Papers by Nicole Sekarski
Revue medicale de la Suisse romande
Archives des maladies du coeur et des vaisseaux
A six month old girl with no significant medical history was admitted to hospital for progressive... more A six month old girl with no significant medical history was admitted to hospital for progressive cyanosis of recent onset refractory to oxygen therapy. There were no detectable cardiac murmurs. Chest X-ray showed an irregular left posterior parahilar infiltration. Echocardiography showed dilatation of the left atrium and ventricle but no cardiac malformation. The diagnosis of pulmonary arteriovenous fistula was suspected. Chest CT scan, magnetic resonance imaging and pulmonary angiography demonstrated the arteriovenous fistula in the lower lobe of the left lung. It was much bigger than the appearances of the chest X-ray suggested. After the left lower lobectomy, the cyanosis completely disappeared. Progressive cyanosis refractory to oxygen therapy without any apparent cardiac or pulmonary disease is strongly suggestive of pulmonary arteriovenous fistula. Surgical treatment is curative whereas the spontaneous outcome of this condition may be lethal.
Journal of Cardiovascular Magnetic Resonance, 2015
Archives des maladies du coeur et des vaisseaux
The authors report the case of a neonate, a premature 36 weeks gestation male child who presented... more The authors report the case of a neonate, a premature 36 weeks gestation male child who presented with a spontaneous thrombosis of the juxtaduetal aorta at 3 days of age. The clinical presentation mimicked that of severe coarctation with cardiocirculatory failure. The diagnosis was ineffective, the introduction of low dose alteplase (plasma activator of human recombinant plasminogen) with continued anticoagulation resulted in near complete lysis of the clot and avoided surgery. Thromboembolic cerebral and renal complications were observed during treatment. However, 6 months after the acute episode, there were no clinical or echographic sequellae. Global renal function remained normal despite mild atrophy of the parenchyma of the left kidney. This combined treatment represents an alternative to high risk surgery. The follow-up of this form of management should be rigorous in view of the potential renal and cerebral complications.
Archives des maladies du coeur et des vaisseaux
Type II mucopolysaccharidosis (Hunter's disease) is a hereditary condition due to a defic... more Type II mucopolysaccharidosis (Hunter's disease) is a hereditary condition due to a deficit of a lysosome specific hydrolase (iduronate sulfatase) inducing an accumulation of dermatane-sulphate and heparane-sulphate in certain organs. Cardiac involvement is constant in this disease and manifests itself essentially by aortic valve stenosis and insufficiency and/or mitral insufficiency which is progressive, irreversible and life-threatening. Two brothers of Portuguese nationality suffering from a so-called slight form of this disease had classical mucopolysaccharide infiltration of their aortic valves. The elder brother, aged 11, had severe aortic insufficiency associated with mild stenosis requiring treatment with vasodilator drugs. The younger, aged 8, had asymptomatic mild aortic regurgitation. Curiously, mitral valve prolapse with regurgitation was present in both children. The association of mitral valve prolapse and type II mucopolysaccharidosis, without other typical cardiac involvement, has only been reported once in the literature.
Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology
The indication for pulmonary artery banding is currently limited by several factors. Previous att... more The indication for pulmonary artery banding is currently limited by several factors. Previous attempts have failed to produce adjustable pulmonary artery banding with reliable external regulation. An implantable, telemetrically controlled, battery-free device (FloWatch) developed by EndoArt SA, a medical company established in Lausanne, Switzerland, for externally adjustable pulmonary artery banding was evaluated on minipigs and proved to be effective for up to 6 months. The first human implant was performed on a girl with complete atrioventricular septal defect with unbalanced ventricles, large patent ductus arteriosus and pulmonary hypertension. At one month of age she underwent closure of the patent ductus arteriosus and FloWatch implantation around the pulmonary artery through conventional left thoracotomy. The surgical procedure was rapid and uneventful. During the entire postoperative period bedside adjustments (narrowing or release of pulmonary artery banding with echocardiographic assessment) were repeatedly required to maintain an adequate pressure gradient. The early clinical results demonstrated the clinical benefits of unlimited external telemetric adjustments. The next step will be a multi-centre clinical trial to confirm the early results and adapt therapeutic strategies to this promising technology.
Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology
Patients with Ebstein's anomaly can present after childho... more Patients with Ebstein's anomaly can present after childhood or adolescence with cyanosis, arrhythmias, severe right ventricular dysfunction and frequently with left ventricular dysfunction secondary to the prolonged cyanosis and to the right ventricular interference. At this point conventional repair is accompanied by elevated mortality and morbidity and poor functional results. We report our experience with three patients (8, 16 and 35 years of age) with Ebstein's anomaly, very dilated right atrium, severe tricuspid valve regurgitation (4/4), bi-directional shunt through an atrial septal defect and reduced left ventricular function (mean ejection fraction = 58%, mean shortening fraction = 25%). All underwent one and a half ventricular repair consisting of closure of the atrial septal defect, tricuspid repair with reduction of the atrialised portion of the right ventricle and end-to-side anastomosis of the superior vena cava to the right pulmonary artery. All patients survived, with a mean follow-up of 33 months. In all there was complete regression of the cyanosis and of the signs of heart failure. Postoperative echocardiography showed reduced degree of tricuspid regurgitation (2/4) and improvement of the left ventricular function (mean ejection fraction = 77%, mean shortening fraction = 40%). In patients with Ebstein's anomaly referred late for surgery with severely compromised right ventricular function or even with reduced biventricular function, the presence of a relatively hypoplastic and/or malfunctioning right ventricular chamber inadequate to sustain the entire systemic venous return but capable of managing part of the systemic venous return, permits a one and a half ventricular repair with good functional results.
Revue médicale suisse
The development in pediatric interventional cardiology has changed the therapeutic strategy for m... more The development in pediatric interventional cardiology has changed the therapeutic strategy for many patients with congenital heart disease. Interventional catheterization became the first choice for valvuloplasty, angioplasty and collateral vessel occlusion. Effective and safe transcatheter interventions exist for closure of atrial or ventricular septal defects and for patent ductus arteriosus. The progress in the technology used in the catheterization laboratory will permit to continue the expansion of the range of interventions performed without surgery. Pediatric cardiologists and congenital heart surgeons must understand each other's interventional techniques and how they can be used in a coordinated fashion. This interaction is essential for the optimal management of patients with both simple and complex congenital heart disease.
Revue médicale suisse, Jan 18, 2015
With the improvement of congenital heart surgery, most children with congenital heart disease wil... more With the improvement of congenital heart surgery, most children with congenital heart disease will survive into adulthood with a good quality of life. Regular cardiac follow-up is recommended for all patients. The adolescent period coincides often with medium and long term consequences and complications and repeat surgery or catheter interventions might be needed. It is therefore of prime importance to begin the transition process early and to pursue it well into adulthood. We have elaborated a formal transition program adapted to youngsters with congenital heart disease.
Revue médicale suisse, Jan 26, 2008
Stents have a long history in traditional valve surgery as both, porcine biological valves as wel... more Stents have a long history in traditional valve surgery as both, porcine biological valves as well as pericardial valves are mounted on stents prior to implantation. Recently stent-mounted biological devices have been compressed up to the point, where they can be passed through a catheter. Various routes can be distinguished for implantation: open access, the trans-vascular route in antegrade or retrograde fashion, as well as direct trans-apical or trans-atrial access. Direct access has the potentialforvideo-endoscopic valve replacement. In theory, as well as in the experimental setting, valved stents have been implanted in tricuspid and caval position respectively, as well as in pulmonary, mitral and aortic locations. The largest clinical experience has been achieved in pulmonary position whereas current efforts target the aortic position.
Revue médicale suisse, Jan 26, 2008
Increasing complexity in management of congenital heart disease imposes more frequent surgeries a... more Increasing complexity in management of congenital heart disease imposes more frequent surgeries and interventions. Each technique has its own limitations, which could impair the anticipated result. Hybrid procedures join the advantages of cardiac surgery and interventions, creating a synergy in the management of these patients with cardiac anomalies. In our experience, hybrid procedures shorten cardiopulmonary bypass, reduce morbidity of surgery and reduce duration of stay in the intensive care unit. For some complex congenital heart diseases for which there are no ideal surgical or interventional options, hybrid procedures are becoming increasingly important in their management. Finally hybrid procedures allow surgeons and cardiologist to achieve complex procedures that could not be possible in another way.
Revue médicale suisse, Jan 26, 2008
Circulation, Jan 10, 2015
Revue médicale suisse, Jan 6, 2008
Fetal arrhythmias form a complicating factor in 1-2% of all pregnancies and in 10% of those cases... more Fetal arrhythmias form a complicating factor in 1-2% of all pregnancies and in 10% of those cases morbidity or even mortality is encountered. The most frequent occurring arrhythmias are premature atrial contractions (PAC). These are usually benign phenomena which resolve spontaneously, but require some follow-up to exclude the development of supraventricular tachycardias (SVT). SVTs are rare but are frequently complicated by fetal congestive heart failure or even fetal death. Timely prenatal pharmacotherapeutic intervention is generally advised to return to an adequate heart rate, preferably sinus rhythm. This study reports on the local experience with these forms of pathologies: of the 26 fetuses encountered with PAC or/and SVT between 2003 and 2005, none experienced serious complications, while 6 required pharmacotherapeutic intervention with sotalol.
Revue médicale suisse, Jan 24, 2006
Revue médicale de la Suisse romande, 2004
Preoperative assessment in patients with congenital heart disease differs according to the age an... more Preoperative assessment in patients with congenital heart disease differs according to the age and the cardiac defect of the patient. In most cases blood tests and echocardiography are often sufficient whereas in complex lesions a more extensive assessment is required, including cardiac catheterization, MRI or CT-Scan. Some tests are also routinely included in the preoperative evaluation of neonates which are not necessary in older children. In each case surgical decisions are made in common with pediatric cardiologist and pediatric cardiac surgeons, based on history, physical exam, lab results and cardiac status of the patient.
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Papers by Nicole Sekarski