Dôme pleural gauche

La complexité de la région cervico-thoracique du dôme pleural impose le plus souvent un bilan préopératoire morphologique complet. Ce travail précise l'anatomie du dôme pleural et de ses principaux rapports, avant de les confronter aux données scanographiques puis aux données en résonance magnétique. Matériel et Méthodes : Ce travail porte sur la dissection de sujets frais et formolés, sur la dissection de sujets frais injectés au latex, sur des coupes transverses anatomiques, scanographiques et en résonance magnétique de sujets frais injectés avec un mélange de latex et de lomeron. Résultats : 12 sujets étudiés permettent de confronter l'anatomie du dôme pleural à sa scanographie puis à son imagerie par résonance magnétique, d'étudier la partie cervicale du canal thoracique, l'appareil suspenseur ainsi que les principales structures nerveuses dans la région du dôme pleural. Conclusion : L'analyse des résultats permet une meilleure localisation des principales structures " vitales " dans la région du dôme pleural gauche, d'expliquer la fréquence des lésions iatrogènes du canal thoracique dans sa partie cervicale, éclaire le rôle fonctionnel de l'appareil suspenseur du dôme pleural ainsi que certains syndromes de type Pancoast et Tobias.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Is Seprafilm Valuable in Infant Cardiac Redo Procedures?

International audienceBACKGROUND: Morbidity and mortality are higher for cardiac reoperations than first operation due to the presence of post-operative adhesions. We retrospectively evaluated the efficacy of the bioresorbable membrane Seprafilm to prevent pericardial adhesions after cardiac surgery in a paediatric congenital heart disease population. METHODS: Seventy-one children undergoing reoperations with sternotomy redo and cardiopulmonary bypass for congenital malformations were included. Twenty-nine of these patients were reoperated after previous application of Seprafilm (treatment group). The duration of dissection, aortic cross clamping and total surgery were recorded. A tenacity score was established for each intervention from the surgeon's description in the operating report. RESULTS: In multivariate analysis, the duration of dissection and the tenacity score were lower in the treatment than control group (p\,<\,0.01), independent of age and interval since preceding surgery. CONCLUSION: Our results suggest that Seprafilm is effective in reducing the post-operative adhesions associated with infant cardiac surgery. We recommend the use of Seprafilm in paediatric cardiac surgery when staged surgical interventions are necessary

AORTLANTIC: French registry of aortic valve-sparing root replacement, preliminary multicenter results from Western France

International audienceOBJECTIVES: Aortic root aneurysms often affect younger patients in whom valve-sparing surgery is challenging. Amongst current techniques, aortic valve-sparing root replacement described by Tirone David has shown encouraging results. The AORTLANTIC registry was instituted for a multicentre long-term evaluation of this procedure. The current initial study evaluates the hospital outcomes of the procedure. MATERIAL AND METHOD: This is a retrospective study of patients operated between January 01, 2004, and December 31, 2020, in 6 hospitals in western France. All study data were recorded in the national digital database of the French Society of Cardiac Surgery: EPICARD. RESULTS: 524 consecutive patients with a mean age of 53(15.1) years underwent surgery. 13% (n = 68) patients presented with acute aortic dissection, 16.5% (n = 86) had associated connective tissue pathology and 7.3% (n = 37) had bicuspid aortic valves. Preoperative aortic regurgitation ≥ 2/4 was present in 65.3% (n = 341) of patients. Aortic valvuloplasty was required in 18.6% (n = 95) patients. At discharge, 92.8% (n = 461) patients had no or 1/4 aortic regurgitation. The stroke rate was 1.9% (n = 10). Intra-hospital mortality was 1.9% (n = 10). CONCLUSION: The AORTLANTIC registry includes 6 centers in western France with more than 500 patients. Despite numerous complex cases (acute aortic dissections, bicuspid aortic valves, preoperative aortic regurgitation), aortic valve-sparing root replacement has a low intra-hospital mortality. The initial encouraging results of this multicentre study warrant further long-term evaluation by future studies. CLINICAL REGISTRATION NUMBER: Nov 2021: This registry was approved by an ethics committee mandated by the CNIL (Commission Nationale de l’Informatique et des Libertés) to approve scientific projects of the Nantes Hospital Centre