Aortic pseudo‐aneurysm following the Bentall procedure is a rare but potentially severe complication. Surgical reintervention represents a high risk. We report on two cases with different pseudo‐aneurysm types which were successfully treated using two different percutaneous techniques. © 2017 Wiley Periodicals, Inc.

Cell replacement therapy for heart failure in human has been shown to have beneficial effects on remodeling, the mechanism of action remains unknown. This study aim is to investigate the destiny of human cardiac precursor cells (CPCs) up to 4 hours after injection into sheep myocardium and mechanical damages mediated by intramyocardial injections. In 2 sheep, CPCs isolated from human right atrial appendage were injected into the left ventricular myocardium with the NOGA (Biosense Webster, USA) catheter. Both animals underwent cell injections 4 and 1 hours before euthanasia, whereas an injection of the same volume of saline was performed 4 hours before sacrifice in one animal to assess mechanical damage related to injections. Myocardial cubes around the injection sites were harvested and embedded in OCT (Optimal Cutting Temperature) compound. Analysis of cryosections showed large amounts of human HLA-1 positive cells intramyocardially (Figure 1) at both time points. Cells were present in clusters and located in elongated lacunae surrounded by intact sheep cardiomycoytes. The same lacunae were identified in tissue samples after saline injection, suggesting that myocardial fibers are pushed apart by the mechanical pressure imposed by the injection. H&E staining (Figure 2) confirmed these results. The size of cell clusters was larger after 1 hour that after 4 hours, indicating a decresasing cell retention over time. Reasons for this are multiple, but a large lymphocytic infiltrate has been identified after 4 hours. View Large Image Figure Viewer

Depuis l\u0027introduction de la ciclosporine, le taux de survie apres transplantation cardiaque a significativement augmente. Nous presentons les resultats du programme de transplantation cardiaque du Centre Hospitalier Universitaire Vaudois, depuis 1987. Nous avons traite 150 patients pour insuffisance cardiaque terminale, en effectuant 152 transplantations cardiaques. Le taux de survie est comparable a celui de la litterature, soit 81%, 70% et 63% a un, cinq et 10 ans respectivement. Nous rapportons l\u0027incidence des complications durant le suivi des patients, ainsi que les modifications de leur prise en charge au long cours.

Reference EPFL-CONF-173780View record in Web of Science Record created on 2012-01-11, modified on 2017-12-10

It has been shown that repolarization alternans, a beat-to-beat alternation in action potential duration, enhances dispersion of repolarization above a critical heart rate and promotes susceptibility to ventricular arrhythmias. It is unknown whether repolarization alternans is measurable in the atria using standard pacemakers and whether it plays a role in promoting atrial fibrillation. In this work, atrial repolarization alternans amplitude and periodicity are studied in a sheep model of pacing-induced atrial fibrillation. Two pacemakers, each with one right atrial and ventricular lead, were implanted in 4 male sheep after ablation of the atrioventricular junction. The first one was used to deliver rapid pacing for measurements of right atrial repolarization alternans and the second one to record a unipolar electrogram. Atrial repolarization alternans appeared rate-dependent and its amplitude increased as a function of pacing rate. Repolarization alternans was intermittent but no periodicity was detected. An increase of repolarization alternans preceding episodes of non-sustained atrial fibrillation suggests that repolarization alternans is a promising parameter for assessment of atrial fibrillation susceptibility.

In pacing-induced models of atrial fibrillation (AF) that mimic atrial high-frequency foci, the increase in AF susceptibility over time is not paralleled by any increase in dispersion of repolarization (DOR). Measurements of effective refractory periods (ERP), however, were performed by using extrastimuli, which bears significant limitation because it cannot evaluate any dynamic increase in DOR that may arise at rapid rates. Repolarization alternans (Re-ALT), a beat-to-beat alternation in action potential duration, enhances DOR above a critical heart rate. It is unknown, however, whether Re-ALT plays a role in promoting AF. Method and results: two DDD pacemakers, each with right atrial (RA) and ventricular leads, were implanted in 4 male sheep (50-80 kg). The 1st pacemaker was used to deliver 1) electrophysiology protocols for measurements of RA ERP (S1S2) and of RA Re-ALT threshold (S1S1), and 2) intermittent RA burst pacing (for 5 sec followed by 2 sec of sinus rhythm) until sustained AF developed. The 2nd pacemaker was used to record a single broadband unipolar RA electrogram (EGM). The AV junction of the 3rd and 4th sheep has been ablated by RF in order to dissociate far-field ventricular activity from RA EGM. RA repolarization wave was detected following depolarization. Sustained AF was successfully induced after 1-14 weeks of intermittent RA burst pacing. RA ERP decreased progressively from 185±39 ms (pre-activation) to 125±15 ms and to 110±20 ms after 2 and 4 weeks of burst pacing respectively. Importantly, Re-Alt threshold (255±15 ms) did not change during the time course RA burst pacing, but the range of pacing CL during which RA Re-ALT was observed increased until sustained AF developed (45±5 ms before vs 105±25 after 2 weeks of RA pacing). Interestingly, despite aggressive atrial burst pacing protocol, significant changes in atrial histology were not observed. Conclusion: we report here for the first time in vivo measurements of atrial Re-Alt using standard pacemaker technology in a chronic sheep model of pacing-induced AF. Interestingly, Re-Alt threshold did not change during the time course of pacing-induced AF but the pacing CL range during which Re-Alt was observed increased proportionally to the decrease in RA ERP. These parameters were unrelated to significant atrial tissue alterations, but involved cellular alterations including at least important proteins involved in intracellular Ca cycling. Our findings suggest that atrial Re-Alt might be a mechanism by which DOR transiently increases, promoting wavebreaks and AF at rapid rates.

The hybrid treatment of aortic aneurysms is indicated in patients having the ostia of supra aortic or visceral branches taken in to the aneurysm. Indeed, these lesions are not eligible for classic endovascular treatment because the existing endoprostheses cannot provide perfusion of the side branches without inducing major endoleaks. The surgical technique consists of 2 steps: firstly, a by-pass between normal aorta and the major aortic branches involved in the aneurysm is performed to guarantee the perfusion of the organs such as brain, bowel, and after endoprosthesis deployment. Secondly, the endoprosthesis is deployed using the classical technique to isolate the aneurysm. The hybrid approach provides safe and reliable treatment of complex aortic aneurysms with mortality and morbidity rate far below the classical open surgery.

Following acute myocardial infarction, necrotic cardiac tissue is replaced by scar leading to ventricular remodeling and pump failure. Transplantation of autologous bone marrow-derived cells into the heart, early post-infarct, aims to prevent ventricular remodeling. This strategy has been evaluated in four controlled, randomized clinical trials, which provided mixed results. A transient improvement in ventricular function was observed in one trial, and a modest improvement (the duration of which remains to be determined) in an additional trial, whereas two trials showed negative results. A modest benefit of bone marrow cell transplantation was also observed in patients with chronic ischemic heart disease. Despite mixed results reported so far, cell therapy of heart disease still is in its infancy and has considerable room for improvement.

Zwischen 1995 und 2005 wuchs die Anzahl der jährlich von uns mit endovaskulären Techniken versorgten Aortenaneurysmen (EVAR) von 0 auf 50, und dies auf allen Stufen der Aorta. Zu unserer Organisation gehören ein breites Team von Chirurgen, ein Lager mit 3 kompletten Familien von Endoprothesen (gerade Endoprothesen, konische Endoprothesen, und Bifurkationen), ein mobiler Wagen mit Zubehör (Einführungsbestecke, Führungsdrähte, Katheter, Ballone etc.) und ein Apparat auf Rädern für die intravaskuläre Ultraschalluntersuchung (IVUS). Letzterer erlaubt es zusammen mit einer mobilen Durchleuchtungsanlage (C-Bogen), in jedem Operationssaal unserer Institution endovaskulär Aneurysmen zu analysieren, und dies in der Regel ohne Angiographie bzw. Kontrastmittel. Deshalb sind wir nicht mehr auf eine ausgiebige bildgebende präoperative Abklärung potenzieller Kandidaten für eine endovaskuläre Sanierung von Aneurysmen angewiesen und können rupturierte Aneurysmen der Bauchaorta oder der thorakalen Aorta ohne Verzug behandeln. Bei der endovaskulären Sanierung von Aortenaneurysmen unterscheiden wir zwischen Prozessschritten (Indikationsstellung, Darstellung der Zugangsgefäße, Ausmessen mittels IVUS und Roadmapping mittels Durchleuchtung, Implantatwahl, Implantatinsertion, Positionierung, Implantatabwurf, Erfolgsbeurteilung, Rekonstruktion der Zugangsgefäße und Nachkontrolle) und Kompetenzstufen (Assistent, Oberarzt, Leitender Arzt). Unsere ultraschallgestützte Technik zur endovaskulären Sanierung von Aneurysmen wurde mittels IVUS-Transporter und Telementoring erfolgreich auch anderen Institutionen zur Verfügung gestellt.

A 48-yr-old trauma victim complained of an acute onset of dyspnea and chest pain. Pulmonary embolism was diagnosed by fast spiral computed tomography (CT) requiring emergency surgical embolectomy. After induction of general anesthesia, transesophageal echocardiography (TEE) examination showed enlargement of the right atrium and the right ventricle, bulging of the interatrial and interventricular septum, and right pulmonary artery thrombus (Fig. 1). Further TEE imaging disclosed free-floating thrombi in the right atrium and a thrombus traversing a patent foramen ovale (PFO) (Fig. 2). Continuous right-to-left shunt through the PFO and moderate tricuspid regurgitation was demonstrated with color flow Doppler (please see video loop available at www.anesthesia-analgesia.org). Pulmonary artery systolic pressure was calculated to be 65 mm Hg. After initiation of cardiopulmonary bypass and cardiotomy, 2 thrombi 2 cm in diameter were removed from the right atrium and the foramen ovale was closed. Subsequently, open pulmonary embolectomy was performed and two large thrombi were removed from the left and the right pulmonary arteries. The patient was successfully weaned from cardiopulmonary bypass and had an uneventful postoperative course.

The cardiac sodium channel Na(v)1.5 plays a key role in cardiac excitability and conduction. The purpose of this study was to elucidate the role of the PDZ domain-binding motif formed by the last three residues (Ser-Ile-Val) of the Na(v)1.5 C-terminus. Pull-down experiments were performed using Na(v)1.5 C-terminus fusion proteins and human or mouse heart protein extracts, combined with mass spectrometry analysis. These experiments revealed that the C-terminus associates with dystrophin, and that this interaction was mediated by alpha- and beta-syntrophin proteins. Truncation of the PDZ domain-binding motif abolished the interaction. We used dystrophin-deficient mdx(5cv) mice to study the role of this protein complex in Na(v)1.5 function. Western blot experiments revealed a 50% decrease in the Na(v)1.5 protein levels in mdx(5cv) hearts, whereas Na(v)1.5 mRNA levels were unchanged. Patch-clamp experiments showed a 29% decrease of sodium current in isolated mdx(5cv) cardiomyocytes. Finally, ECG measurements of the mdx(5cv) mice exhibited a 19% reduction in the P wave amplitude, and an 18% increase of the QRS complex duration, compared with controls. These results indicate that the dystrophin protein complex is required for the proper expression and function of Na(v)1.5. In the absence of dystrophin, decreased sodium current may explain the alterations in cardiac conduction observed in patients with dystrophinopathies.

Repolarization alternans, a beat-to-beat alternation in action potential duration, enhances dispersion of repolarization when propagation velocity is involved. In this work, repolarization dynamics and propagation velocity kinetics are studied in a chronic sheep model of pacing-induced atrial fibrillation. Two pacemakers were implanted in four sheep, the first one to deliver pacing protocols and the second one to record a unipolar electrogram. Measuring in vivo in a free-behaving sheep model right atrial CV kinetics and repolarization alternans during electrical remodelling was shown to be feasible. A significant and gradual decrease of propagation velocity and right atrial effective refractory period during the weeks preceding sustained atrial fibrillation was observed. Repolarization alternans and propagation velocity kinetics are promising parameters for in vivo assessment of atrial fibrillation susceptibility.