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Biomedical subjects

C Planche

Publications and source records attributed to C Planche.

At least 37 records · Page 2Linked to original sources
PubMed1991

Obstructed total anomalous pulmonary venous return. Toward neutralization of a major risk factor.

Among 57 neonates undergoing repair of total anomalous pulmonary venous return with severe pulmonary venous obstruction from 1980 through 1989, date of operation (1980 to 1984), preoperative hemodynamic instability, and failure to monitor pulmonary artery pressure postoperatively were risk factors for death. Thus, among the 30 patients having repair between 1985 and 1989, the 55-month survival rate including hospital deaths was 83%.

Blood Pressure↗
PubMed1991

Anatomic correction of transposition of the great arteries with ventricular septal defect. Experience with 118 cases.

One hundred eighteen patients, 100 with transposition of the great arteries plus ventricular septal defect and 18 with double-outlet right ventricle and subpulmonary ventricular septal defect have undergone arterial switch and patch closure of the ventricular septal defect since February 1983. In transposition of the great arteries the ventricular septal defect was perimembranous in 70 cases, trabecular in 28, and infundibular in 10. Eleven patients had multiple ventricular septal defects. In addition to 18 patients with double-outlet right ventricle, malalignment of the conal septum was present in 19 cases. Coronary type A distribution was recognized in 79 cases, type C in one, type D in 24, and type E in 14. Great arteries were side by side in 19% of cases. Aortic coarctation was present in 31 cases, and subaortic obstruction in 9. Age at operation ranged from 4 days to 4 years (mean, 3.5 +/- 8.3 months), and mean weight was 4.0 +/- 1.6 kg. Thirty-seven infants were younger than age 1 month. Thirty-six patients underwent previous operations: pulmonary artery banding alone (n = 13), pulmonary artery banding and coarctation repair (n = 13), and coarctation repair alone (n = 10). Mean time between the first procedure and the switch was 2.2 months. Six patients with aortic coarctation underwent one-stage repair, through median sternotomy, aortic reconstruction, closure of the ventricular septal defect, and arterial switch. Perioperative mortality was 13.5% (70% confidence limit 10% to 17.6%, n = 16). It was directly related to coronary artery kinking in 50% of deaths and to anatomy and size discrepancy of the great arteries in the remaining deaths. Univariate analysis could not find any significant risk factor of in-hospital mortality. Mean follow-up of 30.3 +/- 23.5 months was achieved in all but 2 survivors. There was one late death. Ten patients underwent 11 reoperations for recoarctation (n = 1), pulmonary stenosis (n = 7), residual ventricular septal defect (n = 2), and stenosis of superior vena cava (n = 1). Two patients needed a permanent pacemaker. Actuarial survival and freedom from reoperation at 5 years were 84.5% +/- 3.6% and 85.7% +/- 4.6%, respectively. We conclude that anatomic correction of complex transposition is a safe method that offers good early and midterm results.

Child, Preschool↗
PubMed1990

[Total cavopulmonary connection. Prevention of inferior vena cava obstruction by postero-external enlargement of the right atrium].

Rerouting the venal caval blood flow towards the pulmonary artery is a functional surgical procedure suitable for several complex congenital heart diseases. Practically, after division of the terminal end of the superior vena cave (SVC) close to the right atrium, the two segments of the SVC are connected to the right pulmonary artery by termino-lateral anastomosis. The inferior vena caval (IVC) blood flow is conducted to the SVC ostium through an intracardiac atunnel constructed within the right atrium. The SVC ostium, smaller than the IVC ostium, may create a haemodynamic obstruction. Eight patients with complex congenital heart diseases were successfully operated upon according to this total cavopulmonary connection procedure which was always associated with widening of the postero-external area of the SVC and right atrium. Post-operative periods were uneventful. Transient supraventricular arrhythmia occurred in one case.

Arteriovenous Shunt, Surgical↗
PubMed1990

Post cardiac surgery phrenic nerve palsy in pediatric patients.

From January 1978 to December 1988, 109 phrenic nerve paralyses (PNP) occurred in a total of 9149 cardiac operations performed in a population of patients younger than 15 years old (1.2%) whose age varied from 1 day to 15 years old and mean weight was 11.3 +/- 8.7 kg. PNP was diagnosed in 43 patients after closed procedures (1.2% of 3509 procedures) and in 66 patients after open heart operations (1.2% of 5640 operations). PNP was right sided in 49 cases and left sided in 60 cases. Open heart operations that predisposed to PNP were those which needed harvesting of autologous pericardium (P less than 0.0001) and wide exposure of the great vessels. The modified right Blalock-Taussig shunt was the main cause of PNP in closed procedures (P less than 0.02). Small children tolerated PNP less well. They needed longer ventilatory support (P less than 0.0005) and developed more respiratory complications. Seventeen children underwent plication of the affected hemidiaphragm and could be subsequently extubated. It is concluded that for prevention of PNP, a high level of attention should be exercised in neonates and small children, particularly when pericardium is harvested or when exposure needs extensive dissection of the great vessels and thymus resection, or at reoperation. We also prefer to avoid the use of iced slush lavage. PNP, when symptomatic, is best managed by continuous positive airway pressure (CPAP) ventilation. Diaphragmatic plication is recommended when after 2-3 weeks there is no recovery of diaphragmatic function or when there are troublesome respiratory complications.

Adolescent↗
PubMed1990

[Results of the surgical treatment of tetralogy of Fallot before 6 months of age. A consecutive series of 62 cases with 49 complete repairs].

From January 1980 to July 1988, 62 infants aged under 6 months with an uncomplicated Tetralogy of Fallot (single ventricular septal defect, normal coronary arteries, no localised pulmonary artery branch stenosis) underwent 64 surgical procedures. The indications for surgery were increasing cyanosis and/or anoxic spells. Fourteen systemic-pulmonary shunts (21.5%), 49 complete repairs (75.4%) and one enlargement of the right ventricular outflow tract and of the main pulmonary artery without closure of the ventricular septal defect, were performed. The results of palliative shunts are preoccupying: cumulative mortality of 36 per cent; high rate of early reoperation for complete repair: 14 per cent. Complete repair was associated with an operative mortality of 14 per cent. Only one child had to be reoperated. There was no late death after complete repair compared with 2 late deaths after shunt. Ultimate results of complete repairs are good. Some risk factors were statistically significantly associated with complete repair: age (2.5 months or less), weight (4,500 g or less), measurements of the pulmonary arteries estimated by the diameter of the right pulmonary artery (5 mm or less). Conversely there was no death in the subgroup of 31 infants aged more than 2.5 months without major pulmonary hypoplasia (diameter of the right pulmonary artery over 3.5 mm). One-stage complete repair give the best short and medium-term surgical results in treatment of uncomplicated Tetralogy of Fallot in infants, irrespective of age and weight providing they have no diminutive pulmonary arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1990

[Accessory mitral tissue responsible for left ventricular outflow obstruction. Reports of 7 cases].

The authors report the medico-surgical experience of Marie Lannelongue hospital of a rare condition: accessory mitral valve tissue. Seven patients aged 2 to 28 years (average: 8.7 years) had left ventricular outflow obstruction due to accessory mitral valve tissue. The diagnostic was not obvious clinically and was based on the association of echocardiographic and angiographic data. This condition was associated with another intra-cardiac malformation in 6 of the 7 patients. Surgical treatment included resection of the accessory mitral valve tissue by an aortic or combined aorto-left atrial approach, together with correction of the associated intracardiac abnormality. The postoperative results were excellent with the regression of the ventriculo-aortic pressure gradient and the physiological integrity of the mitral valve.

Adolescent↗
PubMed1990

Midterm surgical results of arterial switch operation for transposition of the great arteries with intact septum.

Between April 4, 1984, and December 31, 1987, 156 consecutive neonates with simple transposition of the great arteries underwent an arterial switch operation (ASO) at our institution. Surgery was performed before the age of 15 days in 96%, and patient weight was less than 3 kg in 28%. Seventeen patients (10.9%) died after surgery. One patient was lost to follow-up. Of the 138 survivors, two died of myocardial infarction 35 and 40 days, respectively, after surgery. They were the only late deaths, and actuarial survival rates were 87% (70% confidence level [CL], 83-89%) at 45 days and 87% (70% CL, 68-95%) at 52 months. Another patient had a myocardial infarction 50 days after surgery and is well 50 months later. Pulmonary stenosis was observed in 14 patients (10.3%) during the first year after surgery; two patients were reoperated on 10 and 12 months, respectively, after ASO. Aortic regurgitation was observed in 17 patients: two had grades II and III, respectively, aortic regurgitation on aortography; in 15 patients, it was detected only by Doppler examination. At the last follow-up (2-52 months after ASO; mean, 27.3 +/- 11.3 months), all patients were asymptomatic and taking no medication. On bidimensional echocardiography, left ventricular fractional shortening was normal at rest in all survivors but one. One patient had junctional rhythm, and one had Wenckebach periods; the remainder were in sinus rhythm. For as long as 5 years after ASO, late death and reintervention were rare; 99% of the survivors were asymptomatic and had sinus rhythm and good systemic ventricular function.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1989

[Desinsertions of aortic valve prostheses treated by subcoronary implantation of the valve].

Thirteen patients requiring emergency surgery for desinsertion of their aortic valve prostheses were treated by subcoronary aortic valve grafting, using a procedure based on Danielson's method. The particularity characterizing this technique consists in obtaining direct revascularization of the left coronary artery via a coronary sinus approach, thereby reducing the complexity of the surgical operation. All the patients presented valvular ring lesions, associated with aortic root degeneration accountable for failure of conventional artificial aortic valve replacements; in 8 patients, this had been their third aortic prosthetic surgery. The mean survival period for eight patients was 44 months. Considering the highly critical aspect of such lesions, this technique apparently constitutes a working solution, barring all chances for relapse.

Adult↗
PubMed1989

[Anatomical repair of transposition of the great vessels in the neonatal period. 5 years' experience. 246 patients].

In the period between april 1984 and march 1989, 246 newborn children with transposition of the great vessels benefited from anatomical repair of their heart disease. 221 children had simple transposition with normal interventricular septa. These were aged 2 to 23 days (mean age 7.8 +/- 3.5 standard deviation). 25 had transposition of the great vessels associated with a large interventricular septum defect. These were aged 7 to 30 days (mean age 18 +/- 8.3 S.D.). Associated lesions included a small interventricular septum defect in 20 cases which was not treated at the time of the operation; tricuspid insufficiency in 3 cases; and isthmic coarctation of the aorta in 10 cases. According to Yacoub's classification relative to the anatomical distribution of the coronary arteries, all the children fell into the following groups: type A, 172 cases; type B, 8 cases; type C, 12 cases; type D, 40 cases; type E, 14 cases. Preoperative catheterization was carried out in all the children. 96% benefited from Rashkin's atrioseptostomy, 90% had a prostaglandin infusion continuing through surgery. The surgical technique included the use of continuous extracorporal circulation at 20 degrees C, without circulatory arrest. Protection of the myocardium was ensured during aortic clamping by injecting of a crystalloid cardioplegia-inducing solution. The main steps of surgical repair were repositioning of the coronary arteries onto the ancient aortic stump and reconstruction of a pulmonary shunt. Repositioning of the coronary arteries was carried out in accordance with Yacoub's technique in all cases except for the 10 first patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1988

[Surgery for incomplete atrioventricular canal. Mid-term follow-up apropos of 128 patients].

Among 128 consecutive patients operated upon between 1972 and 1984 at the Marie-Lannelongue Surgical Centre for incomplete persistent atrioventricular canal, 102 could be followed up for periods ranging from 18 months to 11 years. Of the 23 patients lost sight of, 19 were foreigners. One patient died during the first postoperative month and two died during the following five months; there was no death thereafter. One patient developed complete atrioventricular block immediately after surgery. At the end of the follow-up period, three patients had been reoperated upon for disinsertion of the patch on the ostium primum associated in one case with massive mitral regurgitation; two complete atrioventricular blocks requiring permanent pacing had occurred some time after surgery; five patients had presented with late atrial dysrhythmia, and only six patients had signs of heart failure primarily due to residual mitral regurgitation. At radiography, the cardiothoracic ratio was reduced in 74 p. 100 of the cases from 0.60 +/- 0.08 to 0.53 +/- 0.05 (p less than 0.001), and the earlier the operation had been performed, the greater the reduction in cardiothoracic ratio (p less than 0.05). A mitral regurgitation murmur was observed in 72 p. 100 of patients immediately after surgery and in 82 p. 100 of patients at the end of the follow-up period. The murmur was usually weak (79 p. 100) with a tendency to remain stable (44 p. 100) or to increase in intensity (43 p. 100, but reoperation was necessary in only one case.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Restrictive cardiomyopathy in children. Ultrastructural findings.

Restrictive cardiomyopathy is usually related to fibrosis of the endocardium or to an infiltrative disorder. However, in few cases, it can be due to isolated pathology of the myocytes but such alterations are not well characterized. This paper reports the disease in two 7 year old patients. There was severe venous congestion and catheterisation revealed increased end diastolic pressure in the ventricles. Both pericardial and myocardial biopsies were performed, as the clinical and haemodynamic data were indistinguishable from constrictive pericarditis. The structure of the pericardium was normal. The endocardium was not thickened. The interstitium of the myocardial tissue was not increased. Electron microscopic examination revealed intracellular masses of disorganized myofilaments. These large deposits may have produced decrease compliance of the myocytes and of the ventricular walls.

Biopsy↗
PubMed1986

Double outlet right ventricle associated with common atrioventricular canal: report of nine anatomic specimens.

Double outlet right ventricle associated with complete atrioventricular (AV) canal is a rare malformation. Nine cases are reported. In this abnormality the anterior AV leaflet is undivided and free floating and the aortic and pulmonary orifices are in the same frontal plane. In four of the nine cases, the conus was bilateral, but it was slightly hypoplastic in two. In five cases there was no subaortic conus and there was mitral-aortic continuity through the ventricular septal defect. Pulmonary stenosis was present in eight cases. Radiograms may best demonstrate the anatomy of the ventricular septal defect; it extends far anteriorly below the aortic valve, and its inferior rim is deviated by the trabecula septomarginalis.

Heart Defects, Congenital↗
PubMed1986

[Rheumatic mitral stenosis. The medical solution].

The first case of balloon catheter valvular dilatation for rheumatic mitral stenosis is reported in a 13 year-old child. The technique, under local anesthesia, required a transseptal access, then the introduction of one, then simultaneously 2 balloon catheters through the mitral valve. A perfect opening of the valve, without mitral insufficiency was obtained. This technique, even if difficult, seems to be adaptable to most children with rheumatic mitral stenosis.

Adolescent↗
PubMed1986

[Surgical anatomy of the interventricular communications of the septal trabecula].

Muscular ventricular septal defects (VSD) are a special anatomical and surgical entity. They are observed in 85% of cases of multiple VSD. This study was based on the operative findings in 70 patients and 20 pathological specimens of muscular VSD. A surgical topographic classification is proposed, superior, intermediate and inferior, with a specific surgical approach for each of the three types. The superiorly situated muscular VSDs are approached through the right ventricle, the intermediate ones through the right atrium and the inferior through the right atrium or left ventricle. Section of the moderator band greatly facilitates the exposure of the intermediate and inferior segments of the septum through the tricuspid valve. Left ventriculotomies should be reserved for inferiorly situated muscular VSD with right ventricles of small volume.

Heart Septal Defects, Ventricular↗