Impact of biventricular and left ventricular pacing on hemodynamics and left ventricular dyssynchrony compared with right ventricular pacing in the early postoperative period following cardiac surgery.

OBJECTIVES: The aims of this study were to test the hypotheses that in the postoperative period following corrective surgery for congenital heart defects: (i) atrio-right ventricular (RA-RV) pacing decreases cardiac output (CO) compared with right atrial (RA) pacing, (ii) atrio-biventricular (RA-BiV) and left ventricular (RA-LV) pacing improves CO compared with RA-RV pacing. STUDY DESIGN: Prospective observational study. PATIENTS: Children 0-2years of age referred for surgery of congenital heart defects were studied during intrinsic rhythm and atrial, atrio-right ventricular, atrio-left ventricular and atrio-biventricular pacing. CO, extrapolated from mean systolic aortic velocity (MSAV), and left ventricular dyssynchrony were assessed using transthoracic echocardiography. RESULTS: RA-RV pacing induced a significant decrease in CO (MSAV 0.52±0.19m/s to 0.46±0.16m/s, p=0.01) and a significant increase in LV dyssynchrony (8.7±7.9ms to 33±21ms, p=0.001). RA-BiV pacing induced a significant increase in CO (MSAV 0.46±0.16m/s to 0.52±0.18m/s, p=0.01) and a significant decrease in LV dyssynchrony (33±21ms to 7±4ms, p=0.0003) compared with RA-RV pacing. RA-LV pacing induced a significant decrease in LV dyssynchrony (33±21ms to 9±7ms, p=0.0007) without a significant improvement of CO compared with RA-RV pacing. CONCLUSIONS: RA-BiV pacing improves CO compared with RA-RV pacing in the early postoperative period following pediatric cardiac surgery. This improvement is related to a reduction in left ventricular dyssynchrony.

[Coronary stents and anaesthesia]. / Endoprothèses coronaires et anesthésie.

The coronary stents are widely used to prevent coronary restenosis after percutaneous coronary intervention. Dual antiplatelet therapy (acetyl salicylic acid and a thienopyridine-clopidogrel or ticlopidine) are prescribed at least during six weeks after conventional stent and six months after drug eluting stent insertion to prevent stent thrombosis. When an invasive procedure is required, a risk of stent thrombosis arises after stopping antiplatelet therapy and a risk of bleeding when continuing this treatment. Therefore, cardiologists should choose carefully the type of coronary stent before insertion and concerned physicians (anaesthesiologists, surgeons, cardiologists) should decide a perioperative strategy in these high-risk patients.

[Coronary stents and anaesthesia: it is time to have national data]. / Stents coronariens et anesthésie: il est temps d'avoir des données nationales.

We report 13 cases of coronary stent patients, undergoing a non cardiac surgery. Despite an heterogenous perioperative management of antiplatelet agents, none of these patients developed any significant complications. Recently, several case reports of postoperative drug eluting stent thrombosis have been reported. However, the actual incidence of this dramatic event is not known. This confirms the need to perform prospective studies or registries of patients with coronary stents undergoing non cardiac surgery, in order to propose evidence-based recommendations on perioperative antiplatelet management in such patients.

[Fatal pulmonary mucormycosis in a diabetic patient]. / Mucormycose pulmonaire fatale chez une patiente diabétique.

We report a case of pulmonary mucormycosis in a 65-year-old diabetic patient. Pulmonary mucormycosis should be suspected in predisposed patients presenting a pneumonia that resists to antibiotics. The microbiologic diagnosis requires usually a biopsy using bronchoscopic or surgical procedures. The optimal therapy requires an early systemic antifungal treatment associated with the resection of the pulmonary lesion and the control of the underlying disease.