[Para valvular leak closure in TAVI]

Literature concerning transcutaneous symptomatic para valvular cardiac leaks closure (PVLC) after trans aortic valve implantation (TAVI) is relatively scarce. Hereby we present 2 clinical cases, one on an Edwards® Sapien 3 valve and the other one on a Medtronic® Evolut R valve. We present also the preliminary results of the 7 PVLC on TAVI included in our prospective FFPP registry during the 2 first years of enrolment (2017-2018), for a total of 158 inclusions for all valves. Seven procedures were performed on 8 leaks, using a majority of vascular plugs (3 Abbott® Amplatzer Vascular Plugs 2 (AVP2), 3 AVP3, 1 AVP4, and 1 muscular Ventricular Septal Defect (VSD) occluder). All procedures were successful without complication. At 1-month follow-up, all patients became asymptomatic. One-year follow-up was already available for 4 patients: 3 of them were symptoms free, and one-who had a second leak not suitable for PVLC-, underwent a « TAVI in TAVI » procedure 2 months after PVLC. This short experience demonstrates the feasibility, the efficacy and the safety of PVLC on TAVI. We expect to be able to offer more in depth information at the end of our prospective ongoing study.

[Sportman's myocardial infarction]

Sport related myocardial infarctions are rare. They concern a population mainly male, of more than 35 years, with a high prevalence of smoker. The initial clinical presentation is serious, with frequent ventricular fibrillations, the mode of revelation that can be a sudden death. The angiographic data mainly shows a single vessel disease or no significant lesion. These characteristics put down the problem of the validity of preparticipation screening for cardiovascular abnormalities, and in particular the place of exercise stress testing. It is advisable to continue the reflexion to determine a reasonable strategy in the tracking of the subjects at risk. This tracking, the correction of cardiovascular risk factors, the diffusion of elementary rules good sporting practices and the management of sudden death with rapid defibrillation on the sporting sites and complexes are current measurements essential to develop.

Tako-Tsubo syndrome after an exercise echocardiography

The Tako-Tsubo syndrome is a clinical entity recently described that associate a chest pain occurring during a stress, an abnormal ECG and/or an increase in the troponin blood level and a transient left ventricular dysfunction with an akinesis involving generally the midsection and the apex of the heart. It has also been reported that left ventricle (LV) dysfunction may involve only the midventricle, although it seems less common. We report the case of a 66 year old woman that developed a stress-induced cardiomyopathy (Tako-Tsubo syndrome) involving the midventricle when performing an exercise echocardiography. To our knowledge, this is the first case reported in such circumstances.

[Patent foramen ovale percutaneous closure: indications, techniques and results]

A patent foramen ovale is almost physiological (15% of the population) but can be associated with some pathological situations in which its closure can be considered. The only medical indication currently accepted is a right-left shunt without elevation of the right pulmonary pressure, whose most famous pattern is the rare platypnea-orthodeoxie syndrome. PFO may be responsible for diving decompression accidents. Before taking the decision of closing a PFO, each situation must be discussed on a case to case basis. In spite of the possible link between some kinds of migraine and PFO, according to current knowledge, there is no evidence of the efficiency of PFO closure in this situation. The secondary prevention of a cryptogenic ischaemic cerebrovascular attack on a young person with a PFO associated to a membranous septum aneurysm, is the most commonly considered indication, but we lack valid data for this indication. The PFO closing procedure is well codified and its success rate is close to 100%, with rare major complications. Residual permeability within the prosthesis ensuring the closure of the PFO decreases gradually to get under 15% after six months. The clinical result is often dramatic when treating right-left shunts. As far as the secondary prevention of cryptogenic ischaemic cerebro vascular attacks in young people is concerned, there might be some clinical benefit, but we are waiting for the results of ongoing randomized and scheduled studies.

[Very late intrastent thrombosis--at 27 months!]

Interrupting platelet antiaggregant therapy in coronary patients treated by stenting exposes them to the risk of cardiac complications. The risk of acute thrombosis of the stent is well known but late intrastent thrombosis is less common and mainly observed with drug eluting stents. The authors report the case of a 54 year old man who had thrombosis of an ordinary stent implanted 27 months previously which occurred in the immediate post-operative period after repair of an inguinal hernia. The interruption of platelet antiaggregant therapy was relayed by flurbiprofen in accordance with recommendations of scientific societies. After a review of the literature, the authors discuss late stent thrombosis and interruption of platelet aggregant therapy in coronary patients before non-cardiac surgery.

[Successful pregnancy after Fontan procedure complicated by recurrent junctional tachycardia]

A woman had a successful pregnancy with a normal delivery at 33 weeks seven years after a modified Fontan procedure for tricuspid atresia. This pregnancy was associated with aggravation of attacks of junctional tachycardia which became symptomatic and recurrent despite prescription of several antiarrhythmic agents.

[Percutaneous mitral valvulotomy: comparison of 2 techniques in 100 matched-pair patients]

The results of percutaneous mitral valvulotomy by the Double Balloon and the Inoue Balloon were compared in 100 patients referred to Marie-Lannelongue Hospital between 7/11/86 and 8/3/91, paired for age, sex and echocardiographic features of the mitral valve. The transvalvular diastolic pressure gradient at catheterisation or Doppler echocardiography decreased significantly and similarly with the two techniques: -65 +/- 19% versus -64 +/- 15% (p = 0.10) and -66 +/- 22% versus -58 +/- 23% (p = 0.20) for the Double-Balloon and the Inoue Balloon techniques respectively. Similarly, the mitral valve surface area measured by planimetry during echocardiography or calculated from the Gorlin formula increased by 0.9 +/- 0.39 cm2 with the Double Balloon and by 0.88 +/- 0.32 cm2 with the Inoué Balloon (p = 0.91) or by 0.98 +/- 0.62 cm2 versus 0.87 +/- 0.45 cm2 (p = 0.42). The number of commissures opened was the same with both techniques. The evolution of mitral regurgitation after dilatation was similar: stable or less severe in 61% dilated by the Double Balloon and 68% by the Inoue Balloon; aggravation by more than one grade in 7 and 5% respectively (p = 0.17). Complications were rare and comparable with both techniques. The results with the two methods were the same if patients with an optimal indication and those with more severe mitral valve disease were considered separately. The rapidity and simplicity of percutaneous mitral valvulotomy with the Inoué Balloon make it the technique of choice.

[Anatomic correction of simple transposition of the great vessels during the neonatal period. 5 years' experience in 235 children]

From March 1984 to August 1989, anatomic surgical correction was performed on 235 newborn infants (2 to 32 days old, mean 8.5 +/- 4) with simple transposition of the great arteries. Ninety-four percent of the patients underwent balloon atrial septostomy before the operation. The anatomy of the coronary arteries according to the Yacoub classification was as follows: type A, 160 patients (68%); type B, 5 patients (2%); type C, 11 patients (5%); type D, 41 patients (17%); and type E, 18 patients (8%). Coronary artery relocation was performed according to the Yacoub technique with some modifications, and the pulmonary artery reconstruction was done using the Lecompte manouver in association with a pericardial patch. The perioperative mortality rate was 8.9 percent for the entire series, significantly higher for the type C (46%, p less than 0.01) and significantly lower for the type D (0%, p less than 0.05). Seven patients were lost of follow-up. The follow-up ranged from 1 to 63 months (mean 21 +/- 14). Four late deaths occurred: 2 from myocardial infarction, 1 from pulmonary hypertension and one from a thrombotic occlusion of the superior Vena cava. One patient had an acute posterior myocardial infarction five months after the operation and his left ventricular contractility is normal at echocardiography three years later. Supravalvular pulmonary stenosis occurred in 17 patients but only two were operated on with no death. Mild aortic regurgitation occurred in nine patients. Ninety eight percent of the survivors have a normal life, with no cardiovascular symptoms and receive no medication.