Assessment of left ventricular recovery in Tako-Tsubo cardiomyopathy using 2D strain echocardiography

Contre la désertification De la convention internationale à l'élaboration participative des programmes d'action nationaux Comme toutes les conventions internationales, la convention sur la désertification est un texte consensuel qui n'indique pas de façon explicite comment mettre en oeuvre toutes ses dispositions. Pourtant, chaque pays affecté est tenu d'élaborer et d'appliquer des programmes d'action nationaux qui doivent être appliqués par les acteurs les plus concernés, les communautés locales. Cet ouvrage propose une démarche pour l'élaboration participative de ces programmes d'action. Il est la synthèse des résultats et des recommandations de la Conférence sous-régionale de vulgarisation de la Convention de lutte contre la désertification et de mise en oeuvre du Plan d'action du RIOD (Réseau international des ONG sur la désertification) en mai 1996. Cette conférence s'inscrivait dans une série de quatre rencontres sous-régionales préconisées afin de faire connaître la convention à un plus grand nombre d'acteurs. Masse Lo - Yacine Diagne - Emmanuel Seck - Série Etudes et recherches n° 190-191 ISBN : 92-9130-0187 - Enda-Editions - Boîte Postale 3370 - Dakar - SENEGAL Tél.: (221) 22-42-29 Télécopie : (221) 23-51-57 E-mail : [email protected]. Prix : 100 FF frais de port inclus pour les pays du Nord - 2 000 FCFA (frais de port : 800 FCFA) pour les pays du SudDe la convention international

Predictors of clinical success after transcatheter para-valvular leak closure: an international prospective multicentre registry

International audienceAbstract Background Prosthetic paravalvular leaks (PVLs) are associated with congestive heart failure and haemolysis, for which the standard treatment is open-heart surgery with the attendant risks to the patient. Transcatheter closure has emerged as an alternative. Patient selection criteria for the best option are needed. We aimed to identify predictors of clinical success after transcatheter PVL closure. Purpose We aimed to identify predictors of clinical success after transcatheter PVL closure. Methods Consecutive patients referred to 24 European centres for transcatheter PVL closure in 2017–2019 were included in a prospective registry (Fermeture de Fuite ParaProthétique, FFPP). Clinical success was absence of any of the following within 1 month: re-admission for heart failure, blood transfusion, open-heart valvular surgery, and death. Results We included 216 symptomatic patients, who underwent 238 percutaneous PVL closure procedures on the mitral (64.3%), aortic (34.0%), or tricuspid (1.7%) valve. The prosthesis was mechanical in 53.3% and biological in 45.3% of procedures. All patients were symptomatic with heart failure, haemolytic anaemia, and the association of both conditions in 48.9%, 7.8% and 43.3%. One, two and three PVL were addressed during the same procedure in 69.6%, 26.6% and 3.8% respectively. Mitral and aortic PVL were severe in 35.3% and 13.8% (p<0.001). PVL was punctiform or extended to 1/8 or 1/4 of valve circumference in 18.6%, 52.4% and 28.1% of cases. A total of 331 devices were implanted. More than one device (up to 5) was implanted in 34.2% of procedures. Vascular plug 3, muscular ventricular septal defect occluder, vascular plug 2 and paravalvular leak device were the most frequently used devices, implanted in 45.0%, 16.0%, 14.2% and 13.6%, respectively. Successful device(s) implantation(s) within the leak and leak reduction ≤ grade 2 occurred in 85.0% and 91.4% of patients with mitral and aortic procedures, respectively (p=0.164), with major intra-procedural adverse event rates of 3.3% and 1.2%, respectively (p=0.371). The clinical success rates were 77.8% and 88.9% following mitral and aortic procedures, respectively (p=0.01). By multivariate logistic regression analysis, technical failure, mechanical valve and haemolytic anaemia were independently associated with absence of clinical success (odds ratios [95% CIs]: 7.7 [2.0–25.0], p=0.002; 3.6 [1.1–11.1], p=0.036 and 3.7 [1.2–11.9], p=0.025; respectively). Conclusion Transcatheter PVL closure is efficient and safe in symptomatic patients but is more challenging and associated with an increased risk of clinical failure when performed in patients with hemolysis and/or on a mechanical valve