Extracorporeal circulation in European Economic Community (ECC in EEC): 1979-1989.

This study determines the evolution of ECC in EEC. After recollecting the great stages of ECC since its routinely use in open heart surgery, the study situates its position in the entire world taking into account several indexes like the Gross National Product (GNP) and its evolution, the life expectancy and some other factors either technical or economical. Only a coarse analysis could be done for Europe due to an unsteady evolution. A more detailed analysis has been achieved for France thanks to a greater number of data. In such a study the major difficulty is to estimate the relevance and consistency of data which can change very quickly and are provided either by companies or by other organization.

[Use of extracorporeal circulation oxygenators (CEC) in the European Economic Community (EEC)]. / Utilisation des oxygénateurs en circulation extra-corporelle (CEC) dans la Communauté Economique Européenne (CEE).

This study analyses the growth of CPB in the EEC. The study situates its position in the world taking into account several indexes such as the Gross National Product and its growth the life expectancy and other technical or economic factors. Only a broad analysis could be performed for Europe to the irregular development of CPB. A more detailed analysis was performed for France thanks to a greater number of data. In this type of study the most important problem is to estimate the relevance and consistency of the data provided either by companies or by other organizations because they can change very quickly.

Monitoring of blood gases during extracorporeal circulation with an artificial lung.

During cardiopulmonary bypass, the heart-lung machine and the patient's gas exchange systems (uptake and elimination) form an undissociable couple. Changes in one of the components lead to corresponding changes in the other. In the artificial lung, like in the natural lung and peripheral tissues, gas exchanges depend on several parameters: blood inlet conditions, blood flow rate, temperature, composition of the gas mixture used for ventilation, blood tissue perfusion, O2 consumption, etc. The perfusionist's primary objective is to obtain from the artificial lung adequate O2 delivery to and CO2 removal from the tissues. This paper discusses the main parameters which must be taken into account and analyses the main sensors currently available for in-line measurement of blood gases.

[Deliveries outside maternity hospitals. 5-year prospective study apropos of 150 cases]. / Les accouchements hors maternité. Etude prospective sur 5 ans à propos de 150 cas.

Deliveries outside of maternity hospitals in 1983 resulted in many high risk newborns. In 40% of cases it occurred in lower socio-economic groups and in 60% was due to lack of information with regards to recent progress in obstetrical care. The presence of regional emergency services (SAMU) and competent pediatric care, has allowed for rapid transport and medical intervention. One hundred and fifty newborns weighing between 850 and 3,790 gms were thus transported: 50% were of low birth weight, 63% born after 38 weeks gestation and 37% were premature. Hypothermia was common and details of labour were unknown. Despite rapid intervention, there were 9 deaths including 6 with severe neonatal asphyxia. Morbidity was related to socio-economic and intellectual parental levels.

[Myocardial fibrosis in cystic fibrosis. A new case report (author's transl)]. / Fibrose myocadique au cours de la mucoviscidose. A propos d'une nouvelle observation.

We report the case of a 9 month-old infant in whom acute heart failure was the presenting symptom of cystic fibrosis. Post-mortem examination showed lesions of myocardial fibrosis associated with typical lesions of cystic fibrosis in the pancreas. Hypoproteinemia and anemia were present and earlier could have suggested the correct diagnosis before the episode of acute heart failure. The analogy of the histologic myocardial changes in cystic fibrosis and in congenital lipomatosis of the pancreas suggests a common pathogeny related to the deficiency of the exocrine secretion of the pancreas.

Ventricular septal defect after acute myocardial infarction: Early repair.

Thirty-eight patients have been operated upon early after acute myocardial infarction with rupture of the ventricular septum. Preoperative management included bedside hemodynamic evaluation, mechanical left heart support, and pharmacologic agents. The results of the surgical repair reflected both the effectiveness and the duration of preoperative treatment. Operation was performed in 14 patients with refractory cardiogenic shock, 10 of whom died (71%). Hemodynamic and clinical stability was achieved in 24 patients. Early operation (average 46 hours of medical management) in 17 patients permitted accurate repair, even with friable tissues; four of these patients died (23%). Delayed operation (average 12 days of monoperative treatment) was performed in seven patients and resulted in a higher mortality rate, three patients dying (43%). The location of the ventricular septal defect (VSD) also influenced the operative risks, the prognosis for posterior defects being worse than that for anterior defects. Optimal myocardial preservation during the entire procedure is of crucial importance to the success of the operation.

[Interruption of the aortic arch and an aorto-pulmonary fistula. Simultaneous correction of lesions in a 5 1/2 month old infant]. / Interruption de l'arche aortique et fistule aorto-pulmonaire. Cure simultanée des lésions chez un enfant de 5 mois et demi.

Aortic arch hypoplasia is rare but carries a poor prognosis. It is usually associated with a left to right shunt at ventricular level. The association of an aorto-pulmonary fistula is exceptional. A case of a 5 1/2 month old infant treated successfully by simultaneous correction is reported with a review of the physiopathological changes. Pulmonary hypertension and aortic perfusion depend on the calibre of the ductus arteriosus and its evolution. The therapeutic problems which result are the suppression or palliation of pulmonary hypertension and resaturisation of distal aortic vascularisation. Surgery is the only hope of cure, and current techniques are reviewed: two stage procedures with revascularisation of the distal aorta and pulmonary artery banding, or simultaneous correction of aortic continuity with suppression of the left to right shunt under cardiopulmonary bypass. The technical conditions are analysed: perfusion of the different aortic segments, methods of reestablishing aortic continuity. Good results are as yet rare, and are obtained after complete correction under cardiopulmonary bypass.

[Acute early mitral insufficiency following myocardial infarction]. / L'insuffisance mitrale aiguë et précoce après infarctus du myocarde.

Five cases of acute mitral incompetence complicating myocardial infarction at an early stage underwent early mitral valve replacement. The surgical indications were deterioration of the clinical and haemodynamic conditions or dependance on medical therapy and intra-aortic balloon pumping. The mitral lesion was haemorrhagic necrosis of the posterior papillary muscle in all cases, associated with rupture of the chordae or papillary muscle in 3 cases. The outcome was favourable in all cases and has been maintained after more than two years post operative follow-up. The problems of the surgical indications, the mitral valve replacement and coronary revascularisation are discussed.

[Intermdeiate forms of atrioventricular defects. Reflections apropos of 50 consecutively operated cases]. / Le canal atrio-ventriculaire dans ses formes partielles. Réflexions à propos de 50 cas opérés consécutivement.

Fifty cases of intermediate forms of atrioventricular defect were treated surgically. The operation was performed in the traditional manner in all cases. One post-operative death and three cases of severe mitral incompetence leading to reoperation were observed. The authors emphasise that it is essential to look for and excise the chordae and abnormal fibrous bands, that it is generally unnecessary to touch the tricuspid valve and that there is a danger of obstructing the aortic canal if the correction of the asymmetry of some mitral clefts is attempted. Analysis of the results leads them to tend to respect the cleft mitral valve when the regurgitation is minimal and to suture it all along its length when the regurgitation is severe. Mitral annuloplasty may be a useful complementary procedure and a left atrial approach may be proposed with this in mind in certain cases. Conduction defects remain a serious problem in this type of surgery; not so much complete heart block, which is exceptional, but trifascicular block, often present preoperatively, whose prognostic is, to say the least, uncertain.

[The "small aortic ring." Hope for a surgical solution]. / Le "petit anneau aortique": un espoir de solution chirurgicale.

The "small aortic ring" was until recently an unresolved problem for surgeons operating on the aortic valves. It used to contraindicate valve replacement in the child, and sometimes led to the insertion of too small a valve in the adult. Some hope of a solution has appeared in the form of three new techniques: enlargement of the aortic ring over the mitral valve, aorto-ventriculoplasty, and apico-aortic shunt. Two adults have had the ring enlarged above the mitral valve with good results in both cases. Five children have had an aorto-ventriculoplasty with good results in two cases, post-operative atrio-ventricular block in one, and two deaths, one early and the other late. These deaths appear to be more closely related to the severity of the initial lesion and to the degree of decompensation of the myocardium than to the operation itself. There are advantages and problems with this technique. An attempt has been made to systematise indications for treatment as a function of the lesions and the state of the patient.