Background: This study evaluated the midterm outcomes, the valve related events and quality of life of patients treated by valve-sparing aortic root replacement (VSRR). Results: Hospital mortality was 1%. There were 10 late deaths (11%) including 5 cardiac cases. Two patients (2%) required an aortic valve or graft prosthesis reoperation. Aortic valve endocarditis occurred in two patients. Thromboembolic events were reported in three patients. None of the following morbidity has been observed: structural valve deterioration, nonstructural dysfunction, valve thrombosis, bleeding event.The 5-and 8-year survival were 92% and 88%, respectively. The 8-year survival free from cardiac death was 88%. The mean of EuroQoL visual analogue scale (EQ VAS) and EQ index were respectively 83±15 (range 30-100) and 0.94±0.12 (range 0.5-1).Conclusions: Eight-year clinical improvement, function of the spared aortic valve and quality of life after valve sparing aortic root surgery appear excellent.

Background Esophageal perforation is a rare surgical pathology in children. Thoracic esophageal perforation is more severe than cervical esophageal perforation. Iatrogenic cause, mainly by endoscopy, is the most common in esophageal perforation. However, perforation induced by “Magill forceps” is exceptional. Case presentation A systematic physical examination revealed pyrexia severe respiratory distress and right-sided pleural effusion. We report the success of non-operative treatment applied to thoracic esophageal perforation due to Magill forceps in a 24-month-old male infant. The immediate and short-term outcomes were excellent. Conclusions Non-operative treatment is possible in iatrogenic perforation of thoracic esophageal in infants. This treatment delivers excellent outcome in carefully selected patients.

Fetus in fetus (FIF) is an extremely rare congenital condition characterized by the parasitic development of a malformed fetal twin within a normal second twin's body. The localization is mostly abdominal in the retroperitoneum. Thoracic localization is extremely rare. In this clinical case, a 5 month old female infant weighing 5 kg presented with a chest mass causing respiratory distress. We realized a chest CT-Scan; the latter revealed a heterogeneous mass, completely occupying the left hemithorax. Imaging studies confirmed the presence of the fetus in fetus occupying the entire left hemithorax and mediastinum, pushing the heart to the right. A complete resection of the mass could be performed under general anesthesia and orotracheal intubation (GA + OTI). The monitoring involved ECG, SpO 2 , NIBP, PR, T°, and Capnometry. The ventilation was first mechanical and secondarily manual. The patient did not receive unipulmonary ventilation nor central IV line. Postoperative period marked by volume overload, anemia, cardiac arrest, with successful resuscitation. Histopathology studies and imaging confirmed the diagnosis. On D9, she was discharged from pediatric critical care and from hospital on day ten postoperative. She presented in good clinical condition after a 3-month follow-up. We report this case in order to show how we took care of this FIF case in the precarious conditions.

Background The fetu in fetu (FIF) is an extremely rare congenital condition characterized by a 2nd fetus that grows into the body of the healthy twin. Its thoracic location is more exceptional. Case presentation We report a case of intrathoracic mass in a 5-month-old female infant, diagnosed after an assessment for respiratory distress. She underwent an emergency left thoracotomy which allowed for the removal of a large thoraco-mediastinal mass inside a membranous sac containing a clear liquid mixed with vernix caseosa. The mass was completely covered with normal skin, three lobes similar to rudimentary outline of the head and limb. It was attached to a single large vascular pedicle. The pathological examination concluded that there was a high possibility of FIF. The postoperative follow-up was uncomplicated, and the child is still in good clinical condition after the 5-month follow-up. Conclusion The assessment of the respiratory distress in an infant with a mass centered by an axial skeleton on the chest x-ray and thoracic CT scan may suggest a diagnosis of intrathoracic FIF.

No abstract

Although cardiopulmonary bypass (CPB) has simplified open heart surgery, it causes adverse effects on the body's systems. This study aims to report the complications related to CPB at the Cardiac Surgery Center of the University Hospital in Dakar (Senegal). This is a retrospective analytical and descriptive study covering a 24 months period (from January 2015 to December 2016). All adult and children patients who underwent open heart surgery using CPB machines were included in this study. 193 patients were eligible during this study's period. Patients' mean age was 23 ± 15 years (range, 2-65), and 52% were female patients. Two complications were observed during CPB. One case of hemolysis and one case of an impossible weaning from CPB. Post-CPB complications were allocated as follows: hematological complications (88.5%) followed by cardiovascular (56%), pleuropulmonary (22.4%), septicemia (4%), renal (3%), systemic inflammatory response syndrome (SIRS) (2%) and neurologic (1%) complications. The overall hospital mortality was 5%. One (1) patient died intra operatively and nine (9) patients in the intensive care unit. The morbidity and mortality related to CPB in our cardiac surgery center is superimposed to those of the literature.

The West African countries have infrequent Cardiac Surgery Centers. Mitral valve replacement (MVR) from such countries raises important postoperative preoccupations. The aim of this study is to report indication and short-term outcomes of MVR at the Cardiac Surgery Center of the University Hospital in Dakar (Senegal). This is a retrospective analytical and descriptive study covering a period of 19 months (From January 2015 to July 2016). All patients with MVR associated or not with tricuspid valve repair were included in this study. Seventy-three (73) patients were eligible. The mean follow-up was 4.2 ± 4 months (range, 1-12). The mean age was 30.4 ± 13 years (range, 9-64). There were 74% of female patients, 53% were in New York Heart Association class III. Preoperative diagnoses were mitral stenosis (31.5%); mitral regurgitation (37%) and mixed mitral disease (31.5%). Crystalloid cardioplegia was performed in 92%, mean CPB time was 79 ± 21 min, mean cross clamp time was 58 ± 15.6 min. Mitral valve exposure was performed by left atriotomy (93%); 99% of mechanical prosthesis was performed. Tricuspid valve repair was performed concomitantly in 48% of patients. Overall Hospital mortality was 8%. Postoperative complications were low output syndrome (19%), pneumonia (12%), surgical wound infection (8%), Pleural effusion (7%). During follow-up, no valve-related morbidity and mortality was recorded. Mechanical valve replacement in Senegal has acceptable early outcomes in terms of morbi-mortality. Preoperative diagnoses were represented in equivalent proportions by mitral stenosis; mitral regurgitation and mixed mitral disease. Our complications were predominantly low output syndrome and pleura pulmonary disorders.

Background: Deep hypothermic circulatory arrest (DHCA) is an extracorporeal circulation (EC) technique used to correct complex congenital cardiac lesions. This technique ensures excellent operating conditions while reducing consequences of organ ischaemia, particularly of the brain. Griepp was the first to demonstrate in 1975, that the technique offered a practical and safe approach for aortic arch surgery. Case Report: Authors aim at reporting the practical conduct of DHCA's first case performed in Dakar (Senegal) on a 30-month-old patient diagnosed with supracardiac total anomalous pulmonary venous connection (TAPVC). The cooling had started 8 minutes after CPB was initiated and continued while the surgeon dissected the pulmonary veins, the collector, and the innominate vein. After the establishment and the starting up of the cardiopulmonary bypass, circulatory arrest was performed at 18°C with 32 minutes of arrest time. The anastomosis between collector and posterior of the left atrium was achieved during a circulatory arrest. In the immediate postoperative period, patient showed episodes of hypothermia and biological bleeding. During her hospitalization, the patient developed a lung infection and PAH crisis, kept under control with antibiotic, diuretics, oxygen and sildenafil. Neurological, kidney, metabolic or ionic complications have not been observed. The patient stayed at the hospital for 32 days. Conclusion: DHCA technique is a common practice in developed countries. However, it can also be carried out in West Africa as evidenced by this clinical case. This prowess testifies a strengthening of our skills in EC technique; and also, the possibility of correcting complex congenital cardiac lesions.