Management of patients with asymptomatic moderate aortic stenosis undergoing coronary artery bypass grafting.

Background And Aims Of The Study: Manual decalcification of the aortic valve was performed systematically in a prospective series of patients with asymptomatic moderate aortic stenosis (AS) undergoing coronary artery bypass grafting (CABG). This study addressed two main issues: (i) whether aortic valve decalcification is a good option to relieve moderate AS; and (ii) whether the natural progression of AS may be delayed by manual valve debridement when surgery is indicated for coronary disease.

Methods: Between October 1997 and March 2001, 14 adult patients with moderate AS underwent concomitant surgical repair of the aortic valve during CABG.

[Epidural anesthesia for Cesarean section in a patient with von Hippel-Lindau syndrome].

Von Hippel-Lindau (VHL) disease is an autosomal dominant disorder with variable penetrance. It is mainly characterized by haemangioblastomas of the retina and central nervous system. Because of physiological effects of uterine contractions, labour and spontaneous vaginal delivery increase the risk of disrupting central nervous system haemangiblastomas.

[Postoperative management. Critical care in intra-abdominal infection after surgical intervention].

Unlabelled: UNDERESTIMATED FREQUENCY: Post-operative intraabdominal infections usually appear as abscesses or injury of the bowel, either alone or in combination. These complications of frequently underestimated frequency are characterized by high mortality. Improvement of their prognosis is obtained by early recognition of the complication and a multidisciplinary approach.

[Peridural abscess complicating spinal anesthesia in a diabetic patient].

Infectious complications of spinal or epidural anaesthesia are rare, particularly after spinal anaesthesia. Most of them consist of a meningitis. We report a case of epidural abscess due to Staphylococcus aureus following spinal anaesthesia in a 62-year-old diabetic patient, diagnosed 45 days after the puncture with bacterial samples and magnetic resonance imaging.

[Coronary gas embolism after laparoscopic surgery].

Gas embolism is a severe complication of laparoscopic surgery. We report two cases: one with lethal peroperative cardiac arrest from massive coronary artery gas embolism recognized during open-chest cardiac massage; the second case, also associated with coronary artery gas embolism, resulted in severe but transient abnormal left ventricular anterior wall motion, subepicardial ischaemia and injury in ECG leads V1 to V5, but unremarkable coronary arteriography and full recovery. The pathophysiology of gas embolism occurring during a laparoscopic procedure, the mechanisms of gas entry into the systemic vascular bed, the clinical, ECG, pulse oximetry, end-tidal CO2 concentration changes and alarm signs are discussed.