C Stankowiak

Centre Hospitalier Régional Universitaire de Lille, Lille, Nord-Pas-de-Calais, France

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Publications (49)43.11 Total impact

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    ABSTRACT: Enteroviruses and other cardiotropic viruses have been associated with the development of late severe adverse cardiac events in infants receiving heart transplants. However, the source and the chronology of cardiac allograft infection by an enterovirus in patients receiving heart transplants remain unknown. Using RT-PCR and immunohistochemistry assays, endomyocardial tissue samples of 30 adult patients were tested to detect the presence of specific enterovirus 5' non-coding (5'NC) sequences and of VP1 capsid protein, and this at the time of cardiac transplantation and at the 12-month biopsy for graft rejection control. Moreover, the endomyocardial detection of genomic sequences of enteroviruses, Epstein-Barr virus, herpes simplex virus, cytomegalovirus (CMV), varicella-zoster virus, adenoviruses, and parvovirus B19 was carried out by RT-PCR and polymerase chain reaction (PCR) assays at the time of late severe cardiac events. Enterovirus RNA and VP1 antigen were both detected in 4 (13%) of 30 patients at the time of the 12-month biopsy for graft rejection control, whereas no enterovirus component was detected in the explanted and implanted heart tissues taken from these 4 patients at the time of transplantation. At the time when severe cardiac events were developed, within 3 months after the positive enterovirus cardiac detection, these four patients demonstrated the presence of endomyocardial enterovirus RNA sequences whereas they were tested negative for the endomyocardial detection of genomic sequences from DNA viruses (except for CMV in two cases), and for a significant level of pp65 CMV antigenemia. Taken together, these findings indicate that enteroviruses could be acquired as a new endomyocardial infection within 12 months after transplantation in adults receiving heart transplants, and suggest that this infection might be an etiological cause for unexplained late severe adverse cardiac events in the heart-transplantated adults.
    Journal of Medical Virology 02/2005; 75(1):47-53. · 2.22 Impact Factor
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    ABSTRACT: To investigate enterovirus replication versus persistence in end-stage cardiac diseases, endomyocardial biopsies from explanted hearts of 70 patients with idiopathic dilated cardiomyopathy (IDCM), 64 patients with chronic coronary disease (CCD), and 45 donors of healthy hearts (controls) were examined by reverse transcriptase-polymerase chain reaction for genomic and antigenomic enterovirus RNA and by VP1 antigen immunohistochemistry. Enterovirus genome was detected in 25 of 70 patients with IDCM and in 21 of 64 patients with CCDs (35.7 vs. 32.8%, respectively; P=.12). Of the 46 patients positive for genomic RNA, only 3 exhibited antigenomic RNA and VP1 antigen that demonstrated active viral replication, whereas 43 had latent infection characterized by the absence of antigenomic RNA associated with or not with VP1 antigen expression. No viral component was detected in control subjects. The findings demonstrate that a small percentage of patients with end-stage chronic cardiac diseases had active enterovirus replication in their myocardium.
    The Journal of Infectious Diseases 11/2000; 182(4):1222-7. · 5.78 Impact Factor
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    ABSTRACT: Background. Pulmonary autograft aortic valve replacement has been introduced in our institution in selected adult patients in light of the known disadvantages and limitations of conventional prosthetic valves.Methods. We prospectively evaluated the use of the pulmonary autograft in a series of 70 young adults (31.2 ± 8.7 years, range 16 to 49 years) operated on from March 1992 to April 1997 with aortic root replacement only.Results. There were no in-hospital deaths and two noncardiac-related late deaths during follow-up of up to 62 months (mean 33 months). Thromboembolic complications were not observed. One patient required reoperation for infective endocarditis 4.3 years after surgery. Discharge echo-Doppler studies showed normal autograft and allograft valve function. Serial echo-Doppler studies showed no significant progression of aortic insufficiency and no dilatation of the autograft. A severe stenosis of the pulmonary allograft developed in 1 patient.Conclusion. Aortic root replacement with a pulmonary autograft, although more complex than conventional prosthetic valve replacement, is a safe, effective, and reproducible procedure in properly selected adult patients. Long-term results remain to be evaluated.
    The Annals of Thoracic Surgery 01/1999; · 3.63 Impact Factor
  • Source
    M A Vasseur, V C Doisy, A G Prat, C Stankowiak
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    ABSTRACT: Gluteal aneurysms, whether true or false, are exceptional. They represent less than 1% of all aneurysms and develop within the superior or inferior gluteal arteries, being branches of the internal iliac artery. We report here the case of a 35-year-old patient with Marfan syndrome in whom annuloaortic ectasia and Barlow's disease with mitral valve insufficiency successively developed followed by a gluteal false aneurysm, which led us to investigate the etiologic mechanism of the patient's conditions. The gluteal aneurysm was successfully treated by selective embolization, which would appear to be the elective therapeutic approach for these lesions.
    Journal of Vascular Surgery 02/1998; 27(1):177-9. · 2.98 Impact Factor
  • Vascular and Endovascular Surgery - VASC ENDOVASC SURG. 01/1998; 32(1):19-32.
  • Cardiovascular Surgery 09/1997; 5:66-66.
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    ABSTRACT: The purpose of this preliminary study was to detect enteroviral infection in the myocardium of 18 patients suffering from idiopathic dilated cardiomyopathy. Enteroviral RNA was detected in endomyocardial tissue by means of retrotranscription and polymerase chain reaction (RT-PCR) followed by Southern-blotting. The myocardial biopsy specimens were taken during heart transplantation in 18 patients with idiopathic dilated cardiomyopathy and 18 healthy donors. Specimens from 11 (61 %) of the 18 patients were positive for enteroviral RNA, whereas control specimens (myocardial specimens from 18 healthy donors) yielded no evidence of enteroviral RNA. This preliminary study suggests that the enteroviral persistence in idiopathic dilated cardiomyopathy could be a major cause of the disease.
    Medecine Et Maladies Infectieuses - MED MAL INFEC. 01/1997; 27(3):322-323.
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    ABSTRACT: This study, which included 153 heart transplant patients, was designed to determine whether the cytomegalovirus (CMV) status of both donor and recipient may influence graft rejection. The follow-up was 1 year and they all received the same triple-drug immunosuppressive regimen with induction (antilymphocyte serum). There was no difference in the total rejection rate, but an increase in repeated rejection rate was shown in transplant recipients with hearts from CMV seropositive donors (P < 0.05). These data strongly suggest the impact of CMV in enhancement but not in induction of rejection. To prevent iterative rejection in the CMV seropositive donor group, antiviral therapy could be proposed during enhancement of antirejection therapy.
    Transplant International 08/1996; 9 Suppl 1:S241-2. · 3.16 Impact Factor
  • Transplantation Proceedings 09/1995; 27(4):2523. · 0.95 Impact Factor
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    ABSTRACT: From March 1992 through March 1995 we have performed 45 Ross procedures for total aortic root replacement in our institution. There were 32 males and 13 females with a mean age of 31 years (range: 3-49 years). Indications for surgery were: aortic stenosis (n = 20), aortic regurgitation (n = 16), native valve endocarditis (n = 6), replacement of prosthetic valve (n = 3). Of these 45 patients 13 (28%) had at least one prior repair. Additional procedures were Dacron graft extension of the autograft (n = 7), enlargement of aortic annulus (n = 3), mitral valve repair (n = 2), CABG (n = 1), closure of VSD (n = 1). The mean cross-clamp time was 132 minutes (76-187 minutes) and the mean bypass time 156 minutes (106-240 minutes). There were two postoperative cardiac deaths, not valve-related, and five non-lethal postoperative complications: right ventricular failure (n = 1), low cardiac output (n = 1), sternal re-entry for bleeding (n = 3). The follow up is complete (1.5-37 months) for the 43 survivors. There was one non-cardiac late death (acute fulminating hepatitis) in an eight years old boy eight months post-operatively. Discharge echo-Doppler studies showed normal autograft and homograft valve function except in one patient who had a grade two aortic regurgitation. Serial echo-Doppler studies showed no significant progression of aortic regurgitation, no significant pulmonary gradients, no dilatation of the autografts during the follow up. It is suggested in conclusion that aortic root replacement with a pulmonary autograft is a safe procedure in selected patients.(ABSTRACT TRUNCATED AT 250 WORDS)
    The Journal of heart valve disease 08/1995; 4(4):368-73. · 0.73 Impact Factor
  • Transplantation Proceedings 03/1994; 26(1):247. · 0.95 Impact Factor
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    ABSTRACT: The authors report a case of left atrial leiomyosarcoma presenting with systemic disturbances and retinal emboli diagnosed by echocardiography and surgery in a 59 year old woman. Surgical ablation was completed by a course of chemotherapy. Histopathological examination confirmed the diagnosis of sarcoma; although the patient remained generally well, severe mitral regurgitation appeared 21 months after surgery. Transoesophageal echocardiography revealed an abnormal, hyper-mobile, intra-atrial echo suggesting a ruptured chordae tendinae and the mitral valves appeared very thickened and retracted. The patient was reoperated and the mitral valve replaced with a bioprosthesis. After a total follow-up of 29 months, the patients is still alive and asymptomatic. The authors underline the importance of echocardiography in the diagnosis of intra-cardiac tumours in general and, in particular, of intra-cardiac sarcomas.
    Archives des maladies du coeur et des vaisseaux 03/1994; 87(2):291-4. · 0.40 Impact Factor
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    ABSTRACT: 458 patients with a Carpentier-Edwards porcine bioprosthesis (aortic (Ao): 169, mitral (Mi): 289) operated between January 1975 and December 1981, were studied during the first trimester of 1987. Forty seven patients underwent an associated operation. The total follow-up was 3,001 patient-years with a maximum follow-up of 11.4 years and a mean follow-up of 6.5 years. Only 5.6% of patients were lost to follow-up. The patients were aged between 20 and 80 years. The actuarial 9-year survival rate was 69.2 +/- 6.3% for aortic prostheses and 79.6 +/- 3.9% for mitral prostheses. The principal cause of valve failure, appearing with a considerable frequency after 5 years, was primary tissue degeneration which alone represented 67.8% of the causes of valve failure. The rate of absence of valve failure, for all causes combined, was 77.8 +/- 5.9% for the aortic position and 74.9 +/- 4.9% for the mitral position. The actuarial rate of absence of primary tissue degeneration at 9 years was 79.7 +/- 4.1% for aortic prostheses and 75.2 +/- 4.4% for mitral prostheses. The frequency of tissue degeneration decreased with increasing age, representing 2.9%, 1.9% and 1.5% patient-years respectively for the age-groups: 20 to 39 years, 40 to 59 years and 60 to 80 years. However, this difference was not statistically significant. Tissue degeneration was the principal cause for reoperation (n = 59) with an operative mortality of 7.8%.
    Annales de Chirurgie 02/1989; 43(8):616-23. · 0.35 Impact Factor
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    ABSTRACT: The popliteal venous aneurysm is a rare cause of recurrent phlebitis and pulmonary embolus. In reference to 3 personal cases, their etiology, their role in the occurrence of phlebitis, the place of phlebography and vascular sonotomography respectively, are discussed. The treatment is essentially surgical.
    Annales de Cardiologie et d Angéiologie 11/1987; 36(8):413-6. · 0.30 Impact Factor
  • A Prat, A Pol, P André, C Stankowiak
    Annales de Chirurgie 02/1987; 41(6):416-9. · 0.35 Impact Factor
  • Annales de Chirurgie 02/1987; 41(6):435-43. · 0.35 Impact Factor
  • Annales de Chirurgie 02/1987; 41(2):160-3. · 0.35 Impact Factor
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    ABSTRACT: From 1973 through 1983, 19 cases of chronic traumatic aneurysms (CTA) were observed. Initial trauma was well documented in every case. Patients mean age at time of trauma was 22; mean age at time of surgery was 34. Sixty per cent of patients had no apparent thoracic injury at time of trauma. Ninety-five per cent had associated injuries. Ten/nineteen were asymptomatic. Eighteen were operated on. Rupture was complete in 11, partial in 7. One of the partial ruptures was a simple scar on the aorta. Eighteen were located at the site of the aortic isthmus, one was at level T8-T9. Seventeen had a prosthetic dacron graft sutured from inside the aneurysm. The case where a simple scar was found had a dacron wrapping. Spinal cord protection was used in all cases except in one who was already paraplegic preoperatively. Various shunts were used in 12 cases; 1 patient in the by-pass group had paraplegia. CTA is not a benign disease and all cases, even asymptomatic, should be operated on with a very low risk of mortality (0/18). Occurrence of paraplegia still remains a possible complication although the risk of spinal cord ischemia seems lower than in arteriosclerotic dissecting aneurysms. We favour the "old" technique of temporary dacron shunt graft in CTA for simplicity and easy assessment of function ot the shunt.
    The Journal of cardiovascular surgery 01/1986; 27(3):268-72. · 1.37 Impact Factor
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    ABSTRACT: Forty-two days after severe thoracic trauma which had led to thrombosis of the left renal artery and to nephrectomy, a 22 year old patient developed anterior wall infarction. Echocardiography and coronary and left ventricular angiography showed distal occlusion of the left anterior descending artery and the presence of a large, mobile thrombus at the left ventricular apex. The thrombus was removed surgically without any complications but a small thrombus adherent to the ventricular scar was observed postoperatively. After a discussion on the different possible physiopathological mechanisms, the authors conclude that the patient probably suffered primary myocardial contusion which led to secondary occlusion of the LAD artery, late myocardial infarction and extension of the initial intraventricular thrombus. This case illustrates the value of two-dimensional echocardiography in the detection and follow-up of ventricular thrombosis.
    Archives des maladies du coeur et des vaisseaux 11/1984; 77(10):1141-5. · 0.40 Impact Factor
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    ABSTRACT: 813 patients underwent aortic (AVR) or mitral valve replacement using the Carpentier-Edwards bioprosthesis from 1976 to 1983. Operative mortality was 5.49% for AVR and 4.59% for MVR. Late mortality and complications were classified using criteria described by the Stanford Group. Actuarial survival at 5 years was 87.9% +/- 2.7% for AVR and 91.1% +/- 1.4% in MVR. Thromboembolism occurred at low rates of 0.48% pt yr for AVR and 0.90% pt yr for MVR. 98.2% +/- 0.90% of AVR and 96.9% +/- 1.3% of MVR pts were free from thromboembolism at 5 years. The low incidence of thromboembolism during the early postoperative period played a role in the low rates observed in the complete study. There was no valve thrombosis. Anticoagulation with warfarin was used in 35% AVR and 75% MVR with rates of bleeding complications of 1.20% pt yr and 1.10% pt yr. Overall valve failure rate was 2.04% pt yr at 5 years for AVR and 1.55% pt yr for MVR. Rates of reoperation for tissue failure remained low (0.24% pt yr for AVR and 0.32% pt yr for MVR). The advantage of a low rate of thromboembolism was not outweighed by the specific problems of bioprosthesis at 5 years.
    European Heart Journal 11/1984; 5 Suppl D:87-94. · 14.72 Impact Factor