Postperfusion stenosis of the common left coronary artery.

Late stenosis is a rare but potentially lethal complication of coronary perfusion. In 3 patients, anginal pain appeared 2 to 6 months after aortic valve surgery. Coronary angiography was performed because of rapid evolution of symptoms. Severe stenosis of the common left coronary artery was shown in all 3 cases. Immediate aorto-coronary bypass was undertaken with good results. Graft patency was demonstrated in 2 cases, 6 and 7 months after the operations.

Surgical treatment of anomalous origin of the left coronary artery in infancy and childhood. Early and late results in 20 consecutive cases.

From 1972 to September, 1979, 20 patients underwent transplantation of the anomalous left coronary artery to the aorta, either directly or via a graft. Correction of ischemia-induced mitral insufficiency was associated in eight patients and a postinfarction left ventricular scar was excised in 12. Operative mortality was high among patients under 1 year of age (4/5). Among older children it was 15%. There were not late deaths among patients surviving the operation (mean follow-up 3 years). All but one had marked clinical improvement and reduction of cardiomegaly. Eleven patients underwent angiographic control, with a patent graft or anastomosis demonstrated in every case. Operation is advocated for patients over 1 year of age. The best treatment of symptomatic infants remains controversial.

Reversible renal failure secondary to severe compensated aortic regurgitation.

Severe renal failure associated with proteinuria occurred in a 21-year patient, who had massive rheumatic aortic regurgitation. There was no sign of congestive heart failure or extra-cellular dehydration. Subacute bacterial endocarditis was ruled out by appropriate laboratory investigations. Prosthetic aortic valve replacement resulted in normalization of the renal function and marked reduction of proteinuria. Renal histology showed severe sclerotic endarteritis involving predominantly the large arteries, and membrano-proliferative-like glomerulopathy without immune deposits. The role of the massive aortic regurgitation in the production of renal failure and histologic alterations is suggested.

[Post-cannulation stenosis of the left coronary artery trunk. 5 operated cases]. / Sténose post-canulation du tronc de l'artère coronaire gauche. Cinq cas opérés

The authors report five cases of stenosis of the trunk of the left coronary artery following cannulation of the coronary artery, and discuss the types of lesion, and whether they exist as an entity. The morbidity of these lesions, and the threat of sudden death which they pose, indicates an aggressive treatment plan: - definite angina occurring 2 to 6 months after aortic surgery (under coronary artery perfusion) is an indication for urgent coronary arteriography; - this investigation must be followed by a revascularization procedure within a few days if it shows a tight stenosis of the coronary trunk. The constant finding of a good vascular bed distally would seem to presage good long-term results.

[Mid-term fate of Beall's prosthesis in the mitral or mitro-tricuspid position. Apropos of 100 cases]. / Devenir à moyen terme des prothèses de beall en position mitrale ou mitro-tricuspidienne

Aiming at investigation, a Beall's valve was implanted in mitral or in mitral-tricuspid positions only on 100 patients, between November 1969 and February 1972. The details of the initial valve lesions, the clinical condition of the patients, and the modalities of prosthetic replacement are described. The causes of death within the first month were analysed. None could be related with the prosthesis itself. At distance, 17 patients were lost of sight, 18 died and 51 were studied from 12-42 months after operation. It results from this investigation: -- that 84% of the patients reexamined were improved. Most of them were included in a better functional class; -- that the incidence of thrombo-embolic accidents amounted to 12% for the whole group of patients, a percentage similar to that observed with other types of prostheses; -- that in contraat, haemolysis is an obvious disadvantage of Beall's prosthesis (20 of 51 cases); -- that abnormal wears in two valves resulted in valve dysfunction compelled to re-operation. These latter two incidents have lead to abandoning this type of prosthesis.

[Immediate hypertensive flare-up after coronary bypass. A predictable complication]. / Poussée hypertensive immédiate après pontage coronaire. Une complication prévisible.

An immediate post-operative rise in blood-pressure occurred in 44% of 191 patients undergoing coronary bypass. In a retrospective study of the patients' records, the authors have endeavoured to determine which of the 23 parameters characteristic of each patient was predictive of post-bypass hypertension. Using a Bayesian discriminant analysis method, they found that the only variables predictive of hypertension in 86% of the cases were an history of myocardial infarction and the urinary sodium/ potassium ratio. When combined, an urinary Na/K ratio below 1 and the absence of previous infarction constitute a good index of possible post-operative rise in blood pressure.

[Surgical treatment of complex forms of congenital heart malformations associated with situs inversus (nine cases) (author's transl)]. / Cardiopathies congénitales et situs inversus. Neuf cas opérés sous circulation extra-corporelle.

Although are, situs inversus is nevertheless encountered in the surgical treatment of heart malformations. This series concerns 1 000 patients who where operated with heart-lung by-pass between 1974 and 1977. In nine cases, the heart was in the situs inversus position and the cardiac malformations associated with this condition, were complex. Yet the results were comparable to those obtained when the heart was in the normal position.

Plasma fibronectin depletion after cardiac surgery in children with or without cardiopulmonary bypass.

Plasma fibronectin depletion decreases resistance to sepsis. After cardiac surgery, septic complications occur more frequently when the surgical procedure is managed with a cardio-pulmonary bypass than when it is not. To determine whether cardio-pulmonary bypass produces a greater decrease in plasma fibronectin than surgery without cardio-pulmonary bypass, we studied plasma fibronectin concentrations in two groups of children operated for congenital heart diseases. Group I: 10 children undergoing surgery with cardio-pulmonary bypass. Group II: 11 children undergoing surgery without cardio-pulmonary bypass. Plasma fibronectin was monitored pre-operatively (t 1) and post-operatively at the 6th hour (t 2), 1st (t 3) and 7th (t 4) days. In both groups, plasma fibronectin concentration dropped at (t 2) and (t 3) and rose again at (t 4). There was no significant difference in plasma fibronectin levels between the two groups at any time. We conclude that the plasma fibronectin decline alone cannot explain why septic complications after surgery are more frequent with cardio-pulmonary bypass than without.

[Primary bacterial aneurysm of the aorta. 4 cases]. / Anévrisme bactérien primitif de l'aorte Quatre observations

The causal agent was a Salmonella in three cases and a Pseudomonas Aeruginosa in one case. In these four patients there was no evidence of endocardities and the causal germ was verified by the bacteriological cultures of the anevrysmal lesions and/or by the blood cultures. In one patient full recovery was obtained by surgical repair after complete bacteriologic cure.

[Measurement of CK-BB isoenzyme after cardiac surgery (author's transl)]. / La créatine kinase après chirurgie cardiaque. Dosage de la fraction BB.

We measured the BB isoenzyme of creatine kinase in the serum of 135 patients following cardiac surgery with cardiopulmonary bypass: 64 infants, 48 children and 23 adults, 56 of them have had, at least, one positive result. The duration of anaesthesia do not have any influence; we have found the same proportion of positive results in the two groups with anaesthesia less or more than 8 hours. Severity and complexity of the surgical procedure induce the CK-BB increase. In many cases, a high serum concentration of CK-BB is not related to clinical cerebral damage. Under this circumstances, it is possible that the rise in CK-BB concentration is not specific of central nervous system lesion.