Antonio Fiore

Unusual 25-Year Durability of an Ionescu-Shiley Pericardial Bioprosthesis

Ionescu-Shiley valve was withdrawn from clinical use in 1987 for its early structural failure after implantation. This was due to valve design rather than the natural properties of bovine pericardium itself. We describe the unexpected 25-year survival of an Ionescu-Shiley bioprosthesis in the mitral and tricuspid positions, implanted to treat endomyocardial fibrosis. This report makes 2 important points: (1) pannus overgrowth may be a favorable determinant of the durability of xenografts, and (2) bovine pericardial valves may have excellent hemodynamic performance and tissue durability for more than 20 years in the mitral position even in young patients.

Surgical management of penetrating thoracic injuries during the Paris attacks on 13 November 2015

OBJECTIVES The Paris terrorist attacks on 13 November 2015 caused 482 casualties, including 130 deaths and 352 wounded. Facing these multisite terrorist attacks, Parisian public and military hospitals simultaneously managed numerous patients with penetrating thoracic injuries. The aim of this study was to analyse this cohort, the injury patterns, and assess the results of this mobilization. METHODS The clinical records of all patients admitted to Parisian public and military hospitals with a penetrating thoracic injury related to the Paris 13 November terrorist attacks were reviewed. RESULTS The study group included 25 patients (7% of the casualties) with a mean age of 34 ± 8 years and a majority of gunshot wounds ( n =  20, 80%). Most patients presented with severe thoracic injury (Abbreviated Injury Score Thorax 3.3 ± 1.2), and also associated non-thoracic injuries in 21 cases (84%). The mean Injury Severity Score was 26.8 ± 9.4. Eight patients (32%) were managed with chest tube insertion and 17 (68%) required thoracic surgery. Lung resection, diaphragmatic repair, and lung suture were performed in 6 (36%), 6 (35%), and 5 cases (29%), respectively. Extra-thoracic surgical procedures were performed in 16 patients, mostly for injuries to the extremities. Postoperative mortality was 12% ( n =  3) and postoperative morbidity was 60% ( n =  15). CONCLUSIONS The coordination of Parisian military and civilian hospitals allowed the surgical management of 25 patients. The mortality is high but consistent with what has been reported in previous series. The current times expose us to the threat of new terrorist attacks and require that the medical community be prepared.

Symptomatic Compression of the Pulmonary Artery by a Thymic Cyst

doi: 10.1111/jocs.12088 (J Card Surg 2013;28:271–272)

A New Three-Dimensional Echocardiography Method to Quantify Aortic Valve Calcification

Background: Aortic valve calcification (AVC) quantification is computed from multidetector computed tomography (MDCT). The aim of this study was to test the hypothesis that three‐dimensional (3D) transthoracic echocardiography can be used to provide a bedside method to assess AVC. Methods: The study included 94 patients (mean age, 78 ± 12 years; mean aortic valve [AV] area, 1.0 ± 0.6 cm2) referred for MDCT and echocardiography for AV assessment. Apical 3D full‐volume data sets focused on the AV region were acquired during transthoracic echocardiography, and a region‐growing algorithm was applied offline to compute 3D transthoracic echocardiographic AVC (AVC‐3DEcho). AVC‐3DEcho was compared with AVC by MDCT and with calcium weight in the subgroup of patients referred for surgery, with explanted AVs analyzed by a pathologist (n = 22). Results: In the explanted valve group, AVC‐3DEcho score exhibited fair correlations with MDCT score (r = 0.85, P < .001), calcium load (r = 0.81, P < .001), and peak AV velocity (r = 0.64, P < .001). In the overall population, AVC‐3DEcho score correlated modestly with MDCT score (r = 0.61, P < .001) but had similar accuracy to identify severe aortic stenosis (area under the curve = 0.94). AVC‐3DEcho > 1,054 mm3 identified severe aortic stenosis with specificity of 100% and sensitivity of 76%. In addition, AVC‐3DEcho was associated with the presence of significant paravalvular regurgitation after transcatheter aortic valve implantation. Finally, intraobserver and interobserver variability for AVC‐3DEcho score was 4.2% and 8.9%, respectively. Conclusions: AVC‐3DEcho correlated with calcium weight obtained from pathologic analysis and MDCT. These data suggest that a bedside method for quantifying AV calcification with ultrasound is feasible. Highlights:A method to quantify AVC by 3D TTE is proposed and evaluated in patients with AS.The AVC‐3DEcho score correlated with calcium weight, MDCT score, and AS severity.AVC by 3D echocardiography was associated with paravalvular leak after TAVI.

Aortic valve replacement in a patient with Sneddon syndrome

1Department of Cardiac and Thoracic Surgery, Hôpitaux-Universitaires-Henri-Mondor, Assistance Publique-Hôpitauxde Paris, Créteil, France 2 SOS-Endocarditis Unit, Hôpitaux-Universitaires-Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France 3Department of Anaesthesiology and Surgical Critical Care Medicine and Inserm U955, Team 3, Hôpitaux-Universitaires-Henri-Mondor, Assistance PubliqueHôpitaux de Paris, Créteil, France 4Department of Cardiology and Inserm U955, Hôpitaux-Universitaires-Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France

Spontaneous mechanical rupture of a papillary muscle effectively resolved by mitral valve repair

We report a case of spontaneous mechanical papillary muscle rupture. In theory, the papillary muscle works as a shock absorber that compensates for geometric changes of left ventricular wall. We believe that the aetiology of papillary muscle rupture, in this case, is linked to the physical and mechanical strains exerted on the papillary. We performed a mitral valve repair with excellent short- and long-term results.

Usefulness of echocardiographic-fluoroscopic fusion imaging in adult structural heart disease

Percutaneous approaches to treat structural heart diseases are growing in number and complexity. Multimodality imaging is essential for planning and monitoring such interventions. The combination of three-dimensional transoesophageal echocardiography with fluoroscopy is the cornerstone of interventional imaging. However, these two modalities are displayed on separate screens, and are handled by different physicians, which requires a complex mental reconstruction for the interventional team. To overcome this issue, echocardiographic-fluoroscopic fusion imaging has been introduced recently in clinical practice. This system combines, in a single view, the precise visualization of catheter and devices provided by fluoroscopy with the continuous soft tissue information provided by echocardiography. In addition, the procedure may be guided using a marker-tracking mode. However, there are few data on how this new technology can have an impact on our routine clinical practice and patient outcomes. In this review, we provide a user manual for the system, discuss its potential clinical applications in adult structural heart diseases and consider future perspectives.

Aortic perforation due to cardiac resynchronisation therapy defibrillator lead placement: Case report and medicolegal considerations.

A 45‐year‐old woman with dilated cardiomyopathy was admitted for the upgrade of a previously implanted pacemaker. Echocardiography showed intraventricular dyssynchrony and a low ejection fraction (0.35). Treatment with a cardiac resynchronization therapy defibrillator (CRT‐D) was selected and the device was implanted. CRT‐D interrogation revealed proper function. Following procedure termination, the patient went into cardiac arrest and died despite resuscitation attempts. An autopsy revealed that the medial aspect of the right atrium was pierced by an active lead and that the aorta had a deep lesion, 2 mm in length, on its lateral aspect. We explain the probable pathogenesis of this patients death.

Long‐Term Survival Following Surgery for Endomyocardial Fibrosis

We report a successful follow‐up after 28 years of a woman with obliterative restrictive endomyocardial fibrosis (EMF) that underwent complete surgical decortication with simultaneous mitral and tricuspid bioprosthetic valve replacement in 1982 and underwent successful reoperation for the structural failure of biological prostheses after 25 years. doi: 10.1111/jocs.12159 (J Card Surg 2013;28:675–677)