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Biomedical subjects

A Thevenet

Publications and source records attributed to A Thevenet.

87 records · Page 5Linked to original sources
PubMedDate not supplied

Dissecting aneurysms of the ascending aorta occurring late after aortic valve replacement.

In 4 patients who had undergone aortic valve replacement, a dissection of the ascending aorta appeared between 7 and 16 years later (mean 12 years). This is a rare complication, occurring in less than one percent of cases. Three cases of aortic regurgitation and one of aortic stenosis developed, and 3 of the cases had dilatation of the ascending aorta and hypertension. The symptoms of dissection were accompanied by signs of either the superior vena caval syndrome or compression of the pulmonary artery. The diagnosis was confirmed by echography and by CT scan. Despite the advances made in the surgery of dissection the prognosis was serious, and 2 of the 4 patients died. Avoidance of this complication depends on replacement of the ascending aorta (composite tube or supracoronary graft according to the involvement of the sinuses of Valsalva) as soon as the diameter of aorta exceeds 55 mm. In cases of moderate dilatation (45-50 mm), systemic reinforcement with Dacron mesh has been shown to have long-term effectiveness.

Aged↗
PubMedDate not supplied

Direct current catheter ablation of an accessory pathway in a recipient with refractory reciprocal tachycardia.

A recurrent reciprocating tachycardia developed in a 45-year-old man 2 years after heart transplantation. Electrocardiograms of both donor and recipient were normal, without patent preexcitation. An electrophysiologic study showed a left-sided Kent bundle with only retrograde conduction property. Because antiarrhythmic therapy was unsuccessful, direct current catheter ablation was performed. Since this procedure the patient remained asymptomatic without antiarrhythmic therapy.

Cardiac Pacing, Artificial↗
PubMedDate not supplied

Upper limb arteritis in Takayasu's disease. Surgical treatment and results.

Non specific inflammatory involvement of the subclavian arteries due to Takayasu's disease is rare, compared to the frequency of atherosclerosis. A personal series of 23 cases of brachiocephalic arteritis, observed between 1967 and 1980 is presented. Mean age of the patients is 30 years, 60% are females. Supra-aortic trunks are only involved in 15 patients and associated with abdominal aorta and renal arteries in 8. By passes with prosthetic grafts or saphenous veins have been most frequently used in revascularization techniques performed in 23 patients, 2 patients have shown progressive evolution with multiple involvement between 4 and 6 years. One death occurred during recurrent active process with occlusion of all brachiocephalic arteries. With a mean follow up of 8 years, 80% of the surgical patients are stabilized with a satisfactory clinical and anatomical result. Operative indication must take into account the sites of occlusive lesions, symptoms and anatomical stage of arteritis.

Adolescent↗
PubMedDate not supplied

Symmetric enlargement of the ascending aorta in supravalvular aortic stenosis of the diffuse type (an alternative to apico-aortic conduit).

Surgical repair of the diffuse form of supravalvular aortic stenosis, (tubular hypoplasia of ascending aorta) is a difficult problem because complete relief of the pressure gradient is not achieved by the insertion of a prosthetic graft across the non coronary sinus of Valsalva. An alternative is to use a left ventricular-aortic by-pass shunt. A more rational reconstructive operation was carried out in a 9 years old boy and consisted of an extended aortic endarterectomy and symmetrical enlargement of the supravalvular ring in all three sinuses of Valsalva with a small patch in the left coronary sinus and a large tubular prosthesis tailored with two tips into the right and the non coronary sinuses of Valsalva and the distal end sutured up to origin of the innominate artery. Relief of pressure gradient has been excellent with control study at one year.

Aorta↗
PubMedDate not supplied

Surgical repair of vertebral artery stenoses.

During an eight year period (1973-1980) 290 patients were submitted to surgery for correction of obstructive lesions at the origin of the vertebral arteries. The pathologic process was atherosclerotic stenosis in 283, kinks in 25 and extrinsic compression in 17 cases. The operative procedures, mostly supraclavicular, on 325 arteries were: ostial endarterectomy (111), subclavian-vertebral endarterectomy (153) with patch (17), reimplantation in subclavian artery (14), subclavian-vertebral anastomosis (6), subclavian resection-anastomosis (5). Associated procedures included supra-aortic trunk reconstruction (9) and carotid endarterectomy (36 simultaneous, 51 pre and 21 post). Postoperative arteriograms were obtained in 33% of the patients with 5% occlusion and 81% excellent results. Hospital mortality was 0.6%. Long-term results with a follow-up from 2 to 9 years (mean 5 years) was the following: mortality 12%, asymptomatic 68%. Obstructive lesions of the vertebral artery are responsible for symptoms of vertebrobasilar insufficiency and are often neglected. Their frequency is suggested by the observation that during a 20-year period, 1,382 carotid, 789 supra-aortic trunk and 683 vertebral operations were performed. This series indicates that trans-subclavian vertebral ostial endarterectomy is a simple and safe procedure, providing durable results.

Adult↗
PubMedDate not supplied

Results following surgical correction of renovascular hypertension.

During a 12 year period, 110 patients were submitted to surgery for correction of renovascular hypertension. The pathologic process was atherosclerosis in 65, fibrodysplasia in 28, aneurysms in 6 abdominal coarctation in 5, aortoarteritis in 2 and 3 miscellaneous lesions. Operative procedures used on 148 renal arteries have been: nephrectomy (12), reconstructive surgery (133). Among them: endarterectomy (89), aorto-renal grafts (20) venous, dacron or arterial autografts, resection and anastomosis (10), direct reimplantation (8), angioplasty (5), arterial spleno-renal anastomosis (1). Postoperative arteriograms have been obtained in 98% of the patients, 4 occlusions occurred in aorto renal grafts, no thrombosis in endarterectomy. Progression of dysplasia and atherosclerosis was observed in 5 patients. The overall clinical results show: cure 55%, improvement 34% and no change 11%. With a difference between atherosclerosis (45% cured, 40% improved, 15% no change) and fibrodysplasia (63% cured, 29% improved and 8% no change). Several parameters are studied correlated with the surgical result. This series support interest to treat operatively renovascular hypertension: 89% of patients benefited from surgery.

Adolescent↗
PubMedDate not supplied

Lillehei-Kaster prosthesis in the aortic position with and without anticoagulants.

Sixty-two patients after aortic valve replacement were given aspirin in place of anticoagulants post operatively. This group is compared with another of 125 patients receiving anticoagulants. In the former group there was one instance of valve thrombosis, five of transient embolic episodes and six late deaths. In the latter group there were two instances of valve thrombosis--both occurring when the anticoagulation was inadequate, one embolic episode and six late deaths. Anticoagulant therapy is recommended for all patients with the Lillehei-Kaster prosthesis. However, where anticoagulants cannot be used control with aspirin is nearly as effective, but with a somewhat higher risk. Long-term results with Lillehei-Kaster valves as regards survival and thromboembolism compare favourably with all contemporary mechanical prostheses and porcine heterografts.

Adolescent↗