Transthyretin amyloid polyneuropathy in France: A cross-sectional study with 413 patients and real-world tafamidis meglumine use (2009-2019).

OBJECTIVE: We aimed to describe characteristics of patients with ATTR variant polyneuropathy (ATTRv-PN) and ATTRv-mixed and assess the real-world use and safety profile of tafamidis meglumine 20mg. METHODS: Thirty-eight French hospitals were invited. Patient files were reviewed to identify clinical manifestations, diagnostic methods, and treatment compliance. RESULTS: Four hundred and thirteen patients (296 ATTRv-PN, 117 ATTRv-mixed) were analyzed. Patients were predominantly male (68.0%) with a mean age of 57.2±17.2 years. Interval between first symptom(s) and diagnosis was 3.4±4.3 years. First symptoms included sensory complaints (85.9%), dysautonomia (38.5%), motor deficits (26.4%), carpal tunnel syndrome (31.5%), shortness of breath (13.3%), and unexplained weight loss (16.0%). Mini-invasive accessory salivary gland or punch skin and nerve biopsies were most common, with a performance of 78.8-100%. TTR genetic sequencing, performed in all patients, revealed 31 TTR variants. Tafamidis meglumine was initiated in 156/214 (72.9%) ATTRv-PN patients at an early disease stage. Median treatment duration was 6.00 years in ATTRv-PN and 3.42 years in ATTRv-mixed patients. Tafamidis was well tolerated, with 20 adverse events likely related to study drug among the 336 patients. CONCLUSION: In France, ATTRv patients are usually identified early thanks to the national network and the help of diagnosis combining genetic testing and mini-invasive biopsies.

'Green Apple' Heart Failure.

We report here the clinical case of an Afro-Caribbean patient referred for complete atrioventricular block for whom a diagnosis of hereditary cardiac amyloidosis was eventually confirmed. Hereditary cardiac amyloidosis is an emerging threat in the Caribbean, and the main goal of this report is to raise the awareness of the disease among physicians.

Epidemiology of the vascular assessment and correlation of the WIfI Classification in lower limb amputee patients at Martinique university hospital in 2018.

BACKGROUND: The precise epidemiological evaluation of amputations is difficult. It is a serious public health and economic problem with a high death rate. The proportion of amputees with pre-amputation vascular status remains unknown. The main objective of our study was to evaluate the proportion of patients with lower limb amputation who had a pre-procedural vascular assessment. The secondary objectives were to evaluate the risk of amputation at the admission of these patients, estimate the incidence of amputations in Martinique, and to collect epidemiological data on this category of patients. MATERIAL AND METHODS: We conducted an epidemiological, retrospective, and observational study, over the year 2018 between January 01 and December 31, including all adults' patients who underwent an amputation of the lower limb at the university hospital center of Martinique. RESULTS: Among the 170 included patients, 79 (46%) patients had a major lower limb amputation. The incidence of amputations in 2018 was estimated at 48.9/100,000 inhabitants. The vascular assessment was performed for 110 (65%) patients. For the other 60 (35%) patients who did not have a vascular assessment, 53 (88%) had a severe infection. This assessment was significantly related to the amputation level: a vascular assessment was performed in 97 (70%) patients with below the knee amputation versus 13 (41%) patients with above the knee amputation (P<0.01). The WIfI classification system found a high risk of amputation for 152 (89%) of patients but also a benefit of revascularization ranked high for 138 (81%) of them. The origin of amputation was limb ischemia for 125 (68%) patients. CONCLUSION: A significant number of patients who underwent lower limb amputation did not have a pre-procedural vascular assessment. Many improvements in the health care are therefore to be implemented. The upcoming M@diCICAT project in Martinique will contribute in the improvement of patient management. The incidence of amputation in Martinique is considered high compared to other countries (French national incidence in 2003=24.8/100,000 inhabitants), and it seems to have remained stable since 2008. Our population is considered to be at high risk of amputation by the SVS-WIfI classification. This score seems adapted to anticipate the evolution of these patients and could be useful in daily practice.

[Arterial-hypertension prevalence in the general population of Martinique]. / Prévalence de l'hypertension artérielle en population générale à la Martinique.

BACKGROUND: Since 1996, arterial hypertension has been recognized as one of the main health priorities in Martinique. However, its prevalence in the general population has never been measured. Furthermore, obesity is increasing in many countries and studies have shown that hypertension is more frequent in obese people than in people with normal body mass index. The objective of this survey is to measure hypertension prevalence in the general population and to study the link between hypertension, weight status and socioeconomic level. METHODS: Cross-sectional study of randomly selected homes in randomly selected geographical islets. All household members in these homes constituted the eligible population. Arterial hypertension was defined as systolic pressure greater than 140mmHg and/or diastolic pressure greater than 90mmHg and/or antihypertensive treatment. Weight status was estimated using the body mass index. RESULTS: Study concerned 1504 persons aged 16 years or older with a sex-ratio of 0.7 and an average age of 48.3 years for men and 48.5 years for women, p=0.88. The prevalence rate of hypertension is 29% [IC(95%): 25.9-31.8] in the sample and declines to 22.5% [IC(95%): 20.1-25.1] using weighted data. The prevalence rate is 33.1% [IC(95%): 30.2-36.6] for overweight and 20.1% [IC(95%): 17.8-22.6] for obesity. Being overweight is more frequent among persons with hypertension than among ones with normal blood pressure, 73.0 versus 47.4%; p<0.001. In those with hypertension, overweight does not differ significantly between men and women, but the prevalence of obesity is greater among women than among men (35.7 versus 20.6 %, p<0.05). CONCLUSION: The high prevalence of both hypertension and obesity in the general Martinican population has been confirmed by this study. Prevention actions are required to decrease the cardiovascular risk in this population.

[Differences between hypertension in Metropolitan France compared to Overseas France Departments and Regions (DOM-ROM)]. / Différences de prise en charge de l'HTA entre la métropole et les DOM-ROM.

BACKGROUND: High blood pressure (HBP) is the most common chronic disease worldwide. In France, its prevalence varies by region. It is high in most Overseas Departments and Regions (DOM-ROM), at 38.2% in Réunion (1), 44% in Mayotte (2), 28% in the French Antilles, 18% in French Guiana, 25% in French Polynesia (3) and 28% in Saint-Martin (4). PURPOSE: To determinate the differences within the same healthcare system between hypertension in Metropolitan France compared to Overseas France Departments and Regions (DOM-ROM). RESULTS: Sex-based differences. In contrast to Metropolitan France, in Overseas France the prevalence of HBP is higher in women, although women show better rates of care (screening and rates of patients "normalised" under medical treatment). The main explanation for this is the higher prevalence of obesity in women. Obesity multiplies the risk of developing hypertension by 2.5 Obesity in Guadeloupe affects 14% of men compared to 31% of women. Socio-economic particularities of hypertension in Overseas France. The numerous epidemiological surveys carried out in the French Antilles have demonstrated the major role of socio-economic conditions in the occurrence of hypertension, alongside the usual risk factors such as sedentary lifestyle, salt consumption and obesity (7). In the absence of socio-economic disparity, there is no significant disparity in the prevalence of hypertension specially in men. CONCLUSIONS: There are differences between France Overseas Regions and Territories (DOM-ROMs) and Metropolitan France in terms of the prevalence, knowledge, treatment and control of hypertension, and these vary according to sex. For men, the prevalence and treatment of hypertension differ very little when considering a population of workers or employees in both regions. On the other hand, for women, the prevalence of hypertension is higher in the French Antilles-Guiana. This difference is not fully explained by the higher prevalence of obesity observed among female employees in the French Antilles-Guiana. For these patients, we also observe better knowledge and better control of hypertension. Care for men in socio-economically disadvantaged situations of precarity must be improved in terms of screening and adherence to treatment.

[The prevalence of abnormal glucose regulation after myocardial infarction: Comparative study in two French ethnic groups]. / Anomalies du métabolisme glucidique au décours d'un syndrome coronarien aigu : une étude comparative de deux groupes ethniques français.

OBJECTIVES: The aim of this study was to compare the prevalence of abnormal glucose tolerance in patients stemming from two French ethnic groups and admitted for acute coronary syndrome (ACS) to intensive coronary care unit. MATERIALS AND METHODS: During a period of six months, 53 and 60 consecutive patients were enrolled at Fort-de-France (Martinique, French West Indies, Afrocaribbeans, group F) and at Bordeaux (France, Europeans, group B), respectively. Glucometabolic state was classified according to medical history and fasting glycemia measured from the fourth day after ACS. RESULTS: At baseline, 36% of the patients of group F and 20% of the patients of group B had previously known diabetes (p=0.06). Prevalence of hypertension was higher in Afrocaribbeans than in Europeans (60 versus 40%, p<0.05). According to fasting glycemia, newly detected diabetes were found in six Afrocaribbeans and only one was found in Europeans; two patients in group F and three patients in group B displayed impaired fasting glycemia. As a whole, 51% of Afrocaribbeans and 27% of Europeans showed abnormal glucose tolerance (p<0.05). Furthermore, Afrocaribbeans displayed lower levels of triglycerides and higher levels of HDL cholesterol than Europeans (p<0.05). CONCLUSION: Our study suggested a higher prevalence of impaired glucose metabolism in French Afrocaribbeans than in European counterparts after ACS. Furthermore, French Afrocaribbeans displayed a more favorable lipoprotein profile. These characteristics look like that of the American and British Afrocaribbeans, maybe because of a common genetic origin.

Elevated alveolar nitric oxide is linked to poor aerobic capacity and chronotropic incompetence in liver transplant candidates.

BACKGROUND & AIMS: Increased nitric oxide is involved in abnormal hemodynamic parameters and respiratory function of cirrhotic patients. We aimed to quantify partitioning exhaled nitric oxide measurements in exhaled air in liver transplantation (LT) candidates and evaluate their relationships with chronotropic incompetence and aerobic capacity. METHODS: We compared exhaled nitric oxide (NO) measurements, heart rate response and peak oxygen uptake during incremental exercise in liver transplantation candidates to those of controls. RESULTS: As opposed to healthy control subjects, LT candidates displayed elevated alveolar NO, blunted chronotropic response and reduced V'O2 at maximal exercise. In LT candidates, median peak V'O2 was 18.7 ml kg-1 min-1 (interquartile range (IQR) 16.2; 21.8), corresponding to 65% (IQR 57; 72) of the predicted value. Compared with controls, LT candidates had increased levels of alveolar NO (median (IQR) 2.0 (1.2; 2.2) versus 3.1 (2.3; 4.5), p < 0.001). In controls, no relations were found between alveolar NO and V'O2 peak or heart rate reserve whereas in cirrhotic patients, negative correlations and negative slopes were found between alveolar NO and V'O2 peak and heart rate reserve decrease. CONCLUSIONS: Increasing alveolar NO could be a specific pathophysiological condition limiting aerobic capacity in LT candidates.

Reducing the burden of arterial hypertension: what can be expected from an improved access to health care? Results from a study in 2420 unemployed subjects in the Caribbean.

High prevalence and poor control of hypertension have been observed in populations with low-socioeconomic status. Comparing an unemployed population with another employed population sharing the same culture, and another employed population living in another environment might enlighten the effects of factors accessible to primary prevention on the one hand and access to health care on the other hand. The objectives are, first, to describe blood pressure (BP) prevalence and control in an unemployed Caribbean population benefiting from State financial support and good access to health care and second, compare the results in this population with those observed, with the same methodology in two employed populations, one in the Caribbean and one in metropolitan France. A cross-sectional study of 2420 consecutive unemployed subjects referred for check-up in the two health centres of Guadeloupe, a French Caribbean island. Hypertension prevalence was 25.2% in men and 22.1% in women. BP was controlled in 17.3% of men and 37.2% of women receiving antihypertensive medication. Among women, 58% were overweight and 29% obese. Prevalence of hypertension was higher among the unemployed and employed Caribbean population, than among an employed metropolitan French population. A high prevalence of obesity was observed in the two Caribbean populations suggesting the interest of primary prevention in the Caribbean. Burden of hypertension in a population relates to the development of hypertension (primary prevention) and control of hypertension (secondary prevention). Identifying hypertensive patients and controlling blood pressure are both important to reduce the disease burden.

[Prevalence of hypertension in a disadvantaged population in Antilles: a major role for obesity?]. / Prévalence de l'HTA en population précaire aux Antilles : rôle majeur de l'obésité?

UNLABELLED: The aim of this study was to evaluate the prevalence of hypertension and its management in a disadvantaged population, essentially composed of those receiving state subsidies and the unemployed. METHODS: The PHAPPG study : Prevalence of Hypertension in a Population Précaire Guadeloupéenne (disadvantaged population in Guadeloupe) included 2420 consecutive people considered to be 'disadvantaged' seen in the two medical examination centres in Guadeloupe between November 2001 and November 2003. RESULTS: The prevalence of obesity was considerable throughout the female population of Antilles (29%). It was recorded in 12% of men. The prevalence of hypertension in the population was 24.7% for men and 22.1% for women. Obesity was the main factor that could explain the higher prevalence of hypertension noted in Antilles, especially among 'disadvantaged' women. In effect, after correction for other risk factors and for age, this prevalence of hypertension was on average three times higher amongst the obese compared to subjects with normal weights. CONCLUSION: The prevalence of hypertension is elevated in the population of Antilles, especially among the disadvantaged. Obesity is the key factor, upon which a primary prevention policy for hypertension could be based.

[Obesity and high blood pressure in French West Indies women, some difference according to definition of obesity; BMI or abdominal obesity]. / Obésité et hypertension artérielle chez la femme antillaise, la prévalence diffère selon la définition utilisée, indice de masse corporelle ou tour de taille.

OBJECTIVES: To compare prevalence of abdominal obesity with obesity defined as BMI >or=30 kg/m2 in a West Indies population, and to define the relation between obesity and hypertension. METHODS: A cross-sectional study of 2420 consecutive unemployed subjects referred for check-up in the two health centres of Guadeloupe, a French Caribbean island. Height and weight were measured and the body mass index (BMI) was calculated as weight/height2 (kg/m2). Obesity was defined as BMI >or=30 kg/m2 and excess weight as BMI >or=25 kg/m2 and<30 kg/m2. Abdominal obesity was defined as waist measurement more than 88 cm for women and more than 102 cm for men. RESULTS: [table: see text] CONCLUSION: A high prevalence of obesity was observed in this Caribbean population suggesting the interest of primary prevention in The Caribbean. In women, abdominal obesity (waist measurement>88 cm) was more frequent than obesity defined as BMI>30 kg/m2). In a multivariate analysis, obesity is an independent risk factor of hypertension (Odds-ratio=3), however the definition of obesity.

[Treatment of hypertension in Guadeloupe (FWI) in 2005: Pretrahguad study]. / Traitements médicamenteux et non médicamenteux chez l'hypertendu en Guadeloupe en 2005 : enquête PRETRAHGUAD.

OBJECTIVES: To estimate life style and drug therapy for treatment of hypertension in Guadeloupe (FWI) in 2005, and to compare the data with those obtained in a similar study realised in France metropolitan population in 2004. METHODS: A cross-sectional study of a sample of 509 subjects selected as being representative of the Guadeloupe population for age (35 years and above), gender, socioeconomic status, and place of living. Subjects who declare to take an antihypertensive medication were classified as treated hypertensive patients. A questionnaire evaluating changes in life style during the last year (physical activities, quality of food consumption, smoking, and alcohol habits) was administered by phone. RESULTS: In 2005, 32% of the population above the age of 35 years was treated for hypertension, corresponding to an estimate of 51,230 subjects. Hypertensive subjects experienced: a weight loss of more than 3 kg in 29 vs 25% in the general population, an increased in fruits and vegetables consumption in 29 vs 46%, a decreased in cheese (11 vs 8%), pork-butchery (23 vs 16%) and alcohol consumption (10 vs 6%). The percentage of subjects who increased their physical activities was not different in the two groups (24 vs 25%). We observed a larger use of diuretics and ACE-I/ARBs prescribed as combined drugs. The most frequent drug prescribed as single drug is calcium antagonist. When the patients are receiving at least two medications or more (41%), combined treatment is found with high frequency (75%). CONCLUSION: Changes in life style were more often applied by the subjects treated for hypertension that by the general population. The dominating place that occupies today fixed-dose combination drugs indicates a change of the therapeutic practices. When comparing with FLAHS study concerning the French metropolitan population, diuretics and calcium antagonist are more often prescribed in Guadeloupe, in witch 90% of the population is Afro-Caribbean.

Changes in prevalence, awareness, treatment and control of hypertension in disadvantaged French Caribbean populations, 2003 to 2014.

In 2003, the PHDG (Prevalence of Hypertension among Disadvantaged Guadeloupeans) study highlighted poor management of hypertension in an unemployed French Caribbean population. New processes of health-care coordination and a pay-for-performance system have since been developed. We aimed to assess changes in hypertension characteristics in disadvantaged French Caribbean populations in the last 10 years. Using PHDG 2003 data, in 2014 we undertook a cross-sectional study with identical methods. The source population comprised all Guadeloupeans having undergone periodic heath checks offered by the Social Security insurance at these dates. Only universal health coverage beneficiaries (i.e. in situations of poverty) aged 18-64 were included (2014 in 2014, 1868 in 2003). Hypertension was defined by antihypertensive treatment or a mean of two blood pressure measures ⩾140/90 mm Hg. The 2003 and 2014 data were age adjusted; comparative morbidity factors (CMF) and 95% confidence intervals were calculated to assess changes over time. Hypertension prevalence decreased from 38.3 to 34.5% (CMF 95% CI: 0.83-0.97). The increase in hypertension awareness was greater for women (from 48.3 to 55.3%, CMF 95% CI: 1.00-1.31) than for men (from 28 to 31.1%, NS). Among hypertensive individuals aware of their condition, proportions of those treated increased for women (from 83.1 to 88.3%, NS) but decreased for men (from 80.2 to 75.8%, NS). Controlled hypertension among treated patients increased in women (from 35.2 to 49.2%, CMF 95% CI: 1.07-1.82) and men (from 12.9 to 30.1%, CMF 95% CI: 1.30-4.21). In conclusion, in these poor French Caribbean populations with theoretically adequate access to care, hypertension control remained far below national goals. Neither awareness nor treatment had improved in men.

[Self monitoring of blood pressure in Guadeloupe in 2005 results of the PRETRAHGUAD enquiry]. / Utilisation des appareils d'automesure tensionnelle en Guadeloupe en 2005: enquête PRETRAHGUAD.

The object of this enquiry was to estimate the number of self monitoring devices for blood pressure measurement in Guadeloupe in 2005 and to determine how they were used. The enquiry included 509 patients aged over 35 years and living in Guadeloupe meeting the inclusion criteria of PRETRAHGUAD: PREvalence et TRAitement de Hypertension en GUADeloupe. The enquiry was made by Qualistat, a survey institute. Designed as a survey, it was based on the two degree quota method. It was carried out by telephone by CATI (Computer Assisted Telephone Inquiry) networked computer programming by ten operators trained by experts of the HTA-GWAD organisation. In addition to questions on socio-demographic background and biometric parameters, the operators also asked about observance of antihypertensive treatment, the ownership of a self monitoring blood pressure device and its usage. A subject who said he took a treatment validated as antihypertensive was considered to be a "treated hypertensive". The results indicate that in 2005, in Guadeloupe, 32% of the population over 35 years of age were treated hypertensives, making a total of 51,230 individuals. Forty three percent of treated hypertensives and 19% of other subjects admitted to having used a self monitoring blood pressure device. Twenty six percent of the study population owned a device. Of the estimated total of 43,220 devices in circulation, nearly half of them were wrist devices. Regular usage (at least once per month) was declared by 73% of hypertensive and 46% of other subjects. Out of the total population, the medical practitioner had spoken of self monitoring of blood pressure to his patients and had incited only 18% to carry it out. The authors conclude that, in 2005, one third of adults over 35 years of age were treated for hypertension and 43% of treated hypertensives owned a self monitoring blood pressure device. The incitation by medical practitioners to use this method of self monitoring remained modest. This technique would seem to be little used by medical practitioners although the patients have started to equip themselves with the device.

[Access to care: not enough to completely abolish the disparity in hypertension management at the socio-economic level]. / Une bonne couverture sociale et un bon accès aux soins: un prérequis nécessaire mais insuffisant pour faire disparaître une disparité de prise en charge de l'HTA selon le niveau socio-économique.

Higher prevalence and poorer control of hypertension have been observed in populations with low socioeconomic status. The causal link between socioeconomic factors and hypertension is complex. What is the impact of medical services compared with other health status determinants? We aimed to assess blood pressure prevalence and control in an unemployed disadvantaged population receiving state financial support and with easy access to health care. This was a cross-sectional study of 2420 consecutive subjects in Guadeloupe, a French Caribbean island, who were referred for check-up in a health centre. As unemployed persons, they all benefited from state financial support and special coverage. Blood pressure was averaged from three consecutive measurements. Subjects not taking antihypertensive medications and with average BP > 140/90 mmHg underwent an additional visit. A total of 1088 men aged 42 +/- 10.6 years and 1332 women aged 40 +/- 11 years were included from November 2001 to November 2003. Hypertension prevalence was 25.2% in men and 22.1% in women, while awareness was 40.2% in men and 73% in women. Blood pressure was controlled (<140/90 mmHg) in 19% of men and 37,2 % of women receiving antihypertensive medication. Among women, 58% were overweight and 29% obese. Hypertension prevalence was slightly higher than that recently observed in cohorts of workers in Caribbean regions and metropolitan France. Control was poorer despite similar awareness and treatment rates. These findings suggest that a universal healthcare system can reduce, but not fully eliminate, disparities in hypertension care and prevalence across income categories.

[Precariousness, cardiovascular risk in the afro-Caribbean population of Saint-Martin. Data from the study CONSANT-SM]. / Précarité, risque cardiovasculaire dans une population afrocaribéenne de Saint-Martin. Données de l'étude CONSANT-SM.

OBJECTIVE: The objective is to describe the prevalence of arterial hypertension (hypertension) and cardiovascular risk factors (FDR) and specify their association with the socio-economic factors in a collectivity of Saint-Martin. MATERIAL AND METHODS: CONSANT-SM is a cross-sectional descriptive study carried out on a representative sample of 400 people. The data collection was conducted by investigators at home. RESULTS: The low income level is significantly associated with abdominal obesity (OR=2.3), with cardiovascular FDR accumulated (OR=3.58). Low level of education (OR=2.86) and abdominal obesity (OR=3.73) are significantly associated with hypertension. DISCUSSION: The link between cardiovascular FDR and precariousness (in our study represented by the variable low levels of income and education) is found in this study carried out on a representative sample of the population of the community of Saint-Martin. CONCLUSION: The strong link between hypertension, obesity and others cardiovascular risk factors (FDR) with precariousness (in our study represented by the variable low levels of income and education) is found in this afro-Caribbean population. This data is an important information for the health program developed by the healthy system.

[Arterial hypertension in the French Caribbean regions: gender related differences]. / Hypertension artérielle aux Antilles: différences liées au sexe.

BACKGROUND: Arterial hypertension is a frequent disease, responsible for a significant morbidity, in the French Caribbean regions. Today, epidemiological studies on this topic remain few. OBJECTIVES: To analyse the prevalence, awareness, treatment and control of arterial hypertension in the French Caribbean regions. METHODS: Analysis of the INHAPAG cohort (Incidence of Arterial Hypertension in the Working population Antillo-Guyanaise) carried out in 2001, and including 6113 active subjects recruited in Guadeloupe, Martinique and Guyana. The procedure of diagnosis of arterial hypertension comprises two visits, with a series of three measurements of the blood pressure at each visit. RESULTS: Prevalence of hypertension is estimated to be 18.9% among women and 19.5% among men. The rates of treatment are higher among women (74.8 vs 34.4%) than among men, resulting in a much better control rate (61.3% vs 38.6% among men). An analysis of factors associated with the presence of arterial hypertension shows a noxious role of low education level among women. CONCLUSION: Our study finds marked differences between women and men in the treatment and control of arterial hypertension and underline the need for improving blood pressure management of the latter.

Surgical treatment of subaortic stenosis after biventricular repair of double-outlet right ventricle.

Out of 180 patients who underwent biventricular repair of double-outlet right ventricle between 1980 and 1995, 9 (5%) required reoperation because of subaortic stenosis. Two other patients who initially underwent operation elsewhere underwent reoperation at our institution because of subaortic stenosis. The median age at biventricular repair was 4 months. Repair consisted of tunnel construction from the left ventricle to the aorta in nine patients; the remaining two patients received an arterial switch operation with ventricular septal defect closure. Subaortic stenosis developed with time: the mean postoperative left ventricle-to-aorta gradient after repair was 10 +/- 19 mm Hg (range, 0 to 50 mm Hg) and became 84 +/- 27 mm Hg (range, 40 to 124 mm Hg) in a mean delay of 45 +/- 66 months (range, 1 to 213 months). At reoperation, the obstruction was caused by the protrusion of the inferior rim of the ventricular septal defect into the left ventricular outflow tract associated with subaortic hypertrophied muscle and membrane. The 11 patients underwent 15 reoperations. Surgical technique consisted of an extended septoplasty in 6 reoperations. In this technique an incision was made in the septal patch and was extended into the muscle toward the apex until a large opening of the left ventricular outflow pathway was obtained. A new patch was then secured to streamline the left ventricular outflow tract. None of the patients who underwent extended septoplasty had to undergo reoperation. There were no early or late deaths. At 115 +/- 85 months after biventricular repair, all patients were in New York Heart Association functional class I or II and the mean postoperative left ventricle-to-aorta gradient was 20 +/- 24 mm Hg (range, 0 to 60 mm Hg). We conclude that after biventricular repair of double-outlet right ventricle, the subaortic region is at risk for the development of stenosis. Surgical treatment adapted to the anatomy of the obstruction can offer good early and midterm results. It seems that an aggressive approach by an extended septoplasty avoids multiple reoperations.

Importance of photo activation of rose bengal for platelet activation in experimental models of photochemically induced thrombosis.

Generation of oxygen free radicals in the lumen of a vessel leads to NO inactivation, modification of lipid components of platelets and endothelial cell membranes, and platelet activation. On this basis, many experimental models of thrombosis have been developed, where the formation of a platelet rich thrombus follows the illumination of a vessel with an appropriately filtered light after intravenous administration of Rose Bengal or another sensitizing dye. However the detailed mechanism of thrombus formation remains poorly known. This work appreciates the contribution of platelet activation directly induced by oxygen free radicals in formation of the platelet rich thrombus, from a study of human platelet aggregation in presence of photo-activated Rose Bengal. The results demonstrate that direct activation of platelets by free radicals generated by Rose Bengal is of low or no importance in formation of the thrombus. Therefore, the main trigger of platelet aggregation and thrombosis in these models is primary endothelial cells injury.

Experimental thrombosis model induced by free radicals. Application to aspirin and other different substances.

A large number of experimental studies suggests that oxygen free radicals play a major role in the pathogenesis of the myocardial lesions observed during the sequence ischemia-reperfusion. The purpose of this study was to determine whether oxygen free radicals can induce thrombosis. In so doing we have developed a new experimental thrombosis model. Reproducible focal thrombosis has been achieved by irradiating mesenteric arterioles of rat for variable time with green filtered light issuing from a mercury lamp after systemic injection of different rose bengal doses. The number of emboli that remove in the blood (N), the duration of total occlusion (T) and the number of emboli per minute were then measured. As control, no rose bengal administration was done and the vessels were exposed to the filtered light. In comparison with this control, results clearly showed that free radicals always induced thrombosis and the induced thrombus was mainly composed of platelets. In this new thrombosis model induced by free radicals antithrombotic drugs (aspirin, 200 mg/Kg, heparin, 2 mg/Kg) and antioxidants (vitamin C, 10 and 20 mg/Kg, allopurinol, 200 and 300 mg/Kg, vitamin E, 500 and 1000 mg/Kg) have been tested. Results have shown that only heparin and vitamin E had an antithrombotic effect on thrombus formation induced by free radicals. This model should be useful in studying the effects of different drugs and could lead to new treatment modalities for ischemic accident and other cardiovascular diseases.