[Adult apico-aortic shunts. A case followed for 6 years]

An apico-aortic shunt enables a reduction in the aortic transvalvular pressure gradient. It is recommended for patients with symptomatic severe stenosis when anatomical constraints contra-indicate valvular replacement. The authors report the case of a patient who underwent this uncommon procedure, which was indicated due to previous coronary bypass surgery using both mammary arteries, plus massive calcification of the ascending aorta. Angio-haemodynamic investigation and MRI performed three years and five years respectively following the procedure confirmed its efficiency. An analysis of the few reported series confirms the value of this special procedure.

[Study of ilio-cava confluence and its relations with the lumbo-sacral spine]

Dissection of 35 human cadavers was performed to assess the variability in the vascular anatomy of ilio-cava confluence and to define the relations with the lumbo-sacral spine and the aortic bifurcation. The ilio-cava confluence was between L4 and S1, most often at the level of L5 and on the median third of spine. The mean height of the ilio-cava confluence was 14mm. The confluence covered the whole of L5-S1 disc in 14% of cases. The main collateral branch was the medial sacral vein. The variability of ilio-cava confluence is great and complicate the anterior approach of lumbo-sacral spine.