Rodolphe Durieux

High Prevalence of Abdominal Aortic Aneurysm in Patients with Three-vessel Coronary Artery Disease

OBJECTIVES Currently, the prevalence of abdominal aortic aneurysm (AAA) in patients with coronary artery disease (CAD) and the correlation between CAD severity and AAA prevalence are not clearly known. We conducted a prospective study to determine the prevalence of AAA in patients undergoing coronary angiography and to determine the risk factors and a coronary profile associated with AAA. METHODS Over an 18-month period, abdominal aortic ultrasound was performed on 1,000 patients undergoing coronary angiography for suspected or known CAD, or prior to valve surgery. Clinical characteristics and coronary profile were collected from the patients. RESULTS The overall number of previously repaired, already diagnosed, and new cases of AAA in the study population was 42, yielding a prevalence of 4.2%. Among the patients with newly detected AAAs, only two had an AAA diameter of >54 mm and were therefore treated surgically. In men aged ≥ 65 years, the prevalence reached 8.6%, while in men with three-vessel CAD it was 14.4%. Multivariate analysis showed that age ≥ 65 years (p = .003), male gender (p = .003), family history of AAA (p = .01), current smoking (p = .002), and three-vessel CAD (p < .001) were significantly associated with a higher prevalence of AAA. CONCLUSION The prevalence of AAA was high in men aged ≥ 65 years and in those with three-vessel CAD regardless of age. While our findings do not prove the cost-effectiveness of screening for AAA in these high risk patients, they do support the usefulness of a quick ultrasound examination of the abdominal aorta during routine transthoracic echocardiography in such patients.

Aneurysm: Epidemiology Aetiology and Pathophysiology

Abdominal aortic aneurysm (AAA) disease is a chronic degenerative disorder and is an important cause of preventable deaths in older patients. Prevalence rates are estimated between 1.3 and 8.9% in men and between 1.0 and 2.2% in women. However, with the aging of the population and the increasing number of smokers, the incidence of the AAA is rising. The prevalence and incidence of thoracic aortic aneurysms (TAA) is more difficult to assess than for the abdominal portion of the aorta due to poorer access to screening. The overall incidence rate of TAAs is estimated at 10.4 per 100,000 person-years. The classical risk factors for atherosclerosis, such as tobacco smoking, male sex, age, hypertension, and hyperlipidemia have all been found to be also risk factors for AAA. The pathophysiology of the aorta above and below the diaphragm has shown significant differences in biomechanical properties, atherosclerotic distribution, proteolytic pattern, and cell signaling pathways that have implications in the development of an aortic aneurysm. During the last decades an overwhelming amount of evidence has been accumulated in support of genetic risk factors contributing to the development, growth and rupture of aneurysms in different segments of the arterial tree. Inflammation and matrix metalloproteinases (MMPs) also play a key role in the pathogenesis of AAA by causing proteolytic degradation of structural proteins. The size of an aneurysm is a universally recognized factor in predicting the probability of rupture; the risk of rupture increases as the diameter of the aneurysm increases. Rupture occasionally occurs in small aneurysms. The risk of rupture and dissection of TAAs also increase with increasing diameter. In addition, not only the size but also the growth rate of the aneurysm has been consistently shown to be critical in predicting rupture.

Intrapericardial bronchogenic cyst adherent to the ascending aorta.

Bronchogenic cysts arise from an abnormal budding of the ventral diverticulum of the foregut or the tracheobronchial tree during embryogenesis. Pericardial location of these cysts is very rare. We describe a case of a young asymptomatic woman with an intrapericardial cystic mass compressing the right heart. Because of severe adhesions of the mass to the ascending aorta and to the right coronary artery, these structures were injured during surgical resection requiring the replacement of the ascending aorta and a coronary artery by-pass graft. Only the histopathologic findings provided the final diagnosis.

Transapical beating-heart chordae implantation in mitral regurgitation: a new horizon for repairing mitral valve prolapse

Mitral regurgitation (MR) is increasingly prevalent in western countries despite reduced incidence of rheumatic disease (1,2). MR results from several heterogeneous conditions, including disorders of the valve leaflets, mitral annulus, chordae tendineae, papillary muscles and left ventricle (LV). MR causes are roughly classified as primary (i.e. organic/structural) or secondary (i.e. functional/non-structural) (3).

Endovascular repair of the left subclavian artery after gunshot wound: an alternative to surgical treatment.

Penetrating injuries of the subclavian artery are associated with a high morbidity and mortality rate. Endovascular treatment with covered stents (stent grafts) has emerged as an effective alternative to surgery, but this new technique is not exempt from complications. We report the case of a male gunshot victim, treated by a covered stent for haemorrhagic shock due to partial subclavian rupture.

Catamenial Pneumothorax : a Case Report and Review of the Literature

Abstract Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occuring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Treatment is medicosurgical: thoracoscopy for pleural abrasion and hormonotherapy to avoid recurrence.

Mycotic innominate artery pseudoaneurysm complicating mitral endocarditis

A 59-year-old man developed a fast-growing mycotic innominate artery pseudoaneurysm complicating medically-treated mitral endocarditis caused by methicillin-susceptible Staphylococcus aureus. The pseudoaneurysm was revealed by ultrasound of the supra-aortic trunks and confirmed by magnetic resonance angiography (Fig. 1). The surgical treatment was performed with resection of the pseudoaneurysm and vascular reconstruction using cryopreserved arterial homografts (Fig. 2).

Extended transsternal thymectomy for myasthenia gravis: a report of 19 consecutive cases.

Abstract Background : Thymectomy is considered as an effective therapeutic option for patients with myasthenia gravis (MG). This study reports the experience of our centre’s investigation into the efficacy and the safety of the procedure and the influence of different pre-operative factors on the surgical outcome. Methods : A retrospective chart review/interview was made of 19 consecutive patients who underwent extended transsternal thymectomy for MG from 1992 to 2003. The severity of the disease was determined according to the Osserman Classification. Efficacy was measured by determining the change in clinical status, the rate of remission during follow-up, and the reduction in medication requirements after thymectomy. Complete remission (CR) was defined as asymptomatic off medication for 6 months. The CR rate was calculated using the Kaplan-Meyer method. Results : The mean age of the patients at surgery was 34 years (range, 9–63) and 78.9% were female. Mean length of follow up was 86 months (range, 24–163). The overall complication rate was 10.6% (1 episode of atrial fibrillation and a left recurrent laryngeal nerve palsy that resolved after the first postoperative month). There was no operative mortality. The mean hospital stay was 9.4 days (range, 5–23). The crude CR rate was 32% (n = 6). The Kaplan-Meier estimate of CR was 42% at 6 years. Age, gender, duration of symptoms, thymic histology, Osserman stage and the presence of thymoma were not identified as prognostic variables. The average daily dose of Medrol® and Mestinon® decreased significantly between the pre-operative period and the last follow-up (Medrol®, p = 0.0081; Mestinon®, p = 0.0013). Conclusions : Transsternal thymectomy for MG is safe and effective. It benefits patients with MG at all stages. Patients with thymoma are not associated with poorer remission rates. Complete responses are durable, as the CR rate remains stable over time.