[Brucella endocarditis of native valves. Report of 3 cases]. / Les endocardites brucelliennes sur valves natives. A propos de 3 cas.

Brucella endocarditis is a rare but a serious complication of human brucellosis. We report 3 cases, the diagnostic was suspected by the patient's history of systemic brucellosis in two cases and established by the culture of native valve material in the third. All the patients underwent surgery for non control of the infections, one patient died in immediately postoperative period by acute cardiac failure. For the other patients, there were no early or late mortality and no recurrence after a follow up of respectively 6 and 84 months. The diagnostic of brucella endocarditis needed a very high degree of clinical suspicion, it requires an early management valve replacement is in the majority of cases, followed by adequate and prolonged antibiotic treatment.

[Thoracic hydatidosis. A review of 1619 cases]. / Les localisations thoraciques de l'hydatidose. A partir de 1619 observations.

We analyzed the cases of 1619 patients who underwent surgery for hydatidosis in a chest localization to present a review of this parasitosis, endemic in Southern Mediterranean countries. A lung localization was observed in 1527 patients (94.6%). Extrapulmonary localizations were less common (5.62%) and included 42 heart cysts, 21 primary pleural cysts, 13 diaphragm cysts, 8 mediastinum cysts and 8 ribs cysts. For pulmonary cysts the sex ratio was 1: 1 (51.46% men, 48.85% women). Mean age was 24 years. A context of hydatid exposure was present in 81.8% of cases. The diagnosis was established on the basis of associated functional signs and an opacity with regular borders on the chest x-ray. Surgical treatment was simple cystecomy in 85.9% of the cases and lung resection in 14. 1%. Operative mortality was 0.785%. Pleuropulmonary recurrence was observed in 21 patients. Thoracic and pulmonary hydatidosis is easily diagnosed and treatment is well defined. It remains however a major challenge for health care with an important social and economic impact. Prevention can only be achieved by carefully designed actions against parasite transmission.

Bidirectional inferior vena cava-pulmonary artery shunt.

BACKGROUND: Bidirectional superior vena cava-pulmonary shunt is widely used as an interim palliation for patients with univentricular hearts. Bidirectional inferior vena cava-pulmonary artery shunt, as an alternative approach of partial Fontan circulation, may offer the advantage of performing the complete Fontan circulation more easily due to the already constructed inferior vena cava lateral tunnel. METHODS: We used bidirectional inferior vena cava-pulmonary artery shunt in 2 patients. Contraindications to a complete Fontan circulation were due to, respectively, a volume-overloaded systemic ventricle and an irregular pulmonary arterial tree. RESULTS: Postoperative courses were uneventful. There were no significant pleural effusions. Transcutaneous oxygen saturations were 77% and 78%. Pulmonary-to-systemic blood flow ratios were 0.57 and 0.63. A complete Fontan circulation was safely performed 8 and 12 months later, without any "Fontan-related" complications. CONCLUSIONS: Bidirectional inferior vena cava-pulmonary artery shunt can be useful in selected patients with univentricular hearts, although its place in the field of "partial Fontan operations" cannot be determined as yet.

[Techniques of correction of partial right abnormal pulmonary venous return associated with atrial septal defect]. / Techniques de correction des retours veineux pulmonaires anormaux partiels droits associés à une communication interauriculaire.

Many techniques have been described for correcting partial right anomalous pulmonary venous drainage to avoid the possible complications of stenosis of the systemic or pulmonary venous return, residual shunt or arrhythmias. Between 1985 and 1994, 33 patients aged 1 to 69 years underwent repair of this malformation. The anomalous drainage was situated at the cavo-atrial junction or above in 25 cases and to the right atrium in 8 cases. Depending on the level of the drainage of the anomalous pulmonary veins, the size of the superior vena cava, the site of atrial septal defect and the age of the patient, 3 techniques were used: simple tunneling, tunneling with widening of the superior vena cava by a patch, tunneling with section of the superior vena cava and its transposition to the right atrium. There was no hospital mortality. Postoperative echocardiography showed a minimal residual shunt which regressed at the two months control examination. No cases of restriction of the systemic or pulmonary venous return were observed. Six patients developed arrhythmias during the hospital period. At the end of follow-up, all patients were asymptomatic without residual shunts or restriction of venous drainage. Persistent arrhythmias were observed in one case (3%). There were no differences in the results of the three techniques used. By using the most appropriate technique of repair for the anatomical form allows correction of this malformation with the minimal number of postoperative complications.

[Pulmonary arborization abnormalities in complex forms of pulmonary atresia with ventricular septal defect: unification, unifocalization and complete repair]. / Défauts d'arborisation pulmonaire des formes complexes d'atrésie pulmonaire à septum ouvert:unification, unifocalisation et réparation complète.

The presence of intrapulmonary arborization abnormalities in patients with pulmonary atresia and ventricular septal defect remains a therapeutic challenge. The aim of this study was to assess the value of procedures of pulmonary unifocalization, i.e. pulmonary unification, remodelling of the central pulmonary arteries and creation of an unifocal pulmonary blood supply, thereby resulting in complete repair. From october 1989 to october 1995, 27 unifocalization procedures were performed in 19 patients. The number of pulmonary segments dependant on non-communicating systemico-pulmonary collaterals was 14.7 +/- 5.4 per patient. The number of non-communicating systemico-pulmonary collaterals was 3.4 +/- 1.2 per patient. The Nakata index was 71 +/- 83 mm2/mm2. There were 3 deaths after an unifocalization procedure (mortality rate 15.8%). In 12 patients (63.2% of cases) a pulmonary arterial tree compatible with a complete repair was obtained. Eight complete repairs, with no mortality, following one or several pulmonary unifocalization procedures with a right to left ventricular systolic pressure ratio of 0.61 +/- 0.12 (range 0.4 to 0.75). Pulmonary unifocalization increases the recruitment of pulmonary segments and thereby the possibilities of complete correction in forms of pulmonary atresia with ventricular septal defect and arborization abnormalities of the pulmonary arterial tree.