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1.
J Hosp Infect ; 99(3): 290-294, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29331660

ABSTRACT

Recently, surgical site infections due to non-tuberculous mycobacteria (NTM) have been linked to heater-cooler unit contamination. The European Centre for Disease Prevention and Control and manufacturers now recommend the use of hydrogen peroxide in filtered water to fill heater-cooler unit tanks. After implementation of these measures in our hospital, heater-cooler units became heavily contaminated by opportunistic waterborne pathogens such as Pseudomonas aeruginosa and Stenotrophomonas maltophilia. No NTM were detected but fast-growing resistant bacteria could impair their detection. The efficiency of hydrogen peroxide and chlorhexidine-alcohol was compared in situ. Chlorhexidine-alcohol treatment stopped waterborne pathogen contamination and NTM were not cultured whereas their detection efficiency was probably improved.


Subject(s)
Alcohols/pharmacology , Bacteria/isolation & purification , Chlorhexidine/pharmacology , Disinfectants/pharmacology , Disinfection/methods , Equipment and Supplies/microbiology , Water Microbiology , Bacteria/drug effects , Cross Infection/prevention & control , Extracorporeal Circulation/methods , Hospitals , Humans , Hydrogen Peroxide/pharmacology
2.
J Hosp Infect ; 93(3): 235-9, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27210271

ABSTRACT

The non-tuberculous mycobacteria (NTM) Mycobacterium wolinskyi caused bacteraemia and massive colonization of an aortic prosthesis in a patient 16 days after cardiac surgery, necessitating repeat surgery and targeted antimicrobial chemotherapy. The infection control team investigated the source and conditions of infection. Peri-operative management of the patient complied with recommendations. The environmental investigation showed that although M. wolinskyi was not recovered, diverse NTM species were present in water from point-of-use taps and heater-cooler units for extracorporeal circulation. This case and increasing evidence of emerging NTM infections in cardiac surgery led to the implementation of infection control procedures in cardiac surgery wards.


Subject(s)
Aorta/surgery , Bacteremia/diagnosis , Environmental Microbiology , Mycobacterium Infections, Nontuberculous/diagnosis , Nontuberculous Mycobacteria/isolation & purification , Prosthesis-Related Infections/diagnosis , Surgical Wound Infection/diagnosis , Bacteremia/microbiology , Equipment and Supplies/microbiology , Humans , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/microbiology , Prosthesis-Related Infections/complications , Prosthesis-Related Infections/microbiology , Surgical Wound Infection/complications , Surgical Wound Infection/microbiology
3.
Eur J Clin Microbiol Infect Dis ; 34(2): 287-301, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25169966

ABSTRACT

Propionibacterium acnes belongs to the normal skin microbiota, but it is also responsible for acne vulgaris and causes serious infections such as endocarditis and surgical site infections (SSI). The P. acnes population is structured into phylogenetic groups, with phylotype I being associated with acne. Herein, we explore the link between phylotypes and clinical origins in a collection of P. acnes isolated from different body sites, involved in deep infections or healthcare-associated infections (HAI), with particular emphasis on strains from cardiac SSI. Cardiac SSI have been further studied in terms of P. acnes population dynamics during the care pathway. The recA and tly genes phylotypes were compared to hemolytic behavior, susceptibility to antimicrobial agents, and clinical origins. An original approach of recA polymerase chain reaction temporal temperature gel electrophoresis (PCR-TTGE) was developed and applied for the direct identification of P. acnes phylotypes in surgical samples, in order to assess their temporal dynamics during the surgical course. Our results underlined the preferential involvement of IA-2/IB and II phylogroups in HAI and SSI. Unlike IA and II, type IA-2/IB presented a gradual increase with the depth of sampling in the peroperative phase of cardiac surgery. Phylotypes IA and IA-2/IB were both predominant in scar tissues and on postoperative skin, suggesting a specific predisposition to recolonize skin. Particular association of the phylotype IA-2/IB with SSI and its propensity to colonize wounds in cardiac surgery was observed. We assumed that the follow-up of P. acnes phylotypes during pathological processes could give new clues for P. acnes pathogenicity.


Subject(s)
Cardiac Surgical Procedures/adverse effects , Gram-Positive Bacterial Infections/microbiology , Propionibacterium acnes/isolation & purification , Acne Vulgaris/microbiology , Bacterial Proteins/genetics , Bacterial Typing Techniques , Base Sequence , Humans , Molecular Sequence Data , Phenotype , Phylogeny , Polymerase Chain Reaction , Propionibacterium acnes/genetics , Propionibacterium acnes/pathogenicity , Rec A Recombinases/genetics , Sequence Analysis, DNA , Skin/microbiology
4.
J Mal Vasc ; 32(4-5): 216-20, 2007 Dec.
Article in French | MEDLINE | ID: mdl-17658233

ABSTRACT

Visceral artery aneurysms constitute a rare vascular disease, with a risk of rupture associated to a high mortality. Often asymptomatic, they are discovered following a routine radiological examination. We present the case of a 71-year-old patient with multiple aneurysms involving the celiac trunk, the splenic artery, and the common hepatic artery. The surgical treatment consisted of an aortohepatic bypass using polytetrafluoroethylene prosthesis, after exclusion of all the aneurysms. The angiography and postoperative angioscan demonstrated the perfect patency of the prosthesis, totally excluding the aneurysms. Given the variety of presentations and the absence of precise predictive factors, there is no therapeutic consensus so far. Surgery is the first therapeutic choice. Endovascular treatment by angioembolization must be reserved for particular conditions. The purpose of this article is to propose the best therapeutic approach on the basis of evidence in the literature.


Subject(s)
Aneurysm/surgery , Celiac Artery , Hepatic Artery , Splenic Artery , Aged , Anastomosis, Surgical , Aneurysm/diagnosis , Aorta/surgery , Blood Vessel Prosthesis , Hepatic Artery/surgery , Humans , Male , Polytetrafluoroethylene
5.
Kardiologiia ; 47(7): 94-6, 2007.
Article in Russian | MEDLINE | ID: mdl-18260901

ABSTRACT

A clinical case of a patient aged 56 years with postinfarction left ventricular aneurysm not complicated with ventricular tachyarrhythmias is presented electrophysiological investigation. Left ventricular aneurysmectomy supplemented with endocardial cryodestruction was carried out. At electrophysiological investigation after surgery ventricular tachycardia could not be induced. In 2 years postoperatively no ventricular tachyarrhythmias were noted. The condition of the patient is satisfactory, corresponds to NYHA class I.


Subject(s)
Cardiac Surgical Procedures , Heart Aneurysm/complications , Heart Aneurysm/etiology , Myocardial Infarction/complications , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/surgery , Cardiac Surgical Procedures/methods , Electrocardiography , Heart Aneurysm/physiopathology , Humans , Male , Middle Aged , Myocardial Infarction/physiopathology , Severity of Illness Index , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/physiopathology
6.
Minerva Chir ; 61(5): 445-50, 2006 Oct.
Article in English | MEDLINE | ID: mdl-17159753

ABSTRACT

There are very few cases in English literature of recurrent postoperative aortic fistulas (RPAFs). These are neo-communications between the aortic bloodstream and the lumen of contiguous organs which occur after unpredictable periods from surgical treatment of a previous fistula. The supradiaphragmatic aorta may fistulize into the airways, pulmonary circulation, oesophagus, and cardiac chambers; the infradiaphragmatic aorta into the intestine, stomach, and vena cava. According to the etiology, aortic fistulas are categorized as postoperative (or secondary) and spontaneous (or primary), and RPAF may be considered a subgroup of secondary fistulas. They may recur even more times in the same patient, hence the role of prevention is of the utmost importance. The simultaneous respect of different surgical principles is crucial to make the risk of recurrence less likely. Surgical treatment represents a real challenge due to the emergency conditions and redo nature of operations. Mortality rate is very high. In this article, we describe a case of recurrent aorto-duodenal communication, we discuss the principles of prevention both for the supra and infradiaphragmatic aorta, we introduce some modifications to the classic categorization and we present the first RPAF literature review.


Subject(s)
Aorta, Abdominal , Aortic Diseases/complications , Intestinal Fistula/etiology , Vascular Fistula/etiology , Aortic Diseases/diagnosis , Aortic Diseases/prevention & control , Aortic Diseases/surgery , Duodenal Diseases/complications , Duodenal Diseases/diagnosis , Duodenal Diseases/surgery , Fatal Outcome , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Humans , Intestinal Fistula/diagnosis , Intestinal Fistula/prevention & control , Intestinal Fistula/surgery , Male , Middle Aged , Postoperative Period , Recurrence , Vascular Fistula/diagnosis , Vascular Fistula/prevention & control , Vascular Fistula/surgery
8.
Arch Mal Coeur Vaiss ; 99(1): 53-9, 2006 Jan.
Article in French | MEDLINE | ID: mdl-16479890

ABSTRACT

The treatment of post-infarction ventricular tachycardias with antiarrhythmic drug therapy, implantable automatic defibrillators, radiofrequency ablation, also includes different surgical procedures such as endocardial resection of the infarct scar, encircling endocardial ventriculotomy and endocardial cryoablation or thermoexclusion by laser. These procedures may be extensive or limited, guided or not by preoperative mapping. The aim of this review of the literature is to update our knowledge of these different surgical techniques and to define their indications.


Subject(s)
Heart Aneurysm/complications , Heart Aneurysm/surgery , Heart Ventricles/surgery , Myocardial Infarction/complications , Tachycardia, Ventricular/surgery , Cryosurgery , Humans , Laser Coagulation , Tachycardia, Ventricular/etiology
9.
Transplant Proc ; 37(6): 2877-8, 2005.
Article in English | MEDLINE | ID: mdl-16182840

ABSTRACT

Heart transplantation-induced dyslipidemia is a recognized risk factor for cardiac allograft vasculopathy that affects survival prognosis. Beyond increased lipids, low-density lipoprotein (LDL) size and systemic factors, including glucose intolerance, oxidative stress, and inflammation, must be taken into account as components of the atherosclerotic risk. The aim of this study was to explore the atherogenic profile of heart transplant recipients (HTR) by assessing lipid parameters, glycemia, oxidative stress status, and inflammation in 59 transplant patients (follow-up of 6 +/- 3 years) compared to 20 healthy volunteers. Classical hypercholesterolemia and hypertriglyceridemia were observed in HTR compared to controls, associated with increased apoCIII levels (0.13 +/- 0.6 vs 0.07 +/- 0.03 g/L, P < .01). Mean LDL size was reduced in HTR compared to controls (25.22 +/- 0.72 vs 26.06 +/- 0.54 nm, P < .001) with an abnormally high prevalence (69% vs 0%, P < .001) of small dense LDL (<25.5 nm). Hyperglycemia (7.3 +/- 3 vs 5.4 +/- 0.8 mmol/L, P < .05) and inflammation (high-sensitive CRP: 3.1 +/- 3 vs 1.6 +/- 0.9 mg/L, P < .001) were evidenced in HTR since no difference in oxidative stress parameters was observed. In conclusion, a high prevalence of small dense LDL is an important component of posttransplantation dyslipidemia.


Subject(s)
Dyslipidemias/blood , Dyslipidemias/etiology , Heart Transplantation/adverse effects , Lipoproteins, LDL/blood , Biomarkers/blood , Cholesterol/blood , Follow-Up Studies , Heart Transplantation/pathology , Humans , Lipoproteins, LDL/classification , Middle Aged , Oxidative Stress , Time Factors , Triglycerides/blood
10.
J Card Surg ; 19(6): 475-80, 2004.
Article in English | MEDLINE | ID: mdl-15548177

ABSTRACT

BACKGROUND AND AIM: The internal thoracic artery (ITA) has a better long-term patency than saphenous veins, and anastomosis between ITA and the left anterior descending artery (LAD) represents the "gold-standard" of surgical myocardial revascularization. The aim of this study is to evaluate the multidetector multislice CT Scan (MCTS) as a means of postoperative evaluation of ITA coronary artery bypass grafts. METHODS: Twenty-eight patients having been operated on for coronary artery bypass with ITA during a 6-months period, benefited, 7 days after surgery, from a patency and anastomotic site control of ITA with a MCTS associated with cardiac gating (Light Speed, General Electric, USA). RESULTS: Internal thoracic artery bypasses are visualized perfectly on all their courses, with possibility of 3D reconstructions, showing the relationship between cardiac cavities and the arterial bypasses. The anastomotic site on the LAD was, in selected cases, perfectly visualized. Sequential bypasses with left ITA are well visualized as well as T or Y right-to-left ITA grafts. However, surgical clips create some image artefacts. CONCLUSIONS: The postoperative control of ITAs are possible by MCTS with a satisfactory resolution. This makes it possible to check the patency of ITAs, their course on the heart surface, and the location and quality of anastomosis with a noninvasive reproductive method.


Subject(s)
Mammary Arteries/diagnostic imaging , Mammary Arteries/surgery , Tomography, X-Ray Computed , Anastomosis, Surgical , Coronary Artery Bypass , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/physiopathology , Coronary Stenosis/surgery , Humans , Imaging, Three-Dimensional , Mammary Arteries/physiopathology , Prospective Studies , Saphenous Vein/diagnostic imaging , Saphenous Vein/physiopathology , Saphenous Vein/transplantation , Severity of Illness Index , Treatment Outcome , Vascular Patency
11.
Arch Mal Coeur Vaiss ; 96(9): 880-4, 2003 Sep.
Article in French | MEDLINE | ID: mdl-14571642

ABSTRACT

About 1 to 8% of patients referred for cardiac surgery in industrialised countries are octogenarians. Hospital mortality is high and depends on age, type of surgery and other predictors of death which are female gender, left congestive heart failure, history of myocardial infarction, chronic obstructive lung disease, renal insufficiency, carotid and others vascular diseases. Morbidity is also very high. Besides supraventricular arrhythmias, respiratory failure is the main cause (20 to 30%) of morbidity, followed by cerebrovascular accident and renal failure. Due to this high rate of postoperative events, the length of stay is significantly increased. At follow-up however, excellent functional status and survival rate is afforded by the operative procedure. The main problem remains the selection of patients in order to improve results.


Subject(s)
Aging , Cardiovascular Surgical Procedures/methods , Hospital Mortality , Age Factors , Aged , Aged, 80 and over , Heart Failure , Humans , Myocardial Infarction/complications , Pulmonary Disease, Chronic Obstructive/complications , Respiratory Insufficiency , Risk Factors , Sex Factors
12.
J Cardiovasc Surg (Torino) ; 44(6): 757-61, 2003 Dec.
Article in English | MEDLINE | ID: mdl-14735041

ABSTRACT

AIM: The treatment of infected vascular surgery sites is challenging. Negative pressure applied uniformly to the entire wound surface has been shown to allow granulation tissue formation and to promote healing of acute and chronic wounds. METHODS: We used the Vacuum-Assisted Closure (VAC, Kinetic Concepts Incorporated, San Antonio, Texas, USA) system in 4 patients with severe groin wound infection after emergency surgery on the femoral artery. RESULTS: In all 4 patients, general health improved and the wound changed rapidly from a large infected cavity to a minor lesion readily covered using a simple surgical technique. CONCLUSION: This study establishes VAC as a very valuable tool for managing severe complications of groin vascular surgery sites even in patients with obesity and/or diabetes mellitus.


Subject(s)
Femoral Artery/surgery , Pressure , Surgical Wound Infection/therapy , Vascular Surgical Procedures/adverse effects , Aged , Aged, 80 and over , Emergency Treatment/adverse effects , Emergency Treatment/methods , Female , Groin/physiopathology , Humans , Male , Middle Aged , Occlusive Dressings , Prospective Studies , Risk Assessment , Sampling Studies , Severity of Illness Index , Surgical Wound Infection/diagnosis , Treatment Outcome , Vacuum , Vascular Surgical Procedures/methods , Wound Healing/physiology
13.
J Chir (Paris) ; 139(4): 232-5, 2002 Sep.
Article in French | MEDLINE | ID: mdl-12410142

ABSTRACT

Extracorporeal circulation (ECC) is not only used for open heart surgery. There are also other surgical and medical applications. ECC can be used for encephalic arteries surgery to induce hypothermia and maximally protect the brain. Femoro-femoral ECC may be needful for urgent traumatologic surgery of the supra-aortic trunci. Intracranial aneurysm repair can occasionally necessitate deep hypothermia and circulatory arrest with ECC. Renal cell carcinomas may metastasize to the right atrium and surgery with ECC is mandatory for complete excision. Some reports in the literature mention use of ECC for hepatic surgery of intra-hepatic aneurysms. With acute peripheral ischemia, metabolites in the affected limb can be washed out with good results. Medical indications for ECC are numerous with pulmonary assistance as one of the foremost when mechanical ventilation failed. Homogeneous and rapid rewarming of hypothermic patients can be achieved with ECC. Finally, some groups have reported the use of ECC to administer chemotherapy in limb melanoma.


Subject(s)
Extracorporeal Circulation/methods , Cardiac Surgical Procedures , Extracorporeal Circulation/instrumentation , Humans , Kidney Diseases/surgery , Liver Diseases/surgery , Medical Oncology , Neurosurgical Procedures , Patient Selection , Rewarming , Thoracic Surgical Procedures , Vascular Surgical Procedures
14.
J Cardiovasc Surg (Torino) ; 43(1): 99-101, 2002 Feb.
Article in English | MEDLINE | ID: mdl-11803339

ABSTRACT

To prevent direct secondary aortoenteric fistulas, a devastating complication of abdominal aortic surgery, we describe here a rapid, very easy to perform and no cost operating technique. A part about 4 cm long of the vascular prosthesis was cut to obtain a partial tailored ring which was passed through the prosthesis. After the anastomosis was realized, the tailored ring was hitched up to totally cover proximal anastomosis and prevent direct contact between aorto-prosthetic anastomosis and the bowel.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Diseases/prevention & control , Blood Vessel Prosthesis Implantation/methods , Fistula/prevention & control , Intestinal Diseases/prevention & control , Intestine, Small/surgery , Humans
15.
Arch Mal Coeur Vaiss ; 94(7): 659-64, 2001 Jul.
Article in French | MEDLINE | ID: mdl-11494625

ABSTRACT

Over an 11 year period from January 1990 to December 2000, 3282 patients underwent isolated or combined surgical myocardial revascularisation. In this group, 42 were aged 80 or over (maximum 87 years), 1.3% of the total patient population. The mean age of this subgroup was 81.8 +/- 1.75 years) with a male predominance (61.9%). All patients were autonomous and considered to be in good general and psychological health. Preoperative coronary angiography showed 33.3% of left main stem lesions either alone or associated with a right coronary lesion. The ejection fraction was over 50% in 78.6% of cases. Saphenous vein grafts were used in all but 5 patients who also had left internal mammary artery grafts. Thirteen patients (31%) underwent combined valvular surgery (11 aortic and 2 mitral valve) and 2 patients underwent combined vascular surgery. Three patients were operated as an emergency. A total of 5 patients died in the first 30 postoperative days, a hospital mortality of 11.9%. There were 2 postoperative hemiplegias and 2 cases of renal failure which were aggravated in the postoperative period. The other patients were discharged from hospital with a satisfactory cardiac and functional status. The global mortality was 14% at 3 years and 18% at 5 years. The main bad prognostic factor for survival was the association of aortic valve surgery. In selected octogenarians in good general and psychological health without severe co-morbid conditions, surgical myocardial revascularisation may be considered with an acceptable operative risk.


Subject(s)
Coronary Artery Bypass , Coronary Disease/surgery , Aged , Aged, 80 and over , Coronary Angiography , Coronary Artery Bypass/mortality , Coronary Disease/diagnostic imaging , Coronary Disease/mortality , Female , Follow-Up Studies , Heart Valve Prosthesis Implantation , Humans , Internal Mammary-Coronary Artery Anastomosis/mortality , Male , Retrospective Studies , Survival Rate , Time Factors
17.
FEBS Lett ; 493(1): 57-62, 2001 Mar 23.
Article in English | MEDLINE | ID: mdl-11278005

ABSTRACT

Cyclosporin A (CsA) is a widely used immunosuppressive agent with severe side effects including hypertension. Here, we investigated the effects of CsA on intracellular free calcium ([Ca(2+)](i)) and the mechanisms involved in vasoconstriction in cultured human coronary myocytes. We used the Fura-2 technique for Ca(2+) imaging. Acute application of CsA at therapeutic concentrations (0.1-10 micromol/l) had no effect. Chronic exposure to CsA (1 micromol/l) for 24 h induced a small (20 nmol/l) but highly significant increase of basal [Ca(2+)](i) and enhanced the occurrence of spontaneous Ca(2+) oscillations. Endothelin- and vasopressin-induced rises of [Ca(2+)](i) were also enhanced. The demonstration that CsA increases basal [Ca(2+)](i) in addition to its impact on agonist receptor stimulation is of major importance for new therapeutic approaches.


Subject(s)
Calcium/metabolism , Cyclosporine/pharmacology , Endothelins/metabolism , Immunosuppressive Agents/pharmacology , Myocardium/cytology , Myocardium/metabolism , Vasopressins/metabolism , Adolescent , Adult , Cells, Cultured , Dose-Response Relationship, Drug , Fluorescent Dyes/pharmacology , Fura-2/pharmacology , Heart Transplantation , Humans , Male , Middle Aged , Spectrometry, Fluorescence , Time Factors
18.
Ann Cardiol Angeiol (Paris) ; 50(6): 312-5, 2001 Oct.
Article in French | MEDLINE | ID: mdl-12555621

ABSTRACT

The chronic constrictive pericarditis is a rare affection, with multiple etiologies and concerning especially the adult. We report a case of chronic constrictive pericarditis in an African child in whom no etiology was found. A review of the literature raises the characteristics of chronic constrictive pericarditis for a better therapeutic management.


Subject(s)
Pericarditis, Constrictive/diagnosis , Africa, Eastern , Child , Chronic Disease , Humans , Male
19.
J Heart Valve Dis ; 9(6): 786-90, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11128785

ABSTRACT

A 16-year-old male with bone marrow failure due to chemotherapy for recurrent acute lymphoblastic leukemia developed an abscess in the lower lobe of the left lung draining through a bronchogastric fistula, as well as mitral valve endocarditis with large vegetations. After a course of antifungal therapy, the left lobe was removed and the fistula closed. The mitral valve was then replaced, after a failed attempt at valve repair, by a mechanical, double-leaflet prosthesis. Microscopy of the lung and heart specimens disclosed hyphae. Cultures of both specimens on Sabouraud's medium recovered a fungus, which was identified by culturing on Czapek's medium as Aspergillus flavus. Despite further antifungal therapy, fatal embolism developed. The emboli contained the same A. flavus as the valve and lung specimens. This case confirms the grim prognosis of primary Aspergillus endocarditis in immunocompromised patients, and suggests that delayed surgical treatment and the presence of another focus of Aspergillus infection may increase the risk of death.


Subject(s)
Aspergillosis , Aspergillus flavus , Endocarditis/microbiology , Lung Abscess/microbiology , Mitral Valve , Adolescent , Aspergillosis/diagnosis , Aspergillosis/surgery , Endocarditis/complications , Endocarditis/diagnosis , Endocarditis/surgery , Heart Valve Diseases/diagnosis , Heart Valve Diseases/microbiology , Heart Valve Diseases/surgery , Humans , Lung Abscess/complications , Lung Abscess/diagnosis , Male , Mitral Valve/surgery , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy
20.
J Am Coll Cardiol ; 36(3): 871-7, 2000 Sep.
Article in English | MEDLINE | ID: mdl-10987613

ABSTRACT

OBJECTIVES: The objective of this study was to determine whether a small-size valve prosthesis contributes to exercise intolerance, as assessed by VO2 measurement during an exhaustive cycle ergometer exercise. BACKGROUND: The determinants of exercise capacity after mechanical aortic replacement are not well known. The selection of small valve sizes has, however, been described as an independent predictor of exercise intolerance as assessed by exercise duration. Maximal oxygen uptake (VO2max) is a good index of exercise tolerance. METHODS: Fourteen patients were eligible, with a mean age of 62 +/- 6 years. Before surgery, the mean left ventricular ejection fraction (LVEF) was 73 +/- 8%. Two valve types with small diameter (19 to 21 mm) were used: Medtronic Hall and St Jude Medical. A healthy sedentary control group (n = 14) paired for age, weight and size was constituted. After one year of follow-up, cardiorespiratory tests were performed. In addition, the gradients through the prostheses were determined by continuous pulse Doppler at rest and immediately after the cardiorespiratory test. RESULTS The exercise tolerance was not significantly different between the control group and patient group: VO2 peak (21.7 vs. 20.4 ml/kg/min; p = 0.42), workloads (115 vs. 93 W; p = 0.13) and ventilatory parameters were similar. The mean and peak gradients at rest and during exercise were not correlated with VO2max. CONCLUSIONS: Valve replacement by small aortic prosthesis does not seem to be a factor of exercise intolerance as assessed by VO2max in patients without LVEF dysfunction before surgery.


Subject(s)
Aortic Valve/surgery , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Physical Endurance , Aged , Anthropometry , Echocardiography, Doppler , Equipment Design , Exercise Test , Female , Hemodynamics , Humans , Male , Middle Aged , Postoperative Period , Spirometry
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