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Biomedical subjects

G Lemoine

Publications and source records attributed to G Lemoine.

At least 55 records · Page 3Linked to original sources

[Valve-fitted prosthetic tubes in the pulmonary outflow tract. Results of a series of 45 operations].

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.

Adolescent↗

[Right pulmonary artery-left atrial fistula. Review of the literature apropos of a case].

This is a rare congenital abnormality with only 17 other reported cases in the world literature. The most frequent sign is cyanosis with peripheral arterial desaturation. Angiography with selective injection in the main pulmonary shows early opacification of the left atrium, so confirming the diagnosis. Occasionally, a catheter can be passed through the fistula. Without surgical treatment there is a danger of systemic arterial embolism and two fatal cases were found in our review of the literature. The fistulous connection is often aneurysmal. It arises either from the right main pulmonary artery or from its branch to the inferior lobe. Associated vascular and pulmonary malformations are not rate. Surgical closure of the fistual is curative with immediate regression of the cyanosis and suppression of possible embolic complications.

Arteriovenous Malformations↗

[Correction of cardiac malformations after corrected transposition of the great vessels. A series of 18 cases operated on by an open heart technique].

Recent progress in the surgical treatment of malformations after transposition has been dealt with has been made in three directions: 1. By knowledge of the position of the conducting pathways in relation to ventricular septal defects, so that total atrioventricular block, the first complication of this type of surgery, may be avoided; 2. By appreciation of the proximity of the conductive pathways to the elements contributing to pulmonary stenosis, which may contra-indicate direct removal of such stenosis. In such a case, a valved tube must be placed between the sub-pulmonary ventricle and the pulmonary artery; 3. By appreciating the frequency, the difficulty in diagnosis and the grave consequences of failing to recognise lesions of the atrioventricular valves, with the result that their systematic investigation should form part of the operative technique.

Adolescent↗

[Long term results (5 years) of the first 50 consecutive operations following Mustard's technique for simple transposition of the great vessels].

The long-term results of Mustard's operation for simple transposition of the great vessels have been studied in a homogenous series of the first 50 consecutive cases operated on by G. Lemoine. The overall mortality was 20% over the 5 year follow-up period. Serious arrhythmias or conduction defects can usually be picked up immediately postoperatively; on the other hand, stenosis of the venae cavae or of the pulmonary venous channels may come on very late and unexpectedly as growth takes place. Reoperation must be carried out to remove these stenoses when they are troublesome.

Adolescent↗

[Pacemakers in children].

This is a study of pacemakers in 32 children with permanent pacemakers, 7 of them for congenital block, and 25 for post-operative block, representing a total of 69 pacemaker implantations. After a brief survey of the results, there is a discussion of the problems of the indications, relative for the congenital blocks, and absolute for the surgical blocks after a short period of observation. The choice of type of pacemaker rests upon three essential features: minimum inconvenience, a good length of active life, and the facility of an increased rate. Recent technical progress has allowed these features to be combined. The pacemakers currently available are shown on a table. The results are to a large extent determined by extreme care being taken over the implantation; meticulous asepsis, a low threshold on the electrode test, a pacemaker which is "comfortable" in its site, all these are essential if the serious complications are to be avoided, namely infection and pacemaker failure. The best route for the child, as for the adult, is by way of an epigastric approach with an abdominal pocket. In the very small infant, it seems better to implant by left thoracotomy, and to site the pacemaker intrapleurally.

Adolescent↗

[Cor triatriatum in infants. Four cases with two surgical successes].

Four cases of cor triatriatum are reported in 6 weeks to 23 months old infants. Two were associated with partial anomalous pulmonary venous connection and one with a mild aortic stenosis. Two were successfully operated on and are now normal children: one of these underwent surgery at 3 months with an hemodynamic control one year later. The two others died: the youngest because of an inadequate overloading transfusion, the other soon after pulmonary angiography. Problems in diagnosis and treatment of this rare but very tractable condition are discussed.

Female↗

[2 cases of solitary pulmonary arteriovenous fistula presenting in the neonatal period].

Two case reports of pulmonary arterio-venous fistulae presenting in the neonatal period are described. One child had severe respiratory distress with cardiac failure and the other presented with cyanosis and a continuous murmur. In both, chest X-ray demonstrated a localised lesion and the presence of an arteriovenous fistula was confirmed by pulmonary angiography. Lobectomy cured both children.

Arteriovenous Malformations↗

[Reconstruction of the pulmonary outflow tract with a valved conduit (author's transl)].

The authors describe 25 patients who underwent open heart surgery for reconstruction of the pulmonary outflow tract with a valved conduit. The following anomalies were observed: six cases of great vessels transposition, five cases of pulmonary artery atresia, five cases of truncus, three cases of tetralogy of Fallot and six cases of single ventricle. Two cases of single ventricle were treated in order to be transformed into a systemic ventricle. The pulmonary outflow was reconstructed with a valved conduit anastomosed between right atrium and pulmonary artery. This study includes pre- and postoperative hemodynamic values, surgical evaluation and a 5-months to 3-years follow-up. The authors emphasize that it is important that the surgical indications are closely related to the morphology and hemodynamics of pulmonary circulation for a better result.

Adolescent↗

[Palliative surgery of transposition of great vessels associated with pulmonary stenosis].

Palliative treatment for transposition of the great vessels with pulmonary stenosis (combined or not with ventricular septal defect) was studied in relation with 24 patients operated upon at Laennec's Hospital in Professor Mathey's section between January 70 and January 74. Three therapeutic attitudes are possible according to whether or not an atrial septal defect is created (Blalock-Hanlon's operation) in combination with the systemic-pulmonary artery anastomosis, and according to whether the operations are performed in one or many steps. It seems that for the badly-tolerated forms of the new-born, combination of both operations seems to be the best attitude, the curative treatment being impossible at this age.

Blood Pressure↗