ABSTRACT
There is a continuous growth in the incidence of cardiovascular and thoracic diseases, especially related to the increased life expectancy. Moreover, the quality and efficacy of care for these pathologies are progressing constantly. The evolution of surgery prompts us to develop less aggressive (minimally invasive), although technically more complex, treatment or diagnostic techniques. Pathologies, which until now required heavy surgeries, are managed today in a less invasive way and become therefore accessible to patients even if they are older or in a poor general condition. In this article, we present our experience in the development of the minimal invasive procedures in cardiovascular and thoracic surgery.
Les pathologies cardiovasculaires et thoraciques, au sens large, sont de plus en plus fréquentes, vu l'augmentation de l'espérance de vie, mais elles sont aussi de mieux en mieux prises en charge. En effet, l'évolution de la chirurgie nous incite à développer des techniques de traitement ou de diagnostic moins agressives (mini-invasives) quoique techniquement plus complexes. Des pathologies qui nécessitaient, jusqu'à présent, des chirurgies lourdes se prennent en charge, aujourd'hui, de manière moins invasive et deviennent donc accessibles à des patients en moins bon état général ou de plus en plus âgés. Nous présentons ici notre expérience dans le développement de l'approche mini-invasive en chirurgie cardiovasculaire et thoracique.
Subject(s)
Cardiovascular Surgical Procedures , Minimally Invasive Surgical Procedures , Thoracic Surgery , Cytoreduction Surgical Procedures , HumansABSTRACT
Heart transplantation remains undoubtedly the most effective treatment for end-stage heart failure, whatever its cause. Last decade has witnessed significant improvements in terms of morbidity and mortality following heart transplant. The 5-year survival rate is now beyond 70 %. However, the shortage of potential donors limits its use and requires strict criteria before listing a candidate for heart transplantation. Herein, we present a review of current indications and results of the heart transplantation program at the University hospital of Liège.
La transplantation cardiaque demeure, à ce jour sans conteste, le traitement de choix de l'insuffisance cardiaque terminale, quelle qu'en soit l'origine. La dernière décennie a été marquée par une amélioration significative des résultats de la transplantation cardiaque tant en termes de mortalité que de morbidité. La survie globale à 5 ans dépasse maintenant 70 %. Cependant, la pénurie d'organes limite malheureusement son emploi et impose des critères de sélection rigoureux des potentiels candidats. Une revue des indications actuelles ainsi qu'un aperçu des résultats de la transplantation cardiaque au CHU de Liège sont présentés.
Subject(s)
Heart Failure , Heart Transplantation , Hospitals, University , Humans , Survival Rate , Tissue DonorsABSTRACT
Aortic valve replacement is nowadays a safe procedure with low morbidity and mortality. However, the evolution of surgery requires the development of less invasive techniques. Aortic valve replacement through a right mini-thoracotomy, technically more complicated, offers a lower rate of complications including less postoperative pain and less blood loss and transfusion, with a faster recovery. We report our early experience of aortic valve replacement through a right anterior mini-thoracotomy.
La chirurgie de remplacement valvulaire aortique offre toujours d'excellents résultats avec une morbidité et une mortalité faibles. Cependant, l'évolution de la chirurgie nous incite à développer des techniques mini-invasives. La mini-thoracotomie antérieure droite, pour la chirurgie de remplacement de la valve aortique, techniquement plus complexe, offre de nombreux avantages. Cette technique assure une réduction des pertes sanguines et des douleurs postopératoires, une meilleure fonction respiratoire, un rétablissement plus rapide (durée de séjour hospitalier plus court) et un bénéfice esthétique. Nous rapportons ici notre expérience initiale de remplacement valvulaire aortique par mini-thoracotomie antérieure droite.
Subject(s)
Aortic Valve , Heart Valve Prosthesis Implantation , Minimally Invasive Surgical Procedures , Hospitals, University , Humans , Length of Stay , Retrospective Studies , Sternotomy , Thoracotomy , Treatment OutcomeABSTRACT
Intramural hematoma of the ascending aorta occurs after rupture of the vasa vasorum. Previously considered as a first step of acute aortic dissection, it was later defined as a separate entity that may or may not lead to arterial dissection. The debate about the most appropriate treatment for a 69-year-old patient with intramural hematoma of the ascending aorta, led to this extensive review of the literature demonstrating that intramural hematoma type A is a life-threatening condition requiring urgent surgical support.
Subject(s)
Aorta , Aortic Diseases/diagnosis , Aortic Diseases/surgery , Hematoma/diagnosis , Hematoma/surgery , Aged , Female , Humans , Rupture, Spontaneous/complications , Tomography, X-Ray Computed , Vasa Vasorum/injuriesABSTRACT
We report the case of a patient admitted with upper gastrointestinal bleeding. The CT scan revealed an aorto-duodenal fistula. This case highlights the progression of radiological imaging in parallel with the clinical course. We take this opportunity to write a brief literature review mainly focused on the description and diagnostic modalities of aortoenteric fistulas.
Subject(s)
Aortic Diseases/complications , Gastrointestinal Hemorrhage/etiology , Intestinal Fistula/complications , Vascular Fistula/complications , Aged , Aorta, Abdominal/pathology , Aortic Diseases/diagnosis , Aortic Diseases/surgery , Fatal Outcome , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/surgery , Humans , Intestinal Fistula/diagnosis , Intestinal Fistula/surgery , Male , Prognosis , Vascular Fistula/diagnosis , Vascular Fistula/surgeryABSTRACT
We report the case of a young woman who suffered from a severe traffic accident with major thoracic trauma consisting of hemopneumothorax and flail chest. At day 5 of mechanical ventilation, a surgical reduction and fixation of the fractured ribs were performed; the patient was liberated from mechanical ventilation the next day and discharged from the intensive care unit two days later. The success of this local first case incites us to further a similar approach in such challenging trauma cases.
Nous rapportons le cas d'une jeune patiente victime d'un accident grave de la circulation avec un traumatisme thoracique sévère ayant entraîné un hémopneumothorax et un volet thoracique. Au 5ème jour de ventilation invasive, une réduction et une fixation chirurgicales du volet thoracique furent réalisées. La patiente fut sevrée de la ventilation invasive le lendemain et transférée en salle de soins banalisés deux jours plus tard. Le succès de cette première thérapeutique nous incite à la proposer à l'avenir dans des situations similaires.
Subject(s)
Flail Chest/surgery , Rib Fractures/surgery , Adult , Female , Flail Chest/therapy , Humans , Intensive Care Units , Respiration, Artificial , Rib Fractures/therapy , Thoracic Injuries/surgery , Thoracic Injuries/therapy , Treatment OutcomeABSTRACT
Endoleaks represent the most common complication of endovascular aortic aneurysm repair. With the increasing use of endovascular techniques for aortic aneurysm repair, the prevalence of endoleaks has risen. While maintaining pressurization of the aneurysm sac, endoleaks expose to persistent risks of an evolution towards rupture. Long-term surveillance with imaging studies is necessary to reduce the incidence of these specific complications that may require intervention. The objective of this article is to draw the attention to the possible occurrence of these complications and to report the elements of diagnosis and treatment.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Endoleak/etiology , Endovascular Procedures/adverse effects , Stents , Aged , Diabetes Mellitus, Type 2/complications , Endoleak/diagnosis , Endoleak/therapy , Humans , Male , Pulmonary Disease, Chronic Obstructive/complications , Risk Factors , Treatment OutcomeABSTRACT
Besides major progress in the pharmacologic treatment of severe chronic heart failure, cardiac resynchronization therapy (CRT) has developped over the last ten years. We report the follow-up of the 36 first patients with a CRT device implanted from July 2000 to November 2002 at the CHR de la Citadelle Hospital in Liege. After a mean follow up of 6 months, no death was observed. The functional benefit of resynchronization is validated by a significant improvement in the NYHA class, an increase in the walking distance measured by the six minute walk test from 268 +/- 103 to 342 +/- 106 meters (p < 0.004) and by a not significant rise in the VO2 max (from 11.1 +/- 2.8 to 14 +/- 10 ml/kg/min; P=0.1). The quality of life, assessed by the Minnesota-Living-In-CHF score, improves from 49 +/- 20 to 35 +/- 22 after the six month follow-up (P=0.02) The echocardiogram also shows a better left ventricular ejection fraction at six months, from 24 +/- 7% to 31 +/- 7% (P<0.05). Based on a better NYHA functional class, responders (n=24; 71%) and non responders (n=10; 29%) were compared; a correlation between the functional class change and the improvement of the ejection fraction was documented, but not with the reduction in QRS width. Our registry, with the potential pitfalls of a monocentric prospective study, confirms the feasability, safety and efficacy of CRT in severe chrbnic heart failure uncompletely corrected pharmocalogically. It remains however approximately 30% of non responding patients, in whom the current clinical studies should help identify the right criteria to predict and discriminate responders.
Subject(s)
Heart Failure/therapy , Pacemaker, Artificial , Activities of Daily Living , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Quality of Life , Treatment Outcome , Ventricular Function, LeftABSTRACT
BACKGROUND: This series aims to prove the positive impact of laparoscopic approach in aortofemoral bypass grafting. METHODS: It concerns a retrospective non randomized study comparing 58 consecutive patients treated with laparoscopic procedure (n = 30) and with a standard open procedure (n = 28) in a single center. The different operating times, the complications and the follow-up of these two groups are compared RESULTS: The demographics and angiographic data of the two groups were comparable. Operating time was longer in the laparoscopic group. However, we noticed a significant shorter hospitalisation stay (p < 0.0001) after the laparoscopic procedure with a mean 5.1 days. There was no significant difference of morbidity. CONCLUSION: We suggest that the trans-peritoneal approach is the best way in laparoscopic procedure in term of exposure and ergonomics. Laparoscopic aortofemoral bypass grafting is feasible, safe and effective. Shortening of operating time is observed as surgeon's experience grows.
Subject(s)
Aorta, Abdominal/surgery , Arterial Occlusive Diseases/surgery , Blood Vessel Prosthesis Implantation/methods , Femoral Artery/surgery , Laparoscopy , Anastomosis, Surgical , Female , Humans , Length of Stay/economics , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
After the recent discovery of an antique engraving representing Iohan Georg Fuchs, the author provides some information about this unknown physician who practiced eye surgery in the Principality of Liège.
Subject(s)
General Surgery/history , Ophthalmology/history , France , History, 18th Century , HumansABSTRACT
Daily in our practice we use terms of anatomy. Some of these terms are directly linked to the name of their discoverer. Very often, we ignore or have forgotten the history of these anatomists. The author, with a short repertory refreshes our memory.
Subject(s)
Anatomy/history , Eponyms , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , HumansABSTRACT
The pharmacological treatment of congestive heart failure has improved its morbidity and mortality. Nevertheless, many patients remain disabled in spite of optimal treatment. The availability of alternative therapies such as heart transplantation or cardiomyoplasty is limited. Newer devices are awaited. Biventricular pacing is a potential option to improve the homogeneity of contraction and the overall mechanical performance without myocardial oxygen consumption increase. This approach has proved acute hemodynamic and functional benefits but has to demonstrate a favourable influence on long term morbidity and mortality.
Subject(s)
Electric Stimulation Therapy , Heart Failure/therapy , Pacemaker, Artificial , Ventricular Function , Hemodynamics , HumansSubject(s)
Coronary Artery Bypass/adverse effects , Graft Occlusion, Vascular/etiology , Mammary Arteries/injuries , Mammary Arteries/transplantation , Coronary Artery Bypass/methods , Coronary Disease/surgery , Graft Occlusion, Vascular/surgery , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/methods , Prognosis , Reoperation , Risk AssessmentABSTRACT
On the occasion of the 100th anniversary of the discovery of blood groups by Karl Landsteiner, the author makes a historical note on the amazing history of the blood transfusion from the origin to the beginning of the XXth century.
Subject(s)
Blood Grouping and Crossmatching/history , Blood Transfusion/history , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , HumansABSTRACT
This paper reviews the literature of Takayasu's arteritis (T.A.). The concept of this disease has evolved considerably over the past decades. T.A. was first described by Mikito Takayasu in 1908, and was thought to be restricted to south-east Asia. But due to the increasing reports from all over the world, it is well established that T.A. has world-wide distribution. Clinical presentation varies according to the location of the arterial lesions. In Europe brachiocephalic trunk lesions prevail and are best managed by an arterial reconstruction. Historical background, epidemiology, etiology, pathology, clinical findings, diagnosis, classification, treatment and long-term prognosis are discussed.
Subject(s)
Endothelium, Vascular/pathology , Takayasu Arteritis/diagnosis , Takayasu Arteritis/therapy , Adrenal Cortex Hormones/therapeutic use , Biopsy, Needle , Disease Progression , Female , Humans , Incidence , Male , Prognosis , Takayasu Arteritis/epidemiology , Vascular Surgical ProceduresABSTRACT
Three hundred years ago, the Collegium Medicorum Leodiensium was founded under the authority of His Majesty the Prince Bishop Joseph- Clemet of bavaria. On the occasion of this anniversary, the author a chronological account and a description of the characteristics of the old medical colleges in Liége (Belgium) from the Middle-Ages up to the early nineteenth century.
Subject(s)
Education, Medical/history , Schools, Medical/history , Belgium , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, Medieval , Pharmacopoeias as Topic/historyABSTRACT
On the occasion of the 150th anniversary of Horace Wells's death, the author makes a historical note about the discovery of the general anesthesia by inhalation.
