[Aneurysm of a saphenous vein aortocoronary shunt caused by fissure syndrome]. / Anévrisme d'un pontage veineux saphène aorto-coronaire révélé par un syndrome fissuraire.

The authors report a new case of an aneurysm of a saphenous vein aorto-coronary shunt. The aneurysm manifested itself by a fissure syndrome in a man 48 years of age, 9 years after myocardial revascularization surgery. A chest X-ray revealed a right paracardiac opacity, and two-dimensional ultrasound picked up an expansive, hypoechoic mass. The diagnosis was confirmed by coronary artery angiography. The aneurysm was opened up and the proximal anastomosis sutured. After a follow-up period of 30 months, the patient is asymptomatic.

[Auriculoventricular block disclosed in the exercise test]. / Les blocs auriculo-ventriculaires démasqués à l'épreuve d'effort.

Sixteen patients, 14 of whom described stress related symptoms, present a severe atrio-ventricular block (A-V B), identified during a stress test while the ECG at rest showed a 1/1 atrioventricular conduction (AV). The electrophysiological study (EPS) creates the A-B Block through atrial stimulation and specifies the location of the A-V B: intra-hissian in 8 patients (7 with small QRS an 1 with widened QRS) and infra-hissian in 8 patients (all with widened QRS). Non-invasive methods constitute the prime approach in the diagnostic work-up of stress symptoms. The ideal treatment consists of a dual-chamber cardiac stimulation.

Benefits and limits of selective right ventricular cineangiography in arrhythmogenic right ventricular dysplasia.

Cineangiographic data from patients with probable arrhythmogenic right ventricular dysplasia (ARVD) were compared with those from matched controls. Some changes previously thought to indicate ARVD did not do so in this study. The abnormalities specific for ARVD were free wall morphological and wall motion abnormalities, particularly bulges and mamillated akinetic areas.

Randomised comparison of coronary stenting with and without balloon predilatation in selected patients.

BACKGROUND: The SWIBAP (stent without balloon predilatation) prospective randomised trial was designed to compare direct coronary stenting with stenting preceded by lesion predilatation with an angioplasty balloon. OBJECTIVE: To determine the feasibility and safety of direct stenting in non-complex coronary lesions in a prospective study. PATIENTS AND DESIGN: All patients < 76 years of age scheduled to undergo angioplasty of a non-complex, non-calcified lesion in a coronary artery of > 3.0 mm, who granted their informed consent, were randomised into the trial. In group I, the stent was placed without balloon predilatation, while in group II stent implantation was preceded by balloon predilatation. The primary end point was the angiographic result according to procedure assigned by randomisation. An intravascular ultrasound substudy was performed in 60 patients. RESULTS: Stent implantation was successful without predilatation in 192 of the 197 group I patients (97.5%), and with predilatation in 197 of the 199 group II patients (99%) (NS). No in-hospital stent thrombosis or death occurred. Overall procedural times, fluoroscopy times, and volumes of contrast agent given (mean (SD)) in group I v group II were 23.50 (13.54) min v 27.96 (15.23) min (p = 0.002), 6.04 (4.13) min v 6.67 (3.65) min (NS), and 135 (65) ml v 157 (62) ml (p < 0.001), respectively. No major adverse cardiovascular events had occurred by 30 days. CONCLUSIONS: The feasibility and safety of direct stenting of selected and non-complex coronary lesions is confirmed. This technique was as successful as the conventional approach and was associated with a minor reduction in fluoroscopic exposure and procedure time and the administration of less contrast agent.