Blowout of Carotid Venous Patch Angioplasty

Two cases of vein patch blowout were observed five and seven days after carotid bifurcation endarterectomy with patch angioplasty. Both patients died in spite of emergency reoperation. One patient developed respiratory failure with subsequent fatal cardiac arrest seven days after reoperation; the other died of extensive hemispheric infarction on the fifth postoperative day. At reoperation both ruptures were found to be located in the middle of the patch whereas the suture lines were intact. Both patients were hypertensive. In the first case, an accessory saphenous vein retrieved from the calf had been the only venous material available for the patch, while the other patient had varicose veins in the contralateral leg. Pathology revealed central transmural tissue necrosis in one of the disrupted patches. A review of the literature regarding morphologic alterations of free vein grafts placed within the arterial circulation as well as hemodynamics in patched arterial segments may provide additional insight as to the inherent benefits and risks of vein patch angioplasty after carotid endarterectomy. When considering vein patch angioplasty, particular attention should be directed to the gross aspect of the vein to be used as well as to any antecedent history of phlebitis

Clinical Case of the Month. Complete Replacement of the Ascending Aorta and Aortic Arch in a Case of Chronic Aortic Dissection

peer reviewedWe report the case of a patient who developed an evolutive chronic aortic dissection after ascending aorta replacement for acute type A aortic dissection. Owing to the development of severe aortic regurgitation, aortic root pseudoaneurysm and aneurysmal dilatation of the arch and descending aorta, reoperation was adviced. Reoperation included Cabrol modification of the Bentall operation and aortic arch replacement with elephant trunk performed under deep hypothermic circulatory arrest. The incidence of late aneurysmal formation in type 1 aortic dissection has been reported to be 30%. Close postoperative follow-up of the aortic diameter is necessary to detect a critical dilatation and to permit elective reoperation

Image of the Month. False Aneurysm of the Left Ventricle.

peer reviewedThoracic aortic dissection constitutes an acute pathology that requires a rapid, accurate and reliable diagnosis. The authors describe and illustrate the advantages and limitations of imaging modalities used in this pathology

Coronary Revascularization of the Beating Heart Using Complete Arterial Grafts

peer reviewedA case of complete arterial revascularization using both mammary arteries and the left radial artery is reported. The operation was done on the beating heart with the adjunct of a Y graft owing to a severely calcified ascending aorta. This observation is the occasion to review the basic principles of beating heart surgery

shone's Syndrome: Report of Four Cases and Review of the Literature

peer reviewedThe observation of four clinical cases of Shone's complex, two of them presenting first with predominant coarctation of the aorta, prompted us to review the pertinent literature. Patients with multiobstructive lesions of the left heart, including Shone's complex, represent a surgical challenge where the adequate management of mitral valve anomalies, subaortic stenosis, and coarctation constitutes the key prognostic factor for satisfactory mid-term outcome

Aortic Media Necrosis in Marfan's Disease in Young Adults. Apropos of 5 Surgically Treated Cases, with 3 Survivals

Five cases of Marfan's syndrome with cardiovascular lesions are presented. Among these five patients, two with type I aortic dissection, one with true aneurysm of the ascending aorta and one with aortic regurgitation underwent composite grafting of the ascending aorta according to the Bentall technique. The fifth patient died preoperatively, due to extensive dissection of the transverse aorta. Marfan's syndrome is transmitted in an autosomal dominant manner. Fifty percent of the patients die at a mean age of 32 years, and 95 p. 100 of the deaths are caused by cardiovascular lesions. These lesions predominantly affect the left cardiac valves (aortic or mitral regurgitation) and the ascending aorta. Except in emergencies, replacement of the ascending aorta by a composite graft must be envisaged in subjects with Marfan's syndrome presenting with aortic regurgitation and dilatation of the aortic root

Multiple Coronary Revascularization Using Exclusively Arterial Bypasses (Internal Mammary Arteries and the Left Radial Artery)

peer reviewe

Place of the Ross Procedure (Pulmonary Autograft) in Aortic Valve Surgery

peer reviewedThe pulmonary autograft operation consists of an aortic replacement using the autologous pulmonary valve. The pulmonary valve is substituted by a cryopreserved pulmonary homograft. This operation is in fact a delicate double valve replacement whose benefits are linked to the viability of the new aortic substitute. The pulmonary autograft has superb hemodynamic features and very low thrombogenicity. The report of a selected observation offers the occasion of defining the current indications of this operation in aortic valve surgery

Clinical case of the month. Primary sarcoma of the pulmonary artery

peer reviewedNous rapportons un cas rare de sarcome de l'artère pulmonaire, diagnostiqué chez un patient souffrant de décompensation cardiaque. L'échographie cardiaque transoesophagienne et la tomodensitométrie thoracique ont permis un diagnostic précis de masse dans l'artère pulmonaire. Le traitement instauré fut une résection chirurgicale, aidée par une circulation extra corporelle et un arrêt cardiaque en hypothermie, et l'analyse anatomopathologique de la pièce réséquée a décris la présence d'un sarcome peu différencié de l'artère pulmonaire. Quoiqu'un traitement postopératoire complémentaire par chimiothérapie a été entrepris, le pronostic vital du patient reste sombre à moyen terme au vu des données de la littérature