[Safety indices for chronic total occlusion recanalisation by antegrade approach without scheduled contralateral injection: A consecutive series of 39 cases]. / Indices de sécurité d'une recanalisation antérograde d'occlusion coronaire chronique sans injection controlatérale en première intention. À propos d'une série consécutive de 39 cas.

INTRODUCTION: Current guidelines for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) recommend dual coronary angiography. AIM OF THE STUDY: Evaluate CTO-PCI with a single approach using safety indices through the microcatheter. POPULATION AND METHODS: Prospective observational study with a consecutive inclusion of 39 patients (mean age of 67 years) treated by antegrade approach without scheduled contralateral angiography. Following safety indices were collected: blood backflow, distal coronary pressure waveform, selective distal contrast injection. RESULTS: Technical success was obtained in 90% of the cases. Balloon dilation was used in 38% of the cases before placement of the microcatheter. Dual angiography was necessary in three cases (8%). A blood backflow and cyclic changes of the distal coronary pressure waveform were noticed in 87% and 84% of the cases, with a positive predictive value of 97% and 79% respectively, for a microcatheter location in the true lumen. Selective distal contrast injection was done in 36 cases with a visualization of the true lumen in 35 cases. One major complication was observed (3%). CONCLUSION: CTO-PCI with a single approach is feasible using safety indices to limit the risks of major complication. The principle of a systematic dual angiography as advocated in current guidelines may deserve to be revisited.

[Fenestration of a spontaneous coronary hematoma with life-threatening dissection: A case of recurrent and multivessel spontaneous coronary artery dissections in a young female]. / Fenestration d'un hématome coronaire spontané avec dissection menaçante : à propos d'un cas de dissections coronaires spontanées récidivantes sur plusieurs vaisseaux chez une jeune femme.

The fenestration of a coronary artery hematoma is a therapeutic option in case of a life-threatening spontaneous coronary artery dissection, if the conservative treatment is not feasible. Here we present the case of a 34-year-old woman who presented three spontaneous coronary artery dissections, on three different arteries, over a period of twenty-one months. The diagnosis was confirmed by endovascular imaging. During an acute coronary syndrome, emergent percutaneous coronary intervention of the left anterior descending artery was performed, successfully, by a fenestration of the hematoma, using an AngioSculpt® scoring balloon.

Abdominoplasty with simultaneous laparoscopic umbilical hernia repair: A practical approach to preserve the umbilical vascularization.

BACKGROUND: Umbilical necrosis is a well-known complication of abdominoplasty, the risk of this complication can be increased when an associated umbilical hernia requires further dissection in peri-umbilical region, potentially leading to umbilical devascularisation. Multiple minimally invasive open techniques were described to avoid this problem. The combined approach of abdominoplasty with laparoscopic umbilical hernia repair is one promising solution to avoid devascularising the umbilicus. METHODS: A retrospective evaluation of patients who underwent concomitant abdominoplasty with laparoscopic umbilical hernia repair from 2007 to 2017 was carried out. All patients were followed up and evaluated for complications, including the incidence of umbilical skin necrosis. RESULTS: A total of 47 patients were included in this study. The average operative duration was 3.3hours with an average hospital stay of 2.5 days. No cases of postoperative umbilical necrosis were encountered. A mean follow-up period was 2.4 years showed no cases of hernia or rectus abdominis diastasis recurrence. Minor complications included 4 cases of dehiscence, one hematoma. There was no major complications. CONCLUSION: The concomitant use of laparoscopic umbilical hernia repair and abdominoplasty is a feasible approach to reduce the risks of umbilical devascularization. Especially in larger hernias and in patients with higher risk of recurrence.

[Management of renal failure in old patients undergoing percutaneous cardiac interventions]. / Prise en charge de l'insuffisance rénale du sujet âgé en cardiologie interventionnelle.

The elderly benefit from the advances of the interventional cardiology, especially for coronary artery disease and aortic valve stenosis. The prevalence of comorbidities is high in old population, but the benefit-risk balance remains often positive. Chronic kidney disease is frequent and amplifies the risks of contrast-induced nephropathy and acute kidney injury with an impact on clinical course and outcomes, and additional costs. Preventive strategies recognized as efficient to limit renal adverse events must be applied. Future approach may involve research in vulnerable old patients undergoing cardiac interventions.

[Paradoxical embolism: Myth or reality?] / Embolie paradoxale : mythe ou réalité ?

Paradoxical embolism should be suspected in front of a clinical phenomenon of thromboembolism associated with an anatomical right-to-left shunt. Others potential cardiac sources of thromboembolism must be ruled out. Strokes constitute the most frequent clinical manifestations of paradoxical embolism. Right-to-left left shunts are in connection with intracardiac defects (atrial septal defect and patent foramen ovale) or pulmonary arteriovenous malformations. The probability that a discovered PFO is stroke-related can be evaluated by a score. Therapeutic approaches for secondary prevention of recurrent stroke include antithrombotic and/or percutaneous treatments. The choice strategy begins to be clearer with the recent results of randomized controlled studies.

[Sex differences in congenital heart disease]. / Différences entre les sexes dans les cardiopathies congénitales.

Gender influences the clinical presentation and the management of some acquired cardiovascular diseases, such as coronary artery disease, resulting in different outcomes. Differences between women and men are also noticed in congenital heart disease. They are mainly related to the prevalence and severity of some congenital heart defects at birth, and in adulthood to the prognosis, incidence of Eisenmenger syndrome and risks of pregnancy. The role of gender on the risk of operative mortality of congenital heart surgery remains debated.

Surgical Management of Large Spontaneous Portosystemic Splenorenal Shunts During Liver Transplantation: Splenectomy or Left Renal Vein Ligation?

OBJECTIVE: Management of splenorenal shunt (SRS) during whole liver transplantation is still controversial. Splenectomy (SP) permits its radical removal, at the price of a specific related morbidity. Left renal vein ligation (LRVL) performs a downstream ligation with potential renal repercussions. This study aimed to compare these techniques regarding portal revascularization and postoperative outcomes. METHODS: From 1994 to 2012, 22 SPs and 7 LRVLs were performed for large SRS (>1 cm) management. RESULTS: There was no difference in operating times or transfusion rates. In both groups, efficient portal flow was initially obtained in all cases. After a median follow-up of 79 months, 2 patients in the SP group presented an altered portal flow owing to persistence of a not disconnected mesentericogonadic or splenorenal shunt. Postoperative morbidity, including infection and portal vein thrombosis, was not significantly different (32% vs 14%). SP allowed a faster correction of the thrombocytopenia. The LRVL group had a moderate and temporary impairment of renal function. CONCLUSIONS: SP and LRVL represent 2 effective procedures to avoid vascular steal in the presence of SRS, but they require a patent portal vein. SP appears to be associated to specific but acceptable intraoperative morbidity, permits treatment of associated splenic artery aneurysm, and enables a faster correction of thrombocytopenia. However, the presence of a remote hilum SRS or another large portosystemic shunt represents a cause of failure of the procedure. LRVL is a safer and less demanding procedure that can suppress portal steal whatever the location of the SRS, but at the price of moderate renal morbidity.

Choice and doses of antibacterial agents for cement spacers in treatment of prosthetic joint infections: review of published studies.

BACKGROUND: Addition of antibacterial drugs to interim antibacterial cement spacers (ACSs) is considered to be standard of care for surgical revision in prosthetic joint infections (PJIs). We reviewed published studies evaluating the choice and doses of antibacterials in spacers. METHODS: We conducted a PubMed search of all clinical study reports evaluating the use of ACSS in a 2-stage hip or knee arthroplasty for treatment of PJI (1988 through August 2011). The trial design, antibacterials used, and end points studied were analyzed. RESULTS: No randomized trials were found comparing either ACSs with different concentrations of antibacterials or ACSs with or without antibacterials. Most of the studies were uncontrolled and used various time points to evaluate the outcome. Twenty publications that reported doses of antibacterials in spacers and had a follow-up of ≥ 24 months after the second stage were selected for review. Most ACSs included vancomycin and aminoglycosides. The doses of aminoglycosides and vancomycin ranged from 0.25 to 4.8 g and from 1 to 4 g, respectively, per 4 g of cement. No association between reported eradication of the infection and antibacterial load was found. CONCLUSIONS: Published data do not allow evaluation of whether antibacterials in temporary cement spacers provide additional benefits in the treatment of PJI, compared with systemic antibacterials, and are not sufficient to support recommendations on dosages. Complications of ACSs have not been consistently analyzed. Prospective randomized trials comparing spacers with and without antibacterials or spacers with different loads of antibacterials are needed to evaluate the safety and efficacy of ACSs.

Regulatory perspective on characterization and testing of orthopedic bone cements.

This paper provides a general regulatory background of acrylic bone cements, chemical composition information on several commercially available bone cements, physical and chemical methods of analyses, mechanical test methods, and risks and failure mechanisms of acrylic bone cements. Suggestions and recommendations presented in Tables 2 and 3 are not mandatory requirements but reflect data and methodologies which the FDA's Orthopedic Devices Branch (ORDB) believes to be acceptable to evaluate most pre-clinical data. FDA may require information in addition to that contained in this paper. In some instances, a sponsor may be able to sufficiently justify the omission of some tests. Although this paper describes certain administrative requirements, it does not take the place of the requirements contained in Title 21 of the Code of Federal Regulations (21 CFR) Parts 801, 807, 812, and 814 or those found in the statute.