Gilles Soulat

Longitudinal strain of systemic right ventricle correlates with exercise capacity in adult with transposition of the great arteries after atrial switch

BACKGROUNDnSystemic right ventricle (sRV) dysfunction in d-transposition of the great arteries following atrial switch (d-TGA) is associated with increased mortality. We aimed to characterize maladaptive sRV mechanisms in d-TGA patients, analyzing relation of echocardiographic parameters of sRV systolic function to objective measurements of exercise capacity.nnnMETHODSnForty-seven adult patients with d-TGA and atrial switch (mean age 31.6±4.2years) underwent conventional echocardiography, bidimensional strain (2D-strain), cardiac magnetic resonance (CMR) imaging and cardiopulmonary exercise evaluation on the same day. Those with median peak oxygen uptake (VO2)>64.5% (n=23) constituted group A, those with VO2≤64.5% (n=24) constituted group B and 23 healthy age and gender matched subjects constituted the control group.nnnRESULTSnIn group A, global longitudinal peak systolic 2D-strain (GLS) of sRV was significantly reduced compared to GLS of normal RV and LV in the healthy control group (p<0.01), however peak longitudinal 2D strain was similar at basal and mid-segment of sRV free wall than normal LV. In group B, GLS was significantly reduced compared to group A (-10.9±2.9% vs -13.1±2.3%, p<0.05), mostly due to significant decrease of interventricular septum longitudinal strain. Other echocardiographic systolic parameters were not significantly different between groups A and B. Only sRV GLS showed significant correlation with functional capacity as measured by VO2 (r=0.42, p<0.01), while CMR RVEF did not.nnnCONCLUSIONnGLS of sRV predicts functional capacity and may be more sensitive than CMR RVEF in detecting early myocardial damage of sRV in patients with d-TGA and atrial switch.

Impaired atrioventricular transport in patients with transposition of the great arteries palliated by atrial switch and preserved systolic right ventricular function: A magnetic resonance imaging study

OBJECTIVESnWe aimed (1) determine if systemic right ventricle filling parameters influence systemic right ventricle stroke volume in adult patients with D-transposition of the great arteries (D-TGA) palliated by atrial switch, using cardiac magnetic resonance imaging and echocardiography, and (2) to study relationship of these diastolic parameters with exercise performance and BNP, in patients with preserved systolic systemic right ventricle function.nnnDESIGNnSingle-center, cross-sectional, prospective study.nnnSETTINGnIn patients with D-TGA palliated by atrial switch, diastolic dysfunction of the systemic right ventricle may precede systolic dysfunction.nnnMETHODSnForty-five patients with D-TGA and atrial switch and 45 age and sex-matched healthy subjects underwent cardiac magnetic resonance imaging and echocardiography. Filling flow-rates measured by phase-contrast cardiac magnetic resonance imaging were analyzed using customized software to estimate diastolic parameters and compared with exercise performance.nnnRESULTSnIn D-TGA, early filling of systemic right ventricle was impaired with a lower peak filling rate normalized by filling volume (Ef/FV measured by cardiac magnetic resonance imaging) and a higher early filling peak velocity normalized by early peak myocardial velocity (EUS /Ea measured by echocardiography) compared with controls (Pu2009≤u2009.04). Stroke volume of systemic right ventricle showed a direct and significant association with pulmonary venous pathway size (respectively ru2009=u20090.50, Pu2009<u2009.01). Systemic right atrial area and systemic right ventricle mass/volume index measured by cardiac magnetic resonance imaging, as well as Ef/FV were significantly correlated with exercise performances and BNP (Pu2009<u2009.01). All correlations were independent of age, gender, body mass index and blood pressure.nnnCONCLUSIONSnSystemic right ventricle pre-load and stroke volume depend mainly on intraatrial pathway function. Moreover, systemic right ventricle remodeling and right atrial dysfunction impair systemic right ventricle filling, leading to BNP increase and exercise limitation. Cardiac magnetic resonance imaging should assess systemic right ventricle filling abnormalities in D-TGA patients.

Long‐Term Engraftment (16 Years) of Myoblasts in a Human Infarcted Heart

We report the case of a patient who had undergone injections of myoblasts in an infarct area 16 years before being referred for heart transplantation. The pathological examination of the explanted heart found persisting myotubes embedded in fibrosis. This finding supports the ability of myoblasts to survive in harsh environments, which can make them appealing candidates for transplantation in diseases requiring supply of new myogenic cells. Stem Cells Translational Medicine 2018;7:705–708

Too big for echocardiography

Clement Karsenty*, Magalie Ladouceur, Mikael Laredo, Laurence Iserin, and Gilles Soulat Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou, France; Centre de référence des malformations Cardiaques Congénitales Complexes, M3C, Paris Descartes University, Paris, France; INSERM UMR1048, Institut des Maladies Métaboliques et Cardiovasculaires, I2MC, Equipe 8, Toulouse, France; and Paris Centre de Recherche Cardiovasculaire, INSERM U970, Paris, France * Corresponding author. Tel: 133 673407752, Fax: 133 156095466, Email: clement.karsenty@hotmail.fr

Paradoxical right heart failure due to persistent ductus arteriosus

A 36-year-old Caucasian male was referred to our unit for subacute and severe heart failure, mainly right heart failure (RHF) with related cachexia. He was known to have patent ductus arteriosus (PDA) since childhood, associated with massive pulmonary regurgitation (PR) sequela of endocarditis, medically treated. Transthoracic echocardiogram (Panel A) revealed dilated left ventricle and right ventricle with biventricular dysfunction and severe PR. PDA minimal diameter was about 5 mm with exclusive left-to-right shunt (V1⁄4 4.5 ms ). Right atrium pressure was elevated. PR was thought to have a preponderant place in the clinical setting of RHF. Surgical pulmonary valve replacement (PVR) associated to PDA closure was initially viewed as the first therapeutic option. However, clinical presentation and biventricular dysfunction predicted a significant surgical risk. To better understand this RHF pathophysiology, we performed a 4D flow magnetic resonance imaging (MRI) at 1.5 T (SignaHDxt, GEHC). First, streamlines representation illustrated flow coming from the PDA to the right ventricle through the PR (Panels B and C, see Supplementary data online Video S1). Second, we were able to measure precisely the flows at different levels (Panel D) and found that PR was responsible for right heart volume overload massively exacerbated by the PDA shunt (QP/QS1⁄4 4.0). We performed an isolated percutaneous closure of the PDA. Patient’s symptoms improved within 24 h spectacularly. PVR is planned in the second stage, more safely. This case illustrates the help of 4D flow MRI in the understanding of complicated haemodynamic situations, alike congenital heart diseases, and thus in choosing therapeutic options. Panels (A) Transthoracic echocardiography parasternal short-axis view showing the pulmonary regurgitation and the left to right shunt through PDA. 4D flow MRI sequences with (B) systolic time and (C) diastolic time frames with streamlines representation of the flow. (D) Results of estimated flow at various levels leading to quantification of QP/QS and QPDA.

Starr–Edwards aortic valve: 50+ years and still going strong: a case report

Abstract The advent of the Starr–Edwards mechanical valve marked the beginning of the modern era for heart valve replacement. Nowadays, this valve has been supplanted by lower profile bileaflet mechanical prostheses that are considered to have better haemodynamics, lesser risk of thrombo-embolic complications, and longer durability without structural prosthesis failure. These assumptions often lead physicians to face with the question of systematically replacing functional Starr–Edwards valves in patients undergoing redo operations on other valves. We report the case of a 67-year-old patient who recently underwent mitral valve replacement for symptomatic rheumatic valve disease with an excellent outcome. During the operation, the Starr–Edwards valve in the aortic position implanted 51u2009years earlier was found to still functioning normally hence was left in place, thereby breaking a new longevity record for a valve prosthesis.

Comparison of brachial and central blood pressures using an oscillometric device with 2 or 6 metre tubing lengths for assessment of central pressure during MRI exam

Background Magnetic resonance imaging (MRI) offers the possibility to measure local and regional indices of aortic function. However calculations of these indices usually require blood pressure (BP) values. Up to now, because of its easier availability, brachial BP was used instead of local aortic pressure. The SphygmoCor Xcel system (AtCor Medical, Australia) estimates aortic pressure noninvasively. It consists in a MRI compatible brachial cuff connected via a hose to a recording unit and computer. The aim of this study was to compare brachial and central BP values given by SphgymoCor Xcel with the standard 2 meters hose and a 6 meters hose more suitable for central BP assessment during MRI.

Accuracy and Inter observer variability of blood flow quantification on 4D flow MRI in adult with transposition of the great arteries corrected by arterial switch

Background 4D flow magnetic resonance imaging appears as a reliable tool for blood flow quantification. However, in patients with transposition of the great arteries corrected by arterial switch, the choice of a high velocity encoding (venc) to avoid velocity aliasing due to pulmonary stenosis, could decrease the accuracy of blood flow quantification in vessels such as superior or inferior vena cava (SVC, IVC) and atrio-ventricular valve (AVV) when blood velocities are lower. Moreover, such accuracy of blood flow estimates can further be influenced by user experience in cardiac imaging due to manual intervention for 3D segmentation process of cardiac structures and correction of background phase offset. Our aim was to investigate the accuracy and inter observer variability of quantitative MR 4D flow estimates in patients with transposition of the great arteries corrected by arterial switch (asTGA).