Clinical and angiographic results of stenting for long coronary arterial atherosclerotic lesions.

A prospective registry of 187 patients who underwent percutaneous coronary angioplasty with attempted long NIR stent delivery was performed. A successful stent delivery was achieved in 93% of cases with a low rate of major cardiovascular events, and 6-month follow-up showed low rates of clinical events, new revascularization procedures, and angiographic restenosis.

Aneurysms and pseudoaneurysms of saphenous vein coronary artery bypass grafts.

Aneurysms of saphenous vein grafts to coronary arteries are unusual complications of coronary artery bypass graft (CABG) surgery. Three patients (men aged 47, 62, and 68 years) are presented with spontaneous chest pains 10, 21, and 17 years after CABG surgery. In one case, the saphenous vein graft had eroded into the right atrium and had established a fistula between the graft and the right atrium. Diagnosis of saphenous vein graft aneurysms was confirmed by echocardiography, computed tomography or magnetic resonance imaging, and by arteriography. Two patients were treated surgically, the third by percutaneous coil embolisation followed by balloon angioplasty of the right coronary artery.

CARDIOMEDIA: a communicable multimedia medical record on Intranet and digital optical memory card.

As part of French health reform, French physicians were computerised by the end of 1998. A specific Intranet network will be used to communicate medical data between the health professionals. The objectives of the CARDIOMEDIA project were to develop and evaluate the feasibility of a coronary multimedia data record stored on an optical card and communicable on Intranet within the hospital. Patients treated by angioplasty at the University Hospital of Rennes participated in the experiment. In general, patients are treated in the University Hospital and are followed up by another health care provider closer to their home. The patient leaves the University Hospital with his card, which is directly available elsewhere for emergency or for consultation. This approach is assumed to reduce the number of examinations and to offer a better patient follow-up. The CARDIOMEDIA card is a specialised record including various data types: text, images, image sequences of coronarography and ECG signals. For this purpose an optical card with its large memory is very convenient. We used the DICOM format for image exchange and management. It is combined with CARDIOMEDIA specific compressing software. For the multimedia record the HTML format and web Intranet method are chosen. This provides an intuitive interface which can combine various data types and helper applications like a DICOM image viewer.

[Thrombosis of a Blalock's anastomosis for Fallot's tetralogy, in the course of a contraceptive treatment (by an anovulatory steroid)]. / Thrombose d'une anastomose de Blalock pour tétralogie de Fallot, au cours d'un traitement contraceptif (par un stéroïde anovulatoire)

PIP: A case of thrombosis of a Blalock anastomosis in a woman with Fallot's tetralogy is presented. She had the anastomosis at age 7 years, and had symptoms of dyspnea, dizziness, and a systolic murmur at the time of a miscarriage at age 21. 5 days after starting a 5 mg combination of norethynodrel and mestranol she was hospitalized for acute dyspnea, cyanosis, fainting, and painful hepatosplenomagaly suggestive of failure of the anastomosis. This was documented by angiography and during surgery when an aortic-pulmonary shunt was done. After several relapses the woman was doing well with some cyanosis and Stage 2 dyspnea. The evidence that oral contraceptives may cause some thromboembolic disease, particularly pulmonary, cerebral, and cardial accidents, is discussed.^ieng

[Comparative study of metabolic criteria of acute myocardial ischemia in man]. / Etude comparative des critères métaboliques de l'ischémie myocardique aiguë en clinique humaine

The study of various myocardial metabolic substrates in basal conditions and in the course of an atrial pacing test in two groups, one control, and the other including angina pectoris in patients with sound coronary arteries, provides the confirmation that the only valid metabolic criterion for acute myocardial ischaemia in man is represented by the decreased extraction or production of lactates. The sugnificance and the specidicity of this parameter is discussed.

[Mitral stenosis and partial abnormal pulmonary venous return. 3 case reports]. / Rétrécissement mitral et retour veineux pulmonaire anormal partiel. Apropos de trois observations

The association of mitral stenosis with an abnormal pulmonary venous return in the absence of an atrial septal defect, is a rare occurrence, and three cases are reported here. If this diagnosis is suggested by the chest Xray, it is confirmed by haemodynamic investigation, which defines the abnormal pulmonary drainage, guages the size of the left-right shunt, and demonstrates the degree of mitral steonsis. If the defect is poorly tolerated, surgical treatment is required.

[Abnormal pulmonary venous return from the right lung into the inferior vena cava or scimitar syndrome. 2 cases: hemodynamic study and surgical correction]. / Le retour veineux pulmonaire anormal du poumon droit dans la veine cave inférieure ou syndrome du cimeterre. Deux observations: étude hémodynamique et correction chirurgicale

Two cases of abnormal venous return from the right lung into the inferior vena cava, or the scimitar syndrome, have been studied. The essential features of this condition are given, emphasis being laid on the haemodynamic findings. Surgical correction of the abnormal pulmonary venous return seems to be a logical solution when the left-right shunt is of significant size.

[Myocardial infarct in 2 stages]. / L'infarctus du myocarde en 2 temps

The two-step myocardial infarction is defined by a peculiar course: the initial stage is a temporary rudimentary infarction, the late stage a typical transmural necrosis, separated by a free interval of a variable duration. A coronary arteriography undertaken when the recurrence starts might eventually lead to recommend an emergency operation: two-step myocardial infarction might represent one of the best indications for emergency aorta-to-coronary artyery by-pass operation.

[Surgical correction of chronic tricuspid insufficiency following infarction of the right ventricle]. / Correction chirurgicale d'une insuffisance tricuspidienne chronique secondaire à un infarctus du ventricule droit.

The case of a 69 year old man with isolated tricuspid regurgitation secondary to right ventricular infarction is reported. The poor long-term tolerance of the regurgitation resulting in severe right ventricular failure in the absence of any left ventricular dysfunction led to tricuspid valve replacement with a bioprosthesis 13 years after the causal infarct.

[Myxoma of the tricuspid valve. Apropos of a case]. / Myxome de la valve tricuspide. A propos d'un cas.

The authors report the case of a chance echocardiographic finding of a tricuspid valve myxoma. Transesophageal echocardiography provided valuable complementary information concerning the precise location of the tumour. Tricuspid valve myxoma is a very rare condition: a review of the literature recensed 16 other cases. This case is of particular interest because of the associated pathological signs: erythemato-papular skin lesions which regresses after ablation of the tumour and a multinodular goitre with a cold isthmic nodule which raised the possibility of the diagnosis of Carney's complex.

[Leiomyosarcoma of the pulmonary artery. Apropos of a case]. / Léiomyosarcome de l'artère pulmonaire. A propos d'un cas.

The authors report a case of sarcoma of the pulmonary artery in a 41 year old woman hospitalised for syncope on effort associated with effort dyspnoea. Chest Xray and echocardiography were "normal", leading to referral for pulmonary scintigraphy and angiography which showed multiple intravascular filling defects in the pulmonary arterial tree. A tumour implanted on a pulmonary valve was discovered at exploratory thoractomy. It was resected and the pulmonary valve replaced with a Carpentier-Edwards bioprosthesis. The histological findings were those of a leiomyosarcoma. The patient was reoperated 19 months later for a local recurrence but the tumour was too extensive for a complete ablation. The patient developed right heart failure and died the day after surgery. Sarcoma of the pulmonary artery is a rare tumour in adults and carries a very poor prognosis. The clinical course is initially insiduous and polymorphic but early diagnosis and complete excision are the only means of improving survival.

[Mid-term outcome of acute right ventricular dysfunction in biventricular myocardial infarction. Hemodynamic and cineangiographic studies]. / Devenir à moyen terme de la dysfonction aiguë du ventricule droit dans les infarctus du myocarde biventriculaires. Etude hémodynamique et cinéangiographique.

This study was designed to evaluate the mid-term outcome of the right ventricular (RV) dysfunction which characterizes infarction of both ventricles in the acute phase. Thirteen patients hospitalized for inaugural posterior or infero-posterior infarction extending to the right ventricle (haemodynamic and cineangiographic diagnosis) were explored in the acute phase and 4 months later by right heart catheterization and selective cineangiography of the right ventricle in a 30 degrees RAO projection. The results were compared with those obtained in a control group. Haemodynamically, the RV filling pressures (p less than 0.001) and the indices of RV dysfunction--i.e. RV end-diastolic pressure/RV systolic pressure ratio (p less than 0.001) and right atrial pressure/pulmonary wedge pressure ratio (p less than 0.02)--were significantly decreased between the acute and chronic phases, but they remained pathological compared with those measured in the control group. Angiographically, the right ventricular dysfunction in the acute phase was reflected in an increase of the RV end-systolic volume (p less than 0.02) and a decrease of the RV ejection fraction (p less than 0.01), whereas diastolic cavitary dilatation was inconstant, with mean values of RV end-diastolic volume close to those found in the control group. The systolic dysfunction persisted, unchanged, during the chronic phase. Segmental kinetics of the inferior wall was much reduced in the acute phase (p less than 0.001), this hypokinesia partially regressing in the chronic phase; but in fact there were wide individual variations, and some patients even recovered an almost normal contractility. Tricuspid valve regurgitation was frequent (6/13 cases) in the acute phase and regressed in 2 out of 3 cases in the chronic phase; its presence introduced a degree of bias in the measurement of RV end-systolic volume and RV ejection fraction, with a tendency to underestimate the severity of diastolic dysfunction. To summarize, right ventricular dysfunction was constant but often modest in the acute phase and remained relatively stable at mid-term, whereas segmental kinetics of the inferior wall improved, sometimes dramatically.

[Salmonella enteritidis pericarditis. Apropos of a case and review of the literature]. / Péricardite bactérienne à Salmonella enteritidis. A propos d'un cas et revue de littérature.

The authors report a case of Salmonella enteritidis pericarditis. The diagnosis was based on bacteriological analyses (blood and effusion cultures and pericardial biopsy). The microbiology of bacterial pericarditis is reviewed underlying the exceptionally rare finding of a non typhi Salmonella in this condition.

[Familial long QT-syncope syndrome. 2 cases of Romano-Ward syndrome]. / Le syndrome QT long-syncope familial. Deux observations de syndrome de Romano et Ward.

Two families with the Romano-Ward syndrome were studied; in family A there were 19 members from three generations, 11 of whom had the abnormality of a long QT interval, 2 of whom had fainting attacks, and 2 of whom died suddenly. In family B, comprising 5 members of two generations, 3 had the anomaly, one of these having fainting attacks, and also having an atrio-ventricular block. The bicycle ergometer test has an important part to play in decisions about treatment of the asymptomatic forms of the condition.

[Infarction of the right ventricle. 1. Hemodynamic diagnosis; pathologic correlations]. / L'infarctus du ventricule droit. 1. Diagnostic hémodynamique - corrélations anatomiques

70 patients with acute myocardial infarction were submitted to a full haemodynamic assessment at the onset of the condition. In 28 of them there was a disproportionate rise in the right ventricular end-diastolic pressure which could not be explained on the basis of a primary rise in left ventricular filling pressures; these were divisable into two subgroups: -- 19 infarcts without septal rupture, almost all with an inferiorly or posteriorly placed lesion (17); in these cases, an analysis of the curves shows, among other features, a syndrome of adiastole whose three forms (minor, moderate or severe) correlate well with the clinical features. Six cases died, and in four of those it was possible to study the correlation with the post-mortem findings: there were major lesions of the free wall of the right ventricle in 3 cases, but constrictive pericardial changes, the main differential diagnosis of right ventricular infarction, in the fourth. -- 9 cases of necrosis of the septum with rupture, of which only 3 had a syndrome of adiastole; three of these necroses were posterior, and post-mortem examination in two of them confirmed that there were indeed major lesions in the posterior wall of the right ventricle. It therefore seems that the diagnosis of infarction of the right ventricle is a haemodynamic one, and rests especially on the discovery of a syndrome of adiastole. Findings such as these are confined almost exclusively to posteriorly placed infarctions.

[Infarction of the right ventricle. 2. Prognostic and therapeutic aspects]. / L'infarctus du ventricule droit. 2. Incidences pronostiques et thérapeutiques

Infarctions of the right ventricle have a reputation for being innocuous which appears to be unjustified; in a group of 21 patients in whom the diagnosis has been based on the haemodynamic principles put forward in the previous paper, we have had 7 deaths. The prognosis appears to be determined by two types of complication: ruptures of the posterior septum (4 cases), which are very distinctive in their clinical and topographical picture; and haemodynamic complications (10 cases of decompensation) which are related fairly rarely with the lesion of the right ventricle (2 cases), but more often with an associated complication, especially hypovolaemia, in which state the involvement of the right ventricle seems to play a particularly major role in increasing the slowing of the circulation. The proposed treatment plan is aimed at the permanent establishment of an effective circulating volume in the uncomplicated cases; in cases with complications, the aims are twofold--filling of the vascular bed and vasodilators, either separately or simultaneously.

[Coronary insufficiency in pheochromocytoma]. / L'insuffisance coronarienne des phéochromocytomes

The authors report the case of a 42 year old female with a phaeochromocytoma who, in the course of a hypertensive episode, had ECG changes typical of a myocardial infarction. These changes regressed within a few days. A normal coronary arteriogram confirmed the purely functional nature of this episode of acute myocardial ischaemia. In addition to the case report, the authors discuss the physio-pathological and electrocardiographic features of the coronary insufficiency of phaeochromocytoma, and also the problem of the rapide regression of the changes of infarction on the ECG.

[Disputable thoracic pain with normal coronary arteries. Metabolic study]. / Douleurs thoraciques litigieuses à coronaires saines Etude métabolique

The search for electrocardiographic, haemodynamic and above an metabolic criteria suggestive of "myocardial ischaemia" in the course of an atrial pacing test was found to be positive in three patients suffering from atypical thoracic pains, and in whom selective coronary arteriograms might be considered as normal. It appaear thus that the criterion of a normal coronary arteriography and a negative or unsignificant effort test is insufficient to discard the diagnosis of "myocardial ischaemia" when confronted with such pains habitually considered as anorganic. The accurate mechanism of these pains, probably identical to that or those of "angina with normal coronary arteriography" remains undecided.

[Prospective study of the diagnostic and prognostic criteria of right ventricular involvement in the acute phase of inferoposterior infarction]. / Etude prospective des critères diagnostiques et pronostiques de l'atteinte ventriculaire droite à la phase aiguë des infarctus inféro-postérieurs.

Right ventricular involvement has been shown to be common in the acute phase of infero-posterior myocardial infarction. The aim of this prospective study was to assess the diagnostic and prognostic value of the different criteria obtained by clinical and paraclinical methods of investigation. Forty patients (35 men, 5 women: mean age 57,1 years) admitted consecutively with this type of transmural infarct without any other cause of acute or chronic volumic or barometric overload of the RV were investigated. In addition to clinical data, the following paraclinical investigations were carried out during the first three days of admission: ECG and vectorcardiogramme (VCG); transaminase levels (SGOT and SGPT), creatinine phosphokinase (CPK), alpha HBDH, serum creatinine, blood gases (pO2), M mode and 2 D echo, right heart catheterisation and cardiac output estimations, selective RV and pulmonary cineangiography centered on the LV in the monoplane 30 degrees LAO projection. Two groups of twenty patients were identified, comparable in age and sex, according to the angiographic extension of akinesia of the RV inferior wall: Group A: extensive akinesia (greater than or equal to 30 p. 100), Group B: very localised or no akinesia (less than 30 p. 100). Analysis of the results showed a number of features characterising patients in Group A: the high incidence of initial shock (45 p. 100 (A)/0 p. 100 (B] and signs of RV failure (85 p. 100/0 p. 100), higher SGOT, SEPT (p less than 0,05) and alpha HBDH (p less than 0,02) but not of CPK; much higher serum creatinine (p less than 0,01) and lower p02 (p less than 0,05); the ECG showed a high incidence (85 p. 100) and specificity (95 p. 100) of ST-T elevation in V3R and V4R, and also 2nd or 3rd degree AV block (60 p. 100/5 p. 100): there were no characteristic VCG changes. Catheterisation showed very significant increases (p less than 0,001) of mean RA, and RV end diastolic pressures, of the RA/mean pulmonary capillary pressure ratio and of Yu's index. There was a moderate increase in PCP (p less than 0,01), a drop in right ventricular systolic work index (RSSWI); adiastole was very common (90 p. 100) and very specific (95 p. 100); angiography showed an increase in RV end diastolic and end systolic volumes (p less than 0,05) and a fall in RV ejection fraction (p less than 0,05) but with a lot of individual variations; there were no significant differences between the two groups as regards the volumes, ejection fractions and p. 100 akinesia of the LV.(ABSTRACT TRUNCATED AT 400 WORDS)

[20 years of mitral valve replacement. Development of a patient profile and operative mortality]. / Vingt ans de remplacements valvulaires mitraux. Evolution du profil des opérés et de la mortalité opératoire.

Between 1971 and 1991, 1,179 mitral valve replacements (MVR) were carried out in 1,134 patients. The sex ratio was stable over this period (0.7 men/women) whereas the average age of the patients increased by 10 years (50 years in 1971, 61 years in 1991). Since 1980, patients over 60 years of age represent about 60% and those over 70 years of age 16 to 22% of the population. The functional status of the patients has tended to be less severe, the NYHA stages III and IV which were initially preponderant, only represent 50 to 60% of patients operated nowadays. This reduction in the severity of symptoms is reflected in the average value of the cardio thoracic index which was 60 in 1971 and 54.8 in 1991. Similarly, the mean pulmonary artery pressures (measured in 823 patients, 69.8%) have decreased from 37.4 mmHg in 1971 to 29.9 mmHg in 1991. Rheumatic fever has tended to be replaced by degenerative etiologies which, since 1985, represent 40 to 50% of cases. Ischemic mitral regurgitation rare before 1980, is more common, presently making up 5 to 15% of MVR cases. In relation with the etiological changes mitral stenosis is giving way to mitral regurgitation as the commonest valve lesion (40 to 50% of cases in 1991). The annual operative mortality is lower (6 to 8%) than in 1982, despite the increasing number of emergency cases (7 to 10% of cases since 1985). The number of MVR with associated tricuspid valve repair has decreased with respect to isolated MVR or associated with aortocoronary bypass grafting. The only constant feature is the death rate due to myocardial dysfunction which remains over 50% whereas mortality related to the prosthetic valves varied over the years.