[Pneumothorax catamenial: results of 18 cases operas]. / Pneumothorax catamenial: resultats de 18 cas opérés.

This study aims to propose a therapeutic approach for catamenial pneumothorax based on outcomes reported in 18 cases. We conducted a retrospective study of 18 female elderly patients with an average age of 32.2 years who had undergone surgery for right (16 cases) and bilateral catamenial pneumothorax (2 cases) from January 1994 to December 2016. The patients were divided into 3 groups on the basis of the evolution of our surgical capability over time: group 1(G1) from January 1994 to June 2006, group 2 (G2) from July 2006 to February 2008, group 3(G3) from March 2008 to December 2016, these groups were composed of 5, 2 and 11 patients respectively. All these patients were nulliparous who had suffered from dysmenorrhoea associated, in 11 cases, to catamenial chest pain since puberty. Standard radiographic evaluation of the chest was sistematically performed and complemented, in 8 cases, by chest CT scan that showed apical bubbles in addition to pneumothorax (5 cases). Exploration through posterolateral mini-thoracotomy (16 cases) and through videothoracoscopy (2 case of G3) showed diaphragmatic fenestrations (18 cases) and bubbles (5 cases). Biopsy of lesions as well as resection of the bubbles were sistematically performed . Surgical treatment of diaphragmatic fenestrations was based, in group 1, on resection-suture with pleural abrasion, in group 2, on Gore-tex patches coverage with pleural abrasion and, in group 3, on patch coverage with pleural talcage. Each patient underwent hormone therapy (triptoreline) for 6 months during postoperative period, in order to suspend menstruations. Surgical outcomes were evaluated on the basis of the recurrence or non-recurrence of a pneumothorax after resumption of menstruations. Mortality was zero. Postoperative hospital length of stay was 9.32 days. Anatomo-pathological examinations confirmed thoracic endometriosis in 9 cases. After a mean follow-up period of 5.3 years, outcomes were good in 12 patients (3/5 in G1, 1/2 in G2 and 8/11 in G3); 3 patients in G3 continued to have minimal episodes of dyspnoea at the beginning of some menstrual cycles without radiological evidence of recidivism, 3 patients (2 in G1 and 1 in G2) had recurrences requiring reoperation. We recommend phrenoplasty using patches associated with pleural talcage and complementary concomitant hormone therapy for 6 months in patients suffering from catamenial pneumothorax with diaphragmatic fenestrations.

Noncardiac thoracic surgery in Abidjan, from 1977 to 2015.

BACKGROUND: To report and analyze noncardiac thoracic operations performed at the Cardiology Institute of Abidjan (Institut de Cardiologie d'Abidjan) from 1977 to 2015. METHODS: This is a retrospective and descriptive study covering 39 years, from 1977 to 2015. This study period was divided into three periods of 13 years each: P1 from 1977 to 1989, P2 from 1990 to 2002 and P3 from 2003 to 2015. Medical records of 2014 operated patients were analyzed: 414 patients for P1, 464 patients for P2, 1,136 patients for P3. The records destroyed in a fire in 1997 were not included in the study. The age, sex, pathologies, types of operations, post-operative complications and mortality were analyzed with usual statistical tests. RESULTS: The average age varied from 35 years in P1 to 31.6 years in P3. Men predominate in all periods. Distribution of important groups of pathologies observed varies significantly over the three periods; In particular, we note an increase in trauma cases (tripling between P1 and P2, 140% between P2 and P3), and a decrease in tumors percentages, and infections and pulmonary sequelae of tuberculosis. Surgical management of thoracic trauma has increased (56.9% in P3) followed by the pleural surgery (21.3%) and pulmonary resections (13.9%). Persistent air leak >7 days was the predominant complication over the three periods. Postoperative empyema increased in P3 (14.7%). Close chest drainage-irrigation is the most frequent procedure performed to sterilize a major complication like postoperative empyema without bronchopleural fistula. Overall mortality decreased from 5.3% in P1 to 3.4% in P3. CONCLUSIONS: Noncardiac thoracic surgery operations still concern infections, pulmonary sequelae of tuberculosis, thoracic tumors and many more thoracic trauma caused by current armed conflicts and terrorist attacks. But access to thoracic surgical care remains difficult for our population secondary to low economic status, and lack of a health insurance system. Therefore surgical consultation is often obtained at a very advanced stage of the disease. Nevertheless overall mortality observed in the practice of this surgery is reasonable.

Surgical experience on chronic constrictive pericarditis in African setting: review of 35 years' experience in Cote d'Ivoire.

BACKGROUND: Surgical experience with chronic constrictive pericarditis (CCP) is rarely documented in Africa; the aim of this study is therefore to review our African experience with CCP from 1977 to 2012 in terms of clinical and surgical outcomes and risk factors of early death after pericardiectomy. METHODS: This retrospective study is related to 120 patients with CCP; there were 72 men and 48 women with an average age at 28.8±10.4 years standard deviation (SD) (8-51 years). The main etiology was tuberculosis (99%). Symptoms secondary to systemic venous congestion were always present: patient were functionally classified according New York Heart Association (NYHA) functional classification: 63 patients presented in class II NYHA and 57 in class III or IV NYHA. The diagnosis confirmed by surgical report was: sub-acute CCP (n=12; 10%), fibrous CCP (n=36; 30%), calcified CCP (n=72; 60%). A pericardiectomy including an epicardiectomy with a systematic release of the ventricles was carried out in every case. Median sternotomy was frequently performed (n=117; 97.5%). RESULTS: Fifteen early deaths (12.5%) were observed, the cause of hospital deaths was due to a low cardiac output (n=12) and to a hepatic failure (n=3). Class III or IV (NYHA) (P=0.01), mitral regurgitation (P<0.05), persistent a diastolic syndrome after surgery (P<0.05) and low cardiac index (CI) (P<0.02) were the important risk factors. Age, size of cardiac X-ray silhouette, right and left ventricular diastolic pressures, ejection fraction (EF), atrial fibrillation and pericardial calcifications had no impact on early survival. The average follow up was 4 years (1-10 years); we lost 22 patients during follow-up. Among survivors, there was no late death; the patients were in class I or II NYHA. Post-operative catheterization evaluation (n=30) shown a significant decrease of the right and left ventricular end-diastolic pressures (P<0.05), of the pulmonary capillary wedge pressure (PCWP) (P<0.05) and of the right atrial pressure (RAP) (P<0.05) and a disappearance of the lack of ventricular diastolic distensibility. CONCLUSIONS: Based on our experience, CCP surgery can be performed safely with an acceptable hospital mortality and a significant improvement of patients' functional status at long term after surgery.

Cardiac surgery in Africa: a thirty-five year experience on open heart surgery in Cote d'Ivoire.

BACKGROUND: Few centers for open heart surgery (OHS) are in Sub-Saharan Africa. Lack of OHS results is also noted. By reporting our African experience on OHS, the aim of this study was to fill the gap. METHODS: It is a retrospective study on 2,612 patients who were subject to an OHS between 1978 and 2013. Data were collected from demographical, clinical, investigative studies, surgical and outcomes parameters. RESULTS: There were 1,475 cases of rheumatic heart diseases (RHD), 126 endomyocardial fibrosis (EMF), 741 congenital heart diseases (CHDs) and 270 various affections. Related to rheumatic valvular surgery we enumerated 1,175 monovalvular (mitral n=778, aortic n=336, tricuspid n=61); 280 bivalvular (mitral + aortic n=150, mitral + tricuspid n=130) and 20 trivalvular. For RHD, average age was 26±10.1 years (4-69 years) and 60% of our patients presented a functional class III or IV according to New York Heart Association (NYHA) classification. A total of 1,481 valvular replacements (bioprostheses n=489, mechanical prostheses n=992) and 445 valvular repair were carried out with a global and late mortality surgery respectively at 7% and 8%. One hundred and twenty-six [126] cases of EMF with right sided form 39, left sided form 40, and bilateral form 47 were colligated. Average age was 12±0.6 years (2-15 years). All patients with EMF underwent surgery; an endocardectomy in all patients combined with valvular reconstruction (n=36) or valvular replacement (n=90) was carried out with a hospital mortality at 16% (n=20). Concerning CHD, the most frequent were ventricular septal defect (VSD) (n=240), atrial septal defect (ASD) (n=200), partial atrio-ventricular sepal defect (n=30) and tetralogy of Fallot (T4F) (n=220), a total correction was performed for those CHD with an early mortality at 6.4% (n=44). CONCLUSIONS: OHS in Cote d'Ivoire was successfully performed in most of our patients, the spectrum of acquired valvular heart diseases and CHDs in our country is similar to others in Sub-Saharan Africa.