Lecompte's closed drainage method combined with omentoplasty: an elective treatment for acute mediastinitis after prosthetic replacement of the ascending aorta?--two successfully treated cases.

Two cases of acute mediastinitis after replacement of the ascending aorta are presented. Both were treated by debridment and immediate closure with placement of multiple Redon suction tubes (Lecompte's method) associated with a primary omentoplasty. Drainage was prolonged up to 15 and 20 days. Patients recovered without any complementary procedure and actual follow-up is respectively at 18 and 20 months. Indications and technique of this combined therapy are discussed.

Heart lymphoma 6 years after a prosthetic ascending aorta replacement: related or unrelated?

An highly malignant B-cell lymphoma developed acutely 6 years after replacement of the aortic root with a Dacron prosthesis, involving the heart and the adjacent mediastinum. Rapid clinical deterioration and absence of early histological confirmation led to exploratory unsuccessful surgery. This case illustrates the rapid evolution of some of these tumours and raises again the hypothesis of the carcinogenic potential of Dacron material.

[Congenital pericardial defect associated with coronary artery disease: surgical treatment]. / Le cas clinique du mois. Association d'une agénésie partielle du péricarde et de lésions coronaires: a propos d'un cas opéré.

The case of a 62-year-old patient presenting with exertional chest pain, atheromatous coronary lesions and left congenital pericardial defect is reported. The diagnostic of peri cardial defect was evoked in relation with a long-known asymptomatic cardiac left malposition and confirmed at surgery. Clinical presentation, diagnosis and management of congenital pericardial defects are discussed.

Ascending aorta syphilitic aneurysm presenting as a dystrophic disease.

A 37-year-old female originating from Central Africa presented with cardiac failure, aortic insufficiency and aortic root dilatation of supposed dystrophic origin. Left coronary ostial dilatation and dense adhesions between the aorta and the pulmonary trunk at operation were the only unusual features. However, pathological examination evoked a syphilitic disease and serology confirmed luetic infection. The diagnosis and the therapeutic approach are discussed. Syphilitic aneurysms belong to the protohistory of vascular surgery, but, in the antibiotherapy era, tracking a syphilitic aneurysm is like fishing for coelacanth. When this pathology mimics a dystrophic aneurysm, diagnosis and therapeutic attitude becomes hazardous and justifies the present report.

Isolated supradiaphragmatic descending thoracic aorta stenosis in a Takayasu's disease: surgical cure.

A 21-year-old male patient presented with a typical middle aortic syndrome. Echography disclosed a severe narrowing of the lower thoracic aorta with parietal thickening. The isolated character of the lesion was confirmed by magnetic resonance imaging and aortography. The surgical cure was realized by a Dacron bypass between the upper thoracic descending aorta and the juxta-diaphragmatic thoracic aorta. Aortic biopsy confirmed Takayasu's disease. Postoperative course was uneventful with normalized blood pressure. The therapeutic options, surgery versus percutaneous dilatation and stent, are discussed.

[Subannular pseudoaneurysm of the left ventricle complicating mitral valve replacement; apropos of a case]. / Pseudo-anévrysme sous-annulaire du ventricule gauche compliquant un remplacement valvulaire mitral; à propos d'un cas.

The authors report the case of a 72 year old woman with a Carpentier-Edwards bioprosthesis implanted in March 1981 for severe mitral stenosis, asymptomatic until 1986. The progression of effort dyspnoea with prosthetic valve dysfunction despite digitalo-diuretic therapy and severe ventricular subannular pseudoaneurysm. Doppler echocardiography and cardiac catheterisation and angiography confirmed the mitral subannular pseudoaneurysm and led to surgical cure of this fibrous structure and implantation of a mechanical mitral valve prosthesis. This complication of mitral valve replacement is a cause of pseudoaneurysm which should not be overlooked.

[Prosthetic duplication of the ascending aorta]. / Duplication prothétique de l'aorte ascendante.

A simple implantation technique for multiple bypass of the ascending aorta with cervico-encephalic and infradiaphragmatic targets is reported. A conduit made by termino-terminal suture of two bifurcated grafts is anastomosed latero-laterally to the ascending aorta. The procedure is easy to perform and provides a suitable trajectory to the grafts.

The role of turns in the structure of an alpha-helical protein.

The turns joining segments of secondary structure have been proposed to be key elements in dictating the folded structures of native proteins. An alternative view assumes that turns play a passive role and are merely default structures that occur as a consequence of interactions between antiparallel segments of secondary structure, with chain reversal being dictated by the context surrounding the turn and not by the sequence of the turn itself. The solvent-exposure of turns and their tolerance to evolutionary variance suggests that they may have little or no effect on the formation of native structures. Previous investigations have focused on various types of beta-turns that connect antiparallel beta-strands with comparatively little reported on the structural role of interhelical turns. Here we probe the structural importance of such a turn in an antiparallel 4-helix bundle by randomly substituting an interhelical tripeptide in cytochrome b-562 with many different amino-acid sequences. Thirty-one of the resulting substituted proteins were characterized and all of them were shown to fold into stable, native-like structures. These results suggest that this interhelical turn does not does not play a dominant role in determining the folded structure of this antiparallel 4-helix bundle.

[Arterial complications of arthroscopic meniscectomies. Apropos of three cases]. / Complications artérielles des méniscectomies arthroscopiques. A propos de trois cas.

The authors report three exceptional cases of vascular lesions occurring during arthroscopic meniscectomies involving the posterior horn of the lateral meniscus. These lesions consisted of false aneurysms of the popliteal artery detected early (1 month) or later (5 months and 3 years) after the procedure, one of which formed a fistula with the accompanying vein. This later case resulted in intermittent claudication of the calf and the other two cases presented with painful flexion deformity of the knee. In the case diagnosed after 1 month, the false aneurysm arose from a punctate injury to the artery and was treated by direct arterial suture. In the other two cases, treatment consisted of excision of the false aneurysm and restoration of arterial continuity by an autologous saphenous vein graft. The quality of the clinical result was confirmed angiographically in all three cases. The anatomy predisposes to this complication which can be avoided by respecting a few simple precautions. The surgeon must be avoided by respecting a few simple precautions. The surgeon must be aware of and look for signs of this complication in order to allow early diagnosis.

[Heart surgery with extracorporeal circulation during pregnancy. Review of the literature with a case history]. / Chirurgie cardiaque sous circulation extra-corporelle durant la grossesse. Revue de la littérature à propos d'un cas.

The authors report a case of replacement of a mitral valve and of tricuspid annuloplasty using extracorporeal circulation in a pregnancy of 23 weeks amenorrhoea with a satisfactory result for the mother and the birth of a healthy baby after 35 weeks of amenorrhoea. A review of the literature made it possible to analyse the problems occurring in pregnancies in woman who have been fitted with a cardiac valve prosthesis and who have to have cardiac surgery in pregnancy.

Follow-up of surgically treated patients with massive pulmonary embolism--with reference to 12 operated patients.

Since 1978, 17 patients have undergone surgery for massive pulmonary embolism in our department. Twelve patients survived and have been followed up for between 2 and 31 months postoperatively (mean 16 months). Reassessment of these patients included exercise tolerance test, pulmonary function test, perfusion scan, right heart catheterization and coagulation screening. Two survivors present major sequelae, namely vascular pruning and definite signs of pulmonary hypertension. The other 10 patients have minimal or no residual vascular occlusion, but show a high incidence of minor abnormalities: slight rise in pulmonary arterial pressure during exercise (3 cases), small angiographic and scintigraphic defects (5 cases), arterial hypoxemia (5 cases) and disturbances of pulmonary function (10 cases). Systemic venous problems were found to be frequent and to be a handicap in 5 cases, and an abnormal pattern of response to exercise was observed in 4 patients. These disturbances may be related to ligation of the vena cava. Various derangements of coagulation were found in all but one of the patients.