[Treatment for carotid stenosis: surgery, the reference]. / Traitement d'une sténose carotide: chirurgie, la référence.

THE CONTROVERSY: The indications for carotid revascularisation are clearly codified, but the surgical treatment is debatable. The angioplasty initially proposed for non-atheromatous stenosis or for high surgical risk patients is used by some as first-line therapy, although no benefit/risk ratio in its favour has been demonstrated. ARE THERE ANY BENEFITS WITH SURGICAL TREATMENT?: The efficacy of surgery in the treatment of atheromatous carotid stenosis has been demonstrated. The interest of angioplasty The advantages expected with carotid angioplasty are the absence of cervical incision and cervical nerve lesions, together with a reduction in the duration of hospitalisation and costs. Nevertheless, there are risks inherent to the femoral puncture and endovascular propagation from the femoral to the carotid artery. Till now, the published studies have not concluded in the superiority or equivalence of angioplasty versus surgery. FOR CERTAIN SUB-GROUPS: It has not been demonstrated but it is possible that a sub-group of high-risk patients could benefit from carotid angioplasty. There are no arguments for recommending angioplasty in the treatment of carotid re-stenosis following endarterectomy or for post-radiation stenosis. ANTI-EMBOLIC TREATMENT SHOULD BE FORESEEN: Carotid angioplasty is associated with embolus, the frequency of which is 8-fold greater than that observed after endarterectomy. The systematic use of cerebral protection is therefore recommended. TODAY: The treatment of reference of carotid stenosis remains endarterectomy conducted by vascular surgeons.

Post-mediastinitis ventricle rupture: closing the chest without closing the heart?

Right ventricular rupture following mediastinitis is an unusual but potentially life-threatening complication of cardiac surgery, related to the "open" debridement technique. There are few reports of complex surgical management including repair of the tear and wound closure with omentoplasty or muscle flap with ECC. We report the case of a patient with a right ventricular rupture complicating mediastinitis, which was successfully treated by direct closure of the chest wall without repairing the ventricle tearing and without ECC. We believe that it can be a quick and effective solution at first attempt, and may be a successful and definitive treatment.