Archives of Cardiovascular Diseases最新文献

{"title":"Pulmonary pressure in the first twelve-months of live: What should we expect?","authors":"A. Callegari,&nbsp;J. Grynblat,&nbsp;M. Mathilde,&nbsp;I. Szezepanski,&nbsp;S. Malekzadeh-Milani,&nbsp;D. Bonnet","doi":"10.1016/j.acvd.2024.07.003","DOIUrl":"10.1016/j.acvd.2024.07.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Mean pulmonary artery pressure (mPAP)<!--> <!-->≥<!--> <!-->20<!--> <!-->mmHg defines pulmonary hypertension (PH).</p></div><div><h3>Objective</h3><p>Critically evaluate this cut-off in very young patients.</p></div><div><h3>Methods</h3><p>In total, 1129 consecutive patients had a reliable mPAP measurement between 1–12<!--> <!-->months of life. These invasive measurements and their clinical history were reviewed.</p></div><div><h3>Results</h3><p>Age was mean<!--> <!-->±<!--> <!-->SD 158<!--> <!-->±<!--> <!-->100<!--> <!-->days, weight 5.5<!--> <!-->±<!--> <!-->1.9<!--> <!-->kg. Patients with a palliated single ventricle anatomy 129/1129, peripheral PA-branch stenosis or MAPCAs 45/1129, PA-banding for open shunt 30/1129, or severe RVOTO 185/1129 were excluded. Of the remaining 726 patients 163/726 (22%) had mPAP<!--> <!-->&lt;<!--> <!-->20<!--> <!-->mmHg while 563 (78%) had PH with mPAP<!--> <!-->≥<!--> <!-->20<!--> <!-->mmHg.</p><p>Overall, PH at TTE was the reason for invasive mPAP measurement in 236 patients and only 16/236 patients (7%) had a mPAP<!--> <!-->&lt;<!--> <!-->20<!--> <!-->mmHg but 12/16 (75%) had a mPAP<!--> <!-->≥<!--> <!-->18<!--> <!-->mmHg. In the group with mPAP<!--> <!-->≥<!--> <!-->20<!--> <!-->mmHg PH persisted at 6-months in 109/236 (46%) (<span><span>Fig. 1</span></span>A) and in 68/236 (28%) at long-term follow-up (<span><span>Fig. 1</span></span>B). In the group with mPAP between 18 and 20<!--> <!-->mmHg PH persisted at 6-months in 9/12 (75%) and in 3/12 (25%) at long-term follow-up. None of the patients with mPAP<!--> <!-->&lt;<!--> <!-->18<!--> <!-->mmHg had PH at follow-up.</p><p>In patients with less than 3<!--> <!-->months of age, PH at TTE was the reason for invasive mPAP measurement in 73/306 (23%) and only 3/73 patients (4%) had a mPAP<!--> <!-->&lt;<!--> <!-->20<!--> <!-->mmHg, but 2/3 (75%) had a mPAP<!--> <!-->≥<!--> <!-->18<!--> <!-->mmHg. In the group with mPAP<!--> <!-->≥<!--> <!-->20<!--> <!-->mmHg PH persisted at 6-months in 34/70 (48%) (<span><span>Fig. 2</span></span>A) and in 34/70 (48%) at long-term follow-up (<span><span>Fig. 2</span></span>B). In the group with mPAP between 18 and 20<!--> <!-->mmHg PH persisted at 6-months in 2/2 (100%) and in 2/2 (100%) at long-term follow-up. None of those with mPAP<!--> <!-->&lt;<!--> <!-->18<!--> <!-->mmHg had PH at follow-up.</p></div><div><h3>Conclusion</h3><p>Pulmonary hypertension defined by mPAP<!--> <!-->≥<!--> <!-->20<!--> <!-->mmHg is very common in this cohort of young patients, especially in case of suspected PH at echo. A different cut-off defined as 18<!--> <!-->mmHg should be discussed in patients with less than 12-months.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S220"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infant mitral valve surgery: Comparison between valvuloplasty and replacement","authors":"S. Bernheim,&nbsp;M. Pontailler,&nbsp;A. Haydar,&nbsp;D. Bonnet,&nbsp;O. Raisky","doi":"10.1016/j.acvd.2024.07.005","DOIUrl":"10.1016/j.acvd.2024.07.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Mitral valve replacement in infants is associated with high mortality and a significant rate of re-intervention. There is limited research examining the long-term consequences of valvuloplasty in this particular age group.</p></div><div><h3>Objective</h3><p>Evaluate patient outcomes with mitral disease (stenosis, regurgitation or both) who had mitral valvuloplasty or replacement in the first year of life.</p></div><div><h3>Methods</h3><p>Descriptive monocentric retrospective study including all children with mitral valve repair or replacement under 1<!--> <!-->year of age over a period of 22<!--> <!-->years (2001–2023). The outcomes assessed were: early mortality (at 30<!--> <!-->days), late mortality, need for re-intervention.</p></div><div><h3>Results</h3><p>Fifty-six patients were identified. Median age at surgery was 147<!--> <!-->days and median weight was 5.1<!--> <!-->kg. Thirty-nine patients underwent mitral valve repair and 17 mitral valve replacement. Mean duration of ICU stay was 7<!--> <!-->days. Overall median hospital stay was 11<!--> <!-->days. Mortality rate was 17.9% (7.1% before discharge). Overall survival was 96% at 30<!--> <!-->days, 86% at 1<!--> <!-->year 82% at 3<!--> <!-->years. Overall survival was significantly higher in patient with mitral valve repair compared to mitral valve replacement (<em>P</em> <!-->=<!--> <!-->0.039). The only mortality risk factor identified was replacement of the mitral valve compare to repair, HR: 9 (1.3–94.8; <em>P</em> <!-->=<!--> <!-->0.038). Twenty-three patients (41.1%) needed re-intervention. The re-intervention free survival rate after repair was 81% at 1<!--> <!-->year; 65% at 5<!--> <!-->years and 46% at 10<!--> <!-->years. The re-intervention free survival rate after replacement was 74% at 1<!--> <!-->year; 55% at 5 and 10<!--> <!-->years. A log-rank test showed no difference in re-intervention free survival between mitral valve repair or replacement.</p></div><div><h3>Conclusion</h3><p>Mitral valve surgery in infants carries particularly high risks and is associated with a high rate of re-interventions. While mitral valvuloplasty demonstrates superior outcomes in term of mortality, it frequently serves as a temporary measure, postponing the need for valve replacement.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S221"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of 3D echocardiography-derived stroke volume ratio with VTI method: A correlation study","authors":"P. Pyra,&nbsp;C. Karsenty,&nbsp;K. Hadeed,&nbsp;Y. Dulac,&nbsp;A. Guitarte,&nbsp;P. Acar","doi":"10.1016/j.acvd.2024.07.044","DOIUrl":"10.1016/j.acvd.2024.07.044","url":null,"abstract":"<div><h3>Introduction</h3><p>Quantification of the pulmonary-to-systemic flow ratio (Qp:Qs) or stroke volume is important in assessing cardiac shunts or regurgitations. While the echocardiography velocity time integral (VTI) method is routinely used, 3D echocardiography offers another non-invasive alternative.</p></div><div><h3>Objective</h3><p>This study aims to correlate stroke volume ratios derived from 3D echocardiography with those obtained by conventional method.</p></div><div><h3>Methods</h3><p>We prospectively included patients with various cardiac conditions and without systemic valve stenosis or atrioventricular regurgitation who underwent conventional echocardiography with 3D acquisitions (4D auto RVQ and LVQ, GE Healthcare) for ratio assessment.</p></div><div><h3>Results</h3><p>Thirty-five patients with a mean age of 7.9<!--> <!-->years old (range: 1.1–16.9) were included, 16 patients with shunt and 19 normal patients. The correlation coefficient between stroke volume ratios obtained by 3D echocardiography and VTI method was 0.876 (<em>P</em> <!-->&lt;<!--> <!-->0.001). The 3D Qp:Qs was closer to 1 in structurally normal hearts [0.99<!--> <!-->±<!--> <!-->0.04] than with the VTI method [1.08<!--> <!-->±<!--> <!-->0.23].</p></div><div><h3>Conclusion</h3><p>3D echocardiography demonstrates good correlation with VTI method in assessing stroke volume ratios, supporting its utility for evaluating cardiac shunts in situations where VTI calculation is not feasible or reliable (like shunts with pulmonary stenosis). Further studies are warranted to validate its use, particularly in comparison with Qp:Qs ratios derived from cardiac magnetic resonance imaging (MRI) and to explore its broader clinical applications.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S240"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic variability of tricuspid leaflets and right ventricle in Ebstein's anomaly: Anatomic and morphogenetic considerations","authors":"C. Huet,&nbsp;J. Karila-Cohen,&nbsp;B. Bessières,&nbsp;D. Bonnet,&nbsp;L. Houyel","doi":"10.1016/j.acvd.2024.07.039","DOIUrl":"10.1016/j.acvd.2024.07.039","url":null,"abstract":"<div><h3>Introduction</h3><p>Ebstein's anomaly of the tricuspid valve (TV) is a congenital cardiac malformation of the tricuspid valve (TV) and right ventricle (RV) characterized by downward displacement of the functional annulus usually involving septal and inferior leaflets. Ebstein's anatomical spectrum is highly variable. This anatomical study aimed to unravel the morphogenetic mechanisms underlying this variability.</p></div><div><h3>Methods</h3><p>Forty-two hearts exhibiting Ebstein anomaly from the Reference Center for Complex Congenital Heart Defects (CHD) collection were macroscopically analysed: 28 isolated and 14 associated with another CHD. Tricuspid leaflets, right ventricle (RV), and associated lesions were analysed. Measurements were related to fetal heart reference values according to gestational age. Specimens were classified depending on the distal insertion of the anterior leaflet: linear, hyphenated or focal.</p></div><div><h3>Results</h3><p>Among isolated Ebstein hearts, distal insertion of the anterior leaflet was linear in 36%, hyphenated in 29% and focal in 36%. Linear insertion was always associated with anterior TV orifice and absent inferior leaflet, with absent septal leaflet in 80%. Atrialisation (thin, paper-like, inferior RV wall) was found in 90% of the linear forms and 37.5% of the hyphenated forms, which were associated with various degrees of inferior and septal leaflets non-delaminationanomalies. In focal forms, only the septal leaflet was involved, and there was no atrialisation. Ventricular septal defect was found in 3 specimens, Uhl-like RV anterior wall in 2, including 1 with left ventricle non compaction. Associated Ebstein anomalies were predominantly found in pulmonary atresia with intact ventricular septum; there was no atrialisation and septal leaflet only was involved.</p></div><div><h3>Conclusion</h3><p>Ebstein anomaly corresponds to an arrest in TV development, early in linear forms, late in focal forms, intermediate in hyphenated forms. Atrialisation was always associated with absent inferior leaflet, underlining developmental interaction between endocardial cushions and myocardium at the RV inferior wall.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Pages S237-S238"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accurate detection of atrioventricular septal defect (AVSD) in fetal ultrasound using artificial intelligence","authors":"B. Stos ,&nbsp;M. Lévy ,&nbsp;E. Héry ,&nbsp;I. Durand ,&nbsp;E. Askinazi ,&nbsp;V. Thorey ,&nbsp;M. De Boisredon ,&nbsp;C. Gardella","doi":"10.1016/j.acvd.2024.07.004","DOIUrl":"10.1016/j.acvd.2024.07.004","url":null,"abstract":"<div><h3>Introduction</h3><p>A deep neural network could accurately detect AVSD in 2nd trimester fetal heart ultrasound video clips.</p></div><div><h3>Objective</h3><p>AVSDs are often undetected before birth, with an impact on morbidity and mortality. In addition, detecting AVSD may allow diagnosing genetic disorders (such as Down syndrome), which are frequently associated.</p><p>Here, we aim at evaluating whether a deep neural network (DNN) could identify AVSD in 2nd trimester (2T) fetal ultrasound video clips.</p></div><div><h3>Methods</h3><p>Patients with single pregnancy who had an echocardiography performed at one center (18–25<!--> <!-->weeks GA) were included retrospectively starting from Jan 1, 2021. Based on clinical records, we included consecutive cases of partial or complete AVSD, and consecutive negative cases referred due to family history. This inclusion criterion was used for negative cases to be more representative of the general population, in a center with a high prevalence of CHD since it only receives patients referred for echocardiography.</p><p>Cases were reviewed by one of two fetal echocardiography experts to confirm that the presence or absence of AVSD was documented in at least one video clip. Patients with no such video clip were excluded.</p><p>The DNN takes as input all the recorded video clips of a given examination and outputs the absence or presence of AVSD, or an “inconclusive” output if its confidence is low. The DNN was trained to detect AVSD, as seen on the four-chamber view, on patients not included in the evaluation.</p></div><div><h3>Results</h3><p>We included 26 cases with AVSD and 129 cases without. The DNN achieved an AUC of 97.1%, a sensitivity of 86.4% (95% CI: 66.7–95.3) and a specificity of 95.2% (95% CI: 90.0–97.8), after excluding inconclusive diagnosis. The DNN predicted a conclusive diagnosis in 95.5% of cases (<span><span>Fig. 1</span></span>).</p></div><div><h3>Conclusion</h3><p>A DNN could accurately identify AVSD in 2T fetal echocardiography. These results establish the groundwork for efficient and accurate AI-assisted fetal ultrasound heart screening.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Pages S220-S221"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New classification of aortic coarctation based on 181 surgical specimens","authors":"P.-E. Seguela ,&nbsp;C. Guidon ,&nbsp;X. Iriart ,&nbsp;Z. Jalal ,&nbsp;J.B. Thambo ,&nbsp;F. Roubertie","doi":"10.1016/j.acvd.2024.07.038","DOIUrl":"10.1016/j.acvd.2024.07.038","url":null,"abstract":"<div><h3>Introduction</h3><p>The term coarctation of the aorta (CoA) stands for a narrowing of the thoracic aorta with heterogeneous morphologic phenotypes resulting in different treatment strategies. Its origin remains controversial (hemodynamical versus ductal tissue theory), some types being detected prenatally, while others are diagnosed later in life.</p></div><div><h3>Objective</h3><p>We attempted to establish a classification system based on a 10-year data collection of surgical specimens.</p></div><div><h3>Methods</h3><p>It was a monocentric retrospective study: using precise descriptions of aortic morphology obtained from operative reports (2010–2020) of 181 patients with CoA, we analyzed different characteristics to generate a classification system.</p></div><div><h3>Results</h3><p>Four types of isthmic CoA were depicted: narrowing (1) associated with aortic hypoplasia (33%), (2) due to a posterior shelf (64%), (3) due to intraluminal membrane (1%) and (4) aortic kinking (2%). Age at surgery ranged from 7 days to 51 years. Prenatal diagnosis rate and associated cardiac anomalies were more frequent in type 1. Distinction of localized (types 2, 3 and 4) and diffuse narrowing (type 1) revealed a significant difference for age at surgery, prenatal diagnosis, and associated anomaly. The presence of a bicuspid aortic valve (48.6%) did not differ according to the types. A left superior vena cava (7.7%) was equally encountered in all the subtypes (<span><span>Fig. 1</span></span>).</p></div><div><h3>Conclusion</h3><p>A new classification system for CoA is presented. According to our data, all the types could be prenatally diagnosed. This classification might be advantageous to better understand pathophysiology of CoA and facilitate scientific communication.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S237"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of aortic parameters by 4d flow MRI in patients with Marfan syndrome and related syndromes","authors":"P. Vignaud-Marighetto,&nbsp;A. Guitarte,&nbsp;F. Bajanca,&nbsp;P. Acar,&nbsp;R. Moreno,&nbsp;H. Rousseau,&nbsp;Y. Dulac,&nbsp;C. Karsenty","doi":"10.1016/j.acvd.2024.07.036","DOIUrl":"10.1016/j.acvd.2024.07.036","url":null,"abstract":"<div><h3>Introduction</h3><p>Predicting aortic root dilation and the risk of aortic dissection in Marfan syndrome remains challenging. Established predictive factors primarily include aortic diameter and younger age. However, a more comprehensive understanding of aortic hemodynamic alterations in this population is warranted. 4D magnetic resonance imaging (MRI) offers a non-irradiating approach for assessing hemodynamic parameters.</p></div><div><h3>Objective</h3><p>This study aimed to assess aortic parameters using 4D flow MRI in young patients diagnosed with Marfan syndrome.</p></div><div><h3>Methods</h3><p>We prospectively included patients over 12<!--> <!-->years old from the “CHU de Toulouse Centre de Référence Marfan” cohort. They underwent MRI with 4D flow sequences and an aortic angiography sequence without contrast agent administration. Pulse wave velocity (PWV) and wall shear stress (WSS) were quantified using Circle CVI software.</p></div><div><h3>Results</h3><p>Since February 2023, we included 13 patients without history of aortic events, all treated with beta-blockers, with a median age of 18<!--> <!-->years old (range: 15 to 39). MRI imaging was successfully conducted in all cases. The addition of 4D flow acquisitions extended the examination time by 15 to 25<!--> <!-->min and the post-processing time by 5 to 10<!--> <!-->min. The median aortic diameter was 35<!--> <!-->mm (range: 32 to 48) and Z-score ranged from +1.2 to +6.1. Both PWV and WSS were quantifiable across all cases: the median PWV measured 5.5<!--> <!-->m/s (range: 2.2 to 13.5), while the median WSS was 0.104<!--> <!-->Pa (range: 0.074 to 1.590). No correlations were observed between age, body surface area, or aortic diameter with either PWV or WSS (<span><span>Fig. 1</span></span>).</p></div><div><h3>Conclusion</h3><p>A non-invasive, non-irradiating, free-breathing assessment of aortic hemodynamics using 4D flow MRI sequences is feasible in both adolescent and adult patients with Marfan syndrome, albeit with some challenges. However, further studies with larger patient cohorts, comparison with control groups, and long-term follow-up are necessary to determine if this method could serve as a prognostic marker.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S236"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"His bundle pacing versus left bundle branch area pacing in patients undergoing atrioventricular node ablation: A prospective and comparative study","authors":"","doi":"10.1016/j.acvd.2024.05.118","DOIUrl":"10.1016/j.acvd.2024.05.118","url":null,"abstract":"<div><h3>Background</h3><div>Pacemaker implantation combined with atrioventricular node ablation (AVNA) is a well-established strategy for uncontrolled atrial arrhythmias. Limited data are available regarding His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) in this setting.</div></div><div><h3>Aim</h3><div>To compare the outcomes of HBP and LBBAP in patients undergoing pacemaker implantation combined with AVN in routine clinical practice.</div></div><div><h3>Methods</h3><div>We prospectively included all patients who underwent AVNA after successful conduction system pacing (CSP) in two hospitals between September 2017 and May 2023. The primary outcome was the 1-year composite of first episode of heart failure hospitalization, symptomatic atrioventricular node reconduction requiring a second AVNA procedure, lead revision or death from any cause.</div></div><div><h3>Results</h3><div>A total of 164 patients underwent AVNA following successful CSP (68 HBP and 96 LBBAP). Mean pacemaker implantation and AVNA procedure times were shorter in the LBBAP group than the HBP group (46<!--> <!-->±<!--> <!-->18 vs 59<!--> <!-->±<!--> <!-->23<!--> <!-->min; <em>P<!--> </em>&lt;<!--> <!-->0.001 and 31<!--> <!-->±<!--> <!-->12 v<em>s</em> 43<!--> <!-->±<!--> <!-->22<!--> <!-->min, respectively; <em>P<!--> </em>&lt;<!--> <!-->0.001). Complete atrioventricular block was more frequently obtained in the LBBAP group (88/96 patients [92%] vs 54/68 patients [79%]; <em>P</em> <!-->=<!--> <!-->0.04). One-year freedom from the composite outcome was more frequent in the LBBAP group (89.7% vs 72.9%; hazard ratio 0.32, 95% confidence interval 0.14<!--> <!-->−<!--> <!-->0.72; <em>P</em> <!-->=<!--> <!-->0.01). The strategy was similarly effective in both groups with a significant improvement in NYHA class and left ventricular ejection fraction. A secondary pacing threshold elevation &gt;1<!--> <!-->V occurred only in the HBP group (11%).</div></div><div><h3>Conclusion</h3><div>In this prospective, comparative study, LBBAP provided better 1-year outcomes than HBP.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Pages 505-513"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise stress echocardiography in coarctation of the aorta","authors":"R. Ly ,&nbsp;S. Hascoet ,&nbsp;N. Combes ,&nbsp;P. Di Marco ,&nbsp;C. Karsenty ,&nbsp;I. Van Aershot ,&nbsp;L. Guirgis ,&nbsp;M. Ratsimandresy ,&nbsp;J. Radojevic","doi":"10.1016/j.acvd.2024.07.007","DOIUrl":"10.1016/j.acvd.2024.07.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Aortic coarctation (COA) is frequent congenital heart disease. It can be difficult to assess the indication for intervention or re-intervention in some cases.</p><p>Exercise stress echocardiography (ESE) can be helpful for hemodynamic evaluation in patients with COA or reCOA.</p></div><div><h3>Objective</h3><p>We aimed to determine ESE parameters predictive of intervention (angioplasty or surgery).</p></div><div><h3>Methods</h3><p>We retrospectively reviewed 94 ESE performed in children (<em>n</em> <!-->=<!--> <!-->14) and adults with native or repaired CoA and unclear indication for intervention in three centers in France.</p><p>Exercise test was performed concomitantly to echocardiography on the e-bike in semi-lying position. The protocol was adapted according to the age and the physical condition. Echocardiography protocol included left ventricular adaptation (LVA) to effort and peak systolic gradient (PSG) at isthmus and appearance of diastolic tail during effort.</p><p>We investigated risk marker associated with subsequent indication for intervention.</p></div><div><h3>Results</h3><p>Median age (min–max) was 26<!--> <!-->years (10–72). Intervention was subsequently performed in thirteen patients (14.7%).</p><p>Fifty-six patients (60.2%) had simple COA and 37 (39.8%) had complex anatomy, 24 (25%) had hypertension. Poor LVA was present in 13 (14%). Diastolic tail during effort appeared in 65 cases. The mean pic isthmus gradient 50<!--> <!-->±<!--> <!-->21<!--> <!-->mmHg (min: 15; max: 124).</p><p>Poor LVA was associated with more interventions (log-rank, <em>P</em> <!-->=<!--> <!-->0.004) (<span><span>Fig. 1</span></span>).</p><p>On univariate analysis presence of antihypertensive drugs (HR: 4.13, 95% CI [1.35–12.65]; <em>P</em> <!-->=<!--> <!-->0.013), systolic blood pressure at rest (HR: 1.04, 95% CI [1.011–1.072]; <em>P</em> <!-->=<!--> <!-->0.007); the lower exercise power (Watts) (HR: 0.98; 95% CI [0.96–0.99]; <em>P</em> <!-->=<!--> <!-->0.001); poor LVA (HR: 5.95, 95% CI [1.56–22.65]; <em>P</em> <!-->=<!--> <!-->0.009); peak systolic gradient at rest and on effort at isthmus (HR: 1.06, 95% CI [1.03–1.10] and HR: 1.04, 95% CI [1.02–1.06]) were significantly predictive of interventions (<span><span>Table 1</span></span>).</p></div><div><h3>Conclusion</h3><p>ESE is a useful tool for hemodynamic evaluation of COA. More severe forms that needed intervention showed less well adaption of the LV to effort and increase in the cardiac output and afterload.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S222"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The place of error in the teaching field of heart surgery","authors":"C. Pavy ,&nbsp;M. Titos","doi":"10.1016/j.acvd.2024.07.053","DOIUrl":"10.1016/j.acvd.2024.07.053","url":null,"abstract":"<div><h3>Introduction</h3><p>Surgical error is a difficult subject to address in our current society that wants to leave no place for it. However, our human condition makes it impossible to disappear.</p></div><div><h3>Objective</h3><p>This study mainly focuses on the management of a serious adverse event happening in the operating room to dwindle collateral damage, particularly in the field of teaching.</p></div><div><h3>Methods</h3><p>The questionnaire was developed in a constructive manner. Face-to-face interviews with voluntary and informed practitioners from different institutions and position were conducted. These interviews were all transcribed and analyzed as part of a heuristic approach. Based on the recent literature, the iterative deductive-inductive text analysis was respected. The verbatim thematic grid has evolved according to the progress of the text study.</p></div><div><h3>Results</h3><p>Nine interviews were carried out (7/9 face-to-face, 2/9 via digital interaction), transcribed and analyzed. The practitioners median age is 54 years old. Six out of nine expressed a serious adverse event leading to death and all expressed its unexpected nature. The reported facts included a distance of time (5/9), and/or person (2/9). The most expressed personal impact apart from an unpleasant experience feeling, is the more or less important, facts rumination (7/9) to analyze and at the same time hoping to undo what has been done. All expressed a desire to verbalize explanation of the facts motivated by the distinction between guilt and responsibility. Everyone appreciated the questionnaire approach (<span><span>Table 1</span></span>).</p></div><div><h3>Conclusion</h3><p>The abilities to manage a serious adverse event in the operating room are very internalized and essentially mobilized to avoid it. The use of these capacities for educational purposes to manage fear and the encystment of these unpleasant experiences does not yet seem successful. This approach would also allow us to remain vigilant regarding the construction of different sophisms.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S244"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}