[Arrhythmogenic effects of antidepressive agents demonstrated by programmed ventricular pacing]. / Effet arythmogène des antidépresseurs. Mise en évidence par la stimulation ventriculaire programmée.

Tricyclic antidepressants and phenothiazines have been blamed for increasing the incidence of sudden death. One of their known mechanisms of action in such cases is to induce torsades de pointes by a so-called "quinidine-like" effect. We report the case of a female patient who was rescued from an episode of cardiac arrest which occurred two months after a myocardial infarction. Right ventricular programmed pacing strongly suggested an arrhythmogenic effect to the antidepressant the patient was receiving. This type of treatment seems to be capable of facilitating the induction of a monomorphous ventricular tachycardia which may degenerate into ventricular fibrillation.

[Atresia of the left coronary artery: a case in a marathon runner. Review of the literature]. / Atrésie du tronc coronaire gauche: une obseration chez un marathonien. Revue de la littérature.

The authors report the case of a very rare coronary malformation: atresia of the left main coronary artery. This anomaly was discovered in a marathon runner who presented effort angina with a positive exercise stress test. At coronary angiography, it was not possible to catheterise the left coronary artery and only a minuscle dimple could be visualised. Selective right coronary catheterisation showed a very large right coronary artery with retrograde injection of the whole of the left coronary network, as far as the left main stem. The authors did not suggest revascularisation because of the good functional tolerance of this malformation.

[Treatment of amiodarone-induced hyperthyroidism by carbimazole with maintenance of amiodarone]. / Traitement d'une hyperthyroïdie à l'amiodarone par carbimazole avec poursuite de l'amiodarone.

The authors report the case of a patient treated with amiodarone for syncopal ventricular tachycardia complicating idiopathic dilated cardiomyopathy in whom symptomatic hyperthyroidism led to a discussion of the different therapeutic options available in this type of case. Neomercazole treatment was prescribed with success enabling maintenance of the antiarrhythmic drug. The reputation of inefficacy of carbimazole should be reconsidered ; high dose therapy should probably be tried in patients with hyperthyroidism when withdrawal of the antiarrhythmic drug does not seem to be possible.

[Atrioventricular block disclosing an isolated congenital aneurysm of the sinus of Valsalva, extending into the septum and not ruptured]. / Bloc auriculo-ventriculaire révélant un anévrysme congénital du sinus de Valsalva, isolé, à propagation septale et non rompu.

A case of a congenital aneurysm of the right anterior sinus of Valsalva (ASV) extending into the septum is reported. The patient, a 20 year old male Central-African, presented with syncopal complete atrioventricular block (AVB) or recent onset. There were no clinical or radiological signs of associated cardiac disease. After implantation of a pacemaker, the diagnosis of an ASV extending into the septum was suggested on routine M mode echocardiography. It was confirmed by two-dimensional echocardiography and aortography. These investigations provided data on its size, its relationship to the cardiac chambers and also showed absence of rupture. The neck of the aneurysm was closed by an endo-aortic approach. There was moderate postoperative aortic regurgitation. This case underlines the value of systematic echocardiography in young patients with AVB of recent onset and obscure origin.

[Infectious endocarditis. A study of 50 patients in a non-university hospital]. / Endocardite infectieuse. A propos de 50 patients consécutifs d'un hôpital non universitaire.

The authors report the results of a single centre study of 50 consecutive patients (average age 66 +/- 14 years; 36 men), admitted between 1992 and 2001 to a peripheral hospital for infectious endocarditis (IE). The median interval to diagnosis was 57 days. There was an underlying cardiac disease in 52% of cases, usually valvular (42%). The site of the IE was the mitral valve in 21 cases, the aortic valve in 19 cases, mitro-aortic valves in 5 cases, native tricuspid valves in 2 cases and pacing catheters in 4 cases (associated with valvular endocarditis in one patient). The causal organism was usually a streptococcus (60%, including 28% of streptococcus bovis), or a staphylococcus (22%): no organism could be found in 7 patients. The average follow-up was 33 +/- 30 months: surgery was indicated in half the patients and 3 patients were turned down because of their poor general condition. In all, 34% of patients died (24% of their IE) in a median interval of 6 months, mainly from infectious or haemodynamic complications. Poor prognostic factors were: age > 70 years, "blind" antibiotic therapy, large-sized vegetations, embolism and renal failure. These data, comparable to the results observed in large series in the literature, underline the importance of multi-disciplinary management of IE and strict prophylaxis.

[Left atrial thrombus in multiple myeloma treated with thalidomide]. / Thrombus de l'oreillette gauche au cours d'un myélome multiple traité par thalidomide.

The occurrence of a left atrial thrombus without a haemodynamic predisposing factor (arrhythmia, mitral valvulopathy, severe left ventricular dysfunction) is a rare event. We report a case during the progression of refractory myeloma, four months after stopping treatment with thalidomide. The promoting haemodynamic factors for left atrial thrombosis in sinus rhythm, described in the literature, had been excluded. In our case the potential role of thalidomide is debatable, in the light of recent publications about venous and arterial thromboses observed with this treatment.

[Youthful popliteal aneurysm]. / Anévrisme poplité juvénile.

Popliteal artery aneurysms are not so clinically frequent but are the most common site of peripheral aneurysms. They usually affect men aged over sixty and are caused by atherosclerosis. Whenever they concern younger men, other more unusual aetiologies such trauma, infection, inflammatory arteritis or popliteal entrapment are responsible. The authors report the first written observation of small size popliteal aneurysm, revealed by intermittent claudication in a 33 years old subject, of which the origin is accelerated atherosclerosis. The evolution after resection of the popliteal aneurysm and end-to-end anastomosis with saphenous vein was favorable. This observation reminds us of various popliteal aneurysm aetiologies, not excluding atherosclerosis due to young age and also underlines that the small size of these aneurysms does not protect against embolism risk.

[Non-invasive management of a serious acute pulmonary embolism]. / Gestion non invasive d'une embolie pulmonaire aiguë grave.

Prompt diagnosis of a large pulmonary embolus is essential in order to initiate appropriate treatment early. We report a case of a large pulmonary embolus in which management was aided solely by noninvasive investigations. Transthoracic echocardiogram showed elevated right heart pressures which together with the patient symptoms suggested a major pulmonary embolus. Spiral computed tomography of the chest confirmed the diagnosis. The source of the embolus was shown by echodoppler. This case illustrates that a diagnosis of a major pulmonary embolus can be made using noninvasive techniques. Pulmonary angiography should be reserved for those rare cases in which diagnostic uncertainty remains rather than being used as a routine examination prior to consideration of therapeutic decision.

[Inflammatory abdominal aortic aneurysm]. / Anévrisme inflammatoire de l'aorte abdominale.

A 58-years-old man, with no medical past history, was examined for abdominal pain and weight loss. An enlarged kidney could be palpated, and abdominal echography showed left hydronephrosis due to ureteral compression by abdominal aortic aneurysm. Laboratory data showed an inflammatory syndrome. CT scan suggested the diagnosis of inflammatory abdominal aortic aneurysm. The use of corticosteroids brought about the regression of the symptoms and the resolution of the ureteral obstruction, permitting aneurysmectomy and prosthesis replacement without ureterolysis. This report shows the interest of preoperative radiological diagnosis of the inflammatory character of abdominal aneurysm. For uncomplicated cases, preoperative treatment using corticosteroids could allow partial regression of the periaortic inflammation and easier surgical repair.

[Acute complication of a composite graft replacement of the aortic root]. / Complication aiguë d'une prothèse de l'aorte ascendante.

A 78-year old man operated for an acute aortic dissection 8 years ago was hospitalized for an unusual clinical presentation with acute cor pulmonale and superior vena caval syndrome. He had poorly controlled high blood pressure, and coronary artery disease with aorto-coronary by-pass 10 years ago. He underwent Bentall procedure 2 years later for type I acute aortic dissection, with vein graft reimplantation on the valvular conduit. A pseudoaneurysm was noted in the post-operative period, which remained stable at 45 mm during the follow-up. Thoracic CT-scan highlighted a 14.5 cm diameter pseudoaneurysm compressing the superior vena cava and right pulmonary artery. Detached right aorto-coronary by-pass, suspected on transesophageal echocardiography, was confirmed peri-operatively; the aortic anastomosis blood in the peri-prosthetic space, explaining the acute clinical picture. The severity of the lesions did not permit surgical repair and the patient died during operation. This observation evidences the complications observed after aortic root replacement and favors echographic and radiological follow-ups (J Mal Vasc 1999; 24: 381-383).

[Bone marrow aplasia related to ticlopidine]. / Aplasie médullaire associée à la ticlopidine.

The authors report two cases of bone marrow aplasia observed 2 months after initiation of a treatment with ticlopidine. The outcome was favorable after discontinuation of therapy. The frequency of this severe drug-induced complication seems to have been underestimated. The absolute necessity of a careful haematological survey during the first 3 months of therapy is pointed out.

[Pheochromocytoma and hyperthyroidism caused by amiodarone]. / Phéochromocytome et hyperthyroïdie à l'amiodarone.

The authors report, in a 66 y. old patient, a case of pheochromocytoma, interesting in that its initial clinical picture is one of amiodarone-induced hyperthyroidism with orthostatic hypotension, and a persisting severe weight loss in spite of the improvement of the thyroid work-up is the indication of an adrenal tumor discovered on tomodensitometry. The accidental combination of these two endocrine diseases delays the already unusual manifestation of this pheochromocytoma and emphasizes the role of radiographic (tomodensitometry) and/or isotopic (MIBG) imaging in the "discovery" of these tumors.

[Myocardial infarction and coronary artery aneurysm]. / Infarctus du myocarde et anévrisme des artères coronaires.

Two cases of aneurysm of the right coronary artery are reported. These atheromatous aneurysms not associated with tight coronary stenosis were responsible for myocardial infarctions treated by early intravenous thrombolysis with a resultant limited area of necrosis. According to the literature, coronary aneurysms associated with stenosis are not rare. Aneurysms not associated with significant stenosis appear to be much less common and the prognosis of patients with such lesions would not seem to be worse than that of those with neither aneurysm nor significant coronary stenosis. From a pathophysiological standpoint, the development of local thrombosis appears to play a determinant role in terms of the clinical manifestation of these aneurysms and its prevention justifies the long term combined prescription of platelet antiaggregants and oral anticoagulants.

[Myocardial infarct complicating thrombopenia induced by pentosan polysulfate]. / Infarctus myocardique compliquant une thrombopénie induite par le polysulfate de pentosane.

The authors report a case of thrombopenia induced by pentosane polysulfate (PSP), complicated by a myocardial infarction. Biological tests showed a platelet pro-aggregating effect of PSP and an IgG immunoglobulin fixed to the platelets. A review of the literature shows that PSP-induced thrombopenias must be known as well as those induced by heparins and that they have similar complications. The thrombopenia may persist with an inappropriate substitution with heparin and the clinical picture may be aggravated. It is desirable to carry out systematic screening for a cross-allergy and prevent it by using anti-vitamin K.

[Non-calcified chronic constrictive pericarditis. Diagnostic difficulties and contribution of complementary tests]. / Péricardite chronique constrictive non calcifiante. Difficultés diagnostiques et apport des examens complémentaires.

The authors report a case of noncalcified chronic constrictive pericarditis, in which the diagnosis was delayed due to an associated mitral stenosis. The diagnostic value of various invasive and noninvasive complementary investigations is discussed.

[Isolated pericardial metastasis of digestive cancer disclosed by tamponade]. / Métastase péricardique isolée d'un cancer digestif révélée par une tamponnade.

The authors report a case of a single secondary tumour of the pericardium presenting as tamponade and occurring three years after sigmoidectomy for an adenocarcinoma of the colon. Gastrointestinal investigations confirmed the absence of any local tumour recurrence. The originality of this case lies in the presentation and isolated nature of this metastasis. Attempted surgical excision failed which, in view of the patient's good general condition, led to suggestion of FUFOL type chemotherapy.

[Myocarditis of pseudo-infarctoid onset]. / Les myocardites à début pseudo-infarctoïde.

The authors report two cases of myocarditis in young individuals in whom clinical and electrocardiographic findings during the acute phase could have led to an erroneous diagnosis of myocardial infarction. The problem in such cases is that of a differential diagnosis with infarction with normal coronary arteries. Few clinical or paraclinical arguments are of diagnostic value, endomyocardial biopsy remaining the reference investigation. Proof of viral infection is not always obtained. It is often the retrospective argument of "complete return to normal" which supports the clinical impression. This usual benign outcome is not always the case, since cases of cardiogenic shock have been reported. The dual nature of the pathogenesis ("myositis" and/or "vasculitis" with thrombus and actual MI) is stressed.

[Severe pulmonary embolism and thrombus of the right atrium. Success of the thrombolytic treatment combining Rt PA and streptokinase]. / Embolie pulmonaire grave et thrombus de l'oreillette droite. Succès du traitement thrombolytique associant Rt PA et streptokinase.

The authors report the case of a patient with a serious recurrence of pulmonary embolism with echocardiographic evidence of a floating serpentine thrombus of the right atrium. The outcome was rapidly satisfactory with disappearance of signs of acute cor pulmonale and lysis of the right atrial thrombus after infusion of two thrombolytic agents: Rt PA and streptokinase. There is no evidence in the literature to indicate that one form of treatment, i.e. surgical thrombectomy or thrombolysis, is markedly superior to the other. Thrombolysis appears to be a useful alternative to surgery. The use of Rt PA and of the combination of two thrombolytics has not been published previously and merits confirmation.

[Myocardial infarction with normal electrocardiogram]. / Infarctus du myocarde à électrocardiogramme normal.

These two cases concern myocardial infarcts where the electrocardiogram (ECG) was within normal limits at admission and throughout the period of hospitalisation, the diagnosis of an infarct being made secondarily on the basis of raised CPK. Both cases involved infarcts limited to the lateral wall due to occlusion of the first marginal artery of the left border. Several recent studies have evaluated the diagnostic value of the ECG in infarcts and have shown its lack of sensitivity in lateral infarcts. The resultant diagnostic difficulties may lead to delayed treatment, the consequences of which should not be capital since it has been shown that infarcts with a normal or minimally abnormal ECG at the time of admission have a favourable short term prognosis.

[Cardiac manifestations in leptospirosis. Apropos of 15 cases observed in New Caledonia]. / Manifestations cardiaques au cours des leptospiroses. A propos de 15 cas observés en Nouvelle-Calédonie.

The authors report the cardiovascular manifestations observed in 15 cases of severe leptospirosis in New Caledonia. Cardiovascular collapse is frequent. Electrocardiographic alterations consist mainly of arrhythmia secondary to atrial fibrillation and repolarisation disorders. A picture of pseudo-pericarditis has also been observed. These cardiac manifestations represent a factor of gravity when associated with multi-visceral manifestations which control the prognosis.