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4. Mesenteric ischemia after coronary artery bypass grafting: should local continuous intra-arterial perfusion with papaverine be regarded as a treatment?

Author

Eker, A, Malzac, B, Teboul, J, and Jourdan, J

Abstract

Mesenteric ischemia after cardiac surgery is rare but dramatic. We present a patient who had acute mesenteric ischemia following low cardiac output after coronary artery bypass grafting. Our patient was successfully treated with continuous intra-arterial perfusion with papaverine. We think that selective angiography must be performed as early as mesenteric ischemia is suspected, to get earlier diagnosis and treatment of an ischemic patient.

Published
1999
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5. [Traumatic aortic regurgitation: diagnostic, management and treatment].

Author

Meunier JP, Berkane N, Lopez S, Sicart-Toulouse C, Malzac B, Isetta C, Camous JP, and Baudouy M

Subjects
Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Aortic Valve pathology, Echocardiography, Esophagus diagnostic imaging, Female, Humans, Male, Middle Aged, Aortic Rupture diagnosis, Aortic Rupture etiology, Aortic Rupture surgery, Aortic Valve injuries, Aortic Valve surgery, Aortic Valve Insufficiency diagnosis, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency surgery, Heart Valve Prosthesis Implantation
Abstract

Traumatic aortic valve regurgitation is a rare complication of non-penetrating thoracic trauma. The most frequent lesion is the isolated injury of the non-coronary cusp. Actually, the transoesophageal echocardiography is the procedure of choice to confirm the diagnosis and to reveal the associated cardiovascular lesions. Surgical management with early operation is the best policy, however this surgery can be delayed for treatment of other life-threatening injuries. Up today, aortic valve replacement (AVR) was recommended to repair traumatic aortic valve regurgitation; nevertheless, in the recent international literature, the number of cases reports with conservative surgery (CS) is increasing: 10 AVR (group I) and 10 CS (group II). Analysis of the post-operative and long term periods shows good results: it confirms the excellent clinical evolution in the group I (mean time of follow-up: 18.2 +/- 16.3 months), and reveals satisfactory results in the group II for patients with isolated lesion (mean time of follow-up: 29.1 +/- 30.7 months). In conclusion, each time the traumatic aortic regurgitation is due to an isolated lesion, the conservative surgery should be performed in order to avoid aortic valve replacement and its potential complications especially in young patients with healthy valves. However, the aortic valve replacement is the safest technique for complex or multiple injuries of the aortic valve.

Published
2004

6. Traumatic aortic regurgitation: aortic valvuloplasty controlled by aortoscopy.

Author

Meunier JP, Berkane N, Lopez S, El Ghobary T, Teboul J, Malzac B, Isetta C, and Jourdan J

Subjects
Accidents, Traffic, Adolescent, Aortic Valve pathology, Aortic Valve Insufficiency pathology, Female, Humans, Wounds, Nonpenetrating pathology, Aortic Valve injuries, Aortic Valve surgery, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency surgery, Endoscopy, Wounds, Nonpenetrating complications, Wounds, Nonpenetrating surgery
Abstract

Traumatic aortic insufficiency is a rare occurrence after blunt chest trauma, and requires surgical treatment. Aortic valve replacement has been proposed as the procedure of choice, but primary valve repair is being performed increasingly more often. In a plead for conservative surgery, we report a case of valvuloplasty that was controlled by intraoperative aortic endoscopy. When operative conditions permit aortic valve repair, this should be carried out in order to avoid aortic valve replacement and its potential complications, especially in young patients with healthy valves. Replacement is the safest treatment for complex or multiple injuries of the aortic valve, however.

Published
2001

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