[Pulmonary hydatid embolism. Study of two personal cases and review of the literature (author's transl)].
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Biomedical subjects
Publications and source records attributed to J Houel.
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The authors present a case of a continuous right lateral sternal murmur which led to the discovery of a systemic-to-pulmonary fistula at the origin of the internal mammary artery. The fact that the patient had a right pulmonary abscess with pyopneumothorax drained several years previously has led them to discuss the possible etiology of this fistula. The murmur disappeared after surgical treatment.
In a series of 103 consecutive surgical patients, the normal and pathological echocardiographic appearances of the tricuspid valve were analysed and compared with the anatomical findings. It was possible to define the nature of the lesions by echocardiography, which was superior to angiography in this field. The right ventricular index (right ventricular dimension body surface area) correlated well with the mean pulmonary artery pressure (r = 0.75; p less than 0.001). The index may be useful in the long term follow-up of post-operative patients.
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The authors consider that the indications for surgery should take into account three unknowns: the natural history of the valvulopathies, our incomplete state of knowledge about the outcome in operated cases, and surgical progress, which may transform the whole subject in a short time. They emphasize the seriousness of the disorders in which mitral incompetence is associated with aortic stenosis and/or incompetence; such cases justify earlier surgery. By contrast, some cases of aortic incompetence, when associated with a predominant mitral valve lesion, may not constitute an indication for valve replacement. Tricuspid annuloplasty is a noteworthy advance which provides a simple answer to some of the problems.
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