[Late complications of a pseudo aneurysm of the left ventricle: thrombus infection and purulent pericarditis]. / Complications tardives d'un faux anévrisme du ventricule gauche: infection du thrombus et péricardite purulente.

Pseudoaneurysm is a rare complication of left ventricle myocardial infarction. Rupture with tamponade and sudden death is the usual outcome. Surgical intervention remains the treatment of choice. Long term survival cases without surgery are rare. Infection of the thrombus is also a possible event. We report the case of a patient with postinfarction left ventricular pseudoaneurysm complicated by infection of the thrombus and purulent pericarditis involving a peptostreptococcus. Infection must be considered a potential complication of left ventricular pseudoaneurysms.

[Transhepatic percutaneous embolisation of a post-traumatic pseudoaneurysm of hepatic artery]. / Embolisation transhépatique percutanée d'un pseudoanévrisme post-traumatique de l'artère hépatique.

Pseudoaneurysm of the hepatic artery is a rare complication of blunt abdominal trauma. We report a case of post-traumatic pseudoaneurysm diagnosed several months after the initial traumatism in a 18-year-old man who presented recurrent abdominal pain. This pseudoaneurysm was successfully treated by association of both classical endovascular treatment and transhepatic percutaneous embolization.

[Prognosis scores to help revascularization for ischemic heart failure]. / Scores pronostiques pour la revascularisation des myocardiopathies ischémiques.

AIMS: Patients suffering from coronary heart disease with ventricular systolic dysfunction present a bad prognosis and should be potentially revascularized. Up to now, surgery appeared to be the most feasible revascularization technique for such patients. Aims of this study were to assess the influence of different treatments (surgery, angioplasty or exclusively medical treatment) on clinical outcome and to establish a prognostic score practitioners to select the most appropriate therapy adapted to their patient profiles. METHOD: From 1995 to 2000, 492 patients were included in this cohort: 365 in the angioplasty group, 96 in the surgical group and 31 in the medical group. Kaplan Meier curves were made with a multivariate analysis to determine the significant predictive factors of mortality and major adverse cardiac events. RESULTS: After a mean follow-up of 32 +/- 19 months, there was no statistical difference in mortality rate between the groups. However, the survival rate without MACE is higher in the surgical group, intermediate in the angioplasty group and lower in the medical group. Using the significant predictive factors of MACE in multivariate analysis, a prognostic score has been established in order to discriminate three categories of severity. For each category, angioplasty was compared with surgery in terms of the event-free-survival rate. For the two extreme categories (severe and non-severe), both treatments were equal. For the intermediate category, surgery obtained greater results. CONCLUSION: This prognostic score could help physicians in choosing the appropriate revascularization technique to treat patients with severe ischemic heart failure.

Simultaneous orthotopic transplantation of carotid and aorta in the rat by the sleeve technique.

Graft vascular disease (GVD) remains the major limitation to long-term survival after solid organ transplantation. Aortic or carotid allografts in rats have been shown to be useful models because similar changes to those observed in man develop within weeks. Both immunological and non-immunological factors influence the process of GVD and a method that could permit rapid multiple arterial allotransplantation in the rat would be of great value. We performed simultaneous orthotopic aortic and carotid allotransplantations in 25 rats. The vessels were anastomosed using a sleeve technique. No immunosuppression was given. The animals were killed at 15, 30, or 60 days and histological analyses of the grafts were performed. The overall survival rate was 80% and the incidence of technical failure was very low. The histopathological aspect revealed typical progressive GVD. In conclusion, we have developed a new model of simultaneous aortic and carotid transplantation in rats. This model, which incorporates a modification of the sleeve anastomosis, is rapid and yields an easy tool to investigate immunological and non-immunological processes driving GVD.

Macroporous polyester-covered stent in an experimental abdominal aortic aneurysm model.

PURPOSE: To validate a recently described animal model of abdominal aortic aneurysm (AAA) and to assess a new macroporous polyester-covered stent for endovascular AAA exclusion. METHODS: Twenty adult sheep had AAAs surgically created by replacing a segment of the infrarenal aorta with an autologous jugular venous graft. Three months later, surviving animals underwent percutaneous implantation of macroporous polyester-covered nitinol stents; 3 animals with untreated AAAs served as controls. Follow-up surveillance included spiral computed tomography at 1 month and digital subtraction angiography at 3 and 6 months. Endografted animals were sacrificed at 1, 3, and 6 months after implantation; specimens from all animals were examined grossly and microscopically. RESULTS: Seven (35%) animals died within 24 hours of causes related to the technique; 1 animal developed paraplegia and was sacrificed on day 1. Three (25%) animals died of spontaneous aneurysm rupture at <10 days, and 6 received the stent-graft at 3 months. The macroporous cover did not prevent continued perfusion of the sac early after stent-graft deployment, but all aneurysms were excluded on the 1-month CT. CONCLUSIONS: Spontaneous AAA rupture occurred earlier and was not as frequent as previously described for this model. Implantation of the covered stent was feasible, but aneurysm exclusion was not immediate.

Pseudoaneurysm and aortobronchial fistula after surgical bypass for aortic coarctation: management with endovascular stent-graft.

PURPOSE: To report the endovascular repair of an aortobronchial fistula at the distal anastomosis of a complex thoracic graft. CASE REPORT: A 61-year-old man operated 18 years prior for aortic coarctation presented with hemoptysis. An aortobronchial fistula was suspected, but spiral computed tomography and angiography showed only a small pseudoaneurysm at the distal anastomosis without revealing the fistulous tract. A Talent stent-graft was successfully deployed through a femoral access, but the large delivery system injured the external iliac artery, producing a retroperitoneal hemorrhage. Prompt balloon occlusion of the aorta and subsequent bypass graft repair of the arterial injury prevented serious sequelae. The patient recovered without further complications. Follow-up imaging to 2 years has documented exclusion of the pseudoaneurysm with no hemoptysis or signs of new false aneurysm formation. CONCLUSIONS: Endovascular exclusion of anastomotic pseudoaneurysms even in complicated cases can be an efficient treatment option, but the procedure must be carefully planned and executed in order to achieve good results.

[Atrial flutter: a possible early sign of acute rejection in heart transplantation. A case report]. / Le flutter atrial: un témoin précoce possible du rejet aigu chez le transplanté cardiaque. A propos d'une observation.

The authors report the case of a cardiac transplant patient with a recurrence of atrial flutter two months after electrical cardioversion and despite long-term preventive treatment with amiodarone. Early investigation for signs of rejection with 4 endomyocardial biopsies was negative. Aggravation of the haemodynamic status due to flutter with a rapid ventricular response led to an attempted radio-frequency ablation. Endocavitary mapping confirmed persistence of sinus activity in the native atrium and the presence of a circuit of type I isthmic flutter (anticlockwise circuit) in the donor atrium. Ablation by radio-frequency in the same procedure was successful. A fifth myocardial biopsy the same day finally confirmed stage 3A acute rejection. No signs of recurrent rejection or arrhythmia have been observed after 24 months' follow-up in this patient. This preliminary experience confirms the need to look for graft rejection by repeated myocardial biopsies in cardiac transplant, patients with atrial flutter and the efficacy of radio-frequency ablation in cases of resistance to conventional therapy.

Aortoduodenal fistula after endovascular stent-graft of an abdominal aortic aneurysm.

Despite satisfying short- and middle-term effectiveness and feasibility, endovascular stent-grafting for abdominal aortic aneurysm is still under evaluation. We report a case of an aortoduodenal fistula after the use of this technique. Enlargement of the upper aneurysmal neck was followed by caudal migration of the major portion of the stent-graft, which resulted in kinking of the device in the aneurysmal sac. Ulcerations were found on adjacent portions of both the aneurysmal sac and the adjacent duodenum. Only the textile portion of the prosthetic contralateral limb separated the aortic lumen from the corresponding duodenal lumen. Early detection of complications after stent-grafting is essential to allow successful treatment, either surgical or endoluminal.

A new rejection criteria in the heterotopically placed rat heart by non-invasive measurement of Dp/Dtmax.

BACKGROUND: The heterotopic heart of rats has been a useful model in the evaluation of immunomodulatory protocols. Graft palpation usually determines the day of rejection. We present in this paper an original method of graft monitoring in allograft rejection. METHODS: Heterotopic cardiac abdominal transplantation was performed in Lewis isografts (n = 15) and in ACI to Lewis allograft (n = 15). A balloon connected to a measurement device was inserted in the left ventricle, and calculation of Dp/Dtmax was possible by recording the intra-left ventricular pressure. A ten-day follow-up was achieved with a daily comparison of palaption, ECG, and Dp/Dtmax. RESULTS: In transplanted hearts, Dp/Dtmax did not change in isografts but significantly decreased in allograft on posttransplantation Day 5 (PTD 5) vs PTD 0.1 and 3 (p < .01). Dp/Dtmax values on PTD 5 and 6 were also statistically significant in allograft vs isograft group (p < .01). Histological analysis at this time showed the occurrence of acute rejection in the allograft group. Graft palpation, and ECG remained normal until PTD 10 and no difference was observed between iso and allo groups. CONCLUSION: This study shows that daily measurement of Dp/Dtmax in heterotopic heart is made possible by our implantable system without interrupting the graft, and gives a more accurate definition of graft rejection than a combination of palpation and ECG. In addition, this method would seem desirable when differences in survival may be expected to be of lesser magnitude.

Endovascular retrieval of two migrated venous stents by means of balloon catheters.

The usefulness of vascular stenting was demonstrated in both arterial and venous applications to restore patency and improve suboptimal results after percutaneous transluminal angioplasty. Dislodgment of venous stents with an embolization into the right cavities or the pulmonary artery, however, is one of the most feared complications of this procedure. Percutaneous removal of these migrated stents is an appealing method of replacing more invasive operative intervention with cardiopulmonary bypass, which may be very hazardous in these often severely ill patients. We describe the cases of two patients with stents that migrated into the right ventricle and the pulmonary artery. In one patient, we were able to successfully remove these stents by using an angioplasty balloon with an operative extraction from the iliac vein, thereby obviating the need for a major operative procedure.

[Heart valve diseases specific in rheumatoid polyarthritis. Apropos of 2 cases]. / Les cardiopathies valvulaires spécifiques dans la polyarthrite rhumatoïde. A propos de deux observations.

Rheumatoid nodules represent a rare cardiac valvular involvement in rheumatoid arthritis. Patients are usually asymptomatic. We report two cases of such involvement: one presented as a tumour implanted on the mitral valve, with systemic embolisation; the other presented as aortic regurgitation with acute heart failure. Surgical treatment was performed in both cases. Histological examination revealed typical rheumatoid nodules. The authors discuss valvular involvement in rheumatoid arthritis.

A rare case of embolizing cardiac tumor: rheumatoid nodule of the mitral valve.

We report the case of a 65-year-old woman with rheumatoid arthritis who was admitted with a stroke. Echocardiographic examination revealed a multilobule, highly mobile tumor on the posterior leaflet of the mitral valve. Surgical exploration showed a tumor infiltrating the valve, the annulus, and the adjacent left ventricular wall, which required complete valve resection. Histologic study demonstrated typical characteristics of a rheumatoid nodule.

[Long-term results of the surgical treatment of acute type A thoracic aortic dissection]. / Résultats à distance du traitement chirurgical des dissections aiguës de l'aorte thoracique de type A.

Out of a population of 110 patients operated as an emergency for acute Stanford type A dissection of the thoracic aorta between 1985 and 1994, there were 84 survivors. Seventy-nine were assessed after a mean follow-up period of 47.3 months. The corrected 1 year, 5 year and 10 year survival rates were 69 +/- 5.1%, 53.1 +/- 6% and 42.1 +/- 7.1% respectively. There were 19 deaths during the study period: in two thirds of cases death was due to cardiovascular complications related to the aortic pathology or hypertension. There were 13 reoperations in 12 patients for complications on the initial site of repair or for progression of the pathological process. The average time to reoperation was 21.5 months with an operative mortality of 3 patients (25%). Predictive factors of reoperation were young age (52 +/- 4.4 years vs 60.1 +/- 1.4 years; p = 0.037), the persistence of a patent false lumen (p = 0.033) and the initial surgical techniques as the incidence of reoperation seemed to be higher after treatment with biological glue alone or resuspension of the aortic valve compared with replacement of the ascending aorta or Bentall's procedure (p = 0.08). The incidence of reoperation also varies with time as it was 1.8 +/- 0.7% at 1 year, 18.5 +/- 6.5% at 5 years and 26% +/- 7.8 at 10 years. In spite of improvements in surgical technique and postoperative care, acute type A dissection of the aorta carries a poor prognosis in both the short and the long-term with a notable number of cardiac or other complications related to repair of the initial aorta. Analysis of these and other reported results suggest that initial surgery should be as complete as possible with extension to the aortic arch when involved: this more aggressive attitude should improve the long-term results by reducing the risk of reoperation responsible for a high mortality rate.

[Traumatic rupture of the thoracic aorta]. / Roturas traumáticas de la aorta torácica.

This is a retrospective analysis of 50 postraumatic aortic rupture (1968-1996, 39 males, mean age: 34.5). Group A is composed of 35 patients with an acute aortic rupture and a prompt diagnosis. Group B includes 13 patients with a chronic rupture. All patients from group A had a severe politraumatism with abdominal, cranial, extremities or hip fractures. Mediastinal thickening with or without hemothorax indicated an angiography or a transesophageal echocardiography lately. In group A, 36 patients have been operated on urgently (12-24 hours); cardiopulmonary bypass was performed on 20 patients; an aorto-aortical bypass was done in 27 cases and a direct suture in the remaining 9. In group B, cardiopulmonary bypass was performed on 9 patients; a aorto-aortical bypass was done in 11 cases and a direct suture in 2. Overall hospital mortality was 16%; 19% in group A and 7.6% in group B. Ischemic paraplejia appeared in 5 patients (10%), all from group A. No false aneurysm developed after 4.5 years of follow-up (3-135 months) in the 38 survivors. The usefulness of transesophageal echocardiography, the importance of medular protection and the utility of several interventionist radiologic techniques are discussed.

[Ureteral involvement in an inflammatory aneurysm of the abdominal aorta. (Apropos of a case. Review of the literature)]. / L'atteinte urétérale dans les anévrysmes inflammatoires de l'aorte abdominale (A propos d'un cas. Revue de la littérature).

Diagnosis and treatment of ureteral obstruction secondary to perianeurysmal retroperitoneal fibrosis are controversial. Diagnosis includes the use of computed tomography and abdominal ultrasound, surgical treatment combines prosthetic graft with preoperative ureteral stenting. Ureterolysis is not always necessary, because aneurysm repair promotes resolution of the inflammatory process and relieves the ureteric obstruction. However radiologic survey is essential as in the case report.

[Beta-adrenergic receptivity and left ventricular hypertrophy caused by pressure overload in man]. / Réceptivité bêta-adrénergique et hypertrophie ventriculaire gauche au cours de la surcharge barométrique humaine.

The effect of left ventricular chronic pressure overload on right atrial (RA) and left ventricular (LV) myocardial beta-adrenoceptor (beta-AR) density and subtypes ([I125] cyanopindolol binding), adenylate cyclase activity (AC) and ADP-pertussis toxin ribosylated proteins was investigated in 13 patients with aortic stenosis (AO) and compared with the results obtained in 10 patients with mitral stenosis (MI) taken as controls. None of the patients included had any impairement of systolic function or increased plasma catecholamine levels. The total number of beta-AR in RA (62 +/- 6 vs 77 +/- 12 fmoles/mg prot) and LV (39 +/- 7 vs 32 +/- 2 fmoles/mg prot) was similar in AO and in MI. The percentage of beta 1-AR was significantly lower in LV from AO (35 +/- 11 vs 73 +/- 5% in MI) but identical in RA (79 +/- 5 vs 73 +/- 8%). The basal activity of AC was similar in membranes from patients with AO (19 +/- 4 and 22 +/- 5 pmol.mg-1 prot in RA and LV) and in controls (21 +/- 6 and 27 +/- 3 pmol.mg-1 prot in RA and LV). Isoprenaline-induced stimulation of AC was significantly lower in LV membranes from patients with AO (7 +/- 6 vs 45 +/- 6% in MI) but remained identical in RA membranes (51 +/- 18 vs 36 +/- 18% in MI). The quantification of ADP-pertussis toxin ribosylated proteins indicated a lower substrate concentration in myocardial membranes from patients with AO when compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)

[Closure of sternotomy with Cotrel staplers]. / Fermeture des sternotomies à l'aide des agrafes de Cotrel.

The authors describe a new method for the closure of median sternotomies based on immediate compression with two or three Cotrel-Dubousset (CD) staples. This method was effective in a series of 100 patients. It was the curative treatment of septic sternal pseudarthrosis, and has been extended to high risk patients (age, severe sternal osteoporosis, obesity, diabetes, chronic respiratory insufficiency) or when surgery requires resection of the internal mammary arteries (IMA).