Right ventricular migration of a venous stent: an unusual cause of tricuspid regurgitation and ventricular tachycardia.
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Biomedical subjects
Publications and source records attributed to Q Désiron.
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Besides major progress in the pharmacologic treatment of severe chronic heart failure, cardiac resynchronization therapy (CRT) has developped over the last ten years. We report the follow-up of the 36 first patients with a CRT device implanted from July 2000 to November 2002 at the CHR de la Citadelle Hospital in Liege. After a mean follow up of 6 months, no death was observed. The functional benefit of resynchronization is validated by a significant improvement in the NYHA class, an increase in the walking distance measured by the six minute walk test from 268 +/- 103 to 342 +/- 106 meters (p < 0.004) and by a not significant rise in the VO2 max (from 11.1 +/- 2.8 to 14 +/- 10 ml/kg/min; P=0.1). The quality of life, assessed by the Minnesota-Living-In-CHF score, improves from 49 +/- 20 to 35 +/- 22 after the six month follow-up (P=0.02) The echocardiogram also shows a better left ventricular ejection fraction at six months, from 24 +/- 7% to 31 +/- 7% (P<0.05). Based on a better NYHA functional class, responders (n=24; 71%) and non responders (n=10; 29%) were compared; a correlation between the functional class change and the improvement of the ejection fraction was documented, but not with the reduction in QRS width. Our registry, with the potential pitfalls of a monocentric prospective study, confirms the feasability, safety and efficacy of CRT in severe chrbnic heart failure uncompletely corrected pharmocalogically. It remains however approximately 30% of non responding patients, in whom the current clinical studies should help identify the right criteria to predict and discriminate responders.
After the recent discovery of an antique engraving representing Iohan Georg Fuchs, the author provides some information about this unknown physician who practiced eye surgery in the Principality of Liège.
Daily in our practice we use terms of anatomy. Some of these terms are directly linked to the name of their discoverer. Very often, we ignore or have forgotten the history of these anatomists. The author, with a short repertory refreshes our memory.
The pharmacological treatment of congestive heart failure has improved its morbidity and mortality. Nevertheless, many patients remain disabled in spite of optimal treatment. The availability of alternative therapies such as heart transplantation or cardiomyoplasty is limited. Newer devices are awaited. Biventricular pacing is a potential option to improve the homogeneity of contraction and the overall mechanical performance without myocardial oxygen consumption increase. This approach has proved acute hemodynamic and functional benefits but has to demonstrate a favourable influence on long term morbidity and mortality.
This paper reviews the literature of Takayasu's arteritis (T.A.). The concept of this disease has evolved considerably over the past decades. T.A. was first described by Mikito Takayasu in 1908, and was thought to be restricted to south-east Asia. But due to the increasing reports from all over the world, it is well established that T.A. has world-wide distribution. Clinical presentation varies according to the location of the arterial lesions. In Europe brachiocephalic trunk lesions prevail and are best managed by an arterial reconstruction. Historical background, epidemiology, etiology, pathology, clinical findings, diagnosis, classification, treatment and long-term prognosis are discussed.
On the occasion of the 150th anniversary of Horace Wells's death, the author makes a historical note about the discovery of the general anesthesia by inhalation.
After a description of the endovascular procedure for the treatment of supra-aortic trunks lesions, the author, through an international review of the literature, analyses the feasibility and the results of this recent surgical technique in comparison to conventional surgery.
In order to assess the benefit of vein patching versus direct closure after carotid endarterectomy, a series of 2271 carotid operations were analysed retrospectively. Apart from 114 procedures consisting of saphenous vein bypass (n = 29) and eversion endarterectomy (n = 85), 2157 open endarterectomies were performed. They were closed either directly (n = 837) or using a vein patch (n = 1320). The combined mortality-major neurological morbidity rate was 1.7%, i.e. 1% mortality (0.2% neurological) and 0.7% permanent neurological morbidity (0.5% ipsilateral to the operated artery). Early symptomatic internal carotid thrombosis was documented in six cases (four following direct closure and two after vein patching). A total of 827 carotid arteries were followed up by duplex scanning on an annual basis (244 direct closure and 583 vein patching). The mean follow-up was 44 months; 69 months for direct closure and 35 months for vein patching. In direct closure, there were 21 stenoses (9%) and 10 occult thromboses (4%); in vein patching carotids, there were 17 stenoses (3%), nine thromboses (1.8%) [corrected] and six pseudoaneurysms (1%). Annual incidence of poor results was 2.4% in direct closure, and 0.87% in vein patching. The only other factor responsible for a significant difference was gender (3.4% in women versus 2.1% in men). In this retrospective study, vein patching appears to be beneficial for the prevention of acute postoperative thrombosis and late stenosis or thrombosis.
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The authors report on 62 surgical corrections for kinking of the internal carotid artery during a 13-year period (1980-1993). This represents 2.8% of all carotid operative procedures (n = 2188) in the same period. It always concerned a significant (< 60 degrees) angulation of a redundant internal carotid artery, that in all but 3 cases was associated with atherosclerotic involvement of the carotid bifurcation. The indication to surgery included transient hemispheric or ocular ischaemia in 25.5% of cases, a regressive neurologic deficit in 8%, a minor stroke in 3%, a stroke in evolution in 11%, and non-lateralized cerebral ischaemia in 21%. In 19 patients (31%) it concerned an asymptomatic high degree stenosis. The surgical technique consisted in carotid transposition-reimplantation after eversion endarterectomy in 37 cases, in posterior transverse plication with patch angioplasty in 20 cases, and in segmental excision with venous interposition graft in 5 cases. There was one postoperative death. The morbidity include one ipsilateral non-fatal stroke and 3 transient ischaemic attacks. A complete long-term follow-up (mean duration 3.4 years) is available for 57 patients. The late incidence of stroke is 1.5% per year. The 5-year survival attains 67%. These long-term results are comparable to the outcome of standard endarterectomy in the same institution. The authors discuss the indication, techniques, and outcome of surgical correction of kinked internal carotid artery. They recommend a shortening procedure, often associated with endarterectomy for severely kinked vessels (angulation 60 degrees or less), symptomatic or not.
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