Introduction La communication inter-atriale (CIA) est la deuxième malformation congénitale du sujet adulte la plus fréquente après la bicuspidie aortique. Parmi les différentes formes de CIA, la sinus venosus représente 5 à 10 % des cas. Malgré le développement de dispositifs de fermeture percutanée, le gold standard reste la chirurgie conventionnelle par sternotomie médiane sous circulation extra-corporelle (CEC). Plusieurs études se sont intéressées à une prise en charge mini-invasive telle que la thoracoscopie ou la chirurgie robotique avec des résultats intéressants. Méthodes Il s’agit d’une étude rétrospective monocentrique ayant inclus 8 patients adultes (75 % d’hommes) âgés de 21 à 68 ans (moyenne : 47±14 ans) entre janvier et septembre 2023. La procédure a été réalisée en décubitus dorsal, par une courte thoracotomie utilitaire antérolatérale droite associée à 3 incisions satellites (caméra, canule d’aspiration, clamp aortique) et avec assistance vidéo 3D. La technique à deux patchs était utilisée pour la réparation avec une canulation fémorale pour la CEC. Résultats Tous les patients présentaient un CIA avec retour veineux pulmonaire anormal partiel et aucun n’avait de veine cave supérieure gauche. Un patient présentait une forme ostium secondum associée et un autre un foramen ovale perméable, fermés simultanément.La durée moyenne de CEC était de 184±12 minutes avec une durée moyenne de clampage de 113±20 minutes. Aucune conversion par sternotomie n’a été nécessaire. La durée moyenne du séjour en en réanimation était de 2,9±2,4 jours et de 7,1±3 jours pour le séjour hospitalier.À deux mois de suivi, aucun décès ni shunt résiduel n’ont été observé pour l’ensemble des patients. Conclusion Une prise en charge chirurgicale mini-invasive par vidéo-thoracoscopie 3D apparaît comme une alternative fiable et reproductible à la sternotomie pour le traitement des CIA sinus venosus.

The decision regarding optimal treatment for atrial septal defect (ASD) in adults should be given by a multidisciplinary ACHD team; the best treatment in the presence of right ventricular overload is timely closure, irrespective of age. So far, despite new percutaneous approach for sinus venosus ASD closure, surgery remains gold standard, performed via a median sternotomy on cardiopulmonary bypass. Minimally invasive cardiac surgery offers the possibility to repair ASD with a video-assisted approach through a right mini thoracotomy. We report the use of a partial thoracoscopic, combining a small anterior thoracotomy to thoracoscopy in 3 adults of 20, 42 and 46 years old, 1 woman and 2 men. Our female patient was offered a periaareolar incision. All 3 patients had a sinus venosus ASD with right ventricular enlargement. They had no pulmonary hypertension and all had one isolated right superior pulmonary vein connected to the superior vena cava. None had a persistent left superior vena cava draining to the coronary sinus and none had significant tricuspid regurgitation. All ASD were successfully repaired with a two-patch technique, by means of 2 ports positioned on the right chest wall to allow the insertion of surgical instruments and a small thoracotomy. Mean time of cardiopulmonary bypass was 188 minutes, mean time of aortic cross-clamp was 122 minutes and mean time of operation was 242 minutes. Post-operative mechanical ventilation duration averaged 309 minutes and the mean duration of ICU stay was less than 24 hours for all. No death, residual shunt, moderate tricuspid regurgitation or lung atelectasis was found at 2 months. This partial thoracoscopic approach appears as a feasible and safe approach for surgical closure of sinus venosus ASD in adults. Furthermore, it seems to allow less pain and better cosmetic outcome, particularly in women, using a periareolar incision.

INTRODUCTION:In 2015, the International Society for Heart and Lung Transplantation (ISHLT) published a consensus document for the selection of lung transplant candidates. In the absence of recent French recommendations, this guideline is useful in order to send lung transplant candidates to the transplantation centers and to list them for lung transplantation at the right time. BACKGROUND:The main indications for lung transplantation in adults are COPD and emphysema, idiopathic pulmonary fibrosis and interstitial diseases, cystic fibrosis and pulmonary arterial hypertension (PAH). The specific indications for each underlying disease as well as the general contraindications have been reviewed in 2015 by the ISHLT. For cystic fibrosis, the main factors are forced expiratory volume in one second, 6-MWD, PAH and clinical deterioration characterized by increased frequency of exacerbations; for emphysema progressive disease, the BODE score, hypercapnia and FEV1; for PAH progressive disease or the need of specific intravenous therapy and NYHA classification. Finally, the diagnosis of fibrosing interstitial lung disease is usually a sufficient indication for lung transplantation assessment. OUTLOOK AND CONCLUSION:These new recommendations, close to French practices, help clinicians to find the right time for referral of patients to transplantation centers. This is crucial for the prognosis of lung transplantation.

BACKGROUND:The writing of surgical and hospitalization reports is time-consuming and does not necessarily enable the increment of a statistical database, tool that is indispensable nowadays to evaluate unit activity or to carry out scientific studies. In order to prevent this double data capture, a computer tool, named CordaBase, has been developed by surgeons and set up in a cardiac surgery unit.MATERIALS AND METHODS:CordaBase is an interactive software that stores medical data. Thanks to its intuitive interface, CordaBase stores data which is classified chronologically in the following categories: past medical history, preoperative assessment, operating gesture, stay in intensive care unit, stay in wards and evolution/monitoring after discharge. This date, stored in an Access base, are then used in the creation of personalized surgical and hospitalization reports. All the data is permanently available and can be used for the carrying out of scientific works or for the evaluation of the unit activity.RESULTS:From March 2009 to December 2010, 2617 consecutive patients operated on in a Cardiac Surgery Unit were recorded prospectively in the software. All of this stored data assisted the surgeon in his or her administrative tasks, thanks to personalized surgical and hospitalization reports, immediately at the secretariat's disposal. The database, which is requisitely filled by administrative work, enables the carrying out of any statistical study on all unit activity.CONCLUSION:With a hindsight of almost 2 years, CordaBase has proven its usefulness in an active cardiac surgery unit, both on an administrative and scientific level. The computerized reports have lightened the medical secretariat's workload and statistical studies have now become possible without having to take the paper medical files out again. In the years to come, the accumulation of medical data prospectively or retrospectively stored will surely confirm the potential of the use of such a software.

Acute type A aortic dissection is a surgical emergency. After replacement of the ascending aorta, the arch and descending aorta often remain dissected, with a 40% risk of aneurysmal evolution at 5 years. Procedural dissections of arteries (coronary, renal, iliac) are treated with uncovered stents. Experimental studies on aortic dissections report suppression of false lumen and histologic cicatrization of stented aortas after 6 weeks.1,2 On the basis of these facts, our strategy was to support aortic cicatrization and prevent aortic dilatation.

OBJECTIVE:The study's objective was to comparatively evaluate surgery and stent-graft repair of acute or subacute traumatic aortic rupture. METHODS:A total of 76 patients (14-76 years old; mean, 37 years; male/female ratio, 63/11) with a traumatic aortic injury were admitted to our hospital between 1981 and 2003. Six patients died within 1 to 9 days of another associated severe traumatic lesion. The 70 remaining patients were divided according to the type of rupture repair. In group 1, 35 patients were treated surgically: 28 with immediate repair and 7 with delayed repair (average time interval 66 days, 5-257 days). In group 2, 29 patients were treated with stent grafting of the aortic isthmus. In group 3, 6 patients with minor aortic lesions were treated medically with a close follow-up. RESULTS:In the 28 patients treated surgically in the emergency department, the mortality and paraplegia rates were 21% and 7%, respectively. No death or paraplegia was observed in the group with delayed surgical repair. With stent grafting, complete exclusion of the pseudoaneurysmal sac was observed in all patients. Except for 1 iliac rupture treated during the same procedure, there was no major morbidity or mortality during the mean follow-up of 46 months (13-90 months). No major complication was observed in group 3. CONCLUSIONS:In stable rupture of the aorta, initial conservative treatment is safe and allows management of the major associated lesions. Stent grafting of the aortic isthmus is a valuable therapeutic alternative to surgical repair, especially in patients considered high risk for conventional thoracotomy.

Évaluer la faisabilité et la fiabilité de la mise en place d'endoprothèses pour traiter les ruptures aiguës post-traumatiques de l'isthme aortique : présentation de notre expérience de 16 patients. Entre janvier 1996 et décembre 2001, 16 patients, âgés en moyenne de 36 ans, ont été traités par cette technique. Tous présentaient des lésions associées et 9 d'entre eux, une instabilité hémodynamique non liée à la rupture isthmique. Après un délai variant de 9 à 245 jours (moyenne 78 jours), une endoprothèse aortique était mise en place par une équipe pluridisciplinaire. Un suivi régulier était réalisé par scanner et échographie transoesophagienne. L'endoprothèse a permis l'exclusion du faux anévrisme dans 100 % des cas. La procédure durait en moyenne 120 minutes et 80 % des patients ont pu être extubés sur table. Le séjour moyen aux soins intensifs était de 24 heures. La seule complication était une compression de la bronche souche gauche par le faux anévrisme, traitée avec succès par une endoprothèse bronchique. Le recul maximal était de 7 ans. La mise en place d'endoprothèse pour rupture aiguë de l'isthme aortique est une technique fiable et peut être proposée comme alternative à la chirurgie pour les polytraumatisés dont les lésions associées augmentent le risque chirurgical. The aim of this study was to evaluate the feasibilityand safety of endovascular repair in acute traumatic aortic rupture on thebasis of our experience with 16 patients. From January 1996 to December 2001,16 patients, with a mean age 36 years, underwent repair of traumatic rupture of the aorta with the use of stent-grafts. Allpatients presented with coexisting injuries and 9 of 16 patients were hemodynamically unstable because of other injury. After a delay rangingfrom 9 to 245 days (mean 78 days), aortic stent-grafting was performed by a multidisciplinary team. Allpatients had regular follow-up with spiral CT and transesophagealechocardiogram. Stent-graftplacement was successful in all patients with exclusion of falseaneurysm. The duration of the procedure was about 120 min andmechanical respiratory assistance could be removed immediately in 80% ofpatients. Mean stay in the intensive care unit was 24 hours. One complication was noted: compression of the left main stem bronchussuccessfully treated with endoprosthesis. Maximum follow-up was7 years. Endovascularstent-graft repair is a valuable technique and is emerging as analternative technique for treating thoracic aortic injury in patients in whomcoexisting injury increases the surgical risk.

PURPOSE:The aim of this study was to evaluate the feasibility and safety of endovascular repair in acute traumatic aortic rupture on the basis of our experience with 16 patients. MATERIALS AND METHODS:From January 1996 to December 2001,16 patients, with a mean age 36 years, underwent repair of traumatic rupture of the aorta with the use of stent-grafts. All patients presented with coexisting injuries and 9 of 16 patients were hemodynamically unstable because of other injury. After a delay ranging from 9 to 245 days (mean 78 days), aortic stent-grafting was performed by a multidisciplinary team. All patients had regular follow-up with spiral CT and transesophageal echocardiogram. RESULTS:Stent-graft placement was successful in all patients with exclusion of false aneurysm. The duration of the procedure was about 120 min and mechanical respiratory assistance could be removed immediately in 80% of patients. Mean stay in the intensive care unit was 24 hours. One complication was noted: compression of the left main stem bronchus successfully treated with endoprosthesis. Maximum follow-up was 7 years. CONCLUSION:Endovascular stent-graft repair is a valuable technique and is emerging as an alternative technique for treating thoracic aortic injury in patients in whom coexisting injury increases the surgical risk.

Le traitement des complications ischémiques secondaires à une dissection aortique a bénéficié ces dernières années d'une meilleure prise en charge du fait des progrès des techniques chirurgicales, de l'anesthésie-réanimation, d'une meilleure connaissance de la vascularisation médullaire et des progrès de l'imagerie par tomodensitométrie multibarrette ; en effet, l'évaluation et la reconnaissance très précoce de malperfusions viscérales permettent de proposer des stratégies thérapeutiques offensives combinant la chirurgie et la radiologie interventionnelle vasculaire. L'approche multidisciplinaire radiologique, chirurgicale, cardiologique et anesthésique doit permettre d'améliorer le pronostic immédiat et tardif des dissections de l'aorte.

IntroductionRedo surgery of the aortic arch in elderly patients inpoor health is associated with a high mortality. Thisregion of the aorta cannot always be treated usingendovascular stents. We report our experience with asurgical case of a false anastomotic aneurysm of theaortic arch, treated by open surgery and subsequentendovascular surgery.Case ReportA 74-year-old patient with a persistent hiccoughunderwent a routine medical examination. He hadundergone an aortic valve replacement in 1982followed by a Bentall procedure and an aortic archreplacement in 1986 due to a dissection. Radiographyand the thoracic computerized tomography revealed afalse aneurysm of the distal anastomosis of the aorticarch, fed by a localized leak at the origin of thebrachiocephalic trunk (Fig. 1). The neck between theleak and the brachiocephalic trunk was 0.7 cm. Anendovascular procedure as the first option wasconsidered because of the patient’s medical historyand his precarious coronary condition.First, via a cervical approach, the left subclavianartery was reimplanted into the left common carotidartery, a carotid–carotid bypass graft and exclusion ofthe left common carotid artery were achieved. Apostoperative surgical haemostasis and a bloodtransfusion were both required. Postoperative com-plications included a left recurrent laryngeal nerveparalysis,pneumonia,and theonsetof atrialfibrillation.Because of these complications we waited 6 monthsbefore carrying out the endovascular procedure.At the second procedure an occlusion balloon wasfirst placed in the left subclavian artery to preventretrograde perfusion from the collaterals from feeding

Aortoesophageal and aortobronchial fistulas constitute a problem in therapy because of the high rates of morbidity and mortality associated with operation. From May 1996 to March 2000, we treated by an endovascular procedure one aortoesophageal and three aortobronchial fistulas. There was no postoperative death. We noted one peripheral vascular complication that required a surgical procedure, one postoperative confusion, and one inflammatory syndrome. In one case, because of a persistent leakage after 21 months, we had to implant a second endovascular stent graft. A few weeks later the reopening of this patient's esophageal fistula led to his death by mediastinitis 25 months after the first procedure. The few cases published seem to bear out the interest, observed in our 4 patients, of an endovascular approach to treat complex lesions such as fistulas of the thoracic aorta especially in emergency or palliative cases.