There is no correlation between the type and the length of the circuit. Furthermore, from the morphological standpoint, thrombocytic changes are also noted. The same can be said of platelet function. In the last part of the work, the authors studied the causes of platelet consumption and their prevention. On the whole, and in practice, consumption of coagulation factors during ECC remains a little disturbing. It is, however, worth continuing to study their prevention.