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Introduction: Hypertrophic cardiomyopathy is an inherited disease characterized by a left ventricular hypertrophy, a diastolic dysfunction and rhythm troubles with risk of sudden death. There was an evolution in the surgical strategy to treat the patients who present a left ventricular outflow tract gradient., Materials and Methods: A retrospective study was conducted: We selected eight cases who presented an hypertrophic cardiomyopathy and operated on. Pre and post operative echocardiographic data were analysed. Follow up was obtained by call or mail to the cardiologist., Results: The patients were classified in four groups: isolated left ventricular outflow tract obstruction, left ventricular outflow tract obstruction and associated lesions, obstructive hypertrophic cardiomyopathy and endocarditis, post operative complications of the hypertrophic cardiomyopathy surgery. We observed a significant decrease of the left ventricular outflow tract mean gradient in the post operative period and at four years., Conclusion: Surgical management of obstructive hypertrophic cardiomyopathy remain an important option in young patients, in case of failure of the ethanol septal ablation or in patients who present other surgical lesions. The dual chamber stimulation remain indicated in old patients.

Objective: Percutaneous aortic valve replacement has been performed in humans mainly for non-surgical candidates. We evaluated on animals a transapical approach to deliver an aortic stented valve without cardiopulmonary bypass., Methods: A tubular pericardial valve fixed within a cobalt-nickel stent (Medtronic, Inc.) was implanted using a transapical approach in five adult sheep. A left thoracotomy was used to access the apex of the heart. The crimped valve was deployed in orthotopic position with a valvuloplasty balloon catheter on the beating heart after decreasing the left ventricular pressure by using either drugs or inferior vena cava occlusion. Deployments were performed under fluoroscopy and epicardial 2D Doppler echocardiography. Exact positioning of the valve into the target area was confirmed by autopsy at the end of the procedures., Results: Valves were unsuccessfully deployed at the target site in all cases but one. Three valves were implanted in a supra-annular position with two of them in supracoronary position. One valve was implanted below the native annulus in the outflow tract. Valvular leak was noted in all but one implants. Coronary obstruction occurred twice and early valve retrograde migration once. Ventricular fibrillation or diastolic cardiac arrest occurred less than 20 minutes after stent deployment in all cases., Conclusion: In our experience the transapical approach does not facilitate delivery of a stented valve. Despite its technically feasibility, advanced stent design and improvements in delivery system are required before to continue experimental studies in transapical approach for aortic stented valve.

The artificial heart is no more a dream but a reality. Over the last 40 years, many circulatory assist devices have been developed. First were the pneumatic devices, external or implantable, providing uni- or biventricular support; next were the partially implantable electromecanical devices. We went from the first generation of devices with all components (pump, energy power, control system) outside of the body to the second generation of devices with the pump and the motor implanted inside the body. Recently, the third generation of artificial hearts appeared with all components implanted inside the body allowing better mobility and quality of life. Results depend on the indication and on the kind of artificial heart implanted: partial (native heart still in place) or total (native heart removed). Essentially developped as a bridge to transplant, the artificial heart is now allowed as destination therapy.

Recently, the third generation of partial electromagnetic artificial hearts appeared, which are a real technological advancement. These new ventricular assist devices are small, implantable, silent and increase the patients' quality of life in comparison with the electromechanical pump of second generation. Their clinical efficiency is at least as good as the second generation in light of the first experiences reported on animals and human beings. Their use as a bridge to transplant and especially as a destination therapy should increase in the coming years as they represent an answer to the health problem, which is the increasing population of patients in heart failure.

The surgical method of ventricular reconstruction described by Dor is recalled with the clinical report of a patient who presented a ventricular aneurysm. The left ventricular reconstructive surgery is based on an anatomical design of the heart described by Torrent-Guasp, where the normal orientation of the left ventricular muscle fibers, oblique in direction, is found parallel with the base of the heart at the time of ventricular dilation. By giving again an elliptic form to the left ventricle, the left ventricular reconstructive surgery improves the cardiac function of the patient who developed a bulky aneurysm after an infarction. Based on this concept, other techniques of ventricular reconstruction intended for patients presenting dilated cardiomyopathy, of ischemic origin or not, are being studied.

Surgery is no longer the only technique to replace a cardiac valve. New percutaneous procedures allow aortic or pulmonary valve implantation. Even if the feasibility of these procedures has been proved, cases reported are very rare and selected. This emergent technology is still at an early stage of development and new prospective studies will be necessary to evaluate these procedures correctly before concluding their clinical benefit. At this time surgery remains the gold standard in terms of cardiac valve replacement.

An aortic valve replacement and an aorto-coronary bypass were done in a woman of 57 years old after an orthotopic liver transplantation. The surgical risk was increased by the antecedent liver transplantation, the immunosuppression, chronic renal insufficiency and antiphospholipid syndrome. Surgery and the post-operative period were not complicated. Cardiac surgery is not a contraindication for patients with a prior organ transplant. These individuals have a higher cardiovascular risk and require a cardiovascular follow-up the modalities of which are yet to be defined.