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Cardiovascular system involvement and its negative prognostic impact have been increasingly identified in coronavirus disease 2019 (COVID‐19) patients. Optimal medical treatment allows for safe management of most of these cardiovascular presentations while COVID‐19‐associated refractory cardiogenic shock could be rescued by veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO). We present a case of acute myocardial injury related to COVID‐19 complicated by refractory cardiogenic shock and treated by VA‐ECMO implantation.

International audience; BACKGROUND AND AIM OF THE STUDY: Data about the beating heart (BH) technique for isolated tricuspid valve (TV) surgery compared to the arrested heart (AH) technique are sparse. We compared the outcomes of isolated TV surgery between BH and AH technique. METHODS: We performed an observational analysis of our database of isolated TV surgery. Patients were divided into two groups according to whether surgery was performed without (BH group) or with (AH group) aortic cross-clamping and cardioplegic arrest. The primary endpoint was survival to hospital discharge. Risk factors for in-hospital mortality were searched with multivariate analyses. We undertook further comparisons after propensity-score matching. RESULTS: From January 2007 to December 2017, we performed 82 isolated TV surgery (BH group, n = 47, 57.3%; AH group, n = 35, 42.7%). The mean age was 59.1 years, 56.1% were female. BH group patients were older (61.8 vs. 55.4 years; p = .035), had greater impaired renal function (glomerular filtration rate, 61.1 vs. 74.6 ml/min; p = .012), were more frequently operated for secondary TR (61.7 vs. 31.4%; p = .008), underwent more frequently a reoperation (53.2 vs. 28.6%; p = .042) and exhibited a higher surgical risk (EuroSCORE II, 3.92 vs. 2.50%; p = .013). In-hospital mortality was not different between both groups, either considering unmatched (BH = 10.6 vs. AH = 5.7%; OR = 1.96, 95% confidence interval [CI] = 0.36-10.77) or matched populations (BH = 10.6 vs. AH = 6.4%; OR = 1.89, 95% CI = 0.36-9.97). Age was the only predictor of in-hospital mortality. CONCLUSIONS: The BH technique showed comparable outcomes to the AH technique for isolated TV surgery despite a higher risk profile.

Transcatheter aortic valve implantation is a therapeutic option for high-risk patients with severe aortic valve stenosis and with cardiac symptoms. This procedure requires the preliminary evaluation by a "heart team" and presents some contraindications. We report the case of a 58-year-old man with severe bicuspid aortic valve stenosis and cardiogenic shock. In spite of contraindications and because of the failure of balloon aortic valvuloplasty, transcatheter aortic valve implantation was performed in emergency.

International audience

International audience

Background Indications for transcatheter aortic valve implantation (TAVI) are being extended towards patients who are not at high risk for surgery. Elderly patients are frequently considered at high risk for surgery; however, little is known about their contemporary management. This prospective multicentre registry was designed to assess the therapeutic decision in elderly patients with severe symptomatic aortic stenosis (AS), according to age and surgical risk. Methods From 1st September to 31st October 2016, consecutive patients aged ≥ 75 years and referred for severe symptomatic AS were included in 32 French centres with on-site TAVI and surgery facilities. The primary endpoint was Heart Team therapeutic decision between medical management, TAVI and surgery. Results In total, 1101 patients were included, of whom 1049 had a therapeutic decision (pending decision in 52) and form the population of the study. Mean age was 84 ± 5 years, 560 patients (53%) were female; 235 patients were aged 8%) in 188 patients (18%), intermediate (ESII 4–8%) in 340 (32%), and low (ESII Fig. 1 ). Conclusions This contemporary survey shows that either TAVI or surgery is considered in 90% of patients aged ≥ 75 years with severe symptomatic AS. At the end of 2016, Heart Teams already extended indications for TAVI towards elderly patients at intermediate risk. The impact of risk scores on the choice between TAVI and surgery strongly depends on age. Even in low-risk patients, TAVI is now the most frequent intervention after the age of 80.

International audience

International audience

Cyclosporine (CsA) related encephalopathy has not been well documented after heart transplantation. We report 2 cases of posterior reversible encephalopathy syndrome (PRES). The first case was a 68-year-old woman who underwent heart transplantation and received immunosuppression with mycophenolate mofetil, prednisone, and CsA. On day 14, she developed arterial hypertension, headache, visual disturbances, and generalized seizures. Fluid-attenuated inversion recovery magnetic resonance imaging (MRI) of the brain showed diffuse and bilateral high signals in the frontal posterior and the occipital areas. The second case was a 19-year-old man with a heart transplant receiving immunosuppression with prednisone and CsA. On day 44, he developed acute headache and generalized seizures. T2-weighted MRI of the brain showed diffuse high signals in the cerebellum, right lenticular and occipital areas. In both cases blood CsA concentration was therapeutic. Both cases recovered but in the first case neurologic findings were reversed only after CsA withdrawal.

Enoximone, a new cardiotonic agent not related to glycosides or catecholamines, has been suggested for treatment of low cardiac output syndromes occurring after cardiopulmonary bypass (CPB). The aim of the present study was to compare enoximone with dobutamine in the management of such cases. Twenty consecutive patients who had undergone cardiac surgery with CPB and who had a cardiac index (CI) less than 2.5 l.min-1.m-2, pulmonary capillary wedge pressure greater than 12 mmHg, and no renal failure, were randomly assigned to receive either enoximone (group E, n = 10) or dobutamine (group D, n = 10). The following parameters were monitored at baseline, 15, 30, 60, 90 min, 2, 6, 10 and 14 h: arterial, central venous, pulmonary arterial and capillary wedge pressures (PCWP), cardiac index (CI), stroke volume index (SVI), stroke work index (SWI), systemic (SVR) and pulmonary vascular resistances, as well as heart rate-pressure product (HRPP). Patients in group E were given a bolus of 0.5-1 mg.kg-1 enoximone over a 20 min period, followed by a continuous infusion of 2-20 micrograms.kg-1.min-1, depending on clinical response. In group D, patients were given 2.5 to 15 micrograms.kg-1.min-1 dobutamine according to clinical response. No other inotropic drug was used during the study period. The aim was to obtain an increase in CI greater than or equal to 30% at the end of the first hour of treatment. Excessive systemic hypotension with low SVR was treated with volume loading.(ABSTRACT TRUNCATED AT 250 WORDS)

Background Strain rate imaging (SRI), a recently developed Doppler-derived process, allows quantification of myocardial systolic function. We investigate whether SRI quantifies the contractile reserve during dobutamine stress tests in heart transplant patients (HT), when compared with normal individuals. Methods An incremental dobutamine test (5 to 40 μg/kg per minute) was performed in 10 HT and 15 control subjects, all of whom displayed normal coronary angiography. Gray-scale and color myocardial Doppler data were acquired in standard B-mode views at baseline, low-dose, peak, and recovery. Longitudinal SR was processed from the myocardial velocities for each segment. The changes in maximal systolic SR were used to quantify myocardial contractile reserve. Results Dobutamine infusion failed to induce clinical symptoms or electrocardiographic (ECG) changes in either group. Visually determined wall motion score was considered normal in all segments for each stage of the dobutamine stress. Heart rate was augmented similarly in both groups during dobutamine infusion. In controls, systolic SR increased gradually with incremental dobutamine dose and returned to baseline values upon recovery. Conversely, in HT patients, the increase in systolic SR was blunted at peak dobutamine, at which point it was significantly different vs controls. Conclusions Quantitative assessment of myocardial function using SRI during dobutamine stress revealed an impaired contractile reserve in HT patients with normal coronary angiography. These subtle changes in regional myocardial function could not be identified using visual wall motion scoring. Additional studies are necessary to evaluate whether SR imaging detection of contractile reserve impairment will improve clinical efficiency or event prediction in this population.

A series of 99 cases of injuries of the extensor system, followed in the 3 Traumatology and Orthopedics Ward (Dijon, France) is presented. Results were analyzed according to Verdan's classification. In most cases, a Jenning "barb-wire" type repair, introduced in France by Y. Allieu, was made. Early mobilization and skin tension problems are emphasized; two cases of degloving on the dorsum of the hand are presented with details. As well, a special place concerning the results of repair in the proximal interphalangeal joint must be reserved, because of the very frequent association of articular destruction and the very difficult problem s of surgical management which arise in these cases.

Resume Les parametres pharmacocinetiques du dextromoramide out ete etudies chez neuf patients devant subir une intervention de chirurgie vasculaire peripherique. Un bolus de 80 μg · kg −1 leur a ete injecte au moment de l'induction de l'anesthesie. Les concentrations plasmatiques sont determinees a l'aide d'une methode de dosage originale qui est decrite. La demi-vie d'elimination moyenne est de 215,3 ± 78,4 min, le volume final de distribution de 0,58 ± 0,20 l · kg −1 , et la clairance d'elimination de 2,0 ± 0,9 ml · kg −1 · min −1 . Le coefficient de partage heptane/eau est de 12,3. La comparaison de ces valeurs avec celles des autres morphiniques montre que le dextromoramide occupe, dans cette famille medicamenteuse, une place particuliere.