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Biomedical subjects

D Guilmet

Publications and source records attributed to D Guilmet.

At least 37 records · Page 2Linked to original sources
PubMed1996

Protection of the spinal cord during surgery of thoraco-abdominal aortic aneurysms.

OBJECTIVE: To assess the risk of ischemic cord injury, we have retrospectively studied the 115 patients who underwent a replacement of the thoracic descending or thoraco-abdominal aorta between January 1980 and December 1994. METHODS: In 72 patients the aortic lesion was located above the diaphragm. The aortic replacement was performed with the aid of extracorporeal circulation in all but 2 patients (97.2%). Only two cases of postoperative paraplegia were observed (2.7%). In 43 patients (10 females and 33 males aged from 26 to 69 years), the occurrence of postoperative paraplegia was considered as a major risk, because of the extension of the aortic lesions (Crawford types I, II and III). Twenty-six patients (60.4%) suffered from chronic dissection and 17 patients had atheromatous aneurysms. Sixteen patients (37.2%) had Marfan syndrome. Twelve patients (27.9%) had already undergone aortic replacement. A preoperative study of the spinal cord vascularization was carried out in 36 patients (83.6%) and the Adamkiewicz artery was visualized in 28 patients (77.8%). In 17 patients (39.5%, group I), the surgical procedure was performed without the aid of extracorporeal circulation. In the remaining 26 patients (60.5%, group II), the surgical procedure was carried out with the aid of cardiopulmonary bypass and profound hypothermic circulatory arrest. Sequential unclamping of the aorta was used in all patients. The cord vascularization was surgically restored in 32 patients (74.4%). When the Adamkiewicz artery was identified, the critical intercostal artery was reimplanted together with the two pairs of adjacent intercostal arteries (25 patients). When the origin of the Adamkiewicz artery remained unknown, the two or three most important patent pairs of intercostal arteries were reimplanted (7 patients). In 8 patients (18.6%) there were no patent intercostal arteries. RESULTS: Hospital mortality accounted for 37.2% (16 patients, including 5 patients with paraplegia). On univariate analysis, extension of the aortic lesions, emergency and redo surgery were the only significant risk factors of mortality (P = 0.05). Cord ischemia was observed in 9 patients (21%): permanent paraplegia in 7 patients (16.2%) and transient medullar disturbance in 2 patients (4.6%). The occurrence of paraplegia was reduced, though not significantly, in group II (16%) vs group I (29%) and in patients with preoperative assessment of the cord vascularization (18% vs 38%). CONCLUSIONS: In our experience: 1) The risk of paraplegia is related to the extension and the type of the aortic lesions. 2) The preoperative study of the medullar vascularization and the use of extracorporeal circulation with deep hypothermia and sequential aortic unclamping, reduce the risk of severe cord ischemia, and 3) Occurrence of postoperative paraplegia depends on several factors and cannot be totally prevented by the surgical technique.

Adult↗
PubMed1996

[Surgery FOR annulo-dystrophic disease of the ascending aorta. Apropos of 203 cases].

From April 73 to June 94, 203 patients (167 men, 36 women) aged from 10 to 74 years (mean 44.8 +/- 15) underwent ascending aortic replacement with a composite graft for: dystrophic aneurysm (AN) (130 cases, 64.5%), chronic dissection (CD) (35 cases, 17.2%), type A acute dissection (AD) (38 cases, 19%). Forty-six patients (22.6%) suffered from Marfan syndrome (24 AN, 13 AD, 9 CD). Thirty patients (14.7%) had undergone a previous cardiac or aortic operation. The ascending aortic replacement was extended to the transverse arch in 28 patients (14%). A mechanical valve was used in 193 cases (95%). The technique of coronary reattachment has varied with time and according to the aortic lesions. The classic "Bentall" technique was used in 87 patients (43%), the "button" technique in 74 (36%), the "Cabrol" technique in 26 (13%) and a "mixed" technique in 16 cases (8%). The hospital mortality rate was 7.3% (15/203) (AN: 2.3%, CD: 11.4%, AD: 21%). The only predictors of hospital death were emergency AD (p < 0.03) and arch replacement (p < 0.02). Mean follow-up was 46 +/- 10 months (2-246). The overall long-term survival rate was (Kaplan Meier) 89 +/- 6% at 1 year, 77.9% at 5 years, 67.7 +/- 12% at 10 years and 61.3% +/- 15% at 12 years. The 10 years survival rate is significantly higher in patients with AN (77.8 +/- 11%) than in those with AD (61.6 +/- 17%) (Log.rank: p < 0.01). The late survival rate is also significantly higher after the "button" or Bentall reimplantation that after the "Cabrol" or "mixed" methods (90 +/- 5% in the "button" group and 88.7 +/- 6%, 83.8 +/- 9% and 76.6 +/- 12% in the "Bentall" group vs 80 +/- 18%, 63 +/- 21% and 58 +/- 35% in the "Cabrol" group at 1, 5 and 8 years, respectively). In conclusion, ascending aortic replacement with a composite graft is a safe procedure especially when performed electively in patients with dystrophic aneurysm or Marfan syndrome. The technique of coronary reimplantation has a significant on the long-term results.

Actuarial Analysis↗
PubMed1996

[Emergency cardiac transplantation].

Emergency cardiac transplantation is a controversial subject in the present context of a lack of donor organs. There are few reports in the literature, which the authors review to suggest a practical approach which is clearly not consensual. The results in the literature report an extramortality of 10 to 30% if the indication of transplantation is that of an emergency. The poor results of emergency transplantation in the present day context of lack of donor organs have led the authors to abandon this indication. They only transplant patients in a stable condition without failure of organs other than the heart.

Actuarial Analysis↗
PubMed1995

[A new model of the sterno-thoracic retractor].

Vertical medial sternotomy is recognized as the best approach for heart surgery. We have modified the double valve Chevalier retractor (widely used since 1962 and adapted by others) to improve its performance. A new articulation on the retractor arms facilitates installation of extracorporeal circulation and epicardial electrodes without removing the device. The position of the rack-bar can also be modified to avoid cervical compression. In addition, the inferior aspect of the rack-bar has been covered with a plate to avoid catching the drapes.

Humans↗
PubMed1995

[Long-term results of cardiac transplantation].

Between 1982 and 1992, 73 patients who had undergone cardiac transplantation and survived the hospital period, were followed up. The actuarial survival was 86%, 65% and 40% at 1, 5 and 7 years. The main causes of the 14 secondary deaths were infection (4), acute rejection (3) and cancer (3). Survival was complicated by acute rejection (1.07 episodes/patient), infection (0.7 episode/patient), cancer, hypertension and renal failure, graft dysfunction and other more secondary side effects. After analysing all the complications, the authors evaluated the quality of long-term survival after cardiac transplantation which allowed one patient out of two to return to normal living but with the threat of secondary graft dysfunction.

Actuarial Analysis↗
PubMed1994

Myocardial viability assessment in ischemic cardiomyopathy: benefits of coronary revascularization.

Patients with ischemic heart disease, congestive heart failure, and low ejection fraction are usually referred for orthotopic heart transplantation. Based on results of myocardial viability assessment, we have prospectively used either coronary artery bypass grafting or orthotopic heart transplantation. From January 1990 to June 1992, among 50 patients initially referred for heart transplantation, 46 showing myocardial viability underwent bypass grafting. Forty-five of these 46 patients were men, and the mean age was 58 +/- 12 years (range, 40 to 70 years). Congestive heart failure was present in all patients, and dyspnea was the main symptom in 80% (37/46). Patients were selected according to three criteria. (1) Myocardial viability was primarily assessed by thallium scintigraphy for up to 24 hours (28/46 patients). When results were negative, patients underwent positron emission tomography (20/46 patients). (2) Regional left ventricular function was assessed using gated blood pool single-photon emission computed tomography combined with (3) full hemodynamic evaluation. Results were as follows: end-diastolic volume, 129 +/- 35 mL/m2; ejection fraction, 0.23 +/- 0.06; cardiac index, 2.4 +/- 0.62 L.min-1.m-2; mean pulmonary artery pressure, 26 +/- 0.90 mm Hg; and mean pulmonary capillary wedge pressure, 16 +/- 1.10 mm Hg. Operative mortality was 2.17% (1/46). During follow-up (mean duration, 18 months), there were three late cardiac-related deaths (arrhythmias) and two noncardiac-related deaths. The 40 long-term survivors are in New York Heart Association class II. Angiography (15 patients) or gated blood pool single photon emission tomography (32) showed improvement in mean ejection fraction to 0.39 +/- 0.13 (range, 0.22 to 0.46).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Late reoperations in patients with aortic dissection.

Aortic dissection is an evolving process that may require one or several reoperations after the initial emergency repair. From January 1977 to September 1993, 148 patients underwent emergency surgery for type A acute aortic dissection. The replacement of the ascending aorta was extended to include the transverse arch in 43 patients (29%). One hundred fifteen patients (78%) survived surgery. During the same period, 37 patients required reoperation once (28), twice (7), or three times (2), for a total of 48 reoperations. Twenty-one patients had undergone initial repair in our institution; 16 patients had been operated on elsewhere. Reoperation was indicated for: aortic valve disease (4); a new dissecting process (7); threatening aneurysmal evolution of a persisting dissection (34); or false aneurysm (3). The re-do procedure involved: the aortic root and/or ascending aorta in 12 cases (group I); the ascending aorta and the transverse arch in 6 cases (group II); the transverse arch alone in 8 cases (group III); the transverse arch and descending aorta, or the descending aorta alone in 11 cases (group IV); and the thoracoabdominal aorta in 11 cases (group V). Risk factors for reoperation were analyzed in the 115 survivors initially operated on at our institution. Seven of 20 Marfan patients (35%) versus 12 of 95 non-Marfan patients (12.6%) required reoperation (p < 0.02). None of the 31 patients surviving arch replacement at initial repair required a reoperation, versus 21 of 84 (25%) patients surviving replacement limited to the ascending aorta (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Aortic dissection. Prevalence, cause, and results of late reoperations.

From January 1977 to September 1992, 143 patients underwent an emergency operation for type A acute aortic dissection. Because of the location of the intimal tear, the replacement of the ascending aorta was extended to the transverse arch in 42 patients (29.3%). One hundred ten patients (78%) survived the operation. During the same period, 32 patients had to be reoperated on once (n = 24) twice (n = 6), or three times (n = 2) for a total of 42 reoperations. Nineteen patients had had the initial repair in our institution, and 13 had been operated on elsewhere. Reoperation was indicated for aortic valve disease (n = 4), recurring dissection (n = 7) threatening aneurysmal evolution of a persisting dissection (n = 28), or false aneurysm (n = 3). The redo procedure involved the aortic root and/or ascending aorta in 15 cases (group I), the transverse arch alone in 7 cases (group II), the transverse arch and the descending aorta or the descending aorta alone in 10 cases (group III), or the thoracoabdominal aorta in 10 cases (group IV). The risk factors for reoperation have been analyzed in the 110 survivors initially operated on in our institution. Seven of 18 patients with Marfan's syndrome (38.8%) versus 12 of 92 without Marfan's syndrome (13%) were reoperated on (p = 0.023). None of the 30 patients surviving arch replacement at initial repair required a reoperation, versus 19 of 80 (23.7%) patients surviving a replacement limited to the ascending aorta (p = 0.013). The overall mortality rate of reoperation was 21.8% (7/32) with a risk of 16.6% (7/42) at each procedure (group I, 13.3%; group II, 0%; group III, 20%; group IV, 30%). Hospital mortality was influenced by emergency operation (5/10) (p < 0.005) and thoracoabdominal replacement (3/10) (p < 0.035). The late survivals after reoperation are 65.1% +/- 17.6% at 1 year and 55% +/- 19.63% at 5 years (Kaplan-Meier, confidence interval 95%). The late survivals, after the initial repair, of the patients undergoing reoperation are 89.6% +/- 11.0%, 79.3% +/- 14.7%, 53.9% +/- 18.1%, and 35.9% +/- 21.8% at 1, 5, 10, and 12 years, respectively. In conclusion, aortic dissection is an evolving process that may require one or several reoperations after the initial repair. At initial emergency operation, the resection of the entry site, when located on or extending to the transverse arch, has reduced the risk of reoperation, in our experience. Elective reoperation must be considered before the occurrence of complications, especially in patients with Marfan's syndrome.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1993

Clonidine premedication for coronary artery bypass grafting under high-dose alfentanil anesthesia: intraoperative and postoperative hemodynamic study.

The purpose of this study was to assess the efficacy of clonidine in achieving perioperative hemodynamic stability in patients undergoing coronary artery bypass grafting performed under high-dose alfentanil anesthesia. Twenty-four patients with left ventricular ejection fraction greater than 0.5 were prospectively studied in a double-blind manner; those requiring emergency procedures were excluded. They were randomized to receive either oral clonidine or placebo together with their premedication. Induction of anesthesia was achieved with 10 mg of alfentanil infused over 5 minutes followed by a continuous infusion of 60 mg/h during 1 hour, or until sternotomy, and then 30 mg/h until the end of surgery. Hemodynamic responses to noxious stimuli were treated with additional alfentanil boluses and isoflurane when these were unsuccessful. Intraoperative hemodynamic profile analyses showed a continuous increase in systemic vascular resistance and mean arterial pressure in the clonidine group from the time of skin incision until the onset of bypass, whereas the cardiac output profiles remained similar in the two groups. The number of additional alfentanil boluses was similar. Isoflurane requirements (1/11 v 4/13) were not significantly different, but only a few patients required this therapy. The postbypass hemodynamic profiles were similar. Severe hemodynamic impairment occurred in the clonidine group during warming in the postoperative period: this group showed a drop in systemic vascular resistance index (1276 +/- 347 v 1757 +/- 415 dyn.sec.cm-5.m2) that could not be compensated for by an increase in cardiac output despite normal filling pressures, causing hypotension (66 +/- 10 v 79 +/- 16 mmHg). This hemodynamic status led to greater requirements for vasoactive agents and inotropics in this group.(ABSTRACT TRUNCATED AT 250 WORDS)

Alfentanil↗
PubMed1993

Aortic dissection: anatomic types and surgical approaches.

Our classification system of acute dissection of the aorta is based on the site of the main intimal tear: Type A: on the ascending aorta; type B: on the transverse aortic arch; type C: on the descending aorta. The extension of the dissecting process is classified as "antegrade" or "retrograde". Acute dissection involving the ascending aorta is an absolute surgical urgency. Any delay in referring the patient to a proper surgical institution or to the operating room increases the risk of death. Fifty per cent of patients, indeed, either untreated or medically supported, die within 48 hours after the onset of symptoms. Surgical therapy is mainly aimed at preventing the patient from dying from intrapericardial rupture of the aorta or from acute massive aortic regurgitation. In type A, it is necessary to replace the ascending aorta with a bloodtight Dacron prosthesis after resecting the entry site, if possible. Downstream, joining the two dissected cylinders by two running sutures and the aid of GRF glue, seals the false lumen. Upstream, the reconstruction of the aortic root and the resuspension of the aortic valve, also by means of running sutures and GRF glue, suppress the aortic valve insufficiency in 90% patients. However, in case of pre-existing annulo-aortic ectasia, the ascending aorta must be replaced by a composite tube according to the Bentail technique. The use of GRF glue since the beginning of 1977, has dramatically improved the immediate and long-term results, accounting for a hospital mortality rate of 10%, in patients less than 65 years old. In type B, resecting the entry site requires that the transverse arch be partially or totally replaced. It is, therefore, mandatory to protect the Central Nervous System. In our experience this is best achieved by perfusing the carotid arteries with cold blood (6 degrees C) during circulatory arrest at moderate core hypothermia (28 degrees C). With this technique of "Cerebroplegia", the hospital mortality rate has been lowered to 28%, higher, though, than in patients undergoing isolated replacement of the ascending aorta. In type C, only the dissections demonstrating symptoms of major complications (rupture or deleterious ischemia) require urgent surgical treatment. In the remaining cases, medical treatment, based on permanent and accurate control of the patient's blood pressure, lead to a good long-term survival rate. Close survey at regular intervals, by means of CT scan or MNR is mandatory to detect any aneurysmal evolution, which may require surgery.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1992

[Etomidate modifies hemodynamic response to fentanyl in patients with impaired left ventricular function].

The haemodynamic effects and the side-effects of anaesthesia using high doses of fentanyl were compared in two groups of 12 patients each. All the patients had poor left ventricular function and were scheduled for elective coronary artery bypass graft surgery or valvular replacement. Patients were randomly assigned to either group. In group EF, patients were given 5 micrograms.kg-1 of fentanyl, followed by 0.3 mg.kg-1 of etomidate. Once they had lost consciousness, they were given 15 mg of pancuronium and 25 micrograms.kg-1 of fentanyl over a 5 min period. Patients in group F received the full 30 micrograms.kg-1 dose of fentanyl over a 5 min period, followed by 15 mg of pancuronium. The patients were intubated 2 min after the end of the fentanyl infusion. They were mechanically ventilated with 100% oxygen. Anaesthesia was maintained with a continuous infusion of fentanyl (total dose 100 micrograms.kg-1). The usual haemodynamic parameters were monitored and calculated, as well as pain during injection of the drugs, myoclonia, chest wall rigidity and the time to loss of consciousness. The two groups were comparable with respect to age, weight, height and surgery. One third of the patients in group EF complained of pain during etomidate injection. The time required to loose consciousness was shorter in group EF (55 +/- 16 sec) than in group F (177 +/- 56 sec) (p < 0.001). The cardiac index decrease in group EF (2.0 +/- 0.4 l.min-1.m-2 vs. 1.9 +/- 0.4 l.min-1.m-2) (p < 0.05), respectively between the time just before tracheal intubation (T1), and 10 min after tracheal intubation (T3).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Intravenous↗
PubMed1991

Cold cerebroplegia. A new technique of cerebral protection during operations on the transverse aortic arch.

Profound hypothermia associated with circulatory arrest is the commonest method of cerebral protection during operations on the aortic arch. This technique allows a limited time to perform the aortic repair, however. It also necessitates prolonged cardiopulmonary bypass to rewarm the patient. This may be the cause of coagulation disorders or infection. Selective perfusion of the carotid arteries can also be used. When the perfusion is derived from the main arterial line, however, the repair of the aorta requires that the vessel be crossclamped, and cannot be performed in an "open, bloodless" manner. To avoid the disadvantages of both techniques, we have developed a new technique of cerebral protection. After a regular cardiopulmonary bypass has been established, the carotid arteries are cannulated and perfused with blood cooled at 6 degrees to 12 degrees C, through a separate heat exchanger, while the core temperature is maintained at moderate hypothermia (25 degrees to 28 degrees C, rectal). To perform the "open" distal repair, the cardiopulmonary bypass is discontinued while the carotid perfusion is maintained (250 to 350 ml/min). When the distal repair is completed, cardiopulmonary bypass is resumed and the carotid perfusion is discontinued. Between 1984 and June 1989, 54 patients (mean age 55 years) were operated on with this method (45 elective operations, 9 emergency procedures). Mean duration of cardiopulmonary bypass was 121 minutes (65 to 248), and mean duration of circulatory arrest was 22 minutes (10 to 51). The electroencephalogram, routinely recorded, showed return of the cerebral activity after a mean time of 12 minutes and normal activity after a mean time of 66 minutes. There was no intraoperative death. Hospital mortality rate was 13% (7/54). One death was related to neurologic disorders. All patients but one awakened normally within 8 hours after operation. Two patients (4.3%) experienced a transient neurologic episode (lateral hemianopia) 9 and 11 days postoperatively. There was no hemorrhagic complication (24-hour average blood loss: 840 +/- 540 ml). In our experience the technique of "cold cerebroplegia" has been demonstrated to provide excellent cerebral protection. It requires no prolonged cardiopulmonary bypass and does not limit the time necessary to perform the aortic repair. It may be considered as a safe alternative to profound hypothermia associated with circulatory arrest.

Adult↗
PubMed1990

Repeated surgery for recurrent dissection of the aorta.

Emergency surgery of acute dissection of the ascending aorta is generally a palliative procedure aimed at preventing the vessel from rupturing into the pericardium. Evolving dissecting aneurysm or recurrence of the dissection process is, therefore, a common complication and may lead to reoperation or death. Between January 1970 and December 1988, 133 patients were operated upon for acute dissection of the ascending aorta. During the same period, 22 patients underwent 26 reoperations for recurrent or evolving dissection. Eleven (50%) patients had Marfan's syndrome. Thirteen patients had been operated upon previously in our institution and 8 had been operated upon elsewhere. In 10 patients, the intimal tear had not been resected during the first operation. Operative procedures varied according to the pathoanatomical features and consisted generally of an extended resection of the aortic arch. Eight reoperations were performed as emergencies and 18 were performed electively. Hospital mortality rate was 18% (4/22). Late follow-up ranged from 3 to 153 months (mean: 55 months) for a cumulative follow-up of 998 months. Late mortality was 27% (5/18) for a linearized rate of 6% pt/yr. The actuarial risk of reoperations is 13.7% +/- 7% and 21% +/- 11% at 5 and 10 years, respectively. Marfan's syndrome and persistence of the primary intimal tear are considered the main risk factors of reoperation, while emergency and thoraco-abdominal replacement are the main risk factors at reoperation.

Adult↗
PubMed1989

[Surgical treatment of chronic pulmonary embolism using thromboembolectomy under extracorporeal circulation and deep hypothermia--a new approach route. 3 cases].

The authors, who have successfully performed thrombectomy of the pulmonary artery under extracorporeal circulation and deep hypothermia in three patients, wish to draw attention to the principal factors of success. The decision to operate, as accepted by most surgeons, rests on the patient's functional status (stage III or IV) and on the presence of a systolic pulmonary arterial pressure exceeding 50 mmHg. Deep hypothermia combined with circulatory arrest seems to be the best method, as it improves visual control, thereby avoiding damage to the endothelium or fracture of the distal thrombi during thrombectomy. Finally, a new approach route (severing of the superior pulmonary vein, opening of the pulmonary artery and use of Volmar-Sisteron strippers) makes it possible to remove the entire thrombus, thus obtaining an almost normal pressure in the pulmonary artery. In all three patients, the complications that are mostly due to intrabronchial haemorrhage by disruption of the endothelium, fracture of the distal thrombus or pulmonary artery contusion were avoided.

Adult↗
PubMed1989

The Omni design: evolution of a valve.

The Lillehei-Kaster prosthesis has been the subject of an engineering evolution to close the gap between engineering expectations and clinical performance. Advanced engineering development in response to users has narrowed this gap with the Omni design (Omniscience titanium and omnicarbon Pyrolite cages). Our studies on mitral Omniscience valves demonstrated that because anatomic and surgical variations, the anterior orientation was more forgiving than the posterior orientation, resulting in lower thrombotic complications (0.5% versus 3.3% patient-year). A subsequent thicker cuff was used to reduce the probability of anatomic interference and incomplete opening after cardiac recovery. Such findings were also incorporated in the Omnicarbon design. Five European centers implanted 354 patients (198 atrial valve replacement, 115 mitral valve replacement, and 41 double valve replacement with Omniscience valves between August 1984 and January 1986. No restrictive patient selection criteria were used. As of June 1987, 96% of the patients at risk were accounted for. Average follow-up was 1.7 +/- 0.4 years (range, 0.3 to 2.8 years), with a total follow-up of 555 years. There were no cases of structural failure or clinically significant hemolysis. Ninety-one percent of the patients improved one or more functional classes. Actuarial analysis of survival probability at 3 years is 92.5% for atrial valve replacement, 97.9% for mitral valve replacement, and 93.6% overall. There were no late deaths from valve thrombosis or thromboembolism. The actuarial freedom from all thromboembolic events (valve thrombosis, thromboembolism, and transient ischemia) is 97.8% at 2 1/2 years. Through close rapport between user surgeons and designers, the evolution of a valve with improved performance becomes a reality.

Actuarial Analysis↗
PubMed1988

Surgery of aortic stenosis and lesions of the ascending aorta.

Between 1978 and 1986, 442 aortic valvular replacements were performed for chronic calcified aortic stenosis. In 11 patients (2.5%, seven men and four women) replacement of the ascending aorta was associated with the valvular replacement, because of: seven supra-coronary aneurysms, two aneurysms involving the Valsalva sinuses, and two acute dissections of the ascending aorta. The repair of the ascending aorta consisted in inserting: one patch on one Valsalva sinus, seven supra coronary Dacron prostheses, three valved conduits (according to the Bentall technique). One patient died postoperatively (9%).

Adult↗
PubMed1988

[Multiple proximal coronaro-pulmonary fistulae. Review of the literature apropos of a new case].

The authors report a new case of multiple proximal coronaro-pulmonary fistula between right coronary arteries, anterior interventricular artery and the trunk of the pulmonary artery, in a 64 year-old female patient with chest pain and a continuous murmur located in the third left intercostal space. The coronary steal is demonstrated by a myocardial scintigraphy during stress with return to normal after surgical ligation. A review of the literature enabled to find 33 cases of this major congenital anomaly of the coronary arteries, defined as an abnormal communication between at least two main coronary vessels and the trunk of the pulmonary artery. This results in a left-right shunt, usually minor without any repercussions on the right cavities and pulmonary pressures. The entire clinical, electrocardiographic, radiological, sonographic, scintigraphic, haemodynamic and angiographic picture is reported for these 33 cases. A physiopathological discussion is proposed. The course of this disease is usually favorable (only one case of myocardial infarction was published, without cardiac failure. Osler's endocarditis or sudden death); this seems to authorize simple monitoring as a logical therapeutic approach except when a myocardial ischemia secondary to coronary steal is demonstrated, imposing a surgical correction.

Arterio-Arterial Fistula↗