[Dynamic left ventricular obstruction associated with a pheochromocytoma reversible after tumor ablation]. / Obstruction dynamique intraventriculaire gauche associée à un phéochromocytome et réversible après son exérèse.

The association of dynamic left ventricular outflow tract obstruction and pheochromocytoma is rare with only about fifteen previously reported cases in the literature. The association may be the result of chronic increased catecholamine secretion which induces intra-ventricular obstruction in a hypertrophied ventricle due to hypertension. The authors report a new case in which the intraventricular gradient on Doppler echocardiography was particularly high at 120 mmHg. The gradient totally regressed after removal of the pheochromocytoma. The finding of a systolic murmur in a patient with pheochromocytoma should lead to the prescription of Doppler echocardiography and diagnosis of left ventricular tract obstruction must lead to the association of betablocker and alphablocker therapy before surgery. The removal of the pheochromocytoma is usually followed by the complete regression of left intraventricular obstruction, as in this case.

[Spontaneous regression of a false aneurysm of the ascending aorta following surgery for dissection]. / Régression spontanée d'un faux anévrisme de l'aorte ascendante consécutif à une chirurgie pour dissection.

We report the case of a 50-year-old man admitted to hospital for a type A aortic dissection. After conventional surgical repair, he was asymptomatic and underwent computed tomography imaging at 15 days, 3 and 6 months. The first CT scan showed a small perigraft circulating false aneurysm which totally disappeared on the last exam. This case emphasizes the potential role of CT scan in the follow-up of patient after aortic surgery and the likely favorable outcome of some false aneurysm.

[Value of the early determination of plasma myoglobin level in the diagnosis of acute myocardial infarction]. / Intérêt des dosages précoces de la concentration sérique de la myoglobine pour le diagnostic de l'infarctus du myocarde en voie de constitution.

Serum myoglobin (Mb) was assayed by immuno-nephelemetry or immuno-turbidimetry together with creatinine kinase activity (CK) by spectrophotometry in 290 consecutive patients admitted to hospital between January 1st and September 30th 1992 in three cardiology departments for chest pain suggesting myocardial infarction (MI). The measurements were made at admission (T0) and 90 minutes later (T90). On admission, patients were classified as certain MI (N = 62), possible MI (N = 107) or definitely not MI (N = 121) and, on discharge, as certain MI (N = 144) or definitely not MI (N = 146). At T0, for a threshold value of 90 mcg/l, Mb assay had a sensitivity of 49.3% and a specificity of 95.2%, a positive predictive value of 91.8% and a negative predictive value of 65.6%. Increasing the threshold of positivity to 130 mcg/l was accompanied by a significant loss of sensitivity (38.2%) without any change in the other parameters. At T90, for a threshold value of 90 mcg/l, Mb assay had a sensitivity of 81.7%, a specificity of 92%, a positive predictive value of 89.5% and a negative predictive value of 85.8%. The increase in sensitivity between T0 and T90 made Mb assay very useful for correctly classifying the initial false negative results (20/28: 71.4%) and for diagnosing the possible MI (27/32: 84.4%). Decreasing the threshold of positivity to 80 or even to 70 mcg/l did not improve the diagnostic value of this test. The sensitivity of Mb assay was significantly higher than that of CK at T0 (49.3% vs 26.4%: p < 0.0001) and at T90 (81.7% vs 48.9%: p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Left ventricular dilatation after primary transmural anterior myocardial infarction. Influence of the percentage of akinesia on echocardiography]. / Dilatation ventriculaire gauche après primo-infarctus antérieur transmural: influence du pourcentage d'akinésie en échographie.

The aim of this study was to determine whether the percentage of akinesia on echocardiography during the acute phase of transmural anterior myocardial infarction could predict secondary left ventricular dilatation. The study group comprised 24 patients (18 men and 6 women) with an average age of 59 years. The patients underwent two echocardiographic examinations, the first during the acute (< 72 hours) phase and the second, 6 months later. Ventricular volumes were calculated by the ellipse monoplane method in the apical 4 chamber view. The percentage of akinesia was defined as the ratio between the length of the akinetic segment and the left ventricular end diastolic perimeter in the apical 4 chamber view. An increase in end diastolic volume (83 +/- 25 vs 62 +/- 18 ml/m2; p < 0.01) and in end systolic volume (51 +/- 27 vs 34 +/- 11 ml/m2; p < 0.01) was observed 6 months after infarction without a significant change in ejection fractions (42 +/- 17% vs 44 +/- 10%). The percentage of akinesia in the acute phase was > 30% in 15 patients (Group I) and < 30% in 9 patients (Group II). The increase in ventricular volumes at 6 months after infarction was significant in Group I (p < 0.02) but not in Group II. At 6 months after infarction, the end systolic volumes were greater (60 +/- 27 vs 37 +/- 22 ml/m2, p < 0.5) and the ejection fractions were lower (35 +/- 13% vs 53 +/- 18%, p < 0.01) in Group I than in Group II.(ABSTRACT TRUNCATED AT 250 WORDS)

[Myocardial bridge of the left anterior descending coronary artery and myocardial infarction: does coronary spasm play a part?]. / Pont myocardique de l'artère interventriculaire antérieure et infarctus du myocarde. Le spasme coronaire a-t-il un rôle?

The association of a myocardial bridge of the left anterior descending (LAD) coronary artery and myocardial infarction is rare. The mechanisms by which the myocardial bridge could predispose to myocardial infarction are tachycardia (reducing the duration of diastolic coronary filling), thrombosis at the site of the myocardial bridge, and coronary spasm which, however, has never been demonstrated in the context of infarction. The aim of this study was to detect coronary spasm by provocative ergometrine testing in 4 patients, all male, aged 21 to 49 years, average 39 years old, who had anterior myocardial infarction associated with myocardial bridging of the LAD artery without atheromatous coronary stenosis. The ergometrine tests were performed during (2 cases) or after coronary angiography (2 cases). The systolic narrowing due to the myocardial bridge ranged from 25 to 95% (average 70%). The ergometrine test was strongly positive in 1 patient and negative in the other 3. Repermeabilisation of a thrombus was suggested in these 3 patients by the recording of an accelerated idioventricular rythm in the acute phase of infarction (2 cases) or by the demonstration of abnormal platelet aggregation (1 case). This is the first report of coronary spasm in a patient with myocardial bridging associated with infarction. However, it is not possible to determine the respective roles of spasm and myocardial bridging in the genesis of the infarct. We suggest systemic provocative ergometrine testing in this situation to orientate the most appropriate treatment.

[Postpartum myocardial infarction with normal coronary arteries. Apropos of a case]. / Infarctus du post-partum à coronaires saines. A propos d'un cas.

A case of painless anteroseptal and high lateral wall infarction presenting as cardiogenic shock with pulmonary oedema 24 hours after childbirth complicated by severe post partum haemorrhage with a coagulation defect, is reported. Coronary angiography performed one month later was normal, with a negative ergometrine provocation test. The authors review five previous reports in the medical literature, and discuss the possible physiopathological mechanisms which, alone or in association could have operated in the reported case.

Evaluation of the elasticity and characteristic impedance of the ascending aorta in man.

In 30 patients, simultaneous measurements of ascending aortic pressure and diameter were performed, allowing one to evaluate: (1) the influence of age, the aortic diastolic pressure, and the radius on the aortic elasticity; (2) the correlations between characteristics impedance of the aorta (Zo), systemic arterial resistance, age and diastolic aortic pressure; and (3) the importance of Zo when comparing two indices of left ventricle performance; one during isovolumic phase ([dP/dt]/Pt)max and the other during the outflow phase (maximum acceleration of aortic blood flow).

[Nodo-ventricular accessory pathway unmasked by a block in the trunk of the bundle of His]. / Voie accessoire nodo-ventriculaire démasquée par un bloc dans le tronc du faisceau de His.

A case is reported in which, contrary to the unusual finding, conduction was slower in an accessory pathway than in the node-His pathway. Only when this latter became blocked (in the trunk of the bundle of His) following on the longest refractory period, was a pre-excitation syndrome unmasked related to the right nodo-ventricular fibres (the fibres of Mahaim).

[Role of the characteristic impedance of the ascending aorta in the evolution of indices of left ventricular performance during the ejection stage]. / Rôle de l'impédance caractéristique de l'aorte ascendante dans l'évaluation des indices de performance ventriculaire gauche en phase éjectionnelle.

In this study of 61 patients (group I: 37 patients with no signs of cardiac failure, group II: 24 patients with signs of cardiac failure), a comparison is made between the indices of left ventricular performance obtained during the isovolumic phase dp/dt/Pt max of the left ventricle (5F Millar micromanometer) and in the ejection phase (ejection fraction, mean speed of fibre contraction, corrected mean systolic ejection speed (left ventricular cineanigiography) and maximal acceleration of the aortic blood flow (electromagnetic velocimeter). Calculations were also made of the modulus of elasticity (Ep) and the characteristic impedance of the ascending aorta (Zo) in every patient. The results show that, for group I patients the correlation between the indices in the isovolumic and ejection phases is improved by taking Zo into account. This result is not true for group II cases except with respect to the acceleration of aortic blood flow. An analysis has been made of the hypotheses and the discrepancies.

[Romano-Ward syndrome and left stellectomy. General review apropos of a recent case]. / Syndrome de Romano-Ward et stellectomie gauche. Revue générale à propos d'un nouveau cas.

A new familial case of the Romano-Ward syndrome in a young girl of 21 years is reported. A progressive worsening of the condition with multiple syncopal attacks, together with difficulty in controlling the patient, lead us to carry out a left stellate ganglionectomy. The operation did not lead to any shortening of the QT interval. It appeared in the end that propranolol was the most effective way of preventing the syncopal attacks.