Olivier Bical - Academia.edu (original) (raw)
Papers by Olivier Bical
Sang Thrombose Vaisseaux, 1994
Les complications neurologiques sont frequentes apres chirurgie cardiaque et leur frequence tend ... more Les complications neurologiques sont frequentes apres chirurgie cardiaque et leur frequence tend a augmenter en raison de l'âge plus avance des patients operes. Ces complications sont en rapport soit avec des embolies, soit avec l'hypoperfusion cerebrale. Les complications neuropsychiatriques ou neuropsychologiques seraient encore plus frequentes (50%). Decelees sur des tests specialises, elles sont en rapport avec des microembolies fibrinoplaquettaires. Les facteurs de survenue de toutes ces complications sont l'âge, l'hypotension, les thromboses du ventricule gauche, une maladie atherosclereuse des troncs supra-aortiques et, de plus en plus frequemment, des lesions atherosclereuses ulcerees de l'aorte ascendante. Ces lesions atherosclereuses frequentes ont fait limiter les manipulations chirurgicales de l'aorte ascendante en chirurgie coronaire
Nous rapportons le cas d'une patiente de 33 ans porteuse d'une coarctation aortique respo... more Nous rapportons le cas d'une patiente de 33 ans porteuse d'une coarctation aortique responsable d'une hypertension maligne, de douleurs invalidantes des membres inferieurs et d'un important gradient de pression trans-stenotique. Un pontage extra-anatomique aorto-aortique par thoracotomie gauche a ete realise, et elle est sortie en convalescence au 4 e jour post-operatoire avec une pression normalisee sans drogue. La description clinique et les alternatives therapeutiques modernes sont presentees.
The Journal of Thoracic and Cardiovascular Surgery, 1979
We have studied the natural history of left ventricular aneurysms (LVA) in 40 patients not treate... more We have studied the natural history of left ventricular aneurysms (LVA) in 40 patients not treated surgically who were followed for a mean period of 5 years, 8 months. These patients have been divided into two groups according to the presence (Group B) or absence (Group A) of significant symptomatology. The causes of death are dominated by arrhythmias and congestive heart failure (CHF). The survival rate at 10 years is 66.7% for the entire group. In asymptomatic patients the 10 year survival rate is 90%, but it is only 46.3% in those who were symptomatic at the time of the initial diagnosis. In general, the clinical course of survivors is stable in Group A but has deteriorated steadily in Group B. Nonfatal complications include arrhythmias (observed in 34% of all patients), thromboembolic phenomena (29%), CHF (29%), and recurrent myocardial infarction (22.5%). Factors influencing prognosis are the extent of the aneurysm, the association of asynergic segments, the ejection fraction of the residual ventricle, the left ventricular end-diastolic pressure (LVEDP), and the presence of ventricular extrasystoles at the time of diagnosis. The mere presence of aneurysm is not, in itself, an indication for operation. Incapacitating angina and refractory CHF are the most valuable indications for surgical resection. The question is raised as to the value of operation in patients with little or no symptoms, in those with isolated life-threatening arrhythmias, and in those in whom a mural thrombus is the only distressing feature.
The Journal of Thoracic and Cardiovascular Surgery, 1987
Fetal lamb experimental models were employed for intrauterine creation and repair of pulmonary ar... more Fetal lamb experimental models were employed for intrauterine creation and repair of pulmonary artery stenosis. The study group was composed of 51 fetal lambs including 29 models of pulmonary artery stenosis and 22 control lambs. Gestational age was 89 days at creation of pulmonary artery stenosis. Fourteen fetal lambs (Group A) were studied after creation of the stenosis at 131 days of gestation and compared to normal age-matched control lambs. The systolic right ventricular pressure was significantly higher after creation of pulmonary artery stenosis (76.6 +/- 17.8 versus 50.3 +/- 23.5 mm Hg), but the systolic pulmonary artery pressure was unchanged. The mean right ventricular weight and the mean right ventricular/left ventricular weight ratio were significantly greater after pulmonary artery stenosis than in normal control animals. The transverse myocyte diameter was not modified by pulmonary artery stenosis, but on electron microscopic study the myocytes appeared mature. Ten lambs (Group B) underwent intrauterine repair of pulmonary artery stenosis at 131 days of gestation without cardiopulmonary bypass. The pulmonary artery was clamped and patched. Immediately after repair the right ventricular pressure fell significantly from 85.8 +/- 18.9 to 62.2 +/- 14.6 mm Hg. At birth, 7 +/- 6 days after repair, Group B was compared to Group C (unrepaired pulmonary artery stenosis, five fetuses) and to normal control lambs. The mean right ventricular weight and the mean right ventricular/left ventricular weight ratio were not statistically different in Group B and in the control group. There were no ultrastructural changes after intrauterine repair. We conclude that intrauterine creation of pulmonary artery stenosis causes right ventricular hypertrophy with more mature myocytes. Intrauterine repair of pulmonary artery stenosis is feasible without cardiopulmonary bypass and rapidly abolishes the preponderance of right ventricular weight over left ventricular weight.
The Journal of Thoracic and Cardiovascular Surgery, 1990
Experimental lamb models were used for intrauterine creation of pulmonary artery stenosis and lat... more Experimental lamb models were used for intrauterine creation of pulmonary artery stenosis and later intrauterine repair or postnatal repair. Intrauterine creation of pulmonary artery stenosis was performed in 23 fetal lambs at 90 +/- 1 days of gestation. Eight lambs underwent intrauterine repair of pulmonary artery stenosis at 135 +/- 1 days of gestation and were studied 110 +/- 13 days after repair. Seven lambs underwent postnatal repair at 57 +/- 9 days after birth and were studied 162 +/- 32 days after repair. Eight fetal lambs with unrepaired pulmonary artery stenosis were studied 89 +/- 18 days after birth. All study lambs were compared with normal control lambs. The systolic right ventricular pressure was significantly higher after unrepaired stenosis (78.6 +/- 6.8 mm Hg) than in other lambs, but there was no statistically significant difference after intrauterine repair (23.3 +/- 2.9 mm Hg), postnatal repair (25.9 +/- 3.4 mm Hg), and normal lambs (21.6 +/- 1.1 mm Hg). The systolic pulmonary artery pressure was also not statistically different in these three groups. The weight measurements were age-adjusted for comparison of postnatal and intrauterine repair with normal lambs. The adjusted heart weights were similar in the three groups. The comparison of the adjusted heart weight/adjusted body weight ratio (10(-3) showed a significantly higher ratio in postnatal repair (7.4 +/- 0.1) than in intrauterine repair (6.1 +/- 0.1). The adjusted right ventricular weight/adjusted left ventricular weight ratio was significantly higher in the postnatal repair group (0.71 +/- 0.01) than in both the intrauterine repair group (0.59 +/- 0.01) and normal lambs (0.59 +/- 0.01). The transverse myocyte diameter was not statistically different in all groups of animals and there were no ultrastructural changes even when the pulmonary stenosis was unrepaired. We conclude that intrauterine repair was more satisfactory than postnatal repair in terms of age-adjusted heart weight results, but we did not find any advantages of intrauterine repair in terms of histologic and ultrastructural changes.
The Journal of Thoracic and Cardiovascular Surgery, 1986
The effectiveness of a water-soluble C-12 alkyl sulfate (T6) (U.S. Patent No. 4,323,358) in retar... more The effectiveness of a water-soluble C-12 alkyl sulfate (T6) (U.S. Patent No. 4,323,358) in retarding bioprosthetic calcification was evaluated in 23 porcine-valved conduits (13 T6-treated conduits and 10 controls) implanted in young sheep between the right ventricle and the pulmonary trunk. The grafts were divided into three groups according to the period of function: Group I, less than 2 months; Group II, 2 to 4 months; and Group III, 5 to 7 months. In Group I (four T6 and four controls), endocarditis occurred in five cases. In Group II (three T6 and three controls), four conduits showed severe fibrous peel ingrowth. In Group III (six T6 and three controls), fibrous peel was the main feature in four conduits and calcium deposits occurred in the porcine aortic wall in all cases, with cusp involvement in two; in both T6-treated and control conduits, chemical analysis showed a much lower calcium content of the cusps (8.45 +/- 80 versus 2.95 +/- 1.52 mg/gm dry weight, respectively) than that reported in other animal or human explants. The grade of calcification in control and T6-treated conduits was equal on x-ray analysis, and no differences in calcification patterns were noted on electron microscopy. This experimental model shows a low degree of cusp calcification and no significant differences between T6-treated and control conduits. Peel formation markedly interferes with performance of the porcine-valved conduit. The results of this analysis indicate that valved conduits are not the optimum model for evaluating calcium-retardant agents in biological valves.
The Journal of Thoracic and Cardiovascular Surgery, 1994
Cardiology in the Young, 2017
Objectives Early surgical management of common arterial trunk is well established and has good pr... more Objectives Early surgical management of common arterial trunk is well established and has good prognosis. Late diagnosis is less common. We reviewed late-diagnosed common arterial trunk management and prognosis for children in developing countries. We also discuss the need for prior catheterisation. Material and methods We reviewed all common arterial trunk patients managed by our humanitarian organization since 1996. Results A total of 41 children with common arterial trunk were managed at a mean age of 3 years old. The lack of adequate facilities in developing countries explains the late management. The decision to proceed with surgery was based on clinical and radiological symptoms of persistent shunt, particularly a high cutaneous saturation level, regardless of catheterization – not carried out systematically. Eight children had to be withdrawn and 33 (80.5%) received operation – mean saturation 91%. The postoperative course was marked by pulmonary arterial hypertension requiri...
Archives of Cardiovascular Diseases Supplements, 2019
Objectives Mecenat-Chirurgie Cardiaque is a humanitarian association whose mission is to enable c... more Objectives Mecenat-Chirurgie Cardiaque is a humanitarian association whose mission is to enable children suffering from cardiac malformations to come to France to access the care that is not available in their native countries. The purpose of this study is to analyse the follow-up of the children managed since the creation of MCC. Methods We reviewed all patients, and analysed long-term survival. Results Since 1996, 3000 children were entrusted, from 66 different countries, mainly from sub-Saharan Africa (68%). Mean age at venue was 7 years old. Main diagnosis were tetralogy of Fallot 25%, VSD 16%, acquired valvular diseases 16%, complex congenital heart disease: single ventricle, pulmonary atresia with VSD, DORV, D-TGV 5% each, truncus arteriosus 2%. In total, 2728 children came to France once, 119 twice, and 11 three times or more. Seven children died before surgery. Among the children, 228 were withdrawn for surgery, mainly because of pulmonary hypertension or overly complex heart disease, or because of venial disease. Among the children, 2765 underwent surgery or intervention. Postoperative mortality has been 2.2%. After a mean follow-up of 4.4 years, 401 children were lost to follow-up (13.4%). At last follow-up, 291 children were dead at a mean age of 10.5. Mean delay until death was 2.3 years. Survival rate at 5 and 10 years was 89% and 84% in operated children, and 74% and 62% in non-operated children respectively, in Fallot 95.4%–94.9%; VSD 94.9%–91.1%; acquired valvular diseases 77.9%–68.5%; single ventricle 78.2%–71.7%. Conclusion With low operative mortality for often very severe heart disease, and good long-term follow-up, the management of children from countries without cardiac surgery is justified by survival similar to that of Western cohorts - except for acquired valvulopathies, presumably because of the difficulty of anticoagulant treatment. Thus our humanitarian action must continue, and improve for an optimal management of the disinherited populations.
The Journal of heart valve disease, 2006
Stentless bioprostheses may be the future valve of choice for aortic valve replacement (AVR). The... more Stentless bioprostheses may be the future valve of choice for aortic valve replacement (AVR). The study aim was to investigate mid-term clinical outcome after AVR with the Medtronic Freestyle valve. Between April 1997 and November 2004, a total of 500 patients (241 females, 259 males) was implanted with a Freestyle bioprosthesis for AVR, without population selection, by a single surgical team at the authors' institutions. Mean patient age was 74.5 +/- 9.6 years (range: 26-91 years); 34 patients (7%) were aged < 60 years, 121 (24%) were aged > 80 years, and 205 (41%) were in NYHA classes III or IV. The surgical procedure used included a modified subcoronary technique in 482 cases and complete root replacement in 18, conducted with mini-extracorporeal circulation. Concomitant procedures included coronary artery bypass grafting in 123 patients (25%), mitral valve repair/replacement in five, and maze in two. Follow up was 98% complete; the mean follow up was 31.3 months (range...
Annales de chirurgie, 1991
Between 1984 and 1988, 12 mediastinitis were observed in a series of 1.724 cases of cardiac surgi... more Between 1984 and 1988, 12 mediastinitis were observed in a series of 1.724 cases of cardiac surgical procedures by sternotomy (0.7%). These 12 patients were retrospectively separated in 2 groups in terms of surgical management. In group I (5 patients in 1984 and 1985) the treatment was mediastinal irrigation and in case of failure, an omental transposition. In group II (7 patients in 1986, 86 and 88) the treatment was mediastinal irrigation and in case of failure, a mobilization of muscle flaps. Four patients died in group I of poly-visceral failure with a persistent severe sepsis. In group II, there was no death and the cicatrization was quickly obtained with an average length of stay in intensive care unit of 62 days. The mediastinal irrigation is the treatment of choice for benign mediastinitis, but the prognosis of severe mediastinitis was in our series greatly improved by muscle flap procedures realized with plastic and reconstructive surgical techniques.
European Journal of Cardio-Thoracic Surgery, 1996
Circulation Research, 1984
The early adaptation to aortic stenosis was studied in eight conscious dogs previously instrument... more The early adaptation to aortic stenosis was studied in eight conscious dogs previously instrumented with a left ventricular micromanometer and ultrasonic crystals measuring left ventricular minor equator, left ventricular major axis, and ventricular wall thickness. Data were compared during control, acute inflation of a supravalvular aortic cuff occluder and 24 hours after aortic stenosis with and without beta-blockade. Acute aortic stenosis increased peak systolic pressure and end-systolic pressure with a decrease of percent systolic shortening of minor diameter (% delta L). Twenty-four hours after aortic constriction for heart rates, end-diastolic dimensions, and systolic pressures similar to those measured during acute aortic stenosis, % delta L was significantly increased, compared with acute aortic constriction, and was close to control values. End-systolic diameter was not significantly different from control during sustained pressure overload, although end-systolic stress was...
The Journal of Thoracic and Cardiovascular Surgery, 2014
Objective: Stentless xenograft bioprostheses may be the future valve of choice for aortic valve r... more Objective: Stentless xenograft bioprostheses may be the future valve of choice for aortic valve replacement. The study aim was to investigate the long-term clinical outcome after aortic valve replacement with the Medtronic Freestyle bioprosthesis (Medtronic Inc, Minneapolis, Minn). Methods: Between April 1997 and November 2004, a total of 500 patients (mean age, 74.5 AE 9.6 years; 52% were male) underwent aortic valve replacement with a Freestyle bioprosthesis, without population selection. The surgical procedure used a modified subcoronary technique in 479 patients and a complete root replacement in 21 patients, conducted with mini-extracorporeal circulation. Concomitant procedures included coronary artery bypass grafting in 122 patients (24%) and mitral valve repair/replacement in 11 patients. Results: The mean cardiopulmonary bypass time was 98 AE 26 minutes, and total aortic crossclamp time was 77 AE 19 minutes. Operative mortality was 5.2%. The median follow-up time was 104.8 AE 5.7 months. During this period, there were 224 deaths (n ¼ 122 cardiovascular and n ¼ 102 noncardiovascular deaths). The actuarial survivals from cardiovascular and valve-related mortality were 67% AE 3% and 70% AE 4%, respectively, at 10 years. Freedom from structural valve deterioration at 10 years was 94% AE 2%. The linearized structural valve deterioration incidence was 0.6% per patient/year. Multivariate Cox regression analysis revealed that older age, impaired renal function, and coronary artery disease were independent predictors of cardiovascular death. In the subgroup of patients aged less than 65 years at implantation (n ¼ 45), the actuarial cardiovascular survival was 83% AE 8% and freedom from structural valve deterioration was 89% AE 6% at 10 years. Conclusions: The use of the Freestyle bioprosthesis for aortic valve replacement resulted in good long-term cardiovascular survival and freedom from structural valve deterioration in this cohort regardless of age at implantation.
BACKGROUND Children with severe congenital heart disease (CHD) are rarely treated in developing c... more BACKGROUND Children with severe congenital heart disease (CHD) are rarely treated in developing countries and have very little to no chance to survive in their local environment. Mécénat Chirurgie Cardiaque (MCC) flies to France children with CHD from developing countries. This report focuses on the early, mid, and late outcomes of 531 children with severe CHD sent to MCC for surgery from 1996 to 2019. METHODS The inclusion criteria were based on diagnosis and not on procedure. MCC is present in 66 countries and has developed a robust staff, including 12 permanent employees and 700 volunteers, with 350 host families based in France, 120 local correspondents, and 100 local physicians. Since 1996, MCC has organized a basic training of local pediatric cardiologists yearly, offering a free 1-month training course. Over time, MCC could count on a pool of doctors trained in basic pediatric cardiology. Flights were secured by the Aviation Sans Frontieres Foundation. Nine French centers per...
European Journal of Cardio-Thoracic Surgery, 2006
Echocardiography, 2015
This case draws our attention to a new type of mitral valve anomaly, which seems to be congenital... more This case draws our attention to a new type of mitral valve anomaly, which seems to be congenital. A 42-year-old man with symptomatic primary severe mitral regurgitation was admitted to our hospital. Echocardiography revealed an aneurysm of the half of the valve, on the anterolateral commissure side, with significant excess tissue. The other half of the valve was normal. The two parts seemed to be separated by a continuous fibrous raphe. The anterolateral papillary muscle was hyperplasic and gave the main part of chordae tendinae.
Cardiovascular surgery (London, England), 1999
Revascularization of the inferior side of the left ventricle is performed most often with aortoco... more Revascularization of the inferior side of the left ventricle is performed most often with aortocoronary free grafts. This article describes a technical improvement for anatomical fit and gain of length of these grafts by directing them to the right side of the heart after a passage behind the inferior vena cava.
Annales de cardiologie et d'angéiologie
Coronary vein grafts are frequently become occluded or develop atherosclerotic lesions in the lon... more Coronary vein grafts are frequently become occluded or develop atherosclerotic lesions in the long-term. In contrast, the internal mammary artery has a very satisfactory long-term patency rate. The use of an internal mammary artery on the LAD consequently increases the benefit of coronary surgery. The benefit of using 2 internal mammary arteries or other arterial grafts for coronary artery bypass surgery is more controversial. The advantages and disadvantages of the various coronary artery grafts are reported together with the clinical experience of several teams in this area. Coronary artery surgery should be reserved to patients with a good general condition, who are likely to benefit from this type of revascularization. The right internal mammary artery is unsuitable for revascularization of the right coronary network and the two internal mammary arteries must be used to revascularize the left coronary network, in order to obtain a good result. However, surgeons must be aware of ...
Cardiovascular Surgery - CARDIOVASC SURG, 1997
Sang Thrombose Vaisseaux, 1994
Les complications neurologiques sont frequentes apres chirurgie cardiaque et leur frequence tend ... more Les complications neurologiques sont frequentes apres chirurgie cardiaque et leur frequence tend a augmenter en raison de l'âge plus avance des patients operes. Ces complications sont en rapport soit avec des embolies, soit avec l'hypoperfusion cerebrale. Les complications neuropsychiatriques ou neuropsychologiques seraient encore plus frequentes (50%). Decelees sur des tests specialises, elles sont en rapport avec des microembolies fibrinoplaquettaires. Les facteurs de survenue de toutes ces complications sont l'âge, l'hypotension, les thromboses du ventricule gauche, une maladie atherosclereuse des troncs supra-aortiques et, de plus en plus frequemment, des lesions atherosclereuses ulcerees de l'aorte ascendante. Ces lesions atherosclereuses frequentes ont fait limiter les manipulations chirurgicales de l'aorte ascendante en chirurgie coronaire
Nous rapportons le cas d'une patiente de 33 ans porteuse d'une coarctation aortique respo... more Nous rapportons le cas d'une patiente de 33 ans porteuse d'une coarctation aortique responsable d'une hypertension maligne, de douleurs invalidantes des membres inferieurs et d'un important gradient de pression trans-stenotique. Un pontage extra-anatomique aorto-aortique par thoracotomie gauche a ete realise, et elle est sortie en convalescence au 4 e jour post-operatoire avec une pression normalisee sans drogue. La description clinique et les alternatives therapeutiques modernes sont presentees.
The Journal of Thoracic and Cardiovascular Surgery, 1979
We have studied the natural history of left ventricular aneurysms (LVA) in 40 patients not treate... more We have studied the natural history of left ventricular aneurysms (LVA) in 40 patients not treated surgically who were followed for a mean period of 5 years, 8 months. These patients have been divided into two groups according to the presence (Group B) or absence (Group A) of significant symptomatology. The causes of death are dominated by arrhythmias and congestive heart failure (CHF). The survival rate at 10 years is 66.7% for the entire group. In asymptomatic patients the 10 year survival rate is 90%, but it is only 46.3% in those who were symptomatic at the time of the initial diagnosis. In general, the clinical course of survivors is stable in Group A but has deteriorated steadily in Group B. Nonfatal complications include arrhythmias (observed in 34% of all patients), thromboembolic phenomena (29%), CHF (29%), and recurrent myocardial infarction (22.5%). Factors influencing prognosis are the extent of the aneurysm, the association of asynergic segments, the ejection fraction of the residual ventricle, the left ventricular end-diastolic pressure (LVEDP), and the presence of ventricular extrasystoles at the time of diagnosis. The mere presence of aneurysm is not, in itself, an indication for operation. Incapacitating angina and refractory CHF are the most valuable indications for surgical resection. The question is raised as to the value of operation in patients with little or no symptoms, in those with isolated life-threatening arrhythmias, and in those in whom a mural thrombus is the only distressing feature.
The Journal of Thoracic and Cardiovascular Surgery, 1987
Fetal lamb experimental models were employed for intrauterine creation and repair of pulmonary ar... more Fetal lamb experimental models were employed for intrauterine creation and repair of pulmonary artery stenosis. The study group was composed of 51 fetal lambs including 29 models of pulmonary artery stenosis and 22 control lambs. Gestational age was 89 days at creation of pulmonary artery stenosis. Fourteen fetal lambs (Group A) were studied after creation of the stenosis at 131 days of gestation and compared to normal age-matched control lambs. The systolic right ventricular pressure was significantly higher after creation of pulmonary artery stenosis (76.6 +/- 17.8 versus 50.3 +/- 23.5 mm Hg), but the systolic pulmonary artery pressure was unchanged. The mean right ventricular weight and the mean right ventricular/left ventricular weight ratio were significantly greater after pulmonary artery stenosis than in normal control animals. The transverse myocyte diameter was not modified by pulmonary artery stenosis, but on electron microscopic study the myocytes appeared mature. Ten lambs (Group B) underwent intrauterine repair of pulmonary artery stenosis at 131 days of gestation without cardiopulmonary bypass. The pulmonary artery was clamped and patched. Immediately after repair the right ventricular pressure fell significantly from 85.8 +/- 18.9 to 62.2 +/- 14.6 mm Hg. At birth, 7 +/- 6 days after repair, Group B was compared to Group C (unrepaired pulmonary artery stenosis, five fetuses) and to normal control lambs. The mean right ventricular weight and the mean right ventricular/left ventricular weight ratio were not statistically different in Group B and in the control group. There were no ultrastructural changes after intrauterine repair. We conclude that intrauterine creation of pulmonary artery stenosis causes right ventricular hypertrophy with more mature myocytes. Intrauterine repair of pulmonary artery stenosis is feasible without cardiopulmonary bypass and rapidly abolishes the preponderance of right ventricular weight over left ventricular weight.
The Journal of Thoracic and Cardiovascular Surgery, 1990
Experimental lamb models were used for intrauterine creation of pulmonary artery stenosis and lat... more Experimental lamb models were used for intrauterine creation of pulmonary artery stenosis and later intrauterine repair or postnatal repair. Intrauterine creation of pulmonary artery stenosis was performed in 23 fetal lambs at 90 +/- 1 days of gestation. Eight lambs underwent intrauterine repair of pulmonary artery stenosis at 135 +/- 1 days of gestation and were studied 110 +/- 13 days after repair. Seven lambs underwent postnatal repair at 57 +/- 9 days after birth and were studied 162 +/- 32 days after repair. Eight fetal lambs with unrepaired pulmonary artery stenosis were studied 89 +/- 18 days after birth. All study lambs were compared with normal control lambs. The systolic right ventricular pressure was significantly higher after unrepaired stenosis (78.6 +/- 6.8 mm Hg) than in other lambs, but there was no statistically significant difference after intrauterine repair (23.3 +/- 2.9 mm Hg), postnatal repair (25.9 +/- 3.4 mm Hg), and normal lambs (21.6 +/- 1.1 mm Hg). The systolic pulmonary artery pressure was also not statistically different in these three groups. The weight measurements were age-adjusted for comparison of postnatal and intrauterine repair with normal lambs. The adjusted heart weights were similar in the three groups. The comparison of the adjusted heart weight/adjusted body weight ratio (10(-3) showed a significantly higher ratio in postnatal repair (7.4 +/- 0.1) than in intrauterine repair (6.1 +/- 0.1). The adjusted right ventricular weight/adjusted left ventricular weight ratio was significantly higher in the postnatal repair group (0.71 +/- 0.01) than in both the intrauterine repair group (0.59 +/- 0.01) and normal lambs (0.59 +/- 0.01). The transverse myocyte diameter was not statistically different in all groups of animals and there were no ultrastructural changes even when the pulmonary stenosis was unrepaired. We conclude that intrauterine repair was more satisfactory than postnatal repair in terms of age-adjusted heart weight results, but we did not find any advantages of intrauterine repair in terms of histologic and ultrastructural changes.
The Journal of Thoracic and Cardiovascular Surgery, 1986
The effectiveness of a water-soluble C-12 alkyl sulfate (T6) (U.S. Patent No. 4,323,358) in retar... more The effectiveness of a water-soluble C-12 alkyl sulfate (T6) (U.S. Patent No. 4,323,358) in retarding bioprosthetic calcification was evaluated in 23 porcine-valved conduits (13 T6-treated conduits and 10 controls) implanted in young sheep between the right ventricle and the pulmonary trunk. The grafts were divided into three groups according to the period of function: Group I, less than 2 months; Group II, 2 to 4 months; and Group III, 5 to 7 months. In Group I (four T6 and four controls), endocarditis occurred in five cases. In Group II (three T6 and three controls), four conduits showed severe fibrous peel ingrowth. In Group III (six T6 and three controls), fibrous peel was the main feature in four conduits and calcium deposits occurred in the porcine aortic wall in all cases, with cusp involvement in two; in both T6-treated and control conduits, chemical analysis showed a much lower calcium content of the cusps (8.45 +/- 80 versus 2.95 +/- 1.52 mg/gm dry weight, respectively) than that reported in other animal or human explants. The grade of calcification in control and T6-treated conduits was equal on x-ray analysis, and no differences in calcification patterns were noted on electron microscopy. This experimental model shows a low degree of cusp calcification and no significant differences between T6-treated and control conduits. Peel formation markedly interferes with performance of the porcine-valved conduit. The results of this analysis indicate that valved conduits are not the optimum model for evaluating calcium-retardant agents in biological valves.
The Journal of Thoracic and Cardiovascular Surgery, 1994
Cardiology in the Young, 2017
Objectives Early surgical management of common arterial trunk is well established and has good pr... more Objectives Early surgical management of common arterial trunk is well established and has good prognosis. Late diagnosis is less common. We reviewed late-diagnosed common arterial trunk management and prognosis for children in developing countries. We also discuss the need for prior catheterisation. Material and methods We reviewed all common arterial trunk patients managed by our humanitarian organization since 1996. Results A total of 41 children with common arterial trunk were managed at a mean age of 3 years old. The lack of adequate facilities in developing countries explains the late management. The decision to proceed with surgery was based on clinical and radiological symptoms of persistent shunt, particularly a high cutaneous saturation level, regardless of catheterization – not carried out systematically. Eight children had to be withdrawn and 33 (80.5%) received operation – mean saturation 91%. The postoperative course was marked by pulmonary arterial hypertension requiri...
Archives of Cardiovascular Diseases Supplements, 2019
Objectives Mecenat-Chirurgie Cardiaque is a humanitarian association whose mission is to enable c... more Objectives Mecenat-Chirurgie Cardiaque is a humanitarian association whose mission is to enable children suffering from cardiac malformations to come to France to access the care that is not available in their native countries. The purpose of this study is to analyse the follow-up of the children managed since the creation of MCC. Methods We reviewed all patients, and analysed long-term survival. Results Since 1996, 3000 children were entrusted, from 66 different countries, mainly from sub-Saharan Africa (68%). Mean age at venue was 7 years old. Main diagnosis were tetralogy of Fallot 25%, VSD 16%, acquired valvular diseases 16%, complex congenital heart disease: single ventricle, pulmonary atresia with VSD, DORV, D-TGV 5% each, truncus arteriosus 2%. In total, 2728 children came to France once, 119 twice, and 11 three times or more. Seven children died before surgery. Among the children, 228 were withdrawn for surgery, mainly because of pulmonary hypertension or overly complex heart disease, or because of venial disease. Among the children, 2765 underwent surgery or intervention. Postoperative mortality has been 2.2%. After a mean follow-up of 4.4 years, 401 children were lost to follow-up (13.4%). At last follow-up, 291 children were dead at a mean age of 10.5. Mean delay until death was 2.3 years. Survival rate at 5 and 10 years was 89% and 84% in operated children, and 74% and 62% in non-operated children respectively, in Fallot 95.4%–94.9%; VSD 94.9%–91.1%; acquired valvular diseases 77.9%–68.5%; single ventricle 78.2%–71.7%. Conclusion With low operative mortality for often very severe heart disease, and good long-term follow-up, the management of children from countries without cardiac surgery is justified by survival similar to that of Western cohorts - except for acquired valvulopathies, presumably because of the difficulty of anticoagulant treatment. Thus our humanitarian action must continue, and improve for an optimal management of the disinherited populations.
The Journal of heart valve disease, 2006
Stentless bioprostheses may be the future valve of choice for aortic valve replacement (AVR). The... more Stentless bioprostheses may be the future valve of choice for aortic valve replacement (AVR). The study aim was to investigate mid-term clinical outcome after AVR with the Medtronic Freestyle valve. Between April 1997 and November 2004, a total of 500 patients (241 females, 259 males) was implanted with a Freestyle bioprosthesis for AVR, without population selection, by a single surgical team at the authors' institutions. Mean patient age was 74.5 +/- 9.6 years (range: 26-91 years); 34 patients (7%) were aged < 60 years, 121 (24%) were aged > 80 years, and 205 (41%) were in NYHA classes III or IV. The surgical procedure used included a modified subcoronary technique in 482 cases and complete root replacement in 18, conducted with mini-extracorporeal circulation. Concomitant procedures included coronary artery bypass grafting in 123 patients (25%), mitral valve repair/replacement in five, and maze in two. Follow up was 98% complete; the mean follow up was 31.3 months (range...
Annales de chirurgie, 1991
Between 1984 and 1988, 12 mediastinitis were observed in a series of 1.724 cases of cardiac surgi... more Between 1984 and 1988, 12 mediastinitis were observed in a series of 1.724 cases of cardiac surgical procedures by sternotomy (0.7%). These 12 patients were retrospectively separated in 2 groups in terms of surgical management. In group I (5 patients in 1984 and 1985) the treatment was mediastinal irrigation and in case of failure, an omental transposition. In group II (7 patients in 1986, 86 and 88) the treatment was mediastinal irrigation and in case of failure, a mobilization of muscle flaps. Four patients died in group I of poly-visceral failure with a persistent severe sepsis. In group II, there was no death and the cicatrization was quickly obtained with an average length of stay in intensive care unit of 62 days. The mediastinal irrigation is the treatment of choice for benign mediastinitis, but the prognosis of severe mediastinitis was in our series greatly improved by muscle flap procedures realized with plastic and reconstructive surgical techniques.
European Journal of Cardio-Thoracic Surgery, 1996
Circulation Research, 1984
The early adaptation to aortic stenosis was studied in eight conscious dogs previously instrument... more The early adaptation to aortic stenosis was studied in eight conscious dogs previously instrumented with a left ventricular micromanometer and ultrasonic crystals measuring left ventricular minor equator, left ventricular major axis, and ventricular wall thickness. Data were compared during control, acute inflation of a supravalvular aortic cuff occluder and 24 hours after aortic stenosis with and without beta-blockade. Acute aortic stenosis increased peak systolic pressure and end-systolic pressure with a decrease of percent systolic shortening of minor diameter (% delta L). Twenty-four hours after aortic constriction for heart rates, end-diastolic dimensions, and systolic pressures similar to those measured during acute aortic stenosis, % delta L was significantly increased, compared with acute aortic constriction, and was close to control values. End-systolic diameter was not significantly different from control during sustained pressure overload, although end-systolic stress was...
The Journal of Thoracic and Cardiovascular Surgery, 2014
Objective: Stentless xenograft bioprostheses may be the future valve of choice for aortic valve r... more Objective: Stentless xenograft bioprostheses may be the future valve of choice for aortic valve replacement. The study aim was to investigate the long-term clinical outcome after aortic valve replacement with the Medtronic Freestyle bioprosthesis (Medtronic Inc, Minneapolis, Minn). Methods: Between April 1997 and November 2004, a total of 500 patients (mean age, 74.5 AE 9.6 years; 52% were male) underwent aortic valve replacement with a Freestyle bioprosthesis, without population selection. The surgical procedure used a modified subcoronary technique in 479 patients and a complete root replacement in 21 patients, conducted with mini-extracorporeal circulation. Concomitant procedures included coronary artery bypass grafting in 122 patients (24%) and mitral valve repair/replacement in 11 patients. Results: The mean cardiopulmonary bypass time was 98 AE 26 minutes, and total aortic crossclamp time was 77 AE 19 minutes. Operative mortality was 5.2%. The median follow-up time was 104.8 AE 5.7 months. During this period, there were 224 deaths (n ¼ 122 cardiovascular and n ¼ 102 noncardiovascular deaths). The actuarial survivals from cardiovascular and valve-related mortality were 67% AE 3% and 70% AE 4%, respectively, at 10 years. Freedom from structural valve deterioration at 10 years was 94% AE 2%. The linearized structural valve deterioration incidence was 0.6% per patient/year. Multivariate Cox regression analysis revealed that older age, impaired renal function, and coronary artery disease were independent predictors of cardiovascular death. In the subgroup of patients aged less than 65 years at implantation (n ¼ 45), the actuarial cardiovascular survival was 83% AE 8% and freedom from structural valve deterioration was 89% AE 6% at 10 years. Conclusions: The use of the Freestyle bioprosthesis for aortic valve replacement resulted in good long-term cardiovascular survival and freedom from structural valve deterioration in this cohort regardless of age at implantation.
BACKGROUND Children with severe congenital heart disease (CHD) are rarely treated in developing c... more BACKGROUND Children with severe congenital heart disease (CHD) are rarely treated in developing countries and have very little to no chance to survive in their local environment. Mécénat Chirurgie Cardiaque (MCC) flies to France children with CHD from developing countries. This report focuses on the early, mid, and late outcomes of 531 children with severe CHD sent to MCC for surgery from 1996 to 2019. METHODS The inclusion criteria were based on diagnosis and not on procedure. MCC is present in 66 countries and has developed a robust staff, including 12 permanent employees and 700 volunteers, with 350 host families based in France, 120 local correspondents, and 100 local physicians. Since 1996, MCC has organized a basic training of local pediatric cardiologists yearly, offering a free 1-month training course. Over time, MCC could count on a pool of doctors trained in basic pediatric cardiology. Flights were secured by the Aviation Sans Frontieres Foundation. Nine French centers per...
European Journal of Cardio-Thoracic Surgery, 2006
Echocardiography, 2015
This case draws our attention to a new type of mitral valve anomaly, which seems to be congenital... more This case draws our attention to a new type of mitral valve anomaly, which seems to be congenital. A 42-year-old man with symptomatic primary severe mitral regurgitation was admitted to our hospital. Echocardiography revealed an aneurysm of the half of the valve, on the anterolateral commissure side, with significant excess tissue. The other half of the valve was normal. The two parts seemed to be separated by a continuous fibrous raphe. The anterolateral papillary muscle was hyperplasic and gave the main part of chordae tendinae.
Cardiovascular surgery (London, England), 1999
Revascularization of the inferior side of the left ventricle is performed most often with aortoco... more Revascularization of the inferior side of the left ventricle is performed most often with aortocoronary free grafts. This article describes a technical improvement for anatomical fit and gain of length of these grafts by directing them to the right side of the heart after a passage behind the inferior vena cava.
Annales de cardiologie et d'angéiologie
Coronary vein grafts are frequently become occluded or develop atherosclerotic lesions in the lon... more Coronary vein grafts are frequently become occluded or develop atherosclerotic lesions in the long-term. In contrast, the internal mammary artery has a very satisfactory long-term patency rate. The use of an internal mammary artery on the LAD consequently increases the benefit of coronary surgery. The benefit of using 2 internal mammary arteries or other arterial grafts for coronary artery bypass surgery is more controversial. The advantages and disadvantages of the various coronary artery grafts are reported together with the clinical experience of several teams in this area. Coronary artery surgery should be reserved to patients with a good general condition, who are likely to benefit from this type of revascularization. The right internal mammary artery is unsuitable for revascularization of the right coronary network and the two internal mammary arteries must be used to revascularize the left coronary network, in order to obtain a good result. However, surgeons must be aware of ...
Cardiovascular Surgery - CARDIOVASC SURG, 1997