Author Correction: Cardiovascular, hematological and neurosensory impact of COVID-19 and variants.

Correction to: European Review for Medical and Pharmacological Sciences 2021; 25 (8): 3350-3364-DOI: 10.26355/eurrev_202104_25747-PMID: 33928623, published online 30 April, 2021. After publication, the authors requested to correct the Acknowledgements of the above-mentioned article. There are amendments to this paper. The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/25747.

Cardiovascular, hematological and neurosensory impact of COVID-19 and variants.

OBJECTIVE: The purpose of this article was to review our clinical experience with COVID-19 patients observed in the Cardiovascular Division of Pompidou Hospital (University of Paris, France) and the Department of Neurology of the Eastern Piedmont University (Novara, Italy), related to the impact on the cardiovascular, hematological, and neurologic systems and sense organs. PATIENTS AND METHODS: We sought to characterize cardiovascular, hematological, and neurosensory manifestations in patients with COVID-19 and variants. Special attention was given to initial signs and symptoms to facilitate early diagnosis and therapy. Indications of ECMO (extracorporeal membrane oxygenation) for cardiorespiratory support were evaluated. RESULTS: Preliminary neurosensorial symptoms, such as anosmia and dysgeusia, are useful for diagnosis, patient isolation, and treatment. Early angiohematological acro-ischemic syndrome includes hand and foot cyanosis, Raynaud digital ischemia phenomenon, skin bullae, and dry gangrene. This was associated with neoangiogenesis, vasculitis, and vessel thrombosis related to immune dysregulation, resulting from "cytokine storm syndrome". The most dangerous complication is disseminated intravascular coagulation, with mortality risks for both children and adults. CONCLUSIONS: COVID-19 is a prothrombotic disease with unique global lethality. A strong inflammatory response to viral infection severely affects cardiovascular and neurological systems, as well as respiratory, immune, and hematological systems. Rapid identification of acro-ischemic syndrome permits the treatment of disseminated intravascular coagulation complications. Early sensorial symptoms, such as gustatory and olfactory loss, are useful for COVID-19 diagnosis. New variants of SARS-CoV-2 are emerging, principally from United Kingdom, South Africa, and Brazil. These variants seem to spread more easily and quickly, which may lead to more cases of COVID.

Comparative anatomy and angiography of the cardiac coronary venous system in four species: human, ovine, porcine, and canine.

INTRODUCTION: The coronary arterial system has been the subject of greater investigation than its venous system due to the importance of human coronary artery disease. With the advent of new percutaneous treatments, the anatomy of the coronary venous system has increasing relevancy. We compared the organization of the coronary venous circulation in three species commonly used in research and compared these to normal humans using both macroscopic anatomic and angiographic studies. ANIMALS: The anatomy of five explanted hearts from healthy dogs, pigs, and sheep were studied macroscopically, and 10 explanted hearts per animal species and 10 clinically normal human were examined by angiography. METHODS: Animal hearts were injected with latex and dissected macroscopically. The coronary venous system of humans was evaluated from clinical angiographic studies. In the animal hearts, a retrograde angiographic study was performed via a Foley catheter in the coronary sinus. RESULTS: The general organization of the coronary venous circulation was similar among humans, dogs, sheep, and pigs. Despite overall similarities to humans, animal hearts demonstrated the absence of the oblique vein of the left atrium and differences in position and organization of venous valves; venous diameters; number of tributary veins; and presence of an anastomosis between the left and right (human anterior and posterior) venous tree. The left azygos of the pig and sheep joined the coronary sinus. CONCLUSIONS: Anatomical differences must be considered when planning biomedical and veterinary studies incorporating cardiac veins. This study provides baseline data regarding structure and organization of the cardiac venous system.

LEOPARD syndrome.

LEOPARD syndrome (LS) is a rare hereditary disorder, characterised mainly by skin, facial and cardiac abnormalities. We report on the case of a six-year-old Djiboutian with typical features of LS. Multiple cardiovascular problems are described, including pulmonary infundibular, valvular and supra-valvular stenosis. A favourable course was observed after successful cardiac surgery. This is the first reported case of LS from the horn of Africa.

Whole body [(18) F]fluorodeoxyglucose positron emission tomography imaging for the diagnosis of pacemaker or implantable cardioverter defibrillator infection: a preliminary prospective study.

We studied the potential use of [(18) F]fluorodeoxyglucose ((18) F-FDG) whole body positron emission tomography (PET)-computed tomography for the diagnosis of device infection and extension of infection. Twenty-one patients with suspected device infection were prospectively included and compared with 14 controls free of infection. (18) F-FDG uptake on the box and on the leads was visually and quantitatively interpreted (using the maximal standard uptake value). The final diagnosis was obtained either from bacteriological data after device culture (n = 11) or by a 6-month follow-up according to modified Duke's criteria (n = 10). Ten patients finally showed infection on bacteriological study (n = 8) or during follow-up (n = 2). Sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 80%, 100%, 100% and 84.6% on patient-based analysis (presence or absence of infection). They were 100%, 100%, 100% and 100% for boxes, but only 60%, 100%, 100% and 73% for leads. Quantitative analysis could be useful for boxes but not for leads, for which the presence of a mild hot spot was the best criterion of infection. The four false negatives on leads received antibiotics for longer than the six true positives (20 ± 7.2 vs. 3.2 ± 2.3 days, p <0.01). Although the study was not designed for this purpose, management could have been modified by PET results in six of 21 patients. (18) F-FDG PET imaging may be useful for the diagnosis of device infection, and could impact on clinical management. Interpretation of negative cases should be performed with caution if patients have received antibiotics.

[Systolic anterior motion (SAM): a rare cause of late failure in mitral valve repair]. / Le SAM: une cause exceptionnelle d'echec tardif de plastie mitrale.

Systolic anterior motion (SAM) of the mitral valve is a rare complication of mitral valve repair. The treatment of the large majority of cases is purely medical. Nevertheless, an early degradation may require reoperation (revision of the repair or valve replacement). The authors report two cases of post-repair SAM with a poor outcome with medical therapy which required reoperation after several years. In both cases, an excess of bivalvular tissue with respect to the size of the mitral orifice was observed. A second repair was possible (sliding valvuloplasty associated with an oval resection of the anterior leaflet) with satisfactory long-term results. The identification of the risk factors and careful analysis of the lesions in cases of SAM after mitral valve repair may lead to a repeat repair and the avoidance of mitral valve replacement.

In vitro speed of sound measurement at intact human femur specimens.

Quantitative ultrasound has been recognized as a useful tool for fracture risk prediction. Current measurement techniques are limited to peripheral skeletal sites. Our objective was to demonstrate the in vitro feasibility of ultrasonic velocity measurements on human proximal femur and to investigate the relationship between velocity and bone mineral density (BMD). Sound velocity images were computed from 2-D scans performed on 38 excised human femurs in transmission at 0.5 MHz. Different regions-of-interest were investigated. Dual x-ray absorptiometry scans have been achieved for BMD measurements in site-matched regions. Our study demonstrates the feasibility of ultrasonic velocity measurements at the hip with reasonable precision (coefficient of variation of 0.3%). The best prediction of BMD was reached in the intertrochanter region (r(2) = 0.91, p < 10(-4)), with a residual error of 0.06 g/cm(2) (10%). Because BMD measured at the femur is the best predictor of hip fracture risk, the highly significant correlation and small residual error found in this study suggest that speed of sound measurement at the femur might be a good candidate for hip fracture risk prediction.

In vitro ultrasound measurement at the human femur.

Measurements of broadband ultrasonic attenuation (BUA) represent an established means of skeletal status assessment in osteoporosis. Today, the skeletal site that is the most widely used clinically is the calcaneus (heel bone). However, we hypothesized that fracture risk predictions could be improved if ultrasound measurements were performed directly at the main site of fracture, e.g., the proximal femur. The goal of this paper is to demonstrate in vitro the feasibility of quantitative ultra sound (QUS) imaging at the upper part of fee femur, and to investigate the relationships of BUA to bone mineral density (BMD). Forty-four excise human femurs were measured in transmission with a pair of focused 0.5-MHz central frequency transducers. Two-dimensional scans were performed, and the radio frequency (rf) signals were recorded at each measurement point. A data acceptance criterion for region of interest (ROI) selection was established based on the linearity of the frequency-dependent attenuation. Five measurements with repositioning were performed on each sample to determine the reproducibility. Dual energy x-ray absorptiometry (DXA) scans have been performed on the samples for BMD measurements: Three ROIs were selected in the specimens: greater, trochanter intertrochanteric, and femoral neck regions. Coefficient of variations were in the range 1.6% to 2.5%. The determination coefficients (r(2)) between BUA and BMD in site-matched ROIs were 0.81, 0.78, and 0.73, respectively, for the greater trochanteric, intertrochanteric, and femoral neck regions. Our results are consistent with data previously shown at the calcaneus and demonstrate the feasibility of QUS measurements at the femur in vitro, with reasonable reproducibility.

[Anatomic variations of the vascularization of the pelvic kidney: apropos of a case and review of the literature]. / Variations anatomiques de la vascularisation des reins pelviens: à propos d'un cas et revue de la littérature.

Blood supply in pelvic kidney presents with more anatomic variations than in a normal positioned lumbar kidney. We report a patient with a right pelvic kidney and a particularly atypic vascularisation. In addition we present a review of the literature with all possible pelvic arterial variations and their frequency.

Bridge to transplantation with the DeBakey VAD axial pump: a single center report.

AIMS: To report our experience with a left ventricular assist device axial pump as a bridge to transplantation: the DeBakey Ventricular Assist Device (VAD). METHODS: From February 1999 to February 2002, nine patients (among which eight males), with a mean age of 47 years, all in NYHA functional class IV, were proposed for a bridge to transplantation with the DeBakey VAD. Five patients had primary dilated cardiomyopathy, four had ischemic cardiomyopathy. All the patients had inotropic support prior to the intervention (dobutamine with a mean dose of 12 mcg/kg per min), six had an intra-aortic counterpulsation, four presented ventricular rhythm disorders. Interventions were performed through sternotomy alone (no need for an abdominal pocket) under extra-corporeal circulation on beating heart (except in one patient suffering from an apical thrombosis for which cardioplegic arrest was performed) as followed: implantation of the apical inflow cannula, tunneling of the percutaneous cable, implantation of the outflow graft under aortic side clamping, starting of the DeBakey VAD during CPB weaning-off. RESULTS: Mean support duration was 81+/-62 days (16-224 days). Eight reoperations were required (three for bleeding or cardiac tamponade, one for haemoperitoneum, one for aortic bifurcation thrombectomy, one for right ventricular assist device implantation, two for iterative replacements of the DeBakey VAD). A significant hemolysis was observed in two patients. No device infection or dysfunction were observed. Secondary recovery of a pulsed flow was observed either clinically or by Echo-Doppler in six patients. Five patients were transplanted, four died prior to transplantation (three from multi-organ failure on post-operative day 35, 16 and 50, respectively, and the last patient was found disconnected at day 109). CONCLUSIONS: The DeBakey VAD is at the origin of renewed interest for continuous flow assist devices. Still under evaluation, the advantages of miniaturization and facility of implantation of this new device seem to be promising.

Posterior approach for simultaneous access to the popliteal and anterior tibial arteries: applications to distal arterial bypass.

Arterial surgery to salvage the lower limb tends to make use of the great saphenous vein, harvested with the subject in the supine position. If this is not possible the small saphenous vein is used, harvested with the subject in the prone position, however this requires a perioperative modification of the procedure. A bypass between the popliteal and anterior tibial arteries can be performed using either a lateral or a medial and lateral approach with the patient supine. In the event of trophic disorders of the lateral compartment of the leg, these approaches are not applicable. In such cases we propose a single posterior approach. The single posterior approach was used on 10 lower limbs from 5 cadavers in the prone position. Approach to the lower part of the popliteal artery was undertaken posteriorly between the two heads of gastrocnemius. The small saphenous vein was entirely dissected 10 cm above the lateral malleolus, the Achilles tendon and short fibular vessels were retracted medially to expose the interossous fascia, which was divided over 10 cm. Medial rotation of the limb by 30 degrees exposed the anterior tibial artery. For 3 of the lower limbs an 8 cm fibular resection was necessary, whereas on the remaining 7 medial rotation enabled excellent exposure of the anterior tibial artery. The single posterior approach to the anterior tibial artery can be applied in cases requiring distal bypass, using the small saphenous vein, between the inferior part of the popliteal artery and the anterior tibial artery.

Left ventricular reconstruction after resection of a large fibroma.

Cardiac fibromas are rare tumors that are histologically benign but potentially lethal because of their location. The prognosis is related to complete resection. We report the case of a 15-year-old boy who, 1 year after partial excision of a large fibroma, underwent successful complete resection through a conventional surgical approach with left ventricular reconstruction.

[Effect of aortic valve replacent for aortic stenosis on cervical arterial blood flow]. / Incidence sur les flux des artères cervicales d'un remplacement valvulaire pour sténose aortique.

Aortic stenosis is known to modify initial upstroke time (IUT) of velocity in peripheral arteries and carotid velocities. The authors conducted a prospective study in 30 patients scheduled for aortic valve replacement for aortic stenosis. The goal was to establish postoperative correction of carotid flow disorders. In the preoperative period, a positive correlation (p < 0.01) was observed between IUT and mean pressure gradient, and a negative correlation (p < 0.02) between IUT and aortic valve area. Post-operatively, the authors observed a large decrease (p < 0.0001) of IUT, and higher (p < 0.05) systolic peaks of velocity (PSV) in all studied arteries. In this article, the authors confirmed the few previous studies which described preoperative velocity modifications in aortic stenosis population, but they also described for the first time their postoperative correction. Therefore, identifying these patterns of peripheral circulatory alterations is important and underestimation of carotid stenosis, currently estimated preoperatively, must be avoided.

[Human valvular substitutes for the treatment of complex progressive endocarditis. Application to aortic, mitral and tricuspid valves]. / Substituts valvulaires humains dans le traitement des endocardites évolutives complexes. Application sur les orifices valvulaires aortiques, mitraux et tricuspides.

The aim of this study was to assess the immediate and long-term results of human valvular substitutes (homografts and autografts) in the treatment of complex progressive endocarditis in aortic, mitral and tricuspid valves. Since 1992, 80 patients (64 men, 16 women) aged 44 +/- 16 years (range 15 to 76 years), were treated. In 53 patients, the endocarditis involved native valves, 4 on previously plastified valves, or prosthetic valves in 27 patients. The endocarditis was recurrent 6 patients. The lesions were situated on the aortic valve (N = 59), mitral valve (N = 5), aortic and mitral valves (N = 12), aortic and tricuspid valves (N = 3), mitral and tricuspid valves (N = 1). The peroperative findings confirmed the lesions diagnosed at echocardiography: prosthetic valve dehiscence (27 patients), prosthetic cusp tear (N = 7), vegetations (N = 61), perforations (N = 48), periannular abscess (N = 47), aorto-ventricular discontinuity (N = 12), aorto-mitral discontinuity (N = 7), right ventricular aortic fistula (N = 1), aorto-pulmonary fistula (N = 1), pseudo-aneurysm (N = 1), ventricular septal defect (N = 1). Eighty-six human valvular substitutes were used (double homograft in 6 patients): aortic homograft (N = 63), pulmonary in the aortic position (N = 1), the mitral position (N = 12), of which 8 were in the mitral and 4 in the tricuspid position, pulmonary autograft (N = 10). Ten mitral valve repairs were performed on infected lesions. Associated procedures included mitral valve repair (N = 5), tricuspid valve repair (N = 1) for non-infarcted valve lesions, replacement of the ascending aorta (N = 2), the aortic arch (N = 1), coronary bypass surgery (N = 2) and one nephrectomy. The hospital mortality was 5% (4 patients). The causes of death were: infarction (N = 2), myocardial failure (N = 1) and multiorgan failure (N = 1). Four early reoperations were required for technical problems, none for endocarditis. Seventy-three of the 76 survivors were followed up for 43 +/- 24 months (range 1 to 84 months). Eight patients died during follow-up, but only 1 of cardiac causes (operation for recurrent endocarditis in a drug abuser). Seven operations were performed, 3 for technical problems or structural failure, 4 for recurrent endocarditis. At 5 years' follow-up, the survival was 81 +/- 5%; 88 +/- 6% of patients were free of endocarditis, 77 +/- 6% had no reoperation: no patient had thromboembolic complications. These results show that human valvular substitutes are adapted for the treatment of complex, progressive aortic, mitral and tricuspid valve endocarditis when techniques of valvular repair are no longer feasible.

[Utilization of aortomyoplasty as a biological pumping system]. / Utilisation de l'aortomyoplastie comme système biologique de contrepulsion.

Aortomyoplasty is a surgical technique of constructing a neo-ventricle on the ascending or descending aorta with the latissimus dorsi muscle. This is electrically stimulated to contract during diastole, thereby creating a system of chronic, haemo-compatible aortic pumping. Long-term experimental studies have shown increases in cardiac output (from 3.6 to 5.5 l/min), decreases in peripheral resistances (from 1574 to 1134 dyne.sec.cm-5) and increases in indices of subendocardial viability (DPTI/TTI: 1.1 to 1.4). These experimental studies have been confirmed by the initial clinical results. To date, world experience includes thirty-six patients. With cardiomyoplasty, aortomyoplasty is a new arm in the therapeutic arsenal against severe cardiac failure by providing a new system of chronic circulatory assistance which is implantable and biocompatible.

Is 10 minutes the optimum immersion time in 0.6% glutaraldehyde for human pericardium?

BACKGROUND AND AIM OF THE STUDY: Pericardial fixation with 0.6% glutaraldehyde is usually assessed by measuring the shrinkage temperature of the tissue: the higher the shrinkage temperature, the greater the degree of cross-linking induced between collagen molecules. Animal pericardium studies have shown maximum response to be obtained after brief immersion (10 min). Our aim was to evaluate the effect of glutaraldehyde immersion time on shrinkage temperature of human pericardium which, to our knowledge, has not yet been studied. METHODS: Pericardial strips were harvested from 40 patients undergoing cardiac surgery. Time of immersion in glutaraldehyde ranged from 3 min to 6 months. Fresh untreated human pericardium samples were used as controls. The relationship between shrinkage temperature and time of treatment with glutaraldehyde was studied using a regression analysis. RESULTS: Glutaraldehyde treatment of pericardial tissues caused an increase in shrinkage temperature that was related biphasically to the time of immersion in glutaraldehyde. Mathematical expression of this curve permitted glutaraldehyde immersion time to be evaluated in relation to the degree of optimal shrinkage temperature. The time required for optimal fixation with glutaraldehyde, as measured by shrinkage temperature, was 100+/-0.77 min. CONCLUSION: Our results suggested that a 10-min exposure to glutaraldehyde was insufficient for 'correct' fixation of human pericardium. Inadequate glutaraldehyde exposure of human pericardium may explain mid and long-term failures reported with this tissue in cardiac surgery.

[Cardiac fibroelastoma. Six operated cases and review of the literature]. / Fibroélastomes cardiaques. Six cas opérés et revue de la littérature.

The authors reviewed the cases of 6 patients operated between September 1994 and February 1999 for a rare benign tumour: papillary fibroelastoma of the heart. These patients, aged 51 +/- 14 years, all have single valvular involvement: mitral (N = 3), aortic (N = 2), tricuspid (N = 1). Five patients were symptomatic: transient ischaemic cerebral events (N = 3) associated with mesenteric infarction requiring ileal resection in 1 case; constituted cerebrovascular accident (N = 1); syncope (N = 1). In this last patient, the fibroelastoma was diagnosed fortuitously on the tricuspid valve. The features and location of the tumours were determined by transoesophageal echocardiography. Surgical treatment in all patients consisted in excising the tumour and preserving the valve. One aortic cusp was reconstructed after excising the tumour with a cryopreserved partial aortic homograft. Peroperative transoesophageal echocardiography confirmed the absence of regurgitation after the procedures in all patients. There were no postoperative complications in any of the cases. No cases of valvular regurgitation or of tumour recurrence were observed during follow-up. Despite the benign histology, cardiac fibroelastomas should be excised because of their embolic complications. Absence of recurrence justifies conservative reconstruction of the affected valve.

Morphometric study of the pulmonary trunk: implications for a new approach of the Ross procedure.

A pulmonary valve autograft may be proposed to replace diseased aortic valves. The explanted pulmonary valve is replaced with a pulmonary homograft with the inherent risk of calcified degeneration. A monocusp valve using the anterior pulmonary trunk has been proposed to reconstruct the right ventricular outflow tract. The aim of this study was to determine the feasibility of this technique. In hearts from 17 adult cadavers, we measured: pulmonary trunk diameter at the leaflet tops (D1). H1 and H2 were respectively from leaflet top to lower and upper levels of the pulmonary trunk bifurcation. D2 = 1.4 D1 was calculated as the monocusp size allowing a 45 degrees opening of the valve and thus permitting good valvular efficacy. G = H1 - D2 determined the feasibility of the technique: G greater than 10 mm, appeared the most favorable, G between 0 and 10 mm, appeared possible, and G less than 0, appeared to be impossible. Mean values of D1, H1 and H2 were respectively: 20.19 mm, 37 mm and 57 mm. The technique was possible in 16 cases (94%) and impossible in 1 case (6%). Preoperative determination of these parameters, by echocardiography or magnetic resonance imaging, appears necessary before applying this new surgical technique.

[Left ventricular reconstruction after excision of a large fibroma]. / Reconstruction ventriculaire gauche après exérèse d'un volumineux fibrome.

The authors report the case of a 15 year old boy with a large left ventricular fibroma discovered after a series of syncopal episodes due to obstruction to ejection. The first attempt to remove the fibroma in Columbia was only partially successful. In view of the risk of death associated with this type of tumour, it was decided to offer the patient complete excision after a full morphological and functional evaluation of myocardial function and the consequences of the tumour on mitral valve function and on the coronary circulation. The operation was performed under cardiopulmonary bypass and aortic clamping by conventional surgery, associated with reconstruction of the cardiac free wall with a large patch of autologous pericardium which was necessary to avoid cardiac transplantation, the ultimate sanction in this indication.