[Dacron aortoplasty. Treatment of aortic coarctation with diffuse isthmic stenosis in infants].
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Biomedical subjects
Publications and source records attributed to P Michaud.
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With the advent of modern therapy, it has become essential to obtain a tissue diagnosis in all cases of pulmonary and mediastinal disease. Since it is often necessary to resort to thoracotomy as a final step in making such a diagnosis, we have sought a procedure that is simpler while capable of providing the same information. Through a standard cervical mediastinoscopy incision, the mediastinum is first explored; if the diagnosis is not obtained, the mediastinal pleura is digitally opened and lung or pleural biopsies are taken. In the course of 1,100 mediastinoscopies since 1969, 275 pleuroscopies have been done. We were able to obtain a tissue diagnosis in 102 (78%) of 131 patients with bronchogenic carcinoma, in 92 (91%) of 102 with benign pulmonary disease, and in all 20 (100%) with pleural disease.
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Over the past 3 years, a Mustard operation has been performed in 38 infants aged 30 days to 24 months, among them 29 less than one year of age. There were 27 TGV with intact ventricular septum, 8 TGV and VSD, (isolated in 3, and associated with PS in 2 and with coarctation of the aorta in 3), 2 TGV with isolated PS, and 1 TGV with aorta-pulmonary window. The operation was carried out under deep hypothermia, circulatory arrest and limited by-pass, using a pericardial patch in all cases but one. The operative mortality is 8% (3 cases) for the whole group, 7% in infants less than one year of age, and 3% for all TGV with intact ventricular septum. The long term results are reviewed, with a follow-up of 2 to 36 months (mean 17 months).
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Ruptured chordae tendinae of the tricuspid valve is exceptional. It results in an intense valvular incompetence through systolic eversion of one leaflet. In fact, this is not always the case, and in patient reported, the clinical picture suggested an obstacle to right ventricular ejection with paroxysmal phenomena of the faintness type, indicating the temporary obstruction of the pulmonary pathway. Right cine-angiocardiography demonstrated a mobile intraventricular neoformationreaching in systole the pulmonary sub-valvar area. No tumour was found on operation. The patient died in the post-operative period. On post-mortem examination there was a rupture of tricuspid chordae tendinae and a raise of the anterior leaflet of the tricuspid valve into the pulmonary infundibulum. Rupture could be related to a severe thoracic trauma which had occurred 17 years previously.
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