Venous involvement in Takayasu's disease: does it exist?

We describe the case of a 46-year-old man with an isolated superior vena cava syndrome, which was relieved by surgery. Pathologic examination revealed segmental involvement of the superior vena cava with dense collagen sclerosis. Histiomonocytic inflammatory transmural infiltration of all layers was histologically compatible with lesions described in Takayasu's disease. Although not previously described, this pathologic aspect suggests the possibility of venous involvement in this disease.

[Abnormal origin of the left coronary artery. Pre- and postoperative hemodynamic and metabolic studies]. / Naissance anormale de la coronaire gauche. Etudes hémodynamiques et métaboliques pré et post-opératoires.

The authors report the case of an asymptomatic 45 year old man in whom an abnormal origin of the left coronary artery was discovered fortuitously. Coronary angiography was carried out for electrocardiographic signs of anterior myocardial infarction and showed the left coronary artery arising from the pulmonary artery: there was apical dyskinesia with alteration of global left ventricular function. The ostium of the left coronary artery was closed and a saphenous vein aorto-left anterior descending artery bypass was performed. There were no complications. Left ventricular function has not improved 8 months after surgery. The haemodynamic and coronary signs of myocardial ischaemia demonstrated preoperatively regressed after surgery: the coronary "steal" caused by the malformation which led to poor perfusion of the territory of the left coronary artery has therefore been corrected by surgery. This procedure should be carried out as early as possible in order to limit extension of the myocardial lesions.

[Intravenous labetalol in normotensive coronary patients. Effects on hemodynamics and myocardial metabolism]. / Le labétalol intraveineux chez le coronarien normotendu. Effets sur l'hémodynamique et le métabolisme myocardique.

The haemodynamic and myocardial metabolic effects of intravenous Labetalol were studied in 7 normotensive coronary patients with at least one significant stenosis on the left anterior descending artery. The study consisted of 5 successive observation periods: basal (I); during atrial pacing at the theoretical maximal heart rate or when anginal pain occurred (II); return to basal conditions (III); 20 minutes after an injection of 1.5 mg/kg of Labetalol over 3 minutes into the pulmonary artery (IV); during repeat atrial pacing at the rate achieved during phase II (V). There was no significant difference between phases I and III except for a slightly faster heart rate in phase III. The effects of Labetalol were assessed by comparing the results during phases III and IV between phases II and V and by analysing the variations between phases I, II, IV and V. In comparison with basal conditions (phase III), Labetalol (phase IV) induced a slight decrease in cardiac output (p less than 0.05), a decrease in aortic pressure and systemic arterial resistances (p less than 0.01) and of the double product. Coronary sinus flow did not change but myocardial oxygen consumption fell by an average of 11% (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute hemodynamic and coronary effects of captopril in chronic cardiac failure]. / Effets aigus hémodynamiques et coronaires du captopril dans l'insuffisance cardiaque chronique.

The acute effects of captopril on haemodynamics, coronary flow and myocardial metabolism were studied in 12 patients with chronic severe cardiac failure (primary cardiomyopathy: 10 cases; ischaemic: 2 cases) in functional Classes III or IV of the NYHA. All patients were male and their average age was 51.3 +/- 14.1 years (range 27 to 68 years). Measurements were carried out under basal conditions and 90 minutes after a single dose of 50 mg (5 cases) or 100 mg (7 cases) of captopril. Captopril administration leads to an increase in cardiac index from 2.05 +/- 0.32 to 2.34 +/- 0.35 l/min/m2 (p less than 0.05) and a greater increase in systolic index from 23.9 +/- 6.7 to 29.8 +/- 6.9 ml/syst/m2 (p less than 0.01), because the heart rate decreased slightly (p less than 0.05). These changes were the result of a decrease in afterload: mean aortic pressure fell from 85 +/- 11.8 to 68 +/- 19.6 mmHg (p less than 0.01) and systemic arterial resistance fell from 2 886 +/- 745 to 2 010 +/- 610 dynes/cm-5/sec/m-2 (p less than 0.01). Captopril also led to a fall in venous tone, i.e. pre-load: left ventricular end diastolic pressure fell from 26.9 +/- 6.1 to 20.8 +/- 6.6 mmHg: p less than 0.01. There was no change in contractility as shown by the absence of variation of the V.max (0.92 +/- 0.18 under basal conditions, and 0.90 +/- 0.15 after 90 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)