Thrombolysis is an effective and safe therapy in stuck bileaflet mitral valves in the absence of high-risk thrombi

AbstractOBJECTIVESWe sought to evaluate the effectiveness and safety of thrombolytic therapy in stuck mitral bileaflet heart valves in the absence of high-risk thrombi.BACKGROUNDCurrent recommendations for the thrombolytic treatment of stuck prosthetic mitral valves are partially based on older valve models and inclusion of patients in whom high-risk thrombi were either ignored or not sought for. The feasibility and safety of thrombolysis in bileaflet models may be affected by the predilection of thrombi to catch the leaflet hinge.METHODSWe studied 12 consecutive patients (men/women = 5/7, age 58.8 ± 14.9 years) who experienced one or more episodes of stuck bileaflet mitral valve over a 33-month period and received thrombolytic therapy with streptokinase, urokinase or tissue-type plasminogen activator. Transesophageal echocardiography was performed in all patients. Patients with mobile or large (>5 mm) thrombi were excluded. Functional class at initial episode was I–II in 4 patients (33.3%) and III–IV in 8 patients (66.6%).RESULTSPatients receiving thrombolytic therapy achieved an overall 83.3% freedom from a repeat operation or major complications (95% confidence interval 51.6–97.9%). Minor bleeding occurred in three patients (25%) and allergic reaction in one (8.3%). Transient vague neurologic complaints, without subjective findings, occurred in four patients (33.3%). Three patients had one or more relapses within 5.2 ± 3.1 months from the previous episode, and readministration of thrombolytics was successful.CONCLUSIONSIn clinically stable patients with stuck bileaflet mitral valves and no high-risk thrombi, thrombolysis is highly successful and safe, both in the primary episode and in recurrence. The best thrombolytic regimen is yet to be established

Evaluation of 17-mm St. Jude Medical Regent prosthetic aortic heart valves by rest and dobutamine stress echocardiography

BACKGROUND: The prosthesis used for aortic valve replacement in patients with small aortic root can be too small in relation to body size, thus showing high transvalvular gradients at rest and/or under stress conditions. This study was carried out to evaluate rest and Dobutamine stress echocardiography (DSE) hemodynamic response of 17-mm St. Jude Medical Regent (SJMR-17 mm) in relatively aged patients at mean 24 months follow-up. METHODS AND RESULTS: The study population consisted of 19 patients (2 men, 17 women, mean age 69.2 ± 7.3 years). All patients underwent rest Doppler echocardiography before and after surgery and basal and DSE at follow up (infused at rate of 5 micrg/Kg/min and increased by 5 microg/Kg/min at 5 min intervals up to 40 microg/Kg/min). The following parameters were evaluated at rest and/or under DSE: heart rate (HR), ejection fraction (EF), cardiac output (CO), peak and mean velocity and pressure gradients (MxV, MnV, MxPG, MnPG), effective orifice area (EOA), indexed EOA (EOAi), left ventricular mass (LVM), indexed LVM (LVMi), Velocity Time Integral at left ventricular outflow tract (VTI LVOT) and transvalvular (Aortic VTI), Doppler velocity index (DVI). At rest MxPG and MnPG were 29.2 ± 7.1 and 16.6 ± 5.8mmHg, respectively; EOA and EOAi resulted 1.14 ± 0.3 cm(2) and 0.76 ± 0.2 cm(2)/m(2); DVI was normal (0.50 ± 0.1). At follow-up LVM and LVMi decreased significantly from pre-operative value of 258 ± 43g and 157.4 ± 27.7g/m(2) to 191 ± 23.8g and 114.5 ± 10.6g/m(2), respectively. DSE increased significantly HR, CO, EF, MxGP (up to 83.4 ± 2 1.9mmHg), MnPG (up to 43.2 ± 12.7mmHg). EOA, EOAi, DVI increased insignificantly (from baseline up to 1.2 ± 0.4 cm(2), 0.75 ± 0.3cm(2)/m(2) and 0.48 ± 0.1 respectively). Two patients developed significant intraventricular gradients. CONCLUSION: These data show that SJMR 17-mm prostheses can be safely implanted in aortic position in relatively aged patients, offering a satisfactory hemodynamic performance at rest and under DSE, with full utilization of its available orifice, suggesting that a possible mild prosthesis-patient mismatch is not an issue of clinical relevance when this small prosthesis is used. Rest and Dobutamine stress echocardiography is a useful and effective means for evaluating prosthesis hemodynamics and for monitoring the expected LVH regression

Compte rendu du colloque « Parallel Lives: Ancient Island Societies in Crete and Cyprus », Nicosie, 2007

Dunn-Vaturi Anne-Elizabeth. Compte rendu du colloque « Parallel Lives: Ancient Island Societies in Crete and Cyprus », Nicosie, 2007. In: Cahiers du Centre d'Etudes Chypriotes. Volume 36, 2006. pp. 233-237

Aux sources du "jeu du chien et du chacal"

International audienceThe archaeological material from Egypt and the Near East includes significant evidence for board games. Commercial relations and military conquests in these regions enabled the diffusion of several games whose ancient names remain unknown, such as the game of Hounds and Jackals, also called the game of 58 holes. This game, attested from the Nile Valley and eastward as far as Iran for more than a millennium, underwent some variations in the shape and decoration of the boards depending on their cultural context. Due to the conditions afforded by the Egyptian climate and pioneering work by Egyptologists, playing scenes and game boards in good states of preservation were discovered since the end of the 19th century. The game of Hounds and Jackals was therefore described as Egyptian early on. This paper tries to determine if we can confirm that the game originated in Egypt or rather in a neighboring region: the earliest examples from the Near East turn out to be as ancient as those found in Egypt, and the eastern corpus proves to be more important during the early second millennium BCE than previously thought.Le matériel archéologique de l’Égypte et du Proche-Orient comporte de nombreux témoignages de jeux de parcours. Les relations commerciales et les conquêtes qui ont animé ces régions ont favorisé la diffusion de certains jeux, tels que le "jeu du chien et du chacal", également connu sous son autre nom moderne de "jeu de 58 trous", car l’on ne connaît pas son appellation originelle. Ce jeu, attesté des rives du Nil aux confins de l’Iran pendant plus d’un millénaire, a subi quelques variations morphologiques et décoratives en fonction de son contexte culturel. Grâce aux conditions climatiques de l’Égypte et aux travaux des pionniers de l’égyptologie, des plateaux en bon état de conservation ont été découverts dès la fin du XIXe siècle. Ainsi, il est admis très tôt que le "jeu du chien et du chacal" est d’origine égyptienne. Cette contribution tente de déterminer si l’on peut considérer que le jeu a pris forme en Égypte ou dans une contrée voisine. En effet, les premières attestations de ce jeu au Proche-Orient rivalisent d’ancienneté avec les jeux égyptiens et le corpus oriental s’avère plus large au début du IIe millénaire que ce qui a pu être envisagé

Les fouilles de Claude Schaeffer à Vounous en 1933

Dunn-Vaturi Anne-Elizabeth. Les fouilles de Claude Schaeffer à Vounous en 1933. In: Cahiers du Centre d'Etudes Chypriotes. Volume 31, 2001. pp. 21-31

Le récolement des antiquités chypriotes dans les collections françaises. Nouvelles perspectives vingt ans après le catalogue d'Antoinette Decaudin

A unit has the responsibility since 1997 to audit the loans of antiques from the Louvre Museum. Significant searches in the archives and on-the-spot visits have allowed us to itemize, in addition to the works of the Louvre attributed to French and foreign museums, the archaeological collections belonging to those museums. The presentation of this material is the continuation of the inventory of Cypriot antiquities in France, undertaken by Annie Caubet when she started out in the Département des antiquités orientales.Dunn-Vaturi Anne-Elizabeth. Le récolement des antiquités chypriotes dans les collections françaises. Nouvelles perspectives vingt ans après le catalogue d'Antoinette Decaudin. In: Cahiers du Centre d'Etudes Chypriotes. Volume 37, 2007. Hommage à Annie Caubet. pp. 71-85

Compte rendu du colloque « Parallel Lives: Ancient Island Societies in Crete and Cyprus », Nicosie, 2007

Dunn-Vaturi Anne-Elizabeth. Compte rendu du colloque « Parallel Lives: Ancient Island Societies in Crete and Cyprus », Nicosie, 2007. In: Cahiers du Centre d'Etudes Chypriotes. Volume 36, 2006. pp. 233-237