[Segmental variations of great saphenous vein diameters in a coronary triple vessel disease population]. / Variations des diamètres segmentaires des veines saphènes internes chez une population coronaire tritronculaire.

BACKGROUND: Great saphenous vein is one of the most used grafts in cardiovascular surgery. There is little amount of data in the medical literature describing dimensions of this vein. This series describes dimensions of the great saphenous vein in a coronary population and their variations. PATIENTS AND METHODS: Retrospective series of patients admitted to the cardiovascular surgery department of Hotel-Dieu de France Hospital - Beirut, between January 2003 and June 2006 for elective coronary artery bypass grafting and having a preoperative Doppler ultrasound of the saphenous veins according to a standardized protocol. Great saphenous vein dimensions were analyzed with regard to patients' characteristics using multivariable analysis of variance. RESULTS: Four hundred and two subjects were included with a mean age 64.4+/-9.3 years and a mean body mass index 27.9+/-4.5 kg/m(2). Women presented 22.6% of the series. Great saphenous vein dimensions' variations according to gender were significant (Multivariate Pillay trace=0.001) below the knee. Dimensions' variations were also significant as function of body mass index (P=0.001) and body surface (P=0.001). Age and cardiovascular risk factors did not influence GSV diameters. CONCLUSION: This series allowed constructing reference tables of the great saphenous vein segmental diameters in patients admitted for coronary artery surgery. Female sex is associated with lower segmental diameters below the knee and body mass index and body surface are linearly associated with segmental diameters at all levels.

Tricuspid insufficiency after blunt chest trauma in a nine-year-old child.

The case of a traumatic tricuspid insufficiency in a child, due to an anterior and septal leaflet rupture at the annulus level is reported for the first time. The early diagnosis 2 months after the trauma enabled a rapid and simple tricuspid valvuloplasty by laeflet reinsertion on the annulus associated with annuloplasty with a good result 6 months after the repair.

[Carcinoid heart disease]. / Cardiopathie carcinoïde.

Carcinoid cardiac disease is a common complication of metastatic carcinoid tumours. It is characterized by tricuspid regurgitation and pulmonary stenosis. A 68 years old woman with a metastatic carcinoid tumour was admitted to hospital for congestive cardiac failure secondary to severe tricuspid regurgitation. Typical carcinoid lesions of the tricuspid and pulmonary valves were observed at echocardiography. A double valve replacement was performed with a favourable outcome. Postoperative echocardiography showed a significant improvement in right ventricular function. Surgical management of carcinoid valvular heart disease of NYHA Stage III patients is associated with an improved 2 years survival (from 8 to 40%) despite a high operative mortality (about 27%). Cardiac surgery remains the only hope of long-term survival with a spectacular improvement in symptoms.

Renal artery pseudoaneurysm after blunt abdominal trauma.

Renal artery pseudoaneurysms are rare after blunt abdominal trauma; only 11 cases have been previously reported. Pseudoaneurysms are caused by decelerating injuries of the renal artery after major falls or automobile accidents. Patients may be asymptomatic for many years, and the pseudoaneurysm may expand and rupture before diagnosis or treatment. The patients in four untreated cases died. The diagnosis of renal artery pseudoaneurysm can be made by Doppler sonography, computerized tomography, renal perfusion imaging, or contrast angiography. Treatment requires either surgical or percutaneous intervention. Renal salvage was possible in five of the seven patients treated. We report two additional patients with successful outcomes after surgical intervention.

[Cardiac failure caused by renal arteriovenous fistula fifty years after nephrectomy. A new case and review of the literature]. / Insuffisance cardiaque par fistule artérioveineuse rénale cinquante ans aprés néphrectomie. Nouvelle observation et revue de la littérature.

Arterio-venous fistulae are rare after nephrectomy. They are the cause of congestive cardiac failure. This case report has two particularities: an exceptionally long interval, 50 years after nephrectomy, and a severe hypertension due to stenosis of the contra-lateral renal artery. Surgical treatment of these fistulae is essential and gives excellent results with rapid regression of the signs of cardiac failure. Percutaneous embolization is an alternative in patients with a high surgical risk. All previously reported cases are reviewed (n = 72) with their aetiological, clinical and therapeutic features.

[Coronary surgery in patients 70 years and older. Report of 70 cases]. / La chirurgie coronaire chez les malades agés de plus de 70 ans. A propos de 70 cas.

Between January 1993 and January 1995, seventy patients over 70 years of age underwent coronary artery revascularization and were retrospectively reviewed. The anesthetic protocole, the surgical technique and the intraoperative myocardial protection were similar for all patients. Fourteen patients (19.8%) suffered major postoperative complications: stroke (3 cases), myocardial infarction (5 cases), left ventricular failure with intraaortic counter-pulsation (2 cases), gastrointestinal hemorrhage (2 cases), respiratory failure (2 cases). Thirty patients (42.6%) had minor complications with no impact on survival or hospital stay. Hospital mortality was 7.1% (5 patients) and was caused by left ventricular failure (2 cases), stroke (1 case), gastrointestinal hemorrhage (1 case), respiratory failure (1 case). Mortality was found to be correlated with preoperative renal failure, peripheral vascular disease and concomitant carotid endarterectomy. Patients remained in the cardiac surgery unit for 60 hours. The mean length of hospital stay was 8.2 days. Follow-up from 1 to 24 months revealed NYHA angina class I-II in 85% of the patients. These results are similar to other studies. We conclude that coronary artery revascularization in the elderly yields good results, with fair mortality and morbidity rates.

[Mycotic aneurysm of the external ilial artery: a very rare complication of coronary angioplasty]. / Anévrysme mycotique de l'artère iliaque externe: une complication rarissime de l'angioplastie coronaire.

Vascular complications, mostly hematomas and false aneurysms, are rare after coronary angiography. Infectious problems are even less frequent and a mycotic aneurysm is an extremely rare complication. Our patient presented with a mycotic aneurysm of the external iliac artery following percutaneous transluminal coronary angioplasty.

Spontaneous cholesterol embolization. A rarely reported entity.

Cholesterol embolization sometimes occurs after invasive procedures involving manipulation of the aorta or its major branches, and less commonly occurs after thrombolytic therapy for acute myocardial infarction. Rarer still is spontaneous cholesterol embolization, a case of which we now report. Our patient experienced peripheral embolization, the origin of which was traced to the infrarenal aortic segment and the common iliac vessels. Aortoiliac reconstruction was successful; we believe that surgical management of this condition should be performed in selected cases.

Spontaneous cholesterol embolization--a rare clinical entity.

Embolization of cholesterol crystals from atheromatous plaques is a rare entity most often seen after invasive procedures involving manipulation of the aorta. Spontaneous CE has been reported in very rare cases. Peripheral signs include livedo reticularis, muscle pain and palpable pulses. Depending on the site of the responsible plaque, emboli may involve visceral organs and produce a systemic illness. Diagnosis is confirmed using skin, muscle and/or renal biopsies. Surgery is recommended when the atheromatous disease is localized to a unique segment which can be replaced.

Total anomalous pulmonary venous connection in adults--a surgical review.

The authors report a case of surgical repair of total anomalous pulmonary venous connection in a 36-year-old male. This is a very rare disease in adulthood since over 80% of the infants die before one year of age. Fifty-two surgical cases were previously reported in the literature. An extensive review of these cases is presented. Surgery is the only treatment and offers excellent short- and long-term results.