Archives des maladies du coeur et des vaisseaux最新文献

{"title":"[Prognosis of isolated atrioventricular block in children. Single center study of 135 cases].","authors":"E Marijon,&nbsp;N Costedoat-Chalumeau,&nbsp;S Georgin-Lavialle,&nbsp;L Fermont,&nbsp;D Bonnet,&nbsp;E Villain","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Isolated complete atrio-ventricular (AV) block in children occurs in anatomically normal hearts in the absence of any known predisposing factor likely to have caused the block. This study aimed to define the current prognosis of these conduction disorders.</p><p><strong>Methods: </strong>135 patients with isolated complete AV block, diagnosed before the age of 15 years, were included in this monocentric, retrospective study.</p><p><strong>Results: </strong>52.6% of the cases were diagnosed in the antenatal or neonatal period, demonstrating their congenital nature. The disease was heralded by symptoms in only 6.7% of cases. A search for maternal anti-Ro/La antibodies was performed in 111 of the patients. It was positive in 56 cases, and was associated with an early diagnosis, a short delay in cardiac pacemaker implantation, and the occurrence of cardiomyopathy (16 cases), the latter representing a critical point in the progression of the disease (37.5% mortality at 6 years). Among the 55 cases not associated with antibodies, 2 cases were familial and no etiology was discovered in the others. The diagnosis was therefore made later, and no progression to cardiomyopathy was noted. A cardiac pacemaker was implanted in 122 patients (66 epicardial, 56 endocardial).</p><p><strong>Conclusions: </strong>Isolated complete AV block in children is not a homogenous entity: 'immunological' blocks are genuinely congenital and their prognosis remains grave, owing to the risk of cardiomyopathy, which is sometimes diagnosed late. The other types of block are diagnosed much later in childhood, and their mechanism is still unknown. They have a good prognosis as long as the indications for pacing the child are respected.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 11","pages":"909, 912-16"},"PeriodicalIF":0.0,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41076045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Evaluation of management of infarction in the Franche Comté province by the use of the Franche Comté Cardiology Registry, May 2005-May 2006].","authors":"F Schiele,&nbsp;R Fouché,&nbsp;G Lassabe,&nbsp;P Bohigas,&nbsp;D Magnin,&nbsp;P Bechetoille,&nbsp;L Thebault,&nbsp;R Faivre,&nbsp;D Boumal,&nbsp;J Frison,&nbsp;J-P Bassand","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Rationale: </strong>The management of acute infarction often necessitates a network of organisation between different centres, thus making it the object of an evaluation of professional practices (EPP). We report the experience in the Franche Comté province of an EPP at a regional level in the management of infarction.</p><p><strong>Methods: </strong>All of the patients admitted to 10 of the 11 centres in the region were included in a prospective survey. Quality indicators for acute and chronic care were defined, as well as scores, on the basis of use of treatments specified in guidelines.</p><p><strong>Results: </strong>Between May 2005 and May 2006, 1,170 patients were admitted. The patients' risk levels and quality scores were calculated. The rate of use of the quality indicators was higher in our survey than that observed in all of the published studies, except for the use of betablockers. The quality of care could therefore be considered as highly satisfactory. Comparison between the centres revealed some differences. Even after adjustment for the risk score on admission, the quality score for acute care was related to mortality at 1 month.</p><p><strong>Conclusions: </strong>An EPP is possible for the management of infarction, on a regional scale such as in the province of Franche Comté. The acute quality score turned out to be an independent factor for mortality. The indicators showed that the quality of care was highly satisfactory, even though more progress could be made in the prescription of betablockers.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 11","pages":"917-24"},"PeriodicalIF":0.0,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41076047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Four years of circulatory support with the INCOR axial pump from Berlin Heart].","authors":"M Kirsch,&nbsp;E Vermes,&nbsp;B Boval,&nbsp;L Drouet,&nbsp;D Loisance","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Implantation of definitive left ventricular support is now a therapeutic option for certain patients in refractory heart failure who are not candidates for transplantation. Here we report the case of a patient assisted for more than 4 years with an INCOR axial pump from Berlin Heart. This case shows the feasibility of long term assistance with a continuous flow pump, and an innovative anti-thrombotic strategy relying on the combination of low molecular weight heparin with platelet anti-aggregants.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 11","pages":"967-70"},"PeriodicalIF":0.0,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41076627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Aortic bioprosthesis implanted percutaneously: three year follow up].","authors":"H Eltchaninoff,&nbsp;C Tron,&nbsp;F Bauer,&nbsp;D Brunet,&nbsp;B Baala,&nbsp;L Drogoul,&nbsp;M Kerkeni,&nbsp;P-Y Litzler,&nbsp;F Tamion,&nbsp;J-P Bessou,&nbsp;A Cribier","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Percutaneous implantation of a bioprosthesis for the treatment of degenerative aortic stenosis ushered in a new era for interventional cardiology, and now represents the best therapeutic option for a growing number of patients for whom surgical aortic replacement would be too risky. This is the case in about a third of symptomatic patients affected. Between 2003 and 2005, we performed initial feasibility studies (I-REVIVE and RECAST) in Rouen, on non-operable patients in a critical state, included for purely compassionate reasons. The valve used was a pericardial bioprosthesis mounted in an expandable balloon stent. The mean age of the patients was 80 years, all had multiple co-morbidity and had been turned down by the cardiac surgeons. In 33 of the 36 included patients, the technique was attempted by the anterograde trans-septal approach (n=27, success rate 80%) or by the retrograde arterial route (n=7, success rate 57%). Echocardiography following implantation revealed a final aortic surface area of 1.70 cm2 and a transvalvular gradient of 9 mmHg. A significant paravalvular aortic leak was noted in 5 cases. There were 6 deaths by 1 month, related to the procedure, and 10 deaths by 6 months, from non-cardiac causes and not related to the procedure. There was no occurrence of coronary occlusion, secondary displacement or dysfunction of the prosthesis. In December 2006, 8 patients reached 2 years of follow up, and two others reached 3 years, symptom free and still with an unchanged valvular function. Significant technological improvements have made the technique simpler, quicker and safer, with very much improved short and long term results. The new trans-apical approach is under evaluation with some promising initial results. More than 280 patients have been implanted to date. Other implantable prostheses are under evaluation. This therapeutic modality looks likely to develop rapidly, and in the near future it should offer a new and optimal solution for all high surgical risk or non-operable patients.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 11","pages":"901, 904-8"},"PeriodicalIF":0.0,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41075487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Diagnostic and prognostic significance of CK-MB, troponins, CRP, BNP and/or NT-proBNP in coronary angioplasty. Elevation mechanisms and clinical implications].","authors":"J-P Bertinchant,&nbsp;B Ledermann,&nbsp;L Schmutz,&nbsp;M Pezzano,&nbsp;N Jamaleddin,&nbsp;S Cade,&nbsp;P-F Winum,&nbsp;A Polge","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The recommendations from respected bodies concerning the treatment and follow up of patients undergoing coronary angioplasty for stable angina or acute coronary syndrome (ACS) are essential for reducing the risks related to the procedure, and for preventing the occurrence of long term complications. Measuring the levels of troponin and CK-MB is part of the diagnostic and prognostic strategy during the coronary angioplasty procedure. In this context, the frequent elevation of markers following uncomplicated angioplasty is a sign of minor irreversible myocardial damage, the prognostic significance of which remains under discussion. Recent data suggest that only a basal troponin elevation (more so than CK-MB) prior to angioplasty has a long term prognostic value in ACS ST- patients, and that troponin elevation occurring after the procedure in the presence of normal basal concentrations, is only associated with in-hospital complications. Determining the basal level of troponin would appear to be essential for interpreting any elevation in concentrations following angioplasty. The recommendations should integrate this fundamental point, if it is confirmed. On the other hand, the question has been raised whether other markers (CRP, BNP and/or NT-proBNP) should be systematically measured as a routine prior to angioplasty. An elevation of CRP before and/or after angioplasty is an unfavourable short and long term prognostic factor. Elevation of NT-proBNP before angioplasty is also an unfavourable long term prognostic factor. Recommending a multi-marker strategy might represent a future direction for identifying at risk patients prior to coronary angioplasty, thus enabling specific treatment to be proposed.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 11","pages":"925-33"},"PeriodicalIF":0.0,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41076049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[BNP and echocardiography can predict the occurrence of acute cardiac decompensation during titration of bisoprolol in chronic systolic heart failure].","authors":"A Ben Driss,&nbsp;J-Y Tabet,&nbsp;P Meurin,&nbsp;H Weber,&nbsp;N Renaud,&nbsp;A Grosdemouge,&nbsp;C Bourmayan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>Based on the fact that NYHA class, plasma BNP level, and echocardiographic indices of left ventricular filling pressures are prognostic factors in chronic systolic heart failure, we evaluated their predictive value for acute decompensation following initiation and titration of bisoprolol in this illness.</p><p><strong>Methods and results: </strong>Bisoprolol was initiated and/or increased according to the ESC/ACC/AHA recommendations in 50 patients with stable chronic systolic heart failure (age: 60+/-2 years, males: 88%) in NYHA class? 2 with a left ventricular ejection fraction (LVEF)<40% and a plasma creatinine<250 micromol/l. The clinical parameters, plasma BNP levels and echocardiographic indices were measured blind on the same day, on admission and then once a week for three weeks. On admission, the NYHA was 2.9+/-0.1, mean plasma creatinine 99+/-3 micromol/l, plasma BNP 503+/-57 pg/ml, LVEF 29+/-1%, E/A ratio 1.9+/-0.2, E/Ea ratio 8.8+/-0.3, E wave deceleration time 155+/-9 ms, systolic pulmonary artery pressure 40+/-2 mmHg and the diameter of the inferior vena cava was 16+/-1 mm. Over the course of follow up, an episode of acute decompensation occurred in 16% of the patients (8/50). Using univariate analysis, age and initial (admission) values for NYHA class, blood pressure, plasma BNP level, E/A ratio, E wave deceleration time, E/Ea ratio and the systolic pulmonary arterial pressure allowed prediction of the occurrence of acute decompensation following initiation and titration of bisoprolol. The use of the initial value of NYHA class alone allowed prediction of the occurrence of acute decompensation in just 56% of the patients, and the absence of an occurrence of acute decompensation in 93% of them. Normal results for the echocardiographic indices (systolic pulmonary arterial pressure<40 mmHg or E/A ratio<1.4 or E wave deceleration time>145 ms) as recorded on admission were associated with the absence of an occurrence of acute decompensation is 100% of cases. The combined use of NYHA class>3 and either a BNP>398 pg/ml or echocardiographic indices in favour of an elevation in left ventricular filling pressures (systolic pulmonary arterial pressure>40 mmHg, E/A ratio>1.4 or E wave deceleration time<145 ms) allowed prediction of the occurrence of acute heart failure in 100% of cases</p><p><strong>Conclusion: </strong>The combined use of NYHA class, BNP level and echocardiographic indices for measuring left ventricular filling pressures is more pertinent than the isolated use of clinical parameters for predicting tolerance to bisoprolol in chronic heart failure with a LVEF<40%.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 11","pages":"934-40"},"PeriodicalIF":0.0,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41076050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Therapeutic education for heart failure: a necessity in 2007].","authors":"Y Juillière,&nbsp;V Berder,&nbsp;F Claudot,&nbsp;D Liban,&nbsp;P Jourdain,&nbsp;J-N Trochu","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Heart failure is a severe illness, marked with a still too high morbidity and mortality. Therapeutic education, fundamental for any chronic pathology, is taking a more and more important place in heart failure. Its value has been proved, and its importance in the multidisciplinary management of heart failure patients has been confirmed in terms of improving the prescription of medical treatment and allowing a better quality of life. France was late to recognise this technique, but the successful development of the I-CARE programme should contribute to improving both the quality of care for patients and the understanding of this pathology.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 11","pages":"941-5"},"PeriodicalIF":0.0,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41076051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Rotational coronary angiography].","authors":"W Smida,&nbsp;G Sidéris,&nbsp;V Stratiev,&nbsp;D Logeart,&nbsp;A Ouadhour,&nbsp;F Tarragano,&nbsp;L Bonnevie,&nbsp;I Azancot,&nbsp;P Henry","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Context: </strong>Rotational angiography (RA) is a radiological technique that provides multiple views of a vessel for a single injection of contrast. Its significance in the field of coronary angiography is poorly known at present. This study aimed to compare the radiation dose as well as the volume of contrast used during RA compared to standard angiography (SA), and to evaluate its diagnostic precision.</p><p><strong>Method: </strong>78 patients sent for diagnostic coronary angiography were explored using the radial approach. The patients were randomised between RA (3 acquisitions for the left coronary and 1 for the right coronary) or SA. Once a decision to undertake angioplasty had been made following the angiography (RA or SA), the initial study was complemented using the alternative technique (SA or RA) before the angioplasty procedure was performed at a later stage. The severity of the lesions as shown by RA and SA was compared by four experienced coronary angiography operators.</p><p><strong>Results: </strong>65 patients (mean age 61+/-10 years--mean BMI 26+/-4 Kg/m2) underwent complete RA+SA investigation. The total x-ray dose used during ciné-angiography, the dose received by the patient, and the volume of contrast were significantly reduced in the RA group compared to the SA group (-25%; -36%; -33% respectively). An evaluation of the severity of the stenoses was performed on 168 arterial segments. There was a significant correlation between the two techniques (R=0.95--p<0.001) and the intra-observer variability was non significant (3.7+/-6.8%--p=NS).</p><p><strong>Conclusions: </strong>Rotational angiography allows the radiation dose and the volume of contrast to be reduced, while retaining a diagnostic precision similar to that of standard angiography.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 11","pages":"895-900"},"PeriodicalIF":0.0,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41077863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Heparin-induced thrombocytopenia: a case of persistent thrombocytopenia].","authors":"M Jourdain,&nbsp;P-V Ennezat,&nbsp;J Darchis,&nbsp;J-M Aubert,&nbsp;J-J Bauchart,&nbsp;J-L Auffray,&nbsp;P Asseman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Heparin-induced thrombocytopenia is rare. It should be considered if there is a reduction of at least 40% in the number of platelets and/or a level<100,000/mm3 in any patients who have received heparin in the previous 100 days. On stopping heparin, the rise in platelets is classically rapid, and normal levels are usually obtained in under 7 days. We report a case of heparin-induced thrombocytopenia, which was marked by a severe thrombocytopenia that only returned to normal 19 days after stopping heparin, in a patient treated initially with non-fractionated heparin for a pulmonary embolism secondary to an extensive deep venous thrombosis of the right lower limb.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 11","pages":"959-62"},"PeriodicalIF":0.0,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41076625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Benefits of a healthcare network in the management of cardiovascular disease: HTA Vasc, an innovation in the Nord Pas de Calais region].","authors":"C Mounier-Vehier,&nbsp;P Bocquet,&nbsp;P Marboeuf,&nbsp;G Rosey,&nbsp;A Noël,&nbsp;L-M Gorre","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Created in 2004, the HTA vasc healthcare network intensified detection, multi-disciplinary management and follow up of atheromatous cardiovascular disease and complicated hypertension in the Nord Pas de Calais region. The participating doctors gave their patients a Patient Dossier, as a function of predefined inclusion criteria (patients at elevated cardiovascular risk, as defined by the Haute Autorité de Santé (Higher Authority of Health) stratification. The dossier was presented in the form of a file containing all the information needed to optimise multi-disciplinary management, while at the same time reinforcing therapeutic compliance by patients. Therapeutic education workshops were organised, in order to complement the existing service. In parallel, HTA vasc set up a pilot medical education programme for vascular rehabilitation in six hospitals in the region. HTA vasc also established partnerships with other healthcare networks in the region. A patients' association 'Notre Coeur, Nos Artères', (Our Hearts, Our Arteries) was created in September 2006. About 250 healthcare professionals had joined the network by the end of January 2006, an increase of almost 40% over the year. More than two thirds were independent doctors, and they included cardiologists, neurologists, nephrologists, diabetologists, general practitioners, radiologists, cardiovascular surgeons, rehabilitation doctors, paramedics and pharmacists. More than 260 patients received a follow up dossier. The results of a survey carried out in May 2006 showed a high level of satisfaction: 82% of patients considered the Patient Dossier to be useful and appropriate; 78% of the healthcare professionals stated that the network was of help in the management of patients. HTA vasc received the scientific support of the Sociétés Françaises de Médecine Vasculaire, d' Hypertension Artérielle (French Societies of Vascular Medicine and Hypertension), and the Vascular Group of the Société Française de Cardiologie, with an external audit of the tools and activities undertaken in the region.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 11","pages":"947-54"},"PeriodicalIF":0.0,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41076052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}