[Percutaneous coronary intervention in the management of acute coronary syndromes in Ivory Coast: Challenges and outcomes]. / Angioplastie coronaire dans les syndromes coronariens aigus en Côte d'Ivoire : difficultés et résultats.

AIM: Assess the challenges and outcomes of percutaneous coronary intervention (PCI) in the management of ACS at Abidjan Heart Institute. PATIENTS AND METHODS: Prospective survey carried out from April, 1st, 2010 to April, 29th, 2016. Whole patients aged 18-year-old, admitted at Abidjan Heart Institute for ACS, and who underwent PCI were included in the Registre prospectif des actes de cardiologie interventionnelle de l'institut de cardiologie d'Abidjan (REPACI). Indications and outcomes of PCI were analyzed. RESULTS: Seven hundred and forty-nine patients were admitted for ACS, of which 165 underwent PCI. Ratio PCI/ACS was 0.22. Mean age was 55.6±9.8 years. Male were predominant (sex-ratio=12.7). Main clinical presentation was ST-elevation myocardial infarction (STEMI) in 75.1% of cases. One-vessel disease was predominant in STEMI (52.4%), and multi-vessel disease in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) (51.2%). Most of patients (86.7%) underwent PCI with stent implantation. PCI was performed successfully in 97.0% of cases. Main non-fatal complications were hematoma (2.4%). In-hospital mortality-rate was 1.2%, and one-year mortality-rate was 1.6%. CONCLUSION: PCI is performed in Subsaharan Africa with safety, despite encountered difficulties in its implementation.

Tako-Tsubo syndrome after an exercise echocardiography.

The Tako-Tsubo syndrome is a clinical entity recently described that associate a chest pain occurring during a stress, an abnormal ECG and/or an increase in the troponin blood level and a transient left ventricular dysfunction with an akinesis involving generally the midsection and the apex of the heart. It has also been reported that left ventricle (LV) dysfunction may involve only the midventricle, although it seems less common. We report the case of a 66 year old woman that developed a stress-induced cardiomyopathy (Tako-Tsubo syndrome) involving the midventricle when performing an exercise echocardiography. To our knowledge, this is the first case reported in such circumstances.

[Very late intrastent thrombosis--at 27 months!]. / Une thrombose de stent très tardive...à 27 mois!

Interrupting platelet antiaggregant therapy in coronary patients treated by stenting exposes them to the risk of cardiac complications. The risk of acute thrombosis of the stent is well known but late intrastent thrombosis is less common and mainly observed with drug eluting stents. The authors report the case of a 54 year old man who had thrombosis of an ordinary stent implanted 27 months previously which occurred in the immediate post-operative period after repair of an inguinal hernia. The interruption of platelet antiaggregant therapy was relayed by flurbiprofen in accordance with recommendations of scientific societies. After a review of the literature, the authors discuss late stent thrombosis and interruption of platelet aggregant therapy in coronary patients before non-cardiac surgery.

[Long-term outcome of a patient with hypertrophic obstructive cardiomyopathy treated by alcohol septal transcoronary ablation]. / Suivi à long terme d'une patiente atteinte de cardiomyopathie obstructive traitée par alcoolisation septale.

We report here the long term follow-up of the first french case, at our knowledge, of alcohol septal transcoronary ablation in March 1998 in Clinique Ambroise Paré in an 76 year-old woman. This patient was in NYHA III-IV functional class and at control outflow gradient was 100 mmHg. She was prior treated with high dosis of beta-blockers then DDD-pacemaker with no effects on symptoms. The technique used was the one described by Sigwart and al., with injection of 3 cm3 of ethyl alcohol in the first septal branch, after checking decrease of gradient during occlusion of septal branche with balloon angioplasty. After alcohol ablation, the gradient decreased immediately to 15 mmHg and disappeared at long-term follow up. Three years and half after the procedure, no complication occurred, the patient remains asymptomatic and the control echocardiography shows interventricular septal reduction of thickness from 22 to 12 mm.

[Paroxysmal ischemic mitral valve insufficiency]. / Insuffisance mitrale ischémique paroxystique.

The prognosis of patients with coronary artery disease may be threatened by ischaemic mitral regurgitation. Apart from rupture of a papillary muscle which requires rapid valve replacement. Chronic ischaemic papillary muscle dysfunction can often be a severe complication of ischaemic heart disease. The authors report the case of a patient with dyspnoea but no angina of effort. Cardiovascular investigations with right heart catheterisation demonstrated the occurrence of severe mitral regurgitation only during angioplasty of the left marginal artery.

Short-term variability of blood pressure during sleep in snorers with or without apnea.

In normal subjects, the level and variability of blood pressure decrease during non-rapid eye movement (non-REM) sleep. In contrast, sleep apnea is associated with large swings in nocturnal pressure. In this study, we evaluated a computer-derived index of all-night blood pressure variability in normotensive snorers with or without sleep apnea. We also examined this index in snorers receiving medical treatment for coexistent ischemic heart disease. Beat-to-beat blood pressure was recorded with a photoplethysmographic device (Finapres) throughout polysomnography. Subjects were categorized into four groups: those without cardiovascular disease without or with sleep apnea (> or = 15 apnea plus hypopnea per hour of sleep), and those with ischemic heart disease without or with sleep apnea. A frequency distribution histogram of all increases and decreases of blood pressure according to their amplitudes was drawn and the SD of the distribution used as an estimation of variability. Mean systolic and diastolic pressures during the total sleep time were not different among the four groups. In contrast, the SD of the distribution of systolic and diastolic pressure variations that were higher in the apneic than in the nonapneic groups (P < .05) correlated with apnea plus hypopnea (P < .0001) and transient electroencephalographic arousal number per hour of sleep (P < .0001). In both apneic and nonapneic subjects, blood pressure variability as assessed by SD decreased during stages 3 and 4 of non-REM sleep compared with stages 1 and 2 and REM sleep (P < .001). Blood pressure variability was similarly increased in apneic subjects with or without ischemic heart disease. We speculate that in apneic individuals with coexistent ischemic heart disease, pressure variability that is increased despite treatment with beta-blockers or calcium antagonists may be a risk factor for acute coronary events.

[Ostial stenosis of the left main coronary artery after mediastinal radiotherapy. Apropos of a case]. / Sténose ostiale du tronc commun de la coronaire gauche après radiothérapie médiastinale. A propos d'un cas.

Coronary artery disease (CAD) is a well-known complication of mediastinal irradiation. We report a case of subocclusive ostial stenosis of the left main coronary artery, in a 27 years old man, who had been irradiated 14 years before for a stage 4 Hodgkin's disease. Among the 68 reported cases of CAD attributed to radiotherapy, 11 involved an ostial stenosis of either right coronary artery, or left main coronary artery or both. Thus mediastinal irradiation seems to be a definite cause of ostial coronary artery stenosis; several types of myocardial revascularization have been suggested for this kind of CAD.

[Severe pulmonary artery involvement of Takayasu arteritis. 3 cases and review of the literature]. / Formes artérielles pulmonaires graves de l'artérite de Takayasu. trois observations et revue de la littérature.

Three cases of pulmonary arterial disease were identified out of a cohort of 75 cases of Takayasu's disease. In the first case, pulmonary hypertension considered to be idiopathic caused massive haemoptysis and the death of a 48 year old Spanish woman; autopsy revealed characteristic stenoses of the common carotid arteries. In the second case, haemoptysis led to pneumonectomy in a 23 year old West Indian woman with a diagnosis of agenesis of the right pulmonary artery. Disease of the supraaortic vessels occurred several months later and a retrospective diagnosis of Takayasu's disease of the pulmonary artery was made. In the third case, systematic pulmonary angiography in a 41 year old French woman referred for Takayasu's disease of the supraaortic arteries showed severe stenosis of the right pulmonary artery. She developed severe haemoptysis four years later which led to an attempted balloon angioplasty of the right pulmonary artery and embolisation of a branch of the right coronary artery thought to be the cause of the haemoptysis. This was complicated by posterior wall myocardial infarction but the haemoptysis did not recur thereafter. These three cases and a review of the literature show that the pulmonary lesions of Takayasu's disease occur mostly on the main right pulmonary artery but they may be more distal and involve the pulmonary arterioles. A coronaro-broncho-pulmonary collateral circulation may develop distal to the stenosed segments. The main complications are pulmonary hypertension and massive haemoptysis. Surgery is possible in cases of stenosis of the right main pulmonary artery. The potential role of endoluminal angioplasty is discussed.

[Cardiac toxicity of 5-fluorouracil. Two cases]. / Cardiotoxicité du 5-fluorouracile. Deux observations.

Major ventricular repolarization disorders without evidence of myocardial infarction developed in 2 patients during the first course of a 5-fluorouracil (5-FU) treatment in doses of 1,000 mg/m2/day. Anginal pain was present in one patient but not in the other. The electrical abnormalities persisted for more than 6 weeks in one case. Explorations carried out 2 and 6 weeks later respectively under calcium inhibitors showed absence of coronary artery stenosis, negative methyl ergonovine test (even after 5-FU infusion in one patient) and normal left ventricular kinetics. The mechanism of cardiac toxicity is discussed on the basis of these data: some elements support a coronary spasm and others direct myocardial toxicity.

[Percutaneous angioplasty using spectroscopy-guided pulsed laser]. / Angioplastie percutanée par laser pulsé guidé par spectroscopie.

Percutaneous laser angioplasty was performed in 19 patients with calcified and non-calcified occlusions (4-25 cm long) of the superficial femoral artery, using a pulsed dye laser at 480 nm and a pulse duration of 2 microseconds per pulse. The treatment laser was guided by a 325 nm diagnostic laser that induced tissue fluorescence. The laser system operated through a single 200 microns optical fiber. Computer spectral analysis of the tissue fluorescence located at the distal end of the fiber tip directed emission of the treatment laser only at the atheroma without affecting the arterial wall. A successful primary laser recanalization was obtained in all cases and was followed by balloon dilation in all but one patient. One mechanical perforation and 2 mechanical arterial dissections by the fiber, and 1 perforation and 1 dissection by the guide wire occurred, but no complications due to the treatment or diagnostic laser were observed. The safety of the procedure seemed to be enhanced by the spectroscopic guidance system which enabled plaque recognition. The pulsed dye treatment laser was well tolerated and effective even in heavily calcified arteries.

[Myocardial protection by coronary autotransfusion during angioplasty]. / Protection myocardique par autotransfusion coronaire au cours de l'angioplastie.

Coronary autologous blood perfusion may protect the myocardium against ischemia during arterial occlusion due to balloon inflation. During balloon inflation, arterial blood was perfused via the balloon catheter in 19 patients with single proximal severe left anterior descending artery stenosis and normal left ventricular function. Blood was perfused using a contrast medium injector at a flow rate of 40 ml/min. The balloon was maintained inflated for 60 seconds at 6 atmospheres. Two inflations were performed with perfusion and 2 without. Myocardial ischemia was assessed by ST elevations on both the peripheral and intracoronary ECGs, changes in left ventricular systolic and end diastolic pressures and peak positive and negative dP/dt. A positive response was obtained in 11 patients. In 5 patients, the myocardial ischemia induced by dilatation was not alleviated by the perfusion and in 3 patients ischemia was increased by perfusion. In conclusion, ischemia is inconsistently reduced by autologous blood perfusion and its adverse effect in some patients could limit its use.

[Intraoperative evaluation of mitral valve reconstruction using two-dimensional contrast echocardiography]. / Evaluation per-opératoire de la plastie mitrale par l'échocardiographie bidimensionnelle de contraste.

20 patients who underwent reconstructive surgery for mitral regurgitation were peroperatively investigated by contrasted bidimensional echocardiography using intraventricular injection of 20 ml of physiologic saline. Before the valvuloplasty, the peroperative quantitation of mitral leakage was in all cases closely correlated with the data obtained preoperatively. After the mitral reparation, three groups of patients could be observed: group I (12 cases): absent or minimal regurgitation (0-+); group II (5 cases): moderate mitral regurgitation (++); group III (3 cases): marked regurgitation ( - +) necessitating an immediate ECC. In two cases it was possible to improve successfully the valvular function, in the third case valvular replacement was necessary. The correlation between the data of peroperative contrasted echography at one hand and the clinical examination and the postoperative paraclinical investigations on the other hand was excellent in all cases. Thus the contrasted bidimensional peroperative echocardiography represents a reliable method for predicting the immediate results of mitral reconstructive surgery.

[Compressive hemopericardium of the right atrium after cardiac surgery]. / Hémopéricarde compressif de l'oreillette droite après chirurgie cardiaque.

Between June 1983 and September 1984, 3 patients operated for mitral valve disease presented with acute right heart failure due to right atrial compression. Emergency echocardiography did not show pericardial separation around the ventricles but in the apical 4 chamber view severe right atrial compression by an extracardiac mass was observed. Emergency surgery was performed in all three cases to evacuate a localised haemopericardium despite the absence of pericardial fusion. These cases of acute right ventricular failure underline the importance of multiplying the number of echocardiographic views in order to detect localised pericardial effusion. The diagnosis should be made as soon as possible as clinical deterioration may be rapid despite effusions of small volume. The main differential diagnoses are right atrial thrombosis and acute postoperative pulmonary embolism. In these cases of localised tamponade, the clinical signs are the result of vena caval compression or extrinsic compression of the tricuspid orifice. The preferential localisation of the haemopericardium around the right atrium is difficult to explain. It is probably related to the low pressures in this region. The echocardiographic appearances of this condition have been established allowing reliable diagnosis.