Archives of Cardiovascular Diseases最新文献

{"title":"Independent external evaluation of pediatric HCM Risk Scores in predicting severe ventricular arrhythmias","authors":"M. Wilkin,&nbsp;V. Waldmann","doi":"10.1016/j.acvd.2024.07.012","DOIUrl":"10.1016/j.acvd.2024.07.012","url":null,"abstract":"<div><h3>Introduction</h3><p>Sudden cardiac death (SCD) is the most common cause of death in childhood hypertrophic cardiomyopathy (HCM). Recently, two risk scores have been developed to estimate the 5-year risk of SCD.</p></div><div><h3>Objective</h3><p>We aimed to assess their respective performances in an independent cohort of primary prevention children with HCM.</p></div><div><h3>Methods</h3><p>All patients with HCM<!--> <!-->&lt;<!--> <!-->18-year-old from a single-center were retrospectively included between 2003 and 2023. Secondary and syndromic causes of HCM were excluded as well as children with inaugural sustained ventricular arrythmias. HCM Risk-Kids and PRIMaCY risk scores were calculated at diagnosis and during follow-up. The primary composite outcome included sustained ventricular arrhythmia, appropriate ICD therapy, aborted cardiac arrest, or SCD.</p></div><div><h3>Results</h3><p>Hundred primary prevention children were included (mean age 7.1<!--> <!-->±<!--> <!-->5.6<!--> <!-->years, 59.0% males), with a mean follow-up of 8.6<!--> <!-->±<!--> <!-->5.5<!--> <!-->years.13 (13.0%) patients experienced the primary composite outcome. When only considering events during the 5 first years, Harrel's C index was 0.52 (95% CI: 0.27–0.77) for HCM Risk-Kids (≥<!--> <!-->6%) and 0.70 (95% CI: 0.59–0.80) for PRIMaCY (&gt;<!--> <!-->8.3%), with 1 patient potentially treated by ICD for every 25 ICDs implanted for HCM Risk Kids and 1 for every 14 ICDs implanted for PRIMaCY. When risk scores were repeated and all primary outcomes during follow-up considered, all events except one (93.2%) were correctly identified using both risk scores, with 1 patient potentially treated by ICD for every 5.6 ICDs implanted for HCM Risk Kids and 1 for every 5.3 ICDs implanted for PRIMaCY. Among 44 (44.0%) patients implanted with an ICD, all primary prevention patients who had<!--> <!-->≥<!--> <!-->one appropriate ICD therapy during follow-up had HCM Risk-Kids<!--> <!-->≥<!--> <!-->6% and PRIMaCY<!--> <!-->&gt;<!--> <!-->8.3% at implantation.</p></div><div><h3>Conclusion</h3><p>Our findings suggest imperfect discrimination between low and high-risk HCM patients using these two risk scores. The performance or risk scores was substantially improved by periodic re-assessment during follow-up.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S225"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271094","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":"Pulmonary hypertension induced by right pulmonary artery occlusion: Hemodynamic consequences of BMPR2 mutation","authors":"J. Grynblat ,&nbsp;A. Todesco ,&nbsp;F.K. Akoumia ,&nbsp;D. Bonnet ,&nbsp;P. Mendes-Ferreira ,&nbsp;M. Meot ,&nbsp;C. Vastel-Amzallag ,&nbsp;S. Malekzadeh-Milani ,&nbsp;B. Decante ,&nbsp;M. Levy ,&nbsp;S. Morisset ,&nbsp;M. Humbert ,&nbsp;D. Montani ,&nbsp;D. Boulate ,&nbsp;F. Perros","doi":"10.1016/j.acvd.2024.07.018","DOIUrl":"10.1016/j.acvd.2024.07.018","url":null,"abstract":"<div><h3>Introduction</h3><p>The primary genetic risk factor for heritable pulmonary arterial hypertension (PAH) is the presence of monoallelic mutations in the <em>BMPR2</em> gene. The incomplete penetrance of BMPR2 mutations implies that additional triggers are necessary for PAH occurrence. Pulmonary artery stenosis directly raises pulmonary artery pressure, while the redirection of blood flow to unobstructed arteries lead to endothelial dysfunction and vascular remodeling.</p></div><div><h3>Objective</h3><p>We aimed to evaluate the effect of right pulmonary artery occlusion (RPAO) in rats. Then, we evaluated the effect of BMPR2 loss of function on cardiac and pulmonary vascular remodeling.</p></div><div><h3>Methods</h3><p>Male and female rats with a 71<!--> <!-->bp monoallelic deletion in exon 1 of BMPR2 and their wild-type (WT) siblings underwent acute and chronic RPAO. They were subjected to full high-fidelity hemodynamic characterization. We also examined how chronic RPAO can mimic the pulmonary gene expression pattern associated with installed PH in unobstructed territories.</p></div><div><h3>Expected results</h3><p>RPAO induced pre-capillary PH in male and female rats, both acutely and chronically. BMPR2 mutant and male rats manifested more severe PH compared to their counterparts. While WT rats adapted to RPAO, BMPR2 mutant rats experienced heightened mortality. RPAO induced a decline in cardiac contractility index, particularly pronounced in male BMPR2 rats. Chronic RPAO resulted in elevated pulmonary interleukin-6 (IL-6) expression and decreased Gdf2 expression (corrected <em>P</em>-value<!--> <!-->&lt;<!--> <!-->0.05 and log2 fold change<!--> <!-->&gt;<!--> <!-->1). In this context, male rats expressed higher pulmonary levels of endothelin-1 and IL-6 than females (<span><span>Fig. 1</span></span>).</p></div><div><h3>Perspectives</h3><p>Our novel two-hit rat model presents a promising avenue to explore the adaptation of the right ventricle and pulmonary vasculature to PH, shedding light on pertinent sex and gene-related effects.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S228"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271157","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":"Rheumatic valve disease in children still a burden in sub-Saharan Africa: Diagnostic, therapeutic and prognostic aspects in two hospitals in Central Africa subregion","authors":"J. Tony Nengom ,&nbsp;L. Madjile Baba ,&nbsp;A.P. Menanga ,&nbsp;D. Chelo ,&nbsp;P.O. Koki Ndombo","doi":"10.1016/j.acvd.2024.07.050","DOIUrl":"10.1016/j.acvd.2024.07.050","url":null,"abstract":"<div><h3>Introduction</h3><p>Rheumatic fever remains a public health problem in sub-Saharan Africa. Its impact on the heart valves is the main acquired cardiopathy in children in our environment.</p></div><div><h3>Objective</h3><p>The aim of our study was to investigate the diagnostic, therapeutic and prognostic aspects of rheumatic heart valve disease in children aged 0–18<!--> <!-->years in two hospitals in the city of Yaoundé.</p></div><div><h3>Methods</h3><p>We conducted a cross-sectional analytical study with retrospective and prospective data collection over a 5-years period (2018–2023). All patients aged 0 to 18<!--> <!-->years with an echocardiographically confirmed diagnosis of rheumatic valvulopathy in the cardiology departments of the Chantal Biya Foundation and the Yaoundé Central Hospital were included. We collected sociodemographic, clinical, paraclinical, therapeutic and outcome data.</p></div><div><h3>Results</h3><p>We recruited 106 patients, predominantly female (65.8%); mean age was 11.4<!--> <!-->±<!--> <!-->3 (4–18) years. The most common age group was 10 to 14 years (63.2%). Promiscuity (86.8%) and recurrent sore throat (68.4%) were the most common findings in the past history. Monovalvular involvement (mainly mitral valve) predominated in 60.5% of cases. The proportion of deaths in the population was 7.9%. After multivariate analysis, only the presence of cardiac liver and oedema of the lower limbs increased the risk of having a poor prognosis (OR<!--> <!-->&gt;<!--> <!-->1; <em>P</em> <!-->&lt;<!--> <!-->0.05).</p></div><div><h3>Conclusion</h3><p>The eradication of rheumatic valve disease in children necessarily involves early-prevention. This would involve cleaning up the living environment to prevent streptococcal infections and improving sociodemographic conditions.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S243"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271176","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":"Kills two birds with one stone: Biomechanical properties and three-dimensional modeling of human aortic root with new method of micro-CT","authors":"M. Lenoir ,&nbsp;T. Fringand ,&nbsp;C. Isabelle ,&nbsp;F. Julien ,&nbsp;M. Loïc ,&nbsp;S. Laurent","doi":"10.1016/j.acvd.2024.07.042","DOIUrl":"10.1016/j.acvd.2024.07.042","url":null,"abstract":"<div><h3>Introduction</h3><p>The micro-CT obtain very high-quality of the aortic roots and three-dimensional modeling of aortic leaflets. Different tests (biaxial test) are used to know the biomechanical properties. We propose a new method, which combines pressurization of the aortic root with micro-CT to obtain at the same time, the geometry, and biomechanical properties.</p></div><div><h3>Objective</h3><p>The aim is to investigate healthy aorta mechanical property using a micro-CT under pressure and compare them with literature.</p></div><div><h3>Methods</h3><p>This study was approved by committee on human research at the French agency of biomedicine (PFFS 20-026). Ten aortic roots were obtained fresh from unused donor hearts with non-cardiac causes of death. We used aortic root under pressure at different pressure level (every 20<!--> <!-->mmHg) in order to obtain diameter, geometry, stress-strain curve and Young modulus.</p></div><div><h3>Results</h3><p>All aortic roots (<em>n</em> <!-->=<!--> <!-->10) obtained a three-dimensional modeling of aortic leaflets with excellent quality. The mean age was 61.2<!--> <!-->years [49.5–65.6]. The median of sino-tubular junction diameter was 32.2<!--> <!-->mm [29–36] at 80<!--> <!-->mmHg. The non-linear stress-strain curves of healthy aortic root were characterized. Young moduli were significantly smaller in low pressure (between 20 and 80<!--> <!-->mmHg) 0.6 [0.5–0.8] MPa than high pressure (between 80 and 120<!--> <!-->mmHg) 3.2 [2.5–5.6] MPa, <em>P</em> <!-->=<!--> <!-->0.001 (<span><span>Fig. 1</span></span>).</p></div><div><h3>Conclusion</h3><p>Our new method allows a 3D model of the aortic root associated with measurements of biomechanical properties. Our results are found to be consistent with literature data. This new method evaluates the biomechanical properties while keeping the aortic roots intact and maintaining its geometrical complexity for future global aortic root simulation.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Pages S239-S240"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271255","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":"Cardiogenic shock and infection: A lethal combination","authors":"Miloud Cherbi ,&nbsp;Hamid Merdji ,&nbsp;Vincent Labbé ,&nbsp;Eric Bonnefoy ,&nbsp;Nicolas Lamblin ,&nbsp;François Roubille ,&nbsp;Bruno Levy ,&nbsp;Pascal Lim ,&nbsp;Hadi Khachab ,&nbsp;Guillaume Schurtz ,&nbsp;Brahim Harbaoui ,&nbsp;Gerald Vanzetto ,&nbsp;Nicolas Combaret ,&nbsp;Benjamin Marchandot ,&nbsp;Benoit Lattuca ,&nbsp;Caroline Biendel-Picquet ,&nbsp;Guillaume Leurent ,&nbsp;Edouard Gerbaud ,&nbsp;Etienne Puymirat ,&nbsp;Laurent Bonello ,&nbsp;Clément Delmas","doi":"10.1016/j.acvd.2024.04.005","DOIUrl":"10.1016/j.acvd.2024.04.005","url":null,"abstract":"<div><h3>Background</h3><div>Cardiogenic shock and sepsis are severe haemodynamic states that are frequently present concomitantly, leading to substantial mortality. Despite its frequency and clinical significance, there is a striking lack of literature on the outcomes of combined sepsis and cardiogenic shock.</div></div><div><h3>Methods</h3><div>FRENSHOCK was a prospective registry including 772 patients with cardiogenic shock from 49 centres. The primary endpoint was 1-month all-cause mortality. Secondary endpoints included heart transplantation, ventricular assistance device and all-cause death rate at 1<!--> <!-->year.</div></div><div><h3>Results</h3><div>Among the 772 patients with cardiogenic shock included, 92 cases were triggered by sepsis (11.9%), displaying more frequent renal and hepatic acute injuries, with lower mean arterial pressure. Patients in the sepsis group required broader use of dobutamine (90.1% vs. 81.2%; <em>P</em> <!-->=<!--> <!-->0.16), norepinephrine (72.5% vs. 50.8%; <em>P</em> <!-->&lt;<!--> <!-->0.01), renal replacement therapy (29.7% vs. 14%; <em>P</em> <!-->&lt;<!--> <!-->0.01), non-invasive ventilation (36.3% vs. 24.4%; <em>P</em> <!-->=<!--> <!-->0.09) and invasive ventilation (52.7% vs. 35.9%; <em>P</em> <!-->=<!--> <!-->0.02). Sepsis-triggered cardiogenic shock resulted in higher 1-month (41.3% vs. 24.0%; adjusted hazard ratio: 1.94, 95% confidence interval: 1.36–2.76; <em>P</em> <!-->&lt;<!--> <!-->0.01) and 1-year (62.0% vs. 42.9%; adjusted hazard ratio 1.75, 95% confidence interval 1.32–2.33; <em>P</em> <!-->&lt;<!--> <!-->0.01) all-cause death rates. No significant difference was found at 1<!--> <!-->year for heart transplantation or ventricular assistance device (8.7% vs. 10.3%; adjusted odds ratio 0.72, 95% confidence interval 0.32–1.64; <em>P</em> <!-->=<!--> <!-->0.43). In patients with sepsis-triggered cardiogenic shock, neither the presence of a preexisting cardiomyopathy nor the co-occurrence of other cardiogenic shock triggers had any additional impact on death.</div></div><div><h3>Conclusions</h3><div>The association between sepsis and cardiogenic shock represents a common high-risk scenario, leading to higher short- and long-term death rates, regardless of the association with other cardiogenic shock triggers or the presence of preexisting cardiomyopathy.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Pages 470-479"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691402","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":"Scientific statement from the French neurovascular and cardiac societies for improved detection of atrial fibrillation after ischaemic stroke and transient ischaemic attack","authors":"Nicolas Gaillard ,&nbsp;Jean-Claude Deharo ,&nbsp;Laurent Suissa ,&nbsp;Pascal Defaye ,&nbsp;Igor Sibon ,&nbsp;Christophe Leclercq ,&nbsp;Sonia Alamowitch ,&nbsp;Céline Guidoux ,&nbsp;Ariel Cohen ,&nbsp;French Neurovascular Society,&nbsp;French Society of Cardiology","doi":"10.1016/j.acvd.2024.06.002","DOIUrl":"10.1016/j.acvd.2024.06.002","url":null,"abstract":"<div><div>Atrial fibrillation (AF) is the primary cause of ischaemic stroke and transient ischaemic attack (TIA). AF is associated with a high risk of recurrence, which can be reduced using optimal prevention strategies, mainly anticoagulant therapy. The availability of effective prophylaxis justifies the need for a significant, coordinated and thorough transdisciplinary effort to screen for AF associated with stroke. A recent French national survey, initiated and supported by the Société française neurovasculaire (SFNV) and the Société française de cardiologie (SFC), revealed many shortcomings, such as the absence or inadequacy of telemetry equipment in more than half of stroke units, insufficient and highly variable access to monitoring tools, delays in performing screening tests, heterogeneous access to advanced or connected ambulatory monitoring techniques, and a lack of dedicated human resources. The present scientific document has been prepared on the initiative of the SFNV and the SFC with the aim of helping to address the current shortcomings and gaps, to promote efficient and cost-effective AF detection, and to improve and, where possible, homogenize the quality of practice in AF screening among stroke units and outpatient post-stroke care networks. The working group, composed of cardiologists and vascular neurologists who are experts in the field and are nominated by their peers, reviewed the literature to propose statements, which were discussed in successive cycles, and maintained, either by consensus or by vote, as appropriate. The text was then submitted to the SFNV and SFC board members for review. This scientific statement document argues for the widespread development of patient pathways to enable the most efficient AF screening after stroke. This assessment should be carried out by a multidisciplinary team, including expert cardiologists and vascular neurologists.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Pages 542-557"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1875213624002870/pdfft?md5=71c313911484ddcab3c3fd63cc51412a&pid=1-s2.0-S1875213624002870-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142199342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphological risk markers for major adverse events following transcatheter closure of ostium secundum atrial septal defects in 2253 children and adults","authors":"G. Albenque,&nbsp;E. Valdeolmillos,&nbsp;C. Foray,&nbsp;M. Jaber,&nbsp;F. Lecerf,&nbsp;E. Belli,&nbsp;C. Batteux,&nbsp;J. Petit,&nbsp;S. Hascoët","doi":"10.1016/j.acvd.2024.07.016","DOIUrl":"10.1016/j.acvd.2024.07.016","url":null,"abstract":"<div><h3>Introduction</h3><p>Since the 2000s, transcatheter closure has been the primary treatment for ostium secundum atrial septal defect (osASD) in children and adults.</p></div><div><h3>Objective</h3><p>This study aims to identify factors associated with short-term adverse outcomes following this procedure in a large cohort.</p></div><div><h3>Methods</h3><p>A prospective, single-center cohort study included 2,253 consecutive patients (median age 28<!--> <!-->years; children: <em>n</em> <!-->=<!--> <!-->865, 38.4%) who underwent transcatheter ASD closure with the Amplatzer Septal Occluder (ASO; Amplatzer™ Atrial Septal Occluder Device, Abbott, Chicago, USA) from May 1998 to December 2021. Peri-procedural data associated with major adverse events were investigated retrospectively.</p></div><div><h3>Results</h3><p>The mean ASD diameter, as measured by transthoracic echocardiography, was 18<!--> <!-->mm. About 8.9% of patients had an ASD size-to-body surface area (BSA) ratio of<!--> <!-->≥<!--> <!-->20<!--> <!-->mm/m². Deficient rims (&lt;<!--> <!-->5<!--> <!-->mm) were identified in 27.9% of patients, with retroaortic rim deficiency in 22.7% and inferior rim deficiency in 0.9%. The median ASO diameter was 24<!--> <!-->mm, with a procedural success rate of 98.2%. ASD/BSA<!--> <!-->≥<!--> <!-->20<!--> <!-->mm/m² was associated with procedural failure, while age and weight were not. Major peri-procedural adverse events occurred in 31 patients (1.4%), with 19 device embolizations and 2 cardiac erosions. No peri-procedural deaths were reported. Multivariate analysis showed that deficiency of the inferior vena cava rim and an ASD size/BS ratio<!--> <!-->≥<!--> <!-->20<!--> <!-->mm/m² were significantly associated with major adverse events (<em>P</em> <!-->=<!--> <!-->0.002 and <em>P</em> <!-->=<!--> <!-->0.035, respectively) (<span><span>Fig. 1</span></span>).</p></div><div><h3>Conclusion</h3><p>Transcatheter osASD closure using ASO is safe and effective in a large spectrum population with low rate of peri-procedural adverse events and favorable short-term outcomes. ASD size-to-body surface area ratio (≥<!--> <!-->20<!--> <!-->mm/m²) and inferior rim deficiency are key morphological risk markers for major adverse events following this procedure.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S227"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271048","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":"Transcatheter pulmonary valve implantation: Initial experience with self-expandable valve in patients with congenital heart diseases and comparison with balloon-expandable valve","authors":"Q. Rouau","doi":"10.1016/j.acvd.2024.07.027","DOIUrl":"10.1016/j.acvd.2024.07.027","url":null,"abstract":"<div><h3>Introduction/Background</h3><p>Self-expandable valves have emerged as an alternative option for transcatheter pulmonary valve replacement (TPVR) compared to balloon-expandable valves. However, their efficacy in patients with congenital heart diseases remains relatively unexplored.</p></div><div><h3>Objective</h3><p>This study aims to compare the characteristics and outcomes of patients who underwent TPVR with self-expandable valves versus balloon-expandable valves.</p></div><div><h3>Methods</h3><p>A prospective single-center analysis was conducted, encompassing all consecutive patients (<em>n</em> <!-->=<!--> <!-->89) who underwent TPVR using either balloon-expandable valves (Sapien 3 valves, <em>n</em> <!-->=<!--> <!-->63, 70%) or self-expandable valves (Venus-P, <em>n</em> <!-->=<!--> <!-->26, 30%) between January 2022 and February 2024. Patient characteristics, procedural data, and short-term outcomes were compared. Electrophysiological studies were performed in all patients with tetralogy of Fallot (ToF) prior to the procedure.</p></div><div><h3>Results</h3><p>The median age of patients was 34<!--> <!-->years for Sapien 3 (11 children, youngest: 8<!--> <!-->years) and 46<!--> <!-->years for Venus-P (one child aged 15<!--> <!-->years), <em>P</em> <!-->=<!--> <!-->0.014. Tetralogy of Fallot (ToF) was the primary diagnosis in 49 cases (55%, 32 with Sapien 3 and 17 with Venus-P valve, <em>P</em> <!-->=<!--> <!-->0.041). Native or patched right ventricular outflow tracts were identified in 100% and 54% of patients with Venus-P and Sapien 3 valves, respectively, <em>P</em> <!-->&lt;<!--> <!-->0.001.</p><p>Valve implantation was successful in all patients. Major adverse events occurred in 4.5% of cases (3.8% in Sapien 3 vs. 4.7% in Venus P-valve group, <em>P</em> <!-->=<!--> <!-->0.66). Ventricular ectopy necessitating medical therapy was more frequent in the Venus-P group (19% vs. 0%, <em>P</em> <!-->=<!--> <!-->0.002) including one case of sustained asymptomatic ventricular tachycardia, managed with amiodarone therapy. No peri-procedural deaths were reported.</p></div><div><h3>Conclusion</h3><p>Self-expandable valves demonstrate efficacy for TPVR in patients with large native or patched right ventricular outflow tracts, accompanied by a low rate of major adverse events. However, an increased incidence of ventricular arrhythmias was noted compared to balloon-expandable valves, indicating the importance of long-term follow-up data to better understand outcomes.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S231"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271053","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":"Clinical and paraclinical evolution of term and near term neonates with persistent pulmonary hypertension, treated with treprostinil and/or epoprostenol, hospitalized in NICU","authors":"C. Mazepa ,&nbsp;S. Mur ,&nbsp;G. Gascoin ,&nbsp;L. Storme ,&nbsp;N. Joram ,&nbsp;C. Viard ,&nbsp;Y. Dulac ,&nbsp;M. Butin ,&nbsp;S. Breinig","doi":"10.1016/j.acvd.2024.07.013","DOIUrl":"10.1016/j.acvd.2024.07.013","url":null,"abstract":"<div><h3>Introduction</h3><p>Persistent pulmonary hypertension of the newborn (PPHN) is a serious disease that occurs in 1.9 per 1000 live births. Epoprostenol and treprostinil, witch are prostacyclin analogues, are used by some care teams in the treatment of PPHN, in absence of established proof of their efficacy in this indication.</p></div><div><h3>Objective</h3><p>The main objective of this retrospective multicenter study was to evaluate clinical and paraclinical evolution of newborns treated with treprostinil and/or epoprostenol during neonatal period.</p></div><div><h3>Methods</h3><p>Inclusion of neonates<!--> <!-->≥<!--> <!-->34<!--> <!-->SA and aged<!--> <!-->≤<!--> <!-->28<!--> <!-->days, with clinical signs and<!--> <!-->≥<!--> <!-->1 ultrasound sign of pulmonary hypertension, treated with treprostinil and/or epoprostenol between 01/01/17 and 31/12/22 in 4 French teaching hospitals. Data collected included clinical, biological and ultrasound parameters.</p></div><div><h3>Results</h3><p>Seventy patients were included, with a mean age of 39<!--> <!-->SA<!--> <!-->+<!--> <!-->2.5<!--> <!--> days and a mean birth weight of 3200<!--> <!-->g, including 40 congenital diaphragmatic hernia (57%). On arrival in NICU over 90% of newborns had iso or supra-systemic pulmonary hypertension. The introduction of prostacyclin analogues appears to have a beneficial effect on the pre- and post-ductal saturation differential as well as on the echocardiographic evolution of pulmonary hypertension. The temporality of evolution of pulmonary hypertension seems to depend on the underlying etiology due to the different pathophysiological mechanisms. Moreover, our study shows that epoprostenol and treprostinil can be used in neonates suffering from iNO refractory PPHN without significant adverse effects.</p></div><div><h3>Conclusion</h3><p>We report few adverse effects of epoprostenol and treprostinil in neonates treated for in iNO refractory PPHN. However, the heterogeneity of practices between centers requires further studies to establish recommendations for the use of these molecules in severe neonatal pulmonary hypertension.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Page S226"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271095","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":"Pulmonary artery growth in Fontan: What is the most effective strategy?","authors":"N. Derridj,&nbsp;M. Hily,&nbsp;L. Houyel,&nbsp;S. Malekzadeh-Milani,&nbsp;D. Bonnet","doi":"10.1016/j.acvd.2024.07.035","DOIUrl":"10.1016/j.acvd.2024.07.035","url":null,"abstract":"<div><h3>Introduction</h3><p>The best strategy to achieve optimal growth of pulmonary artery branches (PAs) in functionally univentricular heart (FUH) between partial cavopulmonary connection (PCPC) and total cavopulmonary connection (TCPC) is still controversial, especially the preservation of anterograde pulmonary blood flow (APBF).</p></div><div><h3>Objective</h3><p>To model the growth of PA in FUH between PCPC and TCPC and to assess whether APBF promotes this growth. Then to determine whether the maintenance of an APBF is associated with higher morbidity and mortality.</p></div><div><h3>Methods</h3><p>We retrospectively included all patients with FUH who underwent cardiac catheterization before PCPC and TCPC between 2004 and 2021. A linear regression model was used to model PA growth. We compared mortality and morbidity outcomes between the APBF group and no APBF group using the Kaplan–Meier method.</p></div><div><h3>Results</h3><p>In total, 118 children with FUH with a median follow-up of 8.8<!--> <!-->years were included, 49 (41.5%) had maintained APBF. PA branch growth can be considered continuous and linear over time [fractional polynomials (<em>P</em> <!-->=<!--> <!-->0.2)], estimated at β<!--> <!-->=<!--> <!-->8.5 [0.7–16.2] mm²/year. In multivariate analysis, maintaining an APBF was the only factor associated with increased PA branch growth [β<!--> <!-->=<!--> <!-->55.9 (21.8; 90) mm² (<em>P</em> <!-->=<!--> <!-->0.01)], regardless of TCPC timing (<span><span>Fig. 1</span></span>). Before PCPC, there was no difference in mean pulmonary artery pressure (mPAP) between groups with and without APBF. Between PCPC and TCPC, there was no significant increase in mPAP [13.2 (12–16) vs. 14.1 (12.4–15.8), <em>P</em> <!-->=<!--> <!-->0.3] or transpulmonary pressure gradient [7.2 (5.2–9.3) vs. 6.9 (4.6–9.1), <em>P</em> <!-->=<!--> <!-->0.6] in the APBF group. There was no difference in survival at 6<!--> <!-->years after TCPC between the group with APBF [87.6, 95% CI (65.6%–95.9%)] and the group without APBF [82.3 95% CI (67.8–90.6)]. No difference was also found when comparing morbidity characteristics between the two groups, such as length of hospital stay after TCPC (<em>P</em> <!-->=<!--> <!-->0.7), chylothorax (<em>P</em> <!-->=<!--> <!-->0.81), hemodynamic contraindications to fenestration closure (<em>P</em> <!-->=<!--> <!-->0.9), failing Fontan rate (<em>P</em> <!-->=<!--> <!-->0.38).</p></div><div><h3>Conclusion</h3><p>PAs growth between PCPC and TCPC is significant and can be considered linear over time. By maintaining APBF, growth potential can be achieved much more quickly and without additional risk of morbidity or mortality.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"117 8","pages":"Pages S235-S236"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271310","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}