Holder System for External Pumps Positioned Remote from the CPB Console: 23 Years’ Experience

Since 1995, our objective is to set up the extracorporeal circulation (ECC) in a manner that is both safe and versatile with a holder system which makes possible to install the oxygenator and vacuum-assisted venous drainage (VAVD) hard-shell venous reservoir (HSVR) together with the external pumps, at a distance from the cardiopulmonary bypass (CPB) console but at the same height as the patient’s shoulder. The aim is to reduce the effects of ECC by reducing surface of air/blood, blood/materials contact, the dead space of the system and priming volume of the circuit. Our ECC systems have a biocompatible surface treatment, the oxygenator and HSVR are adapted to the patient (body surface area, pathologies, etc.) and circuit includes short 3/8 in arterial and venous line (adult patients). We introduced into routine VAVD, retrograde autologous priming (RAP), including arterial line, arterial filter and antegrade autologous priming of the venous line (VAP) before the start of ECC. To confirm this development strategy of the ECC, we conducted a series of studies that have permitted to demonstrate the positive impact on postoperative outcomes of patients. Since September 2007, our objective was attained through the creation of a holder system (System U. Borrelli)

Dysfonctions cardiaques transitoires induites par un exercice physique prolongé (Exploration mécanistique par une approche translationnelle)

L activité physique régulière est bénéfique pour la santé cardiovasculaire. Cependant, destravaux ont rapporté des dysfonctions cardiaques après des exercices physiques prolongés (EPP) tels que les marathons ou les triathlons longue distance type "Ironman". Ces dysfonctions sont souvent associées à des dommages myocardiques. Récemment, des études échocardiographiques ont suggéré que ces dysfonctions étaient associées à des baisses de contractilité et de relaxation myocardiques.Toutefois, l atteinte myocardique après un EPP reste à ce jour controversée et les mécanismes sousjacents de ces dysfonctions demeurent inconnus. Dans ce contexte, le but de ce travail de doctorat a été de vérifier la diminution de contractilité et/ou de relaxation du myocarde après un EPP ii) d évaluer l implication de la voie ß-adrénergique et du stress oxydant dans l altération de la fonction cardiaque.Pour cela, une première approche clinique, basée sur l utilisation de l échocardiographie cardiaque haute résolution (et plus particulièrement une technique de pointe, le "Speckle TrackingEchocardiography") nous a permis d appréhender la fonction myocardique par l intermédiaire de l évaluation des déformations et de la torsion du ventricule gauche pendant le cycle cardiaque. Une deuxième approche fondamentale, chez l animal, nous a permis d évaluer la fonction cardiaque après un EPP chez le rat au niveau de l organe entier et de l organe isolé dans des conditions basale et de stress (ß-adrénergique). Des investigations complémentaires ont été réalisées sur le tissu myocardique pour évaluer le stress oxydant (GSH/GSSG, MDA) et des marqueurs de dommages cellulaires cardiaques (troponines I) après avoir bloqué la NAD(P)H oxydase (Nox), enzyme fortement impliquée dans la production d espèces réactives dérivées de l oxygène au niveau cardiaque. Les résultats de ces travaux montrent clairement, chez l Homme et l animal, des baisses de contractilité et de relaxation myocardiques associées à une augmentation des marqueurs de dommages cellulaires cardiaques après un EPP. Alors que la voie ß-adrénergique ne semble pas être impliquée dans ces dysfonctions, nos résultats indiquent que le stress oxydant joue un rôle majeur, puisque lorsque la Nox est bloquée, la fonction cardiaque est majoritairement restaurée après l EPP.Regular physical activity is beneficial for cardiovascular health. However, recentstudies have uncovered the presence of cardiac dysfunctions following prolonged physical exercise(PPE), such as marathon racing, or long-distance triathlons like the Ironman . These cardiacdysfunctions are often associated with damage at the myocardial level. Recently, someechocardiographic studies suggested that these dysfunctions were linked to a diminished myocardialcontractility and relaxation capacity. Nonetheless, the specific impact of PPE on myocardial propertiesremains controversial, and the mechanisms underlying these dysfunctions are thus far unknown.Therefore, within this context, the objectives of this PhD research were to i) verify the purporteddecrease in myocardial contractility and relaxation capacity following PPE, and ii) evaluate the rolesof the B-adrenergic pathway and oxidative stress in the alteration of cardiac function. In order toexplore this adequately, two different approaches were used. Firstly, a clinical approach wasemployed, based on the use of high resolution echocardiography (or more specifically, a leading edgetechnique known as Speckle Tracking Echocardiography), and allowed us to characterise myocardialfunction via the evaluation of left ventricular strain and torsion during a cardiac cycle. The secondfundamental approach, using an animal model, allowed us to evaluate cardiac function following PPEin rats; at a whole organ (in vivo) level and at an isolated organ (ex vivo) level, during both resting andstress (ß-adrenergic) conditions. Complementary investigations were conducted on myocardial tissueto evaluate oxidative stress (GSH/GSSG,MDA) and markers of myocardial damage (troponin I), afterhaving blocked NAD(P)H oxidase (Nox); an enzyme strongly involved in the production of oxidativestress at the cardiac level. Our findings clearly demonstrate, in both humans and animals, a decrease inmyocardial contractility and relaxation capacity, associated with an increase in markers of myocardialdamage, following PPE. Whilst the ß-adrenergic pathway does not appear to be involved in thesedysfunctions, our results indicate that oxidative stress plays a major role, since cardiac function isrestored following PPE when the Nox is blocked.AVIGNON-Bib. numérique (840079901) / SudocSudocFranceF

Myocardial function at the early phase of traumatic brain injury: a prospective controlled study

The concept of brain-heart interaction has been described in several brain injuries. Traumatic brain injury (TBI) may also lead to cardiac dysfunction but evidences are mainly based upon experimental and clinical retrospective studies. Methods We conducted a prospective case-control study in a level I trauma center. Twenty consecutive adult patients with severe TBI were matched according to age and gender with 20 control patients. The control group included adult patients undergoing a general anesthesia for a peripheral trauma surgery. Conventional and Speckle Tracking Echocardiography (STE) was performed within the first 24 post- traumatic hours in the TBI group and PRE/PER-operative in the control group. The primary endpoint was the left ventricle ejection fraction (LVEF) measured by the Simpson’s method. Secondary endpoints included the diastolic function and the STE analysis. Results We found similar LVEF between the TBI group and the PER-operative control group (61 % [56–76]) vs. 62 % [52–70]). LV morphological parameters and the systolic function were also similar between the two groups. Regarding the diastolic function, the isovolumic relaxation time was significantly higher in the TBI cohort (125 s [84–178] versus 107 s [83–141], p = 0.04), suggesting a subclinical diastolic dysfunction. Using STE parameters, we observed a trend toward higher strains in the TBI group but only the apical circumferential strain and the basal rotation reached statistical significance. STE-derived parameters of the diastolic function tended to be lower in TBI patients. Discussion No systematic myocardial depression was found in a cohort of severe TBI patients. Conclusions STE revealed a correct adaptation of the left systolic function, while the diastolic function slightl

Conception aéroélastique optimale d'une aile de missile

Le couplage aéroélastique entre la structure évidée d'une aile de missile de croisière et le fluide en écoulement à vitesse transsonique sur cette aile est exploité pour augmenter la portée du missile. Une boucle de calcul permet de calculer la finesse du missile sous charge à l'équilibre des forces et de vérifier sa tenue structurale. Une exploration systématique de l'espace des paramètres est présentée et analysée

The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging

The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination. Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function. When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed. With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR

Influence of training status and exercise modality on pulmonary O2 uptake kinetics in pre-pubertal girls

The limited available evidence suggests that endurance training does not influence the pulmonary oxygen uptake (V(O)(2)) kinetics of pre-pubertal children. We hypothesised that, in young trained swimmers, training status-related adaptations in the V(O)(2) and heart rate (HR) kinetics would be more evident during upper body (arm cranking) than during leg cycling exercise. Eight swim-trained (T; 11.4 +/- 0.7 years) and eight untrained (UT; 11.5 +/- 0.6 years) girls completed repeated bouts of constant work rate cycling and upper body exercise at 40% of the difference between the gas exchange threshold and peak V(O)(2). The phase II V(O)(2) time constant was significantly shorter in the trained girls during upper body exercise (T: 25 +/- 3 vs. UT: 37 +/- 6 s; P &#60; 0.01), but no training status effect was evident in the cycle response (T: 25 +/- 5 vs. UT: 25 +/- 7 s). The V(O)(2) slow component amplitude was not affected by training status or exercise modality. The time constant of the HR response was significantly faster in trained girls during both cycle (T: 31 +/- 11 vs. UT: 47 +/- 9 s; P &#60; 0.01) and upper body (T: 33 +/- 8 vs. UT: 43 +/- 4 s; P &#60; 0.01) exercise. The time constants of the phase II V(O)(2)and HR response were not correlated regardless of training status or exercise modality. This study demonstrates for the first time that swim-training status influences upper body V(O)(2) kinetics in pre-pubertal children, but that cycle ergometry responses are insensitive to such differences

Longitudinal investigation of training status and cardiopulmonary responses in pre- and early-pubertal children

PurposeThe presence of a maturational threshold that modulates children’s physiological responses to exercise training continues to be debated, not least due to a lack of longitudinal evidence to address this question. The purpose of this study was to investigate the interaction between swim-training status and maturity in nineteen trained (T, 10 ± 1 years, −2.4 ± 1.9 years pre-peak height velocity, 8 boys) and fifteen untrained (UT, 10 ± 1 years, −2.3 ± 0.9 years pre-peak height velocity, 5 boys) children, at three annual measurements.MethodsIn addition to pulmonary gas exchange measurements, stroke volume (SV) and cardiac output ( Q˙) were estimated by thoracic bioelectrical impedance during incremental ramp exercise.ResultsAt baseline and both subsequent measurement points, trained children had significantly (P &#60; 0.05) higher peak oxygen uptake (year 1 T 1.75 ± 0.34 vs. UT 1.49 ± 0.22; year 2 T 2.01 ± 0.31 vs. UT 1.65 ± 0.08; year 3 T 2.07 ± 0.30 vs. UT 1.77 ± 0.16 l min−1) and Q˙ (year 1 T 15.0 ± 2.9 vs. UT 13.2 ± 2.2; year 2 T 16.1 ± 2.8 vs. UT 13.8 ± 2.9; year 3 T 19.3 ± 4.4 vs. UT 16.0 ± 2.7 l min−1). Furthermore, the SV response pattern differed significantly with training status, demonstrating the conventional plateau in UT but a progressive increase in T. Multilevel modelling revealed that none of the measured pulmonary or cardiovascular parameters interacted with maturational status, and the magnitude of the difference between T and UT was similar, irrespective of maturational status.ConclusionThe results of this novel longitudinal study challenge the notion that differences in training status in young people are only evident once a maturational threshold has been exceeded

Speckle Tracking Echocardiography for the Assessment of the Athlete's Heart: Is It Ready for Daily Practice?

PURPOSE OF REVIEW: To describe the use of speckle tracking echocardiography (STE) in the biventricular assessment of athletes' heart (AH). Can STE aid differential diagnosis during pre-participation cardiac screening (PCS) of athletes? RECENT FINDINGS: Data from recent patient, population and athlete studies suggest potential discriminatory value of STE, alongside standard echocardiographic measurements, in the early detection of clinically relevant systolic dysfunction. STE can also contribute to subsequent prognosis and risk stratification. Despite some heterogeneity in STE data in athletes, left ventricular global longitudinal strain (GLS) and right ventricular longitudinal strain (RV ɛ) indices can add to differential diagnostic protocols in PCS. STE should be used in addition to standard echocardiographic tools and be conducted by an experienced operator with significant knowledge of the AH. Other indices, including left ventricular circumferential strain and twist, may provide insight, but further research in clinical and athletic populations is warranted. This review also raises the potential role for STE measures performed during exercise as well as in serial follow-up as a method to improve diagnostic yield

Left and right ventricular longitudinal strain-volume/area relationships in elite athletes.

We propose a novel ultrasound approach with the primary aim of establishing the temporal relationship of structure and function in athletes of varying sporting demographics. 92 male athletes were studied [Group IA, (low static-low dynamic) (n = 20); Group IC, (low static-high dynamic) (n = 25); Group IIIA, (high static-low dynamic) (n = 21); Group IIIC, (high static-high dynamic) (n = 26)]. Conventional echocardiography of both the left ventricles (LV) and right ventricles (RV) was undertaken. An assessment of simultaneous longitudinal strain and LV volume/RV area was provided. Data was presented as derived strain for % end diastolic volume/area. Athletes in group IC and IIIC had larger LV end diastolic volumes compared to athletes in groups IA and IIIA (50 ± 6 and 54 ± 8 ml/(m(2))(1.5) versus 42 ± 7 and 43 ± 2 ml/(m(2))(1.5) respectively). Group IIIC also had significantly larger mean wall thickness (MWT) compared to all groups. Athletes from group IIIC required greater longitudinal strain for any given % volume which correlated to MWT (r = 0.4, p < 0.0001). Findings were similar in the RV with the exception that group IIIC athletes required lower strain for any given % area. There are physiological differences between athletes with the largest LV and RV in athletes from group IIIC. These athletes also have greater resting longitudinal contribution to volume change in the LV which, in part, is related to an increased wall thickness. A lower longitudinal contribution to area change in the RV is also apparent in these athletes