Résumé : A. INTRODUCTION

A.1. The sympathetic nervous system.

A.1.1. General considerations and historical perspective.

A.1.1.1. Historical perspective

A.1.1.2. Reflex regulation of the autonomic nervous system

A.1.1.3. Central control of the autonomic nervous system

A.1.1.4. Sympathetic and parasympathetic components of the autonomic

nervous system

A.1.1.5. Organisation of the sympathetic nervous system

A.1.1.6. Functions of the sympathetic nervous system

A.1.1.7. Neurotransmitters of the sympathetic nervous system

A.1.1.8. Neurotransmitter secretion at effectors organ synapse

A.1.1.9. Adrenoreceptors

A.1.2. Control mechanisms

A.1.2.1. Aortic arch and carotid baroreceptors

A.1.2.2. Low pressure baroreceptors

A.1.2.3. Chemoreceptors

A.1.2.4. Effects of exercise on sympathetic nervous system activation

A.1.2.5. Effects of left ventricular dysfunction on sympathetic nervous

system activation

A.1.2.6. Effects of right ventricular dysfunction and heart

transplantation on sympathetic nervous system activity

A.2. Methodological considerations.

A.2.1. Assessment of sympathetic activity in humans

A.2.2. Circulating catecholamines

A.2.3. Microneurography

A.3. Ergospirometry

A.3.1. Several aspects of physiology of exercise

A.3.2. Principles of exercise testing

A.3.3. Exercise ventilation

A.4. Assessment of chemoreceptor regulation in humans

A.4.1. Peripheral chemoreceptor inhibition

A.4.2. Peripheral and central chemoreceptor activation

A.5. Brief summary of still unresolved questions

A.5.1. Pulmonary arterial hypertension

A.5.2. Heart transplantation

B. SYMPATHETIC CONTROL IN PULMONARY ARTERIAL HYPERTENSION

B.1. Hypothesis tested

B.2. Study populations

B.2.1. Study investigating sympathetic activity in PAH patients

B.2.2. Study investigating the effects of atrial septostomy on MSNA in PAH

patients

B.3. Material, methods and study protocols

B.3.1. Particular measurements in the study investigating sympathetic activity

in PAH patients

B.3.2. Particular measurements in the study investigating effects of atrial

septostomy on MSNA in PAH patients

B.4. Sympathetic nervous activity in PAH and effects of disease severity

B.5. Effects of chemoreflex activation

B.6. Effects of atrial septostomy

C. SYMPATHETIC CONTROL AFTER HEART TRANSPLANTATION

C.1. Hypothesis tested

C.2. Patient population

C.3. Material and methods

C.4. Effects of chemoreflex activation on sympathetic activity and blood pressure

C.5. Effects of chemoreflex activation on exercise intolerance

D. DISCUSSION

D.1. Sympathetic nervous system activation in patients with pulmonary arterial

hypertension

D.2. Effects of atrial septostomy on sympathetic nervous system activation

D.3. Chemoreceptors in heart transplant recipients

D.3.1. Peripheral chemoreceptors deactivation

D.3.2. Peripheral and central chemoreceptors sensitivity

E. CONCLUSIONS

F. REFERENCE LIST

G. ANNEXES

G.1. Publications

G.1.1. Velez-Roa and Ciarka et al, Increased sympathetic nerve activity in

pulmonary artery hypertension, Circulation. 2004 Sep 7;110(10):1308-

12.

G.1.2. Ciarka et al, Atrial septostomy decreases sympathetic overactivity in

pulmonary arterial hypertension, Chest. 2007 Jun;131(6):1831-7.

G.1.3. Ciarka et al, Effects of peripheral chemoreceptors deactivation on

sympathetic activity in heart transplant recipients. Hypertension. 2005

May;45(5):894-900.

G.1.4. Ciarka et al, Increased peripheral chemoreceptors sensitivity and

exercise ventilation in heart transplant recipients. Circulation. 2006 Jan

17;113(2):252-7.

G.2. Annexe thesis title.

G.3. Brief summary in French of described research