[Radial artery occlusion ofter coronarography: is it really a problem?] / L'occlusion de l'artère radiale après cathétérisme cardiaque : est-ce réellement un problème ?

The use of transradial access for cardiac procedures has increased worldwide over the past two decades. Despite the many advantages this technique offers, there remains some concern that radial artery occlusion, a potential complication of radial cannulation, might lead to significant ischemic sequelae in the hand. This paper reviews the major causes, its possible consequences and the strategies for its prevention and treatment. It appears however from multiple studies that there is little or no correlation between radial occlusion and symptomatic hand ischemia.

[Difficulty in diagnosis of a cardiogenic shock with thrombotic and sub-occluded LAD. A train can hide another one!] / Difficulté diagnostic d'un choc cardiogénique sur une sub-occlusion thrombotique de l'IVA. Un train peut en cacher un autre !

The pheochromocytome is a localized tumor at the level of the medullosurrenale in 85% of the cases. The clinical presentation is very variable. Severe Heart failure presentation can be the mode of revelation in 2% of the cases. We present the case of a patient admitted for refractory cardiogenic shock correlated to pheochromocytome tumor. The difficulty of this rare clinical presentation was to confirm rapidly and in emergency this diagnosis in the same time when the patient presents a persistante and severe cardiogenic chock after finding a sub-occluded and thrombotic LAD coronary artery and which was treated by thrombectomy and coronary revascularization. The surgical treatment of this tumor is considered to be a quickly saving treatment. It allows a fast recovery of the cardiac function.

Thermal conductivity measurements of non-metals via combined time- and frequency-domain thermoreflectance without a metal film transducer.

The thermoreflectance-based techniques time- and frequency-domain thermoreflectance (TDTR and FDTR, respectively) have emerged as robust platforms to measure the thermophysical properties of a wide array of systems on varying length scales. Routine in the implementation of these techniques is the application of a thin metal film on the surface of the sample of interest to serve as an opto-thermal transducer ensuring the measured modulated reflectivity is dominated by the change in thermoreflectance of the sample. Here, we outline a method to directly measure the thermal conductivities of bulk materials without using a metal transducer layer using a standard TDTR/FDTR experiment. A major key in this approach is the use of a thermal model with z-dependent heat source when the optical penetration depth is comparable to the beam sizes and measuring the FDTR response at a long delay time to minimize non-thermoreflectivity contributions to the modulated reflectance signals (such as free carrier excitations). Using this approach, we demonstrate the ability to measure the thermal conductivity on three semiconductors, intrinsic Si (100), GaAs (100), and InSb (100), the results of which are validated with FDTR measurements on the same wafers with aluminum transducers. We outline the major sources of uncertainty in this approach, including frequency dependent heating and precise knowledge of the pump and probe spot sizes. As a result, we discuss appropriate pump-frequency ranges in which to implement this TDTR/FDTR approach and present a procedure to measure the effective spot sizes by fitting the FDTR data of an 80 nm Al/SiO2 sample at a time delay in which the spot size sensitivity dominates an FDTR measurement over the substrate thermal properties. Our method provides a more convenient way to directly measure the thermal conductivities of semiconductors.

[Very late drug-eluting stent thrombosis by stent fracture]. / Thrombose coronaire très tardive par fracture du stent actif. Cas clinique et revue de la littérature.

The superiority of drug-eluting stents in reducing the risk of in-stent restenosis compared to bare-metal stents is no longer challenged. Nevertheless, the drug-eluting stents may carry long-term risk of late and very late stent thrombosis. The promoting factors of this complication are usually divided into three chapters depending on the patient, the procedure and the stent. Indeed, the literature has reported several parameters related to the stent itself, such as its length, the malapposition, its diameter, but also more rarely the occurrence of stent fracture. We present the case of a patient admitted for myocardial infarction after a very late thrombosis of Cypher drug-eluting stent four years after its implantation and related to stent fracture.

[Platypnea-orthodeoxia revealed by recurrent syncope episodes]. / Platypnée-orthodéoxie révélée par des syncopes à répétition.

Platypnea-orthodeoxia is a rare clinical condition which must be examined as a differential diagnosis for any bout of faintness occurring during standing or dyspnea that is exacerbated by standing. This syndrome is often associated with a patent foramen ovale. Its physiopathology is not univocal and the association of many anatomical criteria seems to be mandatory. Contrast echocardiography confirms diagnosis and closure of the patent foramen ovale during interventional catheterization and is currently the therapeutic method of choice. After closure of the foramen ovale, clinical improvement is spectacular and durable.

[Multicentric experience with the use of Sheathless 6.5 French-size catheter in coronary angioplasty for bifurcation lesions: feasibility and safety]. / Expérience multicentrique de l'utilisation du Sheathless 6.5 French dans l'angioplastie coronaire des lésions de bifurcation : faisabilité et sécurité

BACKGROUND: Transradial intervention of coronary lesion is increasing in frequency and is associated with lower major vascular access site complications. However, the small size of the radial artery is a major limitation of this technique, especially for bifurcation lesions, because 6-French guiding catheters are necessary to optimize the technique. A Sheathless guiding catheter has recently been introduced, optimizing a large lumen with a small size. OBJECTIVES: The aim of this study is to report our preliminary experience performing bifurcated transradial interventions using a 6.5 French Sheathless guide catheter. PATIENTS AND METHODS: From March 2009 to February 2012 in three hospitals, 46 consecutive patients were enrolled in this study who underwent transradial approach (TRA) for percutaneous bifurcation coronary interventions using the 6.5 French Sheathless Eaucath guiding catheter system because of small radial artery caliber. RESULTS: In this study, 46 patients were enrolled with mean age of 72.13 ± 16.41 years. The majority of patients were females with sex-ratio 0.53. Procedural success using the 6.5 French Sheathless guide catheter system was 100 % with no cases requiring conversion to a conventional guide and catheter system. During procedures, adjunctive devices used in this cohort included IVUS (2 patients), 35 bifurcated lesions were treated with a kissing-balloon technique in the group of 46 patients undergoing bifurcation PCIs, one patient required rotational atherectomy, thrombus-aspiration catheters had used in four patients, FFR-guided angiography in four patients. We report one case of chronic total occlusion bifurcated lesion successfully treated using this hydrophilic catheter. There were no radial artery site complications. CONCLUSION: The treatment of coronary bifurcation lesions with 6.5 French Sheathless guiding catheter by transradial approach is feasible and appears safe in this multicenter study.

The added value of real-time three-dimensional echocardiography in the diagnosis of supravalvar mitral ring: case report and review of the literature.

Supravalvular mitral stenosis is a rare condition characterized by an abnormal ridge, with one or two orifices, covering and obstructing the mitral valve. Preoperative identification of the supravalvular ring is the target for obtaining good surgical results. Two-dimensional echocardiogram and transesophageal echocardiography both failed in reaching this objective. In this case, we showed that three-dimensional echocardiogram is a new technique that provides additional and more accurate echocardiographic characterization of congenital supravalvular mitral stenosis.