[Cardiac permanent pacemaker after transcatheter aortic valve implantation: A predictive and scientific review]. / Quand implanter un stimulateur cardiaque après remplacement valvulaire aortique percutané ? Revue de littérature.

Transcatheter aortic valve implantation (TAVI) is nowadays a worldwide technique in the field of treating aortic stenosis. One of the main side effects linked to the technique are mostly attached to rhythm disturbances, such as atrioventricular (AV) and intraventricular blocks. Consequently, a pacemaker implantation is often required. That implantation rate is estimated between 8 and 30%, depending on the valve chosen. Thanks to main meta analysis on the subject, it has been managed to isolate the following risks factors for AV block development: preoperative right bundle branch block (RBBB: the most powerful element), complete AV block during the procedure, male gender, a so-called porcelain aorta, the absence of previous valvular surgery, the aortic annulus size (i.e when that size is inferior to the valve's one) and the QRS duration after the procedure (the superior threshold has been set at 128ms for the Corevalve). The currently recommendations advice to implant a pacemaker are as followed: high grade AV block (in the main studies, the implantation occurs within the 5 days after the TAVI), complete and transient AV block during the TAVI, second degree AV block and RBBB associated with first degree AV block. Our article aims to review the arrhythmic issues of TAVI.

Angiographic and electron-beam computed tomography studies of retrograde cardioplegia via the coronary sinus.

Retroperfusion of the coronary sinus does not provide homogeneous distribution of cardioplegic solution. The goal of this study was to analyze the distribution of flow during retrograde cardioplegic infusion in cadaveric human hearts with two different techniques of coronary sinus cannulation: (1) internal occlusion of the coronary sinus by balloon inflation and (2) external occlusion by tightening the orifice of the coronary sinus around a simple catheter. To evaluate differences between the two techniques, angiographic and electron-beam computed tomographic studies were performed. Computed digital angiography was performed on 14 hearts. Angiographic patterns varied according to type of coronary sinus cannulation. With the balloon inflation technique, the marginal vein and the anterior descending vein were perfused first; the posterior descending vein was not perfused. This vein was opacified secondarily through a venovenous anastomosis located at the apex of the heart. Backward flow into the right atrium (steal phenomenon) was demonstrated. At completion of retroperfusion, the inferior part of the septum remained poorly opacified. Conversely, angiographic findings after external occlusion of the coronary sinus revealed simultaneous injection of all venous channels. The entire septum was well opacified at completion of retroperfusion. Electron-beam computed tomographic study was performed on eight hearts with the external occlusion technique and nine with the internal occlusion technique. The computed tomographic findings confirmed the results of digital angiography. The peak myocardial enhancement and the peak rising rate of myocardial enhancement within the interventricular septum were significantly more important (p < 0.0001) when the external coronary sinus occlusion mode was used than when the internal coronary sinus occlusion mode was used. In all hearts except one, the right ventricular wall was not opacified, regardless of the type of cannulation and the type of radiologic analysis. This study demonstrates the importance of coronary sinus cannulation technique in optimizing the protection of the interventricular septum with retrograde cardioplegic infusion.

Mitral valve replacement using a cryopreserved mitral homograft.

Mitral valve replacement, using a cryopreserved mitral homograft, was performed in a 49-year-old patient with calcified mitral stenosis. Postoperative course was uneventful. Transesophageal echocardiography performed 6 months later showed normal function of the mitral homograft.

[Mitral valve replacement with cryopreserved mitral homograft]. / Remplacement valvulaire mitral par homogreffe mitrale cryopréservée.

Mitral valve replacement using a cryopreserved mitral homograft was performed in a 49 year old patient with calcified mitral stenosis. The surgical technique is described. The postoperative course was uneventful. Transoesophageal echo performed 4 months later showed a normal function of the mitral homograft.

[Use of the radial artery for coronary artery bypass. A new experience after 20 years]. / Utilisation de l'artère radiale pour les pontages coronaires. Nouvelle expérience 20 ans après.

Twenty years after its first introduction by A. Carpentier, the use of the radial artery (RA) for coronary bypass was reinvestigated because of unexpected good long term results in some patients. Since July 1989, 158 patients (pts) underwent myocardial revascularization using 189 RA grafts (31 pts received 2 grafts). The left internal mammary artery (LIMA) was concomitantly used as a pedicled graft in 151 cases and the right internal mammary artery (RIMA) in 31 cases, a free IMA graft was used in 29 cases and a saphenous vein graft in 40 cases. A mean of 2.8 graft/pt was performed. The target artery receiving the RA was: circumflex (n = 93), diagonal (n = 39), right coronary (n = 47) and LAD (n = 10). Two patients died (1.3%) and three presented a perioperative myocardial infarct (2.5%). Sternal wound infection was noted in three cases of double IMA implant. No ischemia of the hand was observed. All patients received diltiazem started intraoperatively and continued after discharge. In addition, aspirin (100 mg/day) was given at discharge. Early angiographic controls (< 3 weeks) were obtained in the first 60 consecutive patients and revealed: 73/73 patent RA grafts, 58/58 patent LIMA grafts, 16/16 patent RIMA grafts, 15/19 patent free IMA grafts and 10/11 patent vein grafts. Six patients presented a localized narrowing of the RA conduit unrelated to the anastomotic lines (spasm). Late angiographic control (6 to 24 months) was obtained after a mean follow-up of 11 months in 37 patients: 42/46 RA grafts were patent (91.3%) and free of spasm and 4 were occluded.(ABSTRACT TRUNCATED AT 250 WORDS)

[Combined surgery of the mitral valve and the abdominal aorta in a case of Takayasu's disease]. / Chirurgie combinée de la valve mitrale et de l'aorte abdominale dans un cas de maladie de Takayasu.

The authors report the case of a 34-year-old woman, of North African origin, with mitral valve disease and abdominal aortitis. The differential diagnosis between Takayasu' disease, embolism of cardiac origin and rheumatic aortitis is discussed. Treatment of these lesions was by combined cardiac and vascular surgery in a single-stage operation.

Isolated extracardiac unruptured sinus of Valsalva aneurysms.

Reports concerning unruptured, isolated aneurysms of one sinus of Valsalva are rare. These aneurysms usually protrude inside the heart and are very rarely extracardiac. We report 4 cases of isolated, unruptured extracardiac aneurysms of the noncoronary sinus of Valsalva. Clinical symptoms were nonspecific. Operation was performed by patch reconstruction of the dilated aortic sinus without replacement of the ascending aorta. Microscopic examination of the diseased aortic wall revealed absence of medial elastic fibers. Late follow-up in all 4 cases revealed a normal ascending aorta with no dilatation of the aortic root and no aortic regurgitation.

[Extracorporeal circulation in acute ischemia of the lower limb with late detection]. / Circulation extracorporelle de membre dans l'ischémie aiguë vue tardivement.

The authors report a case of acute limb ischemia in a 19 years old patient seen at 9 hours of the injury. They describe a technique of "washing-reperfusion" by a cardio-pulmonary limb bypass (CPLB). Blood pH and kaliema measurements during CPLB were noted. The good clinical result except on the initial nerves deficit, should lead to think that this technique could take a place in the treatment of acute limb ischemia seen lately.

Traumatic ventricular septal defects. Report of 3 cases with tricuspid valve rupture in 2 cases.

Traumatic ventricular septal defects (TVSD) are rare complications of cardiac trauma. This report describes 3 cases of TVSD secondary to penetrating trauma in 2 patients and to blunt trauma in one case. Echocardiography confirmed the diagnosis in all cases. Surgical correction was performed in the 3 cases. In 2 patients associated tricuspid trauma was present requiring tricuspid valve repair.

Cardiac pheochromocytomas.

Cardiac pheochromocytomas are rare. Thirty cases have been reported in the literature. We report the cases of 2 more patients in whom the diagnosis was established using coronary angiography and who underwent surgical resection using cardiopulmonary bypass. We also review the literature on the subject.

[Volvulus of the sigmoid colon]. / Volvulus du côlon sigmoïde.

The authors report of 34 cases of sigmoid colon volvulus occurring in young subjects (15%) and in elderly subjects (60% over the age of 75 years). The diagnosis is frequently suggested by the clinical features and the history (30% of patients have a history of a previous identical episode) and is confirmed by a plain abdominal x-ray and/or an opaque enema. Endoscopy is performed in every case, except in the presence of peritoneal signs, in an attempt to perform detorsion and colonic intubation under direct vision in order to avoid emergency surgery; this procedure is effective in 87% of cases. Emergency surgery has a high mortality rate (43.5%). Elective or deferred emergency surgery after preparation is much safer (6.6% mortality). In patients with multiple diseases, non-surgical conservative management after detorsion too frequently results in repeated complications, leading to decompensation of the concurrent illnesses and a mortality rate of 34%. Endoscopic detorsion followed by surgical resection after a short 3 to 4 day preparation seems to be the best guarantee of therapeutic success.

[Does perineal muscle testing provide information on the quality of the urethral sphincter in women?]. / Le testing des muscles périnéaux renseigne-t-il sur la qualité des sphincters urétraux de la femme?

A prospective study was carried out on 100 women presenting with urinary incontinence with the intent of determining whether a relationship could be found between the quality of the perineal musculature, as assessed by testing the levatores, and that of the urethral sphincters, as assessed by a study of the urethral pressure profile, thereby defining the respective importance of each of these tests. The mean maximum closing pressure values were compared for three groups whose testing was scored good, fair or nil. Evidence of a positive relationship existing between the levatores testing and the maximum closing pressure against rest (p less than 0.05) and stress (holding-back) (p less than 0.01) urethral pressure profiles was brought forth. However, this relationship does not allow to extrapolate the testing results to the sphinters. In practice, at the individual patient level, one may be satisfied by merely testing the pelvic musculature in case of reeducational treatment of incontinence. Nevertheless, whenever surgery is indicated, objective assessment of the urethral sphincters by ways of an urethral pressure profile study is mandatory.

[Broncho-alveolar lavage by fibroscopy in immunodepressed children]. / Lavage broncho-alvéolaire par fibroscopie chez l'enfant immunodéprimé.

Thirty broncho-alveolar lavage (BAL) were performed in order to investigate 30 infectious episodes in immunocompromised children. Twenty patients were previously treated by high-dose chemotherapy and autologous bone marrow transplantation and 6 other patients by conventional methods. A specific etiologic diagnosis was obtained in 16 of 30 episodes (56%), 22 microorganisms were identified by BAL. The most frequently involved microorganism was Candida albicans and the other agents were as follows: 3 cytomegalovirus, 2 Pneumococcus, 2 Pneumocystis carinii, 1 Aspergillosis, 1 syncytial respiratory virus, 1 myxovirus, 1 Pseudomonas aeruginosa, 1 Mycoplasma pneumoniae, 1 Haemophilus influenzae and 1 Escherichia coli. In 5 cases, more than 2 agents were involved. This study emphasizes the diagnostic interest of BAL for infectious diseases of the immunocompromised child. BAL appears to be a non invasive, rapid and reproducible method, and a useful therapeutic approach in the treatment of infectious episodes occurring in grafted children where several microorganisms could be involved at the same time.

[Severe theophylline poisoning in children. Value of hemodialysis with high permeability membrane]. / Intoxication grave à la théophylline chez l'enfant. Intérêt de l'épuration par hémodialyse avec membrane de haute perméabilité.

The authors report a massive accidental ingestion of enteric-coated theophylline (Armophilline ) by a young child. A status epilepticus and elevated theophylline serum concentration (167 mg/l) led to use hemodialysis with high dialytic clearance. The elevated clearance was obtained by the use of high permeability membrane, by bicarbonate dialysate and the best quality of vascular access (Hickman catheter).

[Medical treatment of neonatal chylous ascites: apropos of a case]. / Le traitement médical de l'ascite chyleuse néo-natale: à propos d'un cas.

We report a case of congenital neonatal chylous ascites successfully managed by diet therapy with medium chain triglycerides. There was a rapid decrease in the lipid content of the ascitic fluid which preceded the clinical response.