Utilization of edge-to-edge valve plastic technique to correct severe tricuspid regurgitation in patients with congenital heart disease

Objective Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using edge-to-edge valve plasty technique to correct severe

High-Risk Congenital Coronary Abnormalities in Patients with Bicuspid Aortic Valve

Objective:Abnormal coronary artery origin(ACAO)from the opposite sinus with inter-arterial course of the ectopic proximal vessel is associated with the greatest potential for clinical manifestations,specifically sudden death.Data remain limited regarding the association between bicuspid aortic valve(BAV)and this potentially dangerous coronary variant reported in up to 0.6%in the general population.We investigated the frequency of this high-risk ACAO with inter-arterial course in our surgical series of BAV patients.Methods and Results:We conducted a retrospective study to identify BAV patients with ACAO and inter-arterial course who underwent elective aortic valve/root surgery between 2010 and 2019 in our tertiary center.A total of 279 consecutive patients with BAV were identified.Among these,four patients(1.4%)had ACAO with inter-arterial course.Three patients had abnormal right coronary artery arising from the theoretical opposite coronary sinus with intramural course.The fourth patient presented an abnormal left coronary artery from a single coronary artery arising from the theoretical right coronary sinus with a long inter-arterial course.Conclusion:Our results from a single-center experience support high-risk ACAOS may be more frequently diagnosed in BAV patients,especially in surgical series,justifying a careful preoperative assessment.

Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract

Congenital abnormalities of the kidney and urinary tract(CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis(bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number(agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography(US) is typically the first imaging performed as it is easily available, noninvasive and radiation free used both antenatally and postnatally. Computed tomography(CT) and magnetic resonance imaging(MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management.

Launching a paradigm for first and redo-surgery in primary congenital glaucoma: institutional experience

AIM: To evaluate the outcome of the initial and the redo-surgeries for primary congenital glaucoma(PCG) correlated to its degree of severity. METHODS: A retrospective study involved patients with PCG presented between 2010 and 2018. Medical records were reviewed to assess the degree of the preoperative severity according to the intraocular pressure(IOP), corneal diameter and corneal edema. Success and failure rates were calculated for both first and redo-surgeries at 6 and 12 mo respectively then correlated to the severity of the cases. RESULTS: Complete records were retrieved for 272 eyes(153 patients) with PCG: 43 eyes were mild, 136 moderate and 93 severe. Combined trabeculotomy and trabeculectomy(CTT) had the highest success rate in moderate(96.4%) and severe cases(59.3%) while trabeculotomy had the highest success rate in mild cases(96.3%). Medical records of 88 eyes(63 patients) with recurrent PCG were analyzed, most with severe presentation(59 eyes). Ahmed glaucoma valve(AGV) was used in 67(76%) eyes and augmented trabeculectomy in 21(24%) eyes. At 12 mo, there was no statistically significant difference between both surgeries in total success rate(P=0.256). For mild cases, success rate was 100% for both surgeries. Severe cases had higher success rates following AGV(87%) than augmented trabeculectomy(20%). Preoperative severity of the disease was an independent factor affecting the failure rate in secondary trabeculectomy but not in AGV. Patients younger than 24 mo had higher probabilities of failure following both redo-surgeries with hazard ratio =1.325 and 0.37 for augmented trabeculectomy and AGV respectively. CONCLUSION: Preoperative assessment of the severity of eyes with PCG helps in the selecting the optimal primary and secondary surgery. For first surgery, trabeculotomy is more effective in mild cases whereas; CTT and augmented subscleral trabeculectomy(SST) are appropriate for moderate and severe cases. AGV proved to be superior to augmented SST in severe recurrent cases.

Ellis-Van-Creveld Syndrome and Congenital Cardiac Anomaly: Common Atrium with Atrioventricular Canal Septal Defect

Background: Children presenting with physical features of chondro-ectodermal dysplasia (Ellis-Van Creveld syndrome) such as skeletal and joint abnormalities often have concomitant congenital cardiac anomalies. Presence of cardiorespiratory symptoms in children with Ellis-Van Craved syndrome warrants a thorough cardiologic evaluation to recognize and treat underlying congenital heart anomaly. Aim: A child with physical stigmata of Ellis-Van-Creveld syndrome is evaluated to detect an associated congenital cardiac anomaly and accomplish successful repair of the underlying cardiac lesion to reduce the cardiac related morbidity and improve the patient survival. Case Presentation: Ten years old boy with chondroectodermal dysplasia (dental anomalies, genu valgum and other skeletal abnormalities) presented with dyspnea and cyanosis. Cardiac evaluation by 2D echo revealed an atrioventricular (AV) canal septal defect with AV valve regurgitation and a common atrium. Angiocardiography showed a goose neck deformity of the left ventricular outflow tract. The Qp/Qs was 3.4: 1, with systemic arterial oxygen desaturation (SaO2 of 0.7) and O2 saturation in the common atrium was 0.7. The pulmonary venous connections to the common atrium were anomalous. Atriotomy on cardiopulmonary bypass and on a cardioplegic arrest discerned a partial AV canal septal defect with a common bridging leaflet, clefts in septal leaflets of tricuspid and mitral vlalves, an incompletely closed interventricular communication, and a common atrium with highly anomalous pulmonary venous insertions well anterior (8 cm) to vena caval orifices. Intracardiac repair was performed with two patches of Goertex to partition the common atrium into the pulmonary and systemic venous chambers after repair of the partial AV canal septal defect. Patient required only a temporary afterload reduction with enalapril;otherwise patient had an uneventful postoperative course. At a 2-year follow-up, the child was well without AV valve regurgitation and had normal biventricular function. Conclusion: A child with Ellis-Van-Creveld syndrome with skeletal abnormalities and dental anomalies had manifested with cardio-respiratory symptoms. Preoperative cardiac and intraoperative evaluation showed a common atrium with severely anomalous pulmonary venous connection and partial AV canal septal defect. Successful biventricular repair was accomplished by repairing the partial AV canal septal defect and partitioning the common atrium into left and right atrium by a complex atrial routing technique with two patches of Gore-Tex. On a follow-up at 2 years, the patient had adequate biventricular function without AV valve regurgitation. 114264

Transcatheter pulmonary valve replacement in congenital heart diseases

Surgical repair of a variety of congenital heart diseases involves repair of the right ventricular outflow tract(RVOT)with valved or non-valved conduit to connect the right ventricle(RV)to the pulmonary artery(PA)or just patch enlargement of the native RVOT.With time,this RV-PA conduit will degenerate with deterioration of function,either causing pulmonary stenosis or pulmonary regurgitation.This RVOT dysfunction may result in RV dilation,RV dysfunction,and eventual RV failure and arrhythmias.Multiple surgical pulmonary valve replacement(PVR)is often required throughout the patient’s lifetime.Patients are subjected to increased risks with each additional cardiac operation.Transcatheter PVR(TPVR)has been developed over the past two decades as a valuable non-surgical alternative to restore the RVOT and RV function,and hence reduce patients’lifetime risks related to surgery.This article will discuss the long-term results of TPVR which are demonstrated to be comparable to surgical results and the latest development of large pulmonary valves which will allow TPVR to be performed on native or larger RVOT.

Histopathological study of congenital aortic valve malformations in 32 children

The histopathological characteristics of congenital aortic valve malformations in children were investigated.All the native surgically excised aortic valves from 32 pediatric patients suffering from symptomatic aortic valve dysfunction due to congenital aortic valve malformations between January 2003 and December 2005 were studied macroscopically and microscopically.The patients’medical records were reviewed and the clinical information was extracted.The diagnosis was made by the clinical presentation,preoperative echocardiography,intraoperative examination,and postoperative histopathological study,excluding rheumatic or degenerative aortic valve diseases,infective endocarditis and primary connective tissue disorders,e.g.Marfan syndrome.Among 32 children with congenital aortic valve malformations,the age was ranged from six to 18 years,with a mean of 14.9 years,and there were 27 boys and five girls(male:female=5.4:1).There were five cases of aortic stenosis(AS,15.62%),25 cases of aortic insufficiency(AI,78.13%)and two cases of AS-AI(6.25%),without other valve diseases.Twenty cases still had other congenital heart diseases:ventricular septal defect(19 cases),patent ductus arteriosus(two cases),double-chambered right ventricle(one case),aneurysm of the right anterior aortic sinus of valsalva(three cases).Histopathological examination indicated that the cusps became thickening with unequal size,irregular shape(coiling and prolapse edge),enhanced hardness,and partly calcification.Microscopic investigation revealed the unsharp structure of valve tissue,fibrosis,myxomatous,reduced collagen fiber,rupture of elastic fibers,different degrees of infiltration of inflammatory cells,secondary calcareous and lipid deposit,and secondary fibrosis.Congenital aortic valve malformations in children involve males more than females,mostly associated with other congenital heart diseases.Aortic insufficiency is more common in children with congenital aortic valve malformations.Histopathologically,the leaflets of aortic valve are mainly myxomatous,thickening with unequal size,irregular shape(coiling and prolapse edge),reduced collagen fiber,rupture of elastic fibers,without small vessel proliferation and inflammatory cell infiltration,fibrosis and calcification rarely seen.

A Systematic Approach to Pulmonary Valve Replacement in the Current Era

Background:Pulmonary valve replacement(PVR)can be accomplished via surgical,transcatheter,or hybrid approaches.There are inherent advantages to transcatheter PVR and hybrid PVR without cardiopulmonary bypass.We review the methods and results of a standardized institutional approach to PVR.Methods:Retrospective review of all PVR cases between February 2017 and February 2020.Hybrid PVR entailed off-pump RVOT plication with percutaneous transcatheter PVR.Results:Primary transcatheter PVR was attempted in 37,hybrid PVR was performed in 11,and on-pump surgical PVR was performed in 9.Median age at PVR was 27 years(6–65).Primary transcatheter PVR was successful in 35/37(2 converted to surgical).Standard surgical PVR was utilized for positive coronary compression testing(n=4),stent/valve system migration(n=2),or patient preference(n=3).In the hybrid group mean RVOT diameter was 34 mm(32–38).Median length of stay was 1 day for transcatheter PVR,5 for surgical,and 3 for hybrid(p=0.02).Median follow-up was 1.5 years.Re-interventions were one balloon valve dilation in a transcatheter PVR,and one valve dilation with subsequent transcatheter valve-in-valve PVR in the surgical cohort.One hybrid patient expired 11 months post procedure.Conclusions:A systematic approach to PVR utilizing all approaches in pre-defined order of preference leads to consistent outcomes in a wide variety of anatomic configurations.Transcatheter PVR may be accomplished in the majority of patients.When necessary,hybrid off-pump RVOT plication with transcatheter PVR avoids the need for cardiopulmonary bypass.

Transcatheter pulmonic valve implantation: Techniques, current roles, and future implications

Right ventricular outflow tract(RVOT)obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot,pulmonary atresia/stenosis and other conotruncal abnormalities etc.After surgical repair,these patients develop RVOT residual abnormalities of pulmonic stenosis and/or insufficiency of their native outflow tract or right ventricle to pulmonary artery conduit.There are also sequelae of other surgeries like the Ross operation for aortic valve disease that lead to right ventricle to pulmonary artery conduit dysfunction.Surgical pulmonic valve replacement(SPVR)has been the mainstay for these patients and is considered standard of care.Transcatheter pulmonic valve implantation(TPVI)was first reported in 2000 and has made strides as a comparable alternative to SPVR,being approved in the United States in 2010.We provide a comprehensive review in this space–indications for TPVI,detailed procedural facets and up-to-date review of the literature regarding outcomes of TPVI.TPVI has been shown to have favorable medium-term outcomes free of reinterventions especially after the adoption of the practice of pre-stenting the RVOT.Procedural mortality and complications are uncommon.With more experience,recognition of risk of dreaded outcomes like coronary compression has improved.Also,conduit rupture is increasingly being managed with transcatheter tools.Questions over endocarditis risk still prevail in the TPVI population.Head-to-head comparisons to SPVR are still limited but available data suggests equivalence.We also discuss newer valve technologies that have limited data currently and may have more applicability for treatment of native dysfunctional RVOT substrates.

Percutaneous pulmonary and tricuspid valve implantations: An update

The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology.Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status.Although techniquesof percutaneous pulmonary valve implantation have been described just a decade ago,two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide.In contrast,percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status.Taking into account that an "interdisciplinary challenging",heterogeneous population of patients previously treated by corrective,semi-corrective or palliative surgical procedures is growing inexorably,there is a rapidly increasing need of treatment options besides redo-surgery.Therefore,the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures,to update on current devices,to discuss indications and patient selection criteria,to report on clinical results and finally to consider future directions.

Aortic Valve Replacement in Bicuspid Aortic Valve with a Single Coronary Artery

Coronary artery anomalies combined with bicuspid aortic valve are rare but cause perioperative complications if not detected on time. Because anomalous coronary arteries vary with respect to the ostium’s origin and transverse route, the precise anatomy should be identified preoperatively and the procedure modified. We describe a severely stenotic bicuspid aortic valve and anomalous coronary artery corrected successfully with a modified valve replacement procedure, illustrating the importance of analyzing coronary anatomy preoperatively, regardless of age, to avoid occluding an anomalous artery’s ostium and to address the anomalies. We describe our modified procedure based on the artery’s location for a safe operation.

Management of Posterior Urethral Valves about 26 Cases

Aim: To improve management of the posterior urethral valve (PUV) in children in a hospital environment. Patients and Methods: This was a retrospective descriptive study that covered a sixteen (16) years period, from January 1, 2002 to December 31, 2017, In pediatric surgery and urology departments of our teaching hospital, 26 cases of posterior urethral valve (PUV) were involved. The diagnosis was made by retrograde urethrocystography and micturition, supplemented by ultrasound. Results: During this period, 26 patients (1.7%) had a PUV. The mean age of the patients was 73, 2 months with extremes ranging from 6 to 180 months. Fifteen patients consulted for dysuria, 8 for complete retention of urine. Only one patient had a history of rolling the valves to the benign ones. The main complications found were urinary tract infection in 15 children, urolithiasis in 3 children and renal failure in 2 children. Two children had serum creatinine values of 50 and 58 mg/L. The lamination of the posterior urethral valves was performed in all patients. In our series, we had one death from chronic renal failure in a 6-year-old child with a bilateral mute kidney at IVU. Conclusion: The valve diagnosis of the posterior urethra is made late because the diagnosis is still postnatal.

Use of the GORE^(®) DrySeal Flex Introducer Sheath to Facilitate Implantation of the Transcatheter Venus P-valve

Objectives:We report our experience of using the 65 cm large diameter GORE^(®) DrySeal Flex Introducer sheath to facilitate transcatheter implantation of the Venus P-valve in the pulmonary position.Background:Transcatheter implantation of pulmonary valves can be difficult due to rigidity of the valve delivery system or the anatomy of the RVOT and pulmonary artery bifurcation and the risk of iatrogenic damage to the tricuspid valve support apparatus.Using long sheaths to pass and protect the tricuspid valve may facilitate the procedure.Methods:Multi-centre registry of patients who underwent transcatheter pulmonary valve implantation of the Venus P-valve using the GORE^(®) DrySeal Flex introducer sheath to facilitate passage of the valve to the right ventricular outflow tract.Procedural success,time to valve implantation and radiation safety parameters were analyzed.These data were compared to a control group of subjects treated between July 2014 and May 2016 with the same valve but without the use of GORE^(®) DrySeal.Results:Between December 2016 and September 2018,the Venus P-valve was successfully deployed through the GORE^(®) DrySeal in 12 patients.There were no procedure-related complications.As a control group,10 subjects treated between July 2014 and May 2016 were included.Total procedure time was significantly shorter in the GORE^(®) DrySeal group compared to the control group 96±27 min vs.164±12 min(p<0.001).Total screening time was significantly shorter in the GORE^(®) DrySeal group(24±11 min)when compared with the control group(32±14 min,p<0.001).Conclusions:We describe a modification to the previously described techniques of implanting the Venus P-valve in the pulmonary position after surgical repair of congenital heart disease.In our experience,the GORE^(®) DrySeal sheath has considerably facilitated the procedure and reduced the potential risks.

A Rare Case of Infective Mediastinitis after Melody Valve Implantation

Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease.Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve implantation.There are various treatments for native or prosthetic valve endocarditis.Surgical intervention,combined with intravenous antibiotic treatment,is of paramount importance,in case of concomitant mediastinal infection,in order to ensure the radical debridement of all infected tissue,avoiding any recurrent endocarditis.In this report,we describe a rare case of mediastinitis,associated with an infected endocarditis,occurring 8 months after Melody(Medtronic
,Minneapolis,USA)valve implant,successfully treated with the implantation of a homograft to reconstruct the right ventricular outflow tract.

Neocuspidization of the Pulmonary Valve with Autologous Pericardium in the Adult Patient with Ventricular Septal Defect and Infective Endocarditis: A Case Report and Review of the Literature

Congenital heart disease (CHD) is one of the risk factors for developing infective endocarditis (IE). Right-sided IEoccurs in 5%–10% of endocarditis cases, and pulmonary valve (PV) is involved in less than 2% of such patients.Literature data are few, and optimal treatment methods, indications for surgery, and types of operative techniquesare still under debate. We present an adult patient with a rare combination of the ventricular septal defect (VSD)and PV IE who underwent surgical treatment. Neocuspidization with autologous pericardium was utilized for thereconstruction of his PV. We discuss details of this novel surgical technique.

Outcomes of Self-Expanding Transcatheter Pulmonary Valves:Extended Follow-Up of a Prospective Trial

Background:The Venus-P valve was the first self-expanding valve used world-wide for transcatheter pulmonary valve replacement(TPVR)in patients with severe pulmonary regurgitation(PR).We intended to report the extended follow-up results from the prospective trial(No.NCT02590679).Methods:A total of 38 patients with severe PR(mean age 24.2±13.2)were included.Follow-up data were obtained after implanted at 1,6,and 12 months and yearly after.The frame geometry was assessed on post-implant computer tomography(CT)scanning by calculating the non-circularity[circularity ratio(minimum diameter/maximum diameter)<0.9]and under-expansion[expansion ratio(derived external valve area/nominal external valve area)<0.9).Adverse events(all-cause mortality,reintervention,valve dysfunction,stent fracture and endocarditis)were recorded.Results:All valves were implanted successfully with normal function at discharge.Geometric CT analysis showed underexpanded valve was detected in 22 patients(63%)and non-circular valve was seen in 16 patients(46%).During a median follow-up of 4.8 years(range 0.3-8.1),there were 1 death and 1 surgical explant,both resulting from endocarditis.Five-year freedom from valve dysfunction and stent fracture were 84.8%(95%CI 74.8-94.7)and 83.5%(95%CI 73.8-93.2).Endocarditis occurred in 3 patients at a median time of 7 months.Stent fracture was more common in patients with non-circularity stents.Conclusion:TPVR using Venus-P valve is associated with favorable outcomes at 5 years.Non-circular shapes in the valve level may have a higher risk of stent fracture.

Quadricuspid aortic valve and right ventricular type of myocardial bridging in an asymptomatic middle-aged woman:A case report

BACKGROUND Quadricuspid aortic valve(QAV)is a very rare congenital cardiac defect with the incidence of 0.0125%-0.033%(<0.05%)predominantly causing aortic regurgitation.A certain number of patients(nearly one-half)have abnormal function and often require surgery,commonly in their fifth or sixth decade.QAV usually appears as an isolated anomaly but may also be associated with other cardiac congenital defects.Echocardiography is considered the main diagnostic method although more and more importance is given to computed tomography(CT)and magnetic resonance imaging(MRI)as complementary methods.CASE SUMMARY A 60-year-old female patient was referred for transthoracic ultrasound of the heart as part of a routine examination in the treatment of arterial hypertension.She did not have any significant symptoms.QAV was confirmed and there were no elements of valve stenosis with moderate aortic regurgitation.At first,it seemed that in the projection of the presumed left coronary cusp,there were two smaller and equally large cusps along with two larger and normally developed cusps.Cardiac CT imaging was performed to obtain an even more precise valve morphology and it showed that the location of the supernumerary cusp is between the right and left coronary cusp,with visible central malcoaptation of the cusps.Also,coronary computed angiography confirmed the right-type of myocardial bridging at the distal segment of the left anterior descending coronary artery.Significant valve dysfunction often occurs in middle-aged patients and results in surgical treatment,therefore,a 1-year transthoracic echocardiogram control examination and follow-up was recommended to our patient.CONCLUSION This case highlights the importance of diagnosing QAV since it leads to progressive valve dysfunction and can be associated with other congenital heart defects which is important to detect,emphasizing the role of cardiac CT and MRI.

Acute kidney injury due to bilateral ureteral obstruction in children

Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures.It needs to be promptly suspected in order to attempt a quick renal function recovery.In this paper we concentrated on uncommon causes of obstruction,with the aim of giving a summary of such multiple,rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction,difficult to be suspected at times.Conversely,typical and well-known diseases have been just run over.We considered pediatric cases of ureteral obstruction presenting as bilateral,along with some cases which truly appeared as single-sided,because of their potential bilateral presentation.We performed a review of the literature by a search on Pub Med,Cross Ref Metadata Search,internet and reference lists of single articles updated to May 2014,with no time limits in the past.Given that we deal with rare conditions,we decided to include also papers in non-English languages,published with an English abstract.For the sake of clearness,we divided our research results into 8 categories:(1) urolithiasis;(2) congenital urinary tract malformations;(3) immuno-rheumatologic causes of ureteral obstruction;(4) ureteral localization of infections;(5) other systemic infective causes of ureteral obstructions;(6) neoplastic intrinsic ureteral obstructions;(7) extrinsic ureteralobstructions; and(8) iatrogenic trigonal obstruction or inflammation.Of course,different pathogenic mechanisms underlay those clinical pictures,partly wellknown and partly not completely understood.

Complete Ureteral Duplicity Complicated by Lithiasis with Right Ureterohydronephrosis with Left Renal Excretion Defect: Apropos of a Clinical Case

Ureteral duplication is a congenital malformative uropathy that occurs most often in children. Complete ureteral duplication is defined by a kidney that has two ureters with two orifices that communicate to the bladder through two ureteral meati. It is an anatomical variant that remains rare. Its early discovery is due to a lack of diagnostic means, hence the occurrence of long-term complications. To this end, we observe an increased importance of the morbidity linked to the late diagnosis of this duplicity. Our objective was to show the importance of the morbidity linked to the late diagnosis of this anomaly, the incidence of the infection and the complications that this pathology poses as a problem. It was a clinical case of fortuitous discovery taken care of by a general surgeon in the general surgery department of the hospital “Mother Child” Le Luxembourg Bamako Mali. We report a case of complete ureteral duplication complicated by ureterohydronephrosis on a lithiasis wedged in the uretero-vesical junction of one of the left ureters in its lower portion which required a uretero-lithotomy with bladder reimplantation of the left ureters and secondly to a uretero-lithotomy with bladder reimplantation after two months. The postoperative course was simple.

Case of Incomplete Ureteral Duplication Complicated with Lithiasis and Right Uretero-Hydronephrosis

Ureteral duplication is congenital malformative uropathy that occurs most often in children. Complete ureteral duplication is defined by a kidney that has two ureters with two orifices that communicate to the bladder through two ureteral meati. It is an anatomical variant that remains rare. Its early discovery is due to a lack of diagnostic means, hence the occurrence of long-term complications. To this end, we observe an increased importance of the morbidity linked to the late diagnosis of this duplicity. We report a case of incomplete ureteral duplication complicated by ureterohydronephrosis on lithiasis wedged in the uretero-vesical junction of one of the ureters in its lower portion which required uretero-lithotomy with bladder reimplantation of the ureters. Our aim was to show the importance of the morbidity associated with late diagnosis of this anomaly and the incidence of infection and complications that this pathology poses as a problem. This was a clinical case of fortuitous discovery managed by a general surgeon in the general surgery department of the hospital “Mère Enfant” Le Luxembourg Bamako Mali. The suites were simple.