[Angioscopy and the surgical treatment of varices in the area of the external saphenous vein]. / Angioscopie et traitement chirurgical des varices du territoire de la veine saphène externe.

The study of post-surgical relapses, by ultrasound and phlebographic examinations, shows that the difficulties in the treatment of varices of the external saphena territory are of two types: anatomical and haemodynamic. The venous endoscopy answers precisely to the requirements of the surgical treatment of varices of the popliteal space. It offers an acceptable compromise between aesthetics and efficacy, thanks to the incisions centred on the transcutaneous luminal point. It enables a per-operative control of the ultrasound-Doppler marking and the visualization of the small calibre perforating veins (less than 2 mm), not visible by ultrasound. It especially locates the deep non palpable refluxes situated above the anastomosis of the external saphenofemoral junction. The technique used is very simple thanks to the miniaturization of the equipment and the use of flexible small calibre endoscopes adapted to venous explorations.

[Reoperation on valve bioprostheses. Apropos of 64 cases]. / Réinterventions sur bioprothèses valvulaires. A propos de 64 cas.

Sixty-four patients with one or more bioprostheses were reoperated between 1970 and 1982. Reoperation was performed for degenerative lesions in cases (48%), for aseptic periprosthetic leaks in 18 cases (28%), for infectious lesions in 13 cases (21%) and for thrombosis in 2 cases (3%). Degenerative and infectious lesions were commoner in aortic bioprostheses whilst periprosthetic leaks were commoner in mitral bioprostheses. The average interval between operations was 38 months. This was shorter in patients reoperated for mechanical problems (6 months) than those with infections (28 months) or degenerative (5 years) complications. At reoperation 14 prostheses were reinserted and 50 were replaced. The global hospital mortality was 21% (14 deaths). The mortality was related to the surgical indication: mechanical lesions (11%), degenerative lesions (16%), infectious endocarditis (38%), thrombosis (100%). The mortality rate also varied with time (36% during the period 1970-1978 and 18% during the period 1979-1982). This improvement was related to two factors: the use of cardioplegic solutions for myocardial protection and earlier recognition of surgical indications before the onset of irreversible haemodynamic complications. When choosing a valvular prosthesis, the mortality of reoperation for degenerative changes is the only disadvantage of the bioprosthesis which is silent, rarely complicated by thromboembolism and which does not require anticoagulant therapy for life. The mortality has decreased with time and will continue to fall if the indications for reoperation are based on stethacoustic, electrical, radiological and echocardiographic criteria of valvular dysfunction and not on the presence of overt cardiac failure as is still often the case.

[Reoperation after saphenous aortocoronary bypass]. / Réintervention après pontage saphène aorto-coronaire.

The results of a consecutive series of 24 patients reoperated for coronary bypass grafting between May 1977 and February 1983 are reported. The overall incidence of reoperation was 1.4 p. 100 (24 out of 1 716 cases); the incidence is tending to increase (2.3 p. 100 in 1982). Preoperative assessment revealed the persistence of cardiovascular risk factors: 75 p. 100 of patients had continued to smoke; 61 p. 100 had persistent hyperlipidaemia. The usual presenting syndrome was recurrence of chest pain (21 out of 24 cases) leading to control coronary arteriography on the results of which the surgical indication was based. The average time between the two operations was 38.7 months. The patients were classified into two groups; early reoperation (6 cases) for a technical problem or incomplete revascularisation, and late reoperation (8 cases) for disease of the graft and atherosclerosis. Progression of coronary atherosclerosis was the major long-term cause of occlusion of the saphenous graft (10-14 cases). The arteries most commonly bypassed at reoperation were the left anterior descending and right coronary arteries (12 times each). Reoperation comprised single bypass (13 cases), double bypass (10 cases) and triple bypass (1 case) with an average of 1.5 grafts per patient. The most commonly used vein was the internal saphenous vein (32 out of 36 grafts). Myocardial protection was insured by cardioplegia (13 cases) and intermittent clamping (10 cases) after cooling (general hypothermia at 22 degrees C). Global reoperative mortality (4 p. 100) was higher than for elective primary coronary surgery (2.3 p. 100). The incidence of perioperative infarction was 8 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correction by a calcium inhibitor of a coronary spasm occurring during aortocoronary bypass]. / Correction par un inhibiteur calcique d'un spasme coronaire survenu en cours de pontage aorto-coronarien.

A case of recurrent coronary artery spasm after coronary revascularization under cardiopulmonary bypass is related. The spasm, which occurred under nitroglycerin perfusion, was suspected on the ECG tracing and confirmed during immediate reoperation. It was successfully treated with bepridil, a calcium-channel blocking agent. The use of such agents after cardiac surgery is discussed.

Experimental myocardial infarction in the rat as a quantitative model for the study of anti-ischemic interventions.

The identification of metabolic and drug interventions able to reduce myocardial injury after coronary artery occlusion requires experimental models. The rat model of ischemic injury is technically simple, unexpensive, informative and accessible to quantitative studies. In this present study, 41 rats underwent temporary myocardial ischemia of variable duration using left coronary artery ligation. They were sacrificed at 48 hours, and the heart was immediately frozen in liquid nitrogen. Serial 8 micrometer sections of known intervals were tested for succinodehydrogenase (NBT stain). Gross sectional areas measured planimetrically were utilized to calculate total myocardial volume (Vmyocardium) and infarcted myocardial volume (Vinfarct) with the aid of a programmable calculator. The data showed a linear regression for Vinfarct/Vmyocardium according to the time of ischemia (p 0,001). We suggest to test the efficiency of metabolic and drug interventions on the regression curve of the necrotic tissue using a multiple linear analysis. Since ischemic changes evolve more rapidly in this model, the intervention under study should be set up at the time of coronary artery occlusion.