[Balloon aortic valvuloplasty in the adult. Immediate results and in-hospital complications in the latest series of 141 consecutive patients at the University Hospital of Rouen (2002-2005)]. / Valvuloplastie aortique par ballonnet chez l'adulte. Résultats immédiats et complications intrahospitalières dans la dernière série de 141 patients consécutifs au CHU de Rouen (2002-2005).

UNLABELLED: With the aging population, elderly patients with degenerative, severely calcified, and symptomatic aortic stenosis are becoming a frequent problem in medical decision making, particularly because many are declined for surgical valve replacement. For these patients, balloon aortic dilatation could be a palliative treatment. PATIENTS AND METHODS: we analyzed retrospectively our techniques and complications during hospitalization for percutaneous aortic balloon dilatation in 141 consecutive patients (45% women, mean age 83 +/- 10 y) from January 2002 to April 2005. The Parsonnet's score was 41 +/- 8 and the Euroscore was 10 +/- 2. We excluded the patients enrolled for percutaneous aortic valve implantation. This technique was performed under local anesthesia, from retrograde or antegrade approach. Rapid pacing stimulation (220/bpm) with a pacing-lead placed in the right ventricle was performed during balloon inflation. RESULTS: the aortic valve area was increased from 0.59 +/- 0.19 to 1.02 +/- 0.34 cm2 (p < 0.001) and the transvalvular mean gradient decreased from 49.3 +/- 21.2 to 22.2 +/- 11.8 mmHg (p < 0.001). Six patients (4%) died (3 during aortic valve dilatation) and 9 patients (6%) had non fatal complications: 2 transitory strokes, 8 non surgical vascular complications and 5 episodes of atrio-ventricular complete block (these complication were non exclusive). The patients were discharged at 5, 6 +/- 3 days. CONCLUSION: In the hands of skilled operators, aortic percutaneous balloon dilatation has become a simple technique, associated with a low risk of complications despite a very ill patient population. This technique remains a good option for a number of patients before the onset of percutaneous aortic valve implantation.

Angiographic results and late clinical follow-up after Bard-XT intracoronary stent implantation.

OBJECTIVES: The aim of this study is the assessment of immediate clinical and angiographic results and medium- to long-term clinical follow-up after Bard-XT (Bard, Billerica, Massachusetts) coronary stent deployment. METHODS: The implantation of 196 stents of various lengths (11, 15 and 19 mm) was attempted in 181 patients (70.1% male) from January 1997 to January 1998. Lesions were type A in 5.6% of the cases, type B1 in 44.4%, type B2 in 45.9% and type C in 4.1%. Implantation of the stent was elective in 53.6% and for bail-out situations in 46.4% of the lesions. RESULTS: The immediate angiographic success rate was 98.5% and the immediate clinical success rate (angiographic success with no major complications during in-hospital stay) was 96.9%. The minimal lumen diameter increased from 0.82 +/- 0.6 mm to 3.0 +/- 0.71 mm after intervention, relative to an immediate post-procedural residual stenosis of 3.05 +/- 9.12%. During the mean in-hospital stay of 2.6 +/- 1.9 days, 3.8% of the patients had a minor clinical event, and 1.5% had a major clinical event. During late follow-up, 3.9% of the patients died. Clinical follow-up of 89.5% of the eligible patients after 241.1 +/- 73.9 days showed that 80.6% of them had negative stress tests, thus reaching a clinical restenosis rate of 19.4%. In a multivariate analysis, only systemic arterial hypertension (p = 0.0012) and a previous history of myocardial infarction (p = 0.02) had a positive correlation with clinical restenosis. CONCLUSIONS: The preliminary experience with the Bard-XT coronary stent was associated with good immediate and medium- to long-term clinical outcome. The results were comparable to those obtained with slotted-tube stents.

[Percutaneous correction of acquired aortic stenosis and mitral insufficiency in adults]. / Traitement percutané du rétrécissement aortique et de l'insuffisance mitrale de l'adulte.

Aortic stenosis and mitral regurgitation are the most common valvular diseases in western countries. Surgical treatment, aortic valve replacement or mitral valve repair, is the treatment of choice. Innovative technologies could offer an alternative therapeutic option to the patients with increased operative risk. This article will report the early experience with these promising techniques as presented at the High-Tech 2004 meeting.

Aneurysm of the left main coronary artery.

Aneurysm of the left main coronary artery is a rare angiographic finding, with few cases described in the international literature. We report the case of a 42-year-old male with a previous history of acute myocardial infarction, whose coronary angiography indicated triple vessel coronary disease and an aneurysm of the left main coronary artery. A review of the etiology, clinical aspects, and surgical management of coronary arterial aneurysm is presented.