Search

The aim is to report an Ivorian experience of the surgical management of atrial septal defects in adulthood. Our retrospective study included 19 patients over 18 years old operated on for atrial septal defects (ASD) between January 2005 and December 2015 at the Abidjan Heart Institute (AHI). 13 women and 6 men with a mean age of 26±9.07 years were included. For each patient we noted the clinical and para-clinical signs as well as the operative result and the short and long term follow-up data. Patients were symptomatic in 73.7% of cases. Two patients had atrial flutter. On cardiac echo-Doppler, the right ventricle measured 43.5 ±4.2 mm. The systolic pulmonary artery pressure was 45 ± 14.7 mmHg. There were 3 cases of grade III tricuspid insufficiency and 1 case of abnormal venous return. Closure of the septal defect was performed with an autologous pericardial patch in 18 cases. Operative mortality was nil. The average length of stay in the surgical intensive care unit was 2.5 days. Eleven patients presented immediate postoperative complications, including 2 cardiac and 9 extracardiac. The total postoperative hospital stay was 14.7 days. After a mean follow-up of 8.25 ± 4 years, all patients had functional improvement with a significant decrease in right ventricular size and pulmonary arterial pressure. Surgical management of atrial septal defects in adulthood is associated with low mortality with a satisfactory functional outcome. Key words: Atrial septal defect, surgical closure, adult.

Introduction: Despite the advances of interventional catheterization, surgery remains the treatment of choice for some coronary lesions. Objective: To report the indications and results of surgical revascularization of the myocardium at the Abidjan Heart Institute. Patient and Methods: This is a retrospective study of patients with coronary insufficiency who underwent surgical myocardial revascularization between March 2014 and May 2020 in the Cardiovascular Surgery Department of the Abidjan Heart Institute. There were 17 patients, 11 of whom were men (64.7%) and 6 women (35.3%), The mean age of the patients was 57.5 years ± 8.8. All patients were symptomatic with disabling angina in class III of the Canadian Cardiac Society (CCS). This sym- ptomatology had been evolving on average for 5 years and 6 patients had a history of acute coronary syndrome, 2 of whom had undergone prior angioplasty. Coronary angiography revealed mono-truncated (17.6%), bi-truncated (23.5%) and tri-truncated (58.8%) lesions. Results: The patients were operated under cardiopulmonary bypass (CPB) 15 cases (88.2%) and off pump in 2 cases (11.8%). They underwent a single bypass in 23.5% of cases, a double bypass in 47.1% of cases and a triple bypass in 29.4% of cases. We observed 3 cases of complications (17.6%), namely transient acute renal failure, mediastinitis and postoperative bleeding. The operative and hospital mortality was nil. After a mean follow-up of 3 ± 1.8 years, all patients were asymptomatic with a negative stress test at last check-up. Conclusion: Our experience has allowed us to demonstrate the safe performance of surgical myocardial revascularization in our patients with satisfactory and encouraging results.