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BackgroundWhereas first-line bronchial artery embolisation (BAE) is considered standard of care for the management of severe haemoptysis, it is unknown whether this approach is warranted for non-severe haemoptysis.Research questionTo assess the efficacy on bleeding control and the safety of first-line BAE in non-severe haemoptysis of mild abundance.Study design and methodsThis multicentre, randomised controlled open-label trial enrolled adult patients without major comorbid condition and having mild haemoptysis (onset ResultsBleeding recurrence at day 30 after randomisation (primary outcome) occurred in 4 (11.8%) of 34 patients in the BAE strategy and 17 (44.7%) of 38 patients in the medical strategy (difference −33%; 95% CI −13.8% to −52.1%, p=0.002). The 90-day bleeding recurrence-free survival rates were 91.2% (95% CI 75.1% to 97.1%) and 60.2% (95% CI 42.9% to 73.8%), respectively (HR=0.19, 95% CI 0.05 to 0.67, p=0.01). No death occurred during follow-up and no bleeding recurrence needed surgery.Four adverse events (one major with systemic emboli) occurred during hospitalisation, all in the BAE strategy (11.8% vs 0%; difference 11.8%, 95% CI 0.9 to 22.6, p=0.045); all eventually resolved.ConclusionIn non-severe haemoptysis of mild abundance, BAE associated with medical therapy had a superior efficacy for preventing bleeding recurrences at 30 and 90 days, as compared with medical therapy alone. However, it was associated with a higher rate of adverse events.Trial registration numberNCT01278199

Background & Aims Refractory ascites in patients with cirrhosis is associated with poor survival. TIPS is more effective than para-centesis for the prevention of recurrence of ascites but increases the risk of encephalopathy while survival remains unchanged. A more accurate selection of the patients might improve these results. The aim of the present study was to identify parameters of prognostic value for survival in patients with refractory ascites treated with TIPS. Methods One hundred and five consecutive French patients with cirrhosis and refractory ascites treated with TIPS were used to assess parameters associated with 1-year survival. The model was then tested in two different cohorts: a local and prospective one including 40 patients from Toulouse, France, and an external one including 48 patients from Barcelona, Spain. Results The actuarial rate of survival in the first 105 patients was 60% at 1 year. Using multivariate analysis, only lower bilirubin levels and higher platelet counts were independently associated with survival. The actuarial 1-year survival rate in patients with both a platelet count above 75×10 9 /L and a bilirubin level lower than 50μmol/L [3mg/dl] was 73.1% as compared to 31.2%, in patients with a platelet count below 75×10 9 /L or a bilirubin level higher than 50μmol/L. These results were confirmed in the two different validation cohorts. Conclusions The combination of a bilirubin level below 50μmol/L and a platelet count above 75×10 9 /L is predictive of survival in patients with refractory ascites treated with TIPS. This simple score could be used at bedside to help choose the best therapeutic options.

Stent graft has resulted in major advances in the treatment of trauma patients with blunt traumatic aortic injury (TAI) and has become the preferred method of treatment at many trauma centers. In this review, we provide an overview of the place of stent grafts for the management of this disease. As a whole, TEVAR repair of TAIs offers a survival advantage and reduction in major morbidity, including paraplegia, compared with open surgery. However, endovascular procedures in trauma require a sophisticated multidisciplinary and experienced team approach. More research and development of TAI-specific endograft devices is needed and large, multicenter studies will help to clarify the role of TEVAR compared with open repair of TAI.

Points essentiels Le syndrome aortique aigu (SAA) regroupe differentes entites pouvant potentiellement mettre en jeu la survie des patients. Le syndrome aortique aigu regroupe les hematomes de paroi, les ulceres de l’aorte et les dissections aortiques. Les progres de l’imagerie et des techniques endovasculaires permettent une meilleure prise en charge de cette maladie. La place actuelle des stent-grafts pour la prise en charge des SAA se definit sur la base des donnees de la litterature la plus recente.

Thermal ablation: tolerance and efficacy in a population mostly composed of primary lung cancers Purpose Radiofrequency thermal ablation (TA) of lung tumors currently is considered an alternative to surgical management for early primary lung cancers (1) and non-surgical lung metastases. The purpose of this study was to determine the tolerability and efficacy of this treatment in 29 consecutive patients, most of which with primary lung cancers, managed in our center. Materials and methods Twenty-nine patients with 32 lung tumors less than 35 mm in diameter underwent radiofrequency thermal ablation between May 2004 and July 2008. The CT examinations performed during and after the ablation were reviewed to determine lesion characteristics, complications, treatment, local recurrence rate and survival rate. Results Sixty-nine percent of our population consisted of primary lung cancer. The incidence of pneumothorax was 72% with 10% requiring drainage. The rate of complete response was 81%. The survival rate at 1 year was 79%. Conclusion Radiofrequency thermal ablation of lung tumors is a minimally invasive technique with high rate of complete response. It can be considered in non-surgical patients with primary or metastatic lung tumors less than 35 mm in diameter.

Cardiac tumors: CT and MR imaging features The CT and MR imaging features of the main cardiac tumors will be reviewed. Cross-sectional imaging features may help differentiate between cardiac tumors and pseudotumoral lesions and identify malignant features. Based on clinical features, imaging findings are helpful to further characterize the nature of the lesion. CT and MR imaging can demonstrate the relationship of the tumor with adjacent anatomical structures and are invaluable in the presurgical work-up and postsurgical follow-up.

Resume Introduction La thermo-ablation (ou radiofrequence) est une nouvelle technique de radiologie interventionnelle utilisee pour le traitement des tumeurs primitives bronchiques ou secondaires de petite taille (inferieures a 3 cm) chez des patients inoperables ou ne pouvant beneficier de radiotherapie externe. Elle est deja utilisee pour le traitement de certains cancers (foie, rein) de facon courante mais est une technique plus recente s’appliquant aux tumeurs pulmonaires primitives et secondaires. Methodes Nous avons suivi, par tomodensitometrie, 12 patients porteurs de primitifs bronchiques traites par cette technique de 2004 a 2008. Resultats Notre etude a montre une bonne tolerance immediate du geste avec des effets iatrogenes mineurs (75% de pneumothorax) et aucun effet iatrogene majeur. De plus, cette technique est associee a un bon controle local (8,3% de recidive locale). Conclusions La radiofrequence apparait comme une alternative interessante chez les patients porteurs d’un cancer bronchique non operable, du fait de sa bonne tolerance et d’un controle local satisfaisant.

Indications for and experience with placement of endovascular stent grafts in the thoracic aorta are still evolving. Recent advances in imaging technologies have drastically boosted the role of pre-procedural imaging. The accepted diagnostic gold standard, digital subtraction angiography, is now being challenged by the state-of-the-art computed tomography angiography (CTA), magnetic resonance angiography (MRA) and trans-oesophageal echocardiography (TEE). Among these, technological advancements of multidetector computed tomography (MDCT) have propelled it to being the default modality used, optimising the balance between spatial and temporal resolutions and invasiveness. MDCT angiography allows the comprehensive evaluation of thoracic lesions in terms of morphological features and extent, presence of thrombus, relationship with adjacent structures and branches as well as signs of impending or acute rupture, and is routinely used in these settings.In this article, we review the current state-of-the-art radiological imaging for thoracic endovascular aneurysm repair (TEVAR), especially focusing on the role of MDCT angiography. After analysing the technical aspects for optimised imaging protocols for thoracic aortic diseases, we discuss pre-procedural determinants of candidacy, and how to formulate interventional plans based on cross-sectional imaging.

RésuméLe besoin se faisait prégnant de définir les indications du coroscanner alors même que la technologie multicoupes évolue. Le scanner 64 coupes a démontré son haut niveau de performances diagnostiques vis à vis des lésions ≥ 50%, sur des populations sélectionnées. Il est utilisé actuellement pour sa valeur prédictive négative (96-98%). Ses performances réelles en terme de quantification lésionnelle sont inférieures à la coronarographie avec une tendance à la surestimation du degré de sténose pour les lésions inférieures à 70%.Pour la détection de la maladie coronaire, le coroscanner doit se positionner, par rapport aux arguments cliniques (probabilité prétest de maladie coronaire) et d’ischémie myocardique fournis par des tests fonctionnels.Les principales indications appropriées retenues sont :●Dans le cadre de la douleur thoracique aiguë, le coroscanner élimine la maladie coronaire avec une excellente VPN et un bon rapport de vraisemblance négatif (0,05), lorsque l’ECG n’est pas contributif, deux dosages de troponine à 6 heures d’intervalle sont négatifs, chez un patient à faible risque de maladie coronaire.●Dans l’angor stable ou la précordialgie atypique, il est justifié chez les patients à risque faible et intermédiaire dont les tests fonctionnels sont non contributifs ou non réalisables, où que l’ECG est ininterprétable.●Il est un complément à la coronarographie pour l’évaluation morphologique de certaines lésions avant recanalisation et mise en place de prothèse (occlusions longues, lésions proximales impliquant l’artère interventriculaire antérieure et l’artère circonflexe).Chez les patients sélectionnés, il est réalisable en remplacement à la coronarographie avant une chirurgie valvulaire.AbstractThere is a need to define the current indications for coronary CT angiography (CCTA) even as technology continuously evolves. CCTA using 64 MDCT units has shown to be highly accurate for diagnosis of sténoses ≥ 50% on selected populations. It is currently used for its negative predictive value (96-98%). Stenosis quantification remains inferior to conventional coronary angiography with tendency to overestimate stenoses

Introduction Le syndrome cave est une urgence oncologique pour laquelle la mise en place d’une prothese cave superieure doit etre discutee. Materiel et methode Afin d’apprecier l’efficacite et les complications de cette methode, nous avons etudie de maniere retrospective 41 patients porteurs de cancers bronchiques et ayant beneficie de la mise en place de protheses en nitinol auto expansibles durant les 5 dernieres annees. Le geste etait associe a une anticoagulation, une corticotherapie par voie generale et un traitement etiologique. Resultats Quarante et un patients ont beneficie de ce traitement (30 hommes et 11 femmes) avec un âge moyen de 59 ans. Les etiologies tumorales du syndrome cave superieur etaient : adenocarcinomes (8), cancers a petites cellules (11), carcinomes epidermoides (9), cancers a grandes cellules (9) ou autres types (4). Tous les patients etaient symptomatiques. Le delai moyen entre l’apparition des symptomes et la realisation du geste etait de 14 jours. Le traitement etait associe a un traitement etiologique de type chimiotherapie seule pour 18 patients, radiotherapie seule pour 1 patient, radio-chimiotherapie pour 14 patients et aucun traitement pour 6 patients. Le geste consistait en la mise en place de 1 (73 %) ou 2 (27 %) protheses, d’une longueur totale moyenne de 7,5 cm et d’un calibre moyen de 14 mm. Aucune complication n’etait rapportee. Une amelioration des symptomes dans les 48 heures etait obtenue chez tous les patients. La survie moyenne apres mise en place de la prothese etait de 6,7 mois. Conclusion La mise en place d’une prothese cave superieure permet une amelioration rapide des symptomes, avec un tres faible taux de complication. Sous reserve d’une technique adequate, ce traitement doit etre envisage en premiere intention chez les patients presentant un cancer bronchique peu radio- ou chimiosensible complique d’un syndrome cave symptomatique.

Les syndromes aortiques aigus regroupent trois entites : la dissection aortique, l’hematome intramural et l’ulcere atherosclereux penetrant. En raison du risque vital, le diagnostic et la prise en charge doivent etre realises rapidement avec la technique la plus fiable et la moins invasive possible. Une imagerie complementaire est indispensable, elle aura plusieurs objectifs : une description precise des lesions, une classification topographique, une recherche d’extension aux troncs supra-aortiques et aux arteres viscerales, ou une atteinte des structures voisines (pericarde, plevre, mediastin). Ce bilan exhaustif permet d’evaluer la severite et le potentiel evolutif des lesions et ainsi guider la strategie therapeutique. Le scanner permet actuellement au mieux le bilan des lesions en urgence, en revanche, il n’apporte pas d’information sur l’etat de la valve aortique. L’echocardiographie a l’avantage d’etre disponible et realisable au lit du patient, dans les unites de soins intensifs, mais elle n’est pas toujours contributive. Cet examen permet en revanche l’evaluation de la fonction ventriculaire, la recherche d’une insuffisance aortique ou d’un epanchement. En fait, ces deux examens sont souvent complementaires. Un traitement medical et une surveillance en reanimation sont indispensables dans tous les cas. En dehors du traitement medical, schematiquement, pour les atteintes de l’aorte ascendante, une intervention chirurgicale en urgence reste la regle, parfois associee a un geste endovasculaire, en particulier en cas de malperfusion viscerale. Pour les dissections de type B, les traitements chirurgicaux ou endovasculaires sont reserves aux complications, dominees par la rupture et les ischemies viscerales. Dans ce cas, les techniques endovasculaires se sont developpees du fait de leur meilleure tolerance. 1) L’exclusion des portes d’entrees par un stent-graft permet la depressurisation du faux chenal et la thrombose de celui-ci. Un remodelage avec une diminution des diametres aortiques est ainsi observe avec une reperfusion des arteres distales. 2) La fenestration par voie endovasculaire est reservee aux malperfusions liees a un mecanisme dynamique. Le principe est de creer un orifice de communication large entre le vrai et le faux chenal pour faire baisser la pression dans le faux chenal. 3) La mise en place de stents non couverts dans les arteres d’organes concernes par la malperfusion peut etre utile pour les ischemies d’origine statique. Au total, les dissections aortiques peuvent beneficier de therapeutiques endovasculaires efficaces, soit isolement, soit en complement d’une chirurgie de l’aorte ascendante.

Multidetector CT is very useful in the evaluation of polytrauma patients. MDCT is valuable for the detection and treatment planning of vascular injuries, but it may not be available to hemodynamically unstable patients. Embolization of visceral and parietal branches of the aorta benefits from advances in catheter technology: hydrophilic catheters and microcatheters are very helpful in this context. Resorbable particles (such as gelatin) and coils are the most useful occlusive agents. Endovascular stenting of aortic rupture is nowadays considered in many centers as the best therapeutic option and can be proposed as an alternative to surgery.

Adenoid cystic carcinoma (ACC) is a common head and neck tumor originating from salivary glands but that can also exceptionally develop in the trachea and major bronchi. ACC is generally considered as a slow-growing, low-grade malignancy with prolonged clinical course. Metastases are very unusual and recurrences are more often local. Treatment for localized ACC is surgery. We here report for the first time a case of lung ACC with a synchronous liver metastasis proved by biopsy. Moreover, we report the interest of performing a 18FDG PET-CT as both primary tumor and liver metastasis presented an intense FDG uptake. The specificity of the liver 18FDG uptake was confirmed by Glut-1 positive immunostaining. We propose that 18FDG PET-CT should be considered in the initial staging of lung ACC in selected patients.

Purpose To describe a case involving perforation of a previously placed aortic Dacron graft by the uncovered proximal stent of a thoracic stent-graft. Case report A 76-year-old man with a surgically treated type A dissection presented with residual type B dissection. Thoracic stent-grafting of the entry site was performed successfully. After 2 years, the patient was admitted for evaluation of a non-pulsating parasternal mass. Computed tomography showed a large, hypodense liquid-like mass affecting the mediastinum up to the subcutaneous tissue. A false aneurysm at the proximal end of the stent-graft was observed arising from an aortic perforation by the uncovered stent. One week later, the mass had almost completely resolved, and the patient has been scheduled for close surveillance. Conclusion This case illustrated the importance of thoroughly examining the long-term durability and compatibility of prosthetic materials.

The authors present the case of a 48-year-old man with diffuse pulmonary lymphangiomatosis. This rare lymphatic disorder is characterized by proliferation of anastomosing lymphatic vessels varying in size. Clinical presentation and imaging findings are highly suggestive. Bronchoscopic examination of this patient showed, for the first time to our knowledge, vesicles disseminated throughout the bronchial tree. Histopathological examinations are necessary to differentiate lymphangiomatosis from lymphangiectasis. The diagnosis can be made by transbronchial biopsy without performing open lung biopsy which was, until now, considered necessary for diagnosis.

Objective The study's objective was to comparatively evaluate surgery and stent-graft repair of acute or subacute traumatic aortic rupture. Methods A total of 76 patients (14–76 years old; mean, 37 years; male/female ratio, 63/11) with a traumatic aortic injury were admitted to our hospital between 1981 and 2003. Six patients died within 1 to 9 days of another associated severe traumatic lesion. The 70 remaining patients were divided according to the type of rupture repair. In group 1, 35 patients were treated surgically: 28 with immediate repair and 7 with delayed repair (average time interval 66 days, 5–257 days). In group 2, 29 patients were treated with stent grafting of the aortic isthmus. In group 3, 6 patients with minor aortic lesions were treated medically with a close follow-up. Results In the 28 patients treated surgically in the emergency department, the mortality and paraplegia rates were 21% and 7%, respectively. No death or paraplegia was observed in the group with delayed surgical repair. With stent grafting, complete exclusion of the pseudoaneurysmal sac was observed in all patients. Except for 1 iliac rupture treated during the same procedure, there was no major morbidity or mortality during the mean follow-up of 46 months (13–90 months). No major complication was observed in group 3. Conclusions In stable rupture of the aorta, initial conservative treatment is safe and allows management of the major associated lesions. Stent grafting of the aortic isthmus is a valuable therapeutic alternative to surgical repair, especially in patients considered high risk for conventional thoracotomy.

CT, MRI and transesophageal echocardiography have become the standard of reference for evaluation of the thoracic aorta. Angiography is mainly performed as a presurgical procedure. Congenital pathologies observed during adulthood include coarctation, patent ductus arteriosus, and aberrant retroesophageal subclavian arteries. Imaging plays a major role for diagnosis and management of patients with acute aortic syndromes: intramural hematoma, dissection, penetrating ulcer and nondissecting aneurysms. Cross sectional imaging of the thoracic aortic wall allows evaluation of inflammatory diseases of the aorta or aortitis.

The aim of this study was to evaluate the frequency and evolution after treatment of mediastinal lymphadenopathy associated with congestive left heart failure on CT scans in correlation with clinical and echocardiographic findings. Thirty-one consecutive patients with subacute left heart failure underwent a clinical evaluation using the NYHA classification, a CT examination, and transthoracic echocardiography at the time of initial presentation (T1). After initiation of medical treatment (T2), follow-up CT scans were systematically obtained together with a clinical evaluation. At T1, all patients showed severe (type III: n=12, 39%; type IV: n=12, 39%) to moderate (type I, n=1, 3%; type II, n=6, 19%) dyspnea with a mean ejection fraction of 39% (range 22-74%). On initial CT scans, enlarged mediastinal lymph nodes were seen in 13 patients (42%) with blurred contours in 5 patients (16%) and hazy mediastinal fat in 1 patient (3%). Significant decrease in the size of lymphadenopathy was observed between T1 and T2 (T1, n=13, 42% vs T2, n=10, 32%; p0.05) with a concurrent decrease in the severity of dyspnea (grade III-IV dyspnea at T1, n=24, 78% vs grade I-II dyspnea at T2, n=26, 83.5%). Patients with enlarged lymph nodes at T1 showed: (a) a significantly lower ejection fraction at echocardiography than those without lymphadenopathy (mean+/-SD value: 34+/-12.9 vs 43+/-13.8%; p=0.04); (b) a significantly larger diameter of the right superior pulmonary vein (mean+/-SD value: 17+/-2.75 vs 14+/-3.9 mm; p=0.04); and (c) a higher frequency of abnormal peribronchovascular thickening ( n=5 vs n=1; p=0.06). Mediastinal lymphadenopathy associated with subacute left heart failure was observed in 13 patients (42%), showing regression after initiation of treatment in 8 of 13 patients (62%).

Resume But Evaluer la faisabilite et la fiabilite de la mise en place d’endoprotheses pour traiter les ruptures aigues post-traumatiques de l’isthme aortique : presentation de notre experience de 16 patients. Materiels et methodes Entre janvier 1996 et decembre 2001, 16 patients, âges en moyenne de 36 ans, ont ete traites par cette technique. Tous presentaient des lesions associees et 9 d’entre eux, une instabilite hemodynamique non liee a la rupture isthmique. Apres un delai variant de 9 a 245 jours (moyenne 78 jours), une endoprothese aortique etait mise en place par une equipe pluridisciplinaire. Un suivi regulier etait realise par scanner et echographie transoesophagienne. Resultats L’endoprothese a permis l’exclusion du faux anevrisme dans 100 % des cas. La procedure durait en moyenne 120 minutes et 80 % des patients ont pu etre extubes sur table. Le sejour moyen aux soins intensifs etait de 24 heures. La seule complication etait une compression de la bronche souche gauche par le faux anevrisme, traitee avec succes par une endoprothese bronchique. Le recul maximal etait de 7 ans. Conclusion La mise en place d’endoprothese pour rupture aigue de l’isthme aortique est une technique fiable et peut etre proposee comme alternative a la chirurgie pour les polytraumatises dont les lesions associees augmentent le risque chirurgical.

Purpose: To evaluate the midterm outcomes of thoracic aortic stent-grafting and the performance of computed tomographic angiography (CTA), radiography, and magnetic resonance angiography (MRA) in endograft surveillance. Methods: Forty-seven patients with traumatic thoracic aortic ruptures (n=16), aneurysms (n=14), false aneurysms (n=3), penetrating ulcers (n=3), and dissections (n=11) treated with stent-grafts were monitored in follow-up using chest radiography and CTA in all patients and MRA in 23 patients. Two perpendicular maximal aortic diameters, the sum of these diameters, and the elliptical cross-sectional area were determined and compared to baseline for the entire group and in subgroup analyses according to lesion type. CTA, MRA, and radiography were compared for their ability to detect endoleak, monitor stent-graft configuration, and measure aortic diameters. Results: The mortality rate was 8.5%. Severe complications were observed in 14.8% (6% neurological complications); 12 (25.5%) patients had primary endoleaks. Over a mean 11-month follow-up (range 0.25–46 months), the aortic diameters decreased for all patients without endoleak (pConclusions: Morbidity and mortality observed after thoracic stent-grafting are acceptable. Radiography is better for monitoring stent-graft conformation, while CTA provides the best overall morphological information. The performance of MRA in endoleak detection is encouraging.

The purpose of our study was to evaluate the feasibility and the safety of transjugular intrahepatic portosystemic shunts (TIPS) with a new expanded-polytetrafluoroethylene-covered stent and the influence of the covering on occlusion rate.Twenty cirrhotic patients (57 +/- 11 years old) admitted with a history of esophageal variceal bleeding (n = 11), refractory ascites (n = 5), or both (n = 4) were included. Five of the patients were treated for TIPS revision, and 15 as de novo TIPS placements. The endoprostheses used were composed of a 2-cm noncovered nitinol stent and a 4- to 8-cm expanded-polytetrafluoroethylene graft covering, and were placed from the portal vein to the ostium of the hepatic vein. Patients underwent Doppler sonography at discharge and again at 1, 3, 6, 9, 12, and 15 months and underwent venography with portosystemic pressure gradient measurement at 6 months and whenever necessary.At the time of this writing, complications included three TIPS restenoses and one recurrent ascites successfully treated by balloon dilation, two cases of segmentary liver ischemia, and one patient with encephalopathy that required shunt reduction. After TIPS placement, the portosystemic pressure gradient dropped from 18 +/- 5 to 5 +/- 4 mm Hg. Primary and secondary patency rates were 80% and 100%, respectively, at 387 days.These results clearly show the feasibility of TIPS placement with the Gore TIPS endoprosthesis stent-graft and its improved patency compared with results in the literature for bare stents. These preliminary results must be certified further with randomized comparative trials between covered and noncovered TIPS stents.

Purpose: To report the endovascular repair of an aortobronchial fistula at the distal anastomosis of a complex thoracic graft. Case Report: A 61-year-old man operated 18 years prior for aortic coarctation presented with hemoptysis. An aortobronchial fistula was suspected, but spiral computed tomography and angiography showed only a small pseudoaneurysm at the distal anastomosis without revealing the fistulous tract. A Talent stent-graft was successfully deployed through a femoral access, but the large delivery system injured the external iliac artery, producing a retroperitoneal hemorrhage. Prompt balloon occlusion of the aorta and subsequent bypass graft repair of the arterial injury prevented serious sequelae. The patient recovered without further complications. Follow-up imaging to 2 years has documented exclusion of the pseudoaneurysm with no hemoptysis or signs of new false aneurysm formation. Conclusions: Endovascular exclusion of anastomotic pseudoaneurysms even in complicated cases can be an efficient treatment option, but the procedure must be carefully planned and executed in order to achieve good results.

To evaluate the efficacy of a new rotational thrombectomy device, and the procedure-related risk of particle embolization.The experiments were performed in transparent silicone tubes. The conditions of flow were as close as possible to physiological parameters. Distal embolization was detected by a mesh of nylon filters.The Straub Rotarex catheter was able to remove all clots. The mean number of migrating particles larger than 1000 microm was 0.17 (+/- 0.38), the mean number of 400-1000 microm migrating particles was 1.08 (+/- 1.04). The mean intervention time was 67 (+/- 37) sec. The mean volume of collected liquid was 96.6 (+/- 24.7) ml.The in vitro results suggest that the Straub Rotarex catheter is able to remove large volumes of thrombus with a limited risk of embolization. The main limitation of our model is the absence of adhesion of the clot to the tube.

Cardiac abscess is an uncommon and fatal complication after transplantation. We report a case of an initially isolated aspergillosis myocardial abscess diagnosed by cardiac magnetic resonance imaging (CMRI). At that time, there was no other biological evidence or other extracardiac manifestations. A three-month course of dual antifungal therapy followed by a single antifungal therapy was empirically given. Six month after admission,Aspergillus fumigatuswas isolated for the first time and the patient deceased from a disseminated aspergillosis.

Aims To study the relationship between left ventricular (LV) trabeculations, volume, and sphericity in patients with dilated cardiomyopathy (DCM) by cardiac magnetic resonance imaging (CMR). Methods and results Eighty-two patients with DCM were prospectively explored by CMR. The segmental trabeculation index (STI) was defined by the ratio of trabeculated layer thickness on compacted layer thickness per segment. The global trabeculation index (GTI) was defined by the ratio of the sum of the total trabeculated layer thickness to the sum of the total compacted layer thickness. The apex was excluded from the analysis. The mean number of segments with trabeculation per patient was 10 ± 2 with a mean GTI of 0.68 ± 0.32. The LV sphericity index was inversely correlated with LV ejection fraction ( R = −0.42, P = 0.0002) and positively with the brain natriuretic peptide (BNP) level ( R = 0.34, P = 0.003). The maximal STI was positively correlated with the indexed LV end-diastolic volume ( R = 0.32, P = 0.004) and the LV sphericity index ( R = 0.25, P = 0.02), but not with the BNP level or LV ejection fraction. The GTI was positively correlated with the LV sphericity index ( R = 0.27, P = 0.016) but not with indexed LV end-diastolic volume, BNP levels, or LV ejection fraction. Conclusion Trabeculation indexes depend on LV shape and are positively correlated with LV sphericity. These results encourage interpreting LV trabeculation with caution in patients with DCM, considering additional morphologic criteria such as LV geometry.

International audience; Computed tomographic coronary angiography (CTCA) has been proposed as a noninvasive test for significant coronary artery disease (CAD), but only limited data are available from prospective multicenter trials. The goal of this study was to establish the diagnostic accuracy of CTCA compared to coronary angiography (CA) in a large population of symptomatic patients with clinical indications for coronary imaging. This national, multicenter study was designed to prospectively evaluate stable patients able to undergo CTCA followed by conventional CA. Data from CTCA and CA were analyzed in a blinded fashion at central core laboratories. The main outcome was the evaluation of patient-, vessel-, and segment-based diagnostic performance of CTCA to detect or rule out significant CAD (≥50% luminal diameter reduction). Of 757 patients enrolled, 746 (mean age 61 ± 12 years, 71% men) were analyzed. They underwent CTCA followed by CA 1.7 ± 0.8 days later using a 64-detector scanner. The prevalence of significant CAD in native coronary vessels by CA was 54%. The rate of nonassessable segments by CTCA was 6%. In a patient-based analysis, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of CTCA were 91%, 50%, 68%, 83%, 1.82, and 0.18, respectively. The strongest predictors of false-negative results on CTCA were high estimated pretest probability of CAD (odds ratio [OR] 1.97, p

Les hypertensions arterielles pulmonaires (HTAP) sont classees selon la nouvelle classification de Dana Point 2008 en cinq groupes. Le diagnostic positif d’HTAP repose sur le catheterisme cardiaque droit qui permet d’affirmer le diagnostic, de definir le niveau de severite de l’hypertension pulmonaire, d’orienter l’etiologie avec notamment l’elimination des cardiopathies gauches, et de realiser un test therapeutique en fin d’intervention. L’echocardiographie est utilisee en depistage et pour la surveillance.

Summary Background Multislice computed tomography coronary angiography (MSCT-CA) is feasible in the emergency department (ED) for ruling out obstructive coronary artery disease (CAD). Aim To investigate a diagnostic strategy using MSCT-CA for the early triage of patients presenting to the ED with acute chest pain suggestive of acute coronary syndrome (ACS), according to the medium-term incidence of clinical events. Methods We conducted a single-centre, prospective, observational cohort study in 123 patients with low-risk to intermediate-risk acute chest pain suggestive of ACS. MSCT-CA was performed using dual-source 64-slice computed tomography with retrospective electrocardiographic gating. Patients without coronary artery lesions were discharged from the ED. The incidences of death, myocardial infarction and myocardial revascularization were collected during a mid-term follow-up. Results According to MSCT-CA, 93 patients (75.6%) had no CAD or coronary artery stenosis less or equal to 50% and 28 patients (22.8%) had stenosis more or equal to 50%. Invasive coronary angiography was performed in 29 patients (23.6%). MSCT-CA accurately identified ten patients (8.13%) with obstructive CAD requiring myocardial revascularization; all had a low TIMI score (0–2) and eight had a low GRACE score. The mean estimated effective dose of MSCT-CA was 16.3 ± 6.4 mSv. Median follow-up was 15 months. No patient (95% CI 0–3.0%) had major adverse cardiovascular events during follow-up. Conclusion MSCT-CA appears to be a useful initial triage tool in the ED. When the MSCT-CA result is negative, it allows safe early discharge because of its high negative predictive value. In a significant number of cases of low-risk ACS, MSCT-CA detects severe coronary lesions and allows further dedicated diagnostic and therapeutic intervention. Reduction of radiation exposure would help acceptance in clinical practice.

Acute aortic syndrome (AAS) describes several life threatening aortic pathologies. Acute aortic syndrome include intramural haematoma, penetrating aortic ulcer and acute aortic dissection. Advances in both imaging and endovascular treatment has led to an increase in diagnosis and improved management of these often catastrophic pathologies. The current place of stent-grafts for the AAS management is defined on the basis of the most recent literature.

To compare cardiac MRI with right heart catheterisation in patients with pulmonary hypertension (PH) and to evaluate its ability to assess PH severity. Forty patients were included. MRI included cine and phase-contrast sequences, study of ventricular function, cardiac cavity areas and ratios, position of the interventricular septum (IVS) in systole and diastole, and flow measurements. We defined four groups according to the severity of PH and three groups according to IVS position: A, normal position; B, abnormal in diastole; C, abnormal in diastole and systole. IVS position was correlated with pulmonary artery pressures and PVR (pulmonary vascular resistance). Median pulmonary artery pressures and resistance were significantly higher in patients with an abnormal septal position compared with those with a normal position. Correlations were good between the right ventricular ejection fraction and PVR, right ventricular end-systolic volume and PAP, percentage of right ventricular area change and PVR, and diastolic and systolic ventricular area ratio and PVR. These parameters were significantly associated with PH severity. Cardiac MRI can help to assess the severity of PH.

Decouverte a l’echographie cardiaque d’une masse intra-auriculaire droite revelee par un syndrome cave superieur chez un homme de 38 ans, sans antecedent. Une IRM est demandee pour faire le bilan.

Les ruptures traumatiques de l’aorte thoracique (le plus souvent isthmiques) ont longtemps ete considerees comme une urgence absolue necessitant un traitement chirurgical immediat. Depuis la fin des annees 1990, de nouveaux modes de prise en charge ont ete developpes. Le traitement endovasculaire des traumatismes aortiques est aujourd’hui considere comme une alternative valable a la chirurgie conventionnelle, permettant d’exclure de facon durable la lesion aortique tout en reduisant les taux de morbidite et de mortalite operatoires. Les principaux avantages sont d’eviter une thoracotomie, de limiter ou d’eviter l’heparinisation ainsi que le syndrome inflammatoire lie a l’utilisation de la circulation extracorporelle, d’eviter tout clampage aortique.

Alors qu’il existe un large consensus en faveur du traitement chirurgical des dissections interessant l’aorte ascendante, le traitement des dissections de l’aorte thoracique descendante reste controverse. A quelques exceptions pres, la plupart des equipes ont en effet adopte, depuis plus de 10 ans, une attitude conservatrice dans le traitement des dissections aigues de l’aorte thoracique descendante, le traitement chirurgical etant reserve aux complications. Les raisons de cette attitude etaient fondees sur trois constats: 1. la mortalite operatoire reste relativement elevee; 2. les resultats a long terme sont comparables que les malades aient ete traites medicalement ou chirurgicalement; 3. le traitement medical stabilise la dissection et previent le deces precoce dans la majorite des cas.

La prise en charge des dissections aortiques (DA) ne fait plus, a ce jour, l’objet d’un consensus du fait de la necessite de traiter les complications peripheriques a type de malperfusion d’organes. Essentiellement digestives, renales et des membres inferieurs, elles sont a l’origine d’une surmortalite de 20% a 1 mois dans les dissections de type A et de 10% dans celle de type B. L’apparition de traitements endovasculaires specifiques de ces malperfusions a modifie l’arbre decisionnel de prise en charge des dissections aortiques.

Un patient de 60 ans nous est adresse pour exploration radiologique d’un syndrome cave superieur par IRM. L’IRM cardiaque met en evidence un processus tissulaire infiltrant. Le bilan d’extension est negatif par ailleurs (scanner thoraco-abdomino-pelvien).

Coronary artery fistulas are rare and half of them are symptomatic. Diagnosis is confirmed by echocardiography and coronarography and can be precisely located by multislice CT-scan. We report the case of a 56-year-old female patient with congestive heart failure caused by a coronaro-cardiac fistula established between the proximal circumflex coronary artery and the right atrium. Surgical exclusion of the fistula was achieved by ligation of both extremities and a running suture on the aneurysmal vessel. Follow-up at 6 months was satisfactory with an asymptomatic patient and absence of recurrence of the fistula on echocardiography.