[The ideal valvular prosthesis is still to come. Which factors can help decide between mechanical and bioprosthetic heart valve replacement?]. / La prothèse valvulaire idéale n'existe toujours pas. quels facteurs entrent en compte pour orienter les choix d'une valve mécanique ou biologique?

The prevalence of valvular heart diseases reaches 2.5% in the overall population. Aortic valve replacement is one of the most common surgical procedures. We report the story of a female patient whose aortic mechanical valve, implanted at the age of 54 years at the time of a mitral valve repair surgery, had to be replaced 14 years later, due to the development of a subvalvular pannus narrowing the valvular orifice. We use this clinical story to compare the advantages and disadvantages of repair surgery and valve replacement with a biological or mechanical prosthesis, and summarize the latest evidence for the choice of the most adequate prosthesis for a particular patient's profile.

[Illustrated literature review of peripartum cardiomyopathy]. / Revue de littérature illustrée de la Cardiomyopathie du péripartum.

Peripartum cardiomyopathy is defined by the development of heart failure with left ventricular systolic dysfunction at the end of pregnancy or in the months following childbirth. Its diagnosis remains difficult due to lack of specificity. Its pathophysiology is still imperfectly understood, but involves both genetic and pregnancy related factors. From a therapeutic viewpoint, the recommendations of the European Society of Cardiology on heart failure are used, but the stage of pregnancy must be taken into account for the treatment choice. The chances of recovery are greater than in other non-ischemic cardiomyopathies. However, an early diagnosis remains crucial to increase the probability of recovery particularly with bromocriptine, which has shown positive results in recent years.

Surgical treatment of cardiovascular complications in patients with Marfan syndrome: a report of two cases and literature review.

Cardiovascular disease is the main cause of morbidity and mortality in patients with Marfan syndrome. The most life threatening complication is aortic root aneurysms leading to aortic dissection or rupture. It can be prevented by regular aortic follow-up and prophylactic aortic surgery. Modern aortic surgery has led to a substantial increase in the life expectancy of these patients. We report two cases of Marfan syndrome with cardiovascular complications. Their management is discussed according to the most recent literature.

[BNP and NT-proBNP: reference values and cutoff limits]. / BNP et NT-proBNP: valeurs de référence et seuils décisionnels.

Natriuretic peptides, particularly BNP and NT-proBNP, are increasingly used as screening test in patients with symptoms suggestive of heart failure (HF). Due to their high negative predictive values, natriuretic peptide determinations allow to exclude chronic HF with great certainty and to identify patients for whom echography is not necessary. These biomarkers are also useful for diagnostic purposes, high plasma levels being related to an increased risk of cardiovascular hospitalisation and death. Risk stratification in patients with HF symptoms is based on "low" and "high" cut-off limits, for which different values have been proposed. The aim of this paper is to discuss the delineation of the decision limits and the intermediate grey zone in comparison to NT-proBNP reference values obtained in a representative group of subjects living in the Liège area (Belgium). Data were analysed in relation to age and gender, two of the main parameters influencing the natriuretic peptide plasma levels.

[Perspectives in the management of congestive heart failure]. / Perspectives thérapeutiques de l'insuffisance cardiaque.

Heart failure constitutes a major public health problem. Its incidence continues to grow and its prognosis remains poor. Therapeutic approach of chronic heart failure with left ventricular systolic dysfunction is well codified. Recommended medical treatment is presented with the description of the different therapeutic classes. Recent advances are discussed. New therapeutic targets are described. Optimization of recognized treatment and application to heart failure of drugs used for other indications are developed. Therapeutic approach of heart failure with preserved ejection fraction is tackled but stays far less well defined. Many studies concerning treatment of acute heart failure are ongoing.

[How I explore...a patient with chronic heart failure]. / Comment j'explore ... une insuffisance cardiaque chronique.

Heart failure is defined by precise criteria associating clinical signs and cardiac abnormalities. The exploration for signs and symptoms must be associated with the systematic realization of an electrocardiogram, a chest X-ray and an echocardiogram to rapidly obtain the diagnosis and direct the patient to an adapted complementary clarification. Other additional tests are available (catheterization, nuclear cardiology imaging,...). The purpose is to confirm the diagnosis, to determine the aetiology and to identify factors of poor prognosis.

[Treatment adherence to guidelines for the management of chronic heart failure]. / Adhésion aux recommandations pour la prise en charge de l'insuffisance cardiaque chronique.

Chronic heart failure is a growing public health problem with a bad prognosis. Despite the seriousness of this syndrome and the well defined therapeutic approach, adherence to guidelines remains poor. After briefly recalling the main points of these guidelines, we present statistical data regarding therapeutic care of these patients. We then present factors influencing prescription or non prescription of heart failure drugs and emphasize the importance of a team management programme and patients pathways.

[Extracorporeal membrane oxygenation (ECMO) in ICU patients suffering from cardiogenic shock, refractory hypoxemia or cardiac arrest]. / L'ECMO (extracorporeal membrane oxygenation) aux soins intensifs: intérêt chez le patient en choc cardiogénique réfractaire, en hypoxémie réfractaire ou en arrêt cardiaque.

ExtraCorporeal Membrane Oxygenation (ECMO) is a cardiopulmonary assistance device able to support patients in cardiac arrest, refractory cardiogenic shock or refractory hypoxemia otherwise sentenced to death. Recent technical progresses, early indication decision, bedside multidisciplinary implant, specific complications screening and echocardiographic weaning testing are crucial points to allow success of this exceptional technique.

[Anemia and heart failure]. / Anémie et insuffisance cardiaque.

The prevalence of heart failure is increasing. Anemia is often present, particularly in severe cases. The Fick equation illustrates the relationship between anemia and heart failure. The concepts of cardiorenal syndrome and erythropoietin resistance are parts of the physiopathology. Anemia is associated with a bad prognosis in heart failure. Nevertheless, it is too early to know precisely whether anemia represents a simple marker of severity or if specific treatment, especially with erythropoietin, is useful in terms of morbidity and mortality. Current guidelines recommend the correction of secondary causes when anemia is present in a heart failure patient.

[Myocardial reinnervation after heart transplantation]. / Réinnervation myocardique après transplantation cardiaque: état de la question.

Despite many studies, cardiac reinnervation after heart transplantation is not yet fully understood. This article reviews the physiology of the transplanted heart and briefly describes the imaging techniques and functional tests which allow demonstration of cardiac reinnervation. The data reported on this subject in the literature are summarized and the remainin uncertainties are underlined.

[Heart transplantation: secondary prevention]. / Transplantation cardiaque: prévention secondaire.

Cardiac transplantation is the treatment of choice for refractory heart failure. An immunosuppressive therapy must be given in the perioperative course to avoid graft rejection. In this article, we review the main classes of immunosuppressive agents (calcineurin inhibitors, anti-metabolities, corticoïds) and their side effects. The general preventive measures and the different kinds of rejection (hyperacute, acute vascular, acute cellular and chronical) are discussed. The current bacterial, protozoarian, mycotic and viral infections are described. We finish with the risk of cancer, mainly skin tumours and non-Hodgkinian lymphomas.