Schmallenberg virus: experimental infection in goats and bucks.

BACKGROUND: Schmallenberg virus (SBV) is an emerging Orthobunyavirus of ruminant livestock species currently circulating in Europe. SBV causes a subclinical or mild disease in adult animals but vertical transmission to pregnant dams may lead to severe malformations in the offspring. Data on the onset of clinical signs, viremia and seroconversion in experimentally infected adult animals are available for cattle and sheep but are still lacking for goats. For a better understanding of the pathogenesis of SBV infection in adult ruminants, we carried out experimental infections in adult goats. Our specific objectives were: (i) to record clinical signs, viremia and seroconversion; (ii) to monitor viral excretion in the semen of infected bucks; (iii) to determine in which tissues SBV replication took place and virus-induced lesions developed. RESULTS: Four goats and two bucks were inoculated with SBV. Virus inoculation was followed by a short viremic phase lasting 3 to 4 days and a seroconversion occurring between days 7 and 14 pi in all animals. The inoculated goats did not display any clinical signs, gross lesions or histological lesions. Viral genomic RNA was found in one ovary but could not be detected in other organs. SBV RNA was not found in the semen samples collected from two inoculated bucks. CONCLUSIONS: In the four goats and two bucks, the kinetics of viremia and seroconversion appeared similar to those previously described for sheep and cattle. Our limited set of data provides no evidence of viral excretion in buck semen.

Host preferences of Palaearctic Culicoides biting midges: implications for transmission of orbiviruses.

Feeding success depends on host availability, host defensive reactions and host preferences. Host choice is a critical determinant of the intensity at which pathogens are transmitted. The aim of the current study was to describe host preferences of Palaearctic Culicoides species (Diptera: Ceratopogonidae) Latreille using traps baited with the five different host species of poultry, horse, cattle, sheep and goat. Collections were carried out nightly in July and August 2009 in western France with three replicates of a 5 × 5 randomized Latin square (five sites, five hosts). Moreover, an ultraviolet (UV) light/suction trap was operated during host-baited collections to correlate Culicoides biting rates and UV light/suction trap catches. A total of 660 Culicoides belonging to 12 species, but comprised mainly of Culicoides scoticus Downes and Kettle, Culicoides dewulfi Goetghebuer and Culicoides obsoletus Meigen, were collected on animal baits. Abundance was highest for the horse, which accounted for 95% of all Culicoides caught, representing 10 species. The horse, the largest bait, was the most attractive host, even when abundance data were corrected by weight, body surface or Kleiber's scaling factor. Culicoides obsoletus was the only dominant species attracted by birds. Both C. scoticus and C. dewulfi were collected mainly from the upper body of the horse. Finally, the quantification of host preferences allows for discussion of implications for the transmission of Culicoides-borne pathogens such as bluetongue virus.

Imaging and modern assessment of the right ventricle.

The right ventricular function is difficult to assess owing to its complex morphology, structure and function. The right ventricle (RV) comprises three compartments, the inlet, the apex, and the outlet contracting with a peristaltic motion from the inflow to the outflow chamber and is tightly linked to left ventricular (LV) function through the pulmonary circulation, the interventricular septum and the myocardium inside the pericardial envelop. The relation of RV function to symptom occurrence, exercise capacity and prognosis in a wide variety of cardiac diseases emphasizes the usefulness of its routine assessment. The evaluation of the RV is largely carried out by echocardiography in daily clinical practice despite important limitations inherent to two-dimensional imaging. Multiple views and numerous parameters allow clinicians to integrate the RV function in the clinical decision-making process. Recent modalities of echocardiography such as myocardial deformation and three-dimensional imaging or exercise echocardiography are promising tools for the assessment of the RV. Cardiac magnetic resonance imaging provides the unique opportunity to image the RV in motion and in three dimensions without the limitation of echogenicity. Therefore, cardiac magnetic resonance imaging is taking a growing place in the assessment of the RV in a wide variety of cardio-pulmonary diseases as pulmonary hypertension, ischemia, arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy, heart failure or congenital heart diseases. Integrating the complex interplay between both ventricles and the pulmonary circulation, this review will discuss the latest results of standard and novel techniques allowing the assessment of RV function by echocardiography and cardiac magnetic resonance imaging, and will provide to the clinicians, facing therapeutic challenges, a comprehensive overview of right heart function.

[Diagnosis of a calcified intramural mass next to the posterior mitral valve: review of 4 cases]. / Diagnostic d'une masse calcifiée intrapariétale adjacente à la valve mitrale postérieure: à propos de 4 cas.

PURPOSE: Calcified intramural tumors next to the posterior mitral valve leaflet are rare. The purpose of this paper is to review the differential diagnosis of such lesions. PATIENTS AND METHODS: The CT and MR imaging features of 4 patients (2 males, 2 females) aged between 67 and 76 years with calcified mass at the base of the mitral valve annulus on echocardiogram are reviewed. RESULTS: From a list of potential diagnoses, the two suggested diagnoses include: post-traumatic calcified myocardial hematoma and liquefaction necrosis of mitral annular calcifications. The diagnostic imaging features are reviewed. CONCLUSION: Post-traumatic calcified myocardial hematoma and liquefaction necrosis of mitral annular calcifications may be difficult to diagnose but should be recognized bevause they require simple follow-up.

[Current indications for cardiac MR imaging]. / Indications cliniques appropriées de l'IRM en pathologie cardio-vasculaire.

MRI has acquired over the years a role in the evaluation of cardiovascular pathology especially with regards to its ability to assess right and left ventricular function and delayed postcontrast "viability" sequences. Current class I clinical indications include: viability for patients with ischemic cardiomyopathy and acute coronary syndrome, etiology and prognostic evaluation of non-ischemic cardiomyopathies including myocarditis and arrhytmogenic right ventricular cardiomyopathy, chronic pericarditis and cardiac masses, non-urgent aortic aneurysm and dissection, congenital cardiopathies: vascular malformations and follow-up after curative or palliative surgery. MRI provides a complete non operator dependent evaluation, and is particularly useful for follow-up since it may be repeated due to its absence of ionizing radiation

[An evaluation of the effectiveness of applying 16-slice computed tomography (CT) to coronary arteries in preoperative aortic valve replacement]. / Evaluation du scanner 16 coupes des artères coronaires dans le bilan préopératoire du rétrécissement valvulaire aortique.

UNLABELLED: An evaluation of the effectiveness of applying 16-slice Computed Tomography (CT) to coronary arteries in preoperative aortic valve replacement. PURPOSE: To evaluate the effectiveness of using 16-slice CT to diagnose a significant stenosis in coronary arteries in patients with severe aortic valve stenosis. MATERIAL AND METHODS: 50 patients were included in the study. After a medium contrast injection, CT images of the arteries were taken using 0.75 mm slices. We paired the images with an ECG. Segments smaller than 1.5 mm were discarded, and the results were compared to those from the coronary angiography. RESULTS: A satisfactory visualization of the coronary network was obtained for 80% (40/50) of the patients. For these 40 patients, 23 of the 29 patients without coronary stenosis were correctly classified but 4 of the 11 patients with coronary lesions were not recognized. The sensitivity of the multi-slice CT in detecting a least one significant coronary stenosis is 63.6%, the specificity 79.3%, positive predictive value 53.8% and negative predictive value 85.2%. CONCLUSION: the 16-slice CT is a relatively effective and minimally invasive tool to highlight before valve replacement significant coronary stenosis in arteries greater than 1.5 mm in diameter in patients with severe aortic valvular stenosis. CT technology is currently insufficient for diagnosis, but we hope that with advances in multi-slice CT engineering, its use will help patients avoid invasive coronary angiographies.

[Septal alcoholisation of hypertrophic obstructive cardiomyopathy in childhood]. / Alcoolisation septale d'une cardiomyopathie hypertrophique obstructive de l'enfant.

The authors report a case of septal alcoholisation in a 6 year old child with hypertrophic obstructive cardiomyopathy responsible for congestive cardiac failure despite optimal betablocker therapy. The indication was retained in a context of mucoviscidosis complicated by multiresistant bacterial infection. At catheterisation, the dominant septal artery was identified and an alcoholisation was performed by the classic technique described in adults. The immediate result was satisfactory with regression of the signs of cardiac failure and reduction of 70 mmHg of the maximal instantaneous pressure gradient (from 160 to 90 mmHg). However, 10 months later, the signs of right heart failure reappeared with a partial increase in the maximal instantaneous pressure gradient (100 mmHg) leading to surgical myectomy while the patient's condition had considerably improved from the pulmonary point of view. Septal alcoholisation would appear to be a therapeutic alternative in children especially in cases with a temporary or permanent contraindication to conventional surgery.

Spread of Coxiella burnetii infection in a flock of sheep after an episode of Q fever.

In October 1998, two abortions associated with Coxiella burnetii occurred in a group of 34 pregnant ewes in the sheep flock belonging to INRA Tours-Nouzilly. The flock was kept in groups of approximately 40 ewes, which were housed together in the same accommodation. The prevalence of C burnetii infection in the groups was investigated by using ELISA and PCR tests, which revealed a high prevalence of C burnetii. The ewes were treated with oxytetracycline to reduce the shedding of C burnetii and to prevent further abortions. Nevertheless, five abortions attributed to C burnetii occurred in January and March 1999 in three groups of ewes, and 24 of the ewes still shed the bacteria into their vaginal tracts. In addition, a serological study was carried out during the first year of life of the female lambs born in 1999 and 2000; 12 per cent of 113 lambs born in 1999 were seropositive for C burnetii by ELISA, and half of the ELISA-positive lambs were born either to serologically positive ewes or to dams that excreted the pathogen into their vaginal tracts. However, all the 150 lambs born in 2000 were ELISA-negative, suggesting that the preventive measures undertaken had suppressed both the abortions and the shedding of C burnetii, and reduced the transmission of the agent.

Clinical and angiographic results of stenting for long coronary arterial atherosclerotic lesions.

A prospective registry of 187 patients who underwent percutaneous coronary angioplasty with attempted long NIR stent delivery was performed. A successful stent delivery was achieved in 93% of cases with a low rate of major cardiovascular events, and 6-month follow-up showed low rates of clinical events, new revascularization procedures, and angiographic restenosis.

[Changes in left ventricular dP/dt during transluminal coronary angioplasty]. / Modifications de la dP/dt ventriculaire gauche au cours de l'angioplastie transluminale coronaire.

The authors studied changes of LV dP/dt during transcutaneous coronary angioplasty (TCA). The aim of the study was to detect the alterations of LV function during coronary occlusion and to evaluate the immediate effects of PCA on myocardial function. Six patients with incapacitating angina and isolated left anterior descending disease were successfully treated by TCA using Gruntzig's technique. The study protocol included several recording sequences per patient during the phases of balloon inflation at progressively increasing pressures from 2 to 10 hours. Each sequence comprised a recording under basal conditions and every 5 seconds during inflation (20 seconds) and deflation (45 seconds) of the following parameters: heart rate, aortic and LV pressures, positive and negative peaks of LV dP/dt, and the intracoronary pressure gradient at the beginning and the end of each sequence. The first part of the results based on 27 recorded sequences analysed the bad effects of myocardial ischaemia; coronary occlusion induced a significant fall (p less than 0.01) in the positive and negative peak dP/dt values and on elevation (p less than 0.01) in LV end diastolic pressure, without affecting LV systolic pressure or heart rate. These changes have the following characteristics: they are early, occurring within seconds of coronary occlusion; they affect LV contraction and relaxation simultaneously, but the effects are more marked on LV relaxation; the severity is proportional to the duration of occlusion; they are totally reversible; the disturbances of relaxation return to normal more quickly than those of contraction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Coronary aneurysm after transluminal angioplasty. Report of 13 cases]. / Anévrysmes coronaires après angioplastie transluminale. A propos de 13 observations.

The aim of this study was to determine the incidence, angiographic characteristics, clinical consequences, therapeutic implications and evolution of coronary arterial aneurysms after percutaneous transluminal coronary angioplasty (PTCA) based on a series of 13 cases out of a total population of 752 patients undergoing balloon dilatation. Before BTCA, 10 patients had unstable angina and 3 had stable angina. The stenoses were of type A in 6 cases and, more complex, type B, in 7 cases. The results of PTCA were good except in 1 case in which the procedure was complicated by a rudimentary infarct due to an extensive intra mural rupture. The frequency of coronary aneurysms evaluated in a series of 150 patients dilated and controlled systematically was 4 p. 100. This complication was observed relatively late, 2 to 13 months after PTCA. The length of aneurysm ranged from 2 to 13 mm (3.9 +/- 2.9 mm). Nine aneurysms were sacciform and 4 were fusiform. They were isolated in 6 cases and associated with restenosis in 7 cases. The predisposing role of an oversized angioplasty balloon was a probable etiological factor; the balloon/artery ratio was over 1.1 in 4 cases and over 1.2 in 3 cases. Intramural rupture observed at the time of PTCA (8/13 cases) did not seem to be a predisposing factor as the incidence of coronary aneurysm was not significantly different in patients without this complication in the group of 150 patients dilated and controlled systematically by angiography (5.8% vs 3%; NS). In the 6 cases of isolated coronary aneurysm the patients were asymptomatic and were followed up with medical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative results of coronary angioplasty performed at the time of coronarography and at a later time]. / Résultats comparés de l'angioplastie coronaire pratiquée dans le même temps ou à distance de la coronarographie.

Between January 1986 and December 1988, 558 patients underwent percutaneous transluminal coronary angioplasty (PTCA) of whom 40 per cent were dilated at the time of diagnostic coronary arteriography. In order to assess the value of this therapeutic strategy we compared the results of 221 patients dilated at the time of diagnostic coronary arteriography (Group 1) with those of 337 patients who underwent deferred PTCA. In Group 1, the incidence of stable angina was lower (26.7% vs 46.3%, p less than 10-5), that of thrombolysed myocardial infarction was higher (24% vs 2.7%, p less than 10-9) and a higher proportion of patients had previously undergone PTCA (29.4% vs 3.2%, p less than 10-9). The proportion of patients with single vessel disease was higher in Group 1 (84.6% vs 74.7%, p less than 0.01) as was that of angioplasty of a single lesion (97.7% vs 88.1%, p less than 10-4). There were fewer dilations of the left circumflex artery in Group 1 (17.2% vs 27.3%, p less than 0.05) which was compensated by a higher number involving the right coronary artery (26.1% vs 15.5%, p less than 0.01). The immediate results were comparable in the two groups with 87.8 per cent primary successes, 3.6 per cent of myocardial infarcts and 1.3 per cent of coronary bypass operations with no fatalities in Group 1. These favorable results encourage the development of PTCA at the time of diagnostic coronary arteriography in the following indications: unstable angina, thrombolysed myocardial infarction and restenosis irrespective of the patient's symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Combination of true and false left ventricular aneurysm. Cine-MRI diagnosis]. / Association d'un vrai et faux anévrysme du ventricule gauche. Diagnostic par ciné-IRM.

The authors report a case of a 68-year-old man with a history of postero-lateral myocardial infarction complicated by a true and a pseudo-aneurysm of the left ventricle, a chance finding during investigation of a systemic embolism. This is a rare association which is clinically difficult to diagnose. The authors describe the different complementary investigations available to make the diagnosis and underline the value of cine-MRI which was particularly useful in this case. Surgery may be indicated in cases of true aneurysm in cases with left ventricular failure but is mandatory in all cases of pseudo-aneurysm irrespective of the clinical presentation.

[Profil and course of complete obstruction of 3 coronary trunks]. / Profil et évolution de l'obstruction compléte des trois troncs coronariens

In a series of 4000 patients subjected to coronary arteriography, 12 were found to have complete obstruction of three major coronary arteries, an incidence of 0.3 p. 100. The clinical manifestations did not follow a typical pattern. Although 9 had a previous myocardial infarction or heart failure, only 6 were incapacitated by angina or dyspnea. Except for one patient, the resting EKG was abnormal. Half had a markedly elevated resting end-diastolic pressure and gross abnormalities of left ventricular contraction. In spite of surgery in 7, with only one operative death, a yearly mortality rate of 20 p. 100 has been recorded during a 3-year follow-up. This extremely low survival rate, the severe functional impairment in half of the survivors, and the subsequent high yearly mortality rate, all suggest that surgery be considered before complete obstruction occurs in patients with significant disease of three coronary arteries. A 10 p. 100 yearly mortality rate reported in patients with triple vessel obstructions, also favours surgery in such patients with the hope of prolonging life, providing good distal runoff and satisfactory left ventricular contraction are present.

[Exercise testing in probable primary hypokinetic cardiomyopathies]. / L'épreuve ergométrique au cours des myocardiopathies hypocinétiques en apparence primitive.

50 patients with primary congestive cardiomyopathy underwent one or several exercise tests at yearly intervals in order to evaluate exercise capacity and to assess the prognosis. Three parameters were studied: the workload, the elevation of the systolic blood pressure (SBP) on exercise and the appearance of premature ventricular beats (PVB) on exercise or during the recovery phase. The results show that when the work loads > 120 watts, an elevation of SBP greater than or equal to 50 mmHg and the appearance of less than 3 PVB per minute were compatible with a moderate degree of physical exertion. On the other hand these same poor prognostic factors were associated with a higher mortality rate after 20 months follow-up.

[Coronary intramural ruptures caused by transluminal angioplasty. Incidence, significance and development controlled by coronary angiography]. / Les ruptures intramurales coronaires induites par l'angioplastie transluminale. Incidence, signification et évolution contrôlée par coronarographie.

The authors report their experience of coronary intimal rupture (CIR) observed at control angiography performed at the end of transluminal angioplasty in a series of 150 cases. This lesion was observed in 34 p. 100 of cases. Two subgroups were established according to the presence (Group I: 51 cases) or absence of CIR (Group II: 99 cases) in order to try and identify any predisposing factor. The following features were compared in each group: age, sex, number of risk factors, duration of the disease, its severity, the site and morphology of the lesions (calcification, length, excentric or concentric) on the artery dilated and the technique used (number of inflations, maximal pressure, guidable catheter). The only significant feature associated with CIR was the morphology of the stenosis. Intimal rupture was statistically more frequent when the stenosis was long, calcific and excentric (p less than 0.05). The excentric character was highly predictive of CIR +/- 0.02) and even of complicated CIR (p less than 0.01). The CIR was complicated in 10 cases (19.6 p. 100) with a higher incidence than in the rest of the population (p less than 0.05). These complications were immediate presenting as attacks of angina leading on to 4 myocardial infarctions (7.8 p. 100) but no deaths. The treatment consisted in an attempt to redilate the artery with effective angioplasty in 3 out of 4 cases. Medical therapy alone was sufficient in 2 cases and 4 patients underwent coronary bypass. There were no complications in cases of initially asymptomatic intimal rupture. The 6 months outcome was controlled by coronary angiography in 131 angioplasties.(ABSTRACT TRUNCATED AT 250 WORDS)

[Aortic stenosis in adults: contribution of catheterization to the study of associated lesions. Apropos of 137 cases]. / Le rétrécissement aortique de l'adulte: apport du cathétérisme pour l'étude des lésions associées. A propos de 137 cas.

The results of cardiac catheterisation in 137 cases of pure adult aortic stenosis considered to be isolated after non-invasive investigation (clinical examination, carotid pulse tracing, echocardiogramme) are reported. The authors analyse the reliability and risks of this examination to which they attribute a triple objective; evaluation of the severity of the AS, evaluation of LV and/or mitral valve dysfunction and the assessment of the coronary circulation in patients with angina or in all patients over 54 years of age or with coronary calcifications. The aortic valve was crossed in 89,8 p. 100 of patients. Coronary angiography was attempted in 128 cases (93,4 p. 100) and was successful in 110 cases (85,9 p. 100). The investigation was complicated by one death (0,73 p. 100) and one femoral artery thrombosis, and was complete in only 74 p. 100 of cases. The results showed the aortic stenosis to be isolated in only 84 cases (61,3 p. 100). In the other 53 cases (38,7 p. 100) there was unrecognised associated pathology: mitral valve disease was diagnosed in 14 cases (12,3 p. 100); significant coronary artery disease (greater than 50 p. 100 narrowing) was observed in 34 of the 110 patients in whom coronary angiography was successful (30,9 p. 100). In the last 5 cases, catheterisation showed: two ASDs, one partial abnormal pulmonary venous drainage, one fusiform aneurysm of the aortic isthmus, one abnormal origin of the left anterior descending artery in the right coronary sinus with a pre-pulmonary trajectory. The authors discuss the value of the various methods of preoperative assessment of AS. The relative reliability of the different non-invasive techniques is compared.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correlations between effort tolerance and the severity of coronary disease. Influence of myocardial lesions]. / Corrélations entre la performance physique des coronariens à l'effort et la sévérité de la maladie coronarienne. Influence des lésions myocardiques.

The influence of coronary and myocardial lesions, defining the severity of the coronary artery disease on effort tolerance was studied in 51 patients. The appearances of the coronary arteriography and ventriculography were compared with the parameters of exercise tolerance: electrocardiographic changes, maximal charge (Cw), total work (TW), maximal systolic arterial pressure (SAP), maximal heart rate, percentage of the theoretical maximal heart rate, double product, exercise capacity index (CEI). The results showed that exercise tolerance (Cw, TW, ECI) and the exercise SAP are mainly affected by the myocardial lesions: patients with very reduced left ventricular ejection fractions and double or triple artery disease have very low indices: average Cw of 60 watts, TW less than 20,000 joules, ECI approximately 50. The SAP only rises slightly. On the other hand, patients with normal or subnormal ejection fractions have much higher indices whatever the state of their coronary arteries; Cw over 80 watts, TW over 30,000 joules, ECI over 80. In addition, major left ventricular dysfunction is associated with ST segment elevation during exercise.

[Secondary coronary fistulas]. / Les fistules coronaires secondaires.

These fistulae are very rare: 8 to 11 p. 100 of all coronary fistulae. Three types are recognised: right coronaro-ventricular, left coronaro-ventricular, and coronao-pulmonary. The two first types are found most frequently in association with a sigmoid atresia on the orifice, and with ventricular hypoplasia in the presence of a functional atrio-ventricular valve. The fistula then serves as a means of ventricular ejection. Of the secondary fistulae, the right coronaro-ventricular type is the most common (73 p. 100). The authors have found 30 cases in the published literature, and add 2 of their own. They have also reviewed the clinical features and the findings on coronary arteriography and post mortem studies on such fistulae. They discuss their etiology, pathogenesis, and physiopathology. Surgical correction involves repairing the fistula in one stage. Fistulae of the left coronaro-ventricular type are exceptions to this rule (9 p. 100), as they are always associated with a rapidly fatal hypoplasia of the left side of the heart. Coronaro-pulmonary fistulae (18 p. 100) are usually found in association with extreme forms of Fallot's tetralogy, and a relatively simple surgical correction can form part of the total correction of the tetralogy.