[Popliteal venous aneurysm and recurrent pulmonary embolism. A case report]. / Anévrysme veineux poplité et embolies pulmonaires récidivantes. A propos d'un cas.

Primary popliteal vein aneurysms are rare, in contrast with veinous dilatation secondary to trauma or complicating an arterio-veinous fistula. The authors report the case of recurrent pulmonary embolism in a 46 year old man with a popliteal vein aneurysm. This veinous malformation usually presents with pulmonary embolism due to migration of blood clot from the thrombosed aneurysmal sack. Ultrasonography and/or venography are diagnostic. Surgical care of the aneurysm should be preferred in young and active patients to partial interruption of the inferior vena cava or anticoagulant therapy alone.

[Spontaneous and isolated dissection of the external iliac artery. Presentation of a case]. / Dissection spontanée et isolée de l'artère iliaque externe. Présentation d'un cas.

Primary dissecting aneurysms of peripheral arteries without involvement of the aorta are rare. The present report deals with a case of dissecting aneurysm of the external iliac artery in a 39-old man treated by resection and prosthetic graft. Although the exact cause of the dissection was not apparent, it seems likely that it was related to disorder of connective tissue because of the presence of a pectus excavatum, a deep palate and an increased hydroxyproline urinary excretion.

[Radiation-induced thrombosis of the carotid artery and lingual necrosis. Report of a case treated by cervical peridural nerve block]. / Thrombose carotide externe radique et nécrose linguale. A propos d'un cas traité par bloc nerveux péridural cervical.

A case of lingual necrosis in a patient irradiated 3 years earlier for a tonsillar tumor is presented. Imputability to a post-radiology bilateral external carotid thrombosis is evoked, where the diagnosis of tumoral recurrence and Horton's disease have been ruled out. Cervical peridural nerve block allowed successful treatment of this lesion.

[Emergency vascular access in patients with renal failure. Apropos of 32 implantations of permcath]. / L'abord vasculaire de secours chez l'insuffisant rénal. A propos de 32 implantations de permcath.

Central venous catheters allow for the most rapid hemodialysis procedure with sparing of peripheral blood vessels. 32 flexible, double-lumen "permcath" catheters were implanted to 27 patients over a period spanning 42 months (February 86-August 89). Catheter placement was definitive in 2 cases while another 30 provided previsory intravenous access for plasmapheresis (25 cases), acute renal insufficiency (7 cases), and chronic renal failure (17 cases). The mean utilization time per patient was 10.7 +/- 8.01 (SE) weeks. As respects chronic renal failure, this provided a time-opportunity for prospective maturation of conventional venous routes of access or transplantation. Permcath thrombosis occurred in 6 instances (18.75%), 5 times unremittingly (15.4%). Infection occurred in 6 patients (18.75%), leading to ablation of the permcath only once. Thus, permcath ensures safe, effective access for hemodialysis and enables maturation of a conventional venous cutdown. It may be used directly as a permanent vascular approach in case of limited life expectancy or of an extremely precarious vascular bed.

[Study of the late results of reimplantation of heart valve prostheses based on 15-year experience]. / Odlegle wyniki reoperacji protez zastawkowych na podstawie 15-letnich doswiadczen.

Authors studied two groups of patients, in which a cardiac valvular prosthesis was reimplanted within 15 years. Data of patients reoperated on (group A) were used to estimate indications, surgical methods, postoperative course and late results. Data of patients which underwent surgery and then requiring reoperation (group B) were used to evaluate the percentage of reoperation falling to 1 patient/1 year according to a primary implanted valvular prosthesis: 42 patients were divided into two groups. 3 perioperative and 12 late deaths (totally 28.3%) were stated in the group A. 5- and 10-year survival rates were 83.3% and 65.6%, respectively. In the group B the lowest percentage of reoperation (1 patient/1 year) were stated in patients with mitral Starr-Edwards 6120 valve (029) and Björk-Shiley aortic valve (0.13). The highest percentage of reoperation was observed in patients with biological prosthetic valves (homograft or heterograft--4.64) and in comparison with patients with primary implanted mechanical prostheses (0.24). Those differences were statistically significant (p less than 0.001).

Aorto-coronary artery saphenous vein bypass surgery. A ten-year follow-up.

The 10-year follow-up of consecutive series of 126 patients who underwent coronary bypass surgery from January 1970 through December 1972 without associated procedures is reported. There were 112 men and 14 women with a mean age of 50.3 +/- 8.0 years. Indications for operation were stable angina pectoris in 35 cases and unstable angina in 91 cases. Eleven patients had one-vessel disease, 55 patients had two-vessel disease and 60 patients had three-vessel disease. The mean number of grafts per patient was 1.8. Graft patency rate was 78.4% at the time of early angiographic control (from one to 24 months). There were two early deaths and 47 late deaths. One patient was last to follow-up. Twenty-six of the late deaths were cardiac in nature (57.7%). The overall 10-year survival rate was 68.0 +/- 4.1%. The factors most clearly related to survival rate were: age (p less than 0.05) ischaemic ST-segment depressions on resting preoperative electrocardiogram (p less than 0.005), preoperative electrocardiographic evidence of anterior, septal or lateral myocardial infarction (p less than 0.05), ventricular function as assessed by preoperative left ventriculography (p less than 0.05). During the follow-up period 35.1% of survivors had had no recurrence of angina and 64.9% had experienced at least one episode of angina. At the ten-year evaluation 33 surviving patients considered themselves free of angina, 27 patients considered the angina to be less severe than before the operation and four considered it to be the same or more severe. A significant positive correlation was noted between clinical response and completeness of revascularization (p less than 0.05).

[Reoperations in valve surgery. Apropos of 194 cases]. / Les réinterventions en chirurgie valvulaire. A propos de 194 cas.

Between 1970 and 1985, 194 patients underwent one or several reoperations after conservative valvular surgery (Group A) or valvular replacement surgery (Group B). Group A: comprised 141 patients with a previous history of closed heart mitral commissurotomy (114 cases), open heart mitral commissurotomy (20 cases), mitral valvuloplasty (5 cases) or aortic commissurotomy (2 cases) reoperated after an average period of 153 +/- 44 months. At reoperation, prosthetic valve replacement of the previously operated valve was systematic and another valvular procedure was also performed in 66 cases. Hospital mortality was 7.8 p. 100. Mortality was high in patients reoperated in functional Class IV of the NYHA classification, after closed heart mitral commissurotomy performed over 10 years before hand. The global mortality rate was 17 p. 100 (average postoperative follow-up of 70 +/- 44 months). The actuarial 5 year survival rate was 85 +/- 6 p. 100 and the 10 year survival was 70 +/- 13 p. 100; NYHA Class IV cardiac failure was a significant poor prognostic factor (p less than 0.05). The prognosis of reoperation after commissurotomy depended mainly on the interval between the relapse of symptoms and reoperation. Group B: comprised 53 patients with valvular prostheses reoperated after an average period of 58 +/- 41 months. The indications of reoperation were prosthetic valve dysfunction (31 cases), perivalvular leak (5 cases), prosthetic valve thrombosis (6 cases), infective endocarditis (7 cases), haemolysis (1 case) and associated valvular disease (10 cases). Reoperation concerned mechanical prostheses in 26 cases and bioprostheses in 24 cases. It consisted in valvular replacement (51 cases) or reinsertion (2 cases). Eight patients underwent second reoperation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Isolated aortic valve replacement in an advanced stage of cardiac failure. Results and prognostic study apropos of 71 cases]. / Remplacement valvulaire aortique isolé à un stade évolué d'insuffisance cardiaque. Résultats et étude pronostique à propos de 71 cas.

Between January 1970 and December 1982, seventy-one patients in functional Stage IV of the NYHA classification underwent isolated aortic valve replacement for aortic incompetence (27 cases), aortic stenosis (18 cases) or mixed aortic valve disease (26 cases). Three haemodynamic criteria were chosen: left ventricular ejection fraction less than 40% (average 34 +/- 2%); arteriovenous difference greater than 6 volumes per 100 ml (average 6.7 +/- 0.2 vol.); left ventricular end diastolic pressure greater than 20 mmHg (average 26 +/- 1.3 mmHg). Analysis of the preoperative data defined the clinical profile of these patients: average cardiac index 2.2 +/- 0.07 l/min/m2; 75% had a cardiothoracic index greater than 0.50%; 61% had at least one conduction defect. The average Sokolow index was 50 +/- 2 mm. Twenty seven of the 71 patients died (36%); there were 7 early postoperative deaths (1st month) (10%), mainly due to ventricular arrhythmias (6 out of 7). There were 20 late deaths (31%) on average 52 +/- 8 months after surgery: 70% were of cardiac origin with a predominance of sudden deaths. There were no deaths in the group of patients operated after 1977, probably because of improved techniques of peroperative myocardial protection. The actuarial survival was 72% at 5 years and 63% at 10 years: long term survival was lower in aortic incompetence (25% at 10 years) compared with aortic stenosis (68%) and mixed aortic valve disease (78%). There was a significant relationship between long term survival and cardiothoracic ratio, ejection fraction, the duration of symptoms before surgery and the presence of atrioventricular or left bundle branch block.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tracheal diverticuli: apropos of a case: malformation etiopathogenesis?]. / Diverticules tracheaux: à propos d'une observation, ét iopathogénie malformative?

A case of 3 contiguous diverticula of the right posterior wall of the upper trachea is reported. The earlier literature on this subject and the different classifications described are studied. Congenital genesis of the tracheal diverticula is suggested by their localisation and histologic bronchial elements, and by embryogenesis and anomalies of the trachea. They are presumed to correspond to a rudimentary, extra, apical bronchis.

[Results of venous aortocoronary bypass with a minimum follow-up of more than 10 years]. / Résultats des pontages veineux aorto-coronaires avec un recul minimal supérieur à 10 ans.

The results of saphenous vein coronary bypass alone were assessed in 126 patients operated between 1970 and 1972 with a postoperative follow-up period of 10 to 12 years. Spontaneous or unstable angina was observed in 72% and incapacitating effort angina in 27.7%. An average of 1.8 grafts per patient was carried out but revascularisation remained incomplete in 51.6% of cases. The early postoperative mortality was 1.58%; the early postoperative infarct rate was 12.7%. There were 47 late deaths, most of which were of cardiac origin (53.2%) or due to cerebrovascular accidents (12.8%). Actuarial survival studies showed an annual mortality rate of 3.2%. The overall 10 to 12 year survival rate was 68.4. The secondary infarction rate was 13.7%, an annual rate of less than 1.5%. Control coronary angiography was carried out in 112 patients; 78% of the grafts remained patent at 2 years. Age (p less than 0.008), basal ECG changes (p less than 0.003) and left ventricular function (p less than 0.05) were significant prognostic factors for survival. One year after surgery, 63.5% of patients were angina free. Thereafter, the annual recurrence rate for angina was 3.1%. After 10 years, 35.4% of patients remained free of angina. A statistical analysis of the factors influencing the recurrence of angina showed that the number of coronary stenoses (p less than 0.02) and the quality of revascularisation (p less than 0.001) were significant factors. After an average follow-up of 75.7 months, 9 patients were reoperated using the internal mammary to revascularize the left anterior descending artery. Sixty per cent of the operated patients were able to return to work.

[Associated coronary and carotid atheroma. Implications and current role of indications for double surgery]. / Athérome coronarien et carotidien associés. Implications et place actuelle d'une double indication chirurgicale.

Coronary insufficiency is responsible for part of the peri-operative mortality of carotid surgery and it is by far the principal long term cause of death. Conversely, cerebral vascular accidents due to extra-cranial carotid stenosis compromise the results of myocardial revascularisation operations less than coronary insufficiency itself. Patients who require double surgery can be recognised on the basis of the clinical findings. The essential indication for this surgery is double clinical instability. Apart from these patients, the group of patients at high risk still need to be defined. Strictly preventative coronary and carotid surgery seem to be less justified, particularly as the currently available prophylactic measures and medical treatments appear to achieve a relative improvement in the long term prognosis of these patients with multiple vessel disease.

[Congenital anomalies of the origin and/or distribution of coronary arteries originating from the aorta. Angiographic study of 39 cases]. / Anomalies congénitales d'origine et/ou de distribution des artères coronaires naissant de l'aorte. Etude angiographique de 39 cas.

39 cases of congenital anomalies in the origin and/or in the distribution of the coronary arteries arisen from the aorta, without associated cardiac abnormality, seen in the course of 6 525 selective coronary arteriographies in adults, are reported and integrated into a general classification of coronary arteries abnormalities. The clinical correlation of these anomalies is specified. The authors emphasize the importance of their diagnosis in the surgery of valve replacement or of myocardial revascularization.

[The cloverleaf skull. Anatomical presentation of a case]. / Le crâne en trèfle. Présentation anatomique d'une observation.

We report the case of a still-born baby girl who had a rare craniostenosis known as the "clover leaf skull syndrome". The 125 previously reported cases were reviewed allowing us to better define the principal features of this condition.

[Prevention of gas microemboli during cardiac surgery. Numerical control of cardiac cavity purging by an ultrasonic detector]. / Prévention des micro-embolies gazeuses en chirurgie cardiaque. Contrôle numérique du débullage des cavités cardiaques par détecteur à ultra-sons.

Despite all precautions taken by cardiac surgeons to eliminate air remaining in the cardiac cavities and pulmonary veins at the end of cardiopulmonary bypass, many micro bubbles probably remain and pass into the systemic circulation with a risk of deteriorations of cerebral or myocardial function. Over the last four years we have used ultrasound to try to prevent the risk of preoperative gas microemboli: the machine is equipped with a detector (a quartz oscillator coupled to a piezoelectric transducer emitting a continuous beam of ultrasound at a frequency of 5 Mhz) which allows the following variables to be determined: the time interval from the onset of detection, the total quantity of bubbles (arbitrary units) in the examined regions, the quantity of bubbles detected over a given time interval which can be adjusted from 15 to 120 seconds. The passage of bubbles is also indicated by light and sound alarms. The smallest diameter of bubbles which can be detected is about 10 mu. There are periaortic probes adaptable to the calibre of the ascending aorta, transcutaneous probes for carotid artery detection and a left ventricular probe. In a preliminary series of 74 valve replacements in adults, this apparatus was used immediately after terminating cardiopulmonary bypass after we had thought that the cardiac cavities had been satisfactorily purged of air, and whilst active aspiration was continued in the ascending aorta distal to the periaortic probe: the total quantity of bubbles detected varied from less than 50 to more than 2000 AU, over a variable period of time which may exceed 20 min after termination of cardiopulmonary bypass. The total quantity of bubbles recorded after mitral valve (582 +/- 154 AU) or combined mitral and aortic valve replacement (685 +/- 167 AU) was generally greater than after isolated aortic valve replacement (335 +/- 126 AU). Therefore, after cardiopulmonary bypass, and despite all efforts at purging the air, we showed that numbers of microbubbles were ejected into the ascending aorta for a variable period of time: only some of them were eliminated by active aspiration through a trocar placed distal to the periaortic probe. The right coronary ostium was poorly protected against microbubbles because of its anatomical situation (6 cases in this series). We therefore established a protocol for the use of this apparatus to aid the purging of the cardiac cavities and pulmonary veins before stopping cardiopulmonary bypass: the manoeuvres, guided by the ultrasound probes, are performed before the left ventricle is allowed to eject blood into the ascending aorta.(ABSTRACT TRUNCATED AT 400 WORDS)

[Pryce's type I intralobar pulmonary sequestration. Apropos of an anatomo-surgical case]. / Séquestration pulmonaire intra-lobaire du type I de Pryce. A propos d'une observation anatomo-chirurgicale.

A case of intralobar pulmonary sequestration revealed by hemoptysis is reported. A left lower lobectomy was performed. Anatomical investigations of the lobe showed a normal lung supplied by an aberrant artery arising from the aorta.