D. Tixier

Myocardial recovery after mechanical support for acute myocarditis: is sustained recovery predictable?

BACKGROUNDnAt present, myocardial recovery with mechanical support for acute myocarditis is a more frequently observed issue. However, predictive parameters of a sustained myocardial recovery are still under investigation.nnnMETHODSnTwo recent cases of mechanical support for acute lymphocytic myocarditis with two different outcomes are reported. Literature about this disease and predictability of a sustainable myocardial recovery are reviewed.nnnRESULTSnAcute lymphocytic myocarditis is an individual entity whose outcome is associated with the importance of healed cell damage. Unfortunately, there are no available means of quantifying the fibrotic scar and endomyocardial biopsy has a high percentage of false-negative results. Echocardiographic assessment of systolic and diastolic cardiac function is difficult while under mechanical support and its significance is not obvious. Forthcoming development of Doppler could better correlate myocardial contractility and histology to be predictive of a sustained recovery after acute myocarditis under mechanical support.nnnCONCLUSIONSnLong-lasting recovery after mechanical support for acute myocarditis remains unpredictable in our experience. More predictive factors are needed.

The target antigens of naturally occurring human anti-beta-galactose IgG are cryptic on porcine aortic endothelial cells.

Abstract: The identification of the xeno‐antigens/xeno‐antibodies combinations involved in pig‐to‐human xenograft rejection is an essential step for understanding this process and for the development of procedures to prevent it. Although it is widely accepted that the terminal disaccharide Galα1,3Gal‐R is by far the major epitope recognized by human natural antibodies reactive with pig tissues, there is also evidence that other carbohydrates epitopes might be important in xenograft rejection.

Effects of the 14F Hemopump on coronary hemodynamics in patients undergoing high-risk coronary angioplasty

BACKGROUNDnThe influence of the 14F Hemopump on coronary hemodynamics in patients with coronary artery disease remains unknown.nnnMETHODSnSystemic and coronary hemodynamic measurements were obtained in eight patients among 13 who underwent high-risk coronary angioplasty in our institution with the support of the Hemopump. Coronary blood flow velocity was measured with a 0.014-inch Doppler-tipped guide wire both proximal and distal to the target lesion.nnnRESULTSnAngioplasty decreases the diameter coronary stenosis from 76% +/- 21% to 22% +/- 11%. Hemopump support did not change systemic hemodynamics either before or after angioplasty. During angioplasty Hemopump support decreased the pulmonary capillary wedge pressure from 23.5 +/- 8.5 mm Hg to 18.6 +/- 7 mm Hg (p = 0.013). No changes in either heart rate, mean and systolic aortic pressures, and cardiac index were observed throughout the procedure. After successful angioplasty was performed, the ratio of proximal to distal flow velocity decreased from 2.11 +/- 1 to 1.65 +/- 0.2 (p = 0.05). However, Hemopump did not affect absolute coronary blood flow velocities or the phasic pattern of flow velocities (diastolic systolic velocity ratio, diastolic and systolic velocity integrals) either in proximal or distal locations either before or after angioplasty.nnnCONCLUSIONSnThis study shows that although the 14F Hemopump produces unloading of the left ventricle, it does not importantly alter coronary hemodynamics when systemic hemodynamics are stable. Whether the Hemopump would maintain or improve coronary blood flow in compromised patients remains to be determined.

The wearable Novacor LVAS at Henri Mondor Hospital

From March 1993 to February 1996, 8 patients have been selected, from a group of 40 patients in cardiogenic shock, referred for urgent cardiac transplantation. Immediate hemodynamical improvement allowed a rapid favorable evolution of organ dysfunction, a weaning off any IV inotropic support. The late evolution was as follows: one patient still on device after 164 days living at home. One patient died at 201 days as a result of the psychological sequellae of an embolic episode. Six patients have been transplanted, with a successful outcome in 5.