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D Metras

Publications and source records attributed to D Metras.

At least 73 records · Page 4Linked to original sources
PubMed1987

Aneurysm of the pulmonary artery with cystic medial necrosis and massive pulmonary valvular insufficiency. Report of two successful surgical cases.

The authors report two cases of true aneurysms of the pulmonary artery (APA) associated with massive pulmonary valvular insufficiency. Both were associated with pulmonary artery hypertension and showed cystic medial necrosis at microscopic examination. One case had no associated defects while the other had a large ventricular septal defect and a small patent ductus arteriosus. Both were treated by aneurysmorrhaphy and a valvular procedure (valve replacement, valvuloplasty). The clinical results were excellent. Catheterization at 2 years showed no further aneurysm formation, no pulmonary hypertension, and mild pulmonary valve insufficiency in both patients. The literature concerning APA is reviewed and the etiology and the surgical treatment of APA discussed. A unique method of treating pulmonary valve insufficiency is reported.

Adolescent↗
PubMed1986

[Infectious endocarditis surgically treated during the acute phase. 26 cases].

Twenty-six patients with infective endocarditis were operated upon during the active phase. The endocarditis was native in 24 cases and developed on cardiac valve prosthesis in 2 cases. Depending on the valve involved, the patients were divided into 3 groups: Ao (aortic valve, n = 13), M (mitral valve, n = 10) and T (tricuspid valve, n = 3). The overall mortality rate was 26% (group Ao 20%, group M 20%); death was due, in most cases, to haemodynamic failure. The duration of pre-operative antibiotic therapy, the functional stage of the disease and the cardiothoracic ratio had no influence on post-operative prognosis. In contrast, the presence of vegetations (notably on the aortic valve) at echocardiography and the pumping and aortic clamping times played a role in operative mortality. Twelve patients were followed up for a mean period of 23.9 months. They are all in stage I or II with significant decrease in cardiothoracic index. In Africa, where bacteriological facilities are often inadequate and cardiac valve diseases are diagnosed at a late stage, infective endocarditis is active in many cases. Under these conditions, early surgery is justified when heart failure is present and the infection is not clinically controlled.

Acute Disease↗
PubMed1985

The surgical treatment of endomyocardial fibrosis: results in 55 patients.

Over a 5 year period we have operated on 55 patients with endomyocardial fibrosis (EMF). The patients were from 4 to 56 years old (mean 13) and they were usually in poor condition at the time of surgery, with 47% in class III, and 24% in class IV with respect to cardiac function. They presented with right heart restrictive diastolic filling pattern (n = 17), mitral insufficiency (n = 18), or a combined syndrome (n = 20). All patients were operated upon during cardiopulmonary bypass and were submitted to a combination of the following procedures: endocardiectomy (30 right ventricular, 28 left ventricular), valvular replacement (21 tricuspid valve, 27 mitral valve), and/or valvuloplasty (10 mitral, five tricuspid). Nine patients, all with left ventricular or bilateral EMF, died in the postoperative period (16%), mainly of low cardiac output. There were five late deaths (three valve related). All other patients were functionally improved at the mean follow-up of 32 months. Twenty-two underwent a late catheterization study. We conclude the following from our experience: EMF is a very severe disease that is seen mainly in childhood and adolescence, carries a poor spontaneous prognosis, and is frequently seen in tropical countries. Surgical treatment is beneficial, but surgical mortality is high. Our technical modifications have totally eliminated the occurrence of postoperative complete heart block. A conservative valvular procedure has been shown to be possible even in some patients with severe mitral insufficiency and left ventricular EMF. The late objective improvement is better in those with left ventricular EMF than in those with right ventricular EMF.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Early coronary atherosclerosis in a malignant pheochromocytoma. Apropos of a case].

An observation of adrenergic myocarditis with clinical and electrical signs of coronary failure is reported. The patient had electrical and enzymatic manifestations of acute anteroseptal necrosis, complicated at the acute stage by complete atrioventricular block and fatal vasoplegic circulatory collapse. Post-mortem examination showed obstructive atherosclerosis of the anterior interventricular artery without anatomic signs of infarction. Pathogenesis of this coronary failure is discussed. In this case, functional coronary insufficiency produced by catecholamine release was associated with coronary atherosclerosis.

Adrenal Gland Neoplasms↗
PubMed1984

Pulmonary arteriovenous fistula coexisting with rheumatic mitral disease. Simultaneous successful correction under cardiopulmonary bypass in one case. Review of the literature.

The authors report a rare case of coexistence of a pulmonary arteriovenous fistula with rheumatic mitral disease. The diagnosis was suspected clinically and with the chest X-ray, and was confirmed by the cardiac catheterization showing mitral disease and a pulmonary arteriovenous fistula with arterial desaturation (70%). Successful surgery (aneurysmal excision and closure of abnormal communication together with mitral valve repair) was undergone under cardiopulmonary bypass. In the literature, 7 cases of this association have been reported, with surgery in 4. None of the cases had a procedure similar to the above-mentioned and simultaneous surgery was not recommended. The authors show that the anatomic situation of the case reported allowed simultaneous surgery, and that cardiopulmonary bypass rendered the procedure easy.

Arteriovenous Fistula↗
PubMed1984

Right ventricular dysfunction after endocardiectomy for right ventricular endomyocardial fibrosis.

Early right ventricular failure following a large endocardiectomy in right endomyocardial fibrosis (EMF) is reported. This diagnosis was confirmed upon echocardiography by the presence of a dilated right ventricle, and hemodynamically (upon postoperative control catheterization) by the presence of right ventricular diastolic dysfunction. The role of the endocardiectomy and of the pericardium in the genesis of this ventricular dysfunction are discussed in the light of this case which was documented by a hemodynamic study and surgically confirmed.

Adolescent↗
PubMed1984

[Echocardiographic, angiographic and hemodynamic development of surgically treated endomyocardial fibrosis].

The echocardiographic, angiographic and haemodynamic evolution of endomyocardial fibrosis (EMF) was assessed in 19 patients: 8 patients with isolated right sided EMF, 3 with predominantly right-sided EMF, and 8 with isolated left sided EMF with mitral regurgitation. Echocardiographic controls were preformed in 16 patients, on average 11.3 months after surgery; angiographic and haemodynamic controls were preformed in 14 patients, on average 14 months after surgery. In isolated or predominantly right-sided EMF, echocardiographic abnormalities of septal motion (paradoxal) disappeared. Although the volume of the right heart chambers decreased, they remained dilated. The syndrome of adiastole disappeared in patients operated early. In left EMF with mitral regurgitation, the M-shaped motion of the septum regressed in the 4 cases in which this abnormality was observed preoperatively. The size of the left heart chambers decreased on post-operative echo and angiographic studies. Left ventricular function returned to normal after surgery. The author underline the differences between right and left-sided EMF with mitral regurgitation. In right-sided EMF the evolution is that of adiastole and surgery should be preformed early because the right ventricular reserve is small. In left-sided EMF with mitral regurgitation, the evolution is that of a valvular lesion with a good postoperative result.

Adolescent↗
PubMed1984

[Conservative valve surgery in endomyocardial fibrosis. Apropos of 8 cases among 46 surgically treated patients].

The authors report their experience of conservative valvular surgery in endomyocardial fibrosis (EMF) (8 cases among 46 surgical cases). These patients were divided into 3 groups: Group I: bilateral EMF predominating on the left side with associated tricuspid involvement (n: 3). Group II: bilateral EMF predominating on the right side with moderate associated mitral involvement (n: 3). Group III: unilateral EMF with massive mitral insufficiency, (n: 2). At surgery, on the side of the conserved valve, the patients had a transvalvular endocardectomy (n: 3) and a valvuloplasty either tricuspid (n: 3) or mitral (n: 5). The results of the valvuloplasty were satisfactory. Two patients died in the post-operative period. Their death was unrelated with the conservative procedure. The authors study the literature concerning the cases of valvular conservative surgery in EMF (n: 4) and define the conditions under which this surgery can be done. They report 2 original cases of pure left sided limited EMF with massive mitral insufficiency successfully treated by a valvuloplasty.

Adolescent↗
PubMed1983

[Open-heart surgery in tropical Africa. Results and peculiar problems of the 1st 300 cases of extracorporeal circulation performed in Abidjan].

The authors report on their experience of 300 open-heart operations performed in Abidjan for cardiac valve disease (149 cases), congenital cardiopathy (100 cases), endomyocardial fibrosis (40 cases) and other lesions. The operational method involved haemodilution, hypothermia, aortic clamping and cardioplegia. The death rate was 13.3%, mostly due to the severity of the condition prior to surgery. A number of specific points are discussed, including haemodilution without blood perfusions, surgery in patients with sickle-cell anaemia, cardiac valve surgery in children and surgery of endomyocardial fibrosis.

Adolescent↗
PubMed1983

Left endomyocardial fibrosis with severe mitral insufficiency; the case for mitral valve repair. A report of 4 cases.

Left ventricular endomyocardial fibrosis accompanied by severe mitral insufficiency occurring in 4 adolescent African patients is reported. Mitral valve repair was successfully performed in all 4 cases including annuloplasty in 3 and chordal shortening in one. Short-term follow-up of up to 10 months indicated substantial clinical improvement and decrease of the cardiothoracic ratio in all. It is emphasized that mitral valve repair appears to be the method of choice in treating mitral incompetence in the localized form of endomyocardial fibrosis, where endocardiectomy is not required in the area of the papillary muscles.

Adolescent↗
PubMed1983

Endomyocardial fibrosis masquerading as rheumatic mitral incompetence. A report of six surgical cases.

This report presents six cases (among 43 surgical cases) of left ventricular EMF presenting as pure mitral insufficiency without any echocardiographic or hemodynamic signs of left ventricular EMF (except apical diverticulum in two cases). Five of these cases were diagnosed at operation, and the sixth was diagnosed on the basis of a characteristic right ventricular angiogram. At operation a fibrotic lesion localized to the level of the anteropapillary muscle, with severe mitral insufficiency, was found. Five patients underwent successful mitral valve replacement and one a successful conservative mitral valve procedure. Postoperative angiograms, done in two patients, showed a normal contour of the left ventricle. A review of the literature did not reveal any previous descriptions of this type of limited left ventricular EMF, mimicking rheumatic mitral insufficiency. In our surgical experience, we have encountered three types of left ventricular EMF: obliterative, extensive, and limited. We emphasize EMF as a possible cause of mitral insufficiency in African children.

Adolescent↗
PubMed1982

Endomyocardial fibrosis: early and late results of surgery in 20 patients.

Twenty patients with endomyocardial fibrosis (EMF), the largest series reported to date, were operated upon between June, 1978, and June, 1980. Eleven were male and nine female, ranging in age from 6 to 23 years (mean 13.3 years). There were seven cases of right ventricular (RVEMF), six of left ventricular (LVEMF), and seven cases of bilateral EMF. All patients underwent endocardiectomy and atrioventricular valve replacement with a xenograft. Four patients had an additional valvular annuloplasty. There were four postoperative deaths (all bilateral EMF): two from low cardiac output and one each from hepatic failure and cerebral malaria. There was one late death from serum hepatitis. The other patients had a relatively difficult postoperative course, but none of the 20 patients atrioventricular block. The longest follow-up of the 15 survivors is 28 months (mean 16.7 months). All patients are symptom free. Three take digitalis and/or diuretics. Ten have been recatheterized from 6 months to 1 year after operation. Intracardiac pressures, the ventricular cineangiogram, liver, and heart size returned to normal in patients with LVEMF; in RVEMF, despite clinical improvement, most of these parameters remained abnormal. Of special interest were (1) our recognitions of an early type of LVEMF and (2) our surgical preservation of a thin juxta-annular rim of fibrosis in the right ventricle to avoid atrioventricular block. Operation is indicated in all patients with LVEMF, despite greater risk. Early intervention is advised in RVEMF to avoid irreversible liver damage and cardiac enlargement.

Adolescent↗
PubMed1981

[Arterial thrombosis of the femoro-popliteal axis. An exceptional case of vascular complication by exostosis (author's transl)].

The authors report an exceptional case of arterial thrombosis of the femoro-popliteal axis, caused by a bony exostosis of the femur. It was a man of 48 years, presenting with sub-acute ischemia of the left lower limb. The different examinations showed an extensive femoro-popliteal artery thrombosis centered by a bony exostosis of the inferior third of the femur. The patient was successfully operated upon with resection of the exostosis and saphenous vein femoro-popliteal by-pass. A review of the literature shows the rarity of vascular complication of exostosis and particularly of thrombosis, previously reported only 4 times. An explanation of the mechanism involves the repeated trauma on the artery in this narrow region and the possibility of superimposed atheroma.

Arteriosclerosis↗