[Immediate and later results of surgical treatment of dyskinesis, of coronary origin, of the walls of the left ventricle (97 cases) (author's transl)].
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Biomedical subjects
Publications and source records attributed to R Soyer.
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In relation with 128 cases of surgical operation for mitral incompetence through ruptured chordae tendinae, the aetiological, anatomical and clinical characteristics of these cases were described. Bacterial endocarditis and spontaneous rupture were present in 77 percent of cases. In 94.4 percent of the cases, the patient coming to operation was in a high functional class (class III and IV of the NYHA). Operation included valve replacement in 100 cases (by a Starr-Edwards prosthesis), while the mitral valve was preserved in 28 patients. The conservative operation presently performed combined the resection-suture of the deinserted area and a reconstitutive valvuloplasty over a Carpentier's ring. Results of this surgery are good in more than 90 percent of the cases.
A surgical operation with a "curative" aim has been performed on four patients with a lone ventricle. It consisted of a IA type in 3 cases and IC type in one. There were one operative death and three long-term survivals. The operation consisted essentially in: a delicate step of partition of the lone cavity and the treatment of the often combined, and sometimes complex, heart malformation. The trauma to the conduction pathways is one of the major dangers of this type of operation and should be avoided or decreased by the detection during operation of the His bundle. Operation should be indicated in badly tolerated forms. Stenosis of the infundibulo-pulmonary pathway interferes with the development of a hypertensive pulmonary arteriolitis, seems to be a favourable element for surgical correction. In the absence of such stenosis, one should perform a banding early enough or discuss the indication for an intracardiac operation in relation with the pulmonary artery resistance.
The present study deals with a series of 40 reoperations in a group of 1279 patients undergoing mitral valve replacement. All reoperations were late following the immediate post-operative period, the earliest being 5 months after the primary operation. The factors which were analyzed are: causes of reoperation, the most frequent being paravalvular leaks and valve thrombosis, diagnostic methods, surgical techniques and results following reoperation.
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