Regarding "Cerebral microembolization after protected carotid artery stenting in surgical high-risk patients: results of a 2-year prospective study"

Peer reviewe

The ostium primum or partial atrioventricular septal defect

peer reviewedaudience: researcher, professional, studentOften assimilated to simple inter-atrial communication, the ostium primum, or partial atrio-ventricular septal defect, is an entity that is characterized by a different embryological mechanism and requires some specific surgical expertise. Basically, knowledge of the morphology of the common atrioventricular valve with 5 components, the topography of the A-V node and His bundle, and the ventricular consequences of the absence of atrio-ventricular septal structures must be taken into account

Aortoaesophageal Fistula Caused by a Thoracic Aortic Aneurysm

peer reviewedPrimary aorto-oesophageal fistula, secondary to an aneurysm of the thoracic aorta, are almost fatal. In the literature, only twenty six successfully operated cases have been reported. We report the case of a 78-year-old man with a thoracic aortic aneurysm eroded into the mid oesophagus. Prompt diagnosis of an aorto-oesophageal fistula resulted from clinical history, CT-imaging and oesophagoscopy. The patient was successfully operated by exclusion of the thoracic aneurysm (insertion of a straight cryopreserved arterial allograft), oesophagectomy and cervical oesophagostomy and jejunostomy. The continuity of the digestive tube was later restored after preliminary aortic valve remplacement (stenosis of 0.8 cm2). This case report is the second in which a cryopreserved allograft was successfully implanted in the management of a primary aorto-oesophageal fistula

Rupture of a giant external iliac aneurysm six years after an aorto-bifemoral bypass

peer reviewedWe report the case of a patient operated on for an aorto-iliac aneurysm with an aorto-bifemoral bypass who presented a metachronous iliac aneurysm rupture, six years later, because of aneurysmal degeneration. We performed bipolar ligation of the external iliac artery and an end-to-end anastomosis of the prosthetic limb to the common femoral artery. We discuss aneurysms of the external iliac artery, characterised by their rarity, their specific morbidity and mortality

Cardiac Surgery in Octogenarians; Peri-Operative Outcome and Long-Term Results

AIMS: Because the elderly are increasingly referred for operation, we reviewed the results of cardiac surgery in patients of 80 years or older. METHODS AND RESULTS: Records of 182 consecutive octogenarians who had had cardiac operations between 1992 and 1998 were reviewed. Follow-up was 100% complete. Seventy patients had coronary grafting (CABG), 70 aortic valve replacement, 30 aortic valve replacement+CABG, and 12 mitral valve repair/replacement. Rates of hospital death, stroke, and prolonged stay (>14 days) were as follows: CABG: 7 (10%), 2 (2.8%) and 41 (58%); aortic valve replacement: 6 (8.5%), 2 (2.8%) and 32 (45.7%); aortic valve replacement+CABG: 8 (26.5%), 1 (3.8%) and 14 (46.6%); mitral valve repair/replacement: 3 (25%), 1 (8.3%) and 5 (41.6%). Multivariate predictors (P<0.05) of hospital death were New York Heart Association functional class, urgent procedure, prolonged cardiopulmonary bypass time, and, after aortic valve replacement, previous percutaneous aortic valvuloplasty. Ascending aortic atheromatous disease was predictive of stroke, while pre-operative myocardial infarction was predictive of prolonged hospital stay. Actuarial 5-year survival was as follows: CABG, 65.8+/-8.8%; aortic valve replacement, 63.6+/-7.1%; aortic valve replacement+CABG, 62.4+/-6.8%; mitral valve repair/replacement, 57.1+/-5.6%; and total, 63.0+/-5.6%. Multivariate predictors of late death were pre-operative myocardial infarction, and urgent procedure. Ninety percent of long-term survivors were in New York Heart Association class I or II, and 87% believed having a heart operation after age 80 years was a good choice. CONCLUSION: Cardiac operations are successful in most octogenarians with increased hospital mortality, and longer hospital stay. Long-term survival and quality of life are good

Aneurysm of the Ascending Aorta after Cardiac Transplantation

We report the case of a 57-year-old female cardiac transplant patient in whom an aneurysm of the recipient side of the ascending aorta developed 1 year after transplantation. Although a mycotic origin was the likely cause, histologic examination diagnosed an atherosclerotic aneurysm

Laparoscopic aortic surgery

peer reviewe

Surgical treatment of atherosclerotic popliteal aneurysms : retrospective study

peer reviewe

Surgical treatment of atherosclerotic popliteal aneurysms

peer reviewe

Effects of increased afterload on left ventricular performance and mechanical efficiency are not baroreflex-mediated

peer reviewedObjective: To assess baroreflex intervention during increase in left ventricular afterload, we compared the effects of aortic banding on the intact cardiovascular system and under hexamethonium infusion. Methods: Six open-chest pigs, instrumented for measurement of aortic pressure and flow, left ventricular pressure and volume, were studied under pentobarbital-sufentanil anesthesia. Vascular arterial properties were estimated with a four-element windkessel model. Left ventricular contractility was assessed by the slope of end-systolic pressure-volume relationship. Results: The effects of aortic banding on mechanical aortic properties were unaffected by autonomic nervous system inhibition. However, increase in peripheral arterial vascular resistance and in heart rate were prevented by hexamethonium. Aortic banding increased left ventricular contractility and stroke work. Left ventricular-arterial coupling remained unchanged, but mechanical efficiency was impaired. These ventricular changes were independent of baroreflex integrity. Conclusions: Our results demonstrate that an augmentation in afterload has a composite effect on left ventricular function. Left ventricular performance is increased, as demonstrated by increase in contractility and stroke work, but mechanical efficiency is decreased. These changes are observed independently of baroreflex integrity. Such mechanisms of autoregulation, independent of the autonomic nervous system, are of paramount importance in heart transplant patients. (C) 2003 Elsevier B.V. All fights reserved