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In chronic pulmonary vascular thrombotic disease, pulmonary thromboendarterectomy lure proved to be effective in reducing pulmonary hypertension and improving gas exchange. However, persistent pulmonary hypertension and unrelenting reperfusion edema are the main causes of death. We report a case of pulmonary thromboendarterectomy followed by an immediate unfavorable postoperative course with acute and persistent pulmonary hypertension, gas exchange impairment, and heart dysfunction. In this particular case, inhaled nitric oxide was successfully administered.

Experimental feasibility of repair of the ureteropelvic junction syndrome by robot.14 procedures were performed in 14 pigs by a laparoscopic technique using the Da Vinci robot in the experimental surgery laboratory.This robot provides real 3D vision by means of articulated intracorporeal instruments controlled from a console. It can be used to perform laparoscopic procedures almost as easily as open surgery. Operators with no previous experience of laparoscopic surgery were able to rapidly perform relatively complex procedures.This technique should allow a reduction of the learning curve and should facilitate operations that are difficult to perform by conventional laparoscopic surgery, especially when reconstruction is necessary, with decreased fatigue for the surgeon.

The promising concept of cell transplantation and cardiac tissue engineering has been developed in the last few years and focused on strategies attempting to replace dysfunctional, necrotic, and/or apoptotic cardiomyocytes with new cells of mesodermal origin. Transplantation of autologous cells minimizes the risk of neoplasia and avoids immune rejection associated with allogenic or xenogenic cells and recent data hold enormous hopes for short term clinical practices. Tissue engineering represents another promising approach that makes possible the creation of new functional tissues to replace the lost or failing one. Three-dimensional polymeric scaffolds provide the mechanical support for the candidate cells until the formation of cardiac-like tissue prior to surgical repair of the infarcted myocardium. For ultimate clinical applications, further investigations have to select the appropriate cell types, to determine the sufficient number of grafted cells and to provide the long term evaluation of these strategies in the global improvements of cardiac function (neoangiogenesis, synchronous contraction and extracellular matrix remodelling).

Background: The relationship between quality of life (QoL) and survival have been poorly investigated. The aim of this study was to determine the value of QoL score as a prognostic factor in a prospective cohort of patients with advanced chronic heart failure (CHF). Methods: QoL assessment was performed with a generic questionnaire: the Duke Health Profile (DHP) and a disease-specific instrument: the Minnesota Living With Heart Failure Questionnaire (LIhFE), in a sample of 108 patients registered in the EPICAL program (hospitalised patients with severe CHF defined by a NYHA grade III/IV, oedema or hypotension, and LVEF

A 71-year old man with a left ventricular assist device, Jarvik 2000 ( Jarvik Heart, New York, NY, USA), presented with unusual complications. Preoperative positron emission tomography and computed tomography (CT) scan revealed no signs of osteitis, but intraoperative bacterial cultures identified Enterobacter aerogenes. The retroauricular pedestal was completely detached from the temporal bone (Figs 1 and 2). A new retroauricular pedestal was successfully repositioned after the detachment of the first one.

We report a case of right ovarian strumal carcinoid tumor responsible for tricuspid regurgitation. Valve replacement and salpingo-oophorectomy were performed. Serotonin level and tomodensitometry were normal at 3-year follow-up. Rarity of strumal carcinoid tumor explains why this tumor has never been reported with carcinoid heart disease before.

Plaques from the coronary arteries of explanted hearts showed massive calcification (15-fold increase) with a loss of scleroproteins (-36%), an increase in the collagen to elastin ratio (twofold) and activation (+15%) of matrix metalloproteinase-2 (MMP-2). Plaque-free portions of the coronary artery gave results similar to those obtained with the internal mammary artery. There was a significant correlation between plaque calcification and MMP-2 activation, suggesting that the two processes may be linked.

International audience; Abstract: OBJECTIVES This study aimed to determine whether the myocardial T-2 relaxation time, determined using a black-blood magnetic resonance imaging (MRI) sequence, could predict acute heart transplant rejection. BACKGROUND The use of black-blood MRI sequences allows suppression of the confusing influence of blood signal when myocardial T-2 is calculated to detect myocardial edema. METHODS A total of 123 investigations, including cardiac MRI and myocardial biopsy, were performed 8 +/- 11 months after heart transplantation. Myocardial T-2 was determined using an original inversion-recovery/spin-echo sequence. RESULTS A higher than normal T-2 (greater than or equal to 56 ms) allowed an accurate detection of the moderate acute rejections evidenced at baseline biopsy (greater than or equal to International Society for Heart and Lung Transplantation grade 2): sensitivity, 89% and specificity, 70% (p < 0.0001). T-2 was increased in grade 2 (n = 11) compared with grade 0 (n = 49, p < 0.05), grade 1A (n = 34, p < 0.05) and grade 1B (n = 21, p < 0.05); T-2 was further increased in grade 3 (n = 8) compared with grade 2 (p < 0.05). In addition, in patients without rejection equal to or greater than grade 2 at baseline, a T-2 higher than normal (56 ms) was correlated with the subsequent occurrence of equal or greater than grade 2 rejection within the next three months: sensitivity 63% (12/19) and specificity 78% (64/82) (p = 0.001). CONCLUSIONS Myocardial T-2 determined using a black-blood MRI sequence, is sufficiently sensitive to identify most; of the moderate acute rejections documented with biopsy at the same time, but is also a predictor of the subsequent occurrence of such biopsy-defined rejections.

Background: Acute pulmonary hypertension occurring after cardiopulmonary bypass can be a cause of post-operative morbidity and mortality. The purpose of this study was to investigate whether bosentan, a non-peptidic mixed endothelin antagonist affected the pulmonary hypertension induced by experimental cardiopulmonary bypass. Methods: Pigs were anesthetized and instrumented to determine hemodynamic measurements. Pigs were randomized to receive either 3 mg/kg bolus + 7 mg/kg per h bosentan (n = 8) or saline (n = 7). All pigs underwent 90 min of cardiopulmonary bypass and were further observed for a 120-min period. Results: In the control group, cardiopulmonary bypass induced a dramatic pulmonary hypertension (+78 ∠ 13%, P , 0.005) and accompanied an increase of pulmonary vascular resistance (+228 ∠ 50%, P , 0.005), whereas, in the treated group, bosentan completely prevented these deleterious effects of cardiopulmonary bypass with only a moderate decrease of systemic vascular resistance (-19 ∠ 14.6%, P , 0.05). Conclusions: The present findings support the hypothesis that endogenous endothelin is a mediator of acute pulmonary hypertension occurring after cardiopulmonary bypass. Bosentan, a mixed endothelin antagonist completely prevented pulmonary hypertension after cardiopulmonary bypass and may, therefore, have therapeutic applications in the management of patients following cardiac surgery. © 1999 Elsevier Science B.V. All rights reserved.

Prosthetic mechanical valves differ from one another in regard to several characteristics including mainly thrombogenicity and hemodynamic profile. The ATS heart valve prosthesis is a bileaflet Pyrolite carbon heart valve that is nearly identical to the St. Jude prosthesis (SJM). ATS is different from the SJM prosthesis in some ways including valve pivot design and absence of pivot guards. It is, thus, a second generation bileaflet prosthesis and as such merits it to be compared with the SJM in terms of hemodynamic performance. The aim of the study was to compare at the 10th post operative day and 180th post operative day the echocardiographic assessment of implanted aortic valve prosthesis (ATS versus SJM).

Background. Because of problems concerning the functional quality of heart transplants, more and more interest has been focused on the physiologic changes occurring during brain death, one of the major possible contributing factors to the myocardial alterations. Methods. The aim of this study was to describe the link between acute experimental brain death and myocardial metabolism. This was achieved by in vivo 3-hour hemodynamic and biological (myocardial lactate production) studies and then in vitro 6-hour phosphorus-31 nuclear magnetic resonance spectroscopy. Two groups of pigs were involved in the study: group I (n = 10) as control and group II (n = 10) as brain-dead animals. Results. Within the first hour, we observed a strong increase in myocardial activity associated with the onset of myocardial lactate production, lasting 2 hours and corresponding to a myocardial anaerobic metabolism period. Despite the apparent normalization before excision of the hearts, phosphorus-31 nuclear magentic resonance spectroscopy revealed to significant decrease in adenosine triphosphate levels in group II when compared with group I. Conclusions. We conclude that, in our study, acute experimental brain death is associated with an early and transient period of myocardial anaerobic metabolism and adenosine triphosphate consumption. These myocardial consequences of brain death could partially explain some observations of hear graft dysfunction.

New diagnostic criteria for infective endocarditis (IE) have been proposed by the Duke University Endocarditis Service (Durham, NC) to update the widely used Beth Israel (Boston) criteria. We compared the Duke criteria with the Beth Israel criteria in a series of 115 consecutive patients with suspected IE who were hospitalized in a referral center. The diagnosis of IE was histologically and/or bacteriologically confirmed for 27 operated patients. If surgery had not been performed on these 27 patients, 22 vs. 12 would have been classified as having ?clinically definite? and ?probable? IE by the Duke vs. the Beth Israel criteria, respectively, whereas 0 vs. 5 would have been ?rejected? by the Duke vs. the Beth Israel criteria, respectively. The improvement in sensitivity of the criteria from 44% (Beth Israel) to 82% (Duke) was statistically significant (P < .01). We confirm that the Duke criteria improve the sensitivity of diagnosis of IE. The specificity of these criteria should be further evaluated.

Changes in hemodynamic and metabolic parameters (systemic oxygen delivery, [DO2], oxygen consumption [VO2], arterial lactate content) in brain-dead and control pigs in the absence of any inotropic or fluid support were studied. Brain death was induced by the inflation of a Foley catheter balloon placed into the subdural space of the animals. Serial atrial natriuretic peptide (ANP) determinations were performed to evaluate concomitant changes occurring in the endocrine function of the heart. Experiments were completed by a volume expansion protocol to provide a dynamic evaluation of these parameters. A significant increase in heart rate (from 113 +/- 5 to 176 +/- 11 beats/min), pulmonary capillary wedge pressure (from 7 +/- 1 to 12 +/- 3 mmHg), dP/dt (from 2040 +/- 340 to 4200 +/- 660 mmHg/sec-1), cardiac output (from 2.4 +/- 0.2 to 3.3 +/- 0.4 L/min), mean arterial pressure (from 66 +/- 8 to 93 +/- 14 mmHg), and systemic oxygen delivery (from 360 +/- 30 to 530 +/- 90 ml/min-1), was observed following brain death induction. These parameters returned below basal values within 60 min. On the contrary, serum lactate and VO2 remained unchanged. Following volume expansion, brain-dead pigs exhibited impaired hemodynamic response, with a significant decrease in dP/dt, MAP, and DO2. These changes were accompanied by a significant decrease in VO2 and a significant increase in lactate plasma levels. At the same time, a similar increase in ANP release was observed in both groups in response to volume expansion, suggesting that despite impaired myocardial contractility, endocrine function of the heart was preserved following brain death. We conclude that brain death leads to early impaired left ventricular contractility, which could be responsible for the changes observed in aerobic to anaerobic metabolism in response to rapid volume infusion. These results suggest that the use of fluid infusion to reduce the need in inotropic support in conventional therapeutic modalities should be used with care in the management of a brain-dead potential organ donor.

Brain death is a pathophysiological condition associated with major hemodynamic changes, temporary myocardial ischemia, and histological damage of the heart. These modifications could be related to a major local release of norepinephrine from myocardial sympathetic nerve endings leading to norepinephrine cardiotoxicity. This study was designed to evaluate the utility of cardiac microdialysis to measure interstitial myocardial norepinephrine release resulting from brain death. The dialysis probe consisted in a 10 x 0.20-mm dialysis fiber with a 18,000 mol wt cutoff. Dialysis probes were implanted into the right and left ventricular walls of the beating heart in anesthetized pigs and perfused with Ringer solution at 2 microliters/min. Dialysate norepinephrine concentration was measured using HPLC with electrochemical detection. The relative recovery rate of norepinephrine in vivo was 34 +/- 4%. Interstitial fluid concentrations were obtained using the following formula: [C]interstitium = [C]dialysate/Recovery in vivo. After brain death, a transient increase in interstitial norepinephrine concentration was observed (from 0.74 +/- 0.20 to 4.50 +/- 0.60 ng/ml and 0.76 +/- 0.20 to 6.2 +/- 0.9 ng/ml in left and right ventricle, respectively, P < 0.01) which far exceeded plasma level increase (from 0.50 +/- 0.10 ng/ml to 0.91 +/- 0.20 ng/ml, P < 0.05). This increase in myocardial norepinephrine was, moreover, biphasic, with a second peak occurring 40 min after brain death. The present study confirms the onset of a dramatic increase in cardiac norepinephrine release from myocardial nerve endings following brain death, and demonstrate the utility of the new cardiac microdialysis technique to assess changes in interstitial fluid content.

The concept of global vascular risk is recognized as an important predictor of major events in patients with coronary artery disease.We aimed to evaluate long term clinical outcome among patients with peripheral vascular disease (PVD) following coronary artery bypass grafting.We studied 589 consecutive patients who underwent isolated coronary artery bypass grafting between January 2003 and June 2005. The impact of peripheral artery disease was assessed by comparing a two year follow-up of 2 groups of patients: patients with (n=243) and without (n=346) PVD.Patients with PVD were significantly older (70±9 vs 64±11 years p

A good result from the heart-lung transplantation depends on the quality of the preservation of cardiopulmonary transplants. To determine the functional and pathological status of the heart-lung block after preservation for several hours, we performed 10 heterologous heart-lung transplantations in Beagle dogs (weight 13.5 kg) under extracorporeal circulation. Weight and length compatibility between donor and receiver was ensured. Measurements of hemodynamics, lung mechanics and blood gases were performed in the donor and in the receiver before the transplantation, and in the receiver after heart-lung reimplantation. Histological studies were carried out by biopsy on the heart and on the lung of the donor before removal, at the beginning of the preservation at low temperature, after 3 h of ischemia in cold, and every hour after recirculation in the heart-lung block. Myocardial preservation was conducted with cold cardioplegia at 4 degrees C (Ringer lactate solution with high potassium). Lung preservation was achieved by injecting a Euro-Collins solution at 4 degrees C, with addition of dog plasma, into the pulmonary artery; during the whole ischemic phase, the lung parenchyma was maintained at 0 degrees C, and inflated at a 10 cm H2O pressure. After transplantation, we observed that cardiac output was low in all cases, with normal or subnormal pulmonary arterial pressure. Dynamic lung compliance was very low immediately after transplantation, and increased when restarting the circulation, but deteriorated again after several hours. At the same time alveolo-arterial O2 pressure difference and arterio-alveolar CO2 pressure difference progressively increased, due to the extensive gas exchange impairment.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-five patients underwent emergency coronary arterial bypass surgery immediately after attempted percutaneous transluminal coronary angioplasty (PTCA). The average time between the onset of PTCA complication and revascularization was 90 min (30-120 min). The surgical indications, the anaesthesia and the perioperative intensive care were analysed. No acute complication was observed during the anaesthesia. Peroperative findings defined two groups: the first "organic" (coronary arterial dissection and/or occlusive coronary thrombi; n = 15), the second "functional" (coronary arterial spasm; n = 10). The rate of perioperative myocardial infarction was significantly higher in the "organic" group. In this group, at the end of the cardiopulmonary bypass, a higher number of patients required circulatory assistance and/or an antiarrhythmic agent, as well inotropic drugs.

Summary Background In Europe, the increase in numbers of patients making legal claims might be due to better knowledge of their rights. In France, a law passed in 2002 provided new opportunities for claims. Aim To assess patient claims related to care in a French cardiology department. Methods From 2003 to 2007, claims brought before the courts and actions of conciliation within the scope of the hospital were collected by year. Cardiology department claims were individualized and compared with those for other departments. Characteristics of patients at the time of the care that prompted the claim, percentage of deaths, reasons for claims and claim results were collected. Results During the 4-year study period, 14% ( n = 45,272) of hospital admissions concerned cardiology, uniformly distributed across the years. In the same period, 845 procedures were recorded, 81 of which related to cardiology. The complaints index was 2.59/1000 patients for the general population and 1.79/1000 for cardiology. The 81 cardiology complaints (52 mediations; 29 litigations) concerned patients aged 62 ± 13 years (68% men). The number of cardiology claims remained stable from 2003 to 2007. Compared with claims concerning other departments, the nature of the plaintiff (more often heirs or husband/wife) and the reason for the claim (less frequently medical care problems; more often death and nosocomial infections) were statistically different. Conclusion Claims related to cardiology care were low and relatively stable over the past 4 years. Nosocomial infections prompted a high proportion of claims and should lead physicians to be vigilant. Cardiology remains relatively protected from litigation. A national registry of hospital claims might be valuable.

ObjectiveWe suggest standardizing aortic valve repair using a physiologic approach by associating root remodeling with resuspension of the cusp effective height and external subvalvular aortic ring annuloplasty.MethodsA total of 187 patients underwent remodeling associated with subvalvular aortic ring annuloplasty (14 centers, 24 surgeons). Three strategies for cusp repair were evaluated: group 1, gross visual estimation (74 patients); group 2, alignment of cusp free edges (62 patients); and group 3, 2-step approach, alignment of the cusp free edges and effective height resuspension (51 patients). The composite outcome was defined as recurrence of aortic insufficiency of grade 2 or greater and/or reoperation.ResultsThe operative mortality rate was 3.2% (n = 6). Treatment of a cusp lesion was most frequently performed in group 3 (70.6% vs 20.3% in group 1 and 30.6% in group 2, P

ContexteLe potentiel angiogénique des cellules souches médullaires n’a pas encore été évalué dans le traitement de l’infarctus du myocarde de type chronique (IDMc), en particulier au niveau des segments nécrotiques réfractaires aux techniques de revascularisation conventionnelle.ObjectifCet essai clinique prospectif preuve de concept (phase II/III) avait comme objectifs principaux (i) de tester l’innocuité de l’implantation intramyocardique des cellules mononucléées (CMNs) autologues et (ii) d’évaluer l’impact précoce de cette réhabilitation cellulaire sur la reperfusion des segments IDMc.Méthodes14 patients, présentant un IDMc > 2mois avec une taille d’IDM > 10 % du VG et une FEVG > 30 et < 50 % sur des critères tomoscintigraphiques (SPECT), ont été répartis de façon aléatoire vers une revascularisation coronarienne optimale seule (Groupe Témoin, n=7) ou associée à une implantation de CMNs (20 à 40 injections, 25×107 à 100×107 cellules) (Groupe Cellule, n=7).RésultatsA un mois post-thérapeutique, une reperfusion significative a été observée à l’examen SPECT (Groupe Cellule=+12±16 % vs Groupe Témoin=-3±8 %, p

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Non disponible / Not available, L'analyse des communications intercellulaires et de leurs rôles dans l'intégration neuroendocrine du tissu cardiaque est examinée dans deux modèles physiopathologiques, la mort cérébrale et l'infarctus expérimental du myocarde chez le porc. Le développement d'une application originale de la technique de microdialyse du liquide interstitiel à l'étude du myocarde permet le monitorage de la libération de noradrénaline (NA) et de trois peptides vasoconstricteurs, le Neuropeptide Y, (NPY) l'Angiotensine II (Ang II) et l'Endothéline (ET-I). Après la mort cérébrale, l'existence d'une libration massive de NA et prolongée du NPY, explique la survenue de lésions myocardiques précoces selon un mécanisme toxique direct et/ou d'une vasoconstriction coronaire. Une production myocardique d'Ang II et une libération préférentielle d'ET-I vers le pôle tissulaire sont également démontrés. Ce dernier peptide ne semble pas être responsable de l'ischémie myocardique globale observée chez les animaux en état de mort cérébrale. L'analyse des conséquences d'une ischémie myocardique focalisée sur la neurotransmission sympathique met en évidence une libération modérée de NPY utilisé comme témoin d'exocytose. Dans le territoire ischémique, une libération intense de Na selon un mécanisme non exocytosique par le biais d'un fonctionnement inversé du système de recapture de la NA est mise en évidence. Enfin, la mise à disposition d'un outil simple permettant l'analyse de la composition du liquide interstitiel constitue une avancée déterminante dans le domaine de l'étude du métabolisme cellulaire ou de la pharmacologie cardio-vasculaire.