Matthias Kirsch

Glutathione Deficiency in Cardiac Patients Is Related to the Functional Status and Structural Cardiac Abnormalities

Background The tripeptide glutathione (L-gamma-glutamyl-cysteinyl-glycine) is essential to cell survival, and deficiency in cardiac and systemic glutathione relates to heart failure progression and cardiac remodelling in animal models. Accordingly, we investigated cardiac and blood glutathione levels in patients of different functional classes and with different structural heart diseases. Methods Glutathione was measured using standard enzymatic recycling method in venous blood samples obtained from 91 individuals, including 15 healthy volunteers and 76 patients of New York Heart Association (NYHA) functional class I to IV, undergoing cardiac surgery for coronary artery disease, aortic stenosis or terminal cardiomyopathy. Glutathione was also quantified in right atrial appendages obtained at the time of surgery. Results In atrial tissue, glutathione was severely depleted (−58%) in NYHA class IV patients compared to NYHA class I patients (P = 0.002). In patients with coronary artery disease, this depletion was related to the severity of left ventricular dysfunction (P = 0.006). Compared to healthy controls, blood glutathione was decreased by 21% in NYHA class I patients with structural cardiac disease (P<0.01), and by 40% in symptomatic patients of NYHA class II to IV (P<0.0001). According to the functional NYHA class, significant depletion in blood glutathione occurred before detectable elevation in blood sTNFR1, a marker of symptomatic heart failure severity, as shown by the exponential relationship between these two parameters in the whole cohort of patients (r = 0.88). Conclusions This study provides evidence that cardiac and systemic glutathione deficiency is related to the functional status and structural cardiac abnormalities of patients with cardiac diseases. These data also suggest that blood glutathione test may be an interesting new biomarker to detect asymptomatic patients with structural cardiac abnormalities.

Virtual Angioscopy and 3-Dimensional Navigation Findings of the Aortic Arch After Vascular Surgery

The anatomy of the aortic arch is variable, and its detailed analysis on computed tomography (CT) scan may be difficult. Indeed, its curvature, angulations, length of horizontal portion, and origin of supra-aortic trunks (SAT) may vary among individuals. Furthermore, drastic modifications of the patient’s anatomy may be observed after open or endovascular surgery and in case of congenital abnormalities. The 3-dimensional (3D) nature of the aortic arch is then difficult to assess on an axial plane. Current workstations have permitted the reconstruction in 2 dimensions of the aortic arch, and the volume-rendering technique or shaded surface display gives an external analysis of the structures. Virtual angioscopy, first described in 2001,1 allows the realization of an endoluminal navigation in 3 dimensions. It is based on the notion of active vision, in which only visual perception drives the motion of the virtual angioscope.2 The navigation mode allows manual analysis of the elements of the aortic arch under different viewing angles and dynamic localization of abnormalities in relation to SAT with high precision and better understanding. Here are examples of patients having undergone an aortic arch procedure and for whom the fly-through with the help of virtual angioscopy has permitted better understanding of abnormalities of the aortic arch. A 64 Light Speed VCT multidetector-row CT was used (General Electric Medical Systems, Milwaukee, Wis), allowing maximal intensity projection and maximal projection-rendering imaging, as well as 3D rendering of images. Images were analyzed on a dedicated platform (Advantage Windows 4.2, General Electric Medical …

Simplified temporary right ventricular support after implantation of a left ventricular assist device.

Right ventricular failure is one of the most feared complications after implantation of a left ventricular assist device. We provide the technical details for a simplified, percutaneous approach to temporary right heart support.

Physiopathologie des anévrismes idiopathiques de l'aorte thoracique ascendante

BACKGROUND The majority of ascending aortic aneurysms cannot be related to any specific etiology and should be qualified as idiopathic. The incidence of this disease is increasing in the population of the developed countries but its pathobiology is poorly understood. AIM This article is reviewing the publications concerning the pathobiology of idiopathic ascending aortic aneurysms. SOURCES A PubMed search on articles published in English or French, between January 1965 and December 2007, on key-words << aortic root >>, << ascending aorta >>, << aortic arch >>, << thoracic aorta >>, << aneurysm >>, << dilatation >> and << dissection >> was undertaken. Articles on aneurysms related to inflammatory and infectious diseases, congenital or genetic syndromes were excluded. RESULTS The presented data suggests that destructive remodeling of the aortic wall, inflammation and angiogenesis, biomechanical wall stress, and molecular genetics are relevant mechanisms of idiopathic ascending aortic aneurysm formation and progression. LIMITS Sparse data available from few direct studies offer limited knowledge on pathobiology of idiopathic ascending aortic aneurysms. CONCLUSION A more intimate knowledge of the triggers and perpetrating factors of this disease might offer new diagnostic and treatment options.

Paraplegia as a symptom of failure after endovascular therapy of type B aortic dissection in Marfan syndrome

This report describes successful treatment of an unusual case of concomitant paraplegia and type 1 endoleak during the early postoperative course of endovascular therapy of type B dissection in a patient with Marfan syndrome.

Thromboaspiration Leading to Complete Coronary Artery Stripping in Acute Myocardial Infarction After Blast Injury

A54-year-old man without medical history was admitted in our hospital with hemorrhagic shock caused by left compressive hemothorax (Figure 1) after a suicidal gunshot. The entrance site of the projectile was in the 4th left intercostal space. Figure 1. Chest radiograph (posteroanterior view, white arrow shows the bullet). Surgical exploration performed within the 1st hour revealed dissection of the left internal mammary artery and multiple injuries of the lung parenchyma, which could be successfully repaired. Extensive superficial epicardial dilacerations were observed at the level of the mid left anterior descending coronary artery, without penetrating myocardial or coronary artery injury and without pericardial effusion. Coronary flow appeared to be preserved. On transfer into the intensive care unit of the sedated and mechanically ventilated patient, routine 12-lead ECG showed signs of anterior …