[Percutaneous closure of patent ductus arteriosus: results and costs compared to surgical closure]. / Fermeture du canal artériel par voie percutanée: comparaison des résultats et des coûts avec la fermeture chirurgicale.

The comparison of the clinical results and costs of the two methods of closure of patient ductus arteriosus was undertaken in two comparable groups of 40 patients treated in the same period in the same hospital. After transcatheter closure there was a 9% residual shunt rate at 3 years, the 2 patients with a residual continuous murmur being operated secondarily. The only complication was severe haemolysis which regressed after transcatheter ablation of the prosthesis. After surgical closure, there were no residual shunt. Some postoperative complications were observed in 20% of cases, usually benign (ventilatory problems, dysphonia or urinary infection), but occasionally more serious (peroperative lesion of the pulmonary artery). Morbidity, inherent to the technique of closure, was very different and much less in catheter closure. The average cost (daily cost x average length of hospital stay) was much less with transcatheter closure 38,558 francs versus 11,240 francs. On the other hand, the direct cost of transcatheter closure was greater than that of surgery: 32,798 francs versus 20,903 francs, the difference being related to the actual price of the prosthesis. The authors conclude that the 3 year results of transcatheter closure of patent ductus arterious make this technique a reasonable therapeutic alternative to surgery. From the safety point of view, the two techniques are comparable bu patient confort is greater with transcatheter closure for an increase in cost of the initial procedure which should decrease in relation to the types and prices of the prosthesis used.

[Lung resection for cancer in coronary patients. Immediate and medium-term results. Retrospective study in a series of 51 patients]. / Exérèses pulmonaires pour cancer chez le malade coronarien. Résultats immédiats et à distance. Etude rétrospective d'une série de 51 malades.

Patients with both resectable lung cancer and coronary artery disease require preoperative cardiac evaluation in order to determine and prevent the surgical risk and to discuss the desirability of preventive myocardial revascularization. The results of thoracic surgery in coronary disease patients have been studied in a series of 51 patients operated upon for lung cancer at the Marie Lannelongue hospital, Paris, between 1985 and 1988. Thirty-two patients underwent non invasive exploration prior to surgery (exertion ECG in 22, myocardial radioisotope scanning in 10); 35 patients had coronary arteriography at the last moment, and 9 asymptomatic patients with an old history of myocardial infarction had no specific exploration. Forty-nine patients had lung surgery alone, preceded in 5 cases by percutaneous coronary angioplasty; one patient had pulmonary surgery and coronary surgery simultaneously, and another patient had coronary surgery first, later followed by lung surgery. No perioperative death was due to cardiovascular causes. A 75-year old male patient died of respiratory failure 30 days after lobectomy. The postoperative period was totally uneventful in 39 patients. No perioperative myocardial infarction was recorded; 4 patients experienced an episode of thoracic pain with ECG signs of myocardial infarction but no rise in serum enzyme concentrations. One patient had a cerebral vascular accident responsible for hemiplegia. Two late sudden deaths, probably of cardiac origin, occurred 4 and 11 months respectively after surgery. The actuarial survival rate at 3 months was 48 percent. In all survivors, the coronary symptoms were controlled by medical treatment. It seems, therefore, that perioperative complications in this type of patient can be avoided by preoperative evaluation of the coronary disease and by preventive myocardial revascularization in case of critical coronary stenosis.

[Value of superior angiocardiography in the evaluation of the surgical excision of bronchial cancer. Respective role compared to thoracic x-ray computed tomography]. / Intérêt de l'angio-cavographie supérieure dans le bilan d'extirpabilité du cancer bronchique. Place respective par rapport à la tomodensitométrie thoracique.

The place of angiography-superior vena cavography in the assessment of the resectability of a lung cancer must be defined in comparison with the data provided by thoracic computed tomography. Sixty-six patients with proximal lung cancers of doubtful resectability were studied by means of angiography and computed tomography and the results of these preoperative investigations were correlated with the operative findings. The sensitivity of these two examinations for the diagnosis of vascular invasion preventing pulmonary resection is poor (53% and 47% respectively). The specificity and positive predictive value of angiography appear to be slightly superior to those of computed tomography (Sp: 96% and 82%, PPV: 78% and 47%, respectively). The diagnostic performance of these two examinations remains poor. Magnetic resonance imaging may replace these two examinations in the future.

[Atrial septal defect and cyanosis. Apropos of 6 cases related to abnormal drainage of the inferior vena cava into the left atrium]. / Communication interauriculaire et cyanose. A propos de 6 observations en rapport avec un drainage anormal de la veine cave inférieure dans l'oreillette gauche.

The authors report six cases of atrial septal defect (ASD) associated with abnormal drainage of the inferior vena cava into the left atrium responsible for right-to-left shunting, without pulmonary hypertension. The abnormal drainage could be due either to an anatomical malposition of the inferior vena cava opening into the left atrium, or to an abnormal blood flow from this vein, normally located through a low ASD, under the influence of anatomical, mechanical and haemodynamic factors. Clinically, all patients presented with light cyanosis and with the usual signs of ASD. None of them had elevated pulmonary pressure. The lesion, suggested by clinical findings, was diagnosed either at angiography, which in four cases demonstrated an abnormal pulmonary venous return, or at colour-coded doppler echocardiogram, or at surgery. In every case, surgical correction consisted of closure of the often low-sited ADS by a patch which diverted the inferior vena cava into the right atrium and the abnormal venous return towards the left atrium. The short--and long-term results of surgery were excellent. The authors review the literature concerning this unusual association of ASD with an abnormal drainage of the inferior vena cava into the left atrium.

[Percutaneous transluminal angioplasty in complex congenital cardiopathies. Apropos of 2 cases]. / Angioplastie transluminale percutanée dans des cardiopathies congénitales complexes. A propos de deux cas.

Percutaneous transluminal angioplasty (PTA), already widely used in stenosis of peripheral, renal or coronary arteries, has now been extended to congenital heart diseases. Thus, in pulmonary or aortic orificial stenosis this simple and fairly safe method has proved to be a suitable alternative to surgery. In other cases it may be used for tiding the patient over a critical period pending surgery. Finally, PTA may be performed as a palliative treatment of lesions that are too complex for surgery or carry an excessively high operative risk. This applies to the two cases reported here, where PTA enabled us to dilate: the ductus arteriosus in a patient with single ventricle--an application which, to our knowledge, has not yet been reported--and a strongly stenotic pulmonary orifice associated with a complex heart disease. In both cases PTA was successful both haemodynamically and angiographically and was followed by marked clinical improvement. The published cases of complex congenital heart diseases where PTA has been used are reviewed.

[Adult pulmonary valvular stenosis, major stenosing right ventricular hypertrophy and tricuspid insufficiency. Apropos of 2 cases]. / Sténose valvulaire pulmonaire vieillie, hypertrophie ventriculaire droite sténosante majeure et insuffisance tricuspidienne. A propos de 2 observations.

2 cases of severe pulmonary valvular stenosis in two young adults aged 21 and 29 years respectively are presented. Despite the degree of stenosis (4 mm jet), the right ventricular pressures did not exceed systemic pressures because of severe tricuspid regurgitation. This dominated the clinical and anatomical findings, causing aneurysmal dilatation of the right atrium and displacement of the tricuspid valve to the left. The diagnosis of Ebstein's anomaly was raised in one case but excluded by echocardiography and angiocardiography. In spite of the severity of the symptoms and peripheral clinical signs, surgery of the right ventricular outflow tract, tricuspid valvuloplasty and resection of part of the right atrium led to a complete and rapid cure, confirmed by catheterisation one month after operation.

[Malformations of the tricuspid valve associated with Fallot's tetralogy. Apropos of a series of 224 surgically treated Fallot's tetralogies]. / Malformations de la valve tricuspide associées à la tétralogie de Fallot. A propos d'une série de 224 tetralogies de Fallot opérées.

This study was based on 7 children aged 20 months to 13 years with tetralogy of fallot (TOF) and tricuspid valve defects. Cases of endocardial cushion defects (8 cases of atrioventricular) were excluded. Three types of tricuspid valve defect were observed: 4 tricuspid valve prolapse (with one associated mitral valve prolapse); 2 accessory tricuspid valves passing through a ventricular septal defect to prolapse in diastole under the aortic valve; 1 Ebstein anomaly. The prevalence of tricuspid valve defects associated with TOF 3 p. 100 in this series. The diagnosis can: usually be made by 2D echocardiography. Tricuspid valve prolapse (usually the septal leaflet) is visualised in the apical 4 chamber view. The passage of accessory tricuspid tissue across the VSD into the left ventricular outflow tract is visible in the parasternal long axis or subcostal long axis views. Ebstein anomaly can be demonstrated in apical 4-chamber views showing the abnormally apical site of insertion of the septal leaflet of the tricuspid valve and "atrialisation" of part of the right ventricle. Tricuspid valve defects did not pose any special surgical problems during complete repair of TOF but this series did not include any cases of tricuspid hypoplasia or parachute tricuspid valve which have been reported in the literature and which do complicate surgery. Tricuspid valve and subendocardial cushion defects should be looked for systematically in patients with TOF undergoing 2D echocardiography.

[Assessment of the branches of the pulmonary artery by 2-dimensional echocardiography]. / Evaluation des branches de l'artère pulmonaire par l'échocardiographie bidimensionnelle.

Sixty three cases of Fallot's tetralogy aged from 1 month to 30 years old, were studied by 2D echocardiography to evaluate the diameter of the pulmonary arteries and to detect stenosis of the main pulmonary arteries. The right pulmonary artery was visualised clearly enough to be measured in all 63 cases whereas the left pulmonary artery could only be adequately recorded in 58/63 cases. The junction of the two pulmonary arteries was confirmed by 2D echo in 61/63 cases; in two cases, the left pulmonary artery was not connected (2/63), confirmed at angiography and surgery. Six stenoses of the pulmonary arteries, confirmed surgically (6/7), were detected by 2D echo but there were also 3 false positive results. The pulmonary arteries were measured from suprasternal views; the values obtained ranged from 3 to 15 mm. There was a good correlation with the angiographic measurements (R = 0.81 for the right pulmonary, and R = 0.82 for the left pulmonary arteries). Good correlations were also observed between the peroperative and 2D echo measurements (R = 0.84 for the right pulmonary; R = 0.77 for the left pulmonary artery). 2D echocardiography is a non-invasive reliable technique for visualising the pulmonary arteries and their origin, for measuring the calibre of these vessels and for detecting severe proximal pulmonary artery stenosis.

[Diagnosis of a complete atrioventricular canal with infundibular pulmonary stenosis and left superior vena cava by 2-dimensional contrast echocardiography. Apropos of a surgically treated case]. / Diagnostic d'un canal atrio-ventriculaire complet avec sténose infundibulaire pulmonaire et veine cave supérieure gauche par l'échocardiographie bidimensionnelle de contraste. A propos d'un cas opéré.

The case of an eight year old child with complete atrioventricular canal, pulmonary infundibular stenosis and persistent left superior vena cava draining into the coronary sinus is reported. Two-dimensional echocardiography with injection of contrast in a left arm vein gave a precise and complete diagnosis of the malformations before catheterisation and angiography. The complete atrioventricular canal was demonstrated by apical four-chamber views. The pulmonary infundibular stenosis was visualised by a short axis subcostal view. Contrast echocardiography in the apical four-chamber view showed a right-to-left shunt at atrial level at the site of the ostium primum and a right-to-left shunt at ventricular level just below the hemivalve. The left superior vena cava was detected by a short axis suprasternal view which visualised its vertical trajectory as far as the coronary sinus. The lesions were confirmed at surgery, and a complete repair was performed.

[Unexpected findings during surgery for interventricular communication and for banding of the pulmonary artery in the infant and child]. / Surprises de la chirurgie directe de la communication interventriculaire et du décerclage de l'artère pulmonaire chez le nourrisson et l'enfant

While the authors recognise the difficulty of obtaining a complete picture of the lesion in certain types of ventricular shunt with pulmonary hypertension, they emphasise the importance of a precise diagnosis, which may modify the medical treatment and the decision to operate. Conditions may nevertheless be found by surprise at operation, and lead to a modification of the planned action.

[Intraspinal venous hypertension due to multiple anomalies in the caval system. A major cause of myelopathies]. / L'Hypertension veineuse intra-rachidienne par anomalies multiples du système cave. Une cause majeure de myélopathies.

Increased venous intraspinal pressure is described as a venous system disease, resulting in numerous unexplained paraplegias and tetraplegias. The chronic venous stasis in the intraspinal plexuses, into which the circulation of the spinal cord is drained, is due to the association of multiple abnormalities (stenoses, compressions, thromboses) on the major pathways of the caval and azygos system. The abnormalities, most of which are not known, are demonstrated by a special procedure, the cavo-spinal phlebography, and some of them are subjected to surgery.