[Segmental variations of great saphenous vein diameters in a coronary triple vessel disease population]. / Variations des diamètres segmentaires des veines saphènes internes chez une population coronaire tritronculaire.

BACKGROUND: Great saphenous vein is one of the most used grafts in cardiovascular surgery. There is little amount of data in the medical literature describing dimensions of this vein. This series describes dimensions of the great saphenous vein in a coronary population and their variations. PATIENTS AND METHODS: Retrospective series of patients admitted to the cardiovascular surgery department of Hotel-Dieu de France Hospital - Beirut, between January 2003 and June 2006 for elective coronary artery bypass grafting and having a preoperative Doppler ultrasound of the saphenous veins according to a standardized protocol. Great saphenous vein dimensions were analyzed with regard to patients' characteristics using multivariable analysis of variance. RESULTS: Four hundred and two subjects were included with a mean age 64.4+/-9.3 years and a mean body mass index 27.9+/-4.5 kg/m(2). Women presented 22.6% of the series. Great saphenous vein dimensions' variations according to gender were significant (Multivariate Pillay trace=0.001) below the knee. Dimensions' variations were also significant as function of body mass index (P=0.001) and body surface (P=0.001). Age and cardiovascular risk factors did not influence GSV diameters. CONCLUSION: This series allowed constructing reference tables of the great saphenous vein segmental diameters in patients admitted for coronary artery surgery. Female sex is associated with lower segmental diameters below the knee and body mass index and body surface are linearly associated with segmental diameters at all levels.

[Imaging of an aberrant occipital artery arising from the extracranial segment of the internal carotid artery]. / Imagerie d'une artère occipitale aberrante naissant de l'artère carotide interne à l'étage cervical.

We report a case of asymptomatic occlusion of the right internal carotid artery owing to the presence of a rare anatomic variant (occipital artery originating from the extracranial segment of the internal carotid artery). During the preoperative workup for a coronary artery bypass grafting (CABG) in a 65-year-old patient, an occlusion of the right internal carotid artery was visualized on Duplex ultrasound. Distally to the occluded site, the artery was patent thanks to a vessel parallel to it but with a reverse blood flow. MRA and angiography of the brachiocephalic trunk confirmed the occlusion of the internal carotid artery and its opacification distally via an aberrant occipital artery arising at the supra-bulbar level and communicating with the right vertebral artery. Therapeutic abstention was decided and the patient was operated of CABG without any neurological complication. Occipital artery arising from the internal carotid artery is a rare anomaly. Its association with internal carotid artery occlusion may be beneficial because it makes surgery possible, even in a chronic stage, if the patient is symptomatic. If the patient is asymptomatic, therapeutic abstention could be considered.

[Hydatid cyst of the heart simulating coronary ischemia]. / Kyste hydatique du coeur simulant une ischémie coronarienne.

Cardiac echinococcosis is rare despite endemic occurrence of echinococcosis in some regions of the world. Clinical presentation can vary and may be misleading. Diagnosis is facilitated by new imaging techniques. Surgery is mandatory to avoid serious complications. We report a case of cardiac echinococcosis with pseudo, ischemic clinical and electrical presentation.

X-linked transposition of the great arteries and incomplete penetrance among males with a nonsense mutation in ZIC3.

We report on a Lebanese family in which two maternal cousins suffered and died very early in life from cardiac malformations. Both presented with a transposition of the great arteries associated with one or several other cardiac defects. Various minor midline defects were also observed, but there were no situs abnormalities other than a persistent left superior vena cava in one. A maternal uncle of these two babies was born cyanotic and died on the third post-natal day. Analysis of the ZIC3 gene, revealed the presence of a mutation in the second exon leading to a truncation of the protein. Surprisingly, another maternal uncle of the two affected cousins also had the mutation but was not clinically affected. To our knowledge, this is the first instance of incomplete penetrance in a male for a mutation in a chromosome X gene.

[Autosomal dominant Mendelian midline complex. Secundum atrial septal defect associated with cardiac and facial-thoracic defects. A familial case]. / Complexe mendélien de la ligne médiane. Communication interauriculaire de type ostium secundum associée à des malformations cardiaques et facio-thoraciques. A propos d'un cas familial.

The kindred of 38 individuals reported here have various anomalies: 1. facio-thoracic malformations: hypertelorism, nasal deviation, cleft lip and palate, upper-incisors diastema and pectus excavatum; 2. cardiac anomalies: sinus node bradycardia, atrial fibrillation, nodal rhythm, atrial septal defect. Wolff-Parkinson-White syndrome, low insertion of the septal tricuspid valve corresponding to an Ebstein syndrome, pulmonic "en dôme" valve stenosis, aortic valve stenosis, long QT, and intraventricular conduction blocks. Almost all these defects are septal or para-septal. Mitral stenosis is probably rheumatoid. Such median varied pathology has not been yet reported. All the extra-cardiac anomalies are situated along the vertical upper half-body midline. All cardiac anomalies are in the septal or para-septal region. It is an autosomal dominant trait that implies the early embryonic development of the midline of cardiac and extra-cardiac structures.

Autosomal dominant secundum atrial septal defect with various cardiac and noncardiac defects: a new midline disorder.

We report on a Lebanese family in which 12 persons had an atrial septal defect and various cardiac and noncardiac anomalies. Cardiac anomalies are left axis deviation of QRS, right bundle branch block, atrial fibrillation, Wolff-Parkinson-White syndrome, nodal atrioventricular rhythm, aortic stenosis, pulmonic valve stenosis, mitral stenosis (Lutembacher syndrome), and low implantation of the tricuspid valve (Ebstein disease). Noncardiac abnormalities consisted specially of the presence of hypertelorism, cleft lip, and pectus excavatum. This combination appears to constitute a hitherto undescribed autosomal dominant midline disorder of the heart and upper half of the body with almost full penetrance and variable expressivity. The mutation does not map to any known locus involved in atrial septal defect or conduction block.

[Recurrent cerebrovascular accident: unusual and isolated manifestation of myxoma of the left atrium]. / Accident vasculaire cérébral récidivant: manifestation isolée et inhabituelle d'un myxome de l'oreillette gauche.

The authors report an unusual case of left atrial myxoma in a 30-year-old woman, discovered after a recurrent stroke. This tumor was misdiagnosed earlier because of an exclusive neurologic symptomatology, a normal cardiac exam without any sign of mitral obstruction (unusual high implantation of the myxoma within the roof of the left atrium), and the lack of doing an echocardiography which should be systematically done after an ischemic stroke, even if its etiology seems to be evident. Surgical resection of the tumor led to prevent further myxomatous emboli, but unfortunately, the patient keeps severe neurological sequelae.

Acute rupture of a left ventricular false aneurysm.

Left ventricular aneurysm develop when rupture of the free ventricular wall is contained by the inflammatory surrounding tissues. These false aneurysms rupture secondarily and should be treated soon after diagnosis. The diagnosis is suggested by echocardiography and confirmed by cardiac catheterization. Immediate surgery is recommended, with good survival in most reports. The patient presented in this report had ruptured his left ventricular false aneurysm before diagnosis. He was operated and had a good initial postoperative course. He died later from a severe pulmonary infection.

[Coronary surgery in patients 70 years and older. Report of 70 cases]. / La chirurgie coronaire chez les malades agés de plus de 70 ans. A propos de 70 cas.

Between January 1993 and January 1995, seventy patients over 70 years of age underwent coronary artery revascularization and were retrospectively reviewed. The anesthetic protocole, the surgical technique and the intraoperative myocardial protection were similar for all patients. Fourteen patients (19.8%) suffered major postoperative complications: stroke (3 cases), myocardial infarction (5 cases), left ventricular failure with intraaortic counter-pulsation (2 cases), gastrointestinal hemorrhage (2 cases), respiratory failure (2 cases). Thirty patients (42.6%) had minor complications with no impact on survival or hospital stay. Hospital mortality was 7.1% (5 patients) and was caused by left ventricular failure (2 cases), stroke (1 case), gastrointestinal hemorrhage (1 case), respiratory failure (1 case). Mortality was found to be correlated with preoperative renal failure, peripheral vascular disease and concomitant carotid endarterectomy. Patients remained in the cardiac surgery unit for 60 hours. The mean length of hospital stay was 8.2 days. Follow-up from 1 to 24 months revealed NYHA angina class I-II in 85% of the patients. These results are similar to other studies. We conclude that coronary artery revascularization in the elderly yields good results, with fair mortality and morbidity rates.

[Mycotic aneurysm of the external ilial artery: a very rare complication of coronary angioplasty]. / Anévrysme mycotique de l'artère iliaque externe: une complication rarissime de l'angioplastie coronaire.

Vascular complications, mostly hematomas and false aneurysms, are rare after coronary angiography. Infectious problems are even less frequent and a mycotic aneurysm is an extremely rare complication. Our patient presented with a mycotic aneurysm of the external iliac artery following percutaneous transluminal coronary angioplasty.

Concomitant cerebral, brachiocephalic trunk, and cardiac revascularization. An unusual case.

Extensive transthoracic brachiocephalic revascularization is rarely performed. Instances of this operation performed concomitantly with cardiac revascularization and carotid endarterectomy have been reported in fewer than 10 cases in the literature. We report the case of a patient requiring complex brachiocephalic revascularization associated with coronary bypass grafting and a left carotid endarterectomy.

Spontaneous cholesterol embolization. A rarely reported entity.

Cholesterol embolization sometimes occurs after invasive procedures involving manipulation of the aorta or its major branches, and less commonly occurs after thrombolytic therapy for acute myocardial infarction. Rarer still is spontaneous cholesterol embolization, a case of which we now report. Our patient experienced peripheral embolization, the origin of which was traced to the infrarenal aortic segment and the common iliac vessels. Aortoiliac reconstruction was successful; we believe that surgical management of this condition should be performed in selected cases.

Spontaneous cholesterol embolization--a rare clinical entity.

Embolization of cholesterol crystals from atheromatous plaques is a rare entity most often seen after invasive procedures involving manipulation of the aorta. Spontaneous CE has been reported in very rare cases. Peripheral signs include livedo reticularis, muscle pain and palpable pulses. Depending on the site of the responsible plaque, emboli may involve visceral organs and produce a systemic illness. Diagnosis is confirmed using skin, muscle and/or renal biopsies. Surgery is recommended when the atheromatous disease is localized to a unique segment which can be replaced.

Total anomalous pulmonary venous connection in adults--a surgical review.

The authors report a case of surgical repair of total anomalous pulmonary venous connection in a 36-year-old male. This is a very rare disease in adulthood since over 80% of the infants die before one year of age. Fifty-two surgical cases were previously reported in the literature. An extensive review of these cases is presented. Surgery is the only treatment and offers excellent short- and long-term results.

Traumatic rupture of the thoracic aorta--case report.

Acute traumatic rupture of the thoracic aorta due to blunt trauma is a relatively common injury after deceleration accidents. However, only one fifth of these patients survive to reach medical facilities. The limiting factor to successful management is early diagnosis and prompt treatment. A case of acute traumatic rupture of the descending aorta due to blunt trauma is presented. Diagnostic and management modalities are discussed.

Penetrating carotid injuries--a wartime experience.

Thirty-nine patients with penetrating carotid injuries were treated between 1975 and 1987. All were war victims. On admission 27 (69%) had no neurologic deficit (group I), 8 (20.5%) had a mild neurologic deficit (group II), and 4 (10.5%) had a severe deficit (group III). Repair was undertaken in 38 of 39 (97.5%) patients, and carotid ligation was performed in 1 case (2.5%). Associated injuries were found in 25 (65%) patients. All patients survived. At the time of discharge all group I and II patients had a normal neurologic examination. One patient in group III recovered completely, whereas two had significant improvement. One patient remained unchanged. We conclude that repair should be attempted in all patients with carotid injuries who are seen early (less than 120 minutes) after the accident.

Emergency arteriography in the assessment of penetrating trauma to the lower limbs.

One hundred emergency arteriographies (EA) were performed in 87 patients with lower limb trauma due to high-velocity missiles. Thirteen patients had bilateral injuries. In 79 cases, EA findings were positive and led to emergency surgery. In 76 cases an arterial injury was found and treated, a positive predictive value of 96% (76/79). In the other 3 cases, no arterial lesion was found (3 false positives). Among the 21 patients with normal findings from angiography, 10 had surgical exploration because of high clinical suspicion of vascular injury. Arterial injury was found in 2 cases (2 false negatives). In 8 patients, arteriography modified the surgical procedure. In the 11 remaining patients, clinical and echo Doppler follow-up results were normal, a negative predictive value of 90% (19/21). Sensitivity was 97%, specificity 86%, and accuracy 95%. These data show that arteriography in stable patients is a safe and accurate procedure. It permits avoidance of unnecessary surgical exploration in selected patients and helps modify the surgical procedure.

[Indications for arteriography in penetrating wounds of the lower limbs]. / Indication de l'artériographie dans les plaies pénétrantes des membres inférieurs.

One hundred arteriographies were performed in emergency in 87 patients with penetrating trauma of the lower limbs caused by high- or medium-velocity projectiles (bullet or shell fragment). Thirteen patients had bilateral wounds. In 79 cases, the arteriogram was abnormal and led to surgical exploration. In 76 cases, an arterial lesion was found and treated (positive predictive value = 76/79 = 96%). In three cases, no arterial lesion was detected (3 false-positive findings). Among the 21 patients with normal arteriograms, 10 had surgical exploration because of clinical suspicion. An arterial lesion was found in 2 cases (2 false-negative findings). In the other 11 cases, the clinical and Doppler sonographic observations were normal (negative predictive value = 19/21 = 90%). The sensitivity rate was 97%, specificity 86% and accuracy 95%. In 8 cases, arteriography led to modifying the surgical procedure. These results show that preoperative arteriography, performed as an emergent examination in hemodynamically stable patients, allows avoiding surgery in some cases, and modifying the procedure in others.