[Cardiac rehabilitation in adults with congenital heart diseases]. / Réadaptation cardiaque des adultes avec cardiopathies congénitales.

The great advances in the medical and surgical management of congenital heart diseases have allowed many children to reach adulthood with often a good hemodynamic result. Nevertheless most of these adults have a limitation of their functional capacity. This limitation is more or less important, penalizes them in their daily life and alters their quality of life. The origin of this limitation is generally multifactorial. It is linked, of course, to the severity of the heart disease and the quality of the operative result. But there is very often a physical deconditioning. It can be secondary to the heart disease but is often secondary to a lack of physical activity. It is the parents, sometimes overprotective, but frequently the doctors who imposed, often wrongly, this restriction. It is essential to take this dimension into account in view of the important benefits expected for health and quality of life. Cardiac rehabilitation is a privileged tool for providing advice in a suitable environment. This requires close collaboration between cardiac rehabilitators and congenital cardiologists to offer appropriate care. We bring here some reflections and the basic elements to guide the re-training of these patients.

[The best of cardiac rehabilitation in 2006]. / L'essentiel de l'année 2006 en réadaptation cardiaque et cardiologie du sport.

The meta-analysis showing the benefits of physical training revisited: Taylor examined only the cardiac rehabilitation trials of exercise intervention alone (versus usual care) and demonstrated that cardiac mortality is 28 % reduced and exercise appears to have an independent mortality benefit. An economic evaluation of cardiac rehabilitation: a systematic review of 15 economic evaluations. Evidence to support the cost-effectiveness of supervised cardiac rehabilitation compared with usual care in myocardial infarction and heart failure was identified. But further well-designed trials are required. Pronostic value of some variables determined by exercise testing entering cardiac rehabilitation and after physical training. A beneficial effect of physical training versus usual care on BNP and neurohormones in patients with chronic heart disease. Patients on beta blockers after myocardial infarction: determination of a more accurate training heart frequency derived from the classical Karvonen's formula. The combination of trimetazidine with exercise training provides greater improvements in functional capacity, left ventricular function and the endothelium-dependent relaxation of the brachial artery than exercise training alone in patients with ischaemic cardiomyopathy referred for cardiac rehabilitation. Guidelines for resistance exercise after cardiac event: a new paradigm less restrictive, safe and efficient to accelerate patients' return to daily activities. Recommendations for participation in leisure-time physical activity and competitive sports for patients with ischaemic heart disease: the result of consensus among experts from the ESC study group of sports cardiology.

[Best of functional evaluation and cardiac rehabilitation in 2005]. / L'essentiel de l'anné 2005 en évaluation fonctionnelle et réadaptation des cardiaques.

The latest in cardiac rehabilitation has been impacted by: The East German PET publication which showed fewer ischaemic events and progression of the atheromatous disease in symptomatic and stable coronary patients who carry out regular physical exercise in comparison with patients who underwent angioplasty with stenting. Two meta-analyses updated the data showing the benefits of physical training: a 20% reduction in global mortality in coronary disease and 35% in cardiac failure. Two French studies reporting reassuring data for our daily practice: the serious complications of cardiac rehabilitation are exceptionally rare: the register for 2003 with data from 65 French centres, over 25,000 patients and 743,000 patient/exercise hours. Physical training two weeks after mitral valvuloplasty is not harmful for the valve repair and is beneficial in terms of exercise capacity for the patient. Epidemiological studies showing that women and elderly patients are, unfortunately, often excluded from programmes of cardiac rehabilitation.

[Cardiac rehabilitation in the Ile-de-France region. Current organization and suggestions for reorganization]. / Réadaptation cardiaque en Ile-de-France. Etat de l'organisation actuelle et propositions d'aménagement.

The Ile-de-France Regional Hospital Agency wished to complete the Regional Health Organisation Plan for Cardiology from 1999-2004 with a specific report on cardiac rehabilitation. A working group was set up and, after 8 meetings, its conclusions were submitted. They were adopted after presentation to the regional technical committee for cardiology. The requirements for cardiac rehabilitation were defined according to acknowledged indications in the medical literature: about 18,000 patients per year are candidates for cardiac rehabilitation in the Ile de France region. The existing equipment (1999-2000) was reviewed: 435 hospital beds allowing treatment of 5,780 patients per year; 45 day hospital places (only 20 of which were operational in 2000), in addition to a large fee for act activity allowing a total ambulatory management of a further 1,265 patients per year. The following proposals were made: more uniform distribution of hospital beds in the region; develop ambulatory rehabilitation especially on a day hospital basis; create a third possibility of rehabilitation associating home exercise rehabilitation and a program of education, prevention, reinsertion, psychotherapy within a network of extra-hospital care.

[Double-chamber right ventricle, aortic subvalvular stenosis and interventricular septal defect. Apropos of 12 cases]. / Ventricule droit à double chambre, sténose sous-valvulaire aortique et communication interventriculaire. A propos de 12 cas.

The authors report 12 cases of double-chamber right ventricle associated with discrete subaortic stenosis and ventricle septal defect. The statistics derived from 3,292 surgical reports of congenital heart diseases operated on at the Marie-Lannelongue Surgical Center over an 8 years period show that this association is 7 times more frequent than the law of chance. Twenty-two per cent of double-chamber right ventricles had an associated discrete subaortic stenosis and, in 9% of cases of subaortic stenosis a double-chamber right ventricle was observed. The cause of this malformation could be a developmental defect of the primitive interampullar ring.

[Outcome of patients with Eisenmenger syndrome. Apropos of 62 cases followed-up for an average of 16 years]. / Devenir des malades atteints d'un syndrome d'Eisenmenger. A propos de 62 cas avec un suivi moyen de 16 ans.

In an era when heart-lung transplantation offers a therapeutic option for patients with Eisenmenger's syndrome, it is important to assess the natural history of this condition. With this objective the authors studied 62 patients followed-up by the same cardiologist. The average follow-up period was 16 years, but 22 patients were followed up for over 20 years. The average age at death was 29 years. It differed significantly for genetically normal patients (31 years for 21 fatalities) compared with a population of trisomics (21 years for 6 fatalities). Half the patient population lived for over 30 years. Fourteen of the 27 deaths occurred during the third decade and only 4 before the age of 20. The probability of surviving 10 more years for a 20 years old genetically normal patient was 56%. The causes of death in the 19 cases in which it could be established were: 5 sudden deaths, 4 right heart failures, 3 massive haemoptyses, 3 pulmonary emboli, 2 pneumonias and 2 peroperative deaths. The functional disability was nearly always minimal or mild, enabling the patient to work: 24 of the 45 non-trisomic patients had full-time jobs. Pregnancy was a poor prognosis factor and could be lethal (2 deaths due to pulmonary embolism in the post-partum period). A heart-lung transplantation would only seem to be justified in patients with severe symptoms, polycythaemia, irreversible right heart failure and/or haemoptysis.

Metastatic pulmonary calcifications after cardiac surgery in children.

Six children in whom pulmonary calcifications developed after open heart surgery are described. Asymptomatic alveolar lesions appeared within the first 3 weeks after surgery, during or after intensive care. They were first diagnosed as possible infection or edema and secondarily identified as calcifications in the lungs. In five patients, the pulmonary calcifications partially decreased or disappeared, and the prognosis did not seem to be altered. In one patient, the pulmonary calcifications were associated with cardiac calcifications leading to death. The mechanism of these pulmonary calcifications is thought to be predominantly or exclusively metastatic and partially iatrogenic. Data indicated two major causative factors: therapy with massive doses of calcium and postsurgical acute renal failure. Radiographic findings of persistent alveolar lesions of increasing density in patients undergoing antibiotic therapy after open heart surgery are suggestive of the diagnosis of metastatic pulmonary calcifications. Scintigraphy with bone agents or computed tomography is recommended for early confirmation and prevention of therapeutic errors, especially after cardiac transplantation.