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Outcome in patients with congenital heart diseases and pulmonary arterial hypertension (PAH) is closely related to right ventricular (RV) function. Two-dimensional echocardiographic parameters, such as strain imaging or RV end-systolic remodeling index (RVESRI) have emerged to quantify RV function.We prospectively studied 30 patients aged 48±12 years with pretricuspid shunt and PAH and investigated the accuracy of multiple echocardiographic parameters of RV function (tricuspid annular plane systolic excursion, tricuspid annular peak systolic velocity, RV systolic-to-diastolic duration ratio, right atrial area, RV fractional area change, RV global longitudinal strain and RVESRI) to RV ejection fraction measured by cardiac magnetic resonance.RV ejection fraction45% was observed in 13 patients (43.3%). RV global longitudinal strain (ρ [Spearman's correlation coefficient]=-0.75; P=.001; RRVESRI, right atrial area and RV global longitudinal strain are strong markers of RV dysfunction in patients with pretricuspid shunt and PAH.

This paper aims to provide a paediatric cardiac computed tomography angiography expert panel consensus based on the opinions of experts from the Societe francaise d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) and the Filiale de cardiologie pediatrique congenitale (FCPC). This expert panel consensus includes recommendations for indications, patient preparation, computed tomography angiography radiation dose reduction techniques and postprocessing techniques. We think that to realize its full potential and to avoid pitfalls, cardiac computed tomography angiography in children with congenital heart disease requires training and experience. Moreover, paediatric cardiac computed tomography angiography protocols should be standardized to acquire optimal images in this population with the lowest radiation dose possible, to prevent unnecessary radiation exposure. We also provide a suggested structured report and a list of acquisition protocols and technical parameters in relation to specific vendors.

After tetralogy of Fallot (TOF) repair, pulmonary regurgitation and right ventricular function must be monitored. Conventional (2D) cardiac magnetic resonance (CMR) is currently the clinical reference method for measuring pulmonary regurgitation. However, 4DFlow CMR has been reported to provide a more comprehensive flow analysis than 2D CMR. We aimed to compare 4DFlow CMR to 2D CMR for assessing pulmonary regurgitation and flow, as well as aortic flow, in children and adults after surgical repair of TOF.Retrospective analysis of patients with repaired TOF admitted for cardiac MRI with 4DFlow acquisition from 2016 to 2018. Linear regression was used to assess correlations and Bland-Altman analyses were performed.The 60 included patients had a mean age of 18.2 ± 10.4 years (range, 2-54 years). Significant correlations between the two techniques were found for pulmonary regurgitant fraction (R [2] = 0.6642, p 0.0001), net pulmonary flow (R [2] = 0.6782, p 0.0001), forward pulmonary flow (R [2] = 0.6185, p 0.0001), backward pulmonary flow (R [2] = 0.8192, p 0.0001), and aortic valve flow (R [2] = 0.6494, p 0.0001). The Bland-Altman analysis showed no significant bias, narrow limits of agreement, and few scattered points. The correlation between pulmonary and aortic flow was better with 4DFlow CMR than with 2D CMR (R [2] = 0.8564, p 0.0001 versus R [2] = 0.4393, p 0,0001, respectively). Interobserver reliability was good.These results establish the feasibility and reliability of 4DFlow CMR for assessing pulmonary flow in a large paediatric and adult population with repaired TOF. 4DFlow CMR may be more reliable than 2D MRI for pulmonary flow assessment after TOF repair.

Objective: Investigating accuracy of cardiac tomography (CT) derived post-processing3D reconstruction (CT-PPR) and 3D printing to predict percutaneous pulmonary valve implantation (PPVI) feasibility. Background: PPVI feasibility remains challenging in large native regurgitant right ventricle outflow tract (RVOT). Methods: Fifteen patients with large native RVOT were investigated. CT-PPR consisted in RVOT long-axis curvilinear reconstruction (LACR) to measure the landing zone (LZ), and 3D volume rendering for morphological evaluation. A STL was generated to create 3D printed model (flexible resin). Balloon sizing was subsequently performed to measure LZ diameter (3D-MBD), compared to invasive balloon diameter (IBD) during catheterization, considered as the Gold Standard. Two operators predicted the feasibility of PPVI using CT-PPR and 3D printed models independently and blinded to outcome. Results: On 3D printed models, RVOT shape was tubular in 5 patients, divergent in 5 patients, concave in 4 patients and convergent in one. Agreement with CT-PPR RVOT shape morphology assessment was observed in 93% of cases (Kappa coefficient 0.91, p

Anomalous origin of the left circumflex artery (LCA) arising from the right coronary sinus was observed in a 45-year-old man with aortic root aneurysm. Valve-sparing aortic root replacement (VSARR) was decided despite the subannular course of the LCA. A modified Tirone David procedure was performed with specific consideration for distribution of the proximal suture line due to the periaortic and subannular course of the LCA. Due to the risk of LCA injury, a coronary artery bypass grafting was performed using the left internal thoracic artery to secure the perfusion of the LCA. The challenging association of aortic root aneurysm and anomalous origin and course of the LCA was managed successfully during VSARR.

Background Cardiac magnetic resonance (CMR) imaging with velocity encoding along all three directions of flow, known as 4DFlow CMR, provides both anatomical and functional information. Few data are available on the usefulness of 4DFlow CMR in everyday practice. Here, our objective was to investigate the usefulness of 4DFlow CMR for assessing congenital heart disease (CHD) in everyday practice. Methods From 2017 to 2019, consecutive patients who underwent 4DFlow CMR were included prospectively at a single high-volume centre. The parameters recommended by an expert's consensus statement for each diagnosis (congenital valvulopathy, septal defect, complex CHD, tetralogy of Fallot, aortic abnormalities) were assessed by two blinded experienced readers. 4DFlow CMRs that provided all recommended parameters were considered successful. Inter-observer and intra-observer agreement were investigated. Results We included 187 adults and 60 children covering broad ranges of weight (4.5–142 kg) and age (0.1–67 years). 4DFlow CMR was always the second-line imaging modality, after inconclusive echocardiography, and was successful in 231/247 (91%) patients, with no significant difference between children and adults (54/60, 90%; and 177/187, 95%; respectively; p = .13). Longer time using 4DFlow CMR at our centre was associated with success; in children, older age was also associated with exam success. There was an about 12-month learning curve in children. The success rate was lowest in neonates. Inter-observer and intra-observer agreement were substantial. Conclusion Our results suggest that 4DFlow CMR usually provides a comprehensive assessment of CHD in adults and children. A learning curve exists for children and the investigation remains challenging in neonates.

Summary Background Percutaneous paravalvular leak (PVL) closure has emerged as a palliative alternative to surgical management in selected high-risk patients. Percutaneous procedures are challenging, especially for mitral PVL. Accurate imaging of the morphologies of the defects is mandatory, together with precise guidance in the catheterization laboratory to enhance success rates. Aims To describe imaging modalities used in clinical practice to guide percutaneous PVL closure and assess the potential of new imaging tools. Methods Data from the ‘Fermeture de Fuite paraprothetique’ (FFPP) register were used. The FFPP register is an international multi-institutional collaborative register started in 2017 with a retrospective and a prospective part. A descriptive analysis of multimodality imaging used to guide PVL closure in clinical practice was performed. Results Data from 173 procedures performed in 19 centres from three countries (France, Belgium and Poland) were collected, which included eight cases of PVL following transcatheter valve replacement. Transoesophageal echocardiography was used in 167 cases (96.5%) and 3D echocardiography in 87.4% of cases. In one case, 3D-echocardiography was fused with fluoroscopy images in real time using echonavigator software. Details about multimodality imaging were available from a sample of 31 patients. Cardiac computed tomography (CT) was performed before 10 of the procedures. In one case, fusion between preprocedural cardiac CT angiography data and fluoroscopy data was used. In two cases, a 3D model of the valve with PVL was printed. Conclusion Echocardiography, particularly the 3D mode, is the cornerstone of PVL imaging. Other imaging modalities, such as cardiac CT and cardiac magnetic resonance imaging, may be of complementary interest. New techniques such as imaging fusion and printing may further facilitate the percutaneous approach of PVLs.

Background 4D Flow CMR has emerged as an innovative imaging modality providing flow assessment at any selected region of interest. The wide range of dynamic properties and velocity of cardiac flows are a commonly admitted technical limit. We aim to assess if this technique is robust enough to validate the conservation of mass principle applied to vessels and valves of the whole heart. Our working hypothesis was that 4D CMR would prove accurate compared to 2D CMR. Methods Thirty healthy patients underwent both 2D CMR and 4D CMR using a 1.5-T machine. Ventricular volumes were assessed and cardiac output was calculated and used as a reference value. We mapped using 4D Flow analysis (Arterys), cardiac flows from the vena cava to the aorta. The 4D flows through the cardiac valves, and vessels were independently measured by two readers. Agreement between flows measured using 4D CMR and CMR was assessed by linear regression analysis and Bland-Altman plots. Results Mean net flows were 5.5 ± 1.2 L/min through venae cavae, 5.4 ± 1.1 L/min through the tricuspid valve, 5.5 ± 1.1 L/min through the pulmonary valve, 5.4 ± 1.4 L/min through the pulmonary artery, 5.3 ± 1.1 L/min through the pulmonary veins, 5.5 ± 1.0 L/min through the mitral valve, 5.5 ± 1.4 L/min through the aortic valve and 5.5 ± 1.4 L/min through the aorta compared to 5.6 ± 1.1 with 2D CMR. Correlation coefficients between 4D flows measurements and 2D CMR ranged from 0.60 to 0.86. Agreement was strong between cardiac outputs with a mean bias ranging from 0.01 to 0.33 with no significant bias. Interobserver reproducibility of 4D CMR net flow measurements was good (interclass coefficient ranging from 0.89–0.98; and coefficient of variation of 3.7%–6.3%). Conclusion 4D CMR flow measurements correlated with cardiac output measured using CMR in healthy volunteers in all valves and vessels, respecting the conservation of mass principle. 4D CMR seems robust enough to obtain precise hemodynamic features of cardiac flow.

We herein report an unusual life-threatening complication with the Hearmate 3 centrifugal ventricular assist device: proximal outflow graft extrinsic compression due to external thrombus leading to pump dysfunction and urgent heart transplantation. Low flow alarms without other abnormalities lead to the diagnosis of outflow occlusion. There was no evidence for a twist of the outflow graft, and no evidence for outflow thrombosis. The location of the outflow occlusion was particularly difficult to diagnose due to metallic artifacts around the pump. This report underscores that this complication should be screened in case of persistent low-flow alarms with the Heartmate 3 centrifugal pump.

Four-dimensional flow cardiac magnetic resonance (4D CMR) is a promising imaging modality, while its distribution and use remain limited suggesting practical or technical difficulties. We sought to report our preliminary experience in real life of 4D CMR in unselected children and adults with congenital heart disease (CHD). We focused on its feasibility and ability, compared with adults with CHD as control. Methods We herein report 50 examinations over a one-year study period. This modality has been applied as a complementary imaging when conventional imaging modalities were unsatisfactory. Quality was classified according to qualitative and quantitative criteria by two blinded radiologists. Results This study included 22 children and 28 adults. In infant and children mean age was 10.6 ± 6.1 years old [0.3; 18], mean weight was 36.8 ± 24.5 kg [3.8; 105.0], mean height was 149.4 ± 42.1 cm [52; 192]. Clinical indications were 36% of tetralogy of Fallot, 18% of aorta disease, 27% of complex CHD, 9% of ventricular septal defect and 10% of valvulopathy. The feasibility of this examination was excellent, while 100% exam were performed with no need for general anesthesia whatever the indication or patient (infant, child or adult). Average duration of exams were 465 ± 90s [339–610]. The overall quality of exams was satisfactory; 63% of good quality and 23% of medium quality). The evolution of quality over time has shown a progressive improvement which seems to correspond to a 3-month long learning curve. The only predictive factor identified for quality was the experience (X2 = 4.8; P = 0.03 in CHD). Conclusion Based on our preliminary experience, 4D Flow has become a complementary imaging modality accessible in current practice and open to all patients. The quality of this examination was satisfactory and seems to require an estimated learning curve of 3 months according to our experience.

Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) occurs more frequently in women, but little is known about its potential specificities according to sex.To analyse the incidence, management and 1-year mortality of CS according to sex using the FAST-MI programme.The FAST-MI programme consists of four nationwide French surveys carried out 5 years apart from 1995 to 2010, including consecutive patients with AMI over a 1-month period, and with a 1-year follow-up.Among the 10,610 patients included in the surveys, the incidence of CS was 4.8% in men and 8.2% in women (P0.001). Absolute incidence of CS decreased from 1995 to 2010 in both sexes. Mean age in patients with CS tended to decrease in men (from 72±12 to 69±13 years) and to increase in women (from 78±10 to 80±9 years). One-year mortality decreased significantly in men (from 70% in 1995 to 48% in 2010) and in women (from 81% to 54%). Using Cox multivariable analysis, female sex was not an independent correlate of 1-year mortality [hazard ratio (HR): 0.98, 95% confidence interval (CI): 0.78-1.22]. Early use of percutaneous coronary intervention was, however, an independent predictor of 1-year survival in women (HR: 0.55, 95% CI: 0.37-0.81), but showed only a non-significant trend in men (HR: 0.85, 95% CI: 0.61-1.19).The incidence of CS-AMI has decreased in both men and women, but remains higher in women. One-year mortality has significantly decreased for both men and women, and the role of early percutaneous coronary intervention as a potential mediator of decreased mortality seems greater in women than in men.

Introduction Right heart catheterization is an invasive exam that is currently the gold standard to assess pulmonary hemodynamics for diagnosis and follow-up of pulmonary arterial hypertension (PAH) associated with congenital heart diseases (CHD). Cardiac magnetic resonance 4D flow (4D CMR flow) emerges as a promising non-invasive imaging. We assess the accuracy of 4D CMR flow to measure pulmonary cardiac output (Qp). Methods We prospectively included 28 patients with PAH associated with CHD. Qp was measured invasively using Fick principle (direct oxygen consumption measure) during aright heart catheterization (QpF) and compared to Qp measured by 2D (Qp2D) and 4D flow CMR (Qp4D) on the same day. Results Twenty eight patients was included (median age was 42 years old [35–52]) with PAH and CHD (pre-tricuspid shunt n = 23, 82.1%, median mean pulmonary artery pressure 46 mmHg [40-58]; median pulmonary vascular resistance 15.0 WU.m2 [7.5–25.6]) 4D CMR flow analysis were feasible in all patients. Qp4D and QpF were strongly correlated (rho = 0.87, P Fig. 1 ). Conclusion Qp measured by 4D CMR flow is well correlated to QpF. Further studies are needed to explore other potential interests of using 4D CMR flow to assess PAH, including the derivation of additional hemodynamic parameters such as pulmonary artery compliance, wall shear stress and pulse wave velocities, which could provide further insights into pulmonary artery remodeling and interactions between pulmonary arterial stiffening and right ventricular dysfunction.

Background After tetralogy of Fallot (TOF) repair, pulmonary regurgitation and right ventricular function must be monitored. Conventional (2D) cardiac magnetic resonance (CMR) is currently the clinical reference method for measuring pulmonary regurgitation. However, 4D CMR has been reported to provide a more comprehensive flow analysis than 2D CMR. We aimed to compare 4D CMR to 2D CMR for assessing pulmonary regurgitation and flow, as well as aortic flow, in children and adults after surgical repair of TOF. Methods Retrospective analysis of patients with repaired TOF admitted for cardiac MRI with 4D flow acquisition from 2016 to 2018. Linear regression was used to assess correlations and Bland-Altman analyses were performed. Results The 60 included patients had a mean age of 18.2 ± 10.4 years (range, 2–54 years). Significant correlations between the two techniques were found for pulmonary regurgitant fraction (R2 = 0.6642, P Conclusion These results establish the feasibility and reliability of 4D CMR for assessing pulmonary flow in a large paediatric and adult population with repaired TOF. 4D CMR may be more reliable than 2D MRI for pulmonary flow assessment after TOF repair.

Background Outcome of patients with atrial septal defect (ASD) and severe pulmonary arterial hypertension (PAH) relates to right ventricular (RV) function. Magnetic resonance imaging (MRI) remains the gold standard for evaluating the RV function but it is not used routinely. We investigated the relationship between MRI and multiple echocardiography parameters, including the Right Ventricle End-Systolic Remodeling Index (RVESRI), a new prognostic marker in patients with PAH. Methods Twenty-three patients with ASD and severe PAH (median age 49 year old [39-59], Sp02 92% [90–95], WHO functional class II or III, mean pulmonary artery pressure 51 mmHg [40–59]) were included between 2014 and 2018. All patients underwent MRI and echocardiography assessment. Echocardiographic measurements of RV remodeling and function included TAPSE, RV fractional area change (RVFAC), peak systolic velocity of the tricuspid valve (S’TV), right atrial (RA) area, RV strain, Systolic to diastolic ratio, eccentricity index and RVESRI, defined by septum length divided by lateral wall length ( Fig. 1 ). Pericardial effusion was noted. Results Median RV ejection fraction (EF) evaluated with MRI was 46% [34–59]. RV dysfunction (RVEF Conclusion RVFAC, RVESRI and pericardial effusion were markers of RV dysfunction in patients with ASD and severe PAH. RVESRI appears as a simple and reliable parameter for follow-up. Its prognostic value in patients with CHD remains to be demonstrated.

Introduction Four-dimensional flow cardiac magnetic resonance (4D CMR) is an emerging imaging modality for qualitative and quantitative analysis of cardiovascular pathologies. Despite numerous advantages, its distribution and use remain limited suggesting practical or technical difficulties in using this technique routinely. We sought to report our preliminary experience in real life of 4D CMR in unselected children with congenital heart disease (CHD). We focused on its feasibility and ability, compared with adults with CHD as control. Methods We herein report 50 4D CMR examinations over a one-year study period. This modality has been applied as a complementary imaging when conventional imaging modalities were unsatisfactory. Quality was classified according to qualitative and quantitative criteria by two blinded radiologists. Results This study included 22 children and 28 adults (mean age 29.5 ± 18.5 years old [0.3; 54], mean weight 61.0 ± 22.7 kg [3.8; 105.0], mean height 159.8 ± 5.5 cm [52; 192]). In infant and children mean age was 10.6 ± 6.1 years old [0.3; 18], mean weight was 36.8 ± 24.5 kg [3.8; 105.0], mean height was 149.4 ± 42.1 cm [52; 192]. Clinical indications were 36% of tetralogy of Fallot, 18% of aorta disease, 27% of complex CHD, 9% of ventricular septal defect and 10% of valvulopathy. The feasibility of this examination was excellent, while 100% exams were performed with no need for general anesthesia whatever the indication or patient (infant, child or adult). Average duration of exams were 465 ± 90s [339–610]. The overall quality of exams was satisfactory; 63% of good quality and 23% of medium quality. The evolution of quality over time has shown a progressive improvement which seems to correspond to a 3-month long learning curve. The only predictive factor identified for quality was the experience (X2 = 4.8; P = 0.03 in CHD). Conclusion Based on our preliminary experience, 4D Flow has become a complementary imaging modality accessible in current practice and open to all patients, infant, child or adult, without restriction of age, weight, size or pathology. The quality of this examination was satisfactory and seems to require an estimated learning curve of 3 months according to our experience.

Backgroundaortic valve area (AVA) calculated by the continuity equation by echocardiography (CE-TTE) is the method of reference to assess aortic valve stenosis severity (AS). The Hakki’s formula (simplified Gorlin formula) is another method, sometines used during cardiac catheterization to calculate AVA. It can also be adapted to magnetic resonance imaging (CMR) to assess the AVA as previously demonstrated. The aim of our study is to investigate, using a large number of patients with AS, the accuracy of the « hakki-cmr » method to determine the severity of AS compared to C-TTE.Methods and resultsbetween 2007 and 2014, 390 consecutive patients with AS (mean age 81±10 years, men 55%, mean LVEF=60±13%, underwent clinically indicated TTE (IE 33, philips) and CMR (philips ACHIEVA 1.5 tesla) within 30 days. The mean pressure aortic gradient was 44±18mmHg; the AVA was respectively 0.67±0.25cm 2 by CE-TTE, 0.74±0.30cm 2 using HakkiCMR. Hakki’s formula and AVA from CE-TTE were almost interchangeable, with a mean difference of 0.07cm2 (95% limits of agreement 0.15 to 0.21cm2, p

Congenital coronary artery disease (CAD) is commonly asymptomatic and often benign. Investigation of potential myocardial ischemia is also necessary. We report an original observation of abnormal origin and course of the right coronary artery (RCA), abnormal left main artery, and agenesis of the left anterior descending (LAD) artery. This is the first report of an association of 3 types of congenital coronary artery anomaly according to the modified Angelini's classification. This high-risk condition was successfully treated surgically.

Background 4D flow cardiovascular magnetic resonance (4D Flow CMR) enable time-varying and multidirectional comprehensive retrospective flow quantification in patients after repaired tetralogy of Fallot (TOF). This imaging modality must, however, prove its relevance compared to conventional CMR. Methods 4D flow and 2D flow MRI were acquired using a clinical 1.5T MRI scanner (GE; GE Healthcare, Milwaukee, WI, USA). The 4D flow data were acquired in 18 patients after repair of TOF and in 5 healthy controls during free breathing using retrospectively ECG-gated and navigator-gated three-dimensional, three-directional phase contrast MRI (spatial resolution ∼ 1.4 mm, temporal resolution = 33 ms). Data analysis included the evaluation of haemodynamics in the aorta, the pulmonary trunk (TP), quantitative measurements of flow velocity, right ventricular volumes both by conventional 2D CMR and 4D Flow. Results Eighteen patients with TOF underwent 2D CMR and 4D Flow CMR (mean age 31 ± 13 years, mean size 168 ± 13 cm, mean weight 56.2 ± 13.4 kg). Among them 12 patients had complete evaluation including flow and ventricular volumes. The mean systolic ejection volume was 109 ± 44 mL; the mean right ventricle systolic function was 55 ± 12%. The mean end-diastolic right ventricle volume was respectively 185 ± 66 mL by 2D CMR, and 200 ± 68 mL using 4D Flow. The mean pulmonary regurgitation fraction was respectively 39 ± 18% by 2D CMR, and 32 ± 18% using 4D Flow. Pulmonary regurgitation fraction was almost interchangeable according to the Pearson's coefficient (r2 = 0.9, P Conclusions Based on our experience, 4D Flow imaging can be clinically helpful especially in TOF, compared to 2D CMR. Despite some biases, our results shows good accuracy compared to conventional 2D CMR. Further studies are needed to validate our first conclusions.

4D Flow imaging is an innovative magnetic resonance imaging modality for qualitative and quantitative analysis of cardiovascular pathologies. Its applications are multiple and find their interest in contentious situations by providing a complete and innovative analysis. We present here the experience of one year of practice in our center (100 examinations) on adult and pediatric populations (from 6 weeks to 43 years, from 4.6 kg to 85 kg). This modality has been applied as a remedial imaging in ambiguous situations (68% of congenital pathology, 23% of valvulopathy, 9% of large vessel pathology) where conventional imaging modalities have proved non-contributory. The feasibility of this examination was excellent, since only 3 examinations were considered uninterpretable due to a lack of perfusion of gadolinium. All the pediatric population examinations could be performed in a satisfactory comfort (maximum duration of 8 minutes against 40 minutes for a conventional 2D MRI/absence of recourse to general anesthesia). The results were compared with those obtained by conventional methods and were useful in the management of our patients by providing a complete understanding of the pathologies. Used in contentious situations, MRI by 4D Flow has been illustrated as a recourse imaging. Based on our experience, 4D Flow has proved its feasibility in various situations and for various pathologies. It remains to this modality to demonstrate its reproducibility as well as its relevance.

Objective. To develop a rabbit model of closed-chest catheter-induced myocardial infarction. Background. Limitations of rodent and large animal models justify the search for clinically relevant alternatives. Methods. Microcatheterization of the heart was performed in 47 anesthetized 3-4 kg New Zealand rabbits to test five techniques of myocardial ischemia: free coils (n = 4), interlocking coils (n = 4), thrombogenic gelatin sponge (n = 4), balloon occlusion (n = 4), and alcohol injection (n = 8). In order to limit ventricular fibrillation, an antiarrhythmic protocol was implemented, with beta-blockers/amiodarone before and xylocaine infusion during the procedure. Clinical, angiographic, and echographic data were gathered. End points included demonstration of vessel occlusion (TIMI flow grades 0 and 1 on the angiogram), impairment of left ventricular function at 2 weeks after procedure (by echocardiography), and pathologically confirmed myocardial infarction. Results. The best arterial access was determined to be through the right carotid artery. The internal mammary guiding catheter 4-Fr was selected as the optimal device for selective intracoronary injection. Free coils deployed prematurely and tended to prolapse into the aorta. Interlocking coils did not deploy completely and failed to provide reliable results. Gelatin sponge was difficult to handle, adhered to the catheter, and could not be clearly visualized by fluoroscopy. Balloon occlusion yielded inconsistent results. Alcohol injection was the most efficient and reproducible method for inducing myocardial infarction (4 out of 6 animals), the extent of which could be fine-tuned by using a coaxial balloon catheter as a microcatheter (0.52 mm) to achieve a superselective injection of 0.2 mL of alcohol. This approach resulted in a 20% decrease in LVEF and infarcted myocardium was confirmed histologically. Conclusions. By following a stepwise approach, a minimally invasive, effective, and reproducible rabbit model of catheter-induced myocardial infarction has been developed which addresses the limitations of rodent experiments while avoiding the logistical and cost issues associated with large animal models.

AimsGender differences in management of patients with acute coronary syndromes (ACS) have been reported. The aim of this study was to evaluate the impact of gender on myocardial revascularization in patients with ACS from a French nationwide registry (ONACI).Methods and ResultsWe analysed data from a nationwide French prospective multicentre registry including 64,932 ACS patients (mean age 65.7±13.3; 27% women, 31% ST-elevation myocardial infarction (STEMI)) recruited in 99 centres between 2004 and 2008. Women were older than men and had higher rates of cardiovascular risk factors. Women were more likely to have normal vessel/non-significant coronary artery disease (

Background Cardiac magnetic resonance has become common in the management of congenital heart disease because of its ability to visualize structures that remain obscure by echocardiography without ionizing radiation. The 4D flow is an MRI method that simultaneously processes the quantification of blood flow, the quantification of ventricular volumes and function, the visualization of intracardiac and extracardiac structures and blood flow. Objectives The objectives of this study are to assess the feasibility of 4D flow routinely in children and young adults, to compare 4D flow with 2D phase-contrast MRI for quantification of aortic and pulmonary flow and to evaluate the advantage of 4D flow-based volumetric flow analysis compared to 2D phase contrast MRI. Materials and methods Two-dimensional phase-contrast MRI of the aortic root, main pulmonary artery, right and left ventricles and atrias and 4D flow with volumetric coverage of the aorta and pulmonary arteries were performed in 14 patients, 2 (12 and 14 years old) and 12 adults (mean age: 24.1 ± 7.3 years). This CMR concerned various diseases: repaired tetralogy of Fallot (n = 10), aortic coarctation (n = 1), single ventricle heart defect (n = 1) and ventricular communicating shunt (2). Four-dimensional volumetric assessments of ventricles, pulmonary flow and aortic flow were performed and compared to 2D phase-contrast. Four dimensional flow analyses included calculation of net flow and regurgitant fraction with 4D flow analysis. Results Excellent correlations were found between 2D phase-contrast MRI and 4D flow for stroke volumes, aortic and pulmonary flows. Four-dimensional flow provided both anatomic visualization and comprehensive functional analysis showing stenosis, aneurysm and complex turbulent flows. Conclusion In each of these circumstances, CMR has been achieved and has been found to be contributory for complete visualization and adequate evaluation.

Improved early outcome in non-ST elevation myocardial infarction (NSTEMI) patients has been mainly attributed to a broader use of invasive strategies. Little is known about the impact of other changes in early management.We aimed to assess 15-year trends in one-year mortality and their determinants in NSTEMI patients. We used data from 4 one-month French registries, conducted 5 years apart from 1995 to 2010 including 3903 NSTEMI patients admitted to intensive care units.From 1995 to 2010, no major change was observed in patient characteristics, while therapeutic management evolved considerably. Early use of antiplatelet agents, β-blockers, ACE-inhibitors and statins increased over time (P0.001); use of newer anticoagulants (low-molecular-weight heparin, bivalirudin or fondaparinux) increased from 40.8% in 2000 to 78.9% in 2010 (P0.001); percutaneous coronary intervention (PCI)≤ 3 days of admission rose from 7.6% to 48.1% (P0.001). One-year death decreased from 20% to 9.8% (HR adjusted for baseline parameters, 2010 vs. 1995 = 0.47, 95% CI: 0.35-0.62). Early PCI (HR = 0.67; 95% CI: 0.49-0.90), use of newer anticoagulants (HR = 0.62; 95% CI: 0.48-0.78) and early use of evidence based medical therapy (HR = 0.54; 95% CI: 0.40-0.72) were predictors of improved one year-survival.One-year mortality of NSTEMI patients decreased by 50% in the past 15years. Our data support current guidelines recommending early invasive strategies and use of newer anticoagulants for NSTEMI, and also show a strong positive association between early use of appropriate medical therapies and one-year survival, suggesting that these medications should be used from the start.

International audience; Background. - Contrast-induced nephropathy (CIN) severely impacts patient morbidity and mortality, especially in patients with ST-segment elevation myocardial infarction treated by primary coronary angioplasty, whose renal function is often unknown at the time of contrast exposure.Aim. - We sought the incidence and factors predictive of CIN in patients treated by primary coronary angioplasty in our hospital; we also questioned the relevance of Mehran's risk score in this population.Methods. - We considered all patients admitted for primary coronary angioplasty between January 2010 and December 2011, and included 322 patients with complete data on renal function. CIN was defined as a relative (>= 25%) or absolute (>= 44 mu mol/L) increase in serum creatinine following contrast medium administration. We compared patients with or without CIN, to identify predictive factors, and investigated the effectiveness of Mehran's score using a receiver operating characteristic (ROC) curve, Youden's index and a likelihood ratio test.Results. - The incidence of CIN was 9.1%. A multivariable analysis identified two independent risk factors for CIN: impaired glomerular filtration rate and cardiogenic shock at admission (P < 0.05). An elevated Mehran's score was associated with increased incidence of ON, but statistical analysis revealed this score to have poor sensitivity, especially in high-risk patients. Youden's index was very low and the area under the ROC curve was 0.59 in our population.Conclusion. - Renal failure and cardiogenic shock at admission were independent predictors of CIN in our acute myocardial infarction population. Mehran's score added little to the discrimination of patients undergoing primary coronary angioplasty, particularly high-risk individuals.