Management of multidrug-resistant CMV infection in immunocompromised patients: case report of a heart-transplant recipient and review of the literature.

Cytomegalovirus (CMV) remains a leading cause of morbidity after solid organ transplantation. The efficiency of antivirals for the treatment of CMV infections may be hampered because of the emergence of CMV resistance to antivirals. The development of CMV multidrug resistance, which remains uncommon but does occur, constitutes a clinically challenging complication and may contribute to difficult therapeutic management and adverse clinical outcome.

Multislice computed tomography to rule out coronary allograft vasculopathy in heart transplant patients.

Background: This study assessed if invasive coronary angiogram (CA) could be replaced by multislice (64- or 256-row) computed tomography (MSCT) to systematically rule out coronary allograft vasculopathy in heart transplant patients.

Methods: Electrocardiogram-gated contrast-enhanced MSCT (64-row for the first 25 patients and 256-row for the others) was compared with CA. MSCT parameters, adapted to the patient's weight, included 120 kV, 800 mAs, 0.

Interpretation of lipoprotein-associated phospholipase A2 levels is influenced by cardiac disease, comorbidities, extension of atherosclerosis and treatments.

Purpose: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an inflammatory biomarker secreted in the atherosclerotic plaque. Blood levels of Lp-PLA2 predict future cardiovascular events in patients with ischemic disease and heart failure. This association seems to be independent of traditional cardiovascular risk factors.

[Virtual endoscopic navigation and body transparency based on computed tomography. A step towards in vivo imaging].

Progress in HR-CTdata processing has led to lower X-ray exposure and to better diagnostic performance. We describe 19 adult patients (among 5000) examined by HR CT with 64 detectors, acquisition and exposure protocols in mSv, spiral, 0.6-mm slices, 5To PACS.

First experimental use of magnets in cardiac valve repair.

Background And Aim Of The Study: Valve repair is currently performed to treat mitral regurgitation, but aortic valve repair remains a surgical challenge. In contrast, aortic valve replacement leads to complications and constraints on the patients' quality of life and valve durability. The mechanisms that produce malcoaptation of the aortic leaflets, with resultant insufficiency, are mainly due to prolapse or retraction of the leaflets.

Incidence and risk factors for seizures after heart transplantation.

Neurological complications can occur after heart transplantation and present with seizures. We examined the incidence of seizures from a population of adult patients who had received heart transplants over a period of 3 years. Brain MRI and clinical data were analysed to identify the risk factors for the seizures.

Long-term outcome after bare-metal or drug-eluting stenting for allograft coronary artery disease.

Background: Percutaneous coronary intervention (PCI) with bare-metal stenting (BMS) has been reported to be associated with high rates of target-lesion revascularization (TLR) in heart transplant recipients. We aimed to assess the outcome of successful PCI with BMS or drug-eluting stenting (DES) in such patients.

Methods: Ninety-four consecutive heart transplant recipients with successful PCI of de novo lesions with BMS (n = 53) or DES (n = 60) were prospectively followed-up for 3.

Extra-corporeal membrane oxygenation temporary support for early graft failure after cardiac transplantation.

Objective: Early graft failure (EGF) is a major risk for death after heart transplantation. We studied the impact of an extra-corporeal membrane oxygenation (ECMO) temporary support on the operative mortality and the mean-term survival after EGF.

Materials And Methods: Between January 2000 and December 2006, 394 patients underwent orthotopic heart transplantation at our institution.

Paracorporeal pulsatile biventricular assist device versus extracorporal membrane oxygenation-extracorporal life support in adult fulminant myocarditis.

Objective: Biventricular assist device support with a paracorporeal pulsatile device is known to be an efficient bridge to recovery for patients with fulminant myocarditis-related cardiogenic shock. Whether these patients can be as efficiently supported with femorofemoral extracorporeal membrane oxygenation remains unclear.

Methods: From 2001 to 2006, 11 patients were referred to our cardiac surgery department for fulminant myocarditis-related cardiogenic shock.

Resistance pattern of cytomegalovirus (CMV) after oral valganciclovir therapy in transplant recipients at high-risk for CMV infection.

In transplant recipients, cytomegalovirus (CMV) resistance to antivirals causes an increasing problem. Here we report the clinical, therapeutic, and virological characteristics of 11 cases of CMV resistance among transplant recipients at high-risk for CMV infection and receiving valganciclovir as a prophylactic, preemptive or maintenance therapy. Active CMV infection was monitored by viral DNA quantification in whole blood, and CMV resistance was assessed by UL97 and UL54 viral gene sequencing.

Heart transplantation in systemic (AL) amyloidosis: a retrospective study of eight French patients.

Background: Immunoglobulinic (AL) amyloidosis is a complication of plasma cell dyscrasia, characterized by widespread deposition of amyloid fibrils derived from monoclonal light chains. Cardiac amyloid is the main prognostic factor, with a median survival of six months. Cardiac transplantation in AL amyloidosis is associated with high mortality, due to disease recurrence in the allograft and systemic progression.

A new completely flexible ring for mitral valve annuloplasty: the "Rama-Valvuloplasty-Ring". Five-year Pitié Salpétrière experience.

The aim of this study was to analyze the effects about the use of a new completely flexible ring for mitral valve anuloplasty, the "Rama-Valvuloplasty-ring", in 182 patients operated on in the Pitié-Salpétrière Hospital, Paris, France for mitral valve regurgitation (MVR). From January 1998 to December 2003, 182 patients with mitral regurgitation (MR) underwent mitral reconstructive surgery at our institution with the "Rama-Valvuloplasty-Ring". This group was made up of 117 men (64.

Papillary muscle approximation for ischemic mitral valve regurgitation.

In patients with ischemic left ventricular dysfunction and functional mitral regurgitation, the surgical treatment of the mitral insufficiency remains a challenging issue. Several procedures were described to restore a more normal alignment between the mitral annulus and the laterally displaced papillary muscles. We report a new approach to relocate the displaced papillary toward the mitral annulus and to reduce tethering.

[Annuloplasty reduces the mitral leaflets mobility].

The posterior mitral leaflet is usually motionless following mitral valve repair. The aim of this study was to assess (1) the geometric changes of the left ventricular base following prosthetic ring annuloplasty and (2) their impact on the anterior mitral leaflet (AML) mobility. Thirty five patients operated upon for mitral valve repair underwent an intraoperative transesophageal echographic study before and after annuloplasty.

The endovascular treatment of traumatic isthmic aortic rupture: three years follow-up.

The isthmic aortic rupture represents the main cause of death in car crash accidents, because of closed chest trauma. Early medical and surgical care and endovascular prosthesis treatment with semi-invasive method can improve short and mid term survival. Nine patients with traumatic isthmic aortic rupture underwent endoprosthesis aortic implantation.

Long-term results of ascending aorta-abdominal aorta extra-anatomic bypass for recoarctation in adults with 27-year follow-up.

Objective: The surgical treatment of recurrent coarctation in adults supposes a redo left thoracotomy with adhesions and high risk of bleeding and injury of adjacent nerves. The rate of paraplegia in these cases may reach 2.6%.

[Cardiac transplantation in 2008].

The number of heart transplants in France has begun to increase again in the past few years, albeit slowly. Indications for transplants must be discussed on a case-by-case basis and no contraindication should be considered absolute. Heart transplant results have not been modified by the expansion of the selection criteria for donors.

Prevalence of patent foramen ovale and usefulness of percutaneous closure device in carcinoid heart disease.

The aim of this study was to assess (1) the incidence of patent foramen ovale (PFO) in carcinoid syndrome (CS) and (2) the feasibility of percutaneous closure procedure in selected patients with CS. One hundred eight patients were prospectively studied: 54 with CS and an age- and gender-matched control group. All patients underwent conventional and contrast echocardiography.

Bullet embolization from the left brachiocephalic vein to the right ventricle.

We present a rare case of bullet embolism from the left brachiocephalic vein to the right ventricle, following a chest gunshot wound, in a 56-year-old soldier. The bullet was accidentally discovered on a systematic chest X-ray. The bullet was very close to the tricuspid subvalvular apparatus and was about to come out from the ventricle.

Congenital bilateral coronary artery to pulmonary artery fistulas associated with left main trunk stenosis.

A rare case of a 57-year-old patient who presented with an acute coronary syndrome with incidental discovery of bilateral coronary arteriovenous fistulas originating from both coronary arteries to the pulmonary artery trunk and coronary artery atherosclerosis.