[Minimal invasive cardiac surgery]. / Chirurgie cardiaque minimalement invasive.

With the advent of cardiopulmonary bypass in 1953, complex intracardiac procedures were developed and a full sternotomy was established as the standard approach for these. With this technique, cardiac surgery achieved excellent immediate and long-term results that became the gold standard in a variety of cardiac pathologies, both congenital and acquired. By the late 90's, new techniques were developed, associated with less surgical trauma, decreased postoperative pain and faster functional recovery. Today, in specialized centres, minimally invasive cardiac surgery has been shown to achieve comparable and even better results than conventional surgery. It is rapidly becoming a new standard for valvular heart surgery.

Near-fatal acute dissection of the thoracic aorta involving the right coronary artery.

We describe a patient with aortic dissection extending into the right coronary artery who was successfully resuscitated and operated upon after a cardiac arrest during transfer to the operating room. The use of transoesophageal echocardiography was particularly helpful for rapid diagnosis of aortic type A dissection and urgent surgical treatment.

Near-fatal acute dissection of the thoracic aorta involving the right coronary artery.

Aortic dissection is the most common acute disease involving the ascending aorta and carries a high mortality rate if surgical therapy is not initiated rapidly following the onset of symptoms. Therefore, timely recognition of this disease entity coupled with urgent and appropriate management is the key to a successful outcome. We describe a patient with aortic dissection extending into the right coronary artery (RCA) who was successfully resuscitated and operated on following a cardiac arrest during transfer to the operating room.

[Closed trauma of the abdominal aorta--current update]. / Traumatismes fermés de l'aorte abdominale--mise au point.

This study constitutes an update on current knowledge in the literature concerning closed traumas of the abdominal aorta. The morbidity of such lesions, in case of initial survival, depends on both rapid diagnosis and prompt treatment of hypovolemia and ischemia. The presence of associated intestinal lesions renders diagnosis difficult, modifies surgical treatment, and aggravates prognosis.

Floating thrombus in the ascending aorta: a rare cause of peripheral emboli.

The ascending aorta may be the site of origin of systemic embolization in some cases that do not have an identifiable source. We report a case in which a free-floating thrombus in the noncoronary sinus of Valsalva was detected by transesophageal echocardiography as a source of left axillary artery embolism. After removal of this pedunculated thrombus of unknown cause, which was attached on a macroscopically and histologically normal aortic wall, the patient made an uneventful recovery.

Screening for patent foramen ovale and prevention of paradoxical embolus.

Paradoxic embolus is uncommon. Definite diagnosis requires demonstration of thrombus astride a patent foramen ovale (PFO) in a patient presenting cerebral or peripheral arterial embolism. With current echocardiography techniques, it is now possible to identify subjects with a PFO at risk for paradoxal embolism, however, the possibility of screening rekindles debate on prophylaxis and treatment. In the present report, we describe a case involving a woman who presented acute ischemia of the lower extremities with all the pathophysiologic features of paradoxical arterial embolism.

Preoperative inhibition of angiotensin-converting enzyme improves systemic and renal haemodynamic changes during aortic abdominal surgery.

We studied 22 patients undergoing aortic surgery, allocated randomly to receive, before induction of anaesthesia, a single i.v. dose of enalapril 50 micrograms kg-1 or saline. During infrarenal aortic cross-clamping, we observed similar reductions in oxygen uptake in the two groups, despite greater systemic oxygen delivery in enalapril-treated patients; angiotensin-converting enzyme inhibition prevented the reduction in cardiac output and attenuated the decrease in glomerular filtration. Changes in glomerular filtration secondary to aortic clamping were related positively to changes in renal plasma flow (r = 0.83 (saline group) and r = 0.65 (enalapril group)). Creatinine clearance on the first day after operation was significantly higher in the enalapril compared with the saline group. We conclude that enalapril pretreatment is effective in improving systemic oxygen delivery, renal plasma flow and glomerular filtration during aortic abdominal surgery.