[Results of surgical treatment of aorto-cardiac fistulas].

The authors report their experience in the surgical correction of aorto-cardiac fistulae. The long term results emphasise the good prognosis in coronaro-cardiac fistulae (13 cases), the problems posed by residual aortic insufficiency in the case of ruptured aneurysms of the sinus of Valsalva (37 cases), the difficulties in diagnosis in the presence of an interventricular communication in association and, finally, the rarity of communications between the aorta and left ventricle (4 cases).

Surgery for aortic dissection: 53 operated cases with 32 in the acute phase.

53 cases of aortic dissections were operated on between 1961 and 1975 in the Service of Cardiovascular Surgery at the Broussais Hospital, Paris (Prof. Ch. Dubost).

[Surgical treatment of the double outlet right ventricle with pulmonary stenosis. Apropos of 7 cases].

The double outlet right ventricle is a rare malformation, and its surgical correction has been well defined. The authors present seven cases of double outflow of the right ventricle and stenosis of the pulmonary outflow. If the technical problems of those variants with a subaortic septal defect seem to have been overcome, those with a subpulmonary ventricular septal defect present a much more difficult problem.

[Choice of surgical method in the child or adult (excluding infants) suffering from coarctation of the aorta and severe cardiopathy].

A study of a serie of 45 cases of coarctation of the aorta associated with a severe cardiac lesion or malformation, and treated at a single operative session (18 cases) or in two consecutive stages (27 cases) has produced the following conclusions: --Treatment at a single operation is possible, usually at the cost of two consecutive surgical approaches, thus making the operation rather long. This plan, which has given good results in the 18 cases studied (only one death and no serious complications) should be adopted only for young patients who are well-balanced psychologically, and whose cardiac defect is well-compensated. --Treatment in two stages is a more reasonable course for the remainder of the patients, but it must be decided which lesion to treat first: this could be the coarctation if it is a difficult or poorly tolerated one and if the cardiac defect (especially when an aortic valve lesion) is well compensated.

The effect of coronary artery reperfusion on the extent of myocardial infarction.

The effect of the reperfusion on myocardial infarction has been studied in the rat in order to assess the possible reversibility of myocardial damage. The present study deals with reperfusion of experimental myocardial infarction in the rat. Two groups of animals were compared: one was subjected to permanent ischemia and the other was subjected to ischemia of variable duration 1) hour to 24 hours).

[Constrictive fibrous endocarditis. Surgical treatment].

An anatomo-clinical entity, fibrous constrictive endocarditis can betreated srugically, and we carried out this procedure for the first time in 1971, since when we have used it seven times; it consists of an internal stripping of one or both centricles, with removal of one or both the mitral and tricuspid valves. The results were encouraging in the first two cases, and so good in the succeeding ones that this endocardial resection could be put forward as the treatment of choice for a condition whose aetiology is still unclear.

[Perforations of the cervical esophagus in attempted tracheal intubation. A report of 12 cases].

The authors underline the factors favouring perforation of the oesophagus during intubation in the light of 12 personal cases: difficulty in intubation, use of an introducer, inexperienced operator. Such a perforation may result in mediastinitis and should be treated early with massive polyvalent antibiotics and a surgical suture left at rest for approximately one week.

[Intensive care and diet in cases of caustic esophageal stenosis after the first eight days].

On the basis of 12 cases of caustic burns of the oesophagus, the authors describe the technique of alimentation, once the acute phase of the first eight days has passed. From the 8th to the 15th days, calories and provided parenterally. An upper GI series is carried out on the 15th day: if the stomach is healthy, the authors fashion an alimentation gastrostomy, if the stomach is damaged, they carry out gastrectomy with alimentation gastrostomy or jejunostomy.

[Hemodynamic aspect of post ECC cardiac failures. Study of 193 cases].

The aim of this study is to define the hemodynamic characteristics of this "clinical model" of acute cardiac failure observed after cardiac surgery carried out under extra-corporeal circulation, which constitutes the essential cause of "post-operative low cardiac output syndrome". The 193 patients in this study make up a representative sample of patients operated, treated and studied according to a homogeneous methodology for a period of 1 year. The clinical analysis of the post-operative circulatory condition, after exclusion of non cardiogenic syndromes, led to grouping the cases into 5 classes of circulatory change of increasing severity, each corresponding to a specific "therapeutic necessity".

Emergency myocardial revascularization.

From 1969 to 1975, 175 patients with acute coronary insufficiency underwent emergency saphenous vein aorto-coronary bypass grafting (SVBG). The patients were divided into two groups: group I, unstable angina (165 patients) and group II, acute evolving myocardial infarction (ten patients). In group I, the hospital mortality was 8-4%, the incidence of post-operative myocardial infarction was 10-3%.

[Large esophagogastric caustic burns in the adult].

The authors treated, as an emergency, severe caustic burns in adults. They present 13 cases and discuss four deaths. Critical analysis of these observations,compared with the findings of pathology and in the literature, permit one to consider the therapeutic indications.