[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.

[Takayasu's arteritis revealed by aortic regurgitation with ascending aortic aneurysm (About 2 cases)]. / Maladie de Takayasu révélée par une fuite aortique massive associée à un anévrisme de l'aorte ascendante (A propos de deux cas opérés).

Aortic regurgitation caused by non-specific aortitis is relatively rare, and is now considered as an important risk factor related to mortality. Aortic valve replacement surgery is the only curative treatment. Aneurismal dilatation of the ascending thoracic aorta associated with aortic regurgitation is a rare involvement in Takayasu, there are many difficult problems in surgical treatment of this lesion, because of its inflammatory nature, so steroid therapy before and after surgery is therefore vital. We report the cases of tow young Moroccans women (32-35 years-old) with an ascending aortic aneurism associated to aortic insufficiency. The subsequent evaluation of the entire aorta, demonstrated the presence of multiple steno-occlusive lesions. Aortic valve replacement was performed associated with graft replacement of the ascending aorta without coronary artery reimplantation. Histopathological examination of the ascending aorta and aortic valve, showed findings in favour Takayasu's arteritis.

[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.

[Haemangioma of the right atrium revealed by cardiogenic shock]. / Hémangiome de l'oreillette droite révélé par un choc cardiogénique.

Intracardiac haemangioma is a very rare primary benign tumour. A 20 year old female patient, with no significant previous medical history, presented to the emergency department with cardiovascular collapse and vague abdominal pains, with no peripheral signs of cardiac failure. The electrocardiogram showed sinus rhythm with diffuse reploarisation disturbances. Chest radiography revealed cardiomegaly (cardiothoracic index of 0.67) with a right paracardial opacity. Abdominal ultrasound showed a moderate peritoneal effusion and transthoracic ultrasound showed a tumour occupying the right atrial cavity but sparing the interatrial septum. The patient underwent emergency open heart surgery for tumour resection and right atrial wall repair with autologous pericardium. Histology confirmed a haemangioma. Follow-up at one month was uneventful. The clinical, diagnostic and therapeutic features of this case are underlined.