Première Série de Pontages Coronariens au Mali
First Series of Coronary Bypass Operations in Mali
DOI :
https://doi.org/10.5281/hra.v2i7.5850Mots-clés :
Pontage, Coronarien, Centre Festoc, BamakoRésumé
RÉSUMÉ
Le pontage aorto-coronarien (PAC) appelé aussi pontage coronarien est une technique de chirurgie cardiaque consistant à contourner (ponter) une artère coronaire rétrécie ou obstruée en implantant un autre vaisseau en aval de cette dernière, permettant ainsi de revasculariser le territoire de la coronaire atteinte. Nous rapportons trois cas de pontage aorto-coronarien au Mali constituant ainsi la première série jamais réalisée dans le pays. Notre premier cas était un patient de 56 ans qui avait comme terrain un diabète irrégulièrement suivi et qui a été addressé pour prise en charge d’une atteinte coronarienne sévère et symptomatique. L’indication d’un double pontage a donc été posée et réalisée sous circulation corporelle à cœur arrêté. Notre deuxième patient était âgé de 73 ans hypertendu connu, tabagique sevré à 35 paquets année reçu pour insuffisance coronarienne chronique. Il a été réalisé chez lui un pontage de l’IVA (intra myocardique) par artère mammaire interne gauche ; un pontage de la coronaire droite au 1/3 moyen par greffon saphène et un pontage marginale gauche par greffon saphène. Enfin, notre dernier patient était âgé de 61 ans. Elle était connue hypertendue et diabétique et nous a été adressée pour prise en charge chirurgicale d’une atteinte bi tronculaire. Elle a bénéficié d’un pontage de l’IVA par artère mammaire interne gauche et d’un pontage de la diagonale par greffon saphène. Les suites opératoires ont été marquées par le développement de diverses infections dont l’évolution était favorable sous antibiothérapie pour les 2 premiers patients mais a conduit au décès de la dernière patiente. Les patients intéressés par la revascularisation chirurgicale présentent plus de risques de complications postopératoires ainsi une bonne évaluation préopératoire est requise avant toute intervention.
ABSTRACT
The aorto-coronary bypass (ACB) also known as coronary bypass is a technique of cardiac surgery consisting of bypassing a narrowed or blocked coronary artery by implanting another vessel downstream from it, thus revascularizing the area of the affected coronary artery. We report three cases of aorto-coronary bypass in Mali, thus constituting the first series ever performed in the country. Our first case was a 56-year-old patient with irregularly managed diabetes who was referred for the management of severe and symptomatic coronary artery disease. The indication for a double bypass was therefore posed and performed under cardiopulmonary bypass with cardiac arrest. Our second patient was a 73-year-old known hypertensive, former smoker of 35 packs per year who presented with chronic coronary insufficiency. He underwent an LAD bypass (intramyocardial) using the left internal mammary artery; a bypass of the middle third of the right coronary artery using a saphenous vein graft; and a bypass of the left marginal artery using a saphenous vein graft. Lastly, our last patient was a 61-year-old woman known to be hypertensive and diabetic who was referred to us for surgical management of a bi-trunk lesion. She underwent an LAD bypass using the left internal mammary artery and a bypass of the diagonal artery using a saphenous vein graft. The postoperative course was marked by the development of various infections, with favorable evolution under antibiotic therapy for the first two patients but leading to the death of the last patient. Patients interested in surgical revascularization present a higher risk of postoperative complications, making a thorough preoperative evaluation necessary before any intervention.
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(c) Tous droits réservés Baba Ibrahima Diarra , Bakary Coulibaly, Bakary Coulibaly, Modibo Doumbia , Mamadou Touré , Bakary Coulibaly, Sanoussy Daffe , Adama Sidibé , Oumar Doucouré, Bourama Mamoutou Coulibaly , Mamadou Cissé , Kader Traoré , Salia Traoré, Diallo Binta, Siriman Koita, Birama Togola , Seydou Togo, Moussa Abdoulaye Ouattara, Sadio Yena, Guy Fernandez , Bina Nadjeeboulah, Erwan Flecher , Thiery Langanay, Alain Deloche 2024
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