0035 : Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: experience of Clermont-Ferrand hospital

BackgroundThe out-of-hospital cardiac arrest represent the leading cause of death worldwide. Several therapeutic elements such as early reperfusion developed in recent years to reduce the high morbidity and mortality observed in this situation. The objective of this study was to evaluate the influence of emergency coronary angiography (CAG) and primary percutaneous coronary intervention (PCI) on the outcome of patients survivors after out-of-hospital cardiac arrest.MethodsBetween January 2012 and June 2013, a total of 54 consecutive patients survivors of out-of-hospital cardiac arrest underwent systematic emergency coronary angiography.ResultsThirty five of the 54 patients had clinically significant coronary disease on angiography, 23 of whom had coronary-artery occlusion (43%). Angioplasty was attempted in 20 patients and was technically successful in 18. The in-hospital survival rate was 48%. Multivariate logistic-regression analysis revealed that angioplasty was an independent predictor of survival (95 percent confidence interval, 3.1 to 750.1; P =0.006).ConclusionsAcute coronary-artery occlusion is frequent in survivors of out-of-hospital cardiac arrest. Accurate diagnosis by immediate coronary angiography can be followed in suitable candidates by coronary angioplasty, which seems to improve survival

0036 : Predictive value of clinical and electrocardiographic features in survivors of out-of-hospital cardiac arrest

BackgroundAcute coronary lesions are known to be the most common trigger of out of hospital cardiac arrest (OHCA). But the diagnosis of acute coronary artery disease in survivors of out-of-hospital cardiac arrest is difficult. The aim of the present study was to assess the predictive value clinical and electrpcardiographic features in diagnosing the presence of acute coronary lesions among out-of-hospital cardiac arrest patients.MethodsClinical and electrocardiographic data collected before coronary angiography were analyzed to determine whether they could be used to predict the presence of recent coronary – artery occlusion on angiography.Results54 patients underwent coronarography angiography after OHCA; 42% of patients had ST-segment elevation and 57% of patients had other ECG patterns on post-restoration of spontaneous circulation (ROSC) ECG. Acute coronary lesions was found in 66% of patients; Significant coronary artery disease was observed in 83% of patients with ST-segment elevation and in 55% of patients with other ECG patterns on post-ROSC ECG (p = 0.03).Significant coronary artery disease was observed in 100% of patients with chest pain before the arrest and in 55% of patients without chest pain (p=0.02). Chest pain has a good positive predictive value but a low negative predictive value in diagnosing the presence of acute or presumed recent coronary artery lesions (100% and 45%, respectively).ConclusionST-segment elevation and chest pain before arrest after OHCA should not be considered as strict selection criteria for performing emergent coronary angiography in patients resuscitated from OHCA; even in the absence of ST-segment elevation on post- return of spontaneous circulation ECG, acute culprit coronary lesions may be present and considered the trigger of cardiac arrest

0357 : Platypnea orthodeoxia syndrome: focus on predisposing anatomical factors

Platypnea orthodeoxia syndrome (POS) is a rare situation with hypoxia and breathlessness in the upright position recovering in the recumbent position. A mechanical inter-atrial septum distortion, causing redirection of flow from the right to the left atrium through a patent foramen ovale (PFO), despite normal pulmonary pressure, is suggested to explain POS. Prevalence of predisposing anatomical factors remain little knownMethodsAll patients who underwent a PFO closure for a POS were retrospectively included from 2 CHU. Predisposing anatomical factors were investigated.Results67 patients (Median age 72 y.o., interquartile range 61-80; 58.2% men) were included. All patients had dyspnea (76.2% NYHA III or IV, 53.7% under oxygen-therapy). The remaining patients had a refractory hypoxemia (38.2%) without POS. Most frequent predisposing anatomical factor was an enlarged or unwound aorta (n=29, 43.3% 95CI 31.2-56.0) with an aortic aneurysm in 25 patients (37.3%, 95CI 25.8-50.0). Other factors identified were pneumonectomy (n=8, 11.9% CI95 5.3-22.2), a history of cardiac surgery (n=7, 10.5%, 95CI 4.3-20.3), mechanical ventilation (n=6, 9.0% 95CI 3.4-18.5), kyphoscoliosis (n=4, 6.0% 95CI 1.7-14.6), hepatomegaly (n=4, 6.0% 95CI 1.7-14.6, 2 patients with hepato-renal polycystic disease, one hemochromatosis and one cirrhosis), right ventricle failure (n=2,3.0% 95CI 0.4-10.4), pericardial effusions (n=2,3.0% 95CI 0.4-10.4), right ventricle arrhythmogenic dysplasia (n=2,3.0% 95CI 0.4-10.4), diaphragmatic paralysis (n=1, 1.5% 95CI 0.1-8.0), carcinoid syndrome with tricuspid regurgitation (n=1, 1.5% 95CI 0.1-8.0), a right atrium pace-maker lead (n=1, 1.5% 95CI 0.1-8.0) and a tako-tsubo syndrome (n=1, 1.5% 95CI 0.1-8.0).ConclusionAortic aneurysm and pneumonectomy are the most frequent situation leading to a POS. Other causes were observed such as hepato-renal polycystic kidney, or atrial pacemaker probe that may be underdiagnosed in clinical practice

Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

BACKGROUND Trials of patent foramen ovale (PFO) closure to prevent recurrent stroke have been inconclusive. We investigated whether patients with cryptogenic stroke and echocardiographic features representing risk of stroke would benefit from PFO closure or anticoagulation, as compared with antiplatelet therapy. METHODS In a multicenter, randomized, open-label trial, we assigned, in a 1:1:1 ratio, patients 16 to 60 years of age who had had a recent stroke attributed to PFO, with an associated atrial septal aneurysm or large interatrial shunt, to transcatheter PFO closure plus long-term antiplatelet therapy (PFO closure group), antiplatelet therapy alone (antiplatelet-only group), or oral anticoagulation (anticoagulation group) (randomization group 1). Patients with contraindications to anticoagulants or to PFO closure were randomly assigned to the alternative noncontraindicated treatment or to antiplatelet therapy (randomization groups 2 and 3). The primary outcome was occurrence of stroke. The comparison of PFO closure plus antiplatelet therapy with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 2, and the comparison of oral anticoagulation with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 3. RESULTS A total of 663 patients underwent randomization and were followed for a mean (+/- SD) of 5.3 +/- 2.0 years. In the analysis of randomization groups 1 and 2, no stroke occurred among the 238 patients in the PFO closure group, whereas stroke occurred in 14 of the 235 patients in the antiplatelet-only group (hazard ratio, 0.03; 95% confidence interval, 0 to 0.26; P<0.001). Procedural complications from PFO closure occurred in 14 patients (5.9%). The rate of atrial fibrillation was higher in the PFO closure group than in the antiplatelet-only group (4.6% vs. 0.9%, P = 0.02). The number of serious adverse events did not differ significantly between the treatment groups (P = 0.56). In the analysis of randomization groups 1 and 3, stroke occurred in 3 of 187 patients assigned to oral anticoagulants and in 7 of 174 patients assigned to antiplatelet therapy alone. CONCLUSIONS Among patients who had had a recent cryptogenic stroke attributed to PFO with an associated atrial septal aneurysm or large interatrial shunt, the rate of stroke recurrence was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone. PFO closure was associated with an increased risk of atrial fibrillation

Fermeture percutanée du foramen ovale perméable (l'expérience clermontoise)

Objectif : évaluer l'expérience du CHU de Clermont-Ferrand dans la fermeture percutanée du foramen ovale perméable. Il s'agit d'une étude rétrospective, sur 63 patients ayant bénéficié d'une fermeture percutanée en prévention secandaire d'accident ischémique systématique ou en traitement d'un shunt droite-gauche hypoxémiant. Le taux de succès d'implantation est de 100%. Il y a eu 3 (4,8%) complications majeures dont seulement une laisse des séquelles et 11 (12,7%) complications mineures. Il n'y a eu aucune récidive d'accident ischémique ni de désaturation lors du suivi. La fermeture percutanée de foramen ovale perméable est une technique simple, efficace et présentant peu de complications. Des essais randomisés doivent être réalisés afin de pouvoir émettre des recommandations.CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Comparaison de la contribution de l'échographie 3D et de l'IRM à l'évaluation de la fonction ventriculaire droite et de la fuite pulmonaire à distance du traitement chirurgical de tétralogie de Fallot et malformations apparentées (26 cas auvergnats)

Le ventricule droit des patients opérés de Tétralogie de Fallot et de certaines malformations similaires (APSO, TGV CIV RP) est grevé d'une fuite pulmonaire obligatoire. Il est maintenant démontré que cette fuite est source de complications à long terme lorsqu'elle induit une dilatation télédiastolique du ventricule droit supérieure à 150 mL/m2. Pour ces patients une revalvulation chirurgicale peut être proposée avant même d'atteindre cette valeur critique. Le Gold Standard pour la mesure des volumes du ventricule droit est l'IRM. L'échocardiographie 3D est en plein essor dans l'étude de ce type de cardiopathies congénitales mais en France elle est encore limitée. Notre travail étudie la situation clinique et échocardiographique 2D et 3D de 26 patients auvergnats suivis au CHU de Clermont-Ferrand. Parmi eux 19 ont bénéficié d'une IRM. Les résultats montrent une bonne corrélation entre échographie 3D et IRM pour le volume télédiastolique du ventricule droit avec : une sous-estimation par l'échographie 3D de 17,5 mL/m2 seulement par rapport à l'IRM, une déviation standard peu élevée de 12,1 mL/m2. L'échographie 3D pourrait avoir un bel avenir dans cette indication et notamment substituer rapidement l'IRM pour les patients chez lesquels elle est contre-indiquée.CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Communication interventriculaire du nourrisson (évolution à court terme)

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Fermeture percutanée des canaux artériels persistants significatifs par la prothèse Amplatzer Duct Occluder chez des enfants de pods inférieur ou égal à 6-kg (recueil national et rétrospectif de 58 cas)

La fermeture percutanée utilisant l'Amplatzer Duct Occluder (ADO) est une alternative au traitement chirurgical des canaux artériels persistants (CAP) mal tolérés du nourrisson, mais son utilisation est déconseillée chez les enfants = 3.7-mm étaient associés à un taux d'échec et/ou de complications majeures plus élevé. La fermeture percutanée par ADO de CAP symptomatiques d'enfants <= 6-kg est efficace mais grevée d'un fort taux de complications dans certains sous-groupes.TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Perméabilité du foramen ovale après accident vasculaire cérébral ischémique (comparaison de l'échocardiographie trans-thoracique en seconde harmonique, du doppler transcrânien et de l'échocardiographie trans-oesophagienne)

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF