Archives of Cardiovascular Diseases最新文献

Introduction

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.

Objective

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.

Methods

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.

Results

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 > 1; P < 0.05).

Conclusion

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.

Introduction

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.

Objective

The aim is to investigate healthy aorta mechanical property using a micro-CT under pressure and compare them with literature.

Methods

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.

Results

All aortic roots (n = 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, P = 0.001 (Fig. 1).

Conclusion

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.

Background

Methods

Results

Conclusions

Background

Aim

Methods

Results

Conclusions

Introduction

Since the 2000s, transcatheter closure has been the primary treatment for ostium secundum atrial septal defect (osASD) in children and adults.

Objective

This study aims to identify factors associated with short-term adverse outcomes following this procedure in a large cohort.

Methods

A prospective, single-center cohort study included 2,253 consecutive patients (median age 28 years; children: n = 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.

Results

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 (< 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 (P = 0.002 and P = 0.035, respectively) (Fig. 1).

Conclusion

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.

Introduction/Background

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.

Objective

This study aims to compare the characteristics and outcomes of patients who underwent TPVR with self-expandable valves versus balloon-expandable valves.

Methods

A prospective single-center analysis was conducted, encompassing all consecutive patients (n = 89) who underwent TPVR using either balloon-expandable valves (Sapien 3 valves, n = 63, 70%) or self-expandable valves (Venus-P, n = 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.

Results

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), P = 0.014. Tetralogy of Fallot (ToF) was the primary diagnosis in 49 cases (55%, 32 with Sapien 3 and 17 with Venus-P valve, P = 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, P < 0.001.

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, P = 0.66). Ventricular ectopy necessitating medical therapy was more frequent in the Venus-P group (19% vs. 0%, P = 0.002) including one case of sustained asymptomatic ventricular tachycardia, managed with amiodarone therapy. No peri-procedural deaths were reported.

Conclusion

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.

Introduction

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.

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Introduction

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).

Objective

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.

Methods

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.

Results

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 (P = 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 (P = 0.01)], regardless of TCPC timing (Fig. 1). 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), P = 0.3] or transpulmonary pressure gradient [7.2 (5.2–9.3) vs. 6.9 (4.6–9.1), P = 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 (P = 0.7), chylothorax (P = 0.81), hemodynamic contraindications to fenestration closure (P = 0.9), failing Fontan rate (P = 0.38).

Conclusion

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.