[Percutaneous treatment of the pulmonary valve]. / Traitement percutané de la valve pulmonaire.

Right ventricular outflow tract diseases are historically outcomes of surgical reconstruction for heart defects in neonates or children (Tetralogy of Fallot, Ross surgery). This kind of surgery performed during childhood lead often to dysfunctional right ventricular outflow tract (stenosis, leak) in older infants or young adults. In this case, reintervention on the right ventricular outflow tract would be associated with a high surgical risk. Development of the first percutaneous valves in the year 2000 paved the way for the pulmonary revalvulation. This percutaneous procedure has emerged as a credible alternative to the surgery for multioperated high risk patients with congenital cardiopathies. Two valves are currently available on the French market (Melody®, Sapien®); they cover all therapy indications, except the example of very wide outflow tracts which remain a surgical issue. Medical teams in charge of these young patients have to be enough trained in order to limit risks during the procedure. To this end, several teams promote the percutaneous pulmonary revalvulation over surgical revalvulation, this latter becoming limited only to cases in which percutaneous treatment is not feasible.

[Percutaneous treatment of mitral regurgitation by Mitraclip in the elderly]. / Traitement percutané de l'insuffisance mitrale par Mitraclip chez le sujet âgé.

Mitral regurgitation (MR) is the second most common form of valvular heart disease. It is classified as either primary (degenerative) or secondary (functional). Secondary MR is the consequence of myocardium disease. Primary MR from degenerative valve disease is due to a primary disruption of the mitral valve apparatus from either prolapsed or flail leaflets. It covers all aetiologies in which intrinsic lesions affect one or several components of the mitral valve apparatus. Gold-standard therapeutic management of severe primary MR is surgery usually to repair but sometime to replace the mitral valve. However patients considered to be at high-risk due to their age or the presence of comorbidities - accounting for 50% of all patients - are not eligible for surgery. Catheter-based interventions have been developed to correct MR percutaneously. The only such intervention which has been evaluated in organic MR is the edge-to-edge procedure using the MitraClip® (Abbott Vascular, Menlo Park, CA). MitraClip® offers an alternative to open surgical repair or replacement via a minimally invasive route and it was shown in the EVEREST II study that MitraClip® was safer than surgery even though it was less effective in reducing MR. A substantial number of patients are ineligible for mitral valve surgery because of prohibitive surgical risk. For those patients, MitraClip® may offer an alternative treatment option. Percutaneous edge-to-edge repair is the first percutaneous option accepted in the 2012 ESC guidelines: Percutaneous edge-to-edge procedure may be considered in patients with symptomatic severe primary MR who fulfill the echo criteria of eligibility, are judged inoperable or at high surgical risk by a 'heart team', and have a life expectancy greater than 1 year (recommendation class IIb, level of evidence C). Because of its frailty, MitraClip® in the elderly may be a good alternative to mitral surgery when indicated for primary or secondary MD.

Position paper of French Interventional Group (GACI) for TAVI in France in 2018.

Aortic stenosis is a frequent disease in the elderly. Its prevalence is 0.4% with a sharp increase after the age of 65, and its outcome is very poor when the patient becomes symptomatic. The interventional procedure known as TAVI (trans-catheter aortic valve implantation), which was developed in France and carried out for the first time in Rouen by Prof. Alain Cribier and his team in 2002, has proven to be a valid alternative to surgical aortic valve replacement. At first, this technique was shown to be efficient in patients with contra-indications to surgical treatment or deemed to be at high surgical risk. Given the very promising outcomes achieved as a result of close heart team collaboration, appropriate patient selection, simplified procedures and reduced complication rates, transfemoral (TF) TAVI is now preferred in symptomatic intermediate risk patients>75 years old according to the latest ESC guidelines. In 2017, in France, TAVI is currently performed in 50 centers with on-site cardiac surgery. The 2016 TAVI outcomes recorded in the French national TAVI registry (France TAVI) are very encouraging and show that for 7133 patients treated (age 83.4±7 years, logistic Euroscore 14%), 87% of whom via the TF approach, cross-over to surgery was very low (0.5%) with a 3.0% in-hospital mortality rate. The substantial increase in TAVI indications and the improvement of its outcomes may in the near future call for a reconsideration of the number of high volume centers authorized to carry out this technique.

Diagnostic and medical strategy for renovascular hypertension: report from a monocentric pediatric cohort.

UNLABELLED: Renovascular hypertension accounts for 5-10 % of hypertension cases in children; there is currently no consensus on treatment. Here, we report on our clinical experience with this disease and outline the different pathways in which to investigate it. We report retrospectively on ten children diagnosed with renovascular hypertension at the University Hospital of Nantes from 2001 to 2012. The main findings were obtained by fortuitous screening of children aged 2 months to 14 years old with neurofibromatosis (n = 2) and fibromuscular dysplasia (n = 8). The hypertension was always severe yet asymptomatic. Lesions were complicated in nine out of ten cases and included bilateral, multiple, mid-aortic syndrome and aneurysm. Doppler ultrasound associated with computed tomography allowed for a precise diagnosis in seven out of ten cases. Where ambiguities persisted, they were highlighted by arteriography, the gold standard investigation. Medical treatment was insufficient, leading to invasive procedures in nine out of ten children: 2 nephrectomies, 2 autotransplantations, and 21 repetitive percutaneous transluminal angioplasties. After invasive procedures, blood pressure control improved in four cases and was resolved in three. CONCLUSION: Arteriography remains to be the gold standard technique for renovascular hypertension in children and can be combined with angioplasty when medical treatment is rendered obsolete. The role of computed tomography is controversial. Despite the heterogeneity of the children studied, we present a general medical and therapeutic management pathway for the treatment of this disease.

[Superior vena cava syndrome induced by pacemaker probes, 12 years after introduction]. / Un syndrome cave supérieur 12ans après l'implantation d'un pacemaker.

Superior vena cava syndrome is a rare disease, most often found to result from a malignant process, which causes extrinsic compression of the superior vena cava. In recent years, there has been an increase of superior vena cava syndrome related to medical devices (implantable site, pacemaker [PM], central venous line for parenteral nutrition...). We report the case of a 37-year-old patient who developed a superior vena cava syndrome 12 years after implantation of a PM. The diagnosis was established on venography after two negative venous-CT focused on the superior vena cava. The superior vena cava syndrome improved immediately after angioplasty and stenting covering the PM probes at the superior vena cava/brachiocephalic venous trunk junction.

Fracture of the lower cervical spine in patients with ankylosing spondylitis: Retrospective study of 19 cases.

INTRODUCTION: Controversy exists surrounding optimal treatment of cervical spine fractures secondary to ankylosing spondylitis (AS). HYPOTHESIS: The anterior approach is an effective surgical technique for these fractures and can be used to correct the AS-induced cervical-thoracic kyphosis. MATERIALS AND METHODS: This continuous, retrospective series between 1990 and 2010 included 19 patients aged 33 to 84 years who presented with a lower cervical spine fracture in the context of AS. The average follow-up was 45 months. Sixteen of these patients were surgically treated using an anterior approach and anterior fixation. In five patients without any neurological deficit, their cervical-thoracic kyphosis was corrected during the same surgery. Regional kyphosis was measured before the surgery, immediately after the surgery and at the last follow-up. RESULTS: Five deaths occurred; these were all patients with post-traumatic complete quadriplegia. Most the incomplete neurological problems improved (66%). In no cases did the neurological condition worsen. Among the 16 patients operated with the anterior approach, two patients also required an additional procedure with a posterior approach because of a persistent neurological deficit. The fractures in the operated patients who survived (14 patients) had healed within an average 4-month delay (range 3-7 months), without worsening of the kyphosis at final follow-up. In the five cases where the kyphosis was corrected, the correction averaged 26° (range 18-36°); there were no neurological complications. DISCUSSION: Based on these results, we suggest using the anterior approach to perform internal fixation as a treatment for cervical fractures secondary to AS and to correct the cervical-thoracic kyphosis in patients without neurological deficits. LEVEL OF EVIDENCE: Level IV - retrospective study.

[Coronary CTA evaluation of the relationship between mitral valve annulus and coronary circulation: implications for percutaneous mitral annuloplasty]. / Etude de la relation entre l'anneau mitral et la circulation coronaire dans l'insuffisance mitrale par scanner cardiaque: implications dans l'annuloplastie mitrale percutanée.

PURPOSE: To evaluate anatomical relationships between mitral annulus (MA), coronary arteries and coronary sinus (CS) in two groups of patients with and without moderate mitral insufficiency on coronary CTA to identify candidates to percutaneous mitral valve annuloplasty via the coronary sinus without risk of coronary artery occlusion. MATERIALS AND METHODS. Fifty-one ECG-gated coronary CTA examinations, obtained during injection of iodinated contrast material on a 16 MDCT were retrospectively reviewed. The mitral valve annulus diameter, anatomical relationships between CS and coronary arteries and MA-CS distance were compared between both patient groups. RESULTS: The group with mitral insufficiency included 16 patients and the control group included 35 patients. The AP diameter of the MA was 45,7+/-5,2 mm in the group with mitral insufficiency, significantly larger (p=0.0009) compared to the control group (39,3+/-5,9 mm). In 70.4% of cases, the CS was located next to a coronary artery in an overlapping configuration. The unfavorable anatomical configuration with regards to annuloplasty appeared related to mitral insufficiency (p=0.0539). The distance between MA and CS was greatly variable with the CS routinely extending over the left atrial surface: the distance was significantly (p=0.0002) greater for all patients along the posterior surface (8,1+/-3,8 mm) compared to the lateral surface (5,2+/-4,6 mm) with this différence persisting within both groups: p=0.004 for patients with mitral insufficiency and p=0.0001 for control patients. CONCLUSION: Our results demonstrate the value of coronary CTA in selecting candidates to percutaneous mitral annuloplasty. In 70.4% of cases, the CS overlaps a coronary artery with risk of compression at the time of annuloplasty.

[Bi-directional ventricular tachycardia and pheochromocytoma: a case report]. / Tachycardie ventriculaire bidirectionnelle et phéochromocytome: a propos d'un cas.

We present the case of a 48 year old woman who was admitted to our university hospital in cardiogenic shock with bi-directional ventricular tachycardia degenerating into polymorphic venricular tachycardia which resolved spontaneously. Investigation revealed healthy coronary arteries but severe left ventricular dysfunction due to akinesia involving the entire base. There was a rapid improvement within several days. The diagnosis of bilateral phaeochromocytoma was made on the biochemistry and CT scan of the adrenals.

[Arterial rigidity of patients operated successfully for coarctation of the aorta without residual hypertension]. / Etude de la rigidité artérielle des patients opérés avec succès d'une coarctation de l'aorte sans hypertension résiduelle.

In patients successfully operated for coarctation of the aorta, the prevalence of hypertension is higher than that observed in the general population although the exact mechanism is not known. The hypothesis of increased arterial rigidity despite satisfactory correction of the coarctation has been proposed. The authors undertook 24 hour ambulatory blood pressure monitoring coupled with measurement of the QKD interval (pulse wave velocity) in order to evaluate the rigidity of the large arteries. These results were compared with those obtained in control patients paired with respect to gender, age, height and weight. Twenty-six patients with an average age of 14.5 +/- 2.9 years were included (age at time of surgery 6.3 +/- 3.7 years). The statistical data confirmed a higher systolic blood pressure (p<0.05) in the operated patients compared with controls. The results confirm the hypothesis of increased residual arterial rigidity in children operated for coarctation of the aorta which could predispose to secondary hypertension, especially on effort. In the long term, this could be an unquestionable cardiovascular risk factor explaining the increased cardiovascular morbid-mortality compared with the general population.

[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.

Transcatheter closure of patent foramen ovale in patients with platypnea-orthodeoxia: results of a multicentric French registry.

BACKGROUND: Dyspnea and the decrease in arterial saturation in the upright position in elderly subjects is described as platypnea-orthodeoxia syndrome (POS). POS is secondary to the occurrence of an atrial right-to-left shunt through a patent foramen ovale (PFO). METHODS: This French multicentric study reports on 78 patients (mean age 67 +/- 11.3 years) with POS who had transcatheter closure of the PFO; frequently associated diseases were pneumonectomy (n = 36) and an ascending aortic aneurysm (n = 11). In all patients, the diagnosis was confirmed by transthoracic or/and transesophageal echocardiography. Five different closure devices were used: Amplatz (n = 45), Cardioseal (n = 13), Sideris (n = 11), Das Angel Wings (n = 8) and Starflex (n = 1). Closure was successful in 76 patients (97%). RESULTS: Oxygen saturation increased immediately after occlusion from 84.6 +/- 10.7% to 95.1 +/- 6.4% (p < 0.001) and dyspnea improved from grade 2.7 +/- 0.7 to grade 1 +/- 1 (p < 0.001). A small residual shunt was immediately observed in 5 patients (3 with the Cardioseal device, 1 with the Sideris and 1 with the Amplatz) leading to the implantation of a second device in one case (Cardioseal). Two early deaths occurred unrelated to the procedure (one due to sepsis probably related to pneumonectomy, another due to respiratory insufficiency). Other complications were: a small shunt between the aorta and the left atrium, two atrial fibrillations and a left-sided thrombus which disappeared with anticoagulant therapy. At a mean follow-up of 15 +/- 12 months, there were 7 late deaths related to the underlying disease. CONCLUSION: Percutaneous occlusion of the foramen ovale is safe and gives excellent results thanks to continuing improvement in available devices. This technique enables some patients in an unstable condition to avoid a surgical closure.

Effect of injecting collagenase into the uterine artery during a caesarean section on the placental separation of cows induced to calve with dexamethasone.

A caesarean section was performed on 30 cows before normal term and 16 to 20 hours after the induction of parturition with dexamethasone. During the surgical procedure, 20,000 U of bacterial collagenase was injected into the uterine artery of 15 of the cows. The average periods of retention of the fetal membranes were 40 hours in the treated cows and 114 hours in the control cows (P<0.001). At 36 hours after the surgery six of the treated cows (40 per cent) but all 15 of the control cows had retained fetal membranes. The collagenase-treated cows showed no abnormal clinical signs during the 10 days after the operation.

Neointimal hyperplasia after stenting in a human mammary artery organ culture.

Although the use of stents has limited the incidence of restenosis, in-stent restenosis remains an important problem. In-stent restenosis is the result of a healing process that induced neointimal hyperplasia through mechanisms that are still not understood. The aim of this study was to analyze the histological consequences of the healing process following stent implantation. Internal mammary arteries from atheroslerotic patients undergoing coronary artery bypass surgery were stented and maintained in culture for 0-28 days. Stent implantation after predilatation induced an extensive loss of endothelial cells whereas direct stenting preserved endothelium between the struts. Morphometric analysis shows that stent placement induced neointimal thickening. Smooth muscle alpha-actin labeling indicates that neo-intimal formation was mainly due to proliferation and migration of smooth muscle cells. Smooth muscle cell proliferation, assessed by MIB-1 staining, was maximal at day 14 after stent insertion. Human mammary artery organ culture thus provides valuable information on histological consequences of stent implantation with or without predilatation regarding endothelial cell disappearance and neointimal hyperplasia. These data also demonstrate that neointimal thickening induced by stent implantation comprises an intrinsic component resulting from the vessel wall response to stent insertion and suggest that blood factors could play an amplifying but not necessary role.

[Endocarditis and congenital heart disease in the adult]. / Endocardites et cardiopathies congénitales de l'adulte.

The prevalence of congenital cardiopathy is approximately 8% of live births, and 80 to 85% of patients reach adulthood thanks to the progress in the management of even complex malformations. Congenital cardiopathies represent 10 to 18% of adulthood cardiopathies complicated by infectious endocarditis, and in the specialist units for adolescent and adult congenital cardiac patients, 5% of admissions are provoked by endocarditis. The majority of malformations have a risk of infected graft, but patients who have a complex cyanogenic cardiopathy or an operated cardiopathy requiring insertion of prosthetic material, and those who have already had previous episodes of endocarditis are at a very high risk. Longitudinal studies show evolution of the responsible microbes, with an increase of the HACEK group; nevertheless, the streptococci and staphylococci remain uppermost. Diagnosis relies on the classic Duke University criteria but Doppler echocardiography is sometimes difficult to interpret in complex malformations or extra-cardiac sites of infection, and in 6 to 11% of cases the microbe is not identified. Infectious endocarditis remains a particularly serious complication: 50% of patients have aggravation of their cardiopathy and 20 to 30% require surgery; however the mortality has fallen by 20% to a little less than 5% in the most recent series. It is vital that patient education should be pursued even if, in certain circumstances, prophylaxis is not always either possible or effective....

Partial anomalous pulmonary venous connection: correction by intra-atrial baffle and cavo-atrial anastomosis.

The creation of intracaval conduits to repair partial anomalous pulmonary venous connection of the right lung into the superior vena cava can be complicated by arrhythmias and superior vena cava and pulmonary vein obstruction. An intra-atrial baffle, combined with cavo-atrial anastomosis, has been proposed to avoid these complications. The authors report their recent experience with this operative technique. From January 1997 to December 2000, 7 patients with a mean age of 13.5 +/- 9 (2-31) years were operated according to this technique. Only one child did not have an associated atrial septal defect. The mean number of pulmonary veins connected to the superior vena cava was 2.5 +/- 0.5. The immediate postoperative course was uneventful for the seven patients. The mean follow-up was 20 +/- 17 months. No patient developed arrhythmia or superior vena cava or pulmonary vein obstruction at echocardiography. This surgical technique appears to constitute an attractive alternative when pulmonary veins drain abnormally into the superior vena cava above the cavo-atrial junction.

Taurine and hypotaurine in spermatozoa and epididymal fluid of cats.

Taurine and hypotaurine have been found in spermatozoa and seminal plasma of numerous species and are known to have beneficial effects on sperm characteristics in mammals. Taurine is considered an essential dietary constituent in cats. Dietary deficiency has been associated with a range of serious clinical disorders. Quantification of taurine and hypotaurine in the genital tracts of male cats has not been reported. In this study, the concentrations of taurine and its precursors were measured in serum, spermatozoa, epididymal fluid and seminal plasma from cats. The concentrations of taurine measured in serum samples confirmed that the cats were not deficient in taurine. Significant amounts of taurine and hypotaurine were found in spermatozoa, seminal plasma and epididymal flushing fluid. Hypotaurine was not detected in serum samples. These results indicate that hypotaurine may be synthesized in cat testes or epididymides. Cysteamine was not detected in any of the samples.

Mammalian oviduct and protection against free oxygen radicals: expression of genes encoding antioxidant enzymes in human and mouse.

Genetic expression of five antioxidant enzymes involved in mechanisms protecting embryos against reactive oxygen species (ROS) was studied in human and mouse oviducts. The presence of transcripts encoding for gamma-glutamylcysteine synthetase (GCS), glutathione peroxidase (GPX), Cu-Zn-superoxide dismutase (Cu-Zn-SOD), Mn-superoxide dismutase (Mn-SOD) and catalase was analysed by use of the reverse transcription-polymerase chain reaction (RT-PCR). Different expression profiles of transcripts encoding for these enzymes were observed between human and mouse oviducts. In the mouse, all transcripts encoding for the enzymes tested were present in oviduct. In human, only transcripts encoding for GPX, Cu-Zn-SOD and catalase were also detected in oviduct. However, GCS and Mn-SOD transcripts were never observed in human oviduct. Cu-Zn-SOD transcripts are relatively highly expressed whatever species. These results suggest that different gene expression patterns of these antioxidant enzymes between human and mouse may reflect the variations in the ability of embryos to develop in vivo and in vitro. However, hormone related-expression of the missing transcripts in human cannot be ruled out.

Expression of genes encoding antioxidant enzymes in human and mouse oocytes during the final stages of maturation.

The mRNA expression of five enzymes: catalase, Cu-Zn-superoxide dismutase (Cu-Zn-SOD), Mn-superoxide dismutase (Mn-SOD), glutathione peroxidase (GPX), and gamma-glutamylcysteine synthetase (GCS) each involved in protection against free radicals was studied in human and mouse oocytes. In the mouse, oocytes were collected at different stages of maturation in order to determine the storage of these transcripts. For the human, germinal vesicle (GV) oocytes harvested during intracytoplasmic sperm injection (ICSI) procedures and failed fertilized metaphase II (MII) oocytes were analysed. Human and mouse were compared in order to determine whether the differential developmental capacity of mouse and human preimplantation embryos in culture could be explained by the variations in the patterns of expression for these enzymes. mRNA expression for these enzymes was examined using reverse transcription-polymerase chain reaction (RT-PCR). In the mouse, all transcripts (except for catalase) were detected, whatever the maturation stage. No qualitative differences were detected between GV and MII oocytes. In human, all the enzymes (except for catalase) were expressed in MII oocytes and Cu-Zn-SOD was particularly highly expressed. Transcripts corresponding to GPX and Mn-SOD were not detected at GV stage but only at MII stage, suggesting that storage could occur between GV and MII stages. However, using 3' end-specific primers for GPX and Mn-SOD, instead of the oligo(dT)(12-18) primer, for the reverse transcription reaction, the transcripts for these antioxidants enzymes have been detected in human oocytes at the GV stage. This suggests the presence of maturation-specific polyadenylation of these transcripts. These enzymes can be considered as markers of cytoplasmic maturation.

[Double stenosing valve disease after mediastinal radiotherapy: a case report of a 31 year-old man]. / Double valvulopathie sténosante post-radiothérapie médiastinale. A propos d'un cas, chez un homme de 31 ans.

Cardiac complications of radiotherapy for cancer, especially lymphoma and breast cancer, are well documented. The three tunics of the heart can be affected. However, valvular disease is rare and, when present, is usually regurgitant. Stenosis is very rare. The authors report the case of a 31 year old man who developed double mitro-aortic valvular stenosis 20 years after mediastinal radiotherapy associated with aortic regurgitation, right coronary stenosis and inflammatory epicardo-pericarditis with effusion. Surgery was undertaken and associated double aortic and mitral valve replacement and right coronary by pass grafting.

Precursors of taurine in female genital tract: effects on developmental capacity of bovine embryo produced in vitro.

Two precursors of taurine have been studied: cysteamine and hypotaurine. Cysteamine has been quantified in genital secretions and found in follicular fluids of all species tested. On the contrary cysteamine was not detected (or traces) in tubal fluids of the same species. Addition of 50, 100 or 250 microM of cysteamine to the maturation medium used in the culturing of bovine oocytes did not improve the cleavage rate nor the embryo's developmental potential in vitro. Furthermore, at 250 microM, cysteamine seems to be toxic to the embryo. Addition of 0.5-1 mM hypotaurine to the bovine embryo culture medium improved significantly blastocyst production and quality. The respective roles of these 2 taurine precursors on maturation and embryo development are discussed.