Three dimensional echocardiographic assessment of multiple rhabdomyoma in newborn

Cardiac rhabdomyomas represent the most common primary cardiac tumour in children and are strongly associated with tuberous sclerosis complex. This article reports a newborn for whom three-dimensional echocardiogram, with multiplane mode, real-time imaging, full volume and i-slice view, allowed detailed visualisation of multiple highly echogenic and well-circumscribed cardiac rhabdomyoma. Three-dimensional imaging allowed a better definition of the tumour characteristics and provided a better delineation of the spatial relationship of the mass with a tomographic perspective. Three dimensional imaging may facilitate a possible operative planning and should be included in cardiac mass evaluation and follow-up.peer-reviewe

Tako-Tsubo Cardiomyopathy Triggered by Misdirection

Tako-Tsubo cardiomyopathy (TTC), also known as transient left ventricular apical ballooning syndrome or stress-induced cardiomyopathy, is a novel reversible cardiomyopathy mimicking acute myocardial infarction without epicardial coronary artery disease. The exact physiopathology of TTC remains unclear. It is usually precipitated by acute physical or emotional stress and it most commonly affects postmenopausal women. The growing number of clinical cases of TTC have demonstrated a wide field of possible etiologies beyond the emotional stress. We report a case of a 67-year-old postmenopausal woman who was being supplemented by enteral feeding via a nasogastric tube and who developed TTC due to misdirection, probably favored by the mechanical blockade by the nasogastric tube, while swallowing the drug pills

Sport resumption and quality of life after surgical correction of anomalous origin of a coronary artery from the opposite sinus

ObjectivesWe sought to assess the resumption of sport, exercise performances, and quality of life (QoL) in adults and children after surgical repair of anomalous coronary arteries originating from the opposite sinus (ACAOS).Materials and methodsPatients who underwent surgical repair for ACAOS between 2002 and 2022 were retrospectively identified. Information about sports activity and exercise performance based on metabolic equivalents of task (METs) calculated at the last exercise stress test, were collected. QoL was assessed using age-appropriate questionnaires (Paediatric QoL Inventory, cardiac module version 3.0 for patients <18 years; SF-36 QoL Inventory for adults). Patients' METS and patients’ QoL-scores were compared to reference population using the Wilcoxon test.Results45 patients were enrolled (males 71%, adults 49%, anomalous right coronary 84%). Median age at surgery was 15 years; median follow-up after surgery was 2.3 years [4 months–12 years]. All post-operative exercise stress tests were normal, METs and VO2 max patients' values did not differ from healthy children or adults (Exercise intensity: 12.5 ± 4.7 vs. 13.4 ± 2 METS, p = 0.3; VO2 max: 43.6 ± 16.6 vs. 46.9 ± 7 ml/kg/min, p = 0.37). For adults, QoL—scores were similar between ACAOS patients and controls. For children, there was no significant difference between the study patients' scores and those of the reference population, except for physical appearance proxy-report (p = 0.02).ConclusionIn our study, the practice of sports, exercise stress testing and QoL were not adversely affected after ACAOS repair

Capnocytophaga canimorsus endocarditis with root abscess in a patient with a bicuspid aortic valve

Infective endocarditis caused by a zoonotic micro organism is a rare clinical condition. Capnocytophaga canimorsus is a commensal bacterium living in the saliva of dogs and cats which produces rarely reported endocarditis whose incidence may be underestimated, considering its failure to grow on standard media. We reported the case of a 65-year-old man with bicuspid aortic valve endocarditis and multiple abscesses of the aortic wall caused by the canine bacteria C. canimorsus

External Validation of a Risk Score Model for Predicting Major Clinical Events in Adults After Atrial Switch

BACKGROUND: A risk model has been proposed to provide a patient individualized estimation of risk for major clinical events (heart failure events, ventricular arrhythmia, all-cause mortality) in patients with transposition of the great arteries and atrial switch surgery. We aimed to externally validate the model. METHODS AND RESULTS: A retrospective, multicentric, longitudinal cohort of 417 patients with transposition of the great arteries (median age, 24 years at baseline [interquartile range, 18-30]; 63% men) independent of the model development and internal validation cohort was studied. The performance of the prediction model in predicting risk at 5 years was assessed, and additional predictors of major clinical events were evaluated separately in our cohort. Twenty-five patients (5.9%) met the major clinical events end point within 5 years. Model validation showed good discrimination between high and low 5-year risk patients (Harrell C index of 0.73 [95% CI, 0.65-0.81]) but tended to overestimate this risk (calibration slope of 0.20 [95% CI, 0.03-0.36]). In our population, the strongest independent predictors of major clinical events were a history of heart failure and at least mild impairment of the subpulmonary left ventricle function. CONCLUSIONS: We reported the first external validation of a major clinical events risk model in a large cohort of adults with transposition of the great arteries. The model allows for distinguishing patients at low risk from those at intermediate to high risk. Previous episode of heart failure and subpulmonary left ventricle dysfunction appear to be key markers in the prognosis of patients. Further optimizing risk models are needed to individualize risk predictions in patients with transposition of the great arteries.</p

External Validation of a Risk Score Model for Predicting Major Clinical Events in Adults After Atrial Switch

BACKGROUND: A risk model has been proposed to provide a patient individualized estimation of risk for major clinical events (heart failure events, ventricular arrhythmia, all-cause mortality) in patients with transposition of the great arteries and atrial switch surgery. We aimed to externally validate the model. METHODS AND RESULTS: A retrospective, multicentric, longitudinal cohort of 417 patients with transposition of the great arteries (median age, 24 years at baseline [interquartile range, 18-30]; 63% men) independent of the model development and internal validation cohort was studied. The performance of the prediction model in predicting risk at 5 years was assessed, and additional predictors of major clinical events were evaluated separately in our cohort. Twenty-five patients (5.9%) met the major clinical events end point within 5 years. Model validation showed good discrimination between high and low 5-year risk patients (Harrell C index of 0.73 [95% CI, 0.65-0.81]) but tended to overestimate this risk (calibration slope of 0.20 [95% CI, 0.03-0.36]). In our population, the strongest independent predictors of major clinical events were a history of heart failure and at least mild impairment of the subpulmonary left ventricle function. CONCLUSIONS: We reported the first external validation of a major clinical events risk model in a large cohort of adults with transposition of the great arteries. The model allows for distinguishing patients at low risk from those at intermediate to high risk. Previous episode of heart failure and subpulmonary left ventricle dysfunction appear to be key markers in the prognosis of patients. Further optimizing risk models are needed to individualize risk predictions in patients with transposition of the great arteries.</p

Mécanique et remodelage cardiaque des lésions congénitales obstructives du coeur gauche

L’objectif de cette thèse est d'analyser en échocardiographie le remodelage et la fonction cardiaque après correction optimale d’un obstacle congénital du cœur gauche et d’identifier de potentiels marqueurs de risque de survenue de fibrillation atriale. Le premier axe de ce travail est une étude prospective multicentrique qui présente le profil évolutif des arythmies atriales chez les adultes porteurs d’une cardiopathie congénitale. Cette étude démontre l’importance de la fibrillation atriale qui devient l’arythmie prédominante après l’âge de 50 ans chez ces patients. Le deuxième axe de travail s’intéresse à la rigidité atriale, un indice échocardiographique corrélé à la présence de fibrose et à la survenue de fibrillation atriale. Nous avons montré que la rigidité atriale est anormale malgré la correction optimale d’un obstacle congénital du cœur gauche, en particulier chez les patients opérés d’une coarctation aortique. Les troisième et quatrième axe de recherche ont exploré spécifiquement le remodelage et la fonction cardiaque après cure de coarctation. Dans la troisième étude, l’analyse en 2D strain a permis d’identifier une forte prévalence de dysfonction atriale chez des adultes et adolescents opérés d’une coarctation aortique. La fonction atriale est influencée par l’anatomie de l’arche aortique ; une relation entre la fonction atriale et la survenue d’évènements cardiovasculaires a été trouvée. Enfin, dans le dernier travail, l’analyse du cœur droit en 2D strain a permis de révéler des anomalies de la fonction ventriculaire droite après cure de coarctation. Nos résultats illustrent l’apport potentiel des nouvelles techniques d’imagerie comme le 2D strain pour identifier des patients à risque de développer une fibrillation atriale dont la prévention est un des enjeux majeurs de la cardiologie congénitale adulte.The objective of this thesis is to analyze myocardial mechanics and cardiac remodeling and function, using transthoracic echocardiography, after optimal correction of a congenital obstruction of the left ventricle and to identify potential risk markers for the occurrence of atrial fibrillation. The first focus of this work is a prospective multicenter study presenting the evolutionary pattern of atrial arrhythmias in adults with congenital heart disease. This study demonstrates the prominence of atrial fibrillation, which becomes the predominant atrial arrhythmia after the age of 50 in these patients. The second area of study focuses on left atrial stiffness, a recent echocardiographic index well correlated with the presence of atrial fibrosis and occurrence of atrial fibrillation. We demonstrate that left atrial stiffness may be abnormal despite optimal correction of a congenital left heart obstruction, especially in patients experiencing aortic coarctation and in overweight patients. The third and fourth lines of research specifically explore remodeling and cardiac function in patients whose aortic coarctation has been repaired. In the third area of research, we use two-dimensional strain analysis to detect a high prevalence of left atrial dysfunction in adults and adolescents after aortic coarctation repair. Left atrial dysfunction is influenced by the anatomy of the aortic arch; a potential relationship with cardiovascular events and left atrial function is identified. Finally, in the last area of research, we identify anomalies of the right ventricular function after coarctation repair. Our results illustrate the potential contribution of new imaging techniques such as two-dimensional strain to identify patients at risk of developing atrial fibrillation, the prevention of which is one of the current challenges in adult congenital cardiology

Effets de la stimulation biventriculaire sur les paramètres de déformation myocardique (importance du choix du référentiel temporel pour le calcul du Strain)

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Anomalies de la déformation myocardique chez les enfants obèses (étude prospective en 2D strain)

CAEN-BU Médecine pharmacie (141182102) / SudocSudocFranceF