[Giant left ventricular false aneurysme revealing a silent myocardial infarction]. / Volumineux faux anévrisme de la pointe du ventricule gauche révélant un infarctus du myocarde silencieux.

Left ventricular false aneurysms are rare. They are secondary to a myocardial rupture which is contained by adherent pericardium and scar tissue. LV pseudoaneurysm contains no endocardium or myocardium unlike left ventricular true aneurysm. Most cases of LV pseudoaneurysm are related to acute myocardial infarction in inferior or posterior wall. We report a case of a 56-year-old man with a medical history of chronic cigarette smoking, dyslipidemia, and obesity. The patient had no myocardial infarction before. He was admitted for evaluation of important shortness of breath at effort without chest pain for 5 months. Physical exam find an enlarged left ventricular. The electrocardiogram revealed Q waves and ST segment elevation in leads V1 to V6. Transthoracic echocardiogram showed a large thrombosed apical left ventricular false aneurysm, severe left ventricular dysfunction, which were confirmed by cardiac magnetic resonance imaging, this exam also showed no viability in the mid left anterior descending coronary artery territory. The coronary angiography showed an occlusion of the mid left anterior descending coronary artery and a stenosis of the first diagonal artery. The patient was offered a surgical aneurysectomy with coronary artery bypass. The surgery was successful with amelioration of symptoms. We present a rare case of a giant false left ventricular aneurysm complicating a silent myocardial infarction in the anterior wall. The diagnosis is made by cardiac echocardiogram and cardiac magnetic resonance imaging. Because of the important risk of rupture, the surgical treatment is required.

Percutaneous mitral valvuloplasty in patients with low cardiac output at high surgical risk.

Among 1146 patients undergoing percutaneous mitral valvuloplasty for symptomatic mitral stenosis, 8 (4 men and women) were at high risk for surgery on the basis of the New York Heart Association functional class IV (n=8), severe pulmonary hypertension (n=5). All these patients aged 30+/-23.6 years had signs of right heart failure, high echocardiographic score (9.6+/-3.6) and low mitral valve area (0.50+/-0.19 cm(2)). The procedure resulted in an increase in mitral valve area (1.55+/-0.17 cm(2)) with a concomitant reduction in pulmonary artery systolic pressure (58.7+/-9.9 mm Hg) and decrease in tricuspid regurgitation. At follow-up (mean 14+/-3 months), one patient with renal failure... presented with a mitral restenosis is scheduled for mitral valve replacement, two patients with severe tricuspid regurgitation required tricuspid annuloplasty. In conclusion, percutaneous mitral valvuloplasty is feasible and safe in patients at high surgical risk and can be considered as an acceptable alternative to surgery.

[Percutaneous mitral commissurotomy and Lutembacher syndrome]. / Commissurotomie mitrale percutanée et syndrome de Lutembacher.

INTRODUCTION: Lutembacher syndrome refers to the rare combination of congenital atrial septal defect and acquired mitral stenosis. This condition is usually treated surgically by mitral valve operation with concomitant closure of the atrial septal defect. MATERIALS AND METHODS: Between 1993 and 2003, 4 patients with congenital Lutembacher syndrome had percutaneous mitral commissurotomy without closure of the atrial septal defect at our institution. The 4 patients were very symptomatic with right-sided heart failure signs and NYHA functional class III-IV. RESULTS: The procedure was carried out successfully for the four patients. Mitral valve area increased from 0.87 to 1.97 cm2 at mean; left atrial pressure decreased from 28.2 to 12.7 mmHg and the mean valve mitral gradient was reduced from 15.5 to 3.9 mmHg. Functional and clinical improvement was observed in all the cases. During a mean follow up of 55 +/- 29 months, our 4 patients remain pauci symptomatic under medical treatment. CONCLUSION: The percutaneous treatment of the Lutembacher syndrome is currently a possible alternative to the surgery among patients having an anatomy favourable to the procedure.

[Percutaneous mitral valvuloplasty in the pregnant woman Moroccan experience]. / Valvuloplastie mitrale percutanée chez la femme enceinte: expérience marocaine.

Pregnancy is one of the most important factors known to destabilize valvular heart disease. In particular, pregnancy is a major cause of aggravation in the clinical course of women with mitral stenosis (MS). Surgical treatment of MS during pregnancy may be hazardous for both mother and foetus. In this context, percutaneous mitral valvuloplasty using the Inoue balloon may constitute a particularly attractive alternative to surgery. We report the results of percutaneous mitral valvuloplasty achieved in a series of 11 pregnant women.

Difficult percutaneous mitral commissurotomy: failure of the Inoue balloon technique and successful double-balloon technique.

From December 1994 to May 1999, 487 patients underwent percutaneous transvenous mitral commissurotomy according to the Inoue balloon technique for tight mitral stenosis. In three cases, the Inoue balloon technique was not possible because the catheter balloon could not enter the mitral orifice and the double-balloon technique was performed instead. In two cases, a flow-guided balloon catheter met the mitral orifice and the double-balloon technique was effective. In the third case, passing the valve with a flow balloon catheter was impossible, a 0.032" Terumo straight wire crossed the valve, which was dilated with a single balloon the first time and a double balloon the second time. The mitral valve area increased in the three cases from 0.8 to 1.8 cm2, from 0.7 to 1.6 cm2, and from 0.5 to 1.5 cm2, respectively. There were no complications.

[Mixed form of total anomalous pulmonary venous connection: apropos of a case]. / Forme mixte du retour veineux pulmonaire anormal total: a propos d'un cas.

As opposed to partial anomalous of pulmonary venous connection, it is frequent and benigns, the total anomalous of pulmonary venous connection is extremely rare and more serious. The anomalous is severe because all pulmonary venous connection, instead of left heart it go to the right heart. The age of diagnosis is closely tied up anatomics characteristics, so various clinical cases are present. The TAPVC of new born is a surgical emergency, especially where it's block up and release++ cardiorespiratory distress syndrome secondary to OAP. For great children, the total anomlous of pulmonary venous connection can be assumed to a case of atrial septal defect. This study intend to clear up this clinical and anatomical polymorphism and to report an exceptional-form of this congenital anomaly which is mixed total anomalous of pulmonary venous connection.

[Percutaneous transluminal valvuloplasty in congenital pulmonary stenosis in adults. Apropos of 34 cases]. / Valvuloplastie transluminale percutanée des sténoses pulmonaires congénitales chez l'adulte. A propos de 34 cas.

Percutaneous pulmonary valvulotomy is the treatment of choice for isolated congenital pulmonary valvular stenosis in childhood. However, experience of this procedure in the adult is much more limited. Between January 1984 and December 1994, 34 patients with severe or moderate pulmonary valvular stenosis underwent percutaneous transluminal valvuloplasty. The age of the patients ranged from 20 to 47 years (mean 22 +/- 4 years). Cardiac catheterisation was performed using the femoral vein in 27 cases and the internal jugular vein in 7 cases. Success was obtained in 28 patients (81% of cases). Pulmonary artery-right ventricular pressure gradient decreased from 113 +/- 35 to 32 +/- 13 mmHg (p < 0.001) after valvuloplasty with one or two balloon catheters. The tolerance of transluminal valvuloplasty was generally good. The poor results were explained by cases of dysplasic valves or of infundibular reactions. There was one death which occurred 24 hours after the procedure. Clinical and echocardiographic follow-up was obtained in 20 patients, 3 to 36 months after valvuloplasty (average: 23 +/- 13 months). No cases of restenosis were observed. Percutaneous transluminal pulmonary valvuloplasty in the adult is feasible and gives good results which are maintained at medium-term; it has become the treatment of choice of valvular pulmonary stenosis and gives good results which are maintained at medium-term, thereby avoiding surgical valvulotomy.