Infective endocarditis in patients with heart transplantation

[Background] The incidence of nosocomial and health care-related infective endocarditis (IE) is increasing. Heart transplantation (HT) implies immunosuppression and frequent health care contact. Our aim was to describe the current profile and prognosis of IE in HT recipients.[Methods] Multicenter retrospective registry-based study in Spain and France that included cases between 2008 and 2019.[Results] During the study period, 8305 HT were performed in Spain and France. We identified 18 IE cases (rate 0.2%). Median age was 57 years; 12 were men (67%). Valve involvement did not have a predominant location and three patients (16.7%) had atrial or ventricular vegetations without valve involvement. The median age-adjusted Charlson index was 4 (interquartile range 3–5). Eleven IE cases (61%) were nosocomial/health care-related. Median time (range) between HT and development of IE was 43 months (interquartile range 6–104). The major pathogens were Staphylococcus sp. (n = 8, 44%), Enterococcus sp. (n = 4, 22%), and Aspergillus sp. (n = 3, 17%). Although eight patients (44%) had a surgical indication, it was only performed in three cases (17%). Three patients (17%) died during the first IE hospital admission.[Conclusions] IE in HT recipients has specific characteristics. Valve involvement does not have a predominant location and non-valvular involvement is common. Three fifths have a nosocomial/health care-related origin. The major pathogens were staphylococci (44%), enterococci (22%), and Aspergillus (17%). In-hospital mortality was 17%.Peer reviewe

Ablation par courant de radiofréquence des tachycardies jonctionnelles du sujet âgé (expérience rennaise)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Dermatite atopique canine et homéopathie

LYON1-BU Santé (693882101) / SudocSudocFranceF

Prise en charge par époprosténol d'un patient souffrant d'hypertension artérielle pulmonaire

L'hypertension artérielle pulmonaire (HTAP) est une maladie rare caractérisée par l'augmentation progressive des résistances artérielles pulmonaires, aboutissant à une insuffisance cardiaque droite et au décès en l'absence de traitement. Malgré les innovations thérapeutiques qui ont permis des progrès majeurs en termes de prise en charge, il n'existe toujours pas de traitement curatif. L'utilisation de l'époprosténol, traitement spécifique de l'HTAP, nécessite la mise en place d'un cathéter veineux central et l'implication totale du patient. Pour cela la prise en charge de la maladie est multidisciplinaire, continue et nécessite une coopération étroite entre le patient et les différents professionnels de santé impliqués. En effet, dans cette maladie, le patient joue un rôle prépondérant dans le déroulement de la thérapeutique. Le bon déroulement du traitement est étroitement lié à sa bonne volonté de suivre rigoureusement les enseignements qui lui auront été appris pendant l'éducation thérapeutique.Pulmonary arterial hypertension (PAH) is a rare disease characterized by the progressive increase in pulmonary arterial resistance, leading to right heart failure and death in the absence of treatment. Despite therapeutic innovations that have led to major progress in terms of management, there is still no cure. The use of epoprostenol, specific PAH treatment, requires the establishment of a central venous catheter and the full involvement of the patient. For this, the management of the disease is multidisciplinary, continuous and requires close cooperation between the patient and the various health professionals involved. Indeed, in this disease, the patient plays an important role in the development of therapeutics. The proper course of treatment is closely linked to its willingness to strictly follow the teachings that will have been learned during therapeutic education.RENNES1-BU Santé (352382103) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

An unusual indication of heart transplantation

International audienceno abstrac

Three-year haemodynamic performance of the St Jude Trifecta bioprosthesis

International audienceOBJECTIVES To examine the haemodynamic performance of the St Jude Trifecta valve for aortic valve replacement (AVR) at 3 years after implantation. METHODS In a single-centre, prospective, observational, independent study, we enrolled 122 patients who had AVR using a Trifecta bioprosthesis in the July 2010–June 2011 period. A clinical and echocardiographic in-house follow-up was scheduled. RESULTS In our series, 14.7% of patients received a 19-mm, 28.7% had a 21-mm, 35.2% had a 23-mm and 21.3% had a greater-size prosthesis. There were no cases of operative mortality or of valve-related complications both early and at follow-up (except one sudden unexplained death). Completeness of the 3-year echocardiographic follow-up was 80% among survivors. The average mean transvalvular gradient (mTVG) at 3 years was 14.2, 10.8, 8.6, 7.1 and 6.8 mmHg (sizes 19 to 27/29, respectively). There was no statistically significant difference between average mTVGs measured immediately after implantation versus at the 3-year follow-up in the overall population. The average peak transvalvular gradient (pTVG) at 3 years was 25, 20, 16.8, 13.9 and 14.4 mmHg (sizes 19 to 27/29, respectively). The average indexed effective orifice area (iEOA) at 3 years was 0.8, 0.9, 1, 1.3 and 1.3 cm2/m2 (sizes 19–27, respectively). The rate of moderate patient–prosthesis mismatch (PPM) at 3 years was 15.7%; there were two instances of severe PPM (2.2%). All cases of PPM occurred in the 19, 21 and 23 mm size subgroups. CONCLUSIONS The Trifecta valve retains its excellent haemodynamic properties at the 3-year follow-up. The rate of PPM is considerably lo

Hypertension artérielle pulmonaire associée à la prise de léflunomide : 4 cas

National audienc

24 Prognostic value of left atrial reservoir function in patients with severe aortic stenosis

International audienceno abstrac

Impact of Three Different Algorithms for the Screening of SSc-PAH and Comparison with the Decisions of a Multidisciplinary Team

International audienceBackground: to compare three existing screening algorithms of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) with the results of a multidisciplinary team (MDT) meeting from a tertiary center. Methods: we conducted a monocentric longitudinal study from 2015 to 2018. All patients with SSc according to LeRoy’s classification were eligible. Patients were excluded in the case of missing data required by any of the three screening algorithms. The algorithms were applied for each patient at inclusion. Right heart catheterization (RHC) was performed based on the MDT decision. MDT members were all blinded from the results of the three algorithms regarding RHC recommendations. The RHC recommendations of each algorithm were compared with the MDT decision, and the impact on diagnosis and management was evaluated. Results: 117 SSc patients were consecutively included in the study, and 99 had follow-up data over the three-year duration of the study (10 deaths). Among the 117 patients, the MDT suggested RHC for 16 patients (14%), DETECT algorithm for 28 (24%), ASIG for 48 (41%) and ESC/ERS 2015 for 20 (17%). Among the 16 patients who had RHC, SSc-PAH was diagnosed in seven. Among patients with an initial recommendation of RHC based on at least one algorithm but not according to the MDT meeting, no SSc-PAH was diagnosed during the three-year follow-up. Results were unchanged when the new 2018 definition of PAH was applied instead of the previous definition. Conclusion: a MDT approach appears interesting for the screening of SSc-PAH, with a significant reduction of RHC performed in comparison with dedicated algorithms. The specific relevance of a MDT for the management and follow-up of patients with RHC recommended by existing algorithms but with no PAH warrants further studies

Severe Pulmonary Hypertension Associated with COPD: Hemodynamic Improvement with Specific Therapy

International audienceBackground - There is no recommendation for treating pulmonary hypertension (PH) when associated with chronic obstructive pulmonary disease (COPD). Objective - To evaluate the effect of PH-specific therapy in patients with COPD. Methods - All successive patients with severe PH [mean pulmonary arterial pressure (mPAP) ≥35 mm Hg] and COPD, who received specific PH medication and who underwent right heart catheterization at baseline and after 3-12 months of treatment, were analyzed from a prospective database. Results - Twenty-six patients were included with a median follow-up of 14 months. Mean forced expiratory volume in 1 s was 57 ± 20% of predicted, and mean forced expiratory volume in 1 s/forced vital capacity was 47 ± 12%. Dyspnea was New York Health Association classification stage (NYHA) II in 15%, NYHA III in 81% and NYHA IV in 4%. First-line treatments were endothelin receptor antagonists in 11 patients, phosphodiesterase-5 inhibitors in 11 patients, calcium blocker in 1 patient, combination therapy in 3 patients including 2 with a prostanoid. After 6 ± 3 months, pulmonary vascular resistance decreased from 8.5 ± 3 to 6.6 ± 2 Wood units (p < 0.001), with significant improvement of cardiac index from 2.44 ± 0.43 to 2.68 ± 0.63 liters × min × m-2 (p = 0.015) and mPAP from 48 ± 9 to 42 ± 10 mm Hg (p = 0.008). There was no significant difference in dyspnea, 6-min walking distance, echocardiographic parameters or N-terminal pro-brain natriuretic peptide levels. There was no significant difference in arterial oxygen saturation after 3-12 months of treatment. Conclusions - Specific PH medications may improve hemodynamic parameters in COPD patients with severe PH. Appropriate prospective randomized studies are needed to evaluate the potential long-term clinical benefit of treatment