Thromboangiitis obliterans - case report.

Thromboangiitis obliterans (Buerger'€™s disease) represents an inflammatory disease of limbs'€™ small arteries and veins causing vascular thrombosis, and partial or total obstruction. It affects mostly male gender aged 40 years old. The peculiarity of our case is underlined by presenting a 62 years, chronic tobacco user and not compliant female patient known with thromb oangiitisobliterans for almost 15 years. The arteriographic and clinical features with concomitant and sever affected upper and lower limbs are highly suggestive, emphasizing the possibility of Buerger'€™s disease development even in female patients.

Efficacy of TachoSil® as a sutureless hemostatic patch to repair a perforation of the interventricular groove during endocardial radiofrequency ablation.

Catheter ablation is a well-established therapeutic option for management of recurrent ventricular tachycardia in patients with ischemic/non-ischemic heart disease and procedural complications include a mortality rate of up to 3% and a risk of major complications up to 10%. Cardiac perforation following a catheter ablation is rare but serious complication and occurs in 1% of ventricular ablation procedures. The appropriate surgical repair may be challenging and need cardiopulmonary bypass support according to the location of the lesion and the hemodynamic status of the patient. We report the case of a free wall right ventricular perforation of the interventricular groove with cardiac tamponade following catheter ablation for recurrent ventricular tachycardia. Due to the proximity of the left anterior descending artery and the extreme fragility of tissues, the patient was treated successfully by a sutureless patch technique using a fibrin tissue-adhesive collagen fleece (TachoSil®). This technique is a safe and effective surgical option to repair a ventricular perforation especially when the ventricular tissues are fragile. It is simple and enable to realize surgical repair also if the localization of tear is difficult to access and without the need for cardiopulmonary bypass support if hemodynamic conditions are stable.

Telomere length in vascular tissues from patients with atherosclerotic disease.

OBJECTIVES: The present study was aimed at evaluating telomere length in blood and in different vascular tissues with or without atheroma, in 3 groups of subjects: a group of atherosclerotic subjects who underwent surgery (Atherosclerosis-Surgery), a second group of subjects with asymptomatic atherosclerotic carotid plaques but who did not undergo cardiovascular surgery (Atherosclerosis-No surgery), and a third group of subjects without atherosclerotic disease (Controls). The main objective was to determine if there is in vivo regulation of telomere length in situ by atherosclerotic lesions. METHODS: A total of 84 subjects (mean age 69 ± 8 years) were studied. Blood and arterial tissue telomere lengths were determined by Southern blotting. Personal medical history (diabetes, hypertension, cardiovascular disease, dyslipidemia), family medical history, drug intake, and lifestyle were evaluated in the entire population through the use of a questionnaire. RESULTS AND CONCLUSION: Arterial segments which did not develop atherosclerosis such as the saphenous vein and internal mammary artery, had longer telomere length than aortic segments. On the other hand, telomere length was shorter in aortic tissues which presented atherosclerotic lesions compared to corresponding tissues without atherosclerotic lesions. These results also suggest tissue regulation of telomere size by local factors likely related to oxidative stress responses.

[Advanced cardiac failure. New surgical approaches]. / L'insuffisance cardiaque avancée. Approches chirurgicales actuelles.

THERAPEUTIC OPTIONS: Prognosis of advanced heart failure is ominous since survival rate is less than 65% one year after an acute and severe cardiac episode. Medical therapy has proven to be efficient in reducing fatal complications and in delaying critical evolution. Depending on the etiology and the myocardial status, new surgical approaches can also be proposed for repair or substitution. SURGICAL REPAIR: The beneficial effect of myocardial revascularization on severe ischemic cardiomyopathy, the relevance of mitral valve repair in dilated cardiomyopathy, and the advantage of ventricular remodeling in patients with major ventricular dyskinesia has been clearly demonstrated. All these surgical techniques improve ventricular function and enhance survival rate by about 70% after three years. SUBSTITUTION PROCEDURES: The best therapeutic option to recover heart function for normal life and reduced mortality remains, when possible, cardiac transplantation. Ventricular cardiac assist devices are planned as a temporary option to bridge the waiting period to transplantation or for myocardial recovery but can also be proposed as a chronic implantation in an outpatient care scheme. Cardiomyoplasty for therapeutic management of advanced cardiac failure is still a controversial surgical approach. Other clinical strategies such as transmyocardial laser revascularization, myocardial angiogenesis and myocardial cell therapy are being investigated or developed. ADAPTED TREATMENT: Optimal management of each patient with advanced heart failure requires an adequate treatment selected among a wide range of medical and/or surgical strategies.

[Reversible graft dysfunction after cardiac transplantation]. / Dysfonction réversible du greffon après transplantation cardiaque.

The authors report 3 cases of major graft dysfunction after cardiac transplantation which recovered completely with biventricular mechanical assistance in 4 to 8 days. All three cases were primary biventricular graft failures in patients with normal preoperative pulmonary resistances. These early dysfunctions (with no signs of myocardial infarction on electro- or echocardiography and in the absence of abnormal increased peri-operative enzyme levels) associated with total functional recovery conforming to the definition of the phenomenon of myocardial stunning. These results argue in favour of aggressive management of primary graft dysfunction.