First Tirone David’s Intervention In Mali : About A Case At The Festoc Centre In Bamako

Abstract

Surgery to replace the aortic root with a valved tube, whether mechanical or biological, remains the most widely used technique for correcting diseases affecting this segment of the aorta. Although mechanical valves are usually used, they expose patients to the risk of thromboembolic complications associated with anticoagulation. We report the case of the first Tirone David operation performed at the Festoc centre in Bamako. The patient was 60 years old and had been referred for dilatation of the ascending aorta in the context of stage 3 dyspnoea. Physical examination revealed a Musset's sign and a diastolic murmur of intensity 3/6 at the aortic focus. Ultrasound revealed severe aortic insufficiency associated with dilation of the ascending aorta, with the aortic annulus measured at 23.5 mm, the sinus at 50 mm and the sino-tubular junction at 61 mm. Thoracic angioscan showed a saccular aneurysm of the initial segment of the ascending aorta. Coronary angiography was normal. The operation performed was an ascending aorta replacement with preservation of the aortic valve and re-implantation of the coronary arteries. Following the operation, a haemorrhagic syndrome with pre-buffering occurred, prompting repeat surgery 24 hours after the initial operation. The outcome was favourable and the drains were removed 48 hours later.