[Extensive coronary dissection after percutaneous transluminal angioplasty. Apropos of a case]. / Dissection coronaire étendue après angioplastie transluminale percutanée. A propos d'un cas.

The authors report a rare case of very extensive dissection of the right coronary artery immediately after angioplasty; the lesion was totally asymptomatic. Coronary bypass was performed 4 months later without complications and with a satisfactory result at a 15-month follow-up. Coronary dissection during angioplasty is usually located at the site of dilatation: its incidence varies from 6 to 13 p. 100 depending on the series reported. Facilitating factors are analysed, and the management of this complication is discussed: repeat angioplasty and/or emergency or elective coronary bypass, depending on the presence or absence of coronary thrombosis and symptoms, on the importance of the territory threatened and on the quality of collateral circulation.

[Transmural myocardial infarction and Prinzmetal's syndrome in an allergic reaction to glafenine. Physiopathological discussion. Apropos of a case]. / Infarctus myocardique transmural et syndrome de Prinzmetal au cours d'une réaction allergique à la glafénine. Discussion physiopathologique. A propos d'un cas.

The authors report the case of a 38 year old man who experienced at two month' interval, hypersensitivity reactions to the ingestion of 200 mg tablets of glafenine, complicated on the first occasion by a transmural anterior wall myocardial infarction as the first manifestation of coronary artery disease and on the second occasion by Prinzmetal angina due to posterior wall ischaemia. Coronary angiography was more or less normal. The timing of the symptoms in the context of an anaphylactic reaction and their repetition when the same molecule was reintroduced are strong arguments in favour of the pathogenic role of glafenine, even in the absence of biological criteria which are always variable. The mechanism of the coronary problems is discussed with reference to mediators released during the anaphylactic reaction: coronary vasoconstriction due to histamine and leukotriene release; inhibition of prostaglandin synthesis causing potentiation of the effects of histamine; lowering of the vasodilatory and antiaggregant prostacyclin enhancing the vasoconstrictor and platelet aggregant action of thromboxane A2. All the conditions favouring the initiation of coronary spasm with eventual coronary thrombosis, the one aggravating the other, are therefore present.

[Tumor of the tricuspid valve operated on with success. Apropos of a case simulating cyanotic heart disease]. / Tumeur de la valve tricuspide opérée avec succès. A propos d'un cas simulant une cardiopathie cyanogène.

The case of a 36 year old woman with a calcified tumour of the tricuspid valve is reported. The clinical signs suggested tricuspid stenosis with a right to left shunt via a patent foramen ovale simulating a cyanotic heart lesion. Preoperative diagnostic investigations were discordant. Echocardiography showed a stenotic tumoural tricuspid valve. Catheterisation and selective right ventriculography were more suggestive of dominant tricuspid incompetence. The patient was referred for surgery because of the severity of her shortness of breath and cyanosis, and tumoral involvement of the three tricuspid leaflets was found. This was removed and replaced by a bioprosthesis with good results 27 months after surgery. 17 other cases of tricuspid tumours have been previously reported. Their clinical presentation was usually that of a right ventricular tumour with stenosis of the right failure, positional syncope and pericardial effusion in the malignant forms. Signs of tricuspid stenosis with cyanosis and polycythaemia are very rare. The relative diagnostic values of angiography and echocardiography are discussed.

[Chronic respiratory insufficiency. Incidence in the results of surgical valvular replacement]. / Insuffisance respiratoire chronique. Incidence sur les résultats de la chirurgie de remplacement valvulaire

Out of 400 files of patients who underwent valvar correction between 1968 and 1974 under extra corporeal circulation by the thoracic route through median sternotomy 180 were kept for this study. All these 180 patients had a complete functional spirometric examination before operation, analysed in correlation with their valve disease. 39 of them had severe ventilatory insufficiency. Nevertheless the post-operative period was usually simple, and respiratory insufficiency was responsible for one death only of this series. These data were confirmed by the study of 45 autopsied patients who died after operation. At distance from operation, 80 patients were studied, 25 of whom had severe ventilatory insufficiency. In more than half the cases, and particularly in the mitral ones, the ventilatory deficiency was improved. Thus it is concluded that, respiratory insufficiency is rarely a contra-indication to valve replacement surgery in habitual conditions of the median sternotomy as a thoracic route.

[Return to work after myocardial infarction. Study of factors in return to work by the statistical method of analysis of correspondences]. / Reprise du travail après infarctus du myocarde. Etude des facteurs de retour au travail par la méthode statistique d'analyse des correspondances.

A retrospective study has examined the predictive factors of return to work in 184 males patients with myocardial infarction between 1975 and 1982. The statistical method used was that of correspondence analysis which enables to define correlations between variables, here 12 in number. The chances of returning to work are positively correlated to young age (48-52 years), school education and social standing. They were not increased by coronary by-pass surgery. Cardiac insufficiency, and a large area of infarction contribute to the non-return to work, while subsequent angor and arrhythmias do not demonstrate any significant relation. Finally, a patient who has not returned to work after one year seems to have few chances of becoming active again.

[Anaphylactic reaction with coronary spasm following coronarography]. / Réaction anaphylactique avec spasme coronarien. Au décours d'une coronarographie.

The authors report a case of anaphylactic shock following the injection of iodinated contrast medium for coronary angiography and complicated by two spasms affecting segments II and III of the right coronary. Vasospasm was relieved by the injection of linsidomine, revealing an angiographically healthy segment III. Such complications associated with various substances, notably iodinated contrast media, are rare. They should nevertheless always be borne in mind when evaluating anaphylactic type reactions. Vasoactive mediators (histamine, serotonin, arachidonic acid metabolites) released by the allergic reaction appear to play a major role. Treatment based upon pathogenesis can be proposed.