ABSTRACT
Abdominal aortic aneurysm is a chronic degenerative disease that is usually silent until rupture occurs and this complication is still associated in contemporary era with a high rate of mortality. Screening programmes for abdominal aortic aneurysm have been shown to be effective in reducing global mortality in the screened population but these programmes are poorly implemented in the Western countries. As coronary artery disease and abdominal aorta aneurysmal disease share many risk factors, the cardiologist is centrally positioned in the screening strategy, not only to identify patients with higher risk of developing abdominal aortic aneurysm, but also to perform an opportunistic screening during echocardiography. This paper summarises evidence about the feasibility, indications, modalities, benefits and risks related to the opportunistic screening for abdominal aortic aneurysm during echocardiography with a particular emphasis on the population of patients with coronary artery disease.
Subject(s)
Aortic Aneurysm, Abdominal , Coronary Artery Disease , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/epidemiology , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/epidemiology , Echocardiography , Humans , Mass Screening , Medical Futility , Risk FactorsABSTRACT
There is a continuous growth in the incidence of cardiovascular and thoracic diseases, especially related to the increased life expectancy. Moreover, the quality and efficacy of care for these pathologies are progressing constantly. The evolution of surgery prompts us to develop less aggressive (minimally invasive), although technically more complex, treatment or diagnostic techniques. Pathologies, which until now required heavy surgeries, are managed today in a less invasive way and become therefore accessible to patients even if they are older or in a poor general condition. In this article, we present our experience in the development of the minimal invasive procedures in cardiovascular and thoracic surgery.
Les pathologies cardiovasculaires et thoraciques, au sens large, sont de plus en plus fréquentes, vu l'augmentation de l'espérance de vie, mais elles sont aussi de mieux en mieux prises en charge. En effet, l'évolution de la chirurgie nous incite à développer des techniques de traitement ou de diagnostic moins agressives (mini-invasives) quoique techniquement plus complexes. Des pathologies qui nécessitaient, jusqu'à présent, des chirurgies lourdes se prennent en charge, aujourd'hui, de manière moins invasive et deviennent donc accessibles à des patients en moins bon état général ou de plus en plus âgés. Nous présentons ici notre expérience dans le développement de l'approche mini-invasive en chirurgie cardiovasculaire et thoracique.
Subject(s)
Cardiovascular Surgical Procedures , Minimally Invasive Surgical Procedures , Thoracic Surgery , Cytoreduction Surgical Procedures , HumansABSTRACT
Heart transplantation remains undoubtedly the most effective treatment for end-stage heart failure, whatever its cause. Last decade has witnessed significant improvements in terms of morbidity and mortality following heart transplant. The 5-year survival rate is now beyond 70 %. However, the shortage of potential donors limits its use and requires strict criteria before listing a candidate for heart transplantation. Herein, we present a review of current indications and results of the heart transplantation program at the University hospital of Liège.
La transplantation cardiaque demeure, à ce jour sans conteste, le traitement de choix de l'insuffisance cardiaque terminale, quelle qu'en soit l'origine. La dernière décennie a été marquée par une amélioration significative des résultats de la transplantation cardiaque tant en termes de mortalité que de morbidité. La survie globale à 5 ans dépasse maintenant 70 %. Cependant, la pénurie d'organes limite malheureusement son emploi et impose des critères de sélection rigoureux des potentiels candidats. Une revue des indications actuelles ainsi qu'un aperçu des résultats de la transplantation cardiaque au CHU de Liège sont présentés.
Subject(s)
Heart Failure , Heart Transplantation , Hospitals, University , Humans , Survival Rate , Tissue DonorsABSTRACT
Aortic valve replacement is nowadays a safe procedure with low morbidity and mortality. However, the evolution of surgery requires the development of less invasive techniques. Aortic valve replacement through a right mini-thoracotomy, technically more complicated, offers a lower rate of complications including less postoperative pain and less blood loss and transfusion, with a faster recovery. We report our early experience of aortic valve replacement through a right anterior mini-thoracotomy.
La chirurgie de remplacement valvulaire aortique offre toujours d'excellents résultats avec une morbidité et une mortalité faibles. Cependant, l'évolution de la chirurgie nous incite à développer des techniques mini-invasives. La mini-thoracotomie antérieure droite, pour la chirurgie de remplacement de la valve aortique, techniquement plus complexe, offre de nombreux avantages. Cette technique assure une réduction des pertes sanguines et des douleurs postopératoires, une meilleure fonction respiratoire, un rétablissement plus rapide (durée de séjour hospitalier plus court) et un bénéfice esthétique. Nous rapportons ici notre expérience initiale de remplacement valvulaire aortique par mini-thoracotomie antérieure droite.
Subject(s)
Aortic Valve , Heart Valve Prosthesis Implantation , Minimally Invasive Surgical Procedures , Hospitals, University , Humans , Length of Stay , Retrospective Studies , Sternotomy , Thoracotomy , Treatment OutcomeABSTRACT
Minimally invasive aortic valve surgery aims at reducing surgical invasiveness whilst preserving the high efficacy of surgical aortic valve replacement. As such it increases the value of the overall procedure. The surgical experience at the ULg is reported and replaced in the context of the pertinent related litterature.
La réalisation de la chirurgie de la valve aortique par une voie d'abord réduite atténue le traumatisme chirurgical subi par le patient, mais doit garantir un geste de qualité équivalente. Au travers de la présentation d'une histoire clinique inscrite dans la routine, nous rapportons l'expérience du service dans ce domaine et nous la confrontons aux données de la littérature. L'approche mini-invasive apporte des avantages supplémentaires par rapport à la chirurgie conventionnelle et s'inscrit dans l'évolution actuelle des procédures interventionnelles.
Subject(s)
Aortic Valve/surgery , Heart Valve Prosthesis Implantation/methods , Minimally Invasive Surgical Procedures , Sternotomy/methods , Aged , Female , Hospitals, University , HumansABSTRACT
OBJECTIVES: Currently, the prevalence of abdominal aortic aneurysm (AAA) in patients with coronary artery disease (CAD) and the correlation between CAD severity and AAA prevalence are not clearly known. We conducted a prospective study to determine the prevalence of AAA in patients undergoing coronary angiography and to determine the risk factors and a coronary profile associated with AAA. METHODS: Over an 18-month period, abdominal aortic ultrasound was performed on 1,000 patients undergoing coronary angiography for suspected or known CAD, or prior to valve surgery. Clinical characteristics and coronary profile were collected from the patients. RESULTS: The overall number of previously repaired, already diagnosed, and new cases of AAA in the study population was 42, yielding a prevalence of 4.2%. Among the patients with newly detected AAAs, only two had an AAA diameter of >54 mm and were therefore treated surgically. In men aged ≥ 65 years, the prevalence reached 8.6%, while in men with three-vessel CAD it was 14.4%. Multivariate analysis showed that age ≥ 65 years (p = .003), male gender (p = .003), family history of AAA (p = .01), current smoking (p = .002), and three-vessel CAD (p < .001) were significantly associated with a higher prevalence of AAA. CONCLUSION: The prevalence of AAA was high in men aged ≥ 65 years and in those with three-vessel CAD regardless of age. While our findings do not prove the cost-effectiveness of screening for AAA in these high risk patients, they do support the usefulness of a quick ultrasound examination of the abdominal aorta during routine transthoracic echocardiography in such patients.
Subject(s)
Aortic Aneurysm, Abdominal/epidemiology , Coronary Artery Disease/epidemiology , Aged , Aortic Aneurysm, Abdominal/diagnostic imaging , Comorbidity , Female , Humans , Male , Middle Aged , Prevalence , Prospective Studies , Risk Factors , Severity of Illness Index , Smoking/epidemiology , UltrasonographyABSTRACT
ExtraCorporeal Membrane Oxygenation (ECMO) is a cardiopulmonary assistance device able to support patients in cardiac arrest, refractory cardiogenic shock or refractory hypoxemia otherwise sentenced to death. Recent technical progresses, early indication decision, bedside multidisciplinary implant, specific complications screening and echocardiographic weaning testing are crucial points to allow success of this exceptional technique.
Subject(s)
Extracorporeal Membrane Oxygenation/methods , Heart Arrest/therapy , Hypoxia/therapy , Intensive Care Units , Shock, Cardiogenic/therapy , Extracorporeal Membrane Oxygenation/adverse effects , HumansABSTRACT
BACKGROUND: Thymectomy is considered as an effective therapeutic option for patients with myasthenia gravis (MG). This study reports the experience of our centre's investigation into the efficacy and the safety of the procedure and the influence of different pre-operative factors on the surgical outcome. METHODS: A retrospective chart review/interview was made of 19 consecutive patients who underwent extended transsternal thymectomy for MG from 1992 to 2003. The severity of the disease was determined according to the Osserman Classification. Efficacy was measured by determining the change in clinical status, the rate of remission during follow-up, and the reduction in medication requirements after thymectomy. Complete remission (CR) was defined as asymptomatic off medication for 6 months. The CR rate was calculated using the Kaplan-Meyer method. RESULTS: The mean age of the patients at surgery was 34 years (range, 9-63) and 78.9% were female. Mean length of follow up was 86 months (range, 24-163). The overall complication rate was 10.6% (1 episode of atrial fibrillation and a left recurrent laryngeal nerve palsy that resolved after the first postoperative month). There was no operative mortality. The mean hospital stay was 9.4 days (range, 5-23). The crude CR rate was 32% (n = 6). The Kaplan-Meier estimate of CR was 42% at 6 years. Age, gender, duration of symptoms, thymic histology, Osserman stage and the presence of thymoma were not identified as prognostic variables. The average daily dose of Medrol and Mestinon decreased significantly between the pre-operative period and the last follow-up (Medrol, p = 0.0081; Mestinon, p = 0.0013). CONCLUSIONS: Transsternal thymectomy for MG is safe and effective. It benefits patients with MG at all stages. Patients with thymoma are not associated with poorer remission rates. Complete responses are durable, as the CR rate remains stable over time.
Subject(s)
Myasthenia Gravis/surgery , Thymectomy/methods , Adolescent , Adult , Anti-Inflammatory Agents/administration & dosage , Child , Cholinesterase Inhibitors/administration & dosage , Female , Humans , Male , Methylprednisolone/administration & dosage , Middle Aged , Myasthenia Gravis/classification , Pyridostigmine Bromide/administration & dosage , Retrospective StudiesABSTRACT
Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occuring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Treatment is medicosurgical: thoracoscopy for pleural abrasion and hormonotherapy to avoid recurrence.
Subject(s)
Menstruation , Pneumothorax/etiology , Adult , Drainage , Humans , Male , Pneumothorax/physiopathology , Pneumothorax/surgery , RecurrenceABSTRACT
A case of dilated ischemic cardiomyopathy, with severely impaired left ventricular systolic function, treated by endoventriculoplasty and CABG, is reported. The authors discuss the modern concepts regarding the surgical treatment of large anterior asynergic scars following occlusion of the LAD. Since there are more similarities between akinesia and dyskinesia than previously thought, the endoventriculoplasty of DOR may constitute a new way to surgically remodel the left ventricle in dilated cardiomyopathies with large anterior akinesia. This surgery significantly improves the ventricular function and the overall patients' prognosis at short and mid term follow up.
Subject(s)
Cardiomyopathy, Dilated/surgery , Cardiomyoplasty , Heart Ventricles/surgery , Myocardial Ischemia/surgery , Cardiomyopathy, Dilated/complications , Cardiomyoplasty/methods , Female , Humans , Middle Aged , Myocardial Ischemia/complicationsABSTRACT
We report the case of a patient who developed an evolutive chronic aortic dissection after ascending aorta replacement for acute type A aortic dissection. Owing to the development of severe aortic regurgitation, aortic root pseudoaneurysm and aneurysmal dilatation of the arch and descending aorta, reoperation was adviced. Reoperation included Cabrol modification of the Bentall operation and aortic arch replacement with elephant trunk performed under deep hypothermic circulatory arrest. The incidence of late aneurysmal formation in type 1 aortic dissection has been reported to be 30%. Close postoperative follow-up of the aortic diameter is necessary to detect a critical dilatation and to permit elective reoperation.
Subject(s)
Aorta, Thoracic/abnormalities , Aorta, Thoracic/surgery , Aortic Aneurysm/surgery , Aortic Dissection/surgery , Heart Valve Prosthesis Implantation , Aneurysm, False , Bioprosthesis , Chronic Disease , Humans , Male , Middle Aged , ReoperationSubject(s)
Lipoma/diagnosis , Liposarcoma/diagnosis , Retroperitoneal Neoplasms/diagnosis , Adult , Aged , Female , Humans , Lipoma/therapy , Liposarcoma/therapy , Male , Middle Aged , Retroperitoneal Neoplasms/therapyABSTRACT
As shown earlier, the three drugs are effective against most anaerobic bacteria. However, with Bacteroides fragilis the geometric mean MIC of metronidazole (0.43 microgram/ml), ornidazole (0.37 microgram/ml) and tinidazole (0.20 microgram/ml) are statistically different. Moreover, and contrary to generally accepted opinion, some aerobic bacteria such as Moraxella and Bacillus can be susceptible to nitro-imidazoles. The results suggest another mechanism for the action of nitro-imidazoles, different from that previously described. This underscores the major role of the reduction of the nitrogroup by a low-redox-potential. Two strains of strictly anaerobic bacteria show a relative resistance in the microaerophilic zone.
Subject(s)
Bacteria/drug effects , Metronidazole/pharmacology , Nitroimidazoles/pharmacology , Ornidazole/pharmacology , Tinidazole/pharmacology , Aerobiosis , Anaerobiosis , Drug Resistance, Microbial , Microbial Sensitivity Tests , Oxygen/pharmacology , Partial PressureABSTRACT
For a period of 17 months, 670 pneumococci, mostly isolated in the Paris area, have been typed with contercurrent-immunoelectrophoresis ; 338 of them come from cases of pneumonia, bacteremia, meningitis and acute otitis media. An important regrouping of the most frequent serotypes among the 83 known serotypes makes possible a vaccinal prophylaxis. The tetradecavalent vaccine which is now for sale in USA gives, in the four main pathologies of this enquiry, a coverage superior to 80 percent. Choosing the 14 most frequent serotypes of the four main pathologies of their data the authors propose the following vaccinal formula : 1, 3, 4, 5, 6, 7, 8, 10, 12, 14, 15, 18, 19, 23.
Subject(s)
Streptococcus pneumoniae/classification , Adolescent , Adult , Aged , Bacterial Vaccines , Child , Child, Preschool , Counterimmunoelectrophoresis , France , Humans , Immunotherapy , Infant , Infant, Newborn , Meningitis, Pneumococcal/microbiology , Middle Aged , Otitis Media/microbiology , Pneumonia/microbiology , Polysaccharides, Bacterial , Sepsis/microbiology , Serotyping , Streptococcus pneumoniae/immunologyABSTRACT
The authors have carried during one year, in the hospital of Villeneuve-Saint-Georges, a prospective study on 229 cases of pneumococcal infections with bacteriological findings. They emphazise the frequency, the high-exposed groups and the gravity of these infections despite of the antibiotherapy. The emergence of multiply resistant pneumococcus makes out another argument for proposing a preventive vaccination taking notice of the most frequent serotypes found in France.
Subject(s)
Pneumococcal Infections/epidemiology , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Drug Resistance, Microbial , Female , France , Hospitals, General , Humans , Immunotherapy , Infant , Infant, Newborn , Male , Middle Aged , Pneumococcal Infections/prevention & control , Prospective Studies , SerotypingABSTRACT
The authors report the detailed study of a strain of Actinomyces odontolyticus isolated from a pleural liquid. Gas-liquid chromatography can specify the biochemistral metabolism of the germ and set off an endocellular lipidolytic activity.
