[Total abnormal pulmonary venous return. Clinical and therapeutic study apropos of 6 surgical cases].
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Biomedical subjects
Publications and source records attributed to A Brunet.
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We report a case of dissection of the ventricular septum by two aneurysms of the right and left coronary sinuses of Valsalva. Transthoracic and transesophageal echocardiography allowed accurate preoperative assessment and postoperative evaluation.
Two cases of intracardiac thrombi associated with antiphospholipid antibodies are presented, one in the right atrium and the other in the left ventricle, the latter occurring in the presence of normal left ventricular function. In each, the diagnosis was made by transthoracic echocardiography. Both patients had contraindications to thrombolytic therapy and underwent successful surgical thrombectomy. We suggest that serial transthoracic echocardiography may be warranted in the follow-up of patients with primary hypercoagulable states.
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The results of the surgical treatment of Prinzmetal's angina are reported in this study of 60 patients. The operative mortality is 3,3 percent and the incidence of post-operative infarction is 20 percent. 53 patients were followed over an average period of 2,7 years. The global survival rate is 91 percent at 5 years, the infarction rate is 24 percent. 76 percent of the sublims are asymptomac. The patients can be classified in three group : isolated lesions, multiple lesions and spasms.
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Two hundred patients had an aortic valve replacement with the Smeloff-Cutter prosthesis between 1972 and 1980. One hundred and seventy six patients had aortic valve replacement alone (mortality 2.8%) and 24 patients had additional procedures. The overall mortality was 6.5%. One hundred and eighty seven patients have been followed up for from 4 months to 8 years (mean 33 months). The 14 patients who died later are analysed; half of these deaths were prosthesis related. There has been no instance of structural failure, ball variance or massive thrombosis in this series. All but 4 of the survivors showed functional improvement. We consider the Smeloff-Cutter valve a good choice for aortic valve replacement.
34 cases of traumatic rupture of the aortic isthmus have been operated on since 1963: 14 acute ruptures and 20 secondary false aneurysms. Diagnosis was confirmed by aortography. A special feature seen in cases of total transsection is described. Partial extracorporeal bypass was used in 29 cases and direct cross-clamping in 5 cases. Two techniques were used: direct end-to-end anastomosis in 9 patients and Dacron graft interposition in 25 cases. Primary end-to-end anastomosis more often was used in cases of early operation and partial rupture. Hospital mortality was 2 patients in the group of acute ruptures and 0 patient in chronic false aneurysm group. It was related to brain damage or sequelae of prolonged shock. Post-operative course was uneventful but 4 cases of respiratory failure and 4 cases of neurologic disturbances (2 brain dysfunctions and 2 spinal cord dysfunctions). These complications were transient and the patients recovered without sequelae. Clinical results have been recently appreciated in every long-term survivor (mean follow-up: 5 years) and are excellent. Angiographic controls undergone in 10 patients have shown no abnormalities.
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The authors present a series of 98 aorta-coronary bypass procedures without the help of Extracorporeal Circulation. Indications and technique are detailed. There was no hospital mortality and short-term results are satisfactory. This technique, feasible in about 10% of all cases, should be considered especially in old patients, in case of chronic renal insufficiency and in redo surgery.