Luc Bilodeau

INTRODUCTION: The outcomes of perforation during aortocoronary saphenous vein graft (SVG) percutaneous coronary intervention (PCI) are poorly studied. METHODS: We reviewed all 12 SVG perforations that occurred between November 2005 and November 2011 at two tertiary referral centers. The acute and long-term outcomes of these patients were examined. RESULTS: The perforation was located in the SVG body (n = 6), aortic (n = 3), or distal (n = 3) anastomosis...

Coronary artery bypass graft surgery remains one of the most widely performed surgical procedures in North America and aortocoronary saphenous vein grafts (SVG) are the most frequently used surgical conduits. SVG disease (SVGD) remains the leading cause of symptomatic coronary artery disease postcoronary artery bypass graft. When optimal medical therapy is ineffective, repeat surgery is associated with higher mortality combined with less favorable clinical and angiographic results, thus percutaneous revascularization on SVG is currently the standard of care for the revascularization of SVGD...

OBJECTIVE: We investigated whether the Quantitative Blush Evaluator (QuBE) value predicts functional and contrast-enhanced cardiovascular magnetic resonance (CMR) outcomes at 4-6 months after primary percutaneous coronary intervention (PCI) inpatients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: QuBEis a computer-assisted open source program to quantify myocardial reperfusion.Although a higher QuBE value is associated with improved myocardial reperfusion measures and lower 1-year mortality, the association with intermediate functional parameters after STEMI has not yet been investigated...

The purpose of the present study was to determine the prognostic value of N-terminal pro-brain natriuretic peptide (NT-pro-BNP), among other serum biomarkers, on cardiac magnetic resonance (CMR) imaging parameters of cardiac function and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. We measured NT-pro-BNP, cardiac troponin T, creatinine kinase-MB fraction, high-sensitivity C-reactive protein, and creatinine on the patients' arrival at the catheterization laboratory in 206 patients with ST-segment elevation myocardial infarction...

AIMS: Mortality of massive pulmonary embolism remains exceedingly high despite thrombolytic therapy. Despite initial encouraging results, rheolytic thrombectomy has not been considered the first choice of treatment in the current European Guidelines for massive pulmonary embolism, even in cases of major contraindication to thrombolysis. Our objective was to assess the efficacy of rheolytic thrombectomy in the specific treatment of massive pulmonary embolism with contraindication to systemic thrombolytic therapy...

OBJECTIVES: The aim of the study was to evaluate whether the "Quantitative Blush Evaluator" (QuBE) score is associated with measures of myocardial reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) treated in two hospitals with 24/7 coronary intervention facilities. BACKGROUND: QuBE is an open source computer program to quantify myocardial perfusion. Although QuBE has shown to be practical and feasible in the patients enrolled in the Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS), QuBE has not yet been verified on reperfusion outcomes of primary percutaneous coronary intervention (PCI) patients treated in other catheterization laboratories...

BACKGROUND: We assessed the safety and feasibility of permanent implantation of a novel coronary sinus mitral repair device (PTMA, Viacor Inc). METHODS AND RESULTS: Symptomatic (New York Heart Association class 2 or 3) patients with primarily functional mitral regurgitation (MR) were included. A diagnostic PTMA procedure was performed in the coronary sinus venous continuity. MR was assessed and the PTMA device adjusted to optimize efficacy. If MR reduction (> or =1 grade) was observed, placement of a PTMA implant was attempted...

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of combined proximal embolic protection with thrombus aspiration (Proxis Embolic Protection System [St. Jude Medical, St. Paul, Minnesota]) in ST-segment elevation myocardial infarction patients. BACKGROUND: Embolization during primary percutaneous coronary intervention (PCI) may result in microvascular obstruction, reduced myocardial perfusion, and impaired prognosis. METHODS: Two hundred eight-four patients were randomized to primary PCI with the Proxis system versus primary PCI alone after angiography...

OBJECTIVES: We evaluated the long-term clinical and angiographic results of 'fused-gold' (NIRFlex Royal) and 'bare' (NIRFlex) stainless steel stents in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: Recent studies have shown high clinical and angiographic restenosis rates following the intracoronary implantation of 'gold-coated' stainless steel stents. The new 'fused-gold' stent, with improved surface characteristics and flexibility, was developed to improve procedural and long-term results, while maintaining enhanced radiopacity...

An unusual case of a toothpick perforating the distal one-third of the duodenum, penetrating the inferior vena cava and thereafter migrating to the right atrium with extensive pericardial fibrosis is reported. A 60-year-old man was admitted to the emergency department because of epigastric pain, which had progressively worsened. After partial recovery, he was discharged. However, after four episodes of different gastrointestinal bacteria septicemias of unknown origin over a period of five months, the patient was transferred to Laval Hospital (Laval, Quebec) for clinical investigation...

Despite the promise of proangiogenic gene therapy most clinical trials have failed to show benefit for the primary end point analysis. The NOGA angiogenesis Revascularization Therapy: assessment by RadioNuclide imaging (NORTHERN) trial was a double-blind, placebo-controlled study of intramyocardial vascular endothelial growth factor (VEGF165) gene therapy versus placebo, involving seven sites across Canada, designed to overcome major limitations of previous proangiogenic gene therapy trials. A total of 93 patients with refractory Canadian Cardiovascular Society (CCS) class 3 or 4 anginal symptoms were randomized to receive 2,000 microg of VEGF plasmid DNA or placebo (buffered saline) delivered via the endocardial route using an electroanatomical NOGA guidance catheter...

Acute ventricular septal rupture - ventricular septal defect (VSD) following acute myocardial infarction remains a critical condition. We present an 80 year-old patient with an acute VSD following an acute inferior myocardial infarction. Percutaneous VSD closure with an Amplatzer ventricular septal occluder (AVSO) was performed successfully, two days after initial admission. In-hospital follow-up was uneventful. We speculate that percutaneous VSD closure with an AVSO can be an alternative to surgical correction for these patients...

A new method for solid phase parallel synthesis of chemically and conformationally diverse macrocyclic peptidomimetics is reported. A key feature of the method is access to broad chemical and conformational diversity. Synthesis and mechanistic studies on the macrocyclization step are reported.

Balloon refractory calcific coronary plaques remain a technical challenge. Stent underexpansion is known as a major cause of restenosis and thrombosis. We report a case of in-stent restenosis 5 months after stent suboptimal implantation in a noncompliant calcific atherosclerotic plaque which could not be disrupted by repeated prolonged high-pressure balloon inflations. High-energy excimer laser use altered underlying lesion morphology, allowing full stent apposition. Advances in equipment and technique have allowed more frequent use of high energy excimer laser technology during percutaneous coronary angioplasty with very low rates of complications...

OBJECTIVE: This study evaluated human feasibility and acute efficacy of a novel percutaneous transvenous mitral annuloplasty (PTMA) device (Viacor) placed temporarily in the coronary sinus (CS): the implant allows in-situ incremental adjustment to optimally reduce the anterior-posterior mitral annulus (MA) dimension, and improve leaflet co-aptation and reducing mitral regurgitation (MR). BACKGROUND: Surgical annuloplasty remains the standard treatment of severe ischemic MR but its application is limited by high morbidity and mortality...

A 41-year-old man was referred to the Montreal Heart Institute, Montreal, Quebec, for primary angioplasty of an acute anterolateral wall myocardial infarction. Coronary angiography revealed the culprit lesion to be a subtotal left main coronary artery with Thrombolysis In Myocardial Infarction (TIMI) trial grade 1 flow associated with a filling defect compatible with an aggressive thrombotic process. The use of rheolytic thrombectomy and a drug-eluting stent for this distal left main target lesion are described...

BACKGROUND: Epidemiological information on patients with acute coronary syndromes managed in specialized cardiac centres is limited. OBJECTIVE: To report the evolution of demographics, treatment and outcome of patients admitted to a tertiary coronary care unit (CCU) over a 17-year period. METHODS: A prospective database of 18,719 patients admitted from April 1986 to March 2003 in a 21-bed CCU was analyzed. RESULTS: From 1986 to 2003, the number of admissions increased from 937 to 1577 per year, while the length of stay declined from 7...

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The post-Coronary Artery Bypass Graft (Post-CABG) trial has shown that aggressive compared to moderate lowering of low-density lipoprotein cholesterol (LDL-C) delayed the progression of obstructive disease in aortocoronary saphenous vein grafts and in the left main coronary artery. Patients had been allocated to high-and low-dose lovastatin therapy for a 4-5 year period. The present study evaluated the effect of LDL-C lowering and the role of cardiovascular risk factors on the progression of arteriosclerosis in the distal abdominal aorta and common iliac arteries...

We report the design of a platform for the delivery of hydrophobic drugs via a macromolecular prodrug approach combined with LbL-assembled polyelectrolyte multilayers. A hyaluronan ester prodrug of the chemotherapeutic drug paclitaxel has been synthesized. Conjugation of the drug to hyaluronan through a labile succinate ester did not inhibit its activity. Using quartz crystal microbalance, atomic force microscopy, and UV spectroscopy, we have shown that the presence of the hydrophobic paclitaxel moieties does not prohibit the layer-by-layer construction of the multilayers...