[Cardiac tumor epidemiology in adults in Lebanpn]

Primary cardiac tumors are rare but potentially fatal. No studies have discussed this issue yet on the national level. We describe the epidemiology of cardiac tumors in adults in Lebanon. The data were taken from the hospitals, the patients and/or their doctors by means of a questionnaire. Fifty-seven cases of cardiac tumors were found, mainly myxomas in the left atrium. Dyspnea was the most frequent symptom. Transthoracic echocardiography was the main diagnostic tool. Transesophageal echocardiography was inconstantly made, scanner and MRI rarely while contrast echocardiography has never been used. Almost half of the patients had a follow-up and none had a familial screening. The collected data urged us to propose a unique and homogenous strategy for diagnosis, treatment and follow-up of cardiac tumors in Lebanon

[Coronary angioplasty for primary cardiogenic schock following myocardial infraction]

In the setting of acute myocardial infarction [AMI], several investigators have demonstrated that emergency coronary angioplasty [PTCA] reduces in-hospital mortality of primary cardiogenic shock [CS] from 90% to less than 50% however, few studies have focused on the current outcome of non selected patients in whom the onset of AMI is immediately complicated by CS.To evaluate in-hospital mortality of the patients admitted to our institution for Q wave AMI presented in CS. Between 05/93 and 05/03, 30 consecutive pts, 26 men and 4 women, in CS following AMI were treated with direct PTCA, 26 without thrombolysis and 4 as rescue after failed streptokinase. AMI was defined by prolonged chest pain and 1 mm ST segment elevation in 2 contiguous peripheral leads or 2 mm for precordial leads on the admission ECG. The diagnosis of CS was based on the combination of systolic blood pressure of r 90 mm Hg, unresponsive to volume expansion, signs of acute circulatory failure [cyanosis, cold extremities, restlessness, mental confusion or coma] and congestive heart failure secondary to myocardial dysfunc-tion. In 40% of cases the diagnosis of CS was only clinical and in 60% of cases was confirmed by a Swan Ganz catheter. Mean age was 62,3 +/- 12,3 years, 7 had triple vessel disease, 14 a double vessel disease, 8 a single vessel disease and in one case a left main disease. The AMI was anterior in 22 pts [73%], inferior in 8 [27%]. Intraaortic balloon was used in 3 pts, CPR in 16 [47%], transitory pacemaker in 1 pt, inotropes in 25 pts, emergency coronary artery bypass grafting [CABG] in 1 pt. Success for PTCA with a residual stenosis r 50% and a TIMI flow III was obtained in 26 pts [87%]. Mean time between CS and revascularization was 219 +/- 302 minutes. 19 pts [63%] survived and 11 pts [37%] died while at the hos-pital, 6 from intractable shock, 4 from multiple organ failure and in 1 case from pulmonary hemorrhage. Mean time of revascularization for the surviving was 190 +/- 329 min, and for the dead 295 +/- 212 min. Hospital mortality for inferior infarction is 12.5% after successful angioplasty. Comparison of surviving and non surviving number of patients according to revascularization time showed a significant difference of these groups whether the revascularization was accomplished before or after 120 minutes

[Value of the tilt test in the management of unexplained syncope]

Syncope is a frequent medical problem that causes much difficulty in order to explain its etiology. Recently, tilt table testing became an investigation of choice in patients presenting with unexplained syncope. To present a series of patients presenting an unexplained syncope, investigated with a tilt test and to compare our results to the literature. 257 patients [mean age of 42.7 +/- 15.4 years] presenting an unexplained syncope between 1997 and 2002 were assessed with a usual tilt test, then in case of negative test a sensitization with iso-proterenol intravenously or sublingual trinitrin was realized. 88 patients [34.2%] had spontaneous positive test, 79 patients [30.8%] had positive test after sensitization and 90 patients [35%] had negative test in spite of sensitization. With a diagnostic return of 65% in this series, the tilt test seems to be the non-invasive investigation of choice in unexplained syncope

Fermeture percutanee des communications interauriculaires par la prothese Amplatzer

Percutaneous closure of an atrial septal detect [ASD] was undertaken in 10 patients aged from 3 to 33 years. The Amplatxer device was introduced intravenously and positioned under fluoroscopic and echographic control. the size of the ASD varied from 13 to 20 mm and that of the devices from 15 to 32 mm. one patient was operated for the removal of an improperly positioned device and closure of the ASD. All the other patients were discharged 24 hours after the procedure with successfull closure of the ASD. Complications were benign: spontaneously regressive arrhythmias [1 case] and migraines [2 cases]. our series reflects the experience of others, showing the faisability and efficiency of the procedure. tridimensionnal or intracardiac echocardiography may improve this technique in the future

Accident vasculaire cerebral recidivant: manifestation isolee et inhabituelle d'un myxome de l'oreillette gauche

The authors report an unusual case of left atrial myxoma in a 30-year-old woman, discovered after a recurrent stroke. This tumor was misdiagnosed earlier because of an exclusive neurologic symptomatology, a normal cardiac exam without any sign of mitral obstruction [unusual high implantation of the myxoma within the roof of the left atrium], and the lack of doing an echocardiography which should be systematically done after an ischcmic stroke, even if its etiology seems to be evident.Surgical resection of the tumor led to prevent further myxomatous emboli, but unfortunately, the patient keeps severe neurological sequelae