[Challenges of coronary catheterization after TAVR]. / Difficultés de cathétérisme coronaire après TAVI.

PURPOSE: Coronary catheterization after transcatheter aortic valve implantation (TAVR) may be challenging. The main objective of the study is to assess the feasibility of coronary catheterization and angioplasty according to each type of valve. PATIENTS AND METHOD: We retrospectively studied coronary angiography or percutaneous angioplasty procedures after TAVR in two different centers. The catheterization success of coronary artery was evaluated according to the quality of engagement in ostium and opacification of the artery. Other indicators were collected including catheters used, fluoroscopy and angiography times, DAP and the volume of the contrast agent. RESULTS: Among 1512 TAVR procedures, 33 patients were included. The Sapien 3® valve was implanted in 22 patients and the Evolut® in 11 patients (7 Evolut-R® and 4 Evolut Pro®). Coronary angiography with selective or partially selective catheterization has been successfully performed in all patients with a Sapien 3® valve. In the Evolut® group we identified 3 cases of non-selective catheterization for the right coronary and 1 case for the left coronary. Standard Judkins catheters seem to be the most suitable for both types of valve with very good efficiency. CONCLUSION: The results of our study is promising for the future of TAVR with a coronary catheterization success rate close to 100% with some difficulties for the Evolut® supra-annular valves. Special attention should be paid to the technique of implantation and orientation of cups in the aortic sinus.

[Diagnosing cardiac amyloidosis in magnetic resonance imaging: The discriminating factors]. / Le diagnostic de l'amylose cardiaque par résonance magnétique : les éléments discriminants.

Infiltrative cardiomyopathies refers to deposits of substances in the myocardial tissue resulting in a structural abnormality and/or alteration of cardiac function. Cardiac amyloidosis is an extracellular infiltration of amyloid fibril. Cardiac magnetic resonance imaging (MRI) is essential (in the) for its diagnosis. MRI sequences (morphological, viability and parametric mapping) allow a structural and dynamic analysis of the cardiac function as well as a characterization of the myocardial tissue: edema, fatty infiltration, fibrosis. In cardiac amyloidosis, the morphological sequences classically highlight ventricular hypertrophy and thickening of the heart valves. Ventricular functions are assessed by the cine sequences (The cine sequences make it possible to evaluate the ventricular functions.) The viability sequences show (a more diffuse distribution of hypersignals) an abnormal pattern of late gadolinium enhancement in both circumferential and sub-endocardial distribution. The relaxometry sequences or parametric T1 and/or T2 mapping allow the spatial visualization of quantitative changes of the myocardium. The presence of macroscopic myocardial edema or fibrosis causes a prolongation of the native T1 and an increase of the extracellular volume.

[Common femoral artery bailout stenting with covered stent graft due to TAVR vascular complication: Clinical long term follow-up]. / Suivi clinique après implantation d'un stent couvert dans l'artère fémorale commune au décours immédiat d'une complication vasculaire per-TAVI.

BACKGROUND: Vascular complications are frequent in the context of transcatheter aortic valve replacement and may require the implantation of a covered stent graft in the common femforal artery. However, common femoral artery is considered to be at high risk of stent fracture or occlusion due to high mobility of the hip joint. PATIENTS AND METHODS: We analyzed medical records of patients with transcatheter aortic valve replacement related vascular complications between 2015 and 2018, treated with commom femoral artery transluminal angioplasty or surgery. Vascular complications or suspect symptoms were followed up by phone calls. RESULTS: Among 552 patients, 43 patients were included. Twelve (11.6 %) were managed by prolonged balloon inflation, 5 (11.6 %) by first line surgery and 26 (60.4 %) by the implantation of a covered stent graft. Among the latter group, the covered stent graft was efficient in 24 patients (92.3 %). The median follow-up was 430 days [3-1499]. The first-line surgery group had a higher risk of red blood cell transfusion and all causes mortality. At follow-up, no patient had suspicious symptoms of vascular covered stent complication. Four patients (9.3 %) had US-doppler or CT vascular imaging at follow-up, showing no evidence of stent fracture or occlusion. CONCLUSION: In our study, the implantation of a covered stent graft in the common femoral artery was an efficient and safe strategy for the management of transcatheter aortic valve replacement related vascular complications.

[Intracardiac mass: Why not a liquefaction necrosis of a mitral annulus calcification?]. / Masse cardiaque: et si c'était une liquéfaction caséeuse de calcification mitrale?

We report the case of an asymptomatic 70-year-old woman with a liquefaction necrosis of mitral annulus calcification. This mass was discovered incidentally during an echocardiographic examination. Additional treatment was not performed because liquefaction necrosis of mitral calcification usually has a benign prognosic. A scheduled clinical review with an echocardiographic examination and cardiac MRI was planified. The patient is actually healthy without any complication.

FemoSeal Evaluation Registry (FER). Prospective study of femoral arterial closure with a mechanical system on 100 patients who underwent angioplasty procedures.

BACKGROUND: The objective of this study is to evaluate the effectiveness and the safety of the FemoSeal mechanical closure system in order to obtain hemostasis of the puncture site following angioplasty procedures performed through femoral arterial approach. METHOD: A single-centre prospective registry was conducted from November 2010 to April 2011, comparing the results of manual compression (n=111 patients), hemostatic bandages compression (n=43 patients) and FemoSeal mechanical closure (n=100 patients). The end points evaluated were the following: successful hemostasis, major and minor complications right after the procedures and major and minor complications at 1 month follow-up. The patients' feedback about their comfort was also collected right after the procedure and after one month. RESULTS: Successful hemostasis with FemoSeal was obtained in 93% of the patients (n=93). Seven patients required additional slight manual compressions or compression bandages. The use of FemoSeal was not associated with any major complications, significantly reducing (P<0.05) the number of complications compared to other compression techniques over the studied period. Only one minor complication was observed with FemoSeal (a 1.5-cm-hematoma, which reabsorbed spontaneously without any issue). CONCLUSION: In our experience, the use of FemoSeal is effective in achieving hemostasis performed through femoral arterial approach up to 7F and is associated with a very low rate of complications.

[Value of cardiac MRI for intraventricular thrombi's diagnosis]. / Intérêts et valeur de l'IRM cardiaque pour la recherche des thrombus intraventriculaires.

BACKGROUND: Intraventricular thrombosis is a serious event, generally complicating a wide myocardial infarction. It requires an adapted therapy, based on the oral anticoagulants. The diagnosis is generally carried out by trans-thoracic echocardiography but with an insufficient sensitivity and a specificity. In this context, the place of cardiac MRI remains to be explored. PATIENTS AND METHOD: We carried out a retrospective registry of all cardiac MRI done in our hospital since 2003, for assessment of an intracardiac mass or an cerebral stroke. The aim was to compare the results of cardiac MRI with those of echocardiography and contrast ventriculography. RESULTS: Our registry includes 26 cases of intraventricular thrombi, confirmed by cardiac MRI. Our results confirm the lack of sensitivity of echocardiography and the ventriculography. The Kappa correlation coefficient of echocardiography and ventriculography, with respect to the MRI, are very weak, respectively of -0.08 and 0.16. CONCLUSIONS: The values of echocardiography and contrast ventriculography seem limited. The realization of a complementary cardiac MRI must be recommended as often as possible in case of doubt or high risk disease.

[From the standard coronary angiography to the double rotational angiography: results of a retrospective mono-centric registry]. / De la coronarographie standard à la double angiographie rotationnelle : résultats d'un registre mono-centrique rétrospectif.

X-ray doses (delivered) to the patients during coronary angiography (CA) and percutaneous coronary intervention (PCI) show ability of one certain deterious effects and can be sometimes at very high level. According to the European directives, all the equipments allowing to make diagnostic and interventional procedure integrate a unit of measure of the Dose Area Product. This measure is associated in a linear way with the effective dose and allows to measure the stochastic risk, the indicator also of good practices. Stemming from general vascular rotational acquisition technology, the cardiac rotational angiography is potentially beneficial for the patients and the operators concerning the exposure in ionizing radiations. The purpose of this study is to measure retrospectively the various dominating indicators in the irradiation of the patients on a series of case realized from January, 2009 till May, 2009 further to the implementation of this technique of acquisition. The dose area product, the duration of fluoroscopy as well as the number of acquired images were measured after coronary angiogram at 250 consecutive patients between January, 2009 and May, 2009. The procedures were realized by four operators, using the femoral access. The dose area product, the durations of fluoroscopy as well as the number of images has been respectively of 39,3 Gy cm(2) [4,7-210,65 Gy cm(2)], 8,4 minutes [0,8-38 minutes] and 575 frames [175-1427 frames] in standard coronary angiogram; 33,64 Gy cm(2) [4,95-85,6 Gy cm(2)], 2,8 minutes [1,1-26 minutes], 503 frames [314-836 frames] in single rotational coronary angiogram; 24,26 Gy cm(2) [5,74-51,1 Gy cm(2)], 3,9 minutes [1,3-14 minutes], 272 frames [127-429 frames] in double rotational coronary angiogram. In conclusion, the exposure of the patient to the X-rays, the practitioners and paramedical in interventional cardiology depends on the operator, on the fluoroscopy time and on the number of acquired images. The double rotational angiography is one of the solution to achieve these objectives.

[Identification of anomalous coronary arteries and their anatomic course by multidetector computed tomography coronarography. A retrospective registry]. / L'utilisation du scanner cardiaque multibarrettes pour l'exploration des anomalies coronaires. Analyse d'une série rétrospective monocentrique.

BACKGROUND: The coronary anomalies are generally asymptomatic and rare. However, their potential complications are serious and mainly represented by the risk of sudden death. The coronarography appears insufficient to carry out the complete assessment of these anomalies, and in particular to study the arterial course. The endpoint of our series is to evaluate the interest of the coronary computed tomography (CT) in this indication. PATIENTS AND METHODS: We report the results of a 16-slice coronary-CT monocentric retrospective series among 12 patients presenting coronary anomalies diagnosed in coronarography. RESULTS: Coronary-CT has confirmed the diagnosis, specified the coronary course and the relation with the great vessels in 100% of the cases. CONCLUSIONS: Multislice coronary-CT seems an examination of choice for the diagnosis and the presurgical assessment of the coronary aberrations, like for the distinction of the benign and malign forms. Its effectiveness and its "non-invasive" character are strong arguments to include it in the assessment of syncopes linked to effort in the young adult.