Jean Christophe Macia

Precordial Thump in the Catheterization Laboratory Experimental Evidence for Commotio Cordis

A 57-year-old man was admitted to our institution for a diagnostic coronarography. During the right coronary injection (Iomeron 350, Altana Pharma, Le Mee sur Seine, France), complete atrioventricular block occurred for 3 seconds. A precordial thump was performed to restart …

An hs-TNT Second Peak Associated with High CRP at Day 2 Appears as Potential Biomarkers of Micro-Vascular Occlusion on Magnetic Resonance Imaging after Reperfused ST-Segment Elevation Myocardial Infarction

Introduction: Micro-vascular occlusion (MVO) in a myocardial infarction (MI) is associated with an increased risk of heart failure and mortality. Hs-T-troponin has a double peak kinetic after MI. The aim was to determine if this kinetic was correlated to MVO evaluated by cardiac magnetic resonance imaging (MRI) after MI. Methods: This is a monocentric retrospective study. Inclusion criteria were hospitalization for MI, Thrombolysis In Myocardial Infarction flow 0 at coronary angiography, reperfusion within 12 h from the onset of chest pain, cardiac MRI within the first month, and a 5-days’ biological follow-up with at least hs-T-Troponin and C-reactive protein (CRP). Statistics were performed using the R software. Results: Ninety-eight patients were included. Fifty-three patients (54.1%) had MVO at MRI. The existence of MVO was associated with a trend of more kissing procedure during primary percutaneous coronary intervention (p = 0.06), a significantly more frequent second peak of troponin (p = 0.048), a significantly higher CRP level (p < 0.0001) and a longer time to balloon (p = 0.01). The association of CRP level above 40 mg/L at day 2 and the observation of a second peak of troponin were associated to 95% of MVO in ST-segment elevation MI patients. By contrast, in the absence of these 2 criteria, MVO was absent in 78% of the cases. This score was associated with a higher rate of hospitalisation at 2 years. Conclusion: A biological score integrating hs-TNT second peak and CRP might help to predict MVO and predict outcomes after reperfused MI in our population.

Collagen plug-based vascular closure devices do not decrease vascular and bleeding complications occurring after balloon aortic valvuloplasty

BACKGROUNDnThe benefits of vascular closure devices (VCDs) in the prevention of vascular complications after femoral intervention remain controversial.nnnAIMnTo evaluate the efficiency of collagen plug-based VCDs in the prevention of femoral access complications after balloon aortic valvuloplasty.nnnMETHODSnWe conducted a prospective analysis of consecutive patients who underwent balloon aortic valvuloplasty by femoral retrograde technique in our centre between 2009 and 2012. Group 1 included 75 patients in whom femoral puncture haemostasis was obtained with the use of an 8F collagen plug-based VCD (Angio-Seal™; Saint-Jude Medical, Inc.); group 2 included 105 patients who had manual or mechanical groin compression (FemoStop™; RADI Medical Systems, Inc.). We did not use heparin during the procedure. We collected data on major in-hospital adverse events, majorxa0bleeding (Bleeding Academic Research Consortium classification≥3) and vascular access complications.nnnRESULTSnWe included 180 patients with severe and symptomatic aortic stenosis. Indications for valvuloplasty were mainly bridge to transcatheter aortic valve implantation or palliative therapy (72%). The groups were similar in terms of median age, lower limb artery disease and body mass index. Vascular and bleeding complications occurred in 11.1% of patients and were not decreased with the use of VCDs (relative risk 2.60, 95% confidence interval 1.10-3.09; P=0.05). These findings were consistent across all prespecified subgroups. Duration of hospital stay was not reduced by VCDs.nnnCONCLUSIONSnBased on the results of this study, performed with small-size sheaths and without heparin, collagen plug-based VCDs increase femoral access complications following aortic valvuloplasty. Systematic use of VCDs in elderly patients, with probable advanced limb atherosclerosis, is questionable.

149: Balloon aortic valvuloplasty can it be performed safely without heparin?

Bleeding and femoral access complications which occurred after balloon aortic valvuloplasty (BAV) may be enhanced by the systematic use of heparin during the procedure. We assessed the hypothesis that BAV performed without heparin may be associated with lower complications rates. Methods We conducted a retrospective analysis of all consecutive patients who had undergone BAV in our center between 2008 and 2011. We evaluated 3 groups: group 1 included patients whose BAV was performed with large sheaths (10 to 12 F) and use of unfractionated heparin (UH) (50IU/kg bolus IV); patients whose BAV was performed with use of smaller size sheaths (8 or 9 F) who were divided into group 2 (with UH bolus) and group 3 (without UH bolus). We collected all major in-hospital adverse events, bleeding (≥BARC 3), vascular complications (including pseudoanerysm or arterio venous fistula) and acute limb ischemia. Results Overall, 132 patients were included in this study. The 3 groups had similar median age (84 years) or previous lower extremity artery disease (overall n= 36, 27%, p=0.79). Vascular and bleeding complications were observed in 17 patients (12.8%) and were significantly higher when UH was used (table 1) with a relative risk of 2.89 (1.18-6.1). Conversely, absence of heparin did not increase ischemic complications or major in-hospital adverse events (p=0.5). Vascular complications were similar among patients who received heparin whatever the size of the used sheath (table 1). Conclusion Balloon aortic valvuloplasty performed without heparin appears to be safe and is associated with a dramatic reduction of vascular and bleeding events. Although randomization was not used, this marked difference is difficult to explain by confounding factors. Table 1 . Vascular and bleeding complications. group 1 (UH+, LS) n=23 group 2 (UH+, SS) n=46 group 3 (UH-, SS) n=63 p value Femoral access and/or bleeding n=17 (12.8%) 4 (17.3%) 9 (19.5.%) 4 (6.3%)* 0.007 Bleeding n=15 (11.3%) 4 (17.3%) 8 (17.3%) 3 (4.7%)* 0.004 Acute limb ischemia n=4 (2.2%) 0 2 (4.3%) 2 (3.1%) 0.82 UH+: unfractionated heparin bolus 50xa0ui/kg; UH-: no heparin bolus; LS: large sheath; SS: small sheath

Ventricular Tachycardia Late After Cardiac Transplantation

A 65-year-old man presented with 48 hours of palpitations. His ECG on admission demonstrated a broad-complex tachycardia (Figure 1). Eleven years previously he had undergone heterotopic cardiac transplantation for severe ischemic cardiomyopathy. Echocardiography demonstrated a normally contracting donor heart (left ventricular [LV] end-diastolic diameter 41 mm, LV ejection fraction 62%). On the contrary, the native heart showed no …