[Chlamydia infection: An uncommon cause of sexually transmitted myopericarditis]. / Infection à Chlamydia: une cause rare de myopéricardite sexuellement transmissible.

INTRODUCTION: The vast majority of myopericarditis are thought to be caused by viral infection. CASE REPORT: We here report a 46-year-old woman who was admitted twice for clinical presentations compatible with acute coronary syndromes despite normal coronary arteries at angiography. Diagnosis of myopericarditis caused by Chlamydia trachomatis was based on cardiac magnetic resonance and laboratory findings. Treatment with levofloxacin allowed for a full recovery. CONCLUSION: Chlamydia trachomatis infections affect young, sexually active individuals and are responsible for a large proportion of salpingitis, ectopic pregnancy or infertility. Myopericarditis in the setting of chlamydial infection has been seldom reported. Its identification is needed allowing for a specific treatment.

[Transfusion-associated circulatory overload]. / Œdèmes aigus pulmonaires de surcharge post-transfusionnels.

A working group of the French National Hemovigilance Committee has been in charge of heightening awareness of Transfusion-Associated Circulatory Overload (TACO) among physicians and nurses. This multidisciplinary group has produced the present document that focuses on epidemiological data provided by the French haemovigilance network, physiopathology, diagnosis, treatment and specific actions that could prevent or minimize the risk of TACO.

No gender survival difference in a population of patients with chronic heart failure related to left ventricular systolic dysfunction and receiving optimal medical therapy.

INTRODUCTION: Controversial results have been published concerning a possible gender survival difference in patients with chronic heart failure (CHF). METHODS: We analysed data from consecutive patients with stable CHF admitted to our department for prognostic evaluation. Patients underwent coronary angiography, echo-cardiography, radionuclide angiography and a cardiopulmonary exercise test. RESULTS: We included 613 consecutive patients of whom 115 (19%) were women. The major difference in clinical characteristics was a higher proportion of ischaemic cardiomyopathy in men compared to women (51% vs 28%, p<0.0001) and a lower left ventricular ejection fraction (35+/-9 vs 38+/-9%, p=0.001). Therapeutic management was similar in men and women. A total of 140 cardiovascular-related deaths and 4 urgent transplantations occurred during a median follow-up of 1.234 days. There was no gender difference in cardiac survival. Cardiovascular mortality rates at 2 years were 11% in men and 13% in women. CONCLUSIONS: Despite a lower percentage of ischaemic cardiopathy in women, no gender survival benefit was found in our population of CHF patients receiving optimal medical therapy.

[An experimental model of pulmonary valve implantation: a percutaneous and transventricular approach without cardiopulmonary bypass]. / Modèle de mise en place d'une valve pulmonaire: approche percutanée puis trans-ventriculaire sans circulation extracorporelle.

Pulmonary valve replacement by a catheter procedure remains a therapeutic challenge. In this report, the authors demonstrate the possibility of implantation of a porcine xenograft specially prepared on an auto-expanding stent (valved stent) in a sheep model. The porcine xenograft was prepared with hypotonic non-enzymatic solutions. It was sewn onto an auto-expanding stent (Luminex Bard) and inserted into an introduction sheath of 22-24 F (Gore) calibre. In a preliminary approach, the catheter was inserted through the jugular vein. Out of 6 attempts, it was possible to position the valved stent in the pulmonary position in two cases but all the animals died of different causes: tamponade, arrhythmias, air embolism. Following this experience, two valves were implanted through the superior and inferior vena cavae. This first percutaneous approach has been modified to a mixed medico-surgical approach with a transventricular introduction without cardiopulmonary bypass. This was performed through a left thoracotomy with puncture of the pulmonary infundibulum using the same systems of introduction and valved stent. Three implantations were successfully performed. In addition, a reduction of the size of the pulmonary artery was realised to prevent embolisation of the valved stent to the pulmonary artery or one of its branches. The transventricular approach is feasible for implantation of pulmonary valve prosthesis on a stent. This technique could be adapted for correction of pulmonary regurgitation after correction of Tetralogy of Fallot associated with reduction of the pulmonary infundibulum.

[Cell therapy to treat heart failure]. / Thérapie cellulaire et insuffisance cardiaque.

INTRODUCTION: Systolic heart failure is mainly due to a decreased left ventricular systolic function after myocardial infarction. Despite significant improvements in medical management of heart failure, the prognostic remains poor, with a 5-years survival only of 30%. PURPOSE: Current treatments are only able to delay progression toward end-stage heart failure. Heart transplantation is accessible only for selected patients. Thus, in the context of post-myocardial infarction, cell therapy appears to be a new original technique, available for the majority of patients and potentially non-invasive. CONCLUSION: After promising results in experimental models, a phase I clinical trial has been conducted in France, showing the feasibility of intracardiac autologous skeletal myoblast implantation. Other studies in Europe and USA are currently testing a variety of cells and delivery systems. A phase II-trial will begin in France.