[Conservative mitral valve surgery in the treatment of mitral regurgitation due to infective endocarditis. Report of 21 cases]. / La chirurgie conservatrice mitrale dans le traitement de l'insuffisance mitrale infectieuse. A propos de 21 cas.

BACKGROUND: To evaluate the feasibility of mitral valve repair in patients with infective endocarditis (IE). METHODS AND RESULTS: Forty-seven patients operated for mitral endocarditis between 1995 and 2005; 21 underwent mitral valve repair. The repair was performed for acute endocarditis in seven patients at a median of 14 days after the onset of treatment and 14 patients for healed endocarditis after a median of six months. RESULTS: Mitral valve repair was feasible in 21 patients (45%). This repair involved mitral annuloplasty in 16 patients (76%), shortening or transposition of chordae in 10 patients (48%), a pericardial patch in five patients (24%), and suture of perforation in two patients (9%). Associated procedures were aortic valve replacement in seven patients and tricuspid annuloplasty in two. There were no operative deaths. The mean follow up was five years (one to 11). One patient was reoperated for severe mitral regurgitation and another had a stroke due to cerebrovascular embolism in the first postoperative years. No recurrence of infectious endocarditis occurred. CONCLUSIONS: Mitral valve repair in IE gives satisfactory results in terms of survival and symptomatic improvement with a low operative risk. With antibiotic therapy, it provides a cure of mitral lesions even when carried out in the acute phase of endocarditis. Finally, it feasible in several cases with excellent results.

[Results of the surgical closure of ventricular septal defects of various ages: report of 30 cases]. / Résultats de la fermeture chirurgicale des communications interventriculaires à tous les âges. A propos de 30 cas.

OBJECTIVE: To appreciate short and midterm results of patients after surgical closure of the ventricular septal defect. MATERIAL AND METHODS: The study is retrospective and took place in the department of cardiovascular surgery "B", Ibn-Sina hospital, Rabat, Morocco. Between 1995 and 2005, 30 patients underwent a surgical closure of ventricular septal defect. Eighteen patients (60%) were males and twelve (40%) were females with a mean age of 10 years (18 months-36 years). Seven patients (23%) were older than 16 years. All of ventricular septal defects were type 2, unique and most of them perimembranous (70%). Four patients (13%), were older than 16 years, had a significant aortic insufficiency that has dictated the aortotomy for ventricular septal defect repair. The surgical approach through the right atriotomy was sufficient for complete repair in 22 patients (73%). Closure of the defect has been done using a pericardial autologous patch in 28 patients (93%). RESULTS: No operative mortality was observed. The mean follow-up was five years. Eight patients (26%) had a residual ventricular septal defect that progressed to spontaneous closure. Two patients (6%) had a residual pulmonary hypertension and two others a moderate aortic regurgitation. The four patients were older than 16 years. Echocardiography showed a significant reduction in left ventricular dimension and systolic pulmonary artery pressure. At last follow-up, 87% of the patients were in NYHA class 1. CONCLUSION: This study demonstrates that surgical closure of ventricular septal defect ensures a good outcome in short and midterm. Nevertheless, the risk of delayed complications justifies long-term and regular follow-up.

[Post-traumatic false aneurysm of the suprarenal abdominal aorta. Original surgical technique]. / Faux anévrysme post-traumatique de l'aorte abdominale sus-rénale. Technique opératoire originale.

Post-traumatic abdominal aorta false aneurysm is rare, especially in the supra-renal segment. We present the case of a patient which severe respiratory failure who could not be sterno-phreno-laparotomized: we propose an original operative technique of exclusion of the false aneurysm by a limited incision preserving the diaphragm, with circulatory arrest and profound hypothermia, without aortic clamping, under cardiopulmonary bypass. We discuss the other surgical possibilities and propose our technique for special indications.