First Tirone David’s Intervention In Mali : About A Case At The Festoc Centre In Bamako
Baba Ibrahima Diarra, Modibo Doumbia, Mamadou Touré, Sanoussy Daffe, Bakary Coulibaly, Oumar Doucouré, Siriman Koita, Diallo Binta, Salia Traoré, Mahamadoune Coulibaly, Mamadou Bocary Diarra, Birama Togola, Seydou Togo, Moussa Abdoulaye Ouattara, Sadio Yena, Guy Fernandez, Bina Nadjeeboulah, Erwan Flecher, Thiery Langanay, Alain Deloche
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.
