Aneurysm of a common celiomesenteric trunk.

Aneurysm of the celiac and/or superior mesenteric arteries are uncommon, accounting for 10% of visceral artery aneurysms. Aneurysms involving a common celiomesenteric trunk are extremely rare. Up to now only two cases have been reported. In this report we describe a saccular aneurysm originating from the bifurcation of a common celiomesenteric trunk. Treatment consisted of resection followed by suture of the aneurysmal neck. This anatomic variation of the visceral arteries probably resulted from a defect in embryonic development suggesting that the aneurysm was congenital in origin. Other etiologies of aneurysms in this location are atherosclerosis, infection, inflammation, and arterial dystrophy. These lesions are almost always surgical indications requiring complete angiographic study of the visceral vasculature.

Coronary-coronary bypass graft: an arterial conduit-sparing procedure.

From May 1989 to December 1995, 143 patients underwent myocardial revascularization with one (138 patients) or two (five patients) coronary-coronary bypass grafts in addition to other bypass grafts, for a total of 463 distal anastomoses (mean 3.2 +/- 0.6 per patient). Coronary-coronary bypass grafts were chosen for the following reasons: arterial conduit-sparing procedure, inadequate length for in situ graft, calcified ascending aorta, and stenosed or occluded subclavian arteries. One hundred eleven arterial grafts (75%) were used: 85 right internal thoracic arteries, 18 left internal thoracic arteries, and eight radial arteries. Saphenous vein grafts were used in 37 cases (25%, mostly in our early experience). Coronary-coronary bypass grafts were performed on the right coronary artery in 134 cases (90.5%), on the circumflex artery in five cases (3.3%), on the left anterior descending coronary artery in four cases (2.7%), and between two different coronary arteries in five cases (3.3%). Three patients (2%) died of myocardial infarction. Early postoperative angiography showed a patency rate of 98.6% (72/73). During the mean follow-up of 34.6 +/- 20.8 months, two patients died and two underwent reoperation. Results of exercise testing were normal at 2 months in 97% of patients (90/92), at 1 year in 96% (81/84), and at 3 years in 93% (30/32). In conclusion, the coronary-coronary bypass graft provides good results with a variety of conduits and allows the expanded use of arterial grafts, particularly the internal thoracic artery. This can lead to a sparing of arterial conduit and allow complex myocardial revascularization with a liberal use of internal thoracic arteries.

Rupture of a superior mesenteric artery aneurysm in a child.

A 13-year-old child presented with a ruptured aneurysm of the trunk of the superior mesenteric artery most likely due to incipient fibromuscular disease localized in the adventitia. The aneurysm was resected and replaced by an autologous saphenous vein graft. The postoperative course was uneventful. Diagnosis and operative strategy are discussed.

[Accessory mitral tissue responsible for left ventricular outflow obstruction. Reports of 7 cases]. / Tissu mitral accessoire responsable d'une gêne à l'éjection du ventricule gauche. A propos de 7 cas.

The authors report the medico-surgical experience of Marie Lannelongue hospital of a rare condition: accessory mitral valve tissue. Seven patients aged 2 to 28 years (average: 8.7 years) had left ventricular outflow obstruction due to accessory mitral valve tissue. The diagnostic was not obvious clinically and was based on the association of echocardiographic and angiographic data. This condition was associated with another intra-cardiac malformation in 6 of the 7 patients. Surgical treatment included resection of the accessory mitral valve tissue by an aortic or combined aorto-left atrial approach, together with correction of the associated intracardiac abnormality. The postoperative results were excellent with the regression of the ventriculo-aortic pressure gradient and the physiological integrity of the mitral valve.