Comparison of 2-Dimensional, 3-Dimensional, and Surgical Measurements of the Tricuspid Annulus Size: Clinical Implications.

Background: Associated tricuspid annuloplasty is recommended during left-heart valve surgery when the tricuspid annulus (TA) is dilated but methodology for the measurement of TA size and thresholds for TA enlargement are not clearly defined.

Methods And Results: Measurement of the TA diameter (TAD) was prospectively performed using 2-dimensional transthoracic echocardiography (2D-TTE) in 282 patients in 4 different views (parasternal long axis, parasternal short axis, apical 4-chamber [A4C], and subcostal). TAD was also measured using 3D-transesophageal echocardiography in 183 patients (long axis), peroperatively in 120 patients who underwent a tricuspid valve surgery and using TTE (A4C) in 66 healthy volunteers.

How should I treat prosthetic tricuspid stenosis in an extreme surgical risk patient?

Background: A 64-year-old female with rheumatic heart disease and multiple prior valve replacements presented with progressive oedema, ascites and dyspnoea on exertion.

Investigation: Physical examination, transthoracic echocardiography, intracardiac echocardiography, transoesophageal echocardiography, right heart cathetherisation, computed tomography.

Diagnosis: She had a mitral homograft and Physio ring in the tricuspid position, and presented with severe bioprosthetic tricuspid valve stenosis (mean gradient 16 mmHg) and right-sided heart failure.

Role of radiolabelled leucocyte scintigraphy in patients with a suspicion of prosthetic valve endocarditis and inconclusive echocardiography.

Aims: In patients with a suspicion of prosthetic valve endocarditis (PVE), detection of perivalvular infection can be difficult based only on echocardiography. The aim of this retrospective study was to test the interest of radiolabelled leucocyte scintigraphy (LS) for the detection of perivalvular infection in patients with a suspicion of PVE and inconclusive transoesophageal echocardiography (TEE).

Methods And Results: LS was performed in 42 patients.

Right papillary muscle sling: proof of concept and pilot clinical experience.

Objectives: Left-sided intraventricular remodelling by papillary muscle approximation associated with annuloplasty of the mitral valve improved outcomes for severe functional mitral regurgitation compared with annuloplasty alone. We conceived of, and studied, a papillary muscle sling on the right side of the heart associated with annuloplasty, seeking to reduce tricuspid valve tethering and right ventricular volumes and to preserve ventricular function.

Methods: An experimental model on ex vivo porcine hearts established the anatomical feasibility of the procedure.

Surgical management of patients with Marfan syndrome: evolution throughout the years.

Aim: To evaluate the evolution of surgical management in a large population of patients with Marfan syndrome.

Methods: This is a retrospective study of patients fulfilling the Ghent criteria for Marfan syndrome, who visited the Centre de référence national pour le syndrome de Marfan et apparentés and underwent a surgical event before or during follow-up in the centre.

Results: One thousand and ninety-seven patients with Marfan syndrome, according to international criteria, came to the clinic between 1996 and 2010.

Unusual presentation of cryolife O'Brien(R) stentless aortic valve bioprosthesis dysfunction mimicking infective endocarditis.

Objectives: We previously reported a possible but unusual prosthetic-valve infective endocarditis (PV-IE) occurring on a Cryolife O'Brien Stentless Porcine Xenograft (CLOB) (anatomic damages suggestive of IE but negative inflammatory and microbiological markers). We reviewed all cases of aortic PV-IE admitted in our institution and compared the clinical presentation, bacteriological and echocardiographic features according to the type of prosthesis.

Methods: Sixty consecutive cases with possible or definite aortic PV-IE (23 CLOB, 26 mechanical valve and 11 stented bioprosthesis) were admitted between 2002 and 2008.

Transfemoral implantation of an Edwards SAPIEN valve in a tricuspid bioprosthesis without fluoroscopic landmarks.

Aims: We describe the first report of an Edwards SAPIEN valve implanted in a tricuspid bioprosthesis from the femoral vein. We highlight the feasibility of this previously avoided approach and the techniques involved.

Methods And Results: A 61-year-old woman with multiple valve replacements for rheumatic heart disease presented with NHYA IV dyspnoea secondary to a severely stenosed tricuspid bioprosthesis.

The papillary muscle sling for ischemic mitral regurgitation.

Objective: Our objective was to evaluate long-term stability of mitral repair and reverse remodeling in patients with severe ischemic left ventricular dysfunction and functional mitral regurgitation.

Methods: Since June 2000, a total of 37 patients with ischemic functional mitral regurgitation have benefited from a double-level mitral repair that comprises an intraventricular peripapillary muscle sling completed by a classic intra-atrial mitral annuloplasty ring (mean age, 56 years; left ventricular end-diastolic diameter, 70 +/- 0 mm; left ventricular end-systolic diameter, 55 +/- 5.6 mm; ejection fraction, 15% to 45%; pulmonary hypertension > 60 in all patients; all were in New York Heart Association class III-IV).

Bartonella endocarditis complicating congenital heart disease.

The present report describes a case of Bartonella henselae endocarditis affecting an adolescent with congenital heart disease. A teenager from Eastern Europe was referred to for surgical treatment of aortic endocarditis. She admitted close contact with cats.

Redo aortic root surgery for failure of an aortic homograft is a major technical challenge.

Objective: Aortic homografts offer many advantages over prosthetic valves. However, homograft dysfunction due to degeneration or infection may lead to reoperation. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge.

A multi-perforated man: asymptomatic ruptured sinus of Valsalva aneurysm associated with an atrial and ventricular septal defect.

We report the case of an exceptional association of a right coronary sinus of Valsalva aneurysm (SVA) ruptured into the right ventricle, a supracristal ventricular septal defect (VSD) and an atrial septal defect (ASD). Our patient was totally asymptomatic and the diagnosis was established by echocardiography. The patient underwent prompt surgery that consisted in closing the aneurysm and the VSD with a pericardium patch.

The Stentless Cryo-Life O'Brien porcine aortic valve at 10 years.

Background And Aim Of The Study: If stentless devices--with their physiological advantages--are to remain attractive, their long-term durability must equate with that of reference stented valves.

Methods: Between August 1991 and August 2001, 650 patients (mean age 72.0+/-4.

Contemporary results of mitral valve repair for infective endocarditis.

Objectives: We sought to evaluate the feasibility and immediate and late results of mitral valve repair (MVRep) for acute and healed endocarditis.

Background: Improvements in techniques of MVRep have extended its feasibility in complex lesions, but experience with endocarditis is limited.

Methods: Among 78 patients operated on for mitral endocarditis between 1990 and 1999, 63 underwent MVRep.

A new aortoventriculoplasty for prosthetic aortic valve replacement.

Background: Konno aortoventriculoplasty demands a complex double patch reconstruction of left and right ventricular outflow tracts and is subjected to a risk of permanent heart block. A modified technique was used to overcome these difficulties. Patient and methods A 42-year-old woman with congenital aortic stenosis, a diminutive aortic annulus, and severe subaortic muscular obstruction had undergone aortic valve commissurotomy 24 years ago.

Papillary muscle sling: a new functional approach to mitral repair in patients with ischemic left ventricular dysfunction and functional mitral regurgitation.

Background: In patients with ischemic left ventricular dysfunction (LVD) and functional mitral regurgitation (FMR), restoring a more normal alignment between mitral annulus and laterally displaced papillary muscles (PM) may be beneficial in terms of mitral repair and regional dynamics.

Methods: Ten patients, 29 to 78 years old, with an ejection fraction of 25% to 45%, pulmonary hypertension greater than 60, and New York Heart Association Class III-IV, had their PMs drawn together by a tightly encircling loop using a 4-mm Gore-Tex tube. Associated mitral annuloplasty rings were only moderately undersized.