Efficiency of amifostine as a protection against doxorubicin toxicity in rats during a 12-day treatment.

BACKGROUND: Our purpose was to determine the effects of amifostine, a cytoprotective agent, on doxorubicin tolerance and cardiotoxicity in rats. MATERIALS AND METHODS: Male Wistar rats were treated every other day with an intraperitoneal injection of amifostine or saline 30 minutes before intraperitoneal injection of doxorubicin or saline. Weight change was recorded, and contractile function was evaluated after 11 injections by means of the isolated heart. RESULTS: Weight evolution and cardiac function were significantly improved by 7 and 20 mg/kg amifostine (p < 0.001) but not by 50 mg/kg. The final weight were: controls 349 +/- 16 g; doxorubicin alone 258 +/- 54 g; with amifostine: 7 mg/kg 314 + 28 g; 20 mg/kg 312 +/- 32 g; 50 mg/kg 250 +/- 34 g. Left ventricular developed pressure were: controls 137 +/- 15 mmHg; doxorubicin alone 119 +/- 20 mmHg; with amifostine: 7 mg/kg 140 +/- 20 mmHg; 20 mg/kg 137 +/- 25 mmHg; 50 mg/kg 124 +/- 20 mmHg. CONCLUSION: Seven and 20 mg/kg amifostine protected rats from the toxicity of doxorubicin at the cumulative dose of 18 mg/kg during a 12-day treatment, with regard to weight loss and heart contraction.

[Value of pulsed Doppler tissue imaging for early detection of myocardial dysfunction with anthracyclines]. / Intérêt du Doppler tissulaire pulsé pour le dépistage précoce de l'altération de la fonction myocardique aux anthracyclines.

The cumulative and definitive nature of chronic cardiotoxicity of anthracyclines requires a preventive strategy of early diagnosis. The authors undertook a prospective study of the association of echocardiography, mitral Doppler and pulsed Doppler tissue imaging of the left ventricular lateral and posterior walls in the context of this problem in 20 patients without cardiac disease undergoing cancer chemotherapy including anthracyclines. Doppler echocardiography was performed before the first session of chemotherapy and at the end of treatment, 6 +/- 4 months later. After a total cumulative dose of 227 +/- 91 mg/m2 of doxorubicine, there were no changes in left ventricular ejection fraction but a significant decrease in mitral E wave velocity (p = 0.04) and in E/A ratio (p = 0.01), suggesting early changes in left ventricular relaxation. The Doppler tissue examination confirmed the presence of radial and longitudinal abnormalities in myocardial relaxation (decreases in myocardial E wave velocities of the posterior and lateral walls of the left ventricle, p = 0.02 and p = 0.01, respectively). The peak velocity of the myocardial systolic wave (Sm) was significantly decreased in the lateral wall (p = 0.02) and approached statistical significance in the posterior wall (p = 0.07). These results suggest concomitant changes in myocardial systolic and diastolic function with moderate doses of anthracyclines. Therefore, pulsed Doppler tissue examination enables earlier detection of left ventricular cardiotoxicity with anthracyclines than classical echocardiographic parameters.

[One center's experience of coronary angioplasty with a 5 French catheter guide by a femoral approach at the same time as coronary angiography]. / Expérience monocentrique de l'angioplastie coronaire par cathéter guide 5 French menée par voie fémorale dans le même temps que l'examen coronarographique.

The object of this study was to assess the feasibility of so-called ad hoc 5 F percutaneous transluminal coronary angioplasty (PTCA). This monocentric register included 200 consecutive procedures (233 lesions) of 5F PTCA by a femoral approach after a bolus of standard heparin (50 to 70 IU/kg). The population included 15.4% of stable angina, 29.4% of unstable angina, 11% acute phase, 13.5% post-revascularisation angina and 30.7% post-infarction cases. A successful procedure was defined as a good angiographic result without ischaemic complications. A failed 5F procedure was defined by the need to fall back on a 6F PTCA. The peripheral vascular complications were recorded. The lesions were stented in 77.4% of cases including 13.4% of direct stenting. There were 200 successful procedures (87%). The failures (N = 26) were mainly explained by the inability to cross chronic obstruction (N = 11). The ischaemic complications included 2 coronary bypasses (2 retrograde dissections of the left anterior descending artery) and 7 enzymatic increases without ECG changes. Fall back to 6F PTCA was required in 4 cases (1.7%) always because of the instability of the 5F catheter guide before the procedure. The quality of coronary contrast was estimated to be good. The vascular complication rate was low with 2% of communicating haematomas (N = 4). Therefore, 5F PTCA is feasible with failure and complication rates comparable to those reported with catheters of larger dimensions. One of its principal advantages is "ad hoc" angioplasty after 5F coronary angiography.

[Pulmonary embolism in the child: diagnostic and therapeutic particularities]. / Embolie pulmonaire de l'enfant: particularités diagnostiques et thérapeutiques.

BACKGROUND: Pulmonary embolism in children is an overlooked pathology. Yet the first description dates back to the end of the 19th century and this specific pathology is not seldom observed. The main risk factors are trauma, surgery, and foreign bodies. DIAGNOSIS: Thrombophilia can be diagnosed when a thromboembolic event occurs. The initial thrombosis may be found anywhere in the venous network. Venous sonography usually gives the diagnosis. Pulmonary embolism usually has a poor clinical expression. An unexplained situation can be the first manifestation. Echocardiography guides diagnosis confirmed by ventilation-perfusion scintigraphy. TREATMENT: Prophylaxis is achieved with small doses of heparin. Treatment is based on the use of hypocoagulant doses of heparin, potentially after systemic thrombolysis and followed by oral anticoagulation.

Use of the PFA-100 apparatus to assess platelet function in patients undergoing PTCA during and after infusion of c7E3 Fab in the presence of other antiplatelet agents.

The PFA-100 (Dade) is a new functional whole blood analyzer, the accuracy and reliability of which have been evaluated in von Willebrand disease and during acetyl salicylate acid therapy. This new test has the advantages of rapidity and simplicity. It may be useful to monitor new antiplatelet agents, such as GPIIb/IIIa receptor antagonists. The objective of this study was to assess the PFA-100 in comparison with aggregometry and with the percentage of blockaded receptors GPIIb/IIIa during and after c7E3 Fab infusion in fifteen patients undergoing PTCA. Our results showed a change of closure time values from normal to abnormal within a small margin of flow cytometric values (60-75% of blockaded receptors), and moreover a variable platelet response to long-term low dose aspirin treatment in agreement with aggregometry. No influence with heparin was observed. In conclusion, this study shows that PFA-100 may be helpful in the decision making for additional antiaggregant therapy before PTCA or in monitoring long-term GPIIb/IIIa receptor antagonist treatment.

[Cardiac lymphoma disclosed by ischemic accident. A case report]. / Lymphome cardiaque révélé par un accident ischémique. A propos d'un cas.

We report on the detection of a primitive cardiac lymphoma revealed by a cerebral vascular accident in a context of deterioration of the general state with fever. The diagnosis of the cerebral vascular accident was verified by the brain scan. The echocardiography, in particular the transesophageal ultrasound, suggested the diagnosis of cardiac lymphoma due to the existence of an inhomogeneous multilobar mass invading the right ventricle and largely encompassing the right auricle. The histologic diagnosis of a malignant non-Hodgkin's lymphoma of type B malignancy was confirmed by anatomopathology. The evolution was, unfortunately, rapidly unfavorable, with the patient dying in a state of cerebral suffering despite a combination treatment of chemotherapy and radiotherapy.

[Extensive mycotic coronary aneurysm detected by echocardiography. Apropos of a case]. / Volumineux anévrisme mycotique coronaire de découverte échographique. A propos d'un cas.

The authors report the case of a large mycotic right coronary aneurysm detected at echocardiography in a 45 year old patient with AIDS. Although emergency surgery was planned, the patient died of rupture of the aneurysm with cardiogenic shock and sudden pericardial tamponade. This case underlines the diagnostic value of echocardiography, by the transthoracic approach for para-cardiac masses and with the transoesophageal probe for accurate localisation and demonstration of the coronary origin. In this case, the CT scan was less useful than transthoracic echocardiography. Coronary angiography confirmed the strongly suggestive echocardiographic diagnosis and helped decide management strategy. Atheromatous coronary aneurysms may be treated by stenting but mycotic aneurysms require surgical management.

Immediate femoral sheath removal after 6 French routine coronary angioplasty with a weight-adjusted low-dose heparin: results of a prospective registry.

This study assesses the feasibility and safety of immediate sheath removal after coronary angioplasty with the use of 6 French (Fr) guiding catheters by the femoral route and weight-adjusted low-dose heparin (100 IU/kg). We prospectively evaluated such a strategy among a single-center cohort of 261 consecutive patients undergoing routine percutaneous transluminal coronary angioplasty (PTCA). Immediate sheath withdrawal was performed in cases when post-PTCA residual coronary stenosis was less than 30%, with or without stenting. One hundred eighty-two (70%) of the enrolled patients were eligible for immediate sheath removal. When compared with non-eligible patients (sheath removal 4 hours or more post-PTCA), we observed a reduction of hematoma occurrence (15% vs. 30%; p < 0.01), time to manual hemostasis of the puncture site (13.8 +/- 7 vs. 19.7 +/- 12 minutes; p < 0.0001), and time to hospital discharge (2.2 +/- 1.9 vs. 2.8 +/- 1.8 days; p < 0.02), while ischemic event rate was similar (1 vs. 2 non-Q wave myocardial infarction; 2 vs. 1 repeat PTCA for out-of-lab acute vessel closure). In conclusion, a good angiographic result at completion of PTCA using a 6 Fr sheath, even without stenting, makes an immediate sheath removal feasible at no increased risk and with a potential reduction in minor bleeding complications.

[Postpartum myocardial infarction induced by Parlodel]. / Infarctus du myocarde du postpartum induit par le Parlodel.

The authors report the case of a 28 year old woman who developed antero-septoapical myocardial infarction in the post-partum period. This was detected by surface ECG and echocardiography performed after a systemic embolism. The infarction followed treatment with Parlodel for inhibition of lactation. Coronary angiography, performed one month post-partum, was normal and the methergin test was negative. The physiopathological mechanism of myocardial infarction resulted from the association of an iatrogenic spastic phenomenon favourised by the patient restarting to smoke and the physiological arterial hyperactivity of the post-partum period. This mechanism raises the question of preventive measures in cases of inhibition of lactation in the post-partum period, notably stopping smoking.

[Peripheral embolic arterial accident due to pulmonary vein thrombosis revealing bronchial carcinoma]. / Accident artériel périphérique embolique par thrombose d'une veine pulmonaire révélant un carcinome bronchique.

The authors report a case of left superior pulmonary vein thrombosis discovered on transoesophageal ultrasonography in the context of aetiological assessment of a systemic vascular accident. This unusual site of a thrombus on an anatomically perfectly normal left atrium led the authors to perform a more detailed assessment, revealing a previously undiagnosed lung cancer on thoracic CT scan.

[Incidental discovery of asymptomatic Loeffler fibroplastic endocarditis. Report of a case]. / Découverte fortuite d'une endocardite fibroplastique de loeffler asymptomatique. A propos d'un cas.

The authors report a case of fibroplastic endocarditis discovered during echocardiography in an asymptomatic patient in the context of assessment of systematized electrocardiographic modifications. The diagnosis, strongly suspected on the basis of the cardiac MRI findings, was finally confirmed by endocardial biopsy.

Visualization of myocardial infarction six hours after injection of 111 In-antimyosin antibodies using an image subtraction technique.

111 In-antimyosin antibodies are capable of visualizing acute myocardial infarction (MI). Because of slow blood clearance, images are usually recorded 24 or 48 h postinjection. This pilot study was aimed at validating a blood pool subtraction technique, which makes it possible to visualize MI 6 h postinjection. Twenty-five patients with proven MI (16 anterior, 9 inferior) were imaged 10 minutes, 6 and 24 h after an injection of 110 MBq 111 In-labelled antimyosin antibodies, with a mean delay of two weeks after infarction. Three planar views were obtained each time. Using software which performs geometric registration, grey level normalization and subtraction of images, the blood pool image (obtained 10 minutes postinjection) was subtracted from the 6 hour image. The resulting image was the blood pool corrected 6 h image. The 24 h images and the blood pool corrected 6 h images were interpreted blindly and the number of correct, incorrect and indeterminate MI localizations were tabulated. The number of correct localizations was 19/25 for the standard 24 h images and 22/25 for the blood pool corrected 6 h images. With this blood pool subtraction method it was possible to visualize MI 6 h postinjection. Theoretically, this method could be applied six hours after myocardial infarction.

[Value of transesophageal echography in the detection of left intraventricular masses. Apropos of a case of apical thrombus]. / Intérêt de l'échographie transoesophagienne biplan dans la détection des masses intra-ventriculaires gauches. A propos d'une observation de thrombus apical.

The authors report a case of left intraventricular thrombus investigated by two-dimensional transesophageal echocardiography (TEE). Three longitudinal views obtained by rotation, left lateral inclination and by advancing the probe, enabled the precise evaluation of a mass situated at the apex of the left ventricle, together with ventricular morphology and kinetics. Two-dimensional TEE is electively indicated for confirmation of the diagnosis of left intraventricular apical masses, in particular in hypoechogenic patients and to guide possible surgery. The two-plane probe provides a certain number of sections which remain relatively limited but this problem is resolved with the development of multidimensional probes.

What factors determine indium-111 antimyosin monoclonal antibody uptake in patients with myocardial infarction?

The intensity of indium-111 antimyosin monoclonal antibody uptake for visualization of myocardial infarction seems partially dependent on the state of the infarct related coronary artery. The aim of this study is to determine the factors which could account for the monoclonal antibody uptake variability. For this purpose, we investigated 27 patients (mean age 52.7 +/- 9.6 years) with a first proven myocardial infarction, by monoclonal antibody scintigraphy and coronary arteriography within the same period of time (7.12 +/- 6 days). The monoclonal antibody uptake was quantified by the heart/lung ratio on images recorded 24 h after injection. The infarct size was quantitatively estimated on wall motion analysis of twelve segments in 30 degree right anterior-oblique view with a radial method. The infarct related coronary artery state was assessed by the Thrombosis in Myocardial Infarction grade and the functional characteristics of collateral vessels by Rentrop's classification. These three variables as well as location of myocardial infarction, left ventricular ejection fraction, administration of a thrombolytic therapy, delay between myocardial infarction and monoclonal antibody scintigraphy were studied using non parametric test, or by linear regression method in order to determine whether these factors would influence the heart/lung ratio. None of these parameters except infarct size was related to heart/lung ratio. Consequently, monoclonal antibody uptake is only dependent on the extent of infarcted myocardium and the intensity of uptake cannot predict the patency of an infarct related coronary artery.

[Chronic constrictive pericarditis after heart surgery. Apropos of a case]. / Péricardite chronique constrictive post-chirurgie cardiaque. A propos d'un cas.

A case of pericarditis in a 52-year old patient following aorto-coronary shunt surgery is reported which gradually developed into chronic constrictive pericarditis. In this context, the diagnostic criteria of chronic constrictive pericarditis are recalled. The clinical criteria show little specificity; Doppler ultrasound provides good diagnostic information; CT scans and nuclear magnetic imaging can confirm the diagnostic. The post-heart surgery etiology has increased in recent years. The only real treatment is surgical and consists of pericardial decortication.

[Postoperative hemopericardium compressing the left atrium. Apropos of 8 cases]. / Hémopéricardes post-opératoires comprimant l'oreillette gauche. A propos de huit cas.

The authors report 8 cases of hemopericardium compressing the left atrium occurring at varying intervals after cardiac surgery. This is an unusual anatomical and classically rare site of pericardial effusion. This type of tamponnade has special clinical features, leading to a picture of subacute left ventricular failure, by interference with filling and typical echocardiographic appearances, with special features in two-dimensional mode and, in TM mode, an abnormal anterior movement of the posterior wall of the left atrium, which is studied. CT scan of the thorax, when performed, confirms this highly specific topographic situation. This type of effusion must be managed surgically as quickly as possible, with an anterior approach, either by left thoracotomy or by midline sternotomy.

[Malignant histiocytofibroma of the heart simulating myxoma of the left atrium]. / Histiocytofibrome malin du coeur simulant un myxome de l'oreillette gauche.

The authors report a case of malignant fibrous histiocytoma of the left atrium which was excised but rapidly recurred in a 47-year-old woman. Clinical examination, echocardiography and the absence of biochemical abnormalities were in favour of the diagnosis of left atrial myxoma. This report illustrates the clinical similarity between myxoma and sarcoma of the left atrium. Very careful anatomopathological examination of multiple sections of the tumour are necessary to distinguish it from benign tumours, especially myxomas.

[Postoperative hemopericardium compressing the left atrium. Apropos of a case]. / Hémopéricarde postopératoire comprimant l'oreillete gauche. A propos d'un cas.

We report a case of tamponade due to an effusion of blood which had occurred two weeks after an aorto-coronary bypass and was unusually located behind the left atrium. The effusion, with severe clinical symptoms, was diagnosed by echocardiography and computerized tomography of the chest. These examinations provided an accurate anatomical diagnosis on which the approach route of the emergency operation was based.

[Subvalvular aortic stenosis discovered after surgical repair of an atrioventricular canal in the adult. Apropos of a case]. / Rétrécissement aortique sous-valvulaire découvert après correction d'un canal atrio-ventriculaire chez l'adulte. A propos d'une observation.

The case of an adult female patient in whom subaortic stenosis was discovered 9 months after surgical correction of a partial atrioventricular canal is reported. The authors describe the difficulties encountered in the pre-operative diagnosis of this uncommon association and the paraclinical methods now available, notably echocardiography, that may help overcome these difficulties.

[Histiocytoid hemangioma of the heart. Histological and immunohistochemical study of a case]. / Hémangiome histiocytoïde cardiaque. Etude histologique et immunohistochimique d'un cas.

We present the fourth case report of an histiocytoid hemangioma of the heart, which was found incidentally, as in the other three reported cases, in a 50 year old man during surgery for congenital heart disease. A polypoid sessile reddish tumor with a smooth surface, which measured 2 cm in diameter, was found in the right atrium. No necrosis nor cystic areas were seen. Histologic evaluation revealed a proliferation of histiocytoid or epithelioid cells, whose arrangement varied a great deal within the infiltrate. Sometimes, the cells were isolated but in most places they were arranged in sheets or nests surrounded by connective tissue. Some of these nests were compact whereas in others a lumen formation, frequently occupied by erythrocytes, could be appreciated. A striking feature was the presence of vacuolated tumor cells sometimes assuming a signet-ring configuration. Some large vascular spaces were lined by histiocytoid or epithelioid endothelial cells, many of which protruded into the lumen. Multinucleated tumor cells were occasionally observed. Mitoses were rare (up to 1/10 HPF) and scattered inflammatory cells such as lymphocytes, macrophages, neutrophils and eosinophils were seen. Histologic appearance of our patient's tumor is identical to the histiocytoid hemangioma of Rosai et al., which is an ubiquitous endothelial benign neoplasm.