[Middle aortic syndrome: a case report]. / Middle aortic syndrome: à propos d'un cas.

Middle aortic syndrome (MAS) results from a diffuse narrowing of the distal thoracic or abdominal aorta commonly involving both the visceral and renal arteries. Congenital, acquired, inflammatory, and infectious etiologies have been described. Symptoms typically occur within the first three decades of life and include hypertension, lower extremity claudication, and mesenteric ischemia. The condition is considered a life-threatening emergency as a result of the complications associated with severe hypertension. Diagnosis is made with magnetic resonance and computed tomography angiography. Surgical bypass grafting is the optimal method of treatment and must be tailored depending on the distribution of disease. We report one case of MAS treated with thoracic aorta to abdominal aorta bypass and reimplantation of the right renal artery.

[Antifibrinolytic agents and repeat open-heart surgery: a comparison of tranexamic acid and low dose aprotinin]. / Antifibrinolytiques et réinterventions chirurgicales à coeur ouvert: comparaison de l'acide tranexamique aux faibles doses d'aprotinine.

PURPOSE: This retrospective study has for objective to compare the effect of tranexamic acid with low-dose of aprotinin therapy on blood loss in reoperative cardiac surgery. METHODS: Ninety-one adult patients underwent repeated open-heart surgery. Two groups of patients were collected. The aprotinin group AP (N=60) has received an intravenous full low dose of 500000 UIK of aprotinin. The tranexamic group TA (N=31) has received 30 mg/kg of tranexamic acid. Criteria for assessment included: cumulative blood loss at 4 hours and 20 hours after operation, need for transfusion and parameters of coagulation (platelet, fibrinogen count). RESULTS: Demographics characteristics and echocardiographic data were similar between the tow groups. Postoperative blood loss at 4th hour and at 20th hour were reduced in tranexamic group compared with aprotinin group (P=0,009, P=0,001). The transfusion requirement was frequent in the AP group 39% vs 19.4% in TA group. The TA group received fewer total unit of red blood (0.38 unit RBC/patient vs 1.06 in AP group) [RBC=red blood cells]. There was no statistically significant difference in platelet and fibrinogen profiles. CONCLUSION: This study concludes that tranexamic acid and low dose aprotinin effectively reduces postoperative bleeding in repeat open-heart surgery. However, the marked difference in superiority between these tow drug therapies needs the randomized and controlled study.

[Upper digestive bleedings after cardiac surgery]. / Hémorragies digestives hautes après chirurgie cardiaque.

INTRODUCTION: Upper gastrointestinal haemorrhage (UGH) following cardiac surgery is infrequent with high mortality. The aim of this study is to compare the frequency and outcome of UGH in patients who had undergone open heart surgery at our institution. PATIENTS AND METHODS: From January 1994 to December 2005, 1278 cardiac operations were performed. A systematic prophylaxis antiacid was used by antagonists of histaminic receptor (anti-H2, ranitidine 150 mg/12 h) in all patients. The diagnosis was based on clinical symptoms (haematemesis and/or melaena) in the postoperative period and confirmed by fibroscopy. We conducted a retrospective study of these patients. RESULTS: Only 8 of the 1278 (0,6%) cardiac operations were complicated by UGH. Demographic data were reported in Table 1. The mean interval between surgery and UGH was 10+/-3,7 days (range 5,15 days). Gastro-duodenal ulcer was the most common cause of UGH in 5 patients (62%), ulcero-hemorrhagic eosophagitis was developed in one patient (12,5%), candidosic eosophagitis in one and multiple gastric ulcer in one patient (12,5%). Medical treatment was applied in 6 patients (72%) with successful result. Surgical intervention was necessary in 2 patients (25%). 2 patients had repeat gastrointestinal bleeding. One patient was died; he was recorded as having severe sepsis and multiple organ failure in addition to UGH. CONCLUSION: UGH in patients undergoing heart operation is rare but associated with poor prognosis despite antiacid prophylaxis. These complications occurred in patients who had in postoperative bad hemodynamic conditions.

[Tranexamic acid versus aprotinin for the prevention of bleeding during mitral valve surgery ]. / Prévention du saignement dans la chirurgie de la valve mitrale: comparaison de l'acide tranexamique aux faibles doses d'aprotinine.

PURPOSE: This retrospective stady has for objective to compare the effect of Tranexamic Acid (TA) to the low dose of aprotinin (AP) in primary mitral valve surgery in terms of blood loss and transfusion requirements. METHODS: Are included in the study operated patients of a valvulopathy mitral isolated. Two groups of 50 patients are collected. The tranexamic acid group has received 30 mg kg-1 the acid tranexamic and the aprotinin group has received a low regimen as 500,000 UIK of aprotinin. Blood loss by the chest drains are assessed to different times during first 24 hours post cardiopulmonary bypass. In the same way, we have measured the platelet and fibrinogen count. Blood products were administered according to a classic protocol. RESULTS: The two groups are comparable clinic and echocardiographic parameters what authorizes us an appariement acceptable. Various cardiopulmonary bypass times are almost similar. We noticed a tendency to excessive blood loss processed by low regimen aprotinin and a significant rate difference of platelet and the fibrinogen level. But no complication has been recorded in the two groups. CONCLUSIONS: This study demonstrates relatively different effect of the two fibrinolytics inhibitors in primary mitral valve surgery. As for the superiority of one of the two produces, it needs a confirmation by a randomised and controlled clinical trial.

[Angiosarcoma of the right atrium. Presentation of a surgically treated case and comparison with data of the literature]. / Angiosarcome de l'oreillette droite. Présentation d'un cas opéré et comparaison avec les données de la littérature.

The authors report the case of a 28-year-old woman referred to their department by a respiratory medicine department with an inferior mediastinal tumour arising from the right atrium, presenting in the form of dysponea, dry cough and chest pain associated with a general syndrome composed of fever, weight loss and physical asthenia. Physical examination revealed a superior vena cava syndrome, the electrocardiogram showed diffuse repolarization disorders and the chest x-ray showed an opacity of the anterior and inferior mediastinum. The diagnosis of tumour of the right atrium was based on echocardiography and thoracic CT scan. Subtotal surgical resection under cardiopulmonary bypass allowed examination of the histological type of the tumour. After routine chemotherapy, despite negative secondary staging and a favourable immediate course, the patient died 11 months after the operation in a context of local recurrence and hepatic and bone metastases.