Mechanisms increasing n-3 highly unsaturated fatty acids in the heart.

Due to ambiguous findings on cardiovascular benefits of systemic omega-3 fatty acid therapy, endogenous mechanisms contributing to local organ-specific concentrations of highly unsaturated fatty acids (HUFA) were examined. Using gas chromatography, 43 fatty acids were analyzed in atrial and ventricular myocardium and in pericardial fluid of male Wistar rats. To examine the endogenous fatty acid metabolism, precursors were administered into the pericardial sac. Pro- and anti-inflammatory actions were induced by talc or fenofibrate, respectively. Physical exercise and a sedentary obese state were used for increased beta-oxidation. DHA (22:6n-3) was increased in ventricular when compared with atrial myocardium (9.0 ± 2.1% vs. 4.7 ± 1.0%, p < 0.001). Intrapericardial EPA (20:5n-3) application lead to an increase of the succeeding tetracosapentaenoic acid (24:5n-3) in atrial myocardium, which is a key precursor of DHA. In contrast, proinflammatory stimulation of the n-6 HUFA pathway did not influence the n-3 metabolism. Exercise- and obesity-induced increased beta-oxidation, the finalizing step of DHA synthesis, was associated with increased ventricular DHA concentrations (6.7 ± 1.0% vs. 8.4 ± 1.2%, p < 0.01). It is concluded that the endogenous metabolism contributes markedly to myocardial HUFA concentrations. The findings are supposed to influence the efficacy of oral HUFA treatment and provide a rationale for divergent findings of previous trials on omega-3 therapy.

Pericardial fluid of cardiac patients elicits arterial constriction: role of endothelin-1.

Recently, several vasoactive molecules have been found in pericardial fluid (PF). Thus, we hypothesized that in coronary artery disease due to ischemia or ischemia-reperfusion, the level of vasoconstrictors, mainly endothelin-1 (ET-1), increases in PF, which can increase the vasomotor tone of arteries. Experiments were performed using an isometric myograph. Vasomotor effects of PF from patients undergoing coronary artery bypass graft (PFCABG, n = 14) or valve replacement (PFVR, n = 7) surgery were examined in isolated rat carotid arteries (N = 14; n = 26). Vasomotor responses to KCl (40 or 60 mmol/L) were also tested. The selective endothelin A receptor antagonist BQ123 (10(-6) mol/L) was used to elucidate the role of ET-1. Both the first and the second additions of KCl elicited increases in the isometric force of the isolated arteries (KCl1, 6.1 ± 0.2 mN; KCl2, 6.5 ± 0.9 mN). PFCABG and PFVR elicited substantial increases in the isometric force of arteries (PFCABG, 3.1 ± 0.7 mN; PFVR, 3.0 ± 0.9 mN; p > 0.05). The presence of the selective endothelin A receptor blocker significantly reduced arterial contractions to PFCABG (before BQ123, 2.6 ± 0.5 mN vs. after BQ123, 0.8 ± 0.1 mN; p < 0.05). This study is the first to demonstrate that PFs of patients elicit substantial arterial constrictions, which is mediated primarily by ET-1. Interfering with the vasoconstrictor action of PF could be a potential therapeutic target to improve coronary blood flow in cardiac patients.

[Cardiac tamponade as first manifestation of multiple myeloma : A case report with literature review]. / Tamponnade cardiaque : première manifestation du myélome multiple : à propos d'un cas et revue de la littérature.

Multiple myeloma is a hematologic malignancy characterized by clonal proliferation of plasma cells, mainly in bone marrow. Extramedullary disease is reported in many cases and may occur at diagnosis, at progression, or during relapse phase. Pericardial involvement is a rare condition that usually occurs with advanced-stage disease. We report a rare case of 76-year-old women with plasma cell-based pericardial effusion with cardiac tamponade as a form of presentation of multiple myeloma and discuss it in the light of literature. Diagnosis was established by pericardial fluid cytology. The patient received systemic chemotherapy, according to MPT protocol.

[Delayed tamponade: Four cases of rare complication of blunt chest trauma]. / Tamponnade tardive : quatre cas de complication rare du traumatisme fermé du thorax.

Delayed post-traumatic pericardial effusion is a rare condition after blunt trauma. The diagnosis of the effusion can be made by the clinical signs, which is not very specific and the cardiac echography. The etiological diagnosis remains difficult because it requires the elimination of the other causes of pericarditis. Their treatment consists in evacuating the pericardial effusion. The evolution thereafter is simple. We report four cases of patients with pericardial effusion late after a thoracic injury. Imaging the blood test, the examination of the pericardial fluid and the anatomopathological examination of the pericardium, eliminates the other etiologies.

[Infectious and inflammatory complications occurring after cardiac surgery in cardiac rehabilitation centres]. / Complications infectieuses et inflammatoires après chirurgie cardiaque survenues dans les services de réadaptations cardiaques.

Patients undergoing cardiac surgery are older, have complex pathologies and several comorbidities, but need to leave the hospital quickly! Therefore, the mission of cardiac rehabilitation centres has substantially changed. Indeed, if 15 to 25% of patients undergoing cardiac surgery will have a postoperative complication requiring a hospital management (infectious, pericardial, rhythmic, neurologic, pulmonary, digestive, etc.), more than 2/3 of these acute events could be managed by cardiac rehabilitation centres for a lower cost. Therefore, the quickest the patient is transferred to a cardiac rehabilitation centre, the easier the cardiac surgery centre could manage his beds. Infectious complications are the most dreadful, particularly mediastinitis.

[The chronic constrictive pericarditis, a real calcified gangue realizing a mid-ventricular bottleneck: A case report]. / La péricardite chronique constrictive, une véritable gangue calcifiée réalisant un goulot d'étranglement médio-ventriculaire : à propos d'un cas.

A 30-year-old woman consulted for a predominantly right-sided global heart failure chart that had been evolving for about 3 months. Its antecedents include a concept of poorly treated pleuropulmonary tuberculosis at the age of 8 years. Lateral chest X-ray, transthoracic echocardiography and thoracic CT showed ventricular ring calcification with mid-ventricular compression with apical ballooning. The diagnosis of chronic mid-ventricular constrictive pericarditis of tuberculosis etiology was retained. The patient was put on diuretic treatment and the immediate evolution is favorable with a regression of the signs of congestion. Surgical decortication has been indicated.

[Purulent pericarditis in a patient with diabetes mellitus treated by percutaneous pericardiocentesis]. / Péricardite purulente chez un patient diabétique traitée par drainage péricardique percutané.

Purulent pericarditis seldom occurs in Western countries, yet its mortality rate remains high between 20 and 35 % despite early treatment. We report the case of a 43-year-old patient admitted in the intensive cardiologic care unit with a pre-tamponade, requiring an immediate percutaneous pericardiocentesis allowing the drainage of a purulent effusion. Evolution with antibiotic therapy adapted according to the bacteriological findings was favorable and 3-months follow-up shows a near complete regression of the effusion. This case recalls us this rare diagnosis entity and illustrates the possibility of a mere percutaneous pericardial drainage with the condition of a strict medical surveillance.

[Unilateral transudative pleural effusion and constritive pericarditis]. / Transsudat gauche et péricardite constrictive.

INTRODUCTION: Constrictive pericarditis is associated with thickening, fibrosis or inflammation of the pericardium which can lead to signs of right ventricle dysfunction. It is usually a chronic process which can present in a variety of ways. We present two cases of constrictive pericarditis discovered during the investigation of a left-sided pleural effusion. OBSERVATION: The cases represent two sorts of constrictive pericarditis, chronic and due to pericardial effusions. Their common feature was an increase in dyspnoea and a new pleural effusion on the left side. Their difference lies in the presence of a thickened calcified pericardium in one case and the presence of a pericardial effusion in the other. In both cases, non-invasive investigation failed to diagnose any cardiac disease. The presence of constrictive pericarditis was confirmed by right heart catheterization. Treatment by subtotal pericardectomy was effective. CONCLUSION: The thoracic manifestations of constrictive pericarditis are most commonly recurring bilateral pleural effusions. The mode of presentation may be an exudative, or transudative effusion. Unilateral pleural involvement, fibrosis, chylothorax or tumour like presentations may occur. A diagnosis of constrictive pericarditis should be considered in these clinical contexts and an examination of the pericardium performed. Cardiac catheterization can help in the differential diagnosis.

[The role of multimodality imaging in the diagnosis of constrictive pericarditis]. / Apport de l'imagerie cardiaque dans le diagnostic des péricardites chroniques constrictives.

Constrictive pericarditis is a rare heart disease. The diagnosis remains a challenge. In fact, this illness can mimic restrictive cardiomyopathy. Echo-Doppler evaluation helps to establish the diagnosis of constriction; however, this technique is limited in its ability to image the entire pericardium because of its limited acoustic windows by air or bone of thorax. In addition, it is an operator-dependent exploration. Scanner and magnetic resonance imaging provide a large field of view and excellent images, showing the increased pericardial thickness and septal motion abnormalities. This review will consider the emerging role of these imaging modalities in the constrictive pericarditis diagnosis.

Tamponade a rare cause of shock in patients with pancreatitis: difficulty of diagnostic in patients with positive pressure ventilation.

The causes of hemodynamic instability in acute pancreatitis are numerous. Although pericardial effusion during pancreatitis is common, a cardiac tamponade is rarely reported. The diagnosis of compressive cardiac disorders (CDD) by echocardiography is easily reported when the patient is breathing spontaneously; it becomes difficult when the patient is assisted with positive pressure ventilation.

[Aorto-pulmonary fistula found in a 9 year old girl at the Yalgado Ouedraogo University Hospital, Ouagadougou Burkina Faso]. / Fistule Aorto-pulmonaire decouverte chez une fillette de 9 ans au Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou Burkina Faso.

The CS child, aged 9, is evacuated from a health center located 200km away from Ouagadougou (capital of BF) for decompensated heart failure. Clinically we noted a syndrome of congestive heart failure. No obvious cause has been found outside of the advancing age of parents (50 years) and the potential risks of rubella infection. A Doppler echocardiography revealed a fistula aorto-pulmonary 17mm wide associated with a pericardial effusion of average circumferential abundance and a dilation of the left ventricular. Pulmonary radiography showed a large cardiomegaly and left pleurisy. The discovery of congenital heart disease between 2 and 4 years is very rare but the prognosis is good with surgical treatment.

L'enfant C.S âgée de 9 ans est évacuée d'une formation sanitaire située à 200km de Ouagadougou (capitale du BF) pour cardiopathie décompensée. Cliniquement est noté un syndrome d'insuffisance cardiaque globale. Aucune cause évidente n'est retrouvée en dehors de l'âge avancé des parents (50 ans environ) et des risques potentiels d'infection rubéolique. L'échocardiographie Doppler révèle une fistule aorto-pulmonaire large de 17mm associée à un épanchement péricardique de moyenne abondance circonférentielle et une dilatation du ventricule gauche. La radiographie pulmonaire a noté une volumineuse cardiomégalie et une pleurésie gauche. Cette cardiopathie congénitale de découverte habituelle entre 2 et 4 ans est très rare et de pronostic favorable avec le traitement chirurgical.