A True Distal Brachial Artery Aneurysm Treated with a Bifurcated Saphenous Vein Graft.

Brachial artery aneurysms are rare, mostly consisting of false ones secondary to infectious, traumatic, or iatrogenic arterial lesions. True aneurysms of the brachial artery are even more uncommon. Here, we report a case of a 40-year-old fisherman, without any pathological antecedent, who presented with a painful pulsatile mass of the left anterior arm. There was a slight edema with no ischemic signs. The computed tomographic angiography revealed a true 3.7 × 4.2 × 6 cm aneurysm of the distal brachial artery, partially thrombosed, which extended to the bifurcation. A surgical repair was indicated. Intervention consisted of an aneurysmectomy with interposition of an autologous reversed bifurcated saphenous vein graft. Early outcome was good and a 1-year follow-up showed a patent graft with no aneurysmal recurrence. A review of the literature on this rare location of true artery aneurysm and treatment options is outlined in this work.

Adolescent coarctation of aorta treated with subclavian-descending aorta bypass grafting.

BACKGROUND: Aortic coarctation in older children most frequently represents cases of re-coarctation following previous transcatheter or surgical therapy or missed cases of native coarctation. METHODS: We describe three cases of adolescents ­ two girls and one boy ­ with aortic coarctation, operated between January, 2012 and December, 2013. Computed tomography angiography was performed as an essential diagnostic procedure. RESULTS: Hypertension was detected, and weaker arterial pulses in the lower limbs were noted in all cases. All operations were performed via left posterolateral thoracotomy. Aortic coarctation was treated surgically, with left subclavian-lower descending thoracic aorta bypass grafting. Postoperative course was uneventful in all cases. No residual brachial-ankle pressure gradient was observed, and all patients have remained in good condition after the operation. CONCLUSIONS: Surgical treatment of aortic coarctation in adolescent patients can be achieved by resection with end-to-end anastomosis, interposition of a graft or bypass graft across the area of coarctation when the distance to be bridged is too long for end-to-end repair. The extra-anatomic subclavian-descending aortic bypass grafting provides good results in adolescent patients, particularly in those with complex coarctation.

[Determinants factors of hospital morbidity and mortality after reintervention of valve replacement]. / Facteurs déterminants dans la morbi-mortalité hospitaliére des réinterventions d un remplacement valvulaire.

BACKGROUND: Valve surgery involves valvular substitutes that expose to different types of complications that can lead to re subsequent interventions. AIM: was to identify the predictors factors of in-hospital morbidity and mortality of re interventions after valve replacement. METHODS: Retrospective study of 73 consecutive patients who underwent a re valve replacement between 1985 and 2010 in the Cardiovascular Surgical department of La Rabta hospital. RESULTS: The average age at further surgery was 44 years ( 15-80 years) and sex ratio of 0.87 . The average time between interventions was 10 years (3 days -33 years). Different etiologies were found prosthesis thrombosis (36.9% ). The overall hospital mortality was 36.9 % , 11 intraoperative deaths and 16 immediate postoperative deaths. CONCLUSION: The iterative intervention of valve replacement surgery is increasingly mastered by the surgical team. According to this study , the prognosis depends mainly on the patient preoperatively state, the cause of further surgery and its mode of occurrence.

[Transfusion safety: state of the arts (ART)]. / Sécurité transfusionnelle: etat des lieux.

BACKGROUND: Blood transfusion is a high risk activity. AIM: To evaluate transfusion safety in planned cardiac surgery. METHODS: This study was conducted in the blood bank of the Rabta Hospital in two phases: a phase to observe transfusion acts followed by corrective actions and a phase to evaluate the impacts of these corrections on the transfusion practices. Characteristics of the potentially transfused patients, the eventually prescribed, dispensed and transfused blood products and transfusion practices were studied. RESULTS: During the observation phase, 70 patients were enrolled, 51 potentially transfused. Weaknesses concerned the mention of phenotype and transfusion history when ordering blood components as well as the double ABO/D group typing, the phenotype and the cross match performing. Final bedside controls were done in a wrong way. The distribution and the blood administration were established respectively for 208 and 232 blood products. The traceability was established for 86 blood products. During the evaluation phase, 30 patients were enrolled, 15 potentially transfused. Improvement was achieved in the transfusion history notification, phenotype and antibodies screen performing and cross matching. CONCLUSION: Optimisation of blood transfusion can be conceived only with collaboration between the different transfusion structures.

Does Biphasic Calcium Phosphate-Coated Surface Increase the Secondary Stability in Dental Implants? A Split-Mouth Study.

Purpose: This study aimed to evaluate biphasic calcium phosphate coating (BCPC) on the secondary stability of dental implants compared to sand-blasted and acid-etched (SLA) implants. Materials and Methods: This is a split-mouth study. Thirty subjects (20 males and ten females) underwent a dental implant procedure to replace mandibular first or second molars bilaterally. The subjects were randomly assigned to BCPC or SLA groups. The resonance frequency analysis measurements were performed two, four, six, and eight weeks after the implant placement. Results: Sixty implants were placed in the two groups (30 implants per group). The mean ISQ was 52.26 ± 3.73 in group 1 and 50.21 ± 2.59 in group 2 on day 14 after the implant insertion, 63.20 ± 2.76 in group 1 and 58.80 ± 2.14 in group 2 on day 28, 72.30 ± 3.15 in group 1 and 64.53 ± 3.19 in group 2 on day 42, and 78.70 ± 1.56 in group 1 and 71.63 ± 3.22 in group 2 on day 56. The data analysis demonstrated significant differences between the two groups in terms of the mean ISQ at various evaluation times. Conclusion: Regarding ISQ measurements, the secondary stability in BCPC implants may be higher compared to SLA implants in two months after implant insertion.

[Results of surgical treatment of intracardiac total anomalous pulmonary venous return]. / Résultats du traitement chirurgical du retour veineux pulmonaire anormal total intracardiaque :à propos de 7 cas.

BACKGROUND: Total anomalous pulmonary venous return (TAPVR) has a rather low incidence (1-3%) of all congenital heart disease. Intracardiac TAPVR represent 25-30% of all TAPVR. AIM: To report our results and long-term follow-up of surgical management of intracardiac TAPVR. METHODS: Retrospective study of 7 patients with intra cardiac TAPVR treated surgically between Mai 1992 and July 2007. RESULTS: The surgical technique has been an intra atrial procedure in all cases. We didn't report any early post-operative death. Early postoperative complications were principally pulmonary infections. We report one death at three months of follow-up caused by laryngeal stenosis. Late follow-up was good for all patients. CONCLUSION: Good result of surgical treatment of intracardiac TAPVR depends on early diagnosis and adequate surgical technique.

[Late reinterventions after repair of common arterial trunk]. / Les reinterventions tardives apres reparation du tronc arteriel commun.

BACKGROUND: The common arterial trunk is a heart disease in witch a unique arterial trunk, with a unique ventriculo-arterial valve, exits from the ventricular mass and supply directly the coronary, the aortic and also the pulmonary arterial circulations. Its anatomic repair is now possible but necessitates the use of conduit in pulmonary position. AIM: To evaluate the incidence and the causes of late reinterventions after repair of common arterial trunk. METHODS: We retrospectively study the outcome of 17 patients who underwent repair of common arterial trunk between January 1983 and December 2006. The 15 early survivors were followed during a median period of 7 years (range 10 months and 13 years). RESULTS: Nine reinterventions were necessary in 8 patients. Only one conduit reintervention was necessary in the 8 patients. Freedom from conduit reintervention was 73% at 5 years and 33% at 10 years. Three reinterventions were performed in 2 patients for severe truncal valve incompetence, including repair in 2 cases and replacement in one case. Freedom from truncal valve reintervention was 67% at 10 years. CONCLUSION: Late reinterventions are inevitable after repair of common arterial trunk. The most common reasons are conduit stenosis and truncal valve incompetence.

[Atrial septal defects in adults: usefulness of surgical closure]. / Communications interauriculaires de l'adulte: quelle place reste pour la fermeture chirurgicale?

BACKGROUND: The atrial septal defect (ASD) is one of the most common congenital heart diseases in adults. AIM: The objective of our study is to determine the value of the surgical closure of ASD in adults. METHODS: Between January 1990 and December 2006, 87 adult patients underwent surgical closure of ASD. The mean age is 28 years; eighty one patients (93%) were in NYHA class I or II. RESULTS: All patients were operated on with extra corporeal circulation. There were 10% post operative complications, no early or late death. CONCLUSION: surgical closure of ASD in adults given good results and in spite of percutaneous procedures progress surgery keeps some specific indications

[Prosthetic valve endocarditis: about 14 cases]. / La prise en charge chirurgicale des endocardites infectieuses sur prothese valvulaire: a propos de 14 cas.

BACKGROUND: Prosthetic valve endocarditis (PVE) is a serious complication of valve surgery. AIM: The aim of this study is to determine the diagnostic and therapeutic management for PVE. METHODS: It's a retrospective study about 14 cases of PVE operated in the department of cardiovascular surgery of la Rabta hospital between January 1996 and December 2006. RESULTS: In two cases, surgery was performed emergent, in the remnant cases surgery was elective. The coagulase-negative staphylococcus (CNS) is the predominant cause of these PVE.Surgery consisted on seven mitral prosthesis replacements and seven aortic prosthesis replacements.Hospital mortality was 50%. CONCLUSION: In conclusion attention should be made to prevent endocarditis when possible. In case of PVE, an early diagnosis a leads to earlier application of appropriate therapies and improved outcome.

[Konno aortoventriculoplasty: indications and results. 13 cases]. / Aorto-ventriculoplastie de Konno: indications et resultats. A propos de 13 cas.

BACKGROUND: Konno procedure is used to enlarge the aortic root and increase the size of the aortic valve implanted. AIM: The aim of this study is to present the indications of the Konno procedure in congenital and acquired aortic lesions, in young patients with normal or hypoplastic aortic annulus or adults with small aortic annulus. METHODS: We reported our experience of this technique with a retrospective study of 13 patients operated on between 1998 and 2004. RESULTS: The mean diameter of aortic annulus measured in echocardiography is 16.2 mm, and the mean prosthetic valve diameter in post operative control is 20.3 mm. The early Death rate was 16%. In the late follow up of 2 years, the only predictor of myocardial hypertrophy regression was the presence of aortic insufficiency before the operation. In the literature, Konno procedure is reported as a good surgical option for the enlargement of the left ventricular outflow tract, but the results with the Ross-Konno operation are more promising.

[Diaphragmatic paralysis after cardiac surgery in children: value of plication]. / Paralysie phrenique apres chirurgie cardiaque pediatrique: interet de la plicature diaphragmatique. A propos de deux cas.

Phrenic nerve injury is a recognized and severe complication after cardiac surgery. Diaphragmatic paralysis leads to difficulty of weaning the child from the ventilator surgical plication is an easy and safe procedure that result in early clinical and physiological improvements.

[Relevant factors in mitral valve reconstructive surgery. Report of 150 cases]. / Les facteurs determinants dans la chirurgie reconstructrice de la valve mitrale. A propos de 150 cas.

150 patients had mitral valve repair for mitral valve incompetence. There were 57 males and 93 females with a mean age of 22 years, 39% were less than 15 years of age. 60% of the patients were in Class II NYHA and 40% in Class III and IV. According to Carpentier's classification, isolated type I was present in 18 patients (12%), type II in 98 patients (64%) and type III in 34 cases (24%). Mitral repair included correction of valve prolapse, valvular enlargement with pericardial patch and annuloplasty with semi-rigid ring in 128 cases and PTFE patch along the posterior leaflet in 12 cases. The perioperative mortality rate was 2.6% (4 patients). All patients had early post-operative echocardiography. According to this, mitral regurgitation was absent or tiny in 135 patients (92%), grade II in 10 cases and grade III in 2 cases. It was moderate or important in twelve patients (8%). In the late post-operative period, three patients were lost to follow-up. All the others patients were reoperated upon for mitral dysfunction in a mean time of 37 months. The reason for reoperation was in the majority of the cases the recurrence of mitral regurgitation related to increase of valvular and sub valvular disease. The late mortality rate is 7% (10 patients). Out of 126 reviewed survivors on the long run, 71 patients (56%) are asymptomatic in class I, 53 patients (42%) in class II and 2 patients in class III NYHA. Mitral valvuloplasty is the preferred procedure in mitral insufficiency surgical management. It is associated to a low early mortality and morbidity rate. Despite the need for reoperation in about 10% of the cases in the long follow-up, mitral repair offers a good quality of life without anticoagulant treatment.

[Mitral valve repair using Alfieri technique: necessary indication in a case]. / Plastie mitrale selon la technique d'Alfieri: indication de nécessité dans un cas.

Carpentier techniques for valve repair remain our first choice to deal with mitral insufficiency. This case is of a 65 years old woman scheduled for mitral valvuloplasty. Using conventional procedure was prevented by unfavourable anatomic conditions (lack of papillary muscles with chordaes supported by several tiny trabeculations). As an alternative to valve replacement (required in these instances), we performed mitral valvuloplasty according to Alfieri technique. Postoperative outcome was uneventful. Ultrasonographic assessment at 2 months showed competent mitral valve with no residual stenosis. Unless its late results are well defined, this new technique shall be used only in particular cases.

[Veinous thrombectomy. Six case reports]. / La thrombectomie veineuse. A propos de 6 cas.

The aim of this study is to raise up the effect of surgical thrombectomy among other alternative therapies. This retrospective study reports 6 patients (mean age 63 years) admitted with phlegmasia cerulea dolens. All patients underwent surgical venous thrombectomy associated with infracava filter insertion in 2 cases. One patient died in the early postoperative course. In all other cases we noticed good early and late outcome both on clinical examination and duplex scanning assessment. In conclusion, surgical venous thrombectomy can be considered as a good and efficient procedure in the presence of phlegmasia cerulea dolens in order to relieve ischemia and to prevent whenever possible severe chronic venous disorders. However, fibrinolytic therapy might achieve as good results as surgery. Thus, the latter is to be reserved to very severe veinous ischemia with limb loss threatening where fibrinolytic therapy fails or is contre-indicated.