[From Hippocrates to Harvey: twenty centuries of research on circulation]. / D'Hippocrate à Harvey: vingt siècles d'histoire de la circulation.

The concept of blood circulation was difficult to emerge. By assessing the non-religious cause of any disease, Hippocrates allowed future studies and observations to elucidate the concept of blood circulation. Alexandria's school erroneously described the roles of respiration and air transfer up to the viscera. "Arteries are filled with air". Galen demonstrated the absence of air in arteries, but sticked to the opinion of two forms of blood: "spirituous" from the left and "trivial" from the right. The Galenic system implied the presence of anatomic communications between the trivial (right) and spirituous (left) hearts. Genuine Galen's works were lost for the two thirds, but one third was transmitted to the Middle Age and Renaissance by hispano-arabic physicians. Moreover, one of them criticized the Galenic views about transfer of blood from the right to the left via intracardiac holes. The presence of these Galenic cardiac holes could not be visualized by Vesalius, while Servet stressed the crucial role of the lung for the right-left transfer. It was Harvey's achievement to make the synthesis of the real nature of blood continuously circulating from right to left and from left to right via the lungs thanks to the propelling function of the cardiac muscle and without any action of arteries.

[Cardiac metastasis from malignant melanoma]. / Métastase cardiaque d'un mélanome.

The authors describe a case of cardiac metastasis associated with a malignant melanoma, which was removed in its totality. Malignant melanoma is a tumour which metastases frequently at the cardiac level. The mechanism of implantation and the symptomatology of this metastatic localisation are discussed.

[Aortic pseudo-aneurysm after coarctation repair]. / Pseudo-anévrysme de l'isthme aortique après correction chirurgicale de la coarctation aortique.

Aortic pseudo-aneurysm is a well-known late complication after surgical repair of aortic coarctation. We report two cases of pseudo-aneurysm of the aortic isthmus evidenced after previous surgical repair of congenital aortic coarctation. These clinical observations give us the opportunity to underline the importance of a specific lifelong medical follow-up for patients who have undergone such surgery.

Open surgery for abdominal aortic aneurysm or aorto-iliac occlusive disease--clinical and ultrasonographic long-term results.

OBJECTIVE: To determine postoperative and long-term outcome and assess the relevance of abdominal ultrasound (US) after surgery for abdominal aortic aneurysm (AAA) or aortoiliac occlusive disease (AIOD). METHODS: Records of 1704 consecutive patients having graft implantation from 1988 to 2000, either for AAA (n = 1144) or for AIOD (n = 560), were reviewed. In 2006, follow-up was 9180 patients-years for the AAA group and 5450 patients-years for the AIOD group. Among 1006 alive patients, 377 were invited randomly for US and clinical examination. RESULTS: Hospital death occurred in 99 patients (8.6%) of the AAA group (53% in ruptured and 2% in elective AAA), and in 18 patients of the AIOD group (3.2%). There were 581 late deaths, including eight due to prosthesis infection, one to pseudo-aneurysm rupture, and one to graft thrombosis (0.6% graft-related mortality). Prosthesis thrombosis occurred in 32 patients (26 in AIOD group, p < 0.001), and graft infection in 26 (17 in AAA group, p < 0.01). Pseudoaneurysms developed in 90 patients (68 in AIOD group, p < 0.001), including eight at the proximal aortic, one at the distal aortic, two at the iliac and 79 at the femoral anastomosis. In the AAA group only, surgery was required for a new thoraco-abdominal and pararenal aneurysm in eight and four patients, respectively, while US evidenced a 26-35 and a 36-50 mm supraanastomotic aortic dilatation in 65 (32%) and in 14 (7%) patients, at a mean follow-up of 10.5 and 9.3 years, respectively. CONCLUSION: Long-term results are good after open surgery for AAA or AIOD. Prosthesis infection and anastomotic pseudo-aneurysm are the main causes of graft-related mortality and morbidity, respectively. Because of high incidence of asymptomatic supraanastomotic aortic dilatation, all patients with a history of AAA repair should have regular abdominal US.

[Myxomatous mitral valve degeneration: biochemical aspects and physiopathological considerations]. / L'insuffisance mitrale par dégénerescence myxoïde: aspect biochimique et considérations physiopathologiques.

Mitral valve is a complex structure which is submitted to repeated mechanical constraints. In clinical practice, an increasing incidence of mitral insufficiency resulting from myxomatous degeneration is observed. Since myxomatous degeneration is also observed in defined genetic diseases of connective tissues, we propose the hypothesis that idiopathic mitral insufficiency might result from a minor alteration of the interstitial valvular cells and/or their interactions with their support. After a brief review of the role of the extracellular matrix in the heart, some histopathological and biochemical aspects of myxomatous degeneration are presented. Our data and those of the literature will be summarized and a physiopathological hypothesis proposed for myxomatous mitral valve degeneration.

Extended transsternal thymectomy for myasthenia gravis: a report of 19 consecutive cases.

BACKGROUND: Thymectomy is considered as an effective therapeutic option for patients with myasthenia gravis (MG). This study reports the experience of our centre's investigation into the efficacy and the safety of the procedure and the influence of different pre-operative factors on the surgical outcome. METHODS: A retrospective chart review/interview was made of 19 consecutive patients who underwent extended transsternal thymectomy for MG from 1992 to 2003. The severity of the disease was determined according to the Osserman Classification. Efficacy was measured by determining the change in clinical status, the rate of remission during follow-up, and the reduction in medication requirements after thymectomy. Complete remission (CR) was defined as asymptomatic off medication for 6 months. The CR rate was calculated using the Kaplan-Meyer method. RESULTS: The mean age of the patients at surgery was 34 years (range, 9-63) and 78.9% were female. Mean length of follow up was 86 months (range, 24-163). The overall complication rate was 10.6% (1 episode of atrial fibrillation and a left recurrent laryngeal nerve palsy that resolved after the first postoperative month). There was no operative mortality. The mean hospital stay was 9.4 days (range, 5-23). The crude CR rate was 32% (n = 6). The Kaplan-Meier estimate of CR was 42% at 6 years. Age, gender, duration of symptoms, thymic histology, Osserman stage and the presence of thymoma were not identified as prognostic variables. The average daily dose of Medrol and Mestinon decreased significantly between the pre-operative period and the last follow-up (Medrol, p = 0.0081; Mestinon, p = 0.0013). CONCLUSIONS: Transsternal thymectomy for MG is safe and effective. It benefits patients with MG at all stages. Patients with thymoma are not associated with poorer remission rates. Complete responses are durable, as the CR rate remains stable over time.

Bilateral humeral artery aneurysm as a cause of digital ischaemia.

Bilateral humeral artery aneurysm is a very rare condition. Simultaneous bilateral complication of these aneurysms makes it even more unusual. We present a case of a 44-year-old man with bilateral digital ischaemia as a complication of a bilateral humeral artery aneurysm. Anamnestic, clinical and per-operative findings led to several hypotheses. A venous bypass graft was done to exclude both aneurysms and to arrest the embolisation into the digital arteries.

[Recent advances in cardiac and vascular surgery]. / Acquisitions récentes en chirurgie cardiaque et vasculaire.

Significant advances in cardiac surgery include hypothermic circulatory arrest for complex aortic surgery, stentless valve for aortic valvulopathies, conservative treatment of the insufficient aortic valve, surgical interruption of the electrical circuits involved in atrial fibrillation and new extra-corporeal circuits (SMA) to decrease inflammatory systemic reactions, and for, the same reason, heart beating coronary surgery. Advances in vascular surgery include aortic endoprosthesis, coeliscopic aortic surgery and less invasive superficial veins surgery.

[New therapeutic guidelines in lower limb arteriopathy]. / Actualités thérapeutiques à propos de l'artériopathie des membres inférieurs.

This article describes the recent therapeutic options for lower limb arteriopathy and, as much as possible, analyzes the medical and surgical treatments according to the recommendations and levels of evidence.

[Clinical case of the month. Constrictive pericarditis with a macroscopically normal pericardium: apropos of a case]. / Le cas clinique du mois. Péricardite constrictive à péricarde macroscopiquement normal: à propos d'un cas.

The diagnosis of constrictive pericarditis is not easy to make. This rare condition can be suggested by clinical, echocardiograohic, hemodynamic, and radiological signs. It must be distinguished from restrictive cardiomyopathy as therapeutic options are radically different. We present an ambiguous case of constrictive pericarditis with macroscopically normal pericardium recognized 10 years after open-chest cardiac surgery: a large pericardiectomy rapidly induced clinical improvement.

Effect of different contraceptive methods on the oxidative stress status in women aged 40 48 years from the ELAN study in the province of Liege, Belgium.

BACKGROUND: Oxidative stress is associated with the development of several disorders including cardiovascular disease and cancer. Among conditions known to influence oxidative stress, the use of oral contraception (OC) in women has been a matter of ongoing discussion. METHODS: A total of 897 eligible and healthy volunteers were recruited from among the patients of 50 general practitioners participating in the ELAN study (Etude Liégeoise sur les ANtioxydants). A subsample consisting of 209 women aged 40-48 years was studied for a comprehensive oxidative stress status (OSS), including the analysis of antioxidants, trace elements and three markers of oxidative damage to lipids. Among 209 subsample, 49 (23%) were OC users (OCU), 119 (57%) non-contraception users (NCU) and 41 (20%) were intrauterine (hormonal and copper) devices users (IUD). RESULTS: After adjustment for smoking, systolic and diastolic blood pressure and BMI (or waist circumference), a marked and significant increase in lipid peroxides was observed among OCU women when compared with NCU and IUD users. A cut-off value of 660 microM in lipid peroxides allowed the discrimination of OCU from the two other groups. In contrast, no difference was observed in the plasma concentration of both oxidized low-density lipoprotein (LDL) and their related antibodies. The increased level in lipid peroxides was strongly related to higher concentrations of copper (r < 0.84; P < 0.0001, cut-off value 1.2 mg/l). When compared with NCU and IUD users, plasma antioxidant defences were significantly altered in OCU women as shown by lower levels of beta-carotene (decrease of 39%; P < 0.01) and gamma-tocopherol (decrease by 22%; P < 0.01). In contrast, higher concentrations of selenium (increased by 11.8%; P < 0.01) were observed in OCU women. Blood concentrations of vitamin C, alpha-tocopherol and zinc were unaffected by OC use. CONCLUSIONS: The intake of OC significantly increases the lipid peroxidation in women aged 40-48 years. This may represent a potential cardiovascular risk factor for these women.

[Strategies to shorten the time from urgent admission to coronary angioplasty: a recent publication in the New England Journal of Medicine]. / Strategies visant à diminuer le délai entre l'admission aux urgences et l'angioplastie coronaire: à propos d'un article rècent du New England Journal of Medicine.

A recent publication in New England Journal of Medicine stresses the fact that the mere presence of a coronarography equipment to dilate acute myocardial infarction is not sufficient to obtain the opening of the related myocardial infarction artery in due time.

[Rupture of a giant external iliac aneurysm six years after an aorto-bifemoral bypass]. / Rupture d'un anévrysme iliaque externe six ans après un bypass aorto-bifémoral.

We report the case of a patient operated on for an aorto-iliac aneurysm with an aorto-bifemoral bypass who presented a metachronous iliac aneurysm rupture, six years later, because of aneurysmal degeneration. We performed bipolar ligation of the external iliac artery and an end-to-end anastomosis of the prosthetic limb to the common femoral artery. We discuss aneurysms of the external iliac artery, characterised by their rarity, their specific morbidity and mortality.

[The ostium primum or partial atrioventricular septal defect]. / La CIA, de type ostium primum ou canal atrio-ventriculaire partiel.

Often assimilated to simple inter-atrial communication, the ostium primum, or partial atrio-ventricular septal defect, is an entity that is characterized by a different embryological mechanism and requires some specific surgical expertise. Basically, knowledge of the morphology of the common atrioventricular valve with 5 components, the topography of the A-V node and His bundle, and the ventricular consequences of the absence of atrio-ventricular septal structures must be taken into account.

Catamenial pneumothorax: a case report and review of the literature.

Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occuring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Treatment is medicosurgical: thoracoscopy for pleural abrasion and hormonotherapy to avoid recurrence.

Description and evaluation of a simplified technique for replacement of the ascending aorta and proximal arch in degenerative aneurysmal disease.

The distal extension of ascending aorta pathology often requires prosthetic grafting into the proximal arch. In order to perform optimal distal anastomosis, an open technique under a short period of circulatory arrest (CA) was adopted. For this purpose we evaluated prospectively a simplified technique for surgery and perfusion. The aneurysmal aorta was directly cannulated to cool down the patient to 26 degrees C. Under CA and retrograde cerebral perfusion, the diseased aorta and aortic cannulation site were resected. After completion of the distal anastomosis, antegrade rewarming was performed via recannulation of the AAo graft (side branch graft) whilst surgery was proceeded on the root and/or aortic valve. This technique clearly addresses the safety of cannulation into the aneurismal aorta. The issues of cerebral and visceral protection during CA and antegrade reperfusion and rewarming have been analysed prospectively in eight patients operated on over a period of 6 months. Our preliminary results indicate that this technique of arterial cannulation and CA at 26 degrees C for the management of degenerative AAo disease involving the proximal arch appears safe both in terms of cerebral and systemic (visceral, muscular) protection. By this way, the complications related to deep hypothermia and prolonged cardiopulmonary bypass are avoided. This assumption may be only valid for a CA period less than 30 min. This preliminary study is limited by its small size and heterogeneity of the pathologies. However, the simplicity, surgical ease, rapidity and efficacy conveyed by this technique warrant further consideration and evaluation.