Postoperative morbidity and mortality from aortic valve replacements in 25 cases in Senegal.

The purpose is to study the short- and medium-term morbidity and mortality linked to the implantation of an aortic prosthesis during cardiac surgery. This is a longitudinal, retrospective and descriptive study which takes place over a period from January 2017 to March 2020 (38 months) at the level of the thoracic and cardiovascular surgery clinic of the university Hospital Center of Fann in Dakar. All patients who underwent aortic valve replacement during this period were included in the study. A number of the series was 25 patients with a sex ratio of 2.66. The average age of the patients was 29.5 years (8-51 years). In the patients' history, 19 patients (76%) had a notion of recurrent angina. Exercise dyspnea was the most common functional symptomatology present in 24 patients (96%). In the series, there were 22 cases (88%) of aortic insufficiency of various grades (2 to 4) with 7 cases (28%) associated with mitral insufficiency. We had 3 cases (12%) of aortic stenosis. All patients received surgical management under cardiopulmonary bypass. The average duration of cardiopulmonary bypass was 132 minutes ± 41.21 (53-226 minutes). The average duration of aortic clamping was 101 minutes ± 31.87 (53-164 minutes). The surgical procedures consisted in replacing the aortic valve with a biological prosthesis in one patient (4%) and a mechanical prosthesis in 24 patients (96%). The average length of hospital stay in intensive care was 5 days ± 4.03 (2-20 days). The average length of hospital stay was 20.76 days ± 13.19 (9 to 64 days). The average duration of follow-up was 8.2 months ± 4.57 (1 week - 32 months). During the follow-up, only one patient (4%) had developed infectious endocarditis on prosthesis and only one patient (4%) had a complication related to anticoagulant therapy (antivitamin K) such as gingivorrhagia and melena. We had recorded a single case of death at 6 months, a late mortality of 4%. Aortic valve replacement surgery, by median sternotomy gives satisfactory short- and medium-term results with negligible morbidity and negligible operative mortality.

[Anaesthesia in on-pump cardiac surgery for congenital heart diseases at the Cuomo Pediatric Cardiology Center (Senegal)]. / Prise en charge anesthésique des cardiopathies congénitales opérées sous circulation extra - corporelle au Centre de Chirurgie Cardiaque Pédiatrique Cuomo (Sénégal).

Congenital heart diseases account for 0.5-1% of births. The management of children with cardiac malformation requires treatment in a suitable center, adequate medical equipment and specific anesthetic and surgical knowledge. The purpose of this study was to evaluate the anesthetic management of patients with congenital heart diseases in our center after the first year of activity and to compare the obtained results with literature reported data. We conducted a retrospective, descriptive study over a 1-year period, from January to December 2017. All patients undergoing on-pump cardiac surgery for congenital heart disease during this period were included. We collected data from 80 records of patients undergoing surgery for congenital heart disease. Out of these 80 patients, 60 underwent on-pump cardiac surgery (75%). The average age of patients was 7.41 years, with a sex-ratio of 1.22. The mean duration of on-pump cardiac surgery was 82.82 min and the mean duration of aortic clamping was 58.31 min. At the end of the procedure catecholamine production was found in 70% of patients. The most common complication in the postoperative period was right-side heart failure (69%). The average length of stay in the Emergency room was 4.33 days. One patient died, bringing mortality to 1.6%. Congenital heart diseases are complex and highly variable. Improved management techniques have strongly reduced morbi-mortality.

[Indications and results of surgical resection of bubbles arising from pulmonary emphysema]. / Indications et résultats de la chirurgie de résection des bulles d'emphysème pulmonaire.

Surgical resection of bubbles or bullectomy is the gold standard in the treatment of bubbles arising from pulmonary emphysema. It is usually indicated for patients with complicated bubbles or when they are the underlying cause of disabling dyspnea. This study aims to determine the indications for bullectomy and to evaluate surgical outcomes in our Department. We conducted a retrospective, descriptive study of 24 patients (23 men and 1 woman) whose average age was 49 years and who had undergone bullectomy between 2004 and 2013. Collected data were: factors favoring the occurrence of bullous emphysema, the circumstances in which bubble was detected, data from the radiological examinations, data from pulmonary and cardiovascular function testing, data from bullectomy, data from postoperative clinical and functional examination. Morbidity rate was 37.5 %. The main complication was persistent air leak (7 cases). One patient died two days after surgery due to acute respiratory failure. The average follow-up period was 26 months during which we observed improvement of dyspnea in all patients and no complications. Bullectomy is an effective, reliable and safe surgical technique that may improve patients' quality of life for a few years.

[Anatomical bases of external pudendal artery injuries during surgical treatment of pelvic limb varices]. / Bases anatomiques des lésions de l'artère pudendale externe lors de la chirurgie des varices du membre pelvien.

INTRODUCTION: External pudendal artery is a collateral branch of the common femoral artery which is the primary blood supply to the penis or the clitoris. Its relationship with the venous arch of the great saphenous vein and its afferents in femoral triangle, are very narrow. This often entails injuries during crossectomy and great saphenous vein stripping. These lesions can cause sexual dysfunction. METHODS: This study reports the case of a dissection of 22 inguinal regions in 13 men and 9 women who underwent surgical treatment of the femoral triangle. The distribution and the relationship between the external pudendal artery and the venous arch of the great saphenous vein are studied. RESULTS: Single external pudendal artery is the most common. All external pudendal arteries originate from the common femoral artery. The most common type of relationship is between the sub-crossing of the venous arch of the great saphenous vein and a single external pudendal artery. Moreover, we recorded a pre-crossing, an alternate crossing and some relationship with the common femoral vein and the afferences of the venous arch of the great saphenous vein. Some surgical techniques expose more or less to external pudendal artery injury. CONCLUSION: This study confirms previous data but shows some peculiarities about the relationship between the venous arch of the great saphenous vein and external pudendal artery.