[Oral contraceptive and coronary thrombosis. Two clinicopathological cases]. / Pilule contraceptive et thrombose coronaire. Deux cas anatomo-cliniques.

The cases reported are interesting from two points of view: they confirm the thrombotic mechanism of the arteria lesions (coronary amongst others) and the oral contraception pill was the only cardiovascular risk factor, smoking, hyperlipidaemia, hypertension and coronary atherosclerosis having been eliminated. The two young women (31 and 34 years old) presented with severe myocardial infarction and shock, leading to death within hours in one case and within weeks in the other (despite an attempt to resect the infarct and prolonged intraaortic balloon pumping). In both cases multiple thromboses were discovered: coronary, intra cardiac and in the collateral aortic circulation.

PIP: Two young women on oral contraceptives for 4 and 6 years respectively died of severe myocardial infarction and shock. Autopsy discovered in both patients multiple thromboses in the coronary, intracardiac, and in the collateral aortic circulation. Since smoking, hyperlipidemia, hypertension and coronary atherosclerosis were not risk factors, oral contraception seems to have been the only cause for both thrombotic accidents.

[Tricuspid valve replacement by Hancock's prosthesis]. / Le remplacement valvulaire tricuspidien par la prothèse de Hancock.

The medium term results of tricuspid valve replacement with the Hancock bioprosthesis are reported. Twenty eight patients underwent tricuspid valve replacement with this prosthesis between December 1974 and January 1978: mitral valve replacement with a Starr-Edwards or Cooley-Cutter prosthesis was associated in all cases and aortic valve replacement with a Björk-Shiley prosthesis in 11 cases. Follow-up at an average of 36,2 months after operation examined functional status, cardiac size and haemodynamics (in 12 patients). Three patients died in the immediate postoperative period and four others died later: the number of survivors was greater in the triple valve replacement (9/11) than in the double valve replacement group (12/17) but the difference was not statistically significant. Of the 23 surviving patients (average follow-up of 36,2 +/- 9,6 months), 17 were classified in functional Classes I or II of the NYHA classification. All patients had been Class III or IV before operation. The cardiothoracic ratio did not decrease significantly in patients undergoing triple valve replacement. Control cardiac catheterisation showed a significant increase in cardiac index (2,53 +/- 0,11 1/mn/m2, compared to 1,87 +/- 0,35 1/mn/m2 before operation; p less than 0,001) without significant reduction in pulmonary artery or right atrial pressures. The resting gradient across the Hancock bioprosthesis was not related to the size of the prosthesis (No 29-30: 2,17 +/- 2,57 mm Hg; No 31-33: 2,78 +/- 3,53 mm Hg) or with the quality of the functional result. However, on exercise, the gradient across the prosthesis was high, reaching an average of 10,3 +/- 5,2 mm Hg). The operative mortality of tricuspid valve replacement is relatively bioprosthesis associated with mitral and/or aortic valve replacement is relatively bioprosthesis associated with mitral and/or aortic valve replacement is relatively low (about 10%) and could be an argument in favour of broadening the indications for tricuspid valve replacement as resting tricuspid function with a bioprosthesis is satisfactory. However, the stenotic effects on exercise and the uncertainty over the long-term outcome of bioprostheses suggest that surgery should be limited to severe tricuspid stenoses and/or major tricuspid regurgitation organic or functional uncontrolled by digitalis and diuretic therapy.

[Primary arteritis of the right axillary and left pulmonary arteries or Takayasu's disease in an adolescent]. / Artérite primitive des artères axillaire droite et pulmonaire gauche ou maladie de Takayasu chez une adolescente.

The authors report a case of a primitive inflammatory arteriopathy involving the right axillary and left pulmonary arteries, or Takayasu's disease in a 16 years old adolescent. After recalling the criteria of definition and diagnosis of the disease, they stress the value of an early diagnosis during the first preocclusive phase of this exceptional disease, that may well begin at the paediatric age group.