Biomedical subjects
Publications and source records attributed to J P Binet.
As Ph. Blondeau et al. have shown, one-stage operations, especially by the same approach, for coarctation and an associated intracardiac lesion are still rare. Three new cases are reported. The authors emphasise the value of the bithoracotomy approach, and the importance of good management of respiration.
The authors report their experience in 150 cases of aortic arch anomalies treated surgically in children and infants. The progress achieved over the past few years through improved diagnosis and resuscitative care has made it possible to obtain good results in the vast majority of cases.
The authors report a case of a localised form of this strange disorder which was confined to the left ventricle, and in which the diagnosis was tentative for a long time. In this case it was possible to carry out a removal of the fibrous plaque after opening the apex of the left ventricle, the mitral valve being preserved, as described by Dubost; the functional and haemodynamic results of this procedure were very satisfactory.
While the authors recognise the difficulty of obtaining a complete picture of the lesion in certain types of ventricular shunt with pulmonary hypertension, they emphasise the importance of a precise diagnosis, which may modify the medical treatment and the decision to operate. Conditions may nevertheless be found by surprise at operation, and lead to a modification of the planned action.
One case of mediastinal tuberculous lymph node with fistulae into the esophagus is reported in a 9 years old girl. The first symptom was the appearance of epigastric abdominal pain, with secondary dysphagia. The diagnosis was confirmed by histology after thoracotomy and surgical excision. Esophageal tuberculosis is rare and seems to be secondary to contamination from mediastinal lymph nodes. Treatment is always medical and often requires surgery.
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The authors report the greatest number of cases of closure of Inter-Ventricular Communication of the newborn published to date. The use of the new technique of deep hypothermia and extra-corporeal circulation, together with the improvement of post-operative care, have permitted them to obtain results which are particularly satisfactory.
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The authors report their experience with two-stage surgical treatment of severe ventricular septal defects in babies: initial banding of the pulmonary artery, followed by closure of the ventricular septal defect and removal of the band by an open-heart technique. Out of 162 operations to band the pulmonary artery, 90 were for cases of ventricular septal defect. The mortality was low (9.1%) when there was a ventricular septal defect with or without a patent ductus. It is considerably higher (31.4%) when there is a coincident coarctation of the aortic isthmus. So far 38 children have had the second operation, with 2 deaths. The authors have studied the surgical problems and the long-term results (6 months to 3 years follow-up) in the first 29 patients undergoing surgery. Although the results from this two-stage operation are good, when the authors take into account their current experience with one-stage closure of ventricular septal defects in the babies, they feel that this latter technique is to be preferred. Reservations must, however, be expressed when the child is very young (Weighing 3.5 kg or less), when there are multiple defects between the ventricles, and when the defect is severe, with a combination of VSD, patent ductus and coarctation of the aorta, and sometimes when the opertion must be carried out as an emergency.
The authors report their experience of one-stage closure of poorly-tolerated ventricular septal defects in small children and babies. They use both extra-corporeal circulation and profound hypothermia. The results which they present have been very encouraging. They emphasise the fact that the closure is not complete after surgery, and that most of the murmurs which persist post-operatively disappear gradually. Of the neurological defects which were seen in two cases after surgery (one after profound hypothermia and one after extra-corporeal circulation) one resolved completely; in the other (in which there was a cardiac arrest followed by cardiac massage for one hour) certain intermittent visual defects have persisted. All of the other children can now be regarded as normal.
The authors present their 11 year experience of treating severe cases of obstructive cardiomyopathy which were resistant to medical treatment. They consider that myotomy is the simplest procedure (it is always effective) in this mysterious disorder for which it must be admitted that there is no treatment that is entirely satisfactory.
The case is reported of a 67 year old man with obstructive cardiomyopathy treated by an extended myotomy. Serial phonomechanographic tracings and the pre- and post-operative angiograms show the steady progress of the disease towards a major disturbance of left ventricular compliance which became resistant to propranolol, and was partially reversed by myotomy.
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