Archives of Cardiovascular Diseases Supplements最新文献

Introduction

Bronchopulmonary dysplasia is a common pathology of premature newborns caused by oxygen and mechanical ventilation, resulting in hypoalveolarization and impaired angiogenesis. It can be complicated by pulmonary hypertension (PH-BPD) with excess mortality. Celastrol has anti-inflammatory and antioxidant properties.

Objective

We addressed potential therapeutic interest of celastrol in PH-BPD.

Methods

Different concentrations of celastrol (0,1–0,5–1 mg/kg/d) were tested in a murine model of hyperoxic PH-BPD (14 days with 90% O₂–Hx). We evaluated hemodynamic parameters with echocardiography, lung remodeling with histological methods and pulmonary arterial (PA) reactivity with myograph. Cytoplasmic calcium (Ca₂+i) response to endothelin-1 (ET-1) was evaluated in human fetal PA smooth muscle cells (fPASMC) with spectrophotometry in normoxic (21% O₂) and Hx conditions (48 h with 60% O₂). Inflammation and oxidant stress were also addressed.

Results/Expected results

Celastrol reduces mortality at doses of 1 and 0,5 mg/kg/d compared to Hx control. At 1 mg/kg/d, it normalizes PA acceleration time and reduces vascular hyperreactivity to ET-1 inversely to phenylephrine and 5-HT, with no effect on the altered response to acetylcholine induced by Hx. At all doses, it decreases right heart hypertrophy and vascular remodeling but has no effect on media cells proliferation observed in Hx condition. It has also no impact on alveolarization and vascular density. Although celastrol (0.1 and 0.3 μM) decreases the increased Ca₂+i response to ET-1 in Hx in fPASMC, expression of ET-1 receptors was unchanged. In fPASMC, celastrol 0.3 μM decreases the increased concentration of IL6 observed in Hx but has no effect on IL8 and MIF. In both models, Hx-induced oxidant stress remains mild with absence of protein carbonylation and lipid peroxidation and celastrol at 1 mg/kg/d increases heme oxygenase 1 expression.

Conclusion/Perspectives

Celastrol has a preventive dose-dependent effect on major hallmarks of PH induced by Hx and could be considered as a new potential therapeutic option for PH-BPD.

Introduction

Transthoracic echocardiography is the first-line non-invasive investigation for assessing pediatric patients. Sometimes performing echocardiography in pediatric patients can be challenging for physicians and sonographers due to factors such as patient cooperation and time constraints.

Objective

Our primary purpose was to establish whether the Ligence Heart software validated for analyzing adult echocardiography could be transposed to pediatric patients.

Methods

The study was conducted at the University Hospital of Bordeaux between August and September 2022 and included 45 patients with normal or near-normal heart architecture who underwent a 2D TTE. The ultrasound scans were performed manually by two medical practitioners, a senior, a junior and the AI software provided by Ligence Heart Company. Twenty-three features were assessed through echocardiography for each patient. We compared the agreement between methods and observers.

Results/Expected results

The mean age of our patients at the time of evaluation was 8.2 years ± 5.7, and the main reason for referral to our service was the presence of a heart murmur. Bland-Altman analysis showed good agreement between AI and the senior physician for two parameters (aortic annulus and E wave) regardless of the age of the children included in the study. A good agreement between AI and physicians was also achieved for two other features (STJ and EF) but only for patients older than 9 years. For other features, a good agreement was found between physicians but not with the AI, or a poor agreement was established. In the first case, maybe proper training of the AI could improve the measurement, but in the latter case, for now, it seems unrealistic to expect to reach a satisfactory accuracy.

Conclusion/Perspectives

Based on this preliminary study on a small cohort group of pediatric patients, the AI soft originally developed for the adult population had provided promising results in evaluating aortic annulus, STJ, and E wave.

Introduction

Surgical management of mitral valve (MV) disease is challenging in infants. We aimed at reporting the French experience with Melody mitral valve replacement (MVR).

Methods

A retrospective cohort study reporting the French experience with Melody MV replacement (MVR).

Results

Seven symptomatic infants (complete atrioventricular septal defect [n = 4, down syndrome: n = 3], hammock MV [n = 3]) underwent Melody MVR (age: 3 months [28 days–8 months], weight: 4.3 kg [3.2–6.4 kg]) because of severe MV regurgitation (6) or mixed MV disease (1) and 14 mm (11–16 mm) MV annulus. In 2 patients whose MV was felt irreparable, Melody MVR was performed straightaway. The others underwent 2 (1–3) previous attempts of MV repair; 3 were on ECMO. Melody MVR led to competent valve and low gradient (3 mmHg, [1–4 mmHg]). One patient died 3 days post-implant from ECMO-related stroke. Of the 6 discharged home patients, 3 (50%) were readmitted for a definite diagnosis (1) or high suspicion (2) of infective endocarditis, of which 2 died. Over the follow-up, one underwent balloon expansions of the valve at 9- and 16-months post-implant, and mechanical MVR at 2 years; another is currently planned for transcatheter Melody valve dilation.

Conclusion

Melody MVR may be considered in selected infants with small MV annulus as an alternative to mechanical MVR. Our experience highlights a high-risk of late IE that deserves further consideration.

Introduction

Disconnected pulmonary artery is a rare anomaly that can be isolated or associated with complex intracardiac malformations. Early re-implantation of the disconnected pulmonary artery is recommended to allow growth and satisfactory pulmonary perfusion while preventing collateral arteries development.

Objective

To describe the characteristics of patients with disconnected pulmonary artery and, for those who had surgical re-implantation, to determine the incidence, delay and predictive factors of re-intervention for reconnected pulmonary artery stenosis.

Methods

We include patient with diagnosis of congenitally disconnected PA and surgical repair at our institution.

Results/Expected results

Retrospective observational study of 55 patients with a disconnected pulmonary artery. Fifty-one underwent surgical correction and were followed up at our institution between 2000 and 2022.

Disconnected pulmonary arteries were observed in isolation in 31% of the cases. The most frequent form was left pulmonary artery originating from the arterial duct (58%). The re-implantation was done at median age of 12 days. Anastomotic stenosis was observed during follow-up in 71% of the patients with 75% of them requiring re-intervention (55% of the population). The median delay to re-intervention was 3.2 years after re-implantation, and more than 25% of re-interventions on the re-implanted pulmonary artery occurred within the first postoperative year. We found more re-intervention if associated cardiac defect, without significant statistic difference. Weight at re-confluence, presence of ductal tissue at the origin of the pulmonary artery, and prior shunt placement on the disconnected pulmonary artery were not found to be risk factors for re-intervention (Figure 1).

Conclusion/Perspectives

After surgical re-implantation of pulmonary artery, more than 50% of patients required re-intervention for pulmonary artery stenosis. Technical improvements should be sought to reduce incidence of this complication.

Introduction

Although feasible with ultrasound, analysis of the fetal heart rhythm sometimes remains a challenge in the absence of access to the fetal electrocardiogram. In particular in case of suspected long QT, ultrasound does not allow the measurement of the ST segment.

Objective

Within the framework of the ANR SurFAO project, the Surfao-Cardio clinical study consisted in including 20 patients whose fetus did not present any cardiac morphological abnormality, between 22SA and 29SA. A trans-abdominal electrical recording was performed. The abdominal signals were formatted and processed to extract a fetal ECG. From the latter, measurements were made, automatically for RR intervals and manually for PR intervals.

These data were compared for each patient with ultrasound measurements in different modalities (M mode, Mitral-Aorta Profile, VCS-Aorta Doppler, Pulmonary Vein-Pulmonary Artery Doppler).

Results/Expected results

The fetal heart rate was analyzable in 12 of the 20 patients with a possible analysis of the QRS morphology for 12/12 patients and of the PR for 8/12 patients.

The correlations between the ultrasound data and the fetal ECG were respectively R = 0.79 (n = 12, P < 0.05) for heart rate and R = 0.81 (n = 8, P < 0.05) for PR intervals (Figure 1).

Conclusion/Perspectives

This preliminary study showed the feasibility of trans abdominal fetal ECG with good reliability of PR measurement. Some material limitations related to the recording of the trans-abdominal ECG were identified, giving hope for an improvement in the percentage of possible measurements and access to ST-segment measurement.

Introduction

Ventricular arrhythmias and sudden death are recognized complications of tetralogy of Fallot (TOF). Electrophysiological study (EPS) is increasingly performed prior to pulmonary valve replacement (PVR) in these patients to evaluate and treat the arrhythmic substrate.

Objective

We aimed to assess the value of cardiac magnetic resonance (CMR) to refine pre-operative risk stratification in this population.

Methods

A prospective multicenter study was conducted to systematically assess EPS in patients with TOF referred for PVR from January 2020 to December 2021. Multiple CMR parameters were analyzed and correlated with EPS results.

Results/Expected results

Among a total of 120 patients enrolled, 108 (90.0%) patients who had a CMR prior to EPS were analyzed. A VA was inducible in 24 (22.2%) patients. Clinical characteristics of patients associated with EPS results are presented in Table 1. Concerning CMR variables, mean RV end-diastolic volume index was 157 ± 39 ml and was not statistically different in patients with positive vs. negative EPS (164 ± 49 vs. 155 ± 35, P = 0.395). However, a RV/LV end-diastolic volume index ratio > 2.4 was significantly associated with a higher likelihood of inducibility (OR 3.10, 95%CI 1.14–8.74, P = 0.040). Mean RV end-systolic volume index tended to be upper in patient with positive EPS (101 ± 35 vs. 86 ± 26, P = 0.072). The RV ejection fraction measured on CMR also tended to be slightly lower in patients with positive EPS (40 ± 7 vs. 43 ± 9, P = 0.069) unlike the LV ejection fraction (P = 0.600). Mean pulmonary annulus diameter were also significantly associated with positive EPS (31 ± 8 vs. 26 ± 7 mm, OR 1.10 [1.02–1.18] per 1 mm increment, P = 0.012). A pulmonary annulus diameter > 28 mm was associated with an OR of 2.9 [1.10–8.11] (P = 0.047). In multivariable analysis, RV/LV end-diastolic volume index ratio > 2.4 (OR 4.6 [1.2–22.5], P = 0.036) and history of atrial arrhythmia (OR 10.9 [2.6–60.8], P = 0.002) remained independent predictors of VA inducibility (Figure 1).

Conclusion/Perspectives

In patients with TOF prior to PVR, RV/LV end-diastolic volume index ratio and pulmonary annulus diameter are associated with ventricular arrhythmia inducibility during EPS. CMR parameters, in combination with other clinical factors, may be us