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 the correction of diseases affecting this aortic segment [1]. Although mechanical valves are usually used, they expose patients to the risk of thromboembolic complications associated with anticoagulation. We report on the first Tirone David procedure performed at the Festoc center in Bamako. A 60-year-old patient was referred to us for dilatation of the ascending aorta in the context of stage 3 dyspnea. 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. Surgery was performed to replace the ascending aorta, preserving the aortic valve and re-implanting the coronary arteries. The postoperative course was marked by the onset of a haemorrhagic syndrome with pre-buffering, which prompted repeat surgery 24 hours after the first operation. The outcome was favorable, with the drains removed 48 hours later.