[Atrial septal defects in adults: usefulness of surgical closure]. / Communications interauriculaires de l'adulte: quelle place reste pour la fermeture chirurgicale?

BACKGROUND: The atrial septal defect (ASD) is one of the most common congenital heart diseases in adults. AIM: The objective of our study is to determine the value of the surgical closure of ASD in adults. METHODS: Between January 1990 and December 2006, 87 adult patients underwent surgical closure of ASD. The mean age is 28 years; eighty one patients (93%) were in NYHA class I or II. RESULTS: All patients were operated on with extra corporeal circulation. There were 10% post operative complications, no early or late death. CONCLUSION: surgical closure of ASD in adults given good results and in spite of percutaneous procedures progress surgery keeps some specific indications

Aortic endocarditis complicated with a large ventricular septal defect and septic pulmonary embolism.

BACKGROUND: Infectious complications of the aortic valve can lead to severe cardiac failure and widespread contiguous lesions by the involvement of subaortic structures such as aorto-left ventricular discontinuity, destruction of the aortic ring, aortic abscesses, true or false aneurysms and shunts. AIM: Report a new case of a large ventricular septal defect due to infection. CASE REPORT: Abnormal communications occurring during acute aortic valve endocarditis are rare but they are very serious complications. We report a case of a 58 year-old-man, referred to our hospital with the diagnosis of aortic endocarditis with complicating root abscesses, acquired ventricular septal defect (VSD) and pulmonary septic embolism. Surgery was indicated and the whole procedure was performed through the aortic root. The patient underwent a radical resection of the abscesses, reconstruction of the aortic ring, closure of the ventricular septal defect and prosthetic replacement of the aortic valve. The immediate postoperative course was marked by persistent sepsis. Transoesophageal echocardiography showed vegetation's in the right side of the patch without signs of dehiscence. The outcome was fatal due to hemodynamic collapse. CONCLUSION: The authors would like to select and analyze some weaknesses of their procedure like using only the transaortic access that often limits exposure of possible right-side lesions, not removing the pulmonary obstruction and using an important amount of foreign material to reconstruct subvalvular lesions.