Conduction abnormalities after single heart valve replacement (author's transl)]

A total of 300 patients were operated upon for heart valve disease by the same surgeon. The affected valve was the aortic in 200 cases and the mitral in the other 100 patients. The tricuspid valve, coronary arteries, and myocardium were not involved. This report attempts to define the frequency progression, prognosis, and significance of conduction abnormalities which appear during the course of this operation. In 35 cases, of which 16 were post-operative deaths, a histological examination of the conduction pathways was possible. The conclusions to be drawn from these observations are: Conduction abnormalities after single aortic or mitral valve replacement are frequent (1 out of 3 patients).     

Acute aortic dissection mimicking acute abdomen in a 14‐year‐old boy

Aortic dissection is extremely rare in children. Although it usually presents with severe chest pain, atypical clinical presentations mimicking various illnesses may cause misdiagnosis. In this report, the case of a 14‐year‐old boy with symptoms suggestive of acute abdomen, which was finally diagnosed as aortic dissection, is discussed.     

Subvalvular aortic stenosis in adults. Apropos of 31 cases

The aim of this cooperative study was to analyse the clinical profile of subvalvular aortic stenosis (SVAS) in adults. Thirty one cases were collected : patients aged 17 to 60 years (average 34 years). The diagnosis was confirmed in all patients either at surgery (30 cases) or at autopsy (1 case). The overall incidence of SVAS in patients with fixed obstruction to left ventricular ejection operated in the same period was 3.5%. Associated congenital malformations were detected in 15% of cases but intracardiac shunts were rare. Adult SVAS is a purer malformation than in children, probably because of spontaneous and surgical selection. The anatomical type of stenosing lesion in this series was a subaortic ring or membrane; 45% of patients, usually over 40 years of age (7 out of 9) had localised septal hypertrophy at the level of the diaphragmatic obstruction. The clinical presentation was that of mixed aortic disease with associated stenosis and regurgitation. Over 80% of patients had aortic incompetence diagnosed clinically (26 out of 31 cases) or on aortography (24 out of 25 cases); the regurgitant flow was assessed as mild in 15 cases, moderate in 6 cases and severe in 3 cases. There were obvious valvular lesions at surgery in 19 cases, especially in patients over 40 years of age (8 out of 9 cases). The mechanism was variable : non-specific (8 cases), destructive (6 cases), rheumatic (2 cases) or congenital (3 cases). Bacterial endocarditis was particularly common (26% of cases). Adult SVAS is a particularly difficult clinical diagnosis : the electrocardiogram and chest X-ray are not very informative.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of regional cerebral oximetry to estimate neurologic prognostic outcomes in patients administered targeted temperature management

Purpose

The aim of our study is to research the role and efficacy of cerebral oximetry in predicting neurologic prognosis when applied during TTM to patients experiencing coma after CA.

IgG4-related disease and ANCA positive vasculitis in childhood: a case-based review

Clinical Rheumatology - Autoimmune pancreatitis (AIP) type 1 is an IgG4-related disease (IgG4-RD), characterized by inflammatory pseudotumors and histologically by dense lymphoplasmacytic...     

Coronary lesions due to aortic valve disease. II -- Results and indications of aortocoronary bypass surgery]

454 cases of aortic valve replacement were studied: 217 had no significant coronary artery disease, 197 had associated aorto-coronary bypass surgery and 40 coronary artery disease without revascularization surgery:-- The early mortality in the three groups was 5.5%, 21% and 12.5% respectively, the only statistically significant difference being between the first two groups. -- The coronary artery disease was signigicantly more severe in the group which underwent associated aorto-coronary bypass surgery. The early mortality was significantly raised in the group without bypass surgery in cases with severe coronary artery disease (28%) and in the group with bypass surgery with unsuitable coronary artery lesions (35.5%). On the other hand, the long term survival and functional capacity of patients who underwent associated bypass surgery approached that of the non-coronary patients. Combined aortic valve replacement and coronary bypass surgery should therefore be continued in selected cases.     

Aorto-right ventricular shunt and associated aortic valve injury resulting from a penetrating wound of the heart

A case of a traumatic aorto-right ventricular fistula associated with an aortic valve injury and subsequent successful treatment is reported. A possible delay in diagnosis necessitates follow-up of patients after penetrating thoracic wounds. Early surgical treatment is mandatory because of the risks of both heart failure and endocarditis and because of the low operative morbidity. An aortic approach appears to be preferable because it permits repair of both the fistula and the valvular injury. Reconstruction of valvular injuries is preferable since long-term competence without prosthetic replacement can be achieved.     

Abnormal implantation of a coronary artery in a 53-year-old patient. Surgical correction

In a 53-years old patient complaining of dyspnoea and angina of effort, the coronary arteriography demonstrated ab abnormal implantation of the pulmonary artery into the left coronary-artery. Correlated with the 39 cases of the adolescent and the adult published in the literature, the case reported has some peculiarities: poorness of the auscultatory signs consisting in a mild apical systolic murmur; electrocardiographic pattern of left complete bundle-branch block; presence of massive calcifications visible by X-ray into the lateral, wall of the left ventricle. Coronary arteriography and catherization made it possible to demonstrate a left-to-right shunt by backward-flow revascularization of the left coronary artery starting from the right coronary artery. A simple suture of the implantation foramen of the abnomal coronary artery resulted in increased pressure into this artery and was followed by disappearance of angina during an observation period of 5 months.