[Transient left ventricular apical ballooning syndrome. Case report and review of the literature]. / Syndrome de ballonisation apicale transitoire du ventricule gauche. Revue de la littérature à propos d'un cas.

SUBJECT: Transient left ventricular apical ballooning syndrome, known as the japanese name of tako-tsubo was recently described and is characterised at the acute period by a large apical dyskinesia of the left ventricule apex. This syndrome usually mimics an acute coronary syndrome, sometime a cardiac failure or arrhythmias. We report a typical case of a seventy-seven years old women struck by a tako-tsubo syndrome revealed by an acute chest pain after an emotional stress. The diagnosis was proposed because angiography didn't shown any abnormality in spite of a large left ventricular dysfunction at the ventriculography. Actuality and strong points: Tako-tsubo syndrome is more and more published due to a better knowledge of this syndrome, specially in the acute coronary syndrome without coronary abnormality. His physiopathology is not well known but is clearly in relation with an acute stress. Several hypothesis are discussed, helped by some experimental animal model. With an excellent prognosis at a middle-course, his discovery allow an adapted take care especially of the complications. PROSPECT: The setting up of clinic and electrocardiographic reliable and well-tried criteria will allowed an early diagnosis to avoid harmful treatment. His specific treatment is not reached by consensus but will develop by a better knowledge of the physiopathology.

[Direct thrombin inhibitors in coronary angioplasty. Value of bivalirudin ]. / Inhibiteurs directs de la thrombine dans l''angioplastie coronaire. Place de la bivalirudine.

During coronary angioplasty, the association of platelet inhibitors and antithrombin agents is required to prevent myocardial infarction. Bivalirudine, a synthetic direct thrombin inhibitor, has been widely validated in this context and has shown its efficacy and safety in several comparative studies. It is officially recommended as a replacement of NFH and LMWH associated or not with anti-GPIIb/IIIa agents because at comparable efficacy it causes fewer bleeding complications. In acute coronary syndromes without ST elevation, anti GPIIb/IIIa agents reduce angioplasty-related complications and mortality, especially in high risk patients in salvage situations. In the REPLACE-2 trial the clinical efficacy of bivalirudine (associated only when necessary with anti-GPIIb/IIIa agents) was no less than that of NFH associated systematically with anti-GPIIb/IIIa agents at the time of intervention. The incidents of serious adverse events at 30 days (death, infarctus, emergency revascularisation, major bleeding) in the bivalirudine group was 9.2% versus 10.2% in the NFH group. In a retrospective analysis, these results did not seem to be influenced by the prior administration of clopidogrel. Finally, the one year follow-up results showed a lower mortality in patients treated with bivalirudine (1.9% versus 2.5%), essentially in the high risk sub-groups such as the elderly, the diabetic or the renal failure patients. Clinical trials are underway (ACUITY) to study the interaction of anti GPIIb/IIIa agents with bivalirudine in the first hours of acute coronary syndromes and should confirm a major role of direct anti-thrombin drugs in the safety of angioplasty.

["Optigo" hand-held echocardiography in post-surgery of coronary artery bypass graft]. / Intérêt de l'échocardiographe portatif Optigo en période postopérative de chirurgie coronarienne.

INTRODUCTION: After all the advances in electronic miniaturization, first hand-held echocardiographs have finally appeared in echocardiographic laboratories. However, questions still remain about their usefulness in our everyday practice and also about their good diagnosis accuracy. Since some of them do not offer modes such as pulsed or continuous wave Doppler, nor M-mode, they cannot compete with conventional devices. However, they do offer advantages such as their long autonomy, the good quality of their image as well as the one obtained with colour-Doppler mode, in addition obviously to the fact that they can be carried around very easily. OBJECTIVES: To better define their possible uses, we assessed capabilities of one of them, the Optigo (Philips Ultrasound) to analyse patients who had undergone coronary artery bypass surgery. METHOD: Fifty patients have been included in this study few days after the surgery. Each of the patients had two echocardiographic examinations, one with a conventional device and one with the Optigo. Two separated and blinded observers for a subsequent and side-by-side criteria comparison performed the two echocardiograms. RESULTS: Hand-held echocardiography had a good diagnosis accuracy varying from 85% to 95% depending on the analysed criteria. It was more specifically good in the analysis of global or regional left heart function and of the right cavities as well as detecting the existence of pericardial effusion. CONCLUSION: Hand-held echocardiographic device demonstrated high accuracy in assessing patients with recent coronary bypass surgery especially regarding cardiac function and pericardial effusion diagnosis.