Preoperative carriage and postoperative same-species sternal wound infection after cardiac surgery.

Sternal wound infection (SWI) after cardiac surgery remains an important problem. Prediction of pathogens involved in such infection could guide antibiotics. From April 1, 2006 to December 31, 2008, retrospectively, we evaluated the diagnostic value of preoperative methicillin-sensible Staphylococcus aureus (MSSA), methicillin-resistant S.

[Valvular aortic stenosis, left anterior cusp hypoplasia and obstruction of left main coronary artery ostium by a congenital membrane].

Aortic stenosis and obstruction of the left main coronary artery ostium is very rare. This report describes the case of one patient with valvular aortic stenosis, left anterior cusp hypoplasia and obstruction of the left main coronary artery by a congenital membrane. Surgical treatment with aortic valve removal and excision of the congenital membrane was successful.

[Multi-plane transesophageal echocardiography in cardiac angiosarcoma. Apropos of a case].

The authors report the case of a right atrial angiosarcoma extending to the right ventricle, presenting with a massive pericardial effusion, in a 30 year old man. The patient underwent surgical ablation of the tumour with right atrial reconstruction, tricuspid valvuloplasty, plicature of the right ventricle and a right coronary artery bypass graft with complementary chemotherapy. This case illustrates the decisive contribution of multiplane transoesophageal echocardiography in the preoperative investigation, providing accurate information about the site and extension of the tumour, and even about the malignant character of the pathology.

[Complex cardiac lesion diagnosed more than 20 years after the causal injury].

Penetrating wounds of the heart, when not immediately fatal, may give rise to complex lesions associating valvular regurgitations and fistulous connections. The authors report the case of a patient with mitral and aortic regurgitation associated with an aorto-left atrial fistula of traumatic origin and causing invalidating cardiac failure. The interest of this particular case lies in the duration of the interval between the causal trauma and the appearance of symptoms (over 20 years).

[Early postoperative thrombolysis of Saint-Jude aortic valve prosthesis].

The authors report a case of thrombolytic therapy with streptokinase in the early postoperative period after aortic valve replacement with a Saint Jude medical prosthesis. After good initial progress, the patient had to be reoperated on the 12th postoperative day for sternal disunion. Reoperation was followed rapidly by progressive thrombosis of the aortic prosthesis demonstrated by repeated Doppler echocardiographic examination.

[New valvular homografts. Prospects and limits of their viability. Report of 42 implantations].

The regain of interest in aortic homograft bioprostheses is related to the prospects of improved viability resulting from explanation from organ donors, preservation in rich tissue culture media, together with the progress made in techniques of cryopreservation. Viability studies examining morphology of electron microscopy and tests of tissue culture confirm this notion of longer viability. These properties raise hopes of satisfactory long-term results while acknowledging outstanding antigenic problems which require strict A-B-O system compatibility.

[Viability of new valvular homografts. An evaluation at the Henri Mondor Hospital].

The renewed interest in valvular homograft is due to the new concept of their viability. This viability requires procurement from organ donors and preparation in rich tissue culture medium immediately prior to cryopreservation. This viability, confirmed by morphological tests especially electron microscopy, and by cell culture tests is the basis for satisfactory long-term results.

[Echocardiographic-Doppler study of a case of subacute and incomplete parietal rupture after myocardial infarction].

The authors report the case of a 55 year old man who suffered a silent, laterobasal myocardial infarction which was complicated by a subacute pseudo-false aneurysm of the lateral wall of the left ventricle. They underline: The importance of two-dimensional echocardiography in the diagnosis of a neo-para left ventricular cavity showing systolic expansion and communicating with the left ventricle by a narrow neck indicating rupture of the free ventricular wall; The value of two-dimensional color coded Doppler which enables the operator to distinguish the active nature of the neo-left ventricular cavity before surgery and its inactivity after surgery. The surgical indication for emergency resection of the pseudo aneurysm was based on these preoperative non-invasive observations.

[Viability of new valvular homografts. Myth or reality?].

Use in cardiac surgery of aortic homografts as a valvular substitute is old and was specially developed in France by F. Fontan. In fact, these first allografts were non-viable and the results, in aortic position, were not better than current bioprosthesis.

Aortic 125I-albumin transport in patients with Marfan's syndrome and annuloaortic ectasia.

The morphologic, biochemical, and mechanical abnormalities of connective tissue fibrous proteins in Marfan's syndrome have been well studied, and their role in cardiovascular complications is well accepted. Less is known, however, about the state of the amorphous components of the aortic connective tissue. In the course of a study of transmural transport in blood vessels, we have had the opportunity to study dystrophic aorta from two young men who survived elective surgery; both with aortic insufficiency (AI) histologically compatible with Marfan's syndrome.

[Cor triatriatum. Anatomical forms and surgical treatment of 6 consecutive cases].

Six cases of cor triatriatum documented and operated on at Henri-Mondor hospital between 1980 and 1984 are reported. Ages at the time of surgery ranged from 8 months to 57 years. Four of the 6 patients presented with pulmonary hypertension.

[Ventricular dysplasia. Nosology and sudden death].

The arrhythmia generating dysplasia of the right ventricle is a congenital anomaly suggesting a hereditary substratum. It usually manifests itself as follows: a young patient, with recurrent episodes of ventricular tachycardiac. There is no "pathognomonic sign" of dysplasia.

[Aortic subvalvular obstructions. Anatomical forms and surgical treatment of 82 consecutive cases].

The authors report their experience of surgery for subvalvular aortic obstruction in 82 patients aged from 4 to 44 years (mean 15 years). Nearly one-half of the patients presented with symptoms; the others were operated upon for various reasons: gradient exceeding 60 mmHg, development or aggravation of aortic regurgitation, positive exercise test, electrocardiographic or echocardiographic signs of left ventricular repercussions. Nineteen children had previously undergone surgery for another malformation, but the subvalvular aortic obstruction had either been missed during this first operation or had developed subsequently.

Rupture of the right ventricular free wall. An unusual complication of mediastinitis after cardiac surgery.

Of 2171 patients who underwent open heart surgery between 1981 and 1986, 41 (1.8%) developed postoperative mediastinitis and were treated by closed irrigation drainage or open chest therapy. Six patients, (mean age 59 years) developed rupture of the right ventricular free wall.

Nd-YAG laser-induced injury in dog myocardium: optical and ultrastructural study of early lesions.

To characterize myocardial lesions induced by Nd-YAG laser in vivo, laser pulses were delivered on the epicardial surface of beating dog hearts. Acute lesions were studied at the optical and ultrastructural levels. The size of the lesions depended on the power of the laser beam.

[Ventricular tachycardia of ischemic origin. Surgical treatment by encircling thermo-exclusion using the Nd-Yag laser].

Refractory and recurrent ventricular tachycardias are a common cause of death after myocardial infarction. The occurrence of intraventricular re-entries can be prevented by a new surgical treatment based on encircling thermic exclusion. The Nd-YAG laser beam offers 2 major advantages over previous techniques: it acts rapidly with minimal myocardial damage and can even be used in patients with left ventricular dysfunction.

Long-term results with total replacement of the ascending aorta and reimplantation of the coronary arteries.

From November, 1976, to June, 1983, 100 patients, 84 male and 16 female patients ranging in age from 13 to 74 years, were operated on for aortic insufficiency associated with an aneurysm of the ascending aorta. Twenty patients were in New York Heart Association Class I, 22 in Class II, 51 in Class III, and seven in Class IV. The surgical treatment in all cases consisted of total replacement of the ascending aorta with a tube graft containing a prosthetic aortic valve and reimplantation of the coronary arteries by an intermediate tube graft according to the technique already reported.