Yves Pansard

Successful resection of giant intrapericardial lipoma

We report a case of giant extracavitary cardiac lipoma weighing 4,800 g. The mode of presentation, the preoperative evaluation, and the radiographic features are presented. The surgical management of this very rare cardiac pathology is discussed. This is one of the largest cardiac tumors ever reported.

Management of giant coronary artery aneurysm with fistulization into the right atrium

A giant right coronary artery aneurysm communicating with the right atrium is reported. Its diagnosis using echocardiography, computed tomography of the chest, and angiography is illustrated. The operative management of this rare cardiac pathology is described. The role of operation in such a large aneurysm is emphasized.

Left ventricular free wall rupture. Long-term results with a pericardial patch and fibrin glue repair.

Left ventricular free wall rupture has been treated successfully in three cases using an original technique that consists of suturing a plaque of the patients own pericardium (6 to 8 cm in diameter) to the normal tissue encircling the pathologic myocardium, and by injecting 5 ml of human fibrin glue as a cement under the pericardium to reinforce the repair and prevent leaking through the suture line

Aortic valve replacement in relapsing polychondritis

of establishing a diagnosis of aortic arch vessel injury when bleeding, expanding hematoma, absent pulses, and shock are not obvious. Arteriography is not entirely reliable, the false negative rate being approximately 10%.4 In our case, the only sign leading to suspicion of an aortic arch tear was the small mediastinal extravasation of the contrast material, the outline of the aortic arch and great vessels being preserved in the other areas. Patients with aortic or great vessel tears must be treated on an urgent basis because their condition can deteriorate at any time. The literature seems to be about equally divided between those who believe strongly that the repair of cerebral vessels in the presence of a neurologic deficit is associated with a higher risk of mortality and those who do not. Our case, however, confirmed that an obvious neurologic deficit was not worsened by carotid reconstruction and neurologic recovery may even be possible. 5 We believe that cannulation of carotid arteries provides a margin of safety in patients who have acute neurologic deficit attributable to cerebral ischemia after trauma. In conclusion, severe neurologic injury after blunt trauma may be due to the aortic arch tears near the origins of the innominate artery and the LCCA. Aortography should be used more liberally in patients in whom the neurologic deficit could overshadow the vascular trauma and then delay diagnosis. With the slightest suspicion, mediastinal exploration is recommended because it will allow recognition and surgical management of occult injuries. Carotid revascularization should be attempted because the neurologic impairment may be progressively reversible.