[Systemic-pulmonary anastomosis using an expanded polytetrafluoroethylene (PTEF) prosthesis in congenital cardiopathies with pulmonary hypovascularization. Apropos of 37 anastomoses].
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Biomedical subjects
Publications and source records attributed to C de Riberolles.
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The authors report a case of recurrent cerebral embolism in a 43-year-old patient with a familial form of Rendu-Osler-Weber disease and review their experience of 19 cases of pulmonary arteriovenous fistula. Neurological complications were rare but considerably aggravated the disease. They were due to a significant right/left shunt but remained unpredictable, being unrelated to peripheral arterial saturation. The pathophysiological mechanisms and therapeutic possibilities are discussed.
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Immediate and late postoperative results in 70 patients undergoing resection of a true left ventricular aneurysm (50 patients) and of an asynergic area (20 patients) are presented. The operative mortality was 14 per cent. Predicted survival by actuarial methods was 80 per cent at one year after operation and 65 per cent at six years. Functional improvement was obvious with most of the survivors falling in NYHA class I or II. Factors influencing operative mortality were the clinical indication for operation and the anatomical lesion. Late postoperative results were better for true aneurysms than for asynergic areas. An asynergic area was usually associated with multiple coronary vessel lesions and a diffusely ischaemic myocardium. An aneurysm was often associated with a single coronary vessel disease and with good function of the non-infarcted myocardiun.
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The malformations requiring valve fitted prosthetic tubes in the pulmonary outflow tract were mainly persistent truncus arteriosus and pulmonary atresia with ventricular septal defect in this series. The surgical mortality before 18 months was 75% and 19% after this age. The long-term clinical result (average follow up period: 2,5 years) was good or acceptable in 20 of the 32 survivors. There were 5 late deaths and 6 reoperations. The main causes of long-term failures were progressive pulmonary hypertension without shunt, acquired stenoses on the prosthesis and late infection. It is important to assess poor results by catheterisation as reoperation is frequently possible with a relatively low mortality rate (1/6) and encouraging results.
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The authors report 3 cases of pulmonary stenosis with an intact interventricular septum and tricuspid incompetence. The tricuspid regurgitation was corrected in all 3 cases. After recalling the clinical features, they emphasize the importance of seeking for this condition and correcting it in every case if the immediate and long-term results are to be satisfactory.
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