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2. ESICM LIVES 2016: part one: Milan, Italy. 1-5 October 2016

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Bos, L., Schouten, L., van Vught, L., Wiewel, M., Ong, D., Cremer, O., Artigas, A., Martin-Loeches, I., Hoogendijk, A., van der Poll, T., Horn, J., Juffermans, N., Schultz, M., de Prost, N., Pham, T., Carteaux, G., Dessap, A. Mekontso, Brun-Buisson, C., Fan, E., Bellani, G., Laffey, J., Mercat, A., Brochard, L., Maitre, B., Howells, P. A., Thickett, D. R., Knox, C., Park, D. P., Gao, F., Tucker, O., Whitehouse, T., McAuley, D. F., Perkins, G. D., Pham, T., Laffey, J., Bellani, G., Fan, E., Pisani, L., Roozeman, J. P., Simonis, F. D., Giangregorio, A., Schouten, L. R., Van der Hoeven, S. M., Horn, J., Neto, A. Serpa, Festic, E., Dondorp, A. M., Grasso, S., Bos, L. D., Schultz, M. J., Koster-Brouwer, M., Verboom, D., Scicluna, B., van de Groep, K., Frencken, J., Schultz, M., van der Poll, T., Bonten, M., Cremer, O., Ko, J. I., Kim, K. S., Suh, G. J., Kwon, W. Y., Kim, K., Shin, J. H., Ranzani, O. T., Prina, E., Menendez, R., Ceccato, A., Mendez, R., Cilloniz, C., Gabarrus, A., Ferrer, M., Torres, A., Urbano, A., Zhang, L. A., Swigon, D., Pike, F., Parker, R. S., Clermont, G., Scheer, C., Kuhn, S. O., Modler, A., Vollmer, M., Fuchs, C., Hahnenkamp, K., Rehberg, S., Gründling, M., Taggu, A., Darang, N., Öveges, N., László, I., Tánczos, K., Németh, M., Lebák, G., Tudor, B., Érces, D., Kaszaki, J., Huber, W., Trásy, D., Molnár, Z., Ferrara, G., Edul, V. S. Kanoore, Canales, H. S., Martins, E., Canullán, C., Murias, G., Pozo, M. O., Eguillor, J. F. Caminos, Buscetti, M. G., Ince, C., Dubin, A., Aya, H. D., Rhodes, A., Fletcher, N., Grounds, R. M., Cecconi, M., Jacquet-Lagrèze, M., Riche, M., Schweizer, R., Portran, P., Fornier, W., Lilot, M., Neidecker, J., Fellahi, J. L., Escoresca-Ortega, A., Gutiérrez-Pizarraya, A., Charris-Castro, L., Corcia-Palomo, Y., Fernandez-Delgado, E., Garnacho-Montero, J., Roger, C., Muller, L., Elotmani, L., Lipman, J., Lefrant, J. Y., Roberts, J. A., Muñoz-Bermúdez, R., Samper, M., Climent, C., Vasco, F., Sara, V., Luque, S., Campillo, N., Cerrato, S. Grau, Masclans, J. R., Alvarez-Lerma, F., Brugger, S. Carvalho, Jimenez, G. Jimenez, Torner, M. Miralbés, Cabello, J. Trujillano, Garrido, B. Balsera, Casals, X. Nuvials, Gaite, F. Barcenilla, Vidal, M. Vallverdú, Martínez, M. Palomar, Gusarov, V., Shilkin, D., Dementienko, M., Nesterova, E., Lashenkova, N., Kuzovlev, A., Zamyatin, M., Demoule, A., Carreira, S., Lavault, S., Palancca, O., Morawiec, E., Mayaux, J., Arnulf, I., Similowski, T., Rasmussen, B. S., Maltesen, R. G., Hanifa, M., Pedersen, S., Kristensen, S. R., Wimmer, R., Panigada, M., Bassi, G. Li, Ranzani, O. T., Kolobow, T., Zanella, A., Cressoni, M., Berra, L., Parrini, V., Kandil, H., Salati, G., Livigni, S., Amatu, A., Andreotti, A., Tagliaferri, F., Moise, G., Mercurio, G., Costa, A., Vezzani, A., Lindau, S., Babel, J., Cavana, M., Consonni, D., Pesenti, A., Gattinoni, L., Torres, A., Mansouri, P., Zand, F., Zahed, L., Dehghanrad, F., Bahrani, M., Ghorbani, M., Cambiaghi, B., Moerer, O., Mauri, T., Kunze-Szikszay, N., Ritter, C., Pesenti, A., Quintel, M., Vilander, L. M., Kaunisto, M. A., Vaara, S. T., Pettilä, V., Mulier, J. L. G. Haitsma, Rozemeijer, S., Spoelstra-de Man, A. M. E., Elbers, P. E., Tuinman, P. R., de Waard, M. C., Oudemans-van Straaten, H. M., Liberatore, A. M. A., Souza, R. B., Martins, A. M. C. R. P. F., Vieira, J. C. F., Koh, I. H. J., Martínez, M. Galindo, Sánchez, R. Jiménez, Gascón, L. Martínez, Mulero, M. D. Rodríguez, Freire, A. Ortín, Muñoz, A. Ojados, Acebes, S. Rebollo, Martínez, Á. Fernández, Aliaga, S. Moreno, Para, L. Herrera, Payá, J. Murcia, Mulero, F. Rodríguez, Guerci, P., Ince, Y., Heeman, P., Ergin, B., Ince, C., Uz, Z., Massey, M., Ince, Y., Papatella, R., Bulent, E., Guerci, P., Toraman, F., Ince, C., Longbottom, E. R., Torrance, H. D., Owen, H. C., Hinds, C. J., Pearse, R. M., O’Dywer, M. J., Trogrlic, Z., van der Jagt, M., Lingsma, H., Ponssen, H. H., Schoonderbeek, J. F., Schreiner, F., Verbrugge, S. J., Duran, S., van Achterberg, T., Bakker, J., Gommers, D. A. M. P. J., Ista, E., Krajčová, A., Waldauf, P., Duška, F., Shah, A., Roy, N., McKechnie, S., Doree, C., Fisher, S., Stanworth, S. J., Jensen, J. F., Overgaard, D., Bestle, M. H., Christensen, D. F., Egerod, I., Pivkina, A., Gusarov, V., Zhivotneva, I., Pasko, N., Zamyatin, M., Jensen, J. F., Egerod, I., Bestle, M. H., Christensen, D. F., Alklit, A., Hansen, R. L., Knudsen, H., Grode, L. B., Overgaard, D., Hravnak, M., Chen, L., Dubrawski, A., Clermont, G., Pinsky, M. R., Parry, S. M., Knight, L. D., Connolly, B. C., Baldwin, C. E., Puthucheary, Z. A., Denehy, L., Hart, N., Morris, P. E., Mortimore, J., Granger, C. L., Jensen, H. I., Piers, R., Van den Bulcke, B., Malmgren, J., Metaxa, V., Reyners, A. K., Darmon, M., Rusinova, K., Talmor, D., Meert, A. P., Cancelliere, L., Zubek, L., Maia, P., Michalsen, A., Decruyenaere, J., Kompanje, E., Vanheule, S., Azoulay, E., Vansteelandt, S., Benoit, D., Van den Bulcke, B., Piers, R., Jensen, H. I., Malmgren, J., Metaxa, V., Reyners, A. K., Darmon, M., Rusinova, K., Talmor, D., Meert, A. P., Cancelliere, L., Zubek, L., Maia, P., Michalsen, A., Decruyenaere, J., Kompanje, E., Vanheule, S., Azoulay, E., Vansteelandt, S., Benoit, D., Ryan, C., Dawson, D., Ball, J., Noone, K., Aisling, B., Prudden, S., Ntantana, A., Matamis, D., Savvidou, S., Giannakou, M., Gouva, M., Nakos, G., Koulouras, V., Aron, J., Lumley, G., Milliken, D., Dhadwal, K., McGrath, B. A., Lynch, S. J., Bovento, B., Sharpe, G., Grainger, E., Pieri-Davies, S., Wallace, S., McGrath, B., Lynch, S. J., Bovento, B., Grainger, E., Pieri-Davies, S., Sharpe, G., Wallace, S., Jung, M., Cho, J., Park, H., Suh, G., Kousha, O., Paddle, J., Gripenberg, L. Gamrin, Rehal, M. Sundström, Wernerman, J., Rooyackers, O., de Grooth, H. J., Choo, W. P., Spoelstra-de Man, A. M., Swart, E. L., Oudemans-van Straaten, H. M., Talan, L., Güven, G., Altıntas, N. D., Padar, M., Uusvel, G., Starkopf, L., Starkopf, J., Blaser, A. Reintam, Kalaiselvan, M. S., Arunkumar, A. S., Renuka, M. K., Shivkumar, R. L., Volbeda, M., ten Kate, D., Hoekstra, M., van der Maaten, J. M., Nijsten, M. W., Komaromi, A., Rooyackers, O., Wernerman, J., Norberg, Å., Smedberg, M., Mori, M., Pettersson, L., Norberg, Å., Rooyackers, O., Wernerman, J., Theodorakopoulou, M., Christodoulopoulou, T., Diamantakis, A., Frantzeskaki, F., Kontogiorgi, M., Chrysanthopoulou, E., Lygnos, M., Diakaki, C., Armaganidis, A., Gundogan, K., Dogan, E., Coskun, R., Muhtaroglu, S., Sungur, M., Ziegler, T., Guven, M., Kleyman, A., Khaliq, W., Andreas, D., Singer, M., Meierhans, R., Schuepbach, R., De Brito-Ashurst, I., Zand, F., Sabetian, G., Nikandish, R., Hagar, F., Masjedi, M., Maghsudi, B., Vazin, A., Ghorbani, M., Asadpour, E., Kao, K. C., Chiu, L. C., Hung, C. Y., Chang, C. H., Li, S. H., Hu, H. C., El Maraghi, S., Ali, M., Rageb, D., Helmy, M., Marin-Corral, J., Vilà, C., Masclans, J. R., Vàzquez, A., Martín-Loeches, I., Díaz, E., Yébenes, J. C., Rodriguez, A., Álvarez-Lerma, F., Varga, N., Cortina-Gutiérrez, A., Dono, L., Martínez-Martínez, M., Maldonado, C., Papiol, E., Pérez-Carrasco, M., Ferrer, R., Nweze, K., Morton, B., Welters, I., Houard, M., Voisin, B., Ledoux, G., Six, S., Jaillette, E., Nseir, S., Romdhani, S., Bouneb, R., Loghmari, D., Aicha, N. Ben, Ayachi, J., Meddeb, K., Chouchène, I., Khedher, A., Boussarsar, M., Chan, K. S., Yu, W. L., Marin-Corral, J., Vilà, C., Masclans, J. R., Nolla, J., Vidaur, L., Bonastre, J., Suberbiola, B., Guerrero, J. E., Rodriguez, A., Coll, N. Ramon, Jiménez, G. Jiménez, Brugger, S. Carvalho, Calero, J. Codina, Garrido, B. Balsera, García, M., Martínez, M. Palomar, Vidal, M. Vallverdú, de la Torre, M. C., Vendrell, E., Palomera, E., Güell, E., Yébenes, J. C., Serra-Prat, M., Bermejo-Martín, J. F., Almirall, J., Tomas, E., Escoval, A., Froe, F., Pereira, M. H. Vitoria, Velez, N., Viegas, E., Filipe, E., Groves, C., Reay, M., Chiu, L. C., Hu, H. C., Hung, C. Y., Chang, C. H., Li, S. H., Kao, K. C., Ballin, A., Facchin, F., Sartori, G., Zarantonello, F., Campello, E., Radu, C. M., Rossi, S., Ori, C., Simioni, P., Umei, N., Shingo, I., Santos, A. C., Candeias, C., Moniz, I., Marçal, R., e Silva, Z. Costa, Ribeiro, J. M., Georger, J. F., Ponthus, J. P., Tchir, M., Amilien, V., Ayoub, M., Barsam, E., Martucci, G., Panarello, G., Tuzzolino, F., Capitanio, G., Ferrazza, V., Carollo, T., Giovanni, L., Arcadipane, A., Sánchez, M. López, González-Gay, M. A., Díaz, F. J. Llorca, López, M. I. Rubio, Zogheib, E., Villeret, L., Nader, J., Bernasinski, M., Besserve, P., Caus, T., Dupont, H., Morimont, P., Habran, S., Hubert, R., Desaive, T., Blaffart, F., Janssen, N., Guiot, J., Pironet, A., Dauby, P., Lambermont, B., Zarantonello, F., Ballin, A., Facchin, F., Sartori, G., Campello, E., Pettenuzzo, T., Citton, G., Rossi, S., Simioni, P., Ori, C., Kirakli, C., Ediboglu, O., Ataman, S., Yarici, M., Tuksavul, F., Keating, S., Gibson, A., Gilles, M., Dunn, M., Price, G., Young, N., Remeta, P., Bishop, P., Zamora, M. D. Fernández, Muñoz-Bono, J., Curiel-Balsera, E., Aguilar-Alonso, E., Hinojosa, R., Gordillo-Brenes, A., Arboleda-Sánchez, J. A., Skorniakov, I., Vikulova, D., Whiteley, C., Shaikh, O., Jones, A., Ostermann, M., Forni, L., Scott, M., Sahatjian, J., Linde-Zwirble, W., Hansell, D., Laoveeravat, P., Srisawat, N., Kongwibulwut, M., Peerapornrattana, S., Suwachittanont, N., Wirotwan, T. O., Chatkaew, P., Saeyub, P., Latthaprecha, K., Tiranathanagul, K., Eiam-ong, S., Kellum, J. A., Berthelsen, R. E., Perner, A., Jensen, A. E. K., Jensen, J. U., Bestle, M. H., Gebhard, D. J., Price, J., Kennedy, C. E., Akcan-Arikan, A., Liberatore, A. M. A., Souza, R. B., Martins, A. M. C. R. P. F., Vieira, J. C. F., Kang, Y. R., Nakamae, M. N., Koh, I. H. J., Hamed, K., Khaled, M. M., Soliman, R. Aly, Mokhtar, M. Sherif, Seller-Pérez, G., Arias-Verdú, D., Llopar-Valdor, E., De-Diós-Chacón, I., Quesada-García, G., Herrera-Gutierrez, M. E., Hafes, R., Carroll, G., Doherty, P., Wright, C., Vera, I. G. Guerra, Ralston, M., Gemmell, M. L., MacKay, A., Black, E., Wright, C., Docking, R. I., Appleton, R., Ralston, M. R., Gemmell, L., Appleton, R., Wright, C., Docking, R. I., Black, E., Mackay, A., Rozemeijer, S., Mulier, J. L. G. Haitsma, Röttgering, J. G., Elbers, P. W. G., Spoelstra-de Man, A. M. E., Tuinman, P. R., de Waard, M. C., Oudemans-van Straaten, H. M., Mejeni, N., Nsiala, J., Kilembe, A., Akilimali, P., Thomas, G., Egerod, I., Andersson, A. E., Fagerdahl, A. M., Knudsen, V., Meddeb, K., Cheikh, A. Ben, Hamdaoui, Y., Ayachi, J., Guiga, A., Fraj, N., Romdhani, S., Sma, N., Bouneb, R., Chouchene, I., Khedher, A., Bouafia, N., Boussarsar, M., Amirian, A., Ziaian, B., Masjedi, M., Fleischmann, C., Thomas-Rueddel, D. O., Schettler, A., Schwarzkopf, D., Stacke, A., Reinhart, K., Filipe, E., Escoval, A., Martins, A., Sousa, P., Velez, N., Viegas, E., Tomas, E., Snell, G., Matsa, R., Paary, T. T. S., Kalaiselvan, M. S., Cavalheiro, A. M., Rocha, L. L., Vallone, C. S., Tonilo, A., Lobato, M. D. S., Malheiro, D. T., Sussumo, G., Lucino, N. M., Zand, F., Rosenthal, V. D., Masjedi, M., Sabetian, G., Maghsudi, B., Ghorbani, M., Dashti, A. Sanaei, Yousefipour, A., Goodall, J. R., Williamson, M., Tant, E., Thomas, N., Balci, C., Gonen, C., Haftacı, E., Gurarda, H., Karaca, E., Paldusová, B., Zýková, I., Šímová, D., Houston, S., D’Antona, L., Lloyd, J., Garnelo-Rey, V., Sosic, M., Sotosek-Tokmazic, V., Kuharic, J., Antoncic, I., Dunatov, S., Sustic, A., Chong, C. T., Sim, M., Lyovarin, T., Díaz, F. M. Acosta, Galdó, S. Narbona, Garach, M. Muñoz, Romero, O. Moreno, Bailón, A. M. Pérez, Pinel, A. Carranza, Colmenero, M., Gritsan, A., Gazenkampf, A., Korchagin, E., Dovbish, N., Lee, R. M., Lim, M. P. P., Chong, C. T., Lim, B. C. L., See, J. J., Assis, R., Filipe, F., Lopes, N., Pessoa, L., Pereira, T., Catorze, N., Aydogan, M. S., Aldasoro, C., Marchio, P., Jorda, A., Mauricio, M. D., Guerra-Ojeda, S., Gimeno-Raga, M., Colque-Cano, M., Bertomeu-Artecero, A., Aldasoro, M., Valles, S. L., Tonon, D., Triglia, T., Martin, J. C., Alessi, M. C., Bruder, N., Garrigue, P., Velly, L., Spina, S., Scaravilli, V., Marzorati, C., Colombo, E., Savo, D., Vargiolu, A., Cavenaghi, G., Citerio, G., Andrade, A. H. V., Bulgarelli, P., Araujo, J. A. P., Gonzalez, V., Souza, V. A., Costa, A., Massant, C., Filho, C. A. C. Abreu, Morbeck, R. A., Burgo, L. E., van Groenendael, R., van Eijk, L. T., Leijte, G. P., Koeneman, B., Kox, M., Pickkers, P., García-de la Torre, A., de la Torre-Prados, M., Fernández-Porcel, A., Rueda-Molina, C., Nuevo-Ortega, P., Tsvetanova-Spasova, T., Cámara-Sola, E., García-Alcántara, A., Salido-Díaz, L., Liao, X., Feng, T., Zhang, J., Cao, X., Wu, Q., Xie, Z., Li, H., Kang, Y., Winkler, M. S., Nierhaus, A., Mudersbach, E., Bauer, A., Robbe, L., Zahrte, C., Schwedhelm, E., Kluge, S., Zöllner, C., Morton, B., Mitsi, E., Pennington, S. H., Reine, J., Wright, A. D., Parker, R., Welters, I. D., Blakey, J. D., Rajam, G., Ades, E. W., Ferreira, D. M., Wang, D., Kadioglu, A., Gordon, S. B., Koch, R., Kox, M., Rahamat-Langedoen, J., Schloesser, J., de Jonge, M., Pickkers, P., Bringue, J., Guillamat-Prats, R., Torrents, E., Martinez, M. L., Camprubí-Rimblas, M., Artigas, A., Blanch, L., Park, S. Y., Park, Y. B., Song, D. K., Shrestha, S., Park, S. H., Koh, Y., Park, M. J., Hong, C. W., Lesur, O., Coquerel, D., Sainsily, X., Cote, J., Söllradl, T., Murza, A., Dumont, L., Dumaine, R., Grandbois, M., Sarret, P., Marsault, E., Salvail, D., Auger-Messier, M., Chagnon, F., Lauretta, M. P., Greco, E., Dyson, A., Singer, M., Preau, S., Ambler, M., Sigurta, A., Saeed, S., Singer, M., Sarıca, L. Topcu, Zibandeh, N., Genc, D., Gul, F., Akkoc, T., Kombak, E., Cinel, L., Akkoc, T., Cinel, I., Pollen, S. J., Arulkumaran, N., Singer, M., Torrance, H. D., Longbottom, E. R., Warnes, G., Hinds, C. J., Pennington, D. J., Brohi, K., O’Dwyer, M. J., Kim, H. Y., Na, S., Kim, J., Chang, Y. F., Chao, A., Shih, P. Y., Lee, C. T., Yeh, Y. C., Chen, L. W., Adriaanse, M., Trogrlic, Z., Ista, E., Lingsma, H., Rietdijk, W., Ponssen, H. H., Schoonderbeek, J. F., Schreiner, F., Verbrugge, S. J., Duran, S., Gommers, D. A. M. P. J., van der Jagt, M., Funcke, S., Sauerlaender, S., Saugel, B., Pinnschmidt, H., Reuter, D. A., Nitzschke, R., Perbet, S., Biboulet, C., Lenoire, A., Bourdeaux, D., Pereira, B., Plaud, B., Bazin, J. E., Sautou, V., Mebazaa, A., Constantin, J. M., Legrand, M., Boyko, Y., Jennum, P., Nikolic, M., Oerding, H., Holst, R., Toft, P., Nedergaard, H. K., Haberlandt, T., Jensen, H. I., Toft, P., Park, S., Kim, S., Cho, Y. J., Lim, Y. J., Chan, A., Tang, S., Nunes, S. L., Forsberg, S., Blomqvist, H., Berggren, L., Sörberg, M., Sarapohja, T., Wickerts, C. J., Hofhuis, J. G. M., Rose, L., Blackwood, B., Akerman, E., Mcgaughey, J., Egerod, I., Fossum, M., Foss, H., Georgiou, E., Graff, H. J., Kalafati, M., Sperlinga, R., Schafer, A., Wojnicka, A. G., Spronk, P. E., Zand, F., Khalili, F., Afshari, R., Sabetian, G., Masjedi, M., Maghsudi, B., Khodaei, H. Haddad, Javadpour, S., Petramfar, P., Nasimi, S., Vazin, A., Ziaian, B., Tabei, H., Gunther, A., Hansen, J. O., Sackey, P., Storm, H., Bernhardsson, J., Sundin, Ø., Bjärtå, A., Bienert, A., Smuszkiewicz, P., Wiczling, P., Przybylowski, K., Borsuk, A., Trojanowska, I., Matysiak, J., Kokot, Z., Paterska, M., Grzeskowiak, E., Messina, A., Bonicolini, E., Colombo, D., Moro, G., Romagnoli, S., De Gaudio, A. R., Corte, F. Della, Romano, S. M., Silversides, J. A., Major, E., Mann, E. E., Ferguson, A. J., Mcauley, D. F., Marshall, J. C., Blackwood, B., Fan, E., Diaz-Rodriguez, J. A., Silva-Medina, R., Gomez-Sandoval, E., Gomez-Gonzalez, N., Soriano-Orozco, R., Gonzalez-Carrillo, P. L., Hernández-Flores, M., Pilarczyk, K., Lubarksi, J., Wendt, D., Dusse, F., Günter, J., Huschens, B., Demircioglu, E., Jakob, H., Palmaccio, A., Dell’Anna, A. M., Grieco, D. L., Torrini, F., Iaquaniello, C., Bongiovanni, F., Antonelli, M., Toscani, L., Antonakaki, D., Bastoni, D., Aya, H. D., Rhodes, A., Cecconi, M., Jozwiak, M., Depret, F., Teboul, J. L., Alphonsine, J., Lai, C., Richard, C., Monnet, X., László, I., Demeter, G., Öveges, N., Tánczos, K., Németh, M., Trásy, D., Kertmegi, I., Érces, D., Tudor, B., Kaszaki, J., Molnár, Z., Hasanin, A., Lotfy, A., El-adawy, A., Nassar, H., Mahmoud, S., Abougabal, A., Mukhtar, A., Quinty, F., Habchi, S., Luzi, A., Antok, E., Hernandez, G., Lara, B., Enberg, L., Ortega, M., Leon, P., Kripper, C., Aguilera, P., Kattan, E., Bakker, J., Huber, W., Lehmann, M., Sakka, S., Bein, B., Schmid, R. M., Preti, J., Creteur, J., Herpain, A., Marc, J., Zogheib, E., Trojette, F., Bar, S., Kontar, L., Titeca, D., Richecoeur, J., Gelee, B., Verrier, N., Mercier, R., Lorne, E., Maizel, J., Dupont, H., Slama, M., Abdelfattah, M. E., Eladawy, A., Elsayed, M. A. Ali, Mukhtar, A., Montenegro, A. Pedraza, Zepeda, E. Monares, Granillo, J. Franco, Sánchez, J. S. Aguirre, Alejo, G. Camarena, Cabrera, A. Rugerio, Montoya, A. A. Tanaka, Lee, C., Hatib, F., Cannesson, M., Theerawit, P., Morasert, T., Sutherasan, Y., Zani, G., Mescolini, S., Diamanti, M., Righetti, R., Scaramuzza, A., Papetti, M., Terenzoni, M., Gecele, C., Fusari, M., Hakim, K. A., Chaari, A., Ismail, M., Elsaka, A. H., Mahmoud, T. M., Bousselmi, K., Kauts, V., Casey, W. F., Hutchings, S. D., Naumann, D., Wendon, J., Watts, S., Kirkman, E., Jian, Z., Buddi, S., Lee, C., Settels, J., Hatib, F., Pinsky, M. R., Bertini, P., Guarracino, F., Trepte, C., Richter, P., Haas, S. A., Eichhorn, V., Kubitz, J. C., Reuter, D. A., Soliman, M. S., Hamimy, W. I., Fouad, A. Z., Mukhtar, A. M., Charlton, M., Tonks, L., Mclelland, L., Coats, T. J., Thompson, J. P., Sims, M. R., Williams, D., Roushdy, D. Z., Soliman, R. A., Nahas, R. A., Arafa, M. Y., Hung, W. T., Chiang, C. C., Huang, W. C., Lin, K. C., Lin, S. C., Cheng, C. C., Kang, P. L., Wann, S. 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W., Kaymak, C., Okumus, N., Sari, A., Erdogdu, B., Aksun, S., Basar, H., Ozcan, A., Ozcan, N., Oztuna, D., Malmgren, J. A., Lundin, S., Torén, K., Eckerström, M., Wallin, A., Waldenström, A. C., Riccio, F. C., Pogson, D., Antonio, A. C. P., Leivas, A. F., Kenji, F., James, E., Morgan, P., Carroll, G., Gemmell, L., MacKay, A., Wright, C., Ballantyne, J., Jonnada, S., Gerrard, C. S., Jones, N., Salciccioli, J. D., Marshall, D. C., Komorowski, M., Hartley, A., Sykes, M. C., Goodson, R., Shalhoub, J., Villanueva, J. R. Fernández, Garda, R. Fernández, Lago, A. M. López, Ruiz, E. Rodríguez, Vaquero, R. Hernández, Rodríguez, C. Galbán, Pérez, E. Varo, Hilasque, C., Oliva, I., Sirgo, G., Martin, M. C., Olona, M., Gilavert, M. C., Bodí, M., Ebm, C., Aggarwal, G., Huddart, S., Quiney, N., Cecconi, M., Fernandes, S. M., Silva, J. Santos, Gouveia, J., Silva, D., Marques, R., Bento, H., Alvarez, A., Silva, Z. Costa, Diaz, D. Díaz, Martínez, M. Villanova, Herrejon, E. Palencia, de la Gandara, A. Martinez, Gonzalo, G., Lopez, M. A., de Gopegui Miguelena, P. Ruíz, Matilla, C. I. Bernal, Chueca, P. Sánchez, Longares, M. D. C. Rodríguez, Abril, R. Ramos, Aguilar, A. L. Ruíz, de Murillas, R. Garrido López, Fernández, R. Fernández, Laborías, P. Morales, Castellanos, M. A. Díaz, Laborías, M. E. Morales, Cho, J., Kim, J., Park, J., Woo, S., West, T., Powell, E., Rimmer, A., Orford, C., Jones, N., Williams, J., Matilla, C. I. Bernal, de Gopegui Miguelena, P. Ruiz, Chueca, P. Sánchez, Abril, R. Ramos, Longares, M. D. C. Rodríguez, Aguilar, A. L. Ruíz, de Murillas, R. Garrido López, Bourne, R. S., Shulman, R., Tomlin, M., Mills, G. H., Borthwick, M., Berry, W., Huertas, D. García, Manzano, F., Villagrán-Ramírez, F., Ruiz-Perea, A., Rodríguez-Mejías, C., Santiago-Ruiz, F., Colmenero-Ruiz, M., König, C., Matt, B., Kortgen, A., Hartog, C. S., Wong, A., Balan, C., Barker, G., Srisawat, N., Peerapornratana, S., Laoveeravat, P., Tachaboon, S., Eiam-ong, S., Paratz, J., Kayambu, G., Boots, R., Arzapalo, M. F. Aguilar, Vlasenko, R., Gromova, E., Loginov, S., Kiselevskiy, M., Dolgikova, Y., Tang, K. B., Chau, C. M., Lam, K. N., Gil, E., Suh, G. Y., Park, C. M., Park, J., Chung, C. R., Lee, C. T., Chao, A., Shih, P. Y., Chang, Y. F., Lai, C. H., Hsu, Y. C., Yeh, Y. C., Cheng, Y. J., Colella, V., Zarrillo, N., D’Amico, M., Forfori, F., Pezza, B., Laddomada, T., Beltramelli, V., Pizzaballa, M. L., Doronzio, A., Balicco, B., Kiers, D., van der Heijden, W., Gerretsen, J., de Mast, Q., el Messaoudi, S., Rongen, G., Gomes, M., Kox, M., Pickkers, P., Riksen, N. P., Kashiwagi, Y., Okada, M., Hayashi, K., Inagaki, Y., Fujita, S., Nakamae, M. N., Kang, Y. R., Souza, R. B., Liberatore, A. M. A., Koh, I. H. J., Blet, A., Sadoune, M., Lemarié, J., Bihry, N., Bern, R., Polidano, E., Merval, R., Launay, J. M., Lévy, B., Samuel, J. L., Mebazaa, A., Hartmann, J., Harm, S., and Weber, V.

Published
2016
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3. Prognostic and therapeutic implications of pulmonary hypertension complicating degenerative mitral regurgitation due to flail leaflet: A Multicenter Long-term International Study

Author

Barbieri, Andrea, Bursi, Francesca, Grigioni, Francesco, Tribouilloy, Christophe, Avierinos, Jean Francois, Michelena, Hector I., Rusinaru, Dan, Szymansky, Catherine, Russo, Antonio, Suri, Rakesh, Bacchi Reggiani, Maria Letizia, Branzi, Angelo, Modena, Maria Grazia, Enriquez-Sarano, Maurice, Tribouilloy, C., Rusinaru, D., Szymanski, C., Fournier, A., Trojette, F., Touati, G., Remadi, J. P., Grigioni, F., Russo, A., Piovaccari, G., Ferlito, M., Ionico, T., Barbaresi, E., Branzi, A., Savini, C., Martin-Suarez, S., Marinelli, G., Di Bartolomeo, R., Avierinos, J. F., Tafanelli, L., Habib, G., Collard, F., Riberi, A., Metras, D., Barbieri, A., Bursi, F., Grimaldi, T., Nuzzo, A., Modena, M. G., Enriquez-Sarano, M., Michelena, H. I., Suri, R., and Bacchi-Reggiani, M. L.

Published
2011
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5. Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation

Author

Grigioni, Francesco, primary, Benfari, Giovanni, additional, Vanoverschelde, Jean-Louis, additional, Tribouilloy, Christophe, additional, Avierinos, Jean-Francois, additional, Bursi, Francesca, additional, Suri, Rakesh M., additional, Guerra, Federico, additional, Pasquet, Agnés, additional, Rusinaru, Dan, additional, Marcelli, Emanuela, additional, Théron, Alexis, additional, Barbieri, Andrea, additional, Michelena, Hector, additional, Lazam, Siham, additional, Szymanski, Catherine, additional, Nkomo, Vuyisile T., additional, Capucci, Alessandro, additional, Thapa, Prabin, additional, Enriquez-Sarano, Maurice, additional, Suri, R., additional, Clavel, M.A, additional, Maalouf, J., additional, Michelena, H., additional, Enriquez-Sarano, M., additional, Tribouilloy, C., additional, Trojette, F., additional, Szymanski, C., additional, Rusinaru, D., additional, Touati, G., additional, Remadi, J.P., additional, Guerra, F., additional, Capucci, A., additional, Grigioni, F., additional, Russo, A., additional, Biagini, E., additional, Pasquale, F., additional, Ferlito, M., additional, Rapezzi, C., additional, Savini, C., additional, Marinelli, G., additional, Pacini, D., additional, Gargiulo, G.D., additional, Di Bartolomeo, R., additional, Boulif, J., additional, de Meester, C., additional, El Khoury, G., additional, Gerber, B., additional, Lazam, S., additional, Pasquet, A., additional, Noirhomme, P., additional, Vancraeynest, D., additional, Vanoverschelde, J-L., additional, Avierinos, J.F., additional, Collard, F., additional, Théron, A., additional, Habib, G., additional, Barbieri, A., additional, Bursi, F., additional, Mantovani, F., additional, Lugli, R., additional, Modena, M.G., additional, Boriani, G., additional, and Bacchi-Reggiani, L., additional

Published
2019
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7. Survival Implication of Left Ventricular End-Systolic Diameter in Mitral Regurgitation Due to Flail Leaflets. A Long-Term Follow-Up Multicenter Study

Author

Tribouilloy, C, Grigioni, F, Avierinos, Jf, Barbieri, A, Rusinaru, D, Szymanski, C, Ferlito, M, Tafanelli, L, Bursi, F, Trojette, F, Branzi, A, Habib, G, Modena, Maria Grazia, Enriquez Sarano, M, Investigators, Mida, Tribouilloy C, Grigioni F, Avierinos JF, Barbieri A, Rusinaru D, Szymanski C, Ferlito M, Tafanelli L, Bursi F, Trojette F, Branzi A, Habib G, Modena MG, and Enriquez-Sarano

Subjects
Male, Time Factors, Systole, Heart Ventricles, Mitral Valve Insufficiency, Middle Aged, flail, Prognosis, Myocardial Contraction, mitral regurgitation, Echocardiography, Doppler, Ventricular Function, Left, Europe, Survival Rate, Confidence Intervals, Odds Ratio, Humans, Female, Aged, Follow-Up Studies, Retrospective Studies
Abstract

This study analyzed the association of left ventricular end-systolic diameter (LVESD) with survival after diagnosis in organic mitral regurgitation (MR) due to flail leaflets.LVESD is a marker of left ventricular function in patients with organic MR but its association to survival after diagnosis is unknown.The MIDA (Mitral Regurgitation International Database) registry is a multicenter registry of echocardiographically diagnosed organic MR due to flail leaflets. We enrolled 739 patients with MR due to flail leaflets (age 65 +/- 12 years; ejection fraction: 65 +/- 10%) in whom LVESD was measured (36 +/- 7 mm).Under conservative management, 10-year survival and survival free of cardiac death were higher with LVESD40 mm versusor =40 mm (64 +/- 5% vs. 48 +/- 10%; p0.001, and 73 +/- 5% vs. 63 +/- 10%; p = 0.001). LVESDor =40 mm independently predicted overall mortality (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01 to 3.83) and cardiac mortality (HR: 3.09, 95% CI: 1.35 to 7.09) under conservative management. Mortality risk increased linearly with LVESD40 mm (HR: 1.15, 95% CI: 1.04 to 1.27 per 1-mm increment). During the entire follow-up (including post-surgical), LVESDor =40 mm independently predicted overall mortality (HR: 1.86, 95% CI: 1.24 to 2.80) and cardiac mortality (HR: 2.14, 95% CI: 1.29 to 3.56), due to persistence of excess mortality in patients with LVESDor =40 mm after surgery (HR: 1.86, 95% CI: 1.11 to 3.15 for overall death, and HR: 1.81, 95% CI: 1.05 to 3.54 for cardiac death).In MR due to flail leaflets, LVESDor =40 mm is independently associated with increased mortality under medical management but also after mitral surgery. These findings support prompt surgical rescue in patients with LVESDor =40 mm but also suggest that best preservation of survival is achieved in patients operated before LVESD reaches 40 mm.

Published
2009

8. Outcomes in mitral regurgitation due to flail leaflets a multicenter European study

Author

GRIGIONI, FRANCESCO, FERLITO, MARINELLA, BRANZI, ANGELO, Tribouilloy C., Avierinos J. F., Barbieri A., Trojette F., Tafanelli L., Szymanski C., Habib G., Modena M. G., Enriquez Sarano M., Grigioni F., Tribouilloy C., Avierinos J.F., Barbieri A., Ferlito M., Trojette F., Tafanelli L., Branzi A., Szymanski C., Habib G., Modena M.G., and Enriquez-Sarano M.

Published
2008

9. Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation

Author

Lazam, Siham, primary, Vanoverschelde, Jean-Louis, additional, Tribouilloy, Christophe, additional, Grigioni, Francesco, additional, Suri, Rakesh M., additional, Avierinos, Jean-Francois, additional, de Meester, Christophe, additional, Barbieri, Andrea, additional, Rusinaru, Dan, additional, Russo, Antonio, additional, Pasquet, Agnès, additional, Michelena, Hector I., additional, Huebner, Marianne, additional, Maalouf, Joseph, additional, Clavel, Marie-Annick, additional, Szymanski, Catherine, additional, Enriquez-Sarano, Maurice, additional, Michelina, H., additional, Poulain, H., additional, Remadi, J.-P., additional, Touati, G., additional, Trojette, F., additional, Biagini, E., additional, Di Bartolomeo, R., additional, Ferlito, F.M., additional, Marinelli, G., additional, Pacini, D., additional, Pasquale, F., additional, Rapezzi, C., additional, Savini, C., additional, Boulif, J., additional, El Khoury, G., additional, Gerber, B., additional, Noirhomme, P., additional, Vancraeynest, D., additional, Collard, F., additional, Habib, G., additional, Metras, D., additional, Riberi, A., additional, Tafanelli, L., additional, Bursi, F., additional, Lugli, R., additional, Mantovani, F., additional, Manicardi, C., additional, Grazia, M., additional, and Bacchi-Reggiani, L., additional

Published
2017
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12. Comparative value of Doppler echocardiography and cardiac catheterization for management decision-making in patients with left-sided valvular regurgitation

Author

Jean-Luc Rey, Trojette F, J.-P. Lesbre, Christophe Tribouilloy, W. F. Shen, and Laurent Leborgne

Subjects
Aortic valve, Adult, Male, medicine.medical_specialty, Cardiac Catheterization, Aortography, medicine.medical_treatment, Aortic Valve Insufficiency, Decision Making, Regurgitation (circulation), Doppler echocardiography, Ventricular Function, Left, Coronary artery disease, Internal medicine, Mitral valve, medicine, Humans, Prospective Studies, Cardiac catheterization, Aged, Aged, 80 and over, Mitral regurgitation, medicine.diagnostic_test, business.industry, Hemodynamics, Mitral Valve Insufficiency, Middle Aged, medicine.disease, Echocardiography, Doppler, medicine.anatomical_structure, cardiovascular system, Cardiology, Female, Radiology, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal
Abstract

Objective The purpose of this study was to examine the value of non-invasive clinical and Doppler echocardiographic findings, compared to cardiac catherization, in management decision-making for patients with left-sided valvular regurgitation. Methods One hundred and thirty-five consecutive patients with left-sided valvular regurgitation who underwent cardiac catherization and detailed Doppler echocardiography were prospectively studied. Two independent groups of experienced cardiologists, given clinical information combined with either Doppler echocardiographic or cardiac catherization data, decided to operate, not to operate, or remained uncertain. Results In 63 (81%) of 78 patients with mitral regurgitation, there was agreement on the decision for valve surgery or medical treatment between Doppler echocardiography and cardiac catherization. Valve repair was performed in 22 patients, which agreed with the echocardiographic decision. In the remaining 15 patients, although the severity and type of mitral valve lesions and left ventricular functional status were confirmed by Doppler echocardiography, the clinical decision was uncertain; additional information concerning coronary anatomy (13 patients) and pulmonary artery pressure (one patient) or both (one patient) was required. In 47 of 57 patients (82%) with aortic regurgitation, there was agreement on their management as a result of Doppler echocardiography and cardiac catheterization findings. In 10 patients, the clinical decision reached with the help of Doppler echocardiography alone was uncertain and coronary (seven patients), left ventricular (two patients) angiography or aortography (one patient) were requested. Overall, there were no conflicting clinical decisions made by the two methods in patients with either mitral or aortic regurgitation. Conclusions In every patient in whom it was considered that a decision could be reached by echocardiography alone (more than 80% of patients) there was 100% agreement from the cardiac catherization assessment group on the management decision. Therefore, in patients with significant mitral or aortic regurgitation where echocardiographic data is adequate, cardiac catherization can be safely omitted from the investigative process for surgery. Where echocardiographic indices are conflicting, or significant coronary artery disease is suspected, cardiac catherization is required. (Eur Heart J 1996; 17: 272-280)

Published
1996

14. Plasma homocysteine and severity of thoracic aortic atherosclerosis.

Author

Tribouilloy, Christophe M., Peltier, Marcel, Peltier, Michele C. Iannetta, Trojette, Faouzi, Andrejak, Michel, Lesbre, Jean-Philippe M., Tribouilloy, C M, Peltier, M, Iannetta Peltier, M C, Trojette, F, Andrejak, M, and Lesbre, J P

Subjects
HOMOCYSTEINE, ATHEROSCLEROSIS
Abstract

Study Objectives: Plasma homocysteine level is a risk factor for coronary events, stroke, and peripheral atherosclerotic disease. However, few data are available concerning the relationship between homocysteine level and severity of thoracic aortic atherosclerosis. We hypothesized in this multiplane transesophageal echocardiography (TEE) study that homocysteine level is a marker of the presence and severity of thoracic aortic atherosclerosis.Design: Cross-sectional study.Setting: University hospital.Patients: Risk factors, angiographic features, and TEE findings were analyzed prospectively in 82 valvular patients.Measurements and Results: The following risk factors were recorded: age, gender, hypertension, smoking, lipid parameters, diabetes, body mass index, and family history of coronary artery disease. Plasma levels of homocysteine, vitamin B(12), and folic acid were measured for each patient. By univariate analysis, age, diabetes, hypertension, smoking, family history of coronary artery disease, and levels of homocysteine, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were significant predictors of the presence of thoracic aortic plaques. There was a positive correlation between the plasma homocysteine levels and the score of severity of thoracic atherosclerosis (r = 0.48; p = 0.0001) as well as between the homocysteine levels and the grades of severity of aortic intimal changes (p = 0.0008). Multivariate regression analysis revealed that homocysteine was an independent predictor of the presence and severity of thoracic aortic atherosclerosis.Conclusion: This prospective study indicates that plasma homocysteine level is a marker of severity of thoracic atherosclerosis detected by multiplane TEE. These findings emphasize the role of homocysteine as a marker of atherosclerotic lesions in the major arterial locations. [ABSTRACT FROM AUTHOR]

Published
2000
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16. Intimo-intimal intussusception: a rare clinical form of aortic dissection

Author

Touati, G., Carmi, D., Trojette, F., and Jarry, G.

Subjects
*AORTA abnormalities, *CARDIOLOGY
Abstract

A 33-year-old hypertensive man presented with epigastric pain radiating to the back. Transoesophageal echocardiography (TOE) revealed an intimal flap on the aortic arch and descending aorta. No intimal flap of the ascending aorta was detected on TOE or CT. The diagnosis was made on opening the ascending aorta: complete circumferential dissection of the ascending aorta flush with the coronary ostia, with no residual intimal flap, and intimo-intimal glove-finger intussusception of the internal channel into the descending thoracic aorta. Aortic intussusception is a very rare form of Type I dissection, and the absence of intimal tear in the ascending aorta can be misleading and delay the diagnosis. [Copyright &y& Elsevier]

Published
2003
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17. Survival implication of left ventricular end-systolic diameter in mitral regurgitation due to flail leaflets a long-term follow-up multicenter study.

Author

Tribouilloy C, Grigioni F, Avierinos JF, Barbieri A, Rusinaru D, Szymanski C, Ferlito M, Tafanelli L, Bursi F, Trojette F, Branzi A, Habib G, Modena MG, Enriquez-Sarano M, MIDA Investigators, Tribouilloy, Christophe, Grigioni, Francesco, Avierinos, Jean François, Barbieri, Andrea, and Rusinaru, Dan

Abstract

Objectives: This study analyzed the association of left ventricular end-systolic diameter (LVESD) with survival after diagnosis in organic mitral regurgitation (MR) due to flail leaflets. Background: LVESD is a marker of left ventricular function in patients with organic MR but its association to survival after diagnosis is unknown. Methods: The MIDA (Mitral Regurgitation International Database) registry is a multicenter registry of echocardiographically diagnosed organic MR due to flail leaflets. We enrolled 739 patients with MR due to flail leaflets (age 65 +/- 12 years; ejection fraction: 65 +/- 10%) in whom LVESD was measured (36 +/- 7 mm). Results: Under conservative management, 10-year survival and survival free of cardiac death were higher with LVESD <40 mm versus > or =40 mm (64 +/- 5% vs. 48 +/- 10%; p < 0.001, and 73 +/- 5% vs. 63 +/- 10%; p = 0.001). LVESD > or =40 mm independently predicted overall mortality (hazard ratio [HR]: 1.95, 95% confidence interval [CI]: 1.01 to 3.83) and cardiac mortality (HR: 3.09, 95% CI: 1.35 to 7.09) under conservative management. Mortality risk increased linearly with LVESD >40 mm (HR: 1.15, 95% CI: 1.04 to 1.27 per 1-mm increment). During the entire follow-up (including post-surgical), LVESD > or =40 mm independently predicted overall mortality (HR: 1.86, 95% CI: 1.24 to 2.80) and cardiac mortality (HR: 2.14, 95% CI: 1.29 to 3.56), due to persistence of excess mortality in patients with LVESD > or =40 mm after surgery (HR: 1.86, 95% CI: 1.11 to 3.15 for overall death, and HR: 1.81, 95% CI: 1.05 to 3.54 for cardiac death). Conclusions: In MR due to flail leaflets, LVESD > or =40 mm is independently associated with increased mortality under medical management but also after mitral surgery. These findings support prompt surgical rescue in patients with LVESD > or =40 mm but also suggest that best preservation of survival is achieved in patients operated before LVESD reaches 40 mm. [ABSTRACT FROM AUTHOR]

Published
2009
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18. Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation

Author

Francesco Grigioni, Giovanni Benfari, Jean-Louis Vanoverschelde, Christophe Tribouilloy, Jean-Francois Avierinos, Francesca Bursi, Rakesh M. Suri, Federico Guerra, Agnés Pasquet, Dan Rusinaru, Emanuela Marcelli, Alexis Théron, Andrea Barbieri, Hector Michelena, Siham Lazam, Catherine Szymanski, Vuyisile T. Nkomo, Alessandro Capucci, Prabin Thapa, Maurice Enriquez-Sarano, R. Suri, M.A Clavel, J. Maalouf, H. Michelena, M. Enriquez-Sarano, C. Tribouilloy, F. Trojette, C. Szymanski, D. Rusinaru, G. Touati, J.P. Remadi, F. Guerra, A. Capucci, F. Grigioni, A. Russo, E. Biagini, F. Pasquale, M. Ferlito, C. Rapezzi, C. Savini, G. Marinelli, D. Pacini, G.D. Gargiulo, R. Di Bartolomeo, J. Boulif, C. de Meester, G. El Khoury, B. Gerber, S. Lazam, A. Pasquet, P. Noirhomme, D. Vancraeynest, J-L. Vanoverschelde, J.F. Avierinos, F. Collard, A. Théron, G. Habib, A. Barbieri, F. Bursi, F. Mantovani, R. Lugli, M.G. Modena, G. Boriani, L. Bacchi-Reggiani, Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517 (MP3CV), Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, University of Balamand [Liban] (UOB), Marseille medical genetics - Centre de génétique médicale de Marseille (MMG), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Grigioni, Francesco, Benfari, Giovanni, Vanoverschelde, Jean-Loui, Tribouilloy, Christophe, Avierinos, Jean-Francoi, Bursi, Francesca, Suri, Rakesh M., Guerra, Federico, Pasquet, Agné, Rusinaru, Dan, Marcelli, Emanuela, Théron, Alexi, Barbieri, Andrea, Michelena, Hector, Lazam, Siham, Szymanski, Catherine, Nkomo, Vuyisile T., Capucci, Alessandro, Thapa, Prabin, Enriquez-Sarano, Maurice, Suri, R., Clavel, M.A., Maalouf, J., Michelena, H., Enriquez-Sarano, M., Tribouilloy, C., Trojette, F., Szymanski, C., Rusinaru, D., Touati, G., Remadi, J.P., Guerra, F., Capucci, A., Grigioni, F., Russo, A., Biagini, E., Pasquale, F., Ferlito, M., Rapezzi, C., Savini, C., Marinelli, G., Pacini, D., Gargiulo, G.D., Di Bartolomeo, R., Boulif, J., de Meester, C., El Khoury, G., Gerber, B., Lazam, S., Pasquet, A., Noirhomme, P., Vancraeynest, D., Vanoverschelde, J.-L., Avierinos, J.F., Collard, F., Théron, A., Habib, G., Barbieri, A., Bursi, F., Mantovani, F., Lugli, R., Modena, M.G., Boriani, G., Bacchi-Reggiani, L., University of Balamand - UOB (LIBAN), UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, and UCL - (SLuc) Service de pathologie cardiovasculaire

Subjects
Male, atrial fibrillation, mitral regurgitation, mitral repair, percutaneous treatment, prognosis, surgery, Aged, Aged, 80 and over, Atrial Fibrillation, Cohort Studies, Female, Humans, Middle Aged, Mitral Valve Insufficiency, Prevalence, Registries, Cardiology and Cardiovascular Medicine, 030204 cardiovascular system & hematology, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Sinus rhythm, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Ejection fraction, Mitral repair, Absolute risk reduction, Atrial fibrillation, Prognosis, 3. Good health, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Cardiology, medicine.symptom, prognosi, medicine.medical_specialty, Asymptomatic, Article, NO, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, International database, Internal medicine, medicine, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, In patient, Mitral regurgitation, business.industry, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Surgery, business, Percutaneous treatment
Abstract

BACKGROUND: Scientific guidelines consider atrial fibrillation (AF) complicating degenerative mitral regurgitation (DMR) a debated indication for surgery. OBJECTIVES: This study analyzed the prognostic/therapeutic implications of AF at DMR diagnosis and long-term. METHODS: Patients were enrolled in the MIDA (Mitral Regurgitation International Database) registry, which reported the consecutive, multicenter, international experience with DMR due to flail leaflets echocardiographically diagnosed. RESULTS: Among 2,425 patients (age 67 ± 13 years; 71% male, 67% asymptomatic, ejection fraction 64 ± 10%), 1,646 presented at diagnosis with sinus rhythm (SR), 317 with paroxysmal AD, and 462 with persistent AF. Underlying clinical/instrumental characteristics progressively worsened from SR to paroxysmal to persistent AF. During follow-up, paroxysmal and persistent AF were associated with excess mortality (10-year survival in SR and in paroxysmal and persistent AF was 74 ± 1%, 59 ± 3%, and 46 ± 2%, respectively; p < 0.0001), that persisted 20 years post-diagnosis and independently of all baseline characteristics (p values

Published
2019
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19. [Complications of infective endocarditis].

Author

Trojette F, Di Lena C, Bohbot Y, Rusinaru D, and Tribouilloy C

Subjects
Humans, Endocarditis, Bacterial etiology, Endocarditis, Bacterial diagnosis, Endocarditis etiology, Endocarditis diagnosis, Endocarditis complications
Abstract

COMPLICATIONS OF INFECTIVE ENDOCARDITIS. The high in-hospital mortality of patients with infective endocarditis (about 20%) is mainly due to its complications. These complications are essentially of cardiac, neurological, and infectious origin. Rapid diagnosis and early antibiotic treatment are of paramount importance and allow drastic reduction of the frequency and severity of such complications. Discussion with all physicians caring for the patients with infective endocarditis in an "endocarditis team" setting is a mandatory step in management optimization and outcome improvement. This "endocarditis team" approach allows faster identification of patients at high risk of acute heart failure and/or cerebral embolism, and selection of those who might benefit from urgent valvular surgery. Factors associated with high embolic risk are the size and mobility of vegetation, mitral valve endocarditis, and infection with Staphylococcus aureus. When neurological complications occur, there is a risk that these may be worsened by the valvular surgery if there is a hemorrhagic component. This risk needs to be careful weighed in a team approach before sending patients to surgery. Persistent sepsis after effective antibiotic treatments prompts to local extension of the disease or to embolic extra cardiac secondary infectious localization., Competing Interests: F. Trojette, C. Di Lena et D. Rusinaru déclarent n’avoir aucun lien d’intérêts. Y. Bohbot déclare avoir participé à des interventions ponctuelles pour AstraZeneca, Bayer, Novartis et avoir été pris en charge, à l’occasion de déplacements pour congrès, par AstraZeneca et Abbott. C. Tribouilloy déclare avoir participé à une intervention ponctuelle pour Novartis.

Published
2024

20. Optimizing coronary artery opacification and 3D reconstruction from human cadaver hearts in anatomy research.

Author

Barry M, Gun M, Chabry Y, Trojette F, Chardon K, Padurean P, Peltier J, Havet E, and Caus T

Subjects
Male, Female, Humans, Aged, Aged, 80 and over, Latex, Cadaver, Coronary Vessels diagnostic imaging, Imaging, Three-Dimensional methods
Abstract

Objective: This study seeks to identify the ideal dilution rate of a radiopaque product to optimize the visualization of coronary arteries and their branches within human cadaver hearts. The process involves obtaining images in the anatomy laboratory and subsequently constructing a three-dimensional model., Materials and Methods: We utilized 30 human hearts fixed in 10 % formalin (9 females and 21 males) with a mean age of 79 ± 5 years. The initial experiment, involving the first four hearts (referred to as "group 1"), encountered difficulties in opacifying coronary arteries. In this phase, a probabilistic injection of 20 % Visipaque and 80 % latex, with coronary sinus ostium closure, was performed. The optimal mixture ratio was then determined as 33 % Visipaque and 66 % latex. Recognizing the need for on-site injection at the CT Scan table, this protocol was applied to the subsequent 11 hearts in "group 2." Closure of the coronary sinus was deemed unnecessary. The final 15 hearts, constituting "group 3," revealed that the injection should be gradual, maintaining controlled pressure between 120 and 150 mm Hg. Post-injection, hearts were scanned with the injected coronary arteries using an Optima 660 CT scanner. Two-dimensional images were acquired with parameters set at 64 × 0.625 mm, 100 kV, 300-400 mA, and a rotation of 0.5 s. Subsequently, 3D reconstruction was conducted using Advantage Workstation 4.7 (GE Healthcare) and volume rendering with Volume Viewer software, version 15., Results: Significant differences in the percentage of opacified coronaries were observed among the three groups (p < 0.005). This variation underscores the learning curve and comprehension required before establishing a reliable method. Group 1 (N = 4) demonstrated minimal opacification, group 2 (N = 11) displayed partial opacification, while group 3 (N = 15) achieved 100 % opacification of coronary arteries., Conclusion: The successive experiments culminated in the development of a protocol for CT imaging, enabling accurate three-dimensional reconstruction of the normal anatomy of the main and secondary coronary arteries. Our work is grounded in a series of progressively refined and successful experiments., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Published
2024
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21. Impact of cardiac surgery on left-sided infective endocarditis with intermediate-length vegetations.

Author

Scheggi V, Bohbot Y, Tribouilloy C, Trojette F, Di Lena C, Philip M, Hubert S, Menale S, Zoppetti N, Del Pace S, Stefàno PL, Habib G, and Marchionni N

Subjects
Humans, Female, Middle Aged, Aged, Aged, 80 and over, Retrospective Studies, Hospitalization, Endocarditis complications, Endocarditis surgery, Cardiac Surgical Procedures adverse effects, Endocarditis, Bacterial complications, Endocarditis, Bacterial diagnosis, Endocarditis, Bacterial surgery
Abstract

Objective: The best strategy to manage patients with left-sided infective endocarditis (IE) and intermediate-length vegetations (10-15 mm) remains uncertain. We aimed to evaluate the role of surgery in patients with intermediate-length vegetations and no other European Society of Cardiology guidelines-approved surgical indication., Methods: We retrospectively enrolled 638 consecutive patients admitted to three academic centres (Amiens, Marseille and Florence University Hospitals) between 2012 and 2022 for left-sided definite IE (native or prosthetic) with intermediate-length vegetations (10-15 mm). We compared four clinical groups: medically (n=50) or surgically (n=345) treated complicated IE, medically (n=194) or surgically (n=49) treated uncomplicated IE., Results: Mean age was 67±14 years. Women were 182 (28.6%). The rate of embolic events on admission was 40% in medically treated and 61% in surgically treated complicated IE, 31% in medically treated and 26% in surgically treated uncomplicated IE. The analysis of all-cause mortality showed the lowest 5-year survival rate for medically treated complicated IE (53.7%). We found a similar 5-year survival rate for surgically treated complicated IE (71.4%) and medically treated uncomplicated IE (68.4%). The highest 5-year survival rate was observed in surgically treated uncomplicated IE group (82.4%, log-rank p<0.001). The analysis of the propensity score-matched cohort estimated an HR of 0.23 for uncomplicated IE treated surgically compared with medical therapy (p=0.005, 95% CI: 0.079 to 0.656)., Conclusions: Our results suggest that surgery is associated with lower all-cause mortality than medical therapy in patients with uncomplicated left-sided IE with intermediate-length vegetations even in the absence of other guideline-based indications., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2023
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24. The presence of elastic compression stockings reduces the fluid responsiveness of patients in the operating room.

Author

Zogheib E, Maizel J, Cherradi N, Benammar A, Labont B, Hchikat A, Bernasinski M, Trojette F, Slama M, and Dupont H

Subjects
Aged, Cardiac Surgical Procedures, Female, Hemodynamics, Humans, Intraoperative Period, Male, Operating Rooms, Prospective Studies, Fluid Therapy, Stockings, Compression, Stroke Volume
Abstract

Background: The aim of this study was to investigate whether elastic compression stockings (ECS) can affect fluid responsiveness parameters before and during passive leg raising (PLR) maneuvers., Methods: In the operating room (OR), we performed a prospective study including patients referred for cardiac surgery. Blood pressure (BP), ΔPP, heart rate (HR), central venous pressure (CVP), stroke volume (SV) and aortic blood flow (ABF) (by esophageal doppler) were measured according to four conditions: supine position without ECS (baseline 1), lower limbs raised to an angle of 45° (PLR 1), returned to the supine position with ECS (baseline 2), then a second PLR maneuver with ECS was performed (PLR 2)., Results: Twenty patients were included. BP, SV, ABF and CVP increased significantly. ΔPP and HR decreased during PLR 1. At baseline 2, HR and ΔPP decreased significantly compared to baseline 1. During PLR 2, increase of SV (4% [9]) and ABF (4% [9]), and the decrease of ΔPP (-19% [104]) were significantly lower than those observed at PLR 1 (7% [21] P=0.05; 9% [8] P=0.02 and -66% [40] P=0.02, respectively). Eleven patients presented a ΔPP≥13% at baseline 1. Only 1 patient still presented a ΔPP≥13% with ECS at baseline 2. Only 3/9 patients with an increase of ABF ≥10% and 2/11 patients with an increase of PP ≥12% during the PLR 1 presented similar results during PLR 2., Conclusions: In the OR, ECS provoke a self-fluid loading increasing ABF, decreasing ΔPP and PLR response. The presence of ECS should be considered when managing hemodynamic parameters of patients.

Published
2018
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25. Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score.

Author

Zogheib E, Cosse C, Sabbagh C, Marx S, Caus T, Henry M, Nader J, Fumery M, Bernasinski M, Besserve P, Trojette F, Renard C, Duhaut P, Kamel S, Regimbeau JM, and Dupont H

Abstract

Background: Bowel ischemia is a life-threatening emergency defined as an inadequate vascular perfusion leading to bowel inflammation resulting from impaired colonic/small bowel blood supply. Main issue for physicians regarding bowel ischemia diagnosis lies in the absence of informative and specific clinical or biological signs leading to delayed management, resulting in a poorer prognosis, especially after cardiac surgery. The aim of the present series was to propose a simple scoring system based on biological data for the diagnosis of bowel ischemia., Methods: In a retrospective monocentric study, patients admitted in cardiac ICU, after cardiovascular surgery, were screened for inclusion. According to a 1:2 ratio (case-control), matching between two groups was based on sex, type of cardiovascular surgery, and the operative period (per month). Patients were divided into two groups: "ischemic group" which corresponds to patients with confirmed bowel ischemia and "non-ischemic group" which corresponds to patients without bowel ischemia. Primary objective was the conception of a scoring system for the diagnosis of bowel ischemia. Secondary objectives were to detail the postoperative morbidity and the diagnostic features for the distinction between acute mesenteric ischemia and ischemic colitis., Results: Forty-eight patients (1.3%) had confirmed bowel ischemia ("ischemic group"). According to the 2:1 matching, 96 patients were included in the "non-ischemic group." Aspartate aminotransferase > 449 UI/L, lactate > 4 mmol/L, procalcitonin > 4.7 μg/L, and myoglobin > 1882 μg/L were found to be independently associated with bowel ischemia. Based on their respective odds ratios, points were assigned to each item ranging from 4 to 8. AUROCC [95% confidence interval] of the scoring system to diagnose bowel ischemia was 0.93 [0.91-0.95], p < 0.001. The optimal threshold after bootstrapping was ≥ 14 points; this yielded a sensitivity of 85.4%, a specificity of 94.8%, a positive likelihood ratio of 16.42, a negative likelihood ratio of 0.15, a Youden's index of 0.802, and a diagnostic odds ratio of 106.62., Conclusions: A biological scoring system based on PCT, ASAT, lactate, and myoglobin measurement allows the diagnosis of bowel ischemia after cardiac surgery with high accuracy. This score could help clinician to propose an early diagnosis and an early treatment in this high mortality disease.

Published
2018
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26. Fatal multifocal Pasteurella multocida infection: a case report.

Author

Guilbart M, Zogheib E, Hchikat AH, Kirat K, Ferraz L, Guerin-Robardey AM, Trojette F, Moubarak-Daher M, and Dupont H

Subjects
Aged, Animals, Bacteremia complications, Bacteremia microbiology, Dogs, Endocarditis, Bacterial complications, Endocarditis, Bacterial microbiology, Fatal Outcome, Humans, Male, Pasteurella Infections complications, Pasteurella Infections microbiology, Pasteurella multocida growth & development, Shock, Septic complications, Shock, Septic microbiology, Bacteremia pathology, Endocarditis, Bacterial pathology, Pasteurella Infections pathology, Pasteurella multocida pathogenicity, Shock, Septic pathology
Abstract

Background: In humans, Pasteurella multocida infections are usually limited to the soft tissues surrounding a lesion. However, P. multocida can also cause systemic infections (such as pneumonia, lung abscess, peritonitis, endocarditis, meningitis and sepsis)-especially in patients with other underlying medical conditions., Case Presentation: We report on a case of fulminant P. multocida bacteremia at several sites (soft tissues, endocarditis and joints) on a white European man. Despite surgery and intensive medical care, the patient died., Conclusions: The present case emphasizes the importance of appropriate initial treatment of skin wounds. Patients at risk should be aware of the possible consequences of being bitten, scratched or licked by their pet.

Published
2015
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27. The gray zone of the qualitative assessment of respiratory changes in inferior vena cava diameter in ICU patients.

Author

Duwat A, Zogheib E, Guinot P, Levy F, Trojette F, Diouf M, Slama M, and Dupont H

Subjects
Aged, Aged, 80 and over, Critical Care trends, Echocardiography standards, Echocardiography trends, Female, Fluid Therapy standards, Fluid Therapy trends, Hemodynamics physiology, Humans, Intensive Care Units trends, Male, Middle Aged, Prospective Studies, Respiration, Artificial trends, Critical Care standards, Intensive Care Units standards, Respiration, Artificial standards, Vena Cava, Inferior diagnostic imaging
Abstract

Introduction: Transthoracic echocardiography (TTE) is a useful tool for minimally invasive hemodynamic monitoring in the ICU. Dynamic indices (such as the inferior vena cava distensibility index (dIVC)) can be used to predict fluid responsiveness in mechanically ventilated patients. Although quantitative use of the dIVC has been validated, the routinely used qualitative (visual) approach had not been assessed before the present study., Methods: Qualitative and quantitative assessments of the dIVC were compared in a prospective, observational study. After operators with differing levels in critical care echocardiography had derived a qualitative dIVC, the last (expert) operator performed a standard, numeric measurement of the dIVC (referred to as the quantitative dIVC). Two groups of patients were separated into two groups: group (dIVC < 18%) and group (dIVC ≥ 18%)., Results: In total, 114 patients were assessed for inclusion, and 97 (63 men and 34 women) were included. The mean sensitivity and specificity values for qualitative assessment of the dIVC by an intensivist were 80.7% and 93.7%, respectively. A qualitative evaluation detected all quantitative dIVCs >40%. Most of the errors concerned quantitative dIVCs of between 15% and 30%. In the dIVC <18% group, two qualitative evaluation errors were noted for quantitative dIVCs of between 0 and 10%. The average of positive predictive values and negative predictive values for qualitative assessment of the dIVC by residents, intensivists and cardiologists were 83%, 83%, and 90%; and 92%, 94%, and 90%, respectively. The Fleiss kappa for all operators was estimated to be 0.68, corresponding to substantial agreement., Conclusion: The qualitative dIVC is a rather easy and reliable assessment for extreme numeric values. It has a gray zone between 15% and 30%. The highest and lowest limitations of the gray area are rather tedious to define. Despite reliability of the qualitative assessment when it comes to extreme to numerical values, the quantitative dIVC measurement must always be done within a hemodynamic assessment for intensive care patients. The qualitative approach can be easily integrated into a fast hemodynamic evaluation by using portable ultrasound scanner for out-of-hospital patients.

Published
2014
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28. Outcomes in mitral regurgitation due to flail leaflets a multicenter European study.

Author

Grigioni F, Tribouilloy C, Avierinos JF, Barbieri A, Ferlito M, Trojette F, Tafanelli L, Branzi A, Szymanski C, Habib G, Modena MG, and Enriquez-Sarano M

Subjects
Aged, Atrial Fibrillation etiology, Atrial Fibrillation prevention & control, Echocardiography, Doppler, Europe, Female, Heart Failure etiology, Heart Failure prevention & control, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Mitral Valve diagnostic imaging, Mitral Valve physiopathology, Mitral Valve Insufficiency complications, Mitral Valve Insufficiency mortality, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency surgery, Patient Selection, Proportional Hazards Models, Prospective Studies, Registries, Risk Assessment, Severity of Illness Index, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Function, Left, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures mortality, Mitral Valve surgery, Mitral Valve Insufficiency therapy
Abstract

Objectives: The purpose of this study was to assess incidence and predictors of events associated with nonsurgical and surgical management of severe mitral regurgitation (MR) in European institutions., Background: The management of patients with MR remains disputed, warranting multicenter studies to define clinical outcome in routine clinical practice., Methods: The MIDA (Mitral Regurgitation International DAtabase) is a registry created for multicenter study of MR with echocardiographically diagnosed flail leaflet as a model of pure, organic MR. Our cases were collected from 4 European centers. We enrolled 394 patients (age 64 +/- 11 years; 67% men; 64% in New York Heart Association functional class I to II; left ventricular ejection fraction 67 +/- 10%)., Results: During a median follow-up of 3.9 years, linearized event rates/year under nonsurgical management were 5.4% for atrial fibrillation (AF), 8.0% for heart failure (HF), and 2.6% for death. Mitral valve (MV) surgery was performed in 315 (80%) patients (repair in 250 of 315, 80%). Perioperative mortality, defined as death within 30 days from the operation, was 0.7% (n = 2). Surgery during follow-up was independently associated with reduced risk of death (adjusted hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.21 to 0.84; p = 0.014). Benefit was largely driven by MV repair (adjusted HR vs. replacement 0.37, 95% CI 0.18 to 0.76; p = 0.007). In 102 patients strictly asymptomatic and with normal ventricular function, 5-year combined incidence of AF, HF, or cardiovascular death (CVD) was 42 +/- 8%. In these patients, surgery also reduced rates of CVD/HF (HR 0.26, 95% CI 0.08 to 0.89; p = 0.032)., Conclusions: In this multicenter study, nonsurgical management of severe MR was associated with notable rates of adverse events. Surgery especially MV repair performed during follow-up was beneficial in reducing rates of cardiac events. These findings support surgical consideration in patients with MR due to flail leaflets for whom MV repair is feasible.

Published
2008
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29. Totally normothermic aortic arch replacement without circulatory arrest.

Author

Touati GD, Marticho P, Farag M, Carmi D, Szymanski C, Barry M, Trojette F, and Caus T

Subjects
Adult, Aged, Aged, 80 and over, Cardiopulmonary Bypass methods, Cerebrovascular Circulation physiology, Femoral Artery surgery, Heart Atria surgery, Humans, Middle Aged, Postoperative Complications, Radial Artery surgery, Treatment Outcome, Vascular Surgical Procedures methods, Aortic Dissection surgery, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic surgery, Perfusion methods
Abstract

Background: Various techniques have been proposed for cerebral protection during the surgical treatment of complex aortic disease. The authors propose a revisited strategy of normothermic replacement of the aortic arch to avoid limitations and complications of profound hypothermic circulatory arrest., Materials and Methods: From April 2000 to May 2006, 19 patients with an aneurysm of the aortic arch and 10 patients with an acute (7) or a chronic (3) aortic dissection underwent a totally normothermic, complete replacement of the aortic arch using three pumps: One pump ensured antegrade cerebral perfusion, at a flow rate adapted to obtain a pressure of 70 mmHg in the right radial artery, and required a selective cannulation of the supra-aortic vessels. A second pump ensured body perfusion at a flow rate adapted to obtain a pressure of 55 mmHg in the left femoral artery and was situated between the right femoral artery and the right atrium. A special balloon aortic occlusion catheter was placed in the descending thoracic aorta. A third pump ensured intermittent normothermic myocardial perfusion via the coronary venous sinus. The arch reconstruction was performed with no time limit., Results: There were two operative, in-hospital (6.8%) mortalities. All others patients were rapidly extubated, except one, with no neurological sequelae, and postoperative course was uneventful, without coagulopathy or hepato-renal impairment., Conclusions: In the light of these results, a normothermic procedure is possible for arch surgery and may ensure a more physiological autoregulation of cerebral blood flow while maintaining body perfusion without high vascular resistances.

Published
2007
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30. Clinical experience with the mini-extracorporeal circulation system: an evolution or a revolution?

Author

Remadi JP, Marticho P, Butoi I, Rakotoarivelo Z, Trojette F, Benamar A, Beloucif S, Foure D, and Poulain HJ

Subjects
Aged, Aortic Valve surgery, Coronary Artery Bypass, Equipment Design, Extracorporeal Circulation adverse effects, Female, Hemoglobins analysis, Humans, Male, Middle Aged, Miniaturization, Postoperative Complications, Extracorporeal Circulation instrumentation
Abstract

Purpose: We studied a cohort of 150 patients operated on with a new cardiopulmonary bypass (CPB) system. This is the mini-extracorporeal circulation (MECC) system., Description: The MECC is a fully heparin coated closed-loop CPB system that includes a centrifugal pump and has a priming volume of 450 mL. Between March 2001 and September 2002, 150 consecutive patients were operated on using the mini-CPB (MECC) method. This includes 105 coronary artery bypass graft and 45 aortic valve replacement patients. The median age was 66.7 +/- 10.7 years with a gender ratio of 3.27 males to 1 female., Evaluation: The 30-day operative mortality was 1.3%. The hemoglobin concentration was stable and perioperative transfusion was needed in only 6% of all patients. The renal and neuropsychiatric complications were less than 1%., Conclusions: In our experience, the MECC system is a reliable new concept for CPB with good clinical results.

Published
2004
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31. Management of patients with asymptomatic moderate aortic stenosis undergoing coronary artery bypass grafting.

Author

Touati GD, Carmi D, Trojette F, Bidaud M, Popesco D, Ben Amar A, and Poulain H

Subjects
Aged, Aged, 80 and over, Aortic Valve Stenosis complications, Aortic Valve Stenosis diagnostic imaging, Coronary Angiography, Coronary Restenosis etiology, Disease Progression, Echocardiography, Transesophageal, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Recurrence, Severity of Illness Index, Treatment Outcome, Aortic Valve Stenosis surgery, Coronary Artery Bypass
Abstract

Background and Aims of the Study: Manual decalcification of the aortic valve was performed systematically in a prospective series of patients with asymptomatic moderate aortic stenosis (AS) undergoing coronary artery bypass grafting (CABG). This study addressed two main issues: (i) whether aortic valve decalcification is a good option to relieve moderate AS; and (ii) whether the natural progression of AS may be delayed by manual valve debridement when surgery is indicated for coronary disease., Methods: Between October 1997 and March 2001, 14 adult patients with moderate AS underwent concomitant surgical repair of the aortic valve during CABG. Manual valve debridement with restoration of cusp mobility was attempted. Calcified deposits were removed by careful dissection. All patients underwent myocardial revascularization; a mean of 2.38 grafts was performed per patient., Results: Immediately after surgery, mean aortic valve area index (AVAI) was improved, from 0.56+/-0.12 to 1.43+/-0.25 cm2/m2. Patients with the slowest recalcification rates were those with a postoperative/preoperative AVAI ratio of 1.6 to 2.4, those in whom the degree of postoperative aortic insufficiency was very similar to the degree of preoperative regurgitation, and those in whom the preoperative AVAI was >0.55 cm2/m2., Conclusion: Manual aortic valve debridement for moderate AS is a good option when surgery must be performed for coronary disease; the best results were obtained in patients with senile stenosis of a tricuspid aortic valve with an AVAI of 0.55-0.9 cm2/m2.

Published
2002

32. [Ectopic atrial tachycardia complicating a congenital left atrial aneurysm: value of an electro-anatomical mapping system].

Author

Bakkour H, Hermida JS, Benitah-Touati N, Trojette F, Otmani A, Rey JL, and Touati G

Subjects
Adult, Electrocardiography, Electrophysiology, Heart Aneurysm pathology, Heart Aneurysm surgery, Humans, Imaging, Three-Dimensional, Male, Tachycardia, Ectopic Atrial classification, Tachycardia, Ectopic Atrial surgery, Heart Aneurysm complications, Heart Atria abnormalities, Tachycardia, Ectopic Atrial pathology
Abstract

The authors report the case of a patient with a congenital left atrial aneurysm complicated by ectopic atrial tachycardia treated successfully by surgery. Transoesophageal echocardiography and magnetic resonance imaging provided accurate measurements of the aneurysm and its anatomical relationships. Three-dimensional electro-anatomical mapping with the CARTO, system (Biosense) confirmed the shape and dimensions of the aneurysm. The system showed the electrically mute zones and the ectopic focus situated just beyond the aneurysmal neck. Surgical ablation confirmed the morphological and functional data of the imaging techniques and the patient was definitely cured.

Published
2002

33. [Dissection of the aorta complicated by aorto-pulmonary fistula].

Author

Leborgne L, Trojette F, Jarry G, Touati G, Otmani A, Hermida JS, Tribouilloy C, Remond A, Rey JL, and Quiret JC

Subjects
Aged, Aortic Dissection complications, Aortic Dissection surgery, Aortic Aneurysm, Thoracic complications, Aortic Aneurysm, Thoracic surgery, Arterio-Arterial Fistula complications, Arterio-Arterial Fistula surgery, Diagnosis, Differential, Humans, Male, Ultrasonography, Aortic Dissection diagnostic imaging, Aorta, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic diagnostic imaging, Arterio-Arterial Fistula diagnostic imaging, Pulmonary Artery diagnostic imaging
Abstract

The authors report the case of chronic dissection of the aorta presenting with congestive cardiac failure. The diagnosis was made for the first time by transoesophageal echocardiography which showed both the dissection of the aorta and its fistulalisation into the pulmonary artery. Aortography confirmed the diagnosis. The patient underwent surgery which consisted of suture of the fistula and replacement of the ascending aorta with a prosthetic tube. The outcome was favourable after 8 months follow-up.

Published
2001

34. Hemodynamic and echocardiographic effects of hemofiltration performed during cardiopulmonary bypass.

Author

Blanchard N, Toque Y, Trojette F, Quintard JM, Benammar A, and Montravers P

Subjects
Adult, Aged, Coronary Artery Bypass, Double-Blind Method, Female, Humans, Male, Middle Aged, Prospective Studies, Rewarming, Cardiopulmonary Bypass, Echocardiography, Transesophageal, Hemodynamics, Hemofiltration
Abstract

Objective: To evaluate the effects of hemofiltration performed during rewarming before emergence from cardiopulmonary bypass on hemodynamic and echocardiographic parameters., Design: Prospective randomized study; blind analysis of echocardiographic parameters and hemodynamic parameters., Setting: Single-center study performed in a university hospital., Participants: Two groups of 13 adult patients undergoing coronary artery bypass graft surgery., Intervention: Patients were randomized to conventional procedure or hemofiltration performed with a polysulfone hemofilter. Hemofiltration, started at the time of rewarming on cardiopulmonary bypass, was performed with a flow rate adjusted to achieve an ultrafiltrate volume of 15 mL/kg on completion of rewarming., Measurements and Main Results: Hemodynamic (systemic mean arterial pressure, right atrial pressure, heart rate) and echocardiographic parameters (shortening fraction, segmental kinetic score, cardiac output, systemic vascular resistance) were measured before and after hemofiltration and on arrival in the intensive care unit. Heart rate and cardiac index were increased significantly in both groups during the postoperative period. In the control group, systemic vascular resistance was decreased significantly, and cardiac index was increased during the postoperative period, together with significant alterations of segmental kinetic score and shortening fraction. In the hemofiltration group, systemic vascular resistance remained unchanged, associated with a significantly improved segmental kinetic score compared with the control group., Conclusions: Hemofiltration performed during rewarming before emergence from cardiopulmonary bypass is associated with stability of hemodynamic parameters and improved segmental myocardial kinetics.

Published
2000
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35. [Diagnostic value of echocardiography and thoracic spiral CT angiography in the diagnosis of acute pulmonary embolism].

Author

Otmani A, Tribouilloy C, Leborgne L, Vermes E, Trojette F, Beckers C, Remond A, Fonroget J, Rey JL, and Lesbre JP

Subjects
Acute Disease, Angiography methods, Humans, Tomography, X-Ray Computed, Echocardiography, Echocardiography, Transesophageal, Pulmonary Embolism diagnostic imaging
Abstract

The objective of this study was to define the limits of echocardiography and to evaluate thoracic spiral CT angiography (TSCTA) for the diagnosis of pulmonary embolism (PE). One hundred twelve consecutive patients, hospitalised for suspected PE, were included in this prospective study. All were investigated by pulmonary ventilation-perfusion scintigraphy (Sc) and 50 had a high probability of PE on this examination. Sc was normal in 22 patients. Forty patients were excluded because of an intermediate probability. In 50 patients with PE confirmed on Sc, transthoracic echocardiography (TTE) showed only indirect evidence of PE (intracavitary thrombus in 4% of cases). TSCTA demonstrated PE in 82% of cases and did not show any thrombus image when Sc was normal. Its negative predictive value was therefore 70% and its positive predictive value was 100%. Its sensitivity varied according to degree of perfusion defect (96% in the case of lobar lesion, 66% in the case of segmental lesion and 16% for a subsegmental lesion). Multidimensional transoesophageal echocardiography (TOE), performed in 37 of the 50 patients with PE, only revealed thrombi in the pulmonary tree in 3 patients (8%), all presenting severe PE. No thrombus was visualized on TOE in patients with non-serious PE. All thrombi observed on TOE were also demonstrated by TSCTA. In conclusion, TTE usually provides only indirect signs of PE. TOE has a poor diagnostic sensitivity for PE. TSCTA has a better sensitivity than TOE for the detection of thrombi in the pulmonary artery trunk and proximal centimetres of its two branches, but normal CT angiography cannot exclude a distal PE.

Published
1998

36. [Transesophageal echocardiography before electric cardioversion for supraventricular arrhythmia].

Author

Tribouilloy C, Lucas G, Rey JL, Trojette F, Gallet B, Choquet D, and Lesbre JP

Subjects
Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Tachycardia, Supraventricular therapy, Thorax, Echocardiography, Transesophageal, Electric Countershock, Tachycardia, Supraventricular diagnostic imaging
Abstract

Objectives: The aim of this prospective study was to assess the risks of electrical shock cardio-version in the treatment of supraventricular rhythm disorders when administered under effective-dose but short duration anticoagulation in patients with no intracavitary thrombus detectable by transesophageal echocardiography., Patients and Methods: One hundred nineteen patients, mean age 66 years, with permanent arrhythmia due to atrial fibrillation (n = 102), atrial flutter (n = 16) or atrial tachycardia (n = 1) and taking no long-term anticoagulant therapy were treated by electrical shock cardioversion. The patients were given heparin at an effective dose 72 hours prior to cardioversion. A transthoracic and a transesophageal echocardiography were performed less than 24 hours prior to cardioversion., Results: Twenty-one thrombi were evidenced in 16 patients (14.6%) including 18 in the left auricle, 1 in the left atrium and 2 in the right atrium. A spontaneous contrast was visualized in 38 patients (32%). Cardioversion was performed in 103 patients without thrombus and later in 9 of the 16 patients with thrombus after absorption under anticoagulant therapy as evidenced on the control transesophageal echocardiography. A sinus rhythm was obtained in 82% of the cases. All patients were given anti-vitamin K anticoagulants for one month. There were no clinical manifestation of ischemic vascular events during cardioversion nor during the one-month follow-up., Conclusion: Early use of electrical shock cardioversion in patients with supraventricular rhythm disorders can be proposed without long-term anticoagulation therapy if the absence of thrombi is demonstrated by transesophageal echocardiography and short-term heparin is given followed by oral anticoagulants for at least 4 weeks. A large-scale randomized prospective study comparing the conventional strategy with the protocol used in this study would be required to definitively validate this approach and determine its possible advantages.

Published
1998

37. [Non-bacterial thrombosing endocarditis. Apropos of 2 cases].

Author

Tribouilloy C, Mirode A, Leduc I, Peltier M, Trojette F, Tribout B, and Lesbre JP

Subjects
Aged, Echocardiography, Transesophageal, Endocarditis diagnostic imaging, Endocarditis pathology, Female, Heart Neoplasms complications, Heart Valves diagnostic imaging, Heart Valves pathology, Humans, Middle Aged, Thrombosis diagnostic imaging, Thrombosis pathology, Endocarditis complications, Thrombosis etiology
Abstract

The diagnosis of nonbacterial thrombosing endocarditis or marasmic endocarditis must be considered in patients presenting with a combination of cancer and systemic embolism. The pathophysiological mechanisms of this entity are unclear and purely hypothetical. However, hypercoagulability appears to play an essential role in the pathogenesis of this endocarditis, which could be the cardiac expression of a coagulopathy involving the entire vascular system. The authors report two cases of marasmic endocarditis which emphasize the value of transthoracic and transoesophageal echocardiography in the difficult diagnosis of this disease.

Published
1997

38. [Can Doppler echocardiography help to avoid cardiac catheterization in the surgical decision-making in isolated left heart valve diseases?].

Author

Tribouilloy C, Leborgne L, Rey JL, Trojette F, Shen WF, and Lesbre JP

Subjects
Adult, Aged, Aged, 80 and over, Aortic Valve Insufficiency physiopathology, Aortic Valve Insufficiency therapy, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis therapy, Decision Making, Female, Hemodynamics, Humans, Male, Middle Aged, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency therapy, Mitral Valve Stenosis physiopathology, Mitral Valve Stenosis therapy, Prospective Studies, Sensitivity and Specificity, Ventricular Function, Left, Aortic Valve Insufficiency diagnosis, Aortic Valve Stenosis diagnosis, Cardiac Catheterization, Echocardiography, Doppler, Mitral Valve Insufficiency diagnosis, Mitral Valve Stenosis diagnosis
Abstract

The aim of this study was to assess the value of non-invasive investigation based on clinical evaluation and Doppler echography in deciding the operative indications of patients with isolated left heart valvular lesions compared. Three hundred and thirty five patients were included in a prospective study: 78 had MR, 57 had AR, 150 had AS and 50 had MS. All underwent clinical. Doppler echography and catheter studies. The therapeutic decision was taken blind by two groups of 2 cardiologists. Group I took its decision based on clinical findings and results of Doppler echography whilst Group II took its decision on the clinical and catheter data. For each patient, one of the following three choices was proposed: 1) medical treatment: 2) surgery or valvuloplasty with balloon catheter; 3) request for further information. In addition, in group I, the need for coronary angiography was left to the appreciation of two cardiologists. The quantification of the valvular disease was concordant for groups I and II in 93, 97, 98.5 and 100% for MR, AR, AS and MS respectively. These percentages were respectively 97, 95, 92 and 100% for assessment of left ventricular function. The theoretical management decision was concordant between the two groups for 97% of MR, 94.7% of AR, 95.3% of AS and 94% of MS. Complementary information requiring invasive studies was required by group I in 3.9% of cases. A discordant opinion was obtained in 0.6% of cases (2 cases of AS). Coronary angiography was requested by the cardiologists of Group I in 34% of patients, identifying all patients who underwent coronary bypass surgery. These results show that cardiac catheterisation is no longer an essential diagnostic procedure for discussing the indications of valvular surgery in the majority of patients with isolated left heart lesions.

Published
1996

39. [Cardiac involvement in amyloidosis. Apropos of a case of hereditary amyloidosis of neurologic expression].

Author

Dujardin X, Trojette F, Lesbre JP, and Tribouilloy C

Subjects
Amyloidosis complications, Amyloidosis genetics, Cardiomyopathies complications, Diastole, Echocardiography, Electrocardiography, Humans, Male, Middle Aged, Prognosis, Systole, Amyloidosis physiopathology, Cardiomyopathies physiopathology, Nervous System Diseases etiology
Abstract

The authors report a case of hereditary amyloidosis in a 54-year old patient with an essentially neurological clinical expression. The cardiovascular assessment, consisting of echocardiography performed systematically while the patient was free of any cardiac symptoms, revealed typical amyloid infiltration with a hyperechoic, shiny appearance of the myocardium and significant parietal hypertrophy. Systolic function was preserved, in contrast with impairment of diastolic function, revealed by the presence of Appleton type I mitral blood and decreased propagation velocity of the transmitral flow on colour TM. The authors stress the importance of ultrasonographic examination in all patients with suspected cardiac amyloidosis, even in the absence of clinical or electrical signs.

Published
1996

40. [Pulmonary hypertension associated with portal hypertension. Apropos of 2 cases].

Author

Mirode A, Tribouilloy C, Boulanger J, Adam MC, Trojette F, and Lesbre JP

Subjects
Adult, Electrocardiography, Female, Humans, Hypertension, Portal drug therapy, Hypertension, Pulmonary drug therapy, Liver Cirrhosis, Alcoholic complications, Male, Middle Aged, Portal Vein abnormalities, Portasystemic Shunt, Surgical adverse effects, Prognosis, Ultrasonography, Doppler, Color, Hypertension, Portal complications, Hypertension, Pulmonary complications
Abstract

The authors report the cases of two patients with pulmonary hypertension associated with portal hypertension. This is a rare association with a reported prevalence ranging from 0.25 to 0.73%. The diagnosis of portal hypertension preceded that of pulmonary hypertension by several years. The physiopathological mechanism of the latter is not well known although several hypotheses have been proposed. Treatment is only symptomatic. The prognosis is usually poor, the causes of death being related to complications of liver failure and/or portal hypertension or to those of pulmonary hypertension.

Published
1995

41. [Multidimensional transesophageal echocardiography in the determination of the orificial surface of aortic stenoses in adults. Apropos of 85 cases].

Author

Peltier M, Tribouilloy C, Shen W, Ali Mirode A, Trojette F, and Lesbre JP

Subjects
Adult, Aged, Aged, 80 and over, Aortic Valve Stenosis pathology, Cardiac Catheterization, Feasibility Studies, Female, Hemodynamics, Humans, Male, Middle Aged, Prospective Studies, Reproducibility of Results, Aortic Valve diagnostic imaging, Aortic Valve Stenosis diagnostic imaging, Echocardiography, Transesophageal
Abstract

The objective of this study was to assess the validity of multidimensional transoesophageal echocardiography (TOE) in the determination of the orificial surface area of aortic stenosis (AS) in 85 patients, using as a reference the surface area calculated on transthoracic ultrasonography (TTU) by applying the continuity principle (n = 75) and/or by haemodynamic studies using Gorlin's formula (n = 40). Planimetry was able to be performed in 78 of the 85 patients (92%). Planimetry was impossible in 7 patients with massive calcification of the aortic orifice (n = 5) or posterior valve (n = 2). The mean value of the selected angle was 45 +/- 13 degrees (0 to 78 degrees). An excellent correlation was observed between aortic surface area (ASA) measured by multidimensional TOE and TTU (r = 0.94; y = 0.90x +/- 0.10; SEE = 0.10 cm2; p < 0.001). Similarly, the ASA on multidimensional TOE was also well correlated with the haemodynamic surface area (r = 0.90, y = 0.94x +/- 0.05; SEE = 0.09 cm2; p < 0.001). The correlations between multidimensional TOE and TTU measurements (n = 26; r = 0.96; y = 0.85 x +/- 0.11; SEE = 0.07 cm2; p < 0.001) and cardiac catheterization (n = 13; r = 0.92; y = 0.77 x +/- 0.7; SEE = 0.09 cm2; p < 0.001) remained satisfactory in patients with associated aortic incompetence. Multidimensional TOE identifies cases of AS with an ASA on TOE or haemodynamic studies less than or equal to 0.75 cm2 with sensitivities of 93% and 92%, respectively, and a specificity of 100%. Overall, multidimensional TOE allows a precise and reliable evaluation of ASA in the great majority of cases of AS.

Published
1995

42. [Does mitral insufficiency prevent spontaneous contrast phenomenon and formation of thrombi in the left atrium?].

Author

Adam MC, Tribouilloy C, Mirode A, Trojette F, Leborgne L, Bickert P, Shen WF, and Lesbre JP

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Arrhythmias, Cardiac diagnostic imaging, Atrial Function, Left, Brain Ischemia diagnostic imaging, Echocardiography, Doppler, Female, Humans, Male, Middle Aged, Mitral Valve Insufficiency physiopathology, Retrospective Studies, Echocardiography, Transesophageal, Heart Diseases diagnostic imaging, Mitral Valve Insufficiency diagnostic imaging, Thrombosis diagnostic imaging
Abstract

The aim of this study was to assess the influence of mitral regurgitation on the prevalence of left atrial spontaneous echo contrast and thrombosis in 2,180 consecutive patients undergoing transthoracic and transoesophageal echocardiography. Two groups of patients were defined according to the absence (group I) or presence (group II) of grades 3 or 4 mitral regurgitation quantified by transoesophageal echocardiography. Group II was associated with a statistically significant lower frequency of spontaneous echo contrast (0.6 vs 11.2%; p < 0.0001), left atrial thrombosis (0.6 vs 4.2%; p < 0.03), ischaemic cerebrovascular accidents (1.2 vs 21%; p < 0.0001), transient ischaemic attacks (0 vs 12%; p < 0.0001) and systemic embolism (0 vs 4.6%; p < 0.01). Conversely, the prevalence of atrial fibrillation was higher in group II (28 vs 19%; p < 0.01) and there were more patients with left atrial dimensions > or = 5.5 cm (16 vs 6.7%; p < 0.0001). When mitral stenosis and valve prosthesis were excluded, there were no cases of spontaneous echo contrast (8.3 vs 0%; p < 0.001) or left atrial thrombosis (2.9 vs 0%; p < 0.05) in the group with grades 3 or 4 mitral regurgitation. The phenomenon of left atrial spontaneous echo contrast and/or thrombosis is rare in patients with grade 3 or 4 in native mitral valve regurgitation and explains the low incidence of systemic embolism in these cases.

Published
1995

43. [Doppler echocardiography of tricuspid insufficiency. Methods of quantification].

Author

Loubeyre C, Tribouilloy C, Adam MC, Mirode A, Trojette F, and Lesbre JP

Subjects
Humans, Tricuspid Valve Insufficiency diagnosis, Tricuspid Valve Insufficiency physiopathology, Echocardiography, Doppler, Tricuspid Valve Insufficiency diagnostic imaging
Abstract

Evaluation of tricuspid incompetence has benefitted considerably from the development of Doppler ultrasound. In addition to direct analysis of the valves, which provides information about the mechanism involved, this method is able to provide an accurate evaluation, mainly through use of the Doppler mode. In addition to new criteria being evaluated (mainly the convergence zone of the regurgitant jet), some indices are recognised as good quantitative parameters: extension of the regurgitant jet into the right atrium, anterograde tricuspid flow, laminar nature of the regurgitant flow, analysis of the flow in the supra-hepatic veins, this is only semi-quantitative, since the calculation of the regurgitation fraction from the pulsed Doppler does not seem to be reliable; This accurate semi-quantitative evaluation is made possible by careful and consistent use of all the criteria available. The authors set out to discuss the value of the various evaluation criteria mentioned in the literature and try to define a practical approach.

Published
1994

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