Congenital anomalous origin of a single coronary artery and high-level sporting competition.

Using a single clinical case of a professional soccer player presenting an anomalous origin of the right coronary artery, cardiac screening and surgical treatment are described taking into account the recommendations of cardiac and sports societies.

Outcome of heart transplants 15 to 20 years ago: graft survival, post-transplant morbidity, and risk factors for mortality.

OBJECTIVES: The study was conducted to determine the long-term outcome of patients who underwent heart transplantation 15 to 20 years ago, in the cyclosporine era, and identify risk factors for death. METHODS: A retrospective analysis was done of 148 patients who had undergone heart transplantation between 1985 and 1991 at a single center. Operative technique and immunosuppressive treatment were comparable in all patients. RESULTS: Actuarial survival rates were 75% (n = 111), 58% (n = 86), and 42% (n = 62) at 5, 10, and 15 years, respectively. The mean follow-up period was 12.1 +/- 5.6 years for patients who survived more than 3 months after transplantation (n = 131). The major causes of death were malignancy (35.8%) and cardiac allograft vasculopathy (24.7%). No death related to acute rejection was reported after the first month of transplantation. Graft coronary artery disease was detected on angiography in 66 (50.3%), and 7 (5.3%) had retransplantation. Malignancies developed in 131 patients (48.1%), including skin cancers in 31 (23.6%), solid tumors in 26 (19.8%), and hematologic malignancies in 14 (10.6%). Severe renal function requiring dialysis or renal transplantation developed in 27 patients (20.6%). By multivariable analysis, the only pre-transplant risk factor found to affect long-term survival was a history of cigarette use (p < 0.0004). CONCLUSIONS: Long-term survival at 15 years after cardiac transplantation remains excellent in the cyclosporine era. Controlling acute allograft rejection can be achieved but seems to carry a high rate of cancers and renal dysfunction. History of cigarette use affects significantly long-term survival in our study.

Creation of standardized tools for therapeutic education specifically dedicated to chronic heart failure patients: the French I-CARE project.

AIM: To develop educational programs in chronic heart failure (CHF), creation of standardized tools for therapeutic education specifically dedicated to CHF patients was performed as a part of the French I-CARE project. METHODS AND RESULTS: A working group was constituted of cardiologists, nurses and dieticians, specialized in both therapeutic education and CHF. The personal patient's document consisted of a ring binder with dividers containing index cards for 5 units. The unit "Educational diagnosis" comprised a guide for the user and an auto-questionnaire for the patient. The unit "Knowledge of the disease" comprised a whiteboard for explaining cardiovascular physiology, a 3D-model of heart, and a glossary. The unit "Diet control" was composed of posters, a food-card game with a game mat figuring the different meals of a day, a low-salt recipe book, and 1-g salt spoons. The unit "Physical activity and daily life" comprised recommendations for physical activity and questionable real-life situations, and a card game for evaluation. The unit "Medical treatment" consisted of index cards for different cardiovascular drugs. CONCLUSION: These educational tools should help multidisciplinary teams to develop therapeutic education dedicated to CHF in order to improve self-management, morbidity and quality of life in CHF patients.