[Idiopathic left ventricular aneurysm presenting with ventricular tachycardia. A case report]. / Anévrisme ventriculaire gauche idiopathique révélé par une tachycardie ventriculaire. A propos d'un cas.

Left ventricular aneurysm presenting with ventricular tachycardia was observed in a 48 year old man. Aetiological investigation was negative. The differences between aneurysm and diverticulum and the aetiologies of aneurysms are discussed. The treatment of the arrhythmias caused by this condition is discussed with the help of a review of the literature.

[Transluminal dilatation of occluded coronary arteries. Value of retrograde opacification of the occluded vessel by the contralateral artery]. / Dilatation endoluminale d'artères coronaires occluses. Intérêt de l'opacification rétrograde du vaisseau occlus par l'artère controlatérale.

The authors report the results of 8 cases of percutaneous transluminal coronary angioplasty of occluded arteries: the artery concerned was the proximal segment of the left anterior descending artery in 5 cases and the proximal segment of the right coronary artery in 3 cases. All patients had unstable angina with a very positive exercise stress test. The conservation of viable myocardium was the result of an excellent collateral circulation from the controlateral vessel in all patients. In 7 out of the 8 cases, the guide wire and dilating balloon were correctly positioned by opacifying the distal segments of the occluded artery by injection of contrast into the controlateral artery. Almost simultaneous injection of the occluded and controlateral vessels allowed evaluation of the length of the occlusion. Controlateral opacification disappeared immediately after adequate recanalisation to reappear during inflation of the balloon. These cases show that in patients with chronic coronary occlusion, opacification of its distal segments by injection of contrast into the controlateral vessel seems to be helpful and without risk to the patient.

[Initial primary sarcoma of the pulmonary valve and trunk of the pulmonary artery]. / Sarcome intimal primitif de la valve et du tronc de l'artère pulmonaire. Suivi échocardiographique.

Primary sarcomas arising from the trunk or branches of the pulmonary artery are exceedingly rare and usually diagnosed at autopsy. The authors report the case of a 31 year old man referred for investigation of recurrent syncope. Echocardiography, right ventriculography and the thoracic computed tomography led to early diagnosis of a pulmonary artery tumour and surgical resection. Histology revealed a primary sarcoma. The early postoperative course was uncomplicated but one month after surgery a local recurrence was diagnosed at routine echocardiographic examination. The syncopal symptoms recurred seven months after surgery and echocardiography showed tumour recurrence on the interventricular septum and in the pulmonary artery. A second palliative operation was attempted but was unsuccessful because of the size of the tumour.

[Dissection of aorta after aortic valve replacement]. / Dissections de l'aorte après remplacement valvulaire aortique.

The authors report 4 cases of aortic dissection after aortic valve replacement. The aorta was dilated in all four cases before surgery. Two patients died within hours of the dissection, illustrating the poor prognosis of this complication and the difficulties of surgical management. The features of these four cases were compared to those of 29 other cases reported in the last ten years. The initial surgical indication for valve replacement was equally divided between aortic stenosis and regurgitation. The onset of dissection after surgery was very variable, ranging from a few hours to several years after valve replacement. Abnormalities of the aortic wall and peroperative trauma play an important role in the pathogenesis of this complication. The prognosis is very poor, which underlines the importance of preventive measures and regular follow-up of these patients.

[Immediate or delayed angioplasty during the acute phase of myocardial infarction. Apropos of 118 cases]. / Angioplastie immédiate ou différée à la phase aiguë de l'infarctus du myocarde. A propos de 118 cas.

The results of immediate percutaneous transluminal coronary angioplasty (PTCA) (260 +/- 167 minutes after onset of pain and an average of 56 minutes after thrombolysis) and deferred PTCA (average 9.6 days, range 1 to 30 days after infarction) were compared in 118 consecutive patients with acute myocardial infarction. The overall primary success rate of PTCA was 82.2 per cent; it was higher in those patients undergoing deferred angioplasty (96% vs 78%; p less than 0.05). The primary success rate of immediate PTCA was related to the severity of the stenosis before dilatation: 75 per cent success in occluded compared to 84 per cent in suboccluded vessels (over 90% stenosis) and 100 per cent success in vessels with under 90 per cent stenosis. Eighty one per cent of failed angioplasties occurred in patients with occluded arteries, the majority being left anterior descending (LAD) arteries (71.4%). The incidence of restenosis was 13.4 per cent. This complication was diagnosed at coronary arteriography performed 40 days after PTCA in 1 case, 47 days after PTCA in another case and at the 6 month control in 11 cases. Reocclusion was observed in 21 patients (21.7% of immediate successes). The occlusion was diagnosed at the first control after an average of 8 days in 15 cases. The interval between the onset of pain and thrombolysis and dilatation was significantly longer in the group with reocclusion compared with patients without reocclusion (314 minutes vs 193 minutes for thrombolysis, p less than 0.01; and 356 minutes vs 204 minutes fort PTCA, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Right-left shunt caused by sarcoma of the right atrium]. / Shunt droit-gauche secondaire à un sarcome de l'oreillette droite.

A 70 year old woman was admitted for right ventricular failure and cyanosis of recent onset. Echocardiography showed a very large, homogenous, immobile, smooth-contoured mass filling the right atrium. Right atrial pressures were raised but the other intracardiac pressures were normal at catheterisation. Right heart angiography confirmed the voluminous right atrial mass and dilatation of the hepatic veins and showed early opacification of the left heart chambers. A right-to-left shunt was confirmed by oximetry which showed significant desaturation of the blood in the left atrium and ventricle (saturation 78% in the left ventricle). The tumour was also documented by a thoracic CT scan. At surgery, a very large, malignant right atrial tumour was resected which histological examination showed to be an angiosarcoma. The interatrial septum seemed to be intact: there was no true atrial septal defect but a persistent foramen ovale was found. After resection of the tumour the right atrium was reconstructed. The initial postoperative period was uncomplicated but the patient died nine months later of metastatic disease particularly affecting the liver and brain. The clinical presentation of malignant cardiac tumour is very variable but a right-to-left interatrial shunt through a patent foramen ovale has only been reported previously in 2 cases of primary malignant tumours (a rhabdomyosarcoma and an angiosarcoma) and in 1 case of a secondary cardiac metastasis.

[Prospective study of routine screening for cirrhosis and colonic tumors associated with Streptococcus bovis bacteremia]. / Etude prospective de la recherche d'une cirrhose et de tumeurs coliques en cas de bactériémie à Streptococcus bovis.

Between 1987 and 1990, seven patients hospitalized in our hospital had bacteremia caused by Streptococcus bovis. Complete gastrointestinal evaluation was routinely carried out for digestive portal of entry and liver disease screening. In four cases (2 bacteremia, 2 endocarditis), a colonic growth was detected: sigmoid adenoma (n = 1) and rectosigmoid carcinoma (n = 4); in one case (endocarditis), several rectosigmoid carcinomas were associated with alcoholic cirrhosis; in one case (bacteremia), alcoholic cirrhosis was diagnosed; in one case (endocarditis), no gastrointestinal or hepatic portal of entry was found. These cases emphasize the need for simultaneous detection of endocarditis and gastrointestinal portal of entry such as colonic tumor and/or cirrhosis, in case of Streptococcus bovis bacteremia.

[Late myocardial infarction after closure of coronary artery fistula]. / Infarctus myocardique tardif après fermeture d'une fistule coronaro-cardiaque.

Congenital coronary cardiac fistulae are rare conditions for which surgery is the usual indication. The authors report on the case of one female patient of 28 years with a coronary cardiac fistula responsible for exertional dyspnoea and relapsing pulmonary infections. The diagnosis was suggested by a continuous murmur and was confirmed by Doppler echocardiography and catheterization which showed a dilated, sinuous circumflex artery (2 cm) leading into the right atrium. Surgical closure of the fistula was complicated by an early myocardial infarction and a relapse in the same area with resulting mitral insufficiency. The surgical treatment of coronary cardiac fistulae is widely documented in the literature and recent series demonstrate that good results are usually obtained: however, a late infarction has not been described. The constitution of thrombi in the collateral vessels deriving from the distended vessel probably accounts for the particular evolution noted in this specific case.

[Myocardial involvement in AIDS. Echographic study in 85 human immunodeficiency virus infected patients]. / L'atteinte myocardique au cours du SIDA. Etude échographique chez 85 patients infestés par le virus de l'immunodéficience humaine.

Histological and echographic studies of HIV-seropositive patients demonstrated the reality of myocardial involvement during the acquired immunodeficiency syndrome. Eight-five seropositive, asymptomatic patients, 55 of them classified as group IV (CDC criteria), were subjected to echocardiography and measurement of the reduction of the left ventricle fraction. An echographic anomaly was found in 8/85 seropositive patients and in 7/55 group IV patients. This affect on left ventricular contractility seems to occur in patients with a low number of CD4+ lymphocytes (p = NS) and is statistically significantly associated with the level of anti-P24 antibodies/antigenemia (absence of antibodies and positive antigenemia) (p less than 0.05).