171 Definitive pacemaker requirement after percutaneous Edwards Sapien aortic valve implantation: a rare complication

In 2009, more than 6000 patients have been treated with percutaneous aortic valve implantation using one of the two commercialized models of bioprothesis. The occurrence of complete atrioventricular block (AV-Block) requiring a pacemaker was described after implantation, particularly with the Corevalve (up to 25%).Purpose of the StudyTo evaluate the occurrence of conduction abnormalities and requirements for permanent pacing after Edwards Sapien aortic valve implantation.MethodsWe analyzed the standard 12-lead electrocardiograms (ECGs) of 55 consecutive Pts in whom an Edwards Sapien aortic valve was successfully implanted between June 2006 and December 2008 using either trans-femoral or trans-apical approach. We examined the ECGs before treatment, at day 1, and at one-month and analyzed the presence of a second or third-degree AV-block.ResultsMean age was 82 +/- 8.4 years and 46% were female. Logistic Euroscore was 27.8 + 14.9%. We noted a slight increase in HR at day-1 (78.8 + 16 vs 74.9 + 13 b / min, p=0.005) with decrease in QT interval (395±47.7 vs 416.8±40.2 ms, p=0.02). These values returned to baseline values at 1 month. There was no change in PR interval (198.8±42.4 vs 199.7±45.7 ms at day 1, p=0.98 and 199.3±39.8 ms at day 30, p=0.56) and QRS duration (113.3±26.2 vs 116.8±28 ms at day 1, p=0.14 and 113.2±25.4 ms at day 30, p=0.63) neither in the occurrence of hemiblocks. A new left bundle branch developed in 5 Pts (9%) at day one but was not present anymore at day-30. A permanent pacemaker was implanted in 2 cases (4.1%) for 3-degree AV-block: at day 3 one for persistent AV-Block developed immediately after aortic valve predilatation and at day 10 in the second case due to the delayed occurrence of 3-degree AV-Block.ConclusionsIn our experience, conductive disorders and the requirement of a definitive pacemaker after implantation of an Edwards-Sapien bioprothesis are unfrequent (4.1%)

Multicenter Evaluation of Edwards SAPIEN Positioning During Transcatheter Aortic Valve Implantation With Correlates for Device Movement During Final Deployment

ObjectivesThis study sought to evaluate the exact location of Edwards SAPIEN (Edwards Lifesciences, Irvine, California) devices in different stages of implantation and to quantify possible operator-independent device movement during final deployment.BackgroundAccurate device positioning during transcatheter aortic valve implantation is crucial in order to achieve optimal results.MethodsThis multicenter study consisted of 68 procedures with reliable pacemaker capture. Device positions were assessed using fluoroscopic images and the C-THV system (Paieon Medical, Rosh Ha'Ayin, Israel).ResultsThe location after implantation was significantly higher than in the final stage of rapid pacing: 16.7 ± 16.3% of device height below the plane of the lower sinus border versus 32.6 ± 13.8%, p < 0.0001. Operator-independent device-center upper movement during final deployment was 2 ± 1.43 mm, range: −1.3 to 4.6 mm. Device movement was asymmetrical, occurring more in the lower part of the device than in its upper part (3.2 ± 1.4 mm vs. 0.75 ± 1.5 mm, p < 0.001), resulting in device shortening. Multivariate analysis revealed that moderate and severe aortic valve calcification had 49% higher upward movement than mild calcification (p = 0.03), and aortic sinus volume was negatively correlated with movement size (r = −0.35, p = 0.005). This movement was independent of device version (SAPIEN vs. SAPIEN XT), procedural access (transfemoral vs. transapical), and interventricular septum width.ConclusionsThe final Edwards SAPIEN position is mostly aortic in relation to the lower sinus border. There is an operator-independent upward movement of the device center during the final stage of implantation. Anticipated upward movement of the device should influence its positioning before final deployment

Sixty-four multislice computed tomography after transcutaneous implantation of a Cribier-Edwards bioprosthesis in the aortic position.

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[Indications for MRI in coronary disease]

International audienceMagnetic resonance imaging (MRI) has become a useful, even essential, examination in recent years, for the exploration of patients with coronary disease. MRI has several different roles, even though it remains insufficiently requested because insufficiently available. Today it is the reference examination for assessing indicators of ventricular function (volume, ejection fraction, ventricular mass); their prognostic value and importance in determining treatment are well recognized. In the postinfarction period, MRI using late enhancement techniques allows a precise analysis of the extent of necrosis, in terms of segments and transmural involvement. MRI is indicated, especially preoperatively, in cases of ventricular remodeling and its consequences (functional impairment, aneurysms, parietal thrombus). MRI with pharmacological stress may also be used as a tool for detecting myocardial ischemia; in this case, perfusion or first-pass sequences should be used. On the other hand, cardiac MRI for morphologic exploration of the coronary network and measurement of stenosis is not yet routine

MR delayed enhancement imaging findings in suspected acute myocarditis.

International audienceThe purpose of the study was to prospectively assess the clinical impact of routinely performed delayed enhancement imaging in suspected acute myocarditis. A two-centre prospective study was performed in patients with suspected acute myocarditis. The protocol included horizontal long axis, vertical long axis and short axis ciné MR and delayed enhancement imaging after Gd-DTPA infusion (0.2 mmol/kg). Sixty consecutive patients were enrolled (aged 49.4 +/- 17.8 years). MRI demonstrated delayed enhancement sparing the subendocardicardial layer in 51.6% of patients, concordant with the diagnosis of acute myocarditis; 16.7% of patients exhibited delayed enhancement involving the subendocardial layer with irregular margins, concordant with the diagnosis of acute myocardial infarction; 31.7% of patients had delayed enhancement imaging that was considered normal. Routine imaging to identify delayed enhancement provided crucial information in suspected acute myocarditis by reinforcing the diagnosis in 51.6% of patients and correcting a misdiagnosed acute myocardial infarction in 16.7% of patients

Bee+Cl@k: An Implementation of Lattice-Based Array Contraction in the Source-to-Source Translator ROSE

International audienceWe build on prior work on intra-array memory reuse, for which a general theoretical framework was proposed based on lattice theory. Intra-array memory reuse is a way of reducing the size of a temporary array by folding, thanks to affine mappings and modulo operations, reusing memory locations when they contain a value not used later. We describe the algorithms needed to implement such a strategy. Our implementation has two parts. The first part, Bee, uses the source-to-source transformer ROSE to extract from the program all necessary information on the lifetime of array elements and to generate the code after memory reduction. The second part, Cl@k, is a stand-alone mathematical tool dedicated to optimizations on polyhedra, in particular the computation of successive minima and the computation of good admissible lattices, which are the basis for lattice-based memory reuse. Both tools are developed in C++ and use linear programming and polyhedra manipulations. They can be used either for embedded program optimizations, e.g., to limit memory expansion introduced for parallelization, or in high-level synthesis, e.g., to design memories between communicating hardware accelerators