[Tricuspid reoperation in the surgery of rheumatic valve diseases. Apropos of 24 cases]. / Réintervention tricuspidienne dans la chirurgie des valvulopathies rhumatismales. A propos de 24 cas.

Twenty four patients were reoperated on the tricuspid valve alone between 1967 and 1981. The first operation had been performed for mitral valve disease and consisted of 23 mitral valve replacements and one commissurotomy associated with two aortic valve replacements. The surgical decision with regard to the tricuspid valve at the initial operation had been abstention (10 cases), tricuspid valvuloplasty (10 cases) and tricuspid valve replacement (4 cases). Reoperation on the tricuspid valve is rare (0,2 p. 100 of mitral valve operations, 1 p. 100 of mitro-tricuspid valve operations). The 24 cases were divided into 2 groups: --Group I, in which reoperation was indicated for curable tricuspid lesions: .4 reoperations for prosthetic valve dysfunction (4 mechanical prostheses were responsible for 3 thromboses and 1 perivalvular leak); .3 reoperations for failed valvuloplasty (2 Kay valvuloplasties and 1 Carpentier annuloplasty); .2 reoperations for aggravation of neglected functional lesions at the first operation and which were reoperated after 3,5 and 4,5 years, because of increased dilatation of the annulus; .5 reoperations for aggravation of organic lesions which had been neglected in 3 cases and treated by valvuloplasty in 2 cases. Five prosthetic valve replacements were carried out, on average 17 months after the first operation. --Group II, in which reoperation was unable to improve congestive heart failure; dilatation of the tricuspid annulus was only a consequence of the cardiac failure. The secondary tricuspid valve surgery (5 valvuloplasties, 5 annuloplasties) did not alter the extremely poor prognosis of these patients (5 hospital deaths, 3 postoperative deaths within 2 years).(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of single ventricle by direct atriopulmonary anastomosis without tube or valve. Apropos of a case operated on]. / Traitement du ventricule unique par anastomose antrio-pulmonaire directe sans tube ni valve. A propos d'un cas opéré.

A case of single ventricle with pulmonary stenosis operated at 20 years of age by direct atrio-pulmonary anastamosis is presented. This procedure in contrast to classical techniques does not use an intraventricular patch or a valved ventriculo-pulmonary conduit. It is an adaptation of the Fontan technique initially proposed for tricuspid atresia. The operation consisted of closing the right atrioventricular orifice with a piece of Dacron, suturing the pulmonary valves (which were stenosed) and connecting the right atrium and pulmonary artery by a direct anastamosis using the auricle. The clinical result remains satisfactory one year after surgery: the cyanosis has regressed, the functional tolerance is perfect, there is no hepatomegaly and the patient is in sinus rhythm. The technique is very simple and involves less risk to the His bundle than intraventricular septalisation. It should be reserved to cases of single ventricle with low pulmonary pressures and resistance without cardiac failure. The long-term prognosis depends on the tolerance of the right atrium and is, at present, unknown.

Right juxtaposition of the atrial appendages. A case without cono-truncal anomaly.

A three-year old girl with right juxtaposition of the atrial appendages associated with a secundum atrial septal defect and pulmonary hypertension is reported. The appendage anomaly was demonstrated by angiography and confirmed at operation to close the atrial defect.