Prehabilitation Using a Cardiac Rehabilitation Program for a Patient With a Total Artificial Heart Prior to Heart Transplantation.

INTRODUCTION: The last few decades have been marked by significant advances in mechanical cardiocirculatory support. A total artificial heart (TAH) became a viable therapeutic option for numerous patients as a bridge to heart transplantation, particularly for those in end-stage heart failure. This technology aims to address the various subsequent shortfalls of organs. This report reviews the impact of a prehabilitation on a patient with an Aeson TAH (Carmat). DISCUSSION: We assessed improvements in functional capacity and quality of life (QoL) in a newly implanted patient following standard cardiac rehabilitation as a prehabilitation program, using 6-min walk test and the Short Form-12 (SF-12) health survey, respectively. Similar functional improvements were observed over a short period of 2 wk compared with a longer protocol for patients with a heart transplant, and superior effects on QoL. The patient was successfully transplanted 5 mo after the TAH implantation. SUMMARY: Prehabilitation of a patient with a TAH increased both their physical capacity and QoL.

Quantitative assessment of primary mitral regurgitation using left ventricular volumes: a three-dimensional transthoracic echocardiographic pilot study.

AIMS: To investigate the value of assessment of mitral regurgitant fraction (RF) using left ventricular (LV) volumes obtained by three-dimensional echocardiography (3DE) to quantify primary mitral regurgitation (MR). METHODS AND RESULTS: Sixty patients with primary MR in sinus rhythm were prospectively enrolled. RF was calculated using either 2DE or 3DE LV volumes obtained as follows: (LV total stroke volume - LV forward stroke volume by Doppler)/LV total stroke volume. Severity of MR was graded independently by two cardiologists blinded to LV volumetric data using an integrative approach, as recommended by current guidelines. Sixty patients with LV ejection fraction >50% and no MR were also studied. In patients without MR, 3D total LV stroke volume was more strongly correlated with LV forward stroke volume than 2D total LV stroke volume (r = 0.75, P < 0.0001 vs. r = 0.62, P < 0.0001, respectively). The 3D method had a feasibility of 90% in patients with MR. Inter-reader concordance for MR grading (four grades) was excellent with a Kappa-value of 0.90, P < 0.0001. A significant correlation was observed between grade of MR severity and 3D RF (r = 0.83, P < 0.0001) and 2D RF (r = 0.74, P < 0.0001). Comparisons between individual grades for 3D RF were significant (P < 0.05) except for 3+ vs. 4+ MR (P = 0.213). All patients with 3D RF ≥40% had ≥3+ or 4+ MR and those with 3D RF ≤30% had 1+ or 2+ MR with a 'grey' overlap zone between 30 and 40%. CONCLUSIONS: RF can be routinely determined using 3D LV volumes with a high feasibility in patients with primary MR and is reliable for identification of Grade 3+ or Grade 4+ MR. The incorporation of this parameter into the currently recommended multiparametric integrative approach might be helpful to discriminate significant MR.

Acute stent recoil in the left main coronary artery treated with additional stenting.

We report a case of acute stent recoil occurring after the stenting of an ostial left main coronary artery lesion. The marked recoil after high-pressure balloon inflation confirmed that the radial force of the first stent was unable to ensure vessel patency. The addition of a second stent provided the necessary support to achieve a good final result. This case illustrates a possible complication of aorto-ostial angioplasty that could be treated with double stenting.