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Personne :
Magne, Julien

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Magne

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Julien

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Faculté de médecine, Université Laval

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ncf11467891

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Voici les éléments 1 - 10 sur 12
  • PublicationAccès libre
    Traitement chirurgical des valvulopathies mitrales : impacts hemodynamique, fonctionnel et clinique
    (2008) Magne, Julien; Pibarot, Philippe; Dumesnil, Jean G.
    Les pathologies de la valve mitrale sont les valvulopathies les plus fréquentes dans le monde occidental. Elles touchent plus de 6% de la population de plus de 65 ans et ont un impact important sur la survie. L'insuffisance mitrale (IM) ischémique est une complication de la maladie coronarienne, fréquente à la suite d'un IDM. Son pronostic est sombre et le type de traitement chirurgical à appliquer demeure controversé. L'approche la plus commune pour répondre à 1TM ischémique est l'annuloplastie restrictive de la valve mitrale (ARVM) combinée au pontage aorto-coronarien. Cependant, la littérature rapporte des taux élevés de persistance d'IM à la suite de l'ARVM et la présence d'IM postopératoire est associée à un mauvais pronostic. Il est donc indispensable d'identifier les patients à haut risque de persistance d'IM après l'ARVM. Nous avons montré que la mesure des paramètres de la géométrie mitrale préopératoire permettait de prédire avec précision la persistance d'IM et le devenir des patients. L'ARVM consiste à implanter un anneau prothétique de petite taille afin de restaurer la coaptation des feuillets. Cependant, cette procédure peut limiter la mobilité des feuillets et causer une obstruction du flot mitral. Nos travaux ont montré que l'ARVM cause chez une proprotion importante de patients, une sténose mitrale fonctionnelle (SMF) associée à une augmentation de la pression artérielle pulmonaire et à une réduction de la capacité fonctionnelle. Nos travaux soulignent que l'ARVM est associée à un taux élevé de persistance/récurrence d'IM et/ou de SMF. Il est donc important d'identifier les patients à haut risque d'échec de l'ARVM et de développer de nouvelles techniques visant à mieux corriger PIM, sans induire de SMF. Lorsque la valve mitrale n'est pas réparable, le remplacement valvulaire mitral (RVM) est la seule solution. Une de nos étude a démontré que la présence de disproportion patientprothèse (DPP) après un RVM a un impact hémodynamique délétère et est associée à un taux de survie à long terme diminué. Ces travaux soulignent que lorsque le RVM est inévitable, il est important d'appliquer une stratégie afin d'éviter ou, tout du moins, de diminuer la sévérité de la DPP.
  • PublicationRestreint
    A simple Doppler echocardiography method to evaluate pulmonary capillary wedge pressure in patients with atrial fibrillation
    (Wiley-Blackwell Publishing, 2007-08-22) O'Connor, Kim; Deblois, Jonathan; Sénéchal, Mario; Magne, Julien; Bergeron, Sébastien; Poirier, Paul; Pibarot, Philippe; Dumesnil, Jean G.
    OBJECTIVE: The accuracy of E/E' ratio has not been validated in atrial fibrillation (AF). The objective of this study is to compare the accuracy of the E/E' ratio averaged over a sample of 10 cardiac cycles and E/E' ratio obtained in the cycle with the longest RR interval for the estimation of wedge pressure in patients with AF using a simultaneous pulmonary artery occlusive pressure measured with a Swan-Ganz catheter. DESIGN: Twenty-four consecutive patients with AF with a Swan-Ganz catheter were recruited in this study. The majority of patients (92%) were in the early postoperative phase of cardiac surgery. RESULTS: The best sensitivity and specificity was reached with E/E' ratio in the medial position using the one-beat method; E/E' ratio > or = 16 with one beat predicts a wedge pressure >15 mmHg with a sensitivity and specificity of 91% and 85%, respectively. CONCLUSIONS: Measuring E/E' ratio using the one-beat method is a simple and clinically accurate way to estimate wedge pressure in patients with AF.
  • PublicationRestreint
    Continued global left ventricular remodeling is not the sole mechanism responsible for the late recurrence of ischemic mitral regurgitation after restrictive annuloplasty
    (Elsevier, 2009-11-01) Sénéchal, Mario; Magne, Julien; Pibarot, Philippe; Dumesnil, Jean G.
    Background: Recurrence of ischemic mitral regurgitation (MR) late after mitral valve annuloplasty (MVA) is generally believed to be due to continued left ventricular (LV) remodeling. The aim of this study was to determine if other mechanisms could be involved in MR recurrence. Methods and Results: Preoperative (10 ± 11 days), early postoperative (6 ± 4 days), and late postoperative (1.5 ± 0.6 years) transthoracic echocardiograms of 26 patients (68 ± 7 years, 23 male [88%]) who underwent restrictive MVA and coronary artery bypass graft surgery were reviewed. Mitral valve geometry and MR severity were assessed using anterior leaflet and posterior leaflet angles and the anterior leaflet concavity area, defined as the area enclosed between the AL and a line connecting the tip of the leaflet and its basal insertion at the annulus. Recurrent MR (vena contracta > 3 mm) was observed in 10 patients (38.5%). Among the 10 patients with recurrent MR, 5 had significant late postoperative increase in LV end-systolic (preoperative: 66 ± 27 mL; early postoperative: 61 ± 11 mL; late postoperative: 89 ± 30 mL, P = .04) and end-diastolic (preoperative: 122 ± 39 mL; early postoperative: 108 ± 22 mL; late postoperative: 139 ± 39 mL, P = .04) volumes and PL angle (early postoperative: 65 ± 12 degrees; late postoperative: 77 ± 8 degrees, P = .04), suggesting that recurrent MR is related to continued adverse LV remodeling and ensuing worsening of leaflet tethering. However, in the remaining 5 patients with recurrent MR, there was no significant change in LV end-systolic and end-diastolic volumes, but there was a significant increase in anterior leaflet concavity area (early postoperative: 6 ± 11 mm2; late postoperative: 50 ± 3 mm2, P = .012). Conclusion: Although recurrent MR is often associated with continued adverse LV remodeling after restrictive MVA, this mechanism fails to explain all recurrences. In the absence of LV dilatation, recurrent MR might be explained by localized LV remodeling in the vicinity of papillary muscles resulting in increased AL tethering at the bending point.
  • PublicationAccès libre
    Usefulness of NT-pro BNP monitoring to identify echocardiographic responders following cardiac resynchronization therapy
    (BioMed Central, 2009-08-20) Dubois, Michelle; Sénéchal, Mario; Magne, Julien; Champagne, Jean; Philippon, François; Pibarot, Philippe; Dumesnil, Jean G.; O'Hara, Gilles
    Background: Cardiac resynchronization therapy (CRT) improves left ventricular (LV) volumes, mitral regurgitation (MR) severity and symptoms of patients with heart failure (HF). However, = 30% of patients have no significant clinical or echocardiographic improvement following CRT. Reverse remodeling after CRT correlates with improved clinical outcomes. We hypothesized that in NT-pro BNP monitoring is accurate to identify responders following CRT. Methods: 42 consecutive patients (mean age 66 ± 12 years, male 68%) with HF undergoing CRT were prospectively enrolled. Responders at follow-up were defined by echocardiography (decrease in LV end systolic volume = 15%). Echocardiography and NT-pro BNP measurement were performed at baseline and repeated 3 to 6 month after CRT. Results: There was no significant difference between responders (n = 29, 69%) and non-responders (n = 13, 31%) regarding baseline NT-pro BNP level. Responders had significantly higher decrease in NT-pro BNP levels during follow-up than non-responders (absolute: -1428 ± 1333 pg.ml -1 vs. -61 ± 959 pg.ml -1 , p = 0.002; relative: -45 ± 28% vs. 2 ± 28%, p < 0.0001). A decrease of = 15% in NT-pro BNP 3–6 months after CRT identifies echocardiographic responders with a sensitivity of 90% and a specificity of 77%. Conclusion: NT-pro BNP monitoring can accurately identify echocardiographic responders after CRT.
  • PublicationRestreint
    Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation
    (American Heart Association, 2007-02-13) Sénéchal, Mario; Magne, Julien; Hachicha, Zeineb; Pibarot, Philippe; Dumesnil, Jean G.; Dagenais, François
    BACKGROUND: Ischemic mitral regurgitation (MR) often persists after restrictive mitral valve annuloplasty, in which case it is associated with worse clinical outcomes. The goal of the present study was to determine whether persistence of MR and/or clinical outcome could be predicted from preoperative analysis of mitral valve configuration METHODS AND RESULTS : In 51 consecutive patients undergoing restrictive annuloplasty for ischemic MR, posterior leaflet (PL) angle, anterior leaflet angle, coaptation distance, and tenting area were quantified by echocardiography before surgery (6+/-3 days), and MR severity was assessed before and early after surgery (9+/-4 days). Postoperatively, persistence of mild to moderate MR (vena contracta > 3 mm) was observed in 11 (22%) of the patients. The best predictor of postoperative persistence of MR was a PL angle > or = 45 degrees (sensitivity 100%, specificity 97%, positive predictive value 92%, negative predictive value 100%). Patients with persistent MR had markedly lower 3-year event-free survival (26+/-20%) compared with those with nonpersistent MR (75+/-12%, P=0.01). Preoperative presence of a PL angle > or = 45 degrees also was associated with a markedly lower 3-year event-free survival (22+/-17% versus 76+/-12%; P<0.001). CONCLUSIONS: In patients undergoing restrictive annuloplasty for ischemic MR, persistence of MR and 3-year event-free survival can accurately be predicted by preoperative analysis of mitral valve configuration. Patients with a PL angle > or = 45 degrees (ie, with high PL restriction) should thus be considered poor candidates for this procedure, and concomitant or alternative procedures should be contemplated.
  • PublicationRestreint
    Impact of prosthesis-patient mismatch on survival after mitral valve replacement
    (American Heart Association, etc., 2007-03-05) Tanné, David; Magne, Julien; Doyle, Daniel; Pibarot, Philippe; Dumesnil, Jean G.; Dagenais, François; Mathieu, Patrick
    Background — We recently reported that valve prosthesis-patient mismatch (PPM) is associated with persisting pulmonary hypertension after mitral valve replacement. Thus, the objective of this study was to evaluate the impact of PPM on mortality in patients undergoing mitral valve replacement. Methods and Results— The indexed valve effective orifice area was estimated for each type and size of prosthesis being implanted in 929 consecutive patients and used to define PPM as not clinically significant if >1.2 cm2/m2, as moderate if >0.9 and =1.2 cm2/m2, and as severe if =0.9 cm2/m2. Moderate PPM was present in 69% of patients; severe PPM was seen in 9%. For patients with severe PPM, 6-year survival (74±5%) and 12-year survival (63±7%) were significantly less than for patients with moderate PPM (84±1% and 76±2%; P=0.027) or nonsignificant PPM (90±2% and 82±4%; P=0.002). On multivariate analysis, severe PPM was associated with higher mortality (hazard ratio, 3.2; 95% confidence interval, 1.5 to 6.8; P=0.003). Conclusions— Severe PPM is an independent predictor of mortality after mitral valve replacement. As opposed to other independent risk factors, PPM may be avoided or its severity may be reduced with the use of a prospective strategy at the time of operation. For patients identified as being at risk for severe PPM, every effort should be made to implant a prosthesis with a larger effective orifice area.
  • PublicationRestreint
    Prosthesis–patient mismatch after mitral valve replacement : back to reality
    (American Association for Thoracic Surgery, 2008-01-31) Magne, Julien; Pibarot, Philippe; Dumesnil, Jean G.
  • PublicationRestreint
    Ischemic mitral regurgitation : a complex multifaceted disease
    (S. Karger, 2009-03-01) Sénéchal, Mario; Magne, Julien; Pibarot, Philippe; Dumesnil, Jean G.
    Ischemic mitral regurgitation (MR) is a complex multifactorial disease that involves global and regional left ventricular remodeling as well as dysfunction and distortion of the components of the mitral valve including the chordae, annulus and leaflets. This is a frequent (13–59%) complication of myocardial infarction, which is associated with a poor prognosis. The suboptimal results obtained with the most commonly used surgical strategy, that is, restrictive annuloplasty combined with coronary artery bypass graft, emphasize the need to develop alternative or concomitant surgical techniques that directly target the causal mechanisms of the disease. A comprehensive assessment of mitral valve configuration and left ventricular geometry and function prior to surgery as well as an accurate quantification of MR severity at rest and during exercise may help improve patient risk stratification and better individualize the surgical strategy based on the patient’s specific characteristics. The purpose of this review is to summarize the current state of knowledge with regard to the definition, prevalence, mechanisms, outcome and treatment of ischemic MR.
  • PublicationRestreint
    Restrictive annuloplasty for ischemic mitral regurgitation may induce functional mitral stenosis
    (American College of Cardiology, 2008-04-22) Sénéchal, Mario; Magne, Julien; Pibarot, Philippe; Dumesnil, Jean G.; Dagenais, François; Mathieu, Patrick
    Objectives : The purpose of this study was to evaluate mitral valve hemodynamic performance and functional capacity in patients with ischemic mitral regurgitation (MR) who underwent restrictive mitral valve annuloplasty (MVA). Background : Restrictive MVA combined with coronary artery bypass graft is the conventional approach for the surgical management of patients with ischemic MR. We hypothesized that the restriction of the mitral annulus could cause an obstruction to antegrade mitral flow that may affect the patient's functional capacity. Methods : A dobutamine stress echocardiography (DSE) and a 6-min walk test (6MWT) were performed in 24 patients with ischemic MR 13 ± 3 months after restrictive MVA and coronary artery bypass graft and in 20 control patients with coronary artery disease matched for age, gender, and left ventricular ejection fraction. Results : None of the 24 MVA patients had significant MR after operation. Compared with control patients, MVA patients had significantly (p < 0.001) higher resting and stress peak gradients (rest: 13 ± 4 mm Hg vs. 4 ± 1 mm Hg; DSE: 19 ± 6 mm Hg vs. 6 ± 3 mm Hg) and systolic pulmonary arterial pressures (PAP) (rest: 42 ± 13 mm Hg vs. 27 ± 8 mm Hg; DSE: 58 ± 12 mm Hg vs. 38 ± 11 mm Hg) and lower (p = 0.01) 6MWT distance (358 ± 95 m vs. 433 ± 61 m). The resting peak mitral gradient correlated with systolic PAP (r = -0.67; p = 0.001) and 6MWT distance (r = -0.78; p < 0.0001) in the MVA group. Conclusions : The results suggest that performing a restrictive MVA in patients with ischemic MR may create a functional mitral stenosis. This hemodynamic sequel is associated with higher PAP and a worse functional capacity
  • PublicationRestreint
    Mitral repair versus replacement for ischemic mitral regurgitation : comparison of short-term and long-term survival
    (American Heart Association, 2009-09-15) Sénéchal, Mario; Charbonneau, Éric; Magne, Julien; Voisine, Pierre; Girerd, Nicolas; Pibarot, Philippe; Dumesnil, Jean G.; Dagenais, François; Mathieu, Patrick
    Background— When compared to mitral valve replacement (MVR), mitral valve repair (MVRp) is associated with better survival in patients with organic mitral regurgitation (MR). However, there is an important controversy about the type of surgical treatment that should be used in patients with ischemic MR. The objective of this study was to compare the postoperative outcome of MVRp versus MVR in patients with ischemic MR. Methods and Results— Preoperative and operative data of 370 patients with ischemic MR who underwent mitral valve surgery were prospectively collected and retrospectively analyzed. MVRp was performed in 50% of patients (n=186) and MVR in 50% (n=184). Although operative mortality was significantly lower after MVRp compared to MVR (9.7% versus 17.4%; P=0.03), overall 6-year survival was not statistically different between procedures (73±4% versus 67±4%; P=0.17). After adjusting for other risk factors and propensity score, the type of procedure (MVRp versus MVR) did not come out as an independent predictor of either operative (OR, 1.5; 95% CI, 0.7–2.9; P=0.34) or overall mortality (HR, 1.2; 95% CI, 0.7–1.9; P=0.52). Conclusion— As opposed to what has been reported in patients with organic MR, the results of this study suggest that MVRp is not superior to MVR with regard to operative and overall mortality in patients with ischemic MR. These findings provide support for the realization of a randomized trial comparing these 2 treatment modalities.