Constrictive epicarditis.

Constrictive pericarditis is relatively uncommon. Constrictive phenomenon involves in the majority of cases the two layers of the pericardium namely the parietal pericardium and the visceral one. Chronic epicarditis is a distinct and very scarce form where only the visceral pericardium is interested by the pathologic process. We present herein the case of a 25 years old patient admitted in our department for surgical treatment of a chronic visceral pericarditis. We discuss along some important clinical and therapeutic points related to this specific presentation with a special interest to the right ventricular dysfunction after pericardiectomy.

Aortic endocarditis complicated with a large ventricular septal defect and septic pulmonary embolism.

BACKGROUND: Infectious complications of the aortic valve can lead to severe cardiac failure and widespread contiguous lesions by the involvement of subaortic structures such as aorto-left ventricular discontinuity, destruction of the aortic ring, aortic abscesses, true or false aneurysms and shunts. AIM: Report a new case of a large ventricular septal defect due to infection. CASE REPORT: Abnormal communications occurring during acute aortic valve endocarditis are rare but they are very serious complications. We report a case of a 58 year-old-man, referred to our hospital with the diagnosis of aortic endocarditis with complicating root abscesses, acquired ventricular septal defect (VSD) and pulmonary septic embolism. Surgery was indicated and the whole procedure was performed through the aortic root. The patient underwent a radical resection of the abscesses, reconstruction of the aortic ring, closure of the ventricular septal defect and prosthetic replacement of the aortic valve. The immediate postoperative course was marked by persistent sepsis. Transoesophageal echocardiography showed vegetation's in the right side of the patch without signs of dehiscence. The outcome was fatal due to hemodynamic collapse. CONCLUSION: The authors would like to select and analyze some weaknesses of their procedure like using only the transaortic access that often limits exposure of possible right-side lesions, not removing the pulmonary obstruction and using an important amount of foreign material to reconstruct subvalvular lesions.

[HbA1c in the monitoring of type 1 diabetic patients]. / Hemoglobine A1C (HbA1c): interet dans le suivi du diabete type 1.

We conducted this study to determine quality of glycemic control in patients with type 1 diabetes, based on evaluation of mean HbA1c. We enrolled 125 patients with type 1 diabetes who were hospitalized during the period from December 1998 to December 2001. Glycemic control was evaluated on mean of HbA1c in 82 patients and on mean of fasting glycemia values in 43 patients. Mean HbA1c was 9.9%. Mean of plasma fasting glycemia was 11 mmol/l. 22% of patients were perfectly or good controlled (HbA1c < or = 7% or HbA1c 7-7.5%). 12% had a moderate control (HbA1c 7.5 et 9%) and finally 66% of patients had a worse control (HbA1c > 9%). There was an excellent correlation between HbA1c and mean fasting glycemic values (p = 0.00028). Most of patients had unsatifactory control. We stressed on the absolute necessity of intensified insulin therapy and self-monitoring blood glucose.

Acute pulmonary embolism due to the rupture of a right ventricle hydatic cyst.

Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst (often in the liver) into the venous circulation. We report a case of hydatid pulmonary embolism following rupture of a hydatic cyst in the right ventricle. Pulmonary angiography showed right pulmonary occlusion. Echocardiography, computed tomography scan and magnetic resonance imaging showed images suggesting a hydatid cyst. The patient underwent sternotomy and cardiopulmonary bypass in order to treat the heart cyst and remove the hydatic pulmonary obstruction. A concomitant lung hydatid cyst was extirpated.

[Coronary reoperation through left thoracotomy without cardiopulmonary bypass: 3 case reports]. / La chirurgie coronarienne redux à coeur battant par thoracotomie gauche: à propos de trois cas.

With the increasing number of patients who have undergone coronary artery bypass grafting, the incidence of reoperative coronary grafting is also increasing. Reoperative coronary artery bypass grafting is associated with morbidity and mortality rates greater than those of primary coronary operations. Left thoracotomy can provide access for reoperation when repeat median sternotomy is extremely dangerous. Coronary artery grafting on a beating heart and via left thoracotomy can be a good alternative strategy when redo coronary surgery is necessary in the circumflex or left anterior descending territories.