Embolic thrombus on mitral anulus calcification.

Embolic thrombus on mitral anulus calcification (MAC) was demonstrated in an 83-year-old woman with retinal embolism. Mitral anulus calcification has been associated with a significant increase of stroke in elderly people. Atrial fibrillation and calcific emboli have been reported, and embolic thrombus by MAC may be another potential cause.

[Heart valve prosthesis from autologous pericardium. Preliminary results apropos of 15 patients]. / La prothèse cardiaque en péricarde autologue. Résultats préliminaires à propos de 14 patients.

The concept of a heart valve prosthesis made from autologous pericardium is based on the idea of creating and developing a valve with a longer life than heterografts or homografts due to the absence of tissue degeneration causing the deterioration of both of these types of bioprostheses. The first attempts using the fascia lata or the pericardium, implanted in the seventies, were unsuccessful due to problems with pretreatment of the pericardium and other purely technical difficulties. J. Love et al then developed a technique based on Carpentier's earlier work, where a valve is made extemporaneously using the autologous pericardium. We applied this technique in 14 patients from June 1994 to 1995. The mean age of the patients was 68 years (7 males, 7 females). The aortic valve was replaced in all cases. Preoperative findings were: aortic stenosis (n = 7), aortic regurgitation (n = 1), aortic valve disease (n = 6). Two patients also had mitral valve disease and 3 had coronary artery disease. There were no operative deaths and no patients were lost to follow up. Clinical state was satisfactory with a follow-up of 1 to 10 months. Postoperative Doppler echocardiography was performed at 3 and 6 months and showed gradients were very low. This group of patients demonstrated the value and applicability of the concept. The validity of the technique will be evaluated as a function of the long-term results.

[Myxoma of the mitral valve; apropos of 2 surgically treated cases. Review of the literature]. / Myxome de la valve mitrale; á propos de deux cas opérés. Revue de la littérature.

The authors report two cases of anterior mitral valve myxoma. This is an exceedingly rare localisation and these cases add to the other 8 previously reported cases. Intracardiac tumours and valvular endocarditis may be detected non-invasively by echocardiography but the precise diagnosis may be extremely difficult: mitral valve myxoma is an exceptionally rare condition. Treatment was surgical in both reported cases.

Thrombosis of the abdominal aorta. A rare complication of the intraaortic balloon pumping device.

We describe a patient who died due to thrombosis of the abdominal aorta and its branches after placement of an intraaortic balloon pumping device. This rare complication, which occurred despite careful insertion technique, underscores the need to select balloon size as a function of the individual patient's morphology.

[Castleman's disease. An intrapulmonary isolated form with fissural exteriorization]. / Maladie de Castleman. Forme isolée intrapulmonaire à extériorisation scissurale.

We report a well-documented case of Castleman's disease which embodied all the main features of its localized forms, those most frequently described in the literature. This case was particular by its unusual intrapulmonary location and its intra-fissural development, which explains why the diagnosis was not considered preoperatively. A review of the literature showed that beside the localized forms of Castleman's disease multifocal forms have recently been reported; these have a much poorer prognosis, and their treatment has not yet been established.

Treatment of thymomas. A report of 67 cases.

From 1979 to 1989, 126 patients were treated for thymic tumors. Of these, 67 (53%) had thymomas occurring in 27 men and 40 women; the mean age was 46 years: 24 patients had no symptoms and myasthenia gravis was present in 21 cases. A complete resection was performed in 45 patients, associated in 22 with postoperative adjuvant treatment (radiotherapy, 2; radio- and chemotherapy, 20). Two patients had a partial resection followed by radiotherapy and chemotherapy. Twenty patients had initially only a biopsy and were treated by irradiation in 3 cases, radio- plus chemotherapy in 16, radio- plus chemotherapy and subsequent resection in 1 case. The staging was carried out according to the GETT Classification (stage I A:26; I B:6; II:12; III A:1; III B:18; IVA:4). Thymomas were found to be of predominant epithelial type in 12 cases, predominantly lymphocytic type in 9, and mixed in 46. No recurrence occurred after complete resection. The overall 10-year survival was 71.1%. A good correlation was found according to staging: 96% in stage I; 80% in stage II; 35% in stage III. Presence of myasthenia gravis did not affect the results. The best prognostic factor remains complete resection with postoperative radiotherapy to prevent recurrences. The role of adjuvant chemotherapy needs further evaluation.