Intérêt de l'échocardiographie sensibilisée à la dobutamine dans l'évaluation préopératoire du patient opéré de l'aorte abdominale

ObjectiveThe aim of the study was to assess the value of dobutamine echocardiography (DE) for detecting coronary artery disease (CAD) in patients scheduled for abdominal aortic surgery.Study designPreliminary prospective open study.PatientsThirty-three consecutive patients due to undergo elective abdominal aortic surgery, assessed by preoperative DE.MethodsPrevious myocardial infarction and atherosclerotic risk factors (RF) were noted. Incremental doses of dobutamine were administered in order to reach 85% of age-predicted maximal heart rate. The occurrence of regional wall motion abnormalities was considered as a positive test. In this case a coronary angiography was performed.ResultsFour patients had a history of angina pectoris. DE was not interpretable in five patients. Among the patients without symptoms, 12 had three RF or more, 12 had less than three RF. In eight patients with a positive test, coronary angiography showed one or more significant main coronary artery stenoses. All patients with angina pectoris had a positive test. None of patients without symptoms and less than three RF had a positive test, one third of patients with no symptomatology but with three RF or more had a positive test (P < 0.05).ConclusionDE has the ability to identify patients with asymptomatic CAD. DE is recommended in patients with high probability of CAD, ie with three RF or more.     

Influence de la perméabilité de l’artère digitale palmaire sur la récupération nerveuse dans les lésions des nerfs digitaux palmaires

Should the palmar digital artery be repaired in the pedicular section of the finger? This repair is discussed in the case of a unilateral pedicular lesion on a vascularised finger, and often neglected in current surgical practice. The problem is knowing the role of a permeable artery in sensory recovery and cold intolerance. The author presents a retrospective study on palmar digital nerve reinnervation after section with or without palmar digital artery section. Artery permeability was studied by doppler ultrasonography. Forty nerves in 35 patients were studied after at least 3 years had passed. Twenty-five nerves were associated with a permeable artery, 15 with a non permeable artery. The functional result was evaluated with the Weber test (S2PD) and by the presence or absence of cold intolerance. This work demonstrates the statistically significant role of the palmar digital artery in sensitive recovery quality and cold intolerance appearance. Its permeability ensures a better sensitive result with an 8.84 mm S2PD versus 13.47 mm with a non permeable artery. The benefit of the systematic repair of palmar digital artery is thus demonstrated for the first time. This repair is all the more justified if local conditions are unfavorable, in particular in contuse wounds with associated lesions (tendinous or bone).