[Cardiac surgery in the elderly].

Cardiac disease in the elderly represents a major burden on public healthcare. Their frequences is linked to ageing process of general population and prevalence of cardiovascular diseases in older ages. Two diseases are of primary importance in elderly: Aortic valve stenosis is the most common.

Diagnosis, management, and follow-up of systemic venous drainage via a single left superior caval vein into the left atrium.

A 15-month-old boy presented with asymptomatic hypoxaemia due to right-to-left venous shunting via a left superior caval vein emptying into the left atrium, in absence of right superior caval vein. The diagnosis, suspected by contrast echocardiography, was confirmed by computed tomography and angiography. The child underwent surgical correction of the systemic anomalous return by tunnelling the left superior caval vein towards the right atrium.

[Factor VIII hyperactivity: an arterio-venous thrombogenic factor. Case report].

Thrombosis is the principal mechanism in vascular pathology, whether cerebral, coronary or peripheral. During the initial stages of infarction, coagulation contributes to vascular occlusion, the haemostatic factors playing a determining role in the development of atherothrombotic lesions. An increase in a coagulation protein, besides any lowering of anticoagulation protein levels, is a risk factor for thrombosis.

[Early non-obstructive thrombosis of mechanical mitral valve prostheses].

Transoesophageal echocardiography has shown a high incidence on non-obstructive thrombosis after mitral valve replacement with a mechanical prosthesis. The unpredictable outcome and the period during which the complication arises make treatment difficult. The aim of this study was to assess the tolerance and efficacy of the association of long-term heparin and oral anticoagulation, as recommended in this indication.

[Pulmonary alveolar phospholipoproteinosis].

Pulmonary alveolar phospholipoproteinosis is a rare lung disease of unknown cause characterized by surfactant plugging of the alveoli. At the present time, surgical lung biopsy, long considered as the gold standard, is not necessary for positive diagnosis of pulmonary alveolar phospholipoproteinosis when computed tomography anomalies and analysis of bronchial lavage fluids present a typical pattern. Treatment requires abundant lavage, but the demonstration of anti-GM-CSF antibodies in primary forms opens new therapeutic perspectives.

[Role of cardiac resynchronisation in the treatment of cardiac failure].

For 10 years cardiac resynchronisation has seen considerable development, as much on the technological side as at the level of its scientific validation. Several prospective studies have shown the functional benefits of cardiac resynchronisation in a selected population of refractory cardiac failure patients with improvement in symptoms, exercise tolerance and quality of life. Equally, cardiac resynchronisation allows a significant reduction in hospital episodes for cardiac failure and also has a beneficial effect on left ventricular inverse remodelling.

Comparative effects of ventricular resynchronization therapy in heart failure patients with or without coronary artery disease.

Unlabelled: In patients with advanced heart failure, intraventricular conduction delay (IVCD) and left ventricular systolic dysfunction (LVSD), multisite cardiac pacing can be proposed as an additive treatment. The aim of this study was to assess the clinical effectiveness of atrioventricular pacing according to the etiology of LVSD, by comparing the outcome of patients with and without coronary artery disease. Between August 1997 and November 1998, 103 patients were included in the InSync trial and received a biventricular pacemaker and a specifically designed left ventricular pacing lead.

Intra- and interatrial conduction delay: implications for cardiac pacing.

Atrial conduction disorders are frequent in elderly subjects and/or those with structural heart diseases, mainly mitral valve disease, hyperthrophic cardiomyopathies, and hypertension. The resultant electrophysiological and electromechanical abnormalities are associated with a higher risk of paroxysmal or persistent atrial tachyarrhythmias, either atrial fibrillation, typical or atypical flutter or other forms of atrial tachycardias. Such an association is not fortuitous because intra- and interatrial conduction abnormalities delays disrupt (spatial and temporal dispersion) electrical activation, thus promoting the initiation and perpetuation of reentrant circuits.

[Isoniazid-induced pleuro-pericarditis].

We report a case of pleuro-pericarditis related to administration of isoniazid. Drug-induced lupus is well known; we recall the principle clinical, biological and immunological characteristics.

[Comparative study of left ventricular ejection fraction and volume by 2 isotopic methods and contrast angiography].

The tomographic mode has replaced the planar mode for radióisotopic studies of myocardial perfusion but not for the study of systolic ventricular function. The aim of this study was to compare monophotonic emission tomography (MPET), the planar mode (PM) and contrast angiography (Angio). The left ventricular volumes and ejection fractions were measured in 111 patients by the tomographic and planar modes and by biplane angiography in 70 of them.

[Results of heart transplantation: experience of 233 grafts].

Background: Heart failure is one of the leading causes of hospitalization and death. The aim of this study was to evaluate long term outcomes after cardiac transplantation.

Methods: A retrospective review of 222 consecutive cardiac allograft recipients who underwent 233 transplantations between 1986 to 2000 was undertaken.

Suspected pacemaker or defibrillator transvenous lead infection. Prospective assessment of a TEE-guided therapeutic strategy.

Aims: The aim of this prospective study was to assess the clinical value of a management strategy principally based on the results of multiplane transoesophageal echocardiography (TEE) in patients with suspected lead infection.

Methods And Results: Seventy-seven consecutive patients were included. Based on Duke's modified criteria, PTLI was considered as definite in 54 patients (70%) and possible in 23 patients (30%).

Cardiac resynchronization therapy is an important advance in the management of congestive heart failure.

Cardiac resynchronization therapy (CRT) is an emerging therapy that improves symptoms and exercise tolerance in patients with advanced heart failure, left ventricular systolic dysfunction, and intraventricular conduction delay. By correcting the AV, interventricular, and intraventricular dyssynchrony induced by conduction disorders, controlled studies have shown that CRT improved functional status, decreased heart failure hospitalization rate, and might have a positive effect on left ventricular remodeling. Recent and preliminary data from the COMPANION trial suggest that CRT alone or in association with defibrillator capacity significantly reduced total mortality and hospitalization and that total mortality was significantly reduced only in the CRT plus implantable cardioverter defibrillator (ICD) group.

[Prognostic value of thallium 201 myocardial scintigraphy with dipyridamole before peripheral arterial surgery].

The evaluation of patients who are candidates for peripheral arterial surgery is difficult. The aim of this study was to show that dipyridamole stress scintigraphy could be a prognostic aid for patient selection. Between 1991 and 2000, 275 patients underwent dipyridamole stress myocardial scintigraphy before peripheral arterial surgery of the lower limbs (49%), the aortic (33%) or carotid arteries (18%).

[Pregnancy and congenital heart disease].

Congenital cardiopathies currently represent the majority of cardiac anomalies observed during pregnancy. The latter leads to significant haemodynamic modifications which can sometimes be poorly tolerated in the case of severe cardiopathy. However, as a rule pregnancy is generally well supported if the functional state of the patient beforehand is satisfactory (class I or II of the NYHA).

Two cases of 'asthma' revealing a diverticulum of Kommerell.

Among embryonic aortic vascular malformations, persistence of a right aortic arch and aberrant left subclavian artery associated with a diverticulum of Kommerell is rare, and is estimated to occur in 0.1% of the general population. We report two cases of diverticulum of Kommerell in which tracheal compression due to the vascular ring induced respiratory symptoms such as asthmatic dyspnoea.

[Epidemiology and etiology of atrial fibrillation].

Atrial fibrillation is the most common sustained rhythm disturbance, with a heterogeneous presentation, occurring in the presence or absence of detectable heart disease or related symptoms, evolving in paroxysmal, persistent or permanent forms. Prevalence and incidence are mainly depending on age and congestive heart failure. Atrial fibrillation is frequently observed in elderly population.

[Heart re-synchronization with biventricular stimulation: new treatment for refractory heart failure].

Despite continuous progress in drug therapy, many patients are still progressing into advanced heart failure, a very poor condition in terms of quality of life and prognosis. Therapeutic resources are quite limited at that end-stage. Heart transplantation may only be proposed to a small minority of patients.

[Right atrial compressive aneurysm with favorable outcome after surgery at the age of 1 month].

Right atrial aneurysms are uncommon and often revealed by arrhythmia. We report a case of right atrial aneurysm which required an early management and its follow up during one year. The abnormality was detected at 32 weeks gravida during a systematic echography.

Unusual cause of recurrent pneumothorax: excavated metastasis of osteosarcoma.

We report the case of a recurrent right pneumothorax, revealing metastasis of an osteosarcoma, 40 months after complete remission. Seven years after surgical excision, the patient is still considered in complete remission. Pneumothorax is rarely the first manifestation of lung metastasis.

Retiming the failing heart: principles and current clinical status of cardiac resynchronization.

Left or biventricular (BiV) pacing, or cardiac resynchronization therapy, was proposed nearly 10 years ago as an adjunctive treatment for patients with advanced heart failure (HF) complicated by discoordinate contraction due to intraventricular conduction delay. Since then, both short-term and a growing number of long-term clinical trials have reported on the mechanisms and short- and mid-term efficacy of this approach, with encouraging results. Therapy is implemented with novel pacing systems incorporating an endocardial lead to stimulate the lateral free wall via a cardiac vein, and often a right ventricular (RV) apex lead to provide BiV stimulation.