Papers by Stephanie Perrier
European Journal of Pediatrics, 2020
Myocarditis and Kawasaki disease are common but usually distinct diseases in children. During the... more Myocarditis and Kawasaki disease are common but usually distinct diseases in children. During the coronavirus pandemic (COVID-19), reports of a new form of myocarditis with clinical features of Kawasaki appeared. We investigated the place of this new disease in the spectrum encompassing Kawasaki disease and myocarditis. Thirty two consecutive children referred to our centre for a suspicion of Kawasaki or a diagnosis of myocarditis were included and eventually divided into four groups: 11 Kawasaki diseases, 6 Kawasaki syndromes (children with another diagnosis), 7 myocarditis without Kawasaki clinical feature and 7 myocarditis with incomplete Kawasaki clinical features. All were treated with immunoglobulins except those of the myocarditis group. The survival rate was 91%. The 7 children with myocarditis and clinical features of incomplete Kawasaki were all positive for SARS-CoV-2. They had a transient myocardial failure with a favourable course and none had coronary artery disease. Conclusion: Every COVID-19 child within our population had a mild to severe myocarditis and presented with fever plus two or three Kawasaki clinical features. Short-term evolution was good for these children. This new disease seems to fill the gap between isolated myocarditis and Kawasaki disease.
The Annals of Thoracic Surgery, 2021
BACKGROUND During hypoxia or acidosis, S-nitrosoglutathione (GSNO) has been shown to protect the ... more BACKGROUND During hypoxia or acidosis, S-nitrosoglutathione (GSNO) has been shown to protect the cardiomyocyte from IR injury. In a randomised double blinded control study of a porcine model of paediatric CPB, we aimed to evaluate the effects of two different doses (low and high) of GSNO. METHODS Pigs weighing 15-20 kg were exposed to CPB with one hour of aortic cross-clamp. Prior to and during CPB, animals were randomised to receive low dose (up to 20 nmol/kg/min) GSNO (n=8), high dose (up to 60 nmol/kg/min) GSNO (n=6) or normal saline (n=7). Standard cardiac intensive care management was continued for 4 hours post-bypass. RESULTS There was a reduction in myocyte apoptosis after administration of GSNO (p=0.04) with no difference between low and high dose GSNO. The low dose GSNO group had lower pulmonary vascular resistance post-CPB (p=0.007). Mitochondrial Complex I activity normalised to citrate synthase activity was higher after GSNO compared to control (p=0.02), with no difference between low and high dose GSNO. CONCLUSIONS In a porcine model of CPB intravenous administration of GSNO limits myocardial apoptosis through preservation of mitochondrial complex I activity, and improves pulmonary vascular resistance. There appears to be a dose dependent effect to this protection.
The Journal of Thoracic and Cardiovascular Surgery, 2018
The Journal of Thoracic and Cardiovascular Surgery, 2018
FRACS (right) Central Message Delaying surgical closure of patent ductus arteriosus after failed ... more FRACS (right) Central Message Delaying surgical closure of patent ductus arteriosus after failed pharmacotherapy may increase the incidence of chronic lung disease in premature infants.
The Journal of Thoracic and Cardiovascular Surgery, 2018
Neonatal quadricuspid truncal valve and ostial stenosis of intramural left coronary artery. Centr... more Neonatal quadricuspid truncal valve and ostial stenosis of intramural left coronary artery. Central Message Truncal valve tricuspidization with left coronary artery unroofing resulted in excellent repair in a newborn infant with truncus arteriosus and severe truncal valve insufficiency.
Interactive cardiovascular and thoracic surgery, Jan 26, 2018
We herein describe the successful surgical repair of a very rare combination of an aorta-to-left ... more We herein describe the successful surgical repair of a very rare combination of an aorta-to-left ventricle tunnel with the right coronary artery arising from it. The neonate presented with signs of heart failure due to significant regurgitation of blood via the tunnel. The closure of the tunnel was feasible during neonatal period without patches.
The Annals of thoracic surgery, 2017
Extensive perinatal myocardial infarction caused by coronary artery thrombosis is extremely rare ... more Extensive perinatal myocardial infarction caused by coronary artery thrombosis is extremely rare and has a dismal prognosis. We report a 3.5-kg neonate who presented at birth with an extensive myocardial infarction caused by aortic root and left main coronary artery thrombus after an emergency cesarean section. We performed emergency surgical thrombectomy and insertion of extracorporeal membrane oxygenation support. After subsequent conversion to long-term left ventricular assist device with an EXCOR device (Berlin Heart, Berlin, Germany), the patient had no ventricular recovery after 163 days of support. He was successfully bridged to transplantation.
Journal of Cardiac Surgery, 2016
We reported the case of a 56-year-old male with tetralogy of Fallot associated with an aneurysm o... more We reported the case of a 56-year-old male with tetralogy of Fallot associated with an aneurysm of the aortic root and severe aortic insufficiency. Repair of the aortic aneurysm along with a complete tetralogy repair was performed. 1 | INTRODUCTION Cases of uncorrected tetralogy of Fallot (TOF) in adults are rare. 1 We present a case of a 56-year-old patient with unrepaired TOF, pulmonary valvular stenosis without major aorto-pulmonary collaterals (MAPCAs), and an aortic root aneurysm. The surgical management of this rare abnormality is reviewed.
Interactive cardiovascular and thoracic surgery, Jan 22, 2016
The purpose of this study was to assess the impact on hospital mortality and morbidity of extensi... more The purpose of this study was to assess the impact on hospital mortality and morbidity of extensive myocardial revascularization, using arterial grafts in patients undergoing isolated coronary artery bypass grafting (CABG). Our prospective perioperative database was used to define two groups of patients who underwent isolated CABG with cardiopulmonary bypass, based on the years in which the operation was performed: Group A (2000-2003; 898 patients) and Group B (2009-2012; 1249 patients). The baseline and operative characteristics and outcomes were compared. Several significant changes in perioperative variables were observed. Group B included higher percentages of patients aged over 80 years (+58.1%), with diabetes (+32.0%) and with a history of percutaneous coronary intervention (+24.9%). The mean EuroSCORE II was significantly increased from 2.5 ± 4.4% in Group A to 3.2 ± 5.7% in Group B (P= 0.001). The mean number of distal anastomoses was significantly increased over time (total...
Interactive CardioVascular and Thoracic Surgery, 2013
A best evidence topic in cardiac surgery was written according to a structured protocol. The ques... more A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was as follows: is coronary artery bypass graft (CABG) surgery superior to percutaneous coronary intervention (PCI) in terms of in-hospital mortality and morbidity and long-term outcomes in patients with acute myocardial infarction (MI)? A total of 104 papers were returned using the selected search. Of these, six represented the best evidence to answer the clinical question. The selection criteria were comparative studies with only PCI and CABG groups in patients with acute MI. Case reports, reviews, recommendations and studies on a specific population or out of the context of acute MI were excluded. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Almost all PCI patients received stents. One study used drug-eluting stents (DES). Two randomized studies showed similar short-and mid-term morbidities and mortalities in patients with acute MI in the PCI and CABG groups but higher repeat revascularization rates after PCI. Three observational studies found comparable survival, but one of them found more periprocedural events with CABG and the other two found more recurrent ischaemia requiring repeat revascularization in the PCI group. In one cohort study, CABG appeared to be an independent risk factor for death in N-STEMI according to the European Society/American College of Cardiology 2000 definition. The results are strongly influenced by the definition of acute MI. In an institution offering the two techniques with an equivalent accessibility, the principal advantage of PCI is a lower incidence of periprocedural and short-term morbidities. CABG, on the other hand, offers a better durability with less mid-term repeat revascularization required, especially when compared with PCI with DES implantation. Choice had to weight up coronary artery anatomy, number and localization of coronary artery stenosis and accessibility of both PCI and CABG treatments. Medical and surgical discussion within the Heart Team is required to make the best medical decision for each patient.
The Annals of thoracic surgery, 2014
patients and 30 published studies, the bleeding risk associated with LMWH early after mechanical ... more patients and 30 published studies, the bleeding risk associated with LMWH early after mechanical valve surgery was higher compared with the use of oral anticoagulation alone (4.8% versus 3.3%, respectively), with little difference noted in the risk of thromboembolism between the two strategies (0.6% versus 0.9%, respectively) [2]. A high risk of bleeding complications associated with LMWH administration was also noted in a Mayo Clinic report of nearly 3000 cardiac surgery patients, with nearly 9% of patients requiring delayed surgical reexploration after receiving LMWH [3]. In the end, prospective randomized studies are necessary to ascertain the relative risks and benefits of different anticoagulation regimens following mechanical valve replacement. Notwithstanding the encouraging results reported by Kindo and colleagues [1], in this author’s view, routine LMWH bridging after mechanical valve implantation does not appear justified, and may lead to more harm than benefit.
Thrombosis Research, 2014
Background: Obesity is suggested to reduce postoperative bleeding in patients undergoing cardiac ... more Background: Obesity is suggested to reduce postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) but perioperative hemostasis variations have not been studied. Therefore, we investigated the effects of severe obesity (body mass index [BMI] ≥35 kg/m 2) on chest tube output (CTO) and hemostasis in patients undergoing cardiac surgery with CPB. Materials and Methods: We prospectively investigated 2799 consecutive patients who underwent coronary and/ or valve surgery using CPB between 2008 and 2012. 204 patients (7.3%) presented a severe obesity. Results: In the severe obesity group, the 6-h and 24-h CTO were significantly reduced by-21.8% and-14.8% respectively (P b 0.0001) compared with the control group. A significant reduction of the mean number of red blood cell units transfused at 24 h was observed in the severe obesity groups (P = 0.01). On admission to the intensive care unit, a significant increase of platelet count (+ 9.2%; P b 0.0001), fibrinogen level (+12.2%; P b 0.0001) and prothrombin time (+4.1%; P b 0.01) and a significant decrease of the activated partial thromboplastin time (-4.2%; P b 0.01) were observed in the severe obesity group compared with the control group. In multivariate analysis, severe obesity was significantly associated to a decreased risk of excessive bleeding (24-h CTO N 90th percentile; Odds ratio: 0.37, 95% CI: 0.17 to 0.82). No significant differences were observed regarding postoperative thromboembolic events between the two groups. Conclusions: Severe obesity is associated with a prothrombotic postoperative state that leads to a reduction of postoperative blood loss in patients undergoing cardiac surgery with CPB.
Thrombosis Research, 2014
Evidence regarding the behavior of fibrinogen levels and the relation between fibrinogen levels a... more Evidence regarding the behavior of fibrinogen levels and the relation between fibrinogen levels and postoperative bleeding is limited in cardiac surgery under cardiopulmonary bypass (CPB). To evaluate perioperative fibrinogen levels as a predictor of postoperative bleeding in patients undergoing cardiac surgery with CPB. In this prospective, single-center, observational cohort study of 1956 patients following cardiac surgery with CPB, fibrinogen level was measured perioperatively. Excessive bleeding group was defined as patients with a 24-h chest tube output (CTO) exceeded the 90th percentile of distribution. The median 24-h CTO was 728.6±431.1ml. A total of 189 patients (9.7%) were identified as having excessive bleeding. At admission to the intensive care (Day 0), the fibrinogen levels were 2.5±0.8g/l and 2.1±0.8g/l in the control and excessive bleeding groups, respectively (P<0.0001). The fibrinogen level on Day 0 was significantly correlated with the 24-h CTO (rho=-0.237; P<0.0001). Multivariate analysis demonstrated that the fibrinogen level at Day 0 was the best perioperative standard laboratory test to predict excessive bleeding (P=0.0001; odds ratio, 0.5), whereas preoperative fibrinogen level was not a predictor. Using receiver operating characteristics curve analyses, the best Day 0 fibrinogen level cutoff to predict postoperative bleeding was 2.2g/l. In this large prospective study, the fibrinogen level upon admission to the intensive care unit after CPB predicted the risk of postoperative bleeding. Our data add to the concern regarding the fibrinogen level threshold that might require fibrinogen concentrate infusion to reduce postoperative blood loss.
Archives of Cardiovascular Diseases Supplements, 2014
In clinical routine, myocardial perfusion MRI is generally performed with a stress/rest protocol ... more In clinical routine, myocardial perfusion MRI is generally performed with a stress/rest protocol using adenosine as a stressor to visualize ischemic risk zones in the myocardium. Changes in the vasodilator responses to adenosine with age have been reported in the rat thoracic aorta and the isolated-perfused rat heart. This study assesses the effect of maturation on the vascular relaxant action of adenosine in vivo on rats.
Seminars in Thoracic and Cardiovascular Surgery, 2018
Sources of funding: No sources of funding were obtained for this project.
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Papers by Stephanie Perrier