Aneurysm of the abdominal aorta following renal transplantation. Surgical repair with extracorporeal circulation of the graft

The authors report a case of abdominal aortic aneurysm, revealed three years after a renal transplantation in left hypogastric position. A pump-oxygenator was utilised to protect the renal transplant during the aortic aneurysmectomy. The renal function is normal three years after the aneurysmectomy, and the patient presented not prosthesis infection, despite the corticoid and immunosuppressive treatment.     

Technical approach to excision of renal cancers with venous thrombus extending to the right auricle. Apropos of 4 cases

The authors report four cases of renal neoplasm with associated thrombosis of the vena cava, extending to the right auricle. Three cases involved the right kidney. Three patients underwent operation with cardio-pulmonary bypass; two operations were successful and one had a fatal outcome. Although the technique of this operation has been considerably simplified, this operation is not performed routinely.     

How to tailor A "pi" graft for complex myocardial revascularization: a variant of the mammary loop technique

We present a new pattern for tailoring the “π” graft that uses the advantages of the mammary loop technique. The two internal thoracic mammary arteries are skeletonized. The free right mammary artery is anastomosed end-to-side to the proximal part of the in situ left mammary artery to make a “Y” graft. The distal end of the left mammary artery is anastomosed end-to-side to the middle portion of the right one to form a loop with the two arteries. The loop is severed at the appropriate level at the time of the coronary anastomosis to form a “π” graft. This technique allows a more rational use of the length of the two mammary arteries, because the branch leading to the left anterior descending artery is measured and cut precisely at the time of the anastomosis.     

Blood warm reperfusion: a necessary adjunct to heart-valve surgery in low-risk patients?

AIM: The aim of this prospective, randomized study was to determine whether blood warm reperfusion improves myocardial protection provided by cold crystalloid cardioplegia in patients undergoing first-time elective heart-valve surgery, using cardiac troponin I release as the criterion for evaluating the adequacy of myocardial protection. METHODS: Seventy patients with a left ventricular ejection fraction greater than 40% were randomly assigned to 1 of 2 myocardial protection strategies: 1) cold crystalloid cardioplegia with no reperfusion or 2) cold crystalloid cardioplegia followed by 2-minute blood warm reperfusion before aortic unclamping. Cardiac troponin I concentrations were measured in serial venous blood samples drawn immediately prior to cardiopulmonary bypass and after aortic unclamping at 6, 9, 12, and 24 h. RESULTS: Randomization produced 2 equivalent groups. The total amount of cardiac troponin I released (7.17+/- 14.8 mg in the crystalloid cardioplegia with no reperfusion group and 5.82+/-4.66 mg in the crystalloid cardioplegia followed by blood warm reperfusion group) was not different (P > 0.2). Cardiac troponin I concentration did not differ for any sample in either of the 2 groups. The total amount of cardiac troponin I released was higher in patients who required inotropic support (9.14 +/-16.2 mg) than those who did not (4.73+/-4.52 mg; P = 0.009). CONCLUSIONS: Our study shows that adding blood warm reperfusion to cold crystalloid cardioplegia provides no additional myocardial protection in low-risk patients undergoing heart-valve surgery.     

Heparin-induced thrombocytopenia. Practical management of vascular complications]

The authors report 23 cases of heparin-induced thrombocytopenia with vascular complications. The clinical presentation consisted of arterial ischaemia in 16 cases, hemiplegia in 1 case, 4 cases of blue thrombophlebitis, 1 case of bilateral thrombophlebitis, 1 case of pulmonary embolism. The vascular surgeon faced with such emergency complications must be aware of the difficulties of clinical (atypical forms) and laboratory diagnosis (unreliability of platelet aggregability tests). Arterial occlusions are generally accessible to treatment with a Fogarty catheter during an operation performed without the use of heparin. The excessively frequent delay in diagnosis explains the severity of these complications and 2 deaths, 1 case of paraplegia, 4 cases of amputation secondary to arterial occlusion, 4 cases of severe postphlebitis disease, including 2 cases requiring transmetatarsal amputation and one case of pulmonary sequelae after pulmonary embolism were observed in our series of 23 patients. The diagnosis of heparin-induced thrombocytopenia requires immediate discontinuation of heparin therapy. Replacement by low molecular weight heparin is not devoid or risks and can only be considered with a negative platelet aggregability test (in the presence of low molecular weight heparin). As these test can be rarely performed as an emergency procedure, the use of rapid-acting oral anticoagulants appears to be the most reliable solution. The place of platelet antiaggregants and partial interruption of the inferior vena cava is discussed.     

Pulmonary embolism from a parasitic cardiac clot secondary to hepatic alveolar echinococcosis

An exceptional form of hepatic alveolar echinococcosis with metastasis of the right atrium is reported. This cardiac location of the parasitosis was revealed by attacks of pulmonary embolism which produced secondary pulmonary lesions. This case suggests that pulmonary metastases of alveolar echinococcosis of the liver might be due to the migration of parasitic clots from the hepatic veins.     

Monobloc aorto-mitral homograft: report of two cases

Cryopreserved monobloc aorto-mitral homograft implantation to treat complex recurrent endocarditis involving the intervalvular fibrous body and both aortic and mitral orifices, as previously described, remains a technically demanding procedure. We report two cases of recurrent destructive aorto-mitral endocarditis treated by a monobloc aorto-mitral homograft implantation with encouraging results.