[Anomalous origin of coronary arteries in adults]. / Anomalies de connexion proximale des artères coronaires chez l'adulte.

In lack of structural congenital heart disease, anomalous origin of a coronary artery is rare with an angiographic prevalence of approximately 1%. The prognosis depending on anatomical features, initial course of coronary ectopic vessel is important to be considered. Although some anomalies are associated with sudden death, the majority are simply incidental anatomic findings. In patients with high-risk coronary anomalies, the treatment is not clearly codified. Large-scale prospective multicenter studies are needed to define recommendations in the future.

[Transapical approach for aortic stented valve implantation: experimental results]. / Implantation transapicale d'une valve stentée aortique: résultats expérimentaux.

OBJECTIVE: Percutaneous aortic valve replacement has been performed in humans mainly for non-surgical candidates. We evaluated on animals a transapical approach to deliver an aortic stented valve without cardiopulmonary bypass. METHODS: A tubular pericardial valve fixed within a cobalt-nickel stent (Medtronic, Inc.) was implanted using a transapical approach in five adult sheep. A left thoracotomy was used to access the apex of the heart. The crimped valve was deployed in orthotopic position with a valvuloplasty balloon catheter on the beating heart after decreasing the left ventricular pressure by using either drugs or inferior vena cava occlusion. Deployments were performed under fluoroscopy and epicardial 2D Doppler echocardiography. Exact positioning of the valve into the target area was confirmed by autopsy at the end of the procedures. RESULTS: Valves were unsuccessfully deployed at the target site in all cases but one. Three valves were implanted in a supra-annular position with two of them in supracoronary position. One valve was implanted below the native annulus in the outflow tract. Valvular leak was noted in all but one implants. Coronary obstruction occurred twice and early valve retrograde migration once. Ventricular fibrillation or diastolic cardiac arrest occurred less than 20 minutes after stent deployment in all cases. CONCLUSION: In our experience the transapical approach does not facilitate delivery of a stented valve. Despite its technically feasibility, advanced stent design and improvements in delivery system are required before to continue experimental studies in transapical approach for aortic stented valve.

[The results of the artificial heart]. / Les résultats du coeur artificiel.

The artificial heart is no more a dream but a reality. Over the last 40 years, many circulatory assist devices have been developed. First were the pneumatic devices, external or implantable, providing uni- or biventricular support; next were the partially implantable electromecanical devices. We went from the first generation of devices with all components (pump, energy power, control system) outside of the body to the second generation of devices with the pump and the motor implanted inside the body. Recently, the third generation of artificial hearts appeared with all components implanted inside the body allowing better mobility and quality of life. Results depend on the indication and on the kind of artificial heart implanted: partial (native heart still in place) or total (native heart removed). Essentially developped as a bridge to transplant, the artificial heart is now allowed as destination therapy.

[The left ventricular reconstructive surgery at the origin of the treatment of cardiac insufficiency]. / La reconstruction ventriculaire a l'origine du traitement chirurgical de l'insuffisance cardiaque.

The surgical method of ventricular reconstruction described by Dor is recalled with the clinical report of a patient who presented a ventricular aneurysm. The left ventricular reconstructive surgery is based on an anatomical design of the heart described by Torrent-Guasp, where the normal orientation of the left ventricular muscle fibers, oblique in direction, is found parallel with the base of the heart at the time of ventricular dilation. By giving again an elliptic form to the left ventricle, the left ventricular reconstructive surgery improves the cardiac function of the patient who developed a bulky aneurysm after an infarction. Based on this concept, other techniques of ventricular reconstruction intended for patients presenting dilated cardiomyopathy, of ischemic origin or not, are being studied.

[Clinical experiences with the new electromagnetic ventricular assist devices]. / Experiences cliniques avec les nouvelles assistances ventriculaires mécaniques electromagnétiques.

Recently, the third generation of partial electromagnetic artificial hearts appeared, which are a real technological advancement. These new ventricular assist devices are small, implantable, silent and increase the patients' quality of life in comparison with the electromechanical pump of second generation. Their clinical efficiency is at least as good as the second generation in light of the first experiences reported on animals and human beings. Their use as a bridge to transplant and especially as a destination therapy should increase in the coming years as they represent an answer to the health problem, which is the increasing population of patients in heart failure.

[Percutaneous cardiac valve replacement: a review]. / Remplacement percutané des valves sigmoïdiennes. Revue de la littérature.

Surgery is no longer the only technique to replace a cardiac valve. New percutaneous procedures allow aortic or pulmonary valve implantation. Even if the feasibility of these procedures has been proved, cases reported are very rare and selected. This emergent technology is still at an early stage of development and new prospective studies will be necessary to evaluate these procedures correctly before concluding their clinical benefit. At this time surgery remains the gold standard in terms of cardiac valve replacement.

[Mechanical cardiac assistance and artificial heart: historical perspectives]. / Histoire de l'assistance circulatoire mécanique et du coeur artificiel.

The impact of heart failure on patients and economical burden on health insurance resources is increasing. Cardiac transplantation is still the primary treatment for patients who are in end stage heart failure. The development of artificial hearts (total and partial) was implemented by the discrepancy between the scarcity of available donors and the importance of waiting lists for cardiac transplantation. The technical progresses achieved since the first works of Kolff in 1957 now allow these patients to have their circulation restored and go home to wait for their transplantation. The encouraging results of the artificial heart and the miniaturization of these devices allow them to be considered as a possible destination therapy for patients not eligible for cardiac transplantation.

[Cardiac surgery after liver transplantation]. / Chirurgie cardiaque après transplantation hépatique.

An aortic valve replacement and an aorto-coronary bypass were done in a woman of 57 years old after an orthotopic liver transplantation. The surgical risk was increased by the antecedent liver transplantation, the immunosuppression, chronic renal insufficiency and antiphospholipid syndrome. Surgery and the post-operative period were not complicated. Cardiac surgery is not a contraindication for patients with a prior organ transplant. These individuals have a higher cardiovascular risk and require a cardiovascular follow-up the modalities of which are yet to be defined.

[Drainage after thyroid surgery: 264 patients]. / Drainage dans la chirurgie thyroïdienne.

OBJECTIVES: A prospective study was conducted in 1996-1997 in 100 patients who underwent thyroid surgery and who were randomly assigned to receive drainage or not. No statistical difference in complication rate was observed. The aim of the present retrospective study was to assess the consequences of this attitude in patients undergoing surgery since that time and to determine the number of postoperative complications, length of hospital stay, and type of thyroidectomy where cervical drains still appear to be indicated. PATIENTS AND METHODS: Total or partial thyroid surgery was performed in 264 patients between June 1997 and October 2000. Neck dissection was associated with 24 patients. RESULTS: Cervical drains were used in 29 patients (10.9%). Postoperative complications were comparable to those commonly reported. CONCLUSION: Except for neck dissection and mediastinal extension, thyroidectomy can be safely performed without drainage. This attitude reduces the overall hospital stay.