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Leusden, Netherlands

Assaidi A.,Cardiologie pediatrique | Sbragia P.,Cardiologie | Fraisse A.,Cardiologie pediatrique
Catheterization and Cardiovascular Interventions | Year: 2013

Aortic coarctation is an unusual cause of hypertension during pregnancy and its management is not clarified. We report transcatheter balloon dilatation and stenting for native aortic coarctation in a 22-year-old pregnant woman with severe and uncontrolled systemic hypertension. Arterial blood pressure could be successfully controlled with medical treatment during the rest of the pregnancy and the patient underwent uneventful delivery. No adverse events or recoarctation was observed during 24 months clinical follow-up. In conclusion, native aortic coarctation can be successfully treated during pregnancy with transcatheter therapy. More experience is needed to confirm the safety and efficacy of such management. Copyright © 2012 Wiley Periodicals, Inc.

Hypertrophic cardiomyopathy (HCM) is a myocardial disorder characterized by left ventricular hypertrophy with no apparent cause (such as severe hypertension, aortic valve stenosis, etc.). The clinical diagnosis is based on cardiac imaging, commonly using 2D echocardiography and increasingly CMR. HCM is the leading cause of sudden death in young people, especially on the sports field. Many patients remain asymptomatic throughout life, while others develop heart failure, atrialfibrillation and stroke. HCM is the most common genetic (autosomal dominant) cardiovascular disease, with variable penetrance and expression. It is caused by mutations in genes coding for cardiac sarcomeric proteins. Genetic counseling and clinical risk stratification are crucial for all patients. Medical treatment with B-blockers or verapamil improves symptoms but has not been show to modify the clinical course. Patients with outflow obstruction and severe symptoms unresponsive to medical therapy are candidates for alcohol septal ablation or surgical myectomy. Current approaches focus on the prevention of sudden death by means of implantable defibrillators in high-risk patients.

Thebault C.,French Institute of Health and Medical Research | Donal E.,French Institute of Health and Medical Research | Bernard A.,Cardiologie | Moreau O.,French Institute of Health and Medical Research | And 3 more authors.
European Journal of Echocardiography | Year: 2011

Aims: Left ventricular (LV) mechanical dyssynchrony (LVMD) has emerged as a therapeutic target using cardiac resynchronization therapy (CRT) in chronic heart failure patients. Current methods used to evaluate LVMD are technically challenging and do not assess all the components of LVMD simultaneously. We analysed real-time 3D speckle tracking (3DST) echocardiography as a novel method to assess LVMD.Methods and resultsThree-dimensional ST was performed in 60 unselected patients (71 ± 9 years old; 39 with ischaemic cardiomyopathy) who were referred to optimize and to control of a CRT device; implanted according to current guidelines (9 added to be excluded from the protocol). Two standardized conditions [right ventricular (RV) versus an optimized biventricular (BiV) pacing modality] were tested. These two pacing modalities lead to two distinct electrical activation patterns. We sought to test the capability of 3DST to distinguish these two patterns. The LV ejection fraction was 24 ± 9 in the RV mode and 29 ± 10 in BiV. By 3DST, we measured global end-systolic LV deformation and dyssynchrony (standard deviation of the time to peak/16 LV-segment). The 3D radial strain increased from 13.8 ± 5.7 in the RV to 15.9 ± 6.5 in theBiV mode, and the dyssynchrony index decreased from 15.1 ± 5.0 to 11.8 ± 4.1. 3D longitudinal strain increased from -6.9 ± 2.8 in the RV to -7.8 ± 3.2 in the BiV mode, and the dyssynchrony index decreased from 14.2 ± 4.8 to 11.5 ± 5.0 (P < 0.01 for all). The 3D area strain (AS) increased from -15.4 ± 6 in the RV to -18.3 ± 7.0 in the BiV mode, and the dyssynchrony index decreased from 12.2 ± 5.1 to 9.5 ± 4.5 (P < 0.001 for all). Conclusion When image quality is optimal, 3DST might offer a new rapid method to quantify global LVMD in CRT candidates. In a comparison of the utility of various 3D strain measurements, the 3D AS appears to be closed to the ideal parameter that we are looking for. © The Author 2010.

Zabulon A.,Diabetologie | Ozier-Lafontaine N.,Cardiologie | Jocelyn I.,Diabetologie | Jocelyn I.,French Institute of Health and Medical Research
Blood Pressure | Year: 2016

Abstract: We report the clinical case of a 52-year-old man referred to our catheterization laboratory for an acute coronary syndrome. The coronary angiogram course was soon disrupted by a life-threatening blood pressure chaos lasting for hours. An abdominal paraganglioma was eventually diagnosed, requiring surgery. This case outlines the potential diagnosis and therapeutic missteps in managing such patients and suggests strategies for quick improvement. © 2015 Informa UK Ltd, trading as Taylor & Francis Group.

Several cardiovascular imaging techniques have seen major technical improvements in recent years. Visualization of coronary arteries - so important for diagnosis and patientmanagement - is routinely performed by coronarography, but new, less invasive techniques such as computed tomography are now available. Evaluation of myocardialfunction, which may be impaired in case of myocardial hypoperfusion, can now be achieved non invasively by means of echocardiography or scintigraphy. New imaging techniques, and MRI in particular,can provide useful complementary information. Knowledge of the respective advantages andlimitations of these techniques is crucial if physicians are to use them appropriately in their daily practice, thereby avoiding redundant or useless tests and improving patient management.

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