[Complete atrioventricular block of the young adult... do not forget sarcoidosis]. / Bloc auriculoventriculaire complet du sujet jeune... Penser à la sarcoïdose.

The authors report the case of a 27 years old athletic patient, without any antecedents, presenting with a recent complete atrioventricular (AV block, disclosed by an effort dyspnoea and syncope. The electrophysiological exploration showed a nodal AV block. The magnetic resonance imaging revealed the existence of a septal hypersignal in T1 mode enhanced after Gadolinium injection, and left ventricular function normality. It also revealed the existence of a pulmonary parenchyma infiltrate, confirmed by thoracic scanner. Pathological examination of transbronchial biopsies showed noncaseating granuloma, consistent with sarcoidosis. Programmed electrical stimulation induced no ventricular arrhythmia. A dual chamber pace-maker was implanted because of the AV block permanence and the poor clinical tolerance, associated with steroid therapy (prednisolone 1 mg/kg/j). After a 18 months follow-up, the patient remains asymptomatic, and the 12-lead ECG shows a normal AV conduction. The authors discuss the different aetiologies of AVB, and emphasize to realize an exhaustive assessment in young adults. The cardiac localization disclosing sarcoïdosis and the complete AV block disappearance under therapy make that observation original. The occurrence of a complete AV block complicating sarcoidosis poses a management and prognosis problem.

[Heart failure due to non-infectious causes in developing countries: etiologic approach and therapeutic principles]. / Insuffisance cardiaque d'origine non infectieuse en zone tropicale: approche étiologique et principes thérapeutiques.

Cardiovascular disease is a major worldwide health problem with a growing impact in developing countries. Heart failure is the clinical manifestation of many advanced cardiac disorders. It can have numerous etiologies and the incidence of non-infectious causes is increasing with socio-economic development, thus illustrating the global nature of this epidemiologic transition. Several of the numerous non-infectious causes of heart failure involve cardiac diseases specific to tropical areas including dilated cardiomyopathy, endomyocardial fibrosis, and peripartum cardiomyopathy. Other widespread disorders are becoming more common as a result of the epidemiologic transition. Cardiovascular risk factors are changing particularly with regard to the incidence of coronary artery disease, ischemic cardiomyopathy, and hypertension-related complications. The purpose of this article is to provide an overview of non-infectious causes of heart failure in terms of frequency, onset, and therapeutic requirements. Symptomatic treatment of heart failure is same as in developing countries but is often delayed due to shortcomings in the care system.

[Left ventricular noncompaction: a cardiomyopathy in young individuals. Description of first cases in Africa]. / La non compaction du ventricule gauche, une cardiomyopathie du sujet jeune: premieres observations Africaines.

Left ventricular noncompaction (LVNC) is a recently identified and probably rare congenital cardiomyopathy characterized by changes in the structure of the myocardium secondary to incomplete embryogenesis. The purpose of this report is to describe three cases of LVNC involving African patients. To our knowledge these are the first cases described in Africa. All three patients in this series were men from sub-Saharan Africa ranging in age from 23 to 45 years. The first patient in whom cardiomegaly was recognized on a routine chest x-ray was asymptomatic. The second who presented with exertional dyspnea developed left bundle branch block. The third was admitted to the hospital for acute pulmonary edema. In all three cases transthoracic echocardiography suggested diagnosis. The left ventricle was dilated and hypokinetic and the myocardium exhibited a spongy aspect in association with the presence of prominent trabeculations separated by crypts located at the apex and lateral wall. Color Doppler demonstrated that intratrabecular recesses were filled by intraventricular blood flow. Magnetic resonance imaging (MRI) specifically confirmed this morphological feature. Sudden death due to arrhythmia, cardiac insufficiency, and systemic emboli are the main complications of LVNC. The incidence of LVNC, which is certainly underestimated, is highest in young adults but it can be diagnosed at any age. Echocardiography and MRI are effective tools for detection of the morphologic diagnostic criteria. Recent evidence suggests that LVNC is of genetic origin and the data reported here shows that the underlying mutations are present in sub-Saharan populations. Family screening in African populations is still difficult. Therapeutic management is currently based on symptomatic treatment of cardiac insufficiency and can require techniques not readily available in tropical settings.

[Thoracic aortic dissection revealed by systemic cholesterol embolism]. / Dissection de l'aorte thoracique révélée par des embolies systémiques de cristaux de cholesterol.

Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.

[Comparison of four formulas of adjusting QT interval for the heart rate in young elite athletes]. / Intervalle QT chez les athlètes : comparaison de quatre formules de correction dans une population de jeunes sportifs de haut niveau.

PURPOSE: Sudden cardiac death in young athlete is always tragic. Some international guidelines recommend the realization of an electrocardiogram before practicing competitive sports to carry out the risk of sudden cardiac death due to genetic cardiopathy like QT long syndrome. Unfortunately, the diagnosis can be difficult because intensive sport can increase the QT interval over normal recognized values for sedentary people. Using a QT correction formula free of heart rate appears essential. PATIENTS AND METHODS: Four hundred and forty-six young athletes (aged 10 to 18) had an electrocardiogram. QT intervals were measured and four methods were used to correct the QT interval for heart rate. RESULTS: The Bazett formula performed the worst in terms of rate adjustment success. Hodges and Fridericia formulas are the best both in males and females, independently of age. Female had longer QTc intervals than males. CONCLUSION: The most widely used Bazett formula should be surrendered whereas Hodges and Fridericia formulas should be preferred, particularly in young athletes.

[An exceptional case of tricuspid infective endocarditis due to Bartonella henseale revealed by an old pulmonary embolism]. / Un cas exceptionnel d'endocardite infectieuse tricuspide à Bartonella henselae révélée par une embolie pulmonaire « vieillie ¼.

We report a case of blood culture-negative tricuspid infective endocarditis revealed after tick bite by repeated pulmonary infection during one year due to septic pulmonary emboli in a 67-year-old farmer woman. Tricuspid vegetation and pulmonary emboli are calcified. Lyme serology is negative. Serologic test and PCR analysis are positive to Bartonella henselae. The evolution is favorable after antibiotic and anticoagulant treatment. Infective endocarditis due to B. henselae is an exceptional complication of cat scratch disease. You have to think about in case of blood culture-negative endocarditis with calcified valvular lesions even without cat bite, tick seems to be vector of the bacteria.

[Fatal surgical extraction of cardiac resynchronisation therapy defibrillator leads in a context of endocarditis due to methicillin-resistant Staphylococcus epidermidis. A case report and review of literature]. / Extraction chirurgicale fatale de sondes de défibrillateur cardiaque triple chambre dans un contexte d'endocardite à Staphylococcus epidermidis méthicilline-résistant. À propos d'un cas et revue de la littérature.

A 82-year-old man equipped with a cardiac resynchronisation therapy defibrillator for dilated cardiomyopathy with normal coronary arteries, in complete atrioventricular block, develops six months after a change of the generator-pocket a severe endocarditis due to a methicillin-resistant Staphylococcus epidermidis with a large lead vegetation. After 4 days of adapted antimicrobial therapy, a surgical device removal is realised with unfortunately a fatal end during extraction. This observation points out the severity of cardiovascular device infections in old and weak population, as well as the difficulty of treatment choices because of both infectious and rhythmic constraints. The lead extraction is a strong recommendation but the modality and timing of extraction are not consensual, especially in cardioverter defibrillator-dependent patients. Surgical removal remains an alternative to percutaneous lead extraction but with a higher operative risk.

[Lipomatous hypertrophy of the interatrial septum]. / Hypertrophie lipomateuse du septum interatrial.

Lipomatous hypertrophy of the heart is a benign rare tumor characterized by fatty tissue deposits in the interatrial septum. Its diagnosis during life is mostly seen incidental. We report the case of a 74-year-old female patient, in which a cardiac mass protruding in the right atrium was diagnosed by transthoracic echocardiography. Transoesophageal echocardiography examination detected an echogenic infiltration and hypertrophy of the interatrial septum, sparing the foramen ovale. The diagnosis of lipomatous hypertrophy of the interatrial septum is confirmed by MRI, which shows a well limited and not encapsulated tumor, appearing in increased signal density on T1-weighted images, and that decreases with fat-saturated sequences. This tumor did not enhance with the administration of contrast material. The benign and lipomatous nature of the lesion is confirmed, thus making the use of histology unnecessary.

[Cardiac extension of a non-Hodgkin lymphoma revealed by an atrial flutter]. / Flutter atrial révélateur de l'extension cardiaque d'un lymphome malin non hodgkinien.

Primary or secondary cardiac lymphomas are not frequent. Their clinical expression is unusual and the diagnosis is rarely made during the patient's life. Our case report, which is a slow atrial flutter with a pericardial effusion, is an uncommon discovery mode for a malignant lymphoma. Their diagnosis and the mechanism of the arythmia were allowed by non-invasive cardiac imagery (transesophageal echography and magnetic resonance imaging), which showed a tumour-like infiltration of the right atrium, of the right ventricle posterior wall, and of the atrioventricular junction. The diagnosis of a high grade B cell malignant non-hodgkin lymphoma, involving the bone marrow, the liver and the kidneys was made by biopsies of lymph nodes, histological analysis of the bone marrow, and a body CT scan. Throughout the first chemotherapy sequence, we observed a spontaneous return to a sinusal rhythm, and the cardiac MRI showed a regression of the myocardial infiltration and of the pericardial effusion; moreover, the patient's state improved and the peripheral lymph nodes shrank back to a normal size. However, the patient passed away, due to neurological complications 13 months after the diagnosis of lymphoma, without recurrence of cardiac involvement.