[Cardiac sarcoidosis revealed by recurrent ventricular tachycardia]. / Tachycardie ventriculaire récidivante révélant une sarcoïdose cardiaque.

Sarcoidosis is an inflammatory disease whose diagnosis is suggested by clinical and paraclinical signs and confirmed by histological evidence showing granulomatosis without caseous necrosis. The clinical presentation is sometimes misleading and the diagnosis difficult to confirm. We report here the case of a young woman with cardiac sarcoidosis of difficult diagnosis, revealed by a myocardial infarction with normal coronary angiography and recurrent ventricular tachycardia. Multimodal imaging, combined with left ventricular endomyocardial biopsies guided by electrophysiological analysis and endocavitary mapping, finally confirmed the diagnosis, and allowed effective medical treatment.

Detection of Stent Underdeployment by StentBoost Imaging.

OBJECTIVE: To evaluate the additional value of StentBoost® (SB), a motion-corrected X-ray technique that enhances stent visualization, for the assessment of stent deployment and procedure optimization during routine percutaneous coronary interventions (PCI). BACKGROUND: Underdeployment and malapposition of stents during PCI may lead to in-stent thrombosis and restenosis. Coronary angiography (CA) is of limited value for the assessment of stent deployment. Intravascular ultrasound and optical imaging techniques are the gold standard, but are used in <10% of routine PCIs. METHODS: We retrospectively analyzed 260 coronary lesions treated by stent implantation and assessed by SB during 168 consecutive PCI procedures. The immediate results of SB analysis and CA were assessed by 2 independent interventional cardiologists and compared. RESULTS: A total of 275 stents were implanted; 45% were drug-eluting stents (DES). Direct stenting was performed in 78%. Results of SB and angiography were concordant for 210 lesions: 194 stents were correctly deployed (75%) and 16 were underdeployed (6%), shown by both techniques. In 47 patients (18%), SB detected an underdeployment of the stent whereas the angiographic result was good. Postdilatation was performed on the basis of SB in 89% of these cases. The additional contribution of SB was higher for left main lesions and for DES, and was not affected by coronary calcifications. CONCLUSIONS: This study confirmed the usefulness of the stent visualization enhancement technique StentBoost® in current PCI practice. SB revealed about 20% underdeployed stents not detected by CA, and allowed for optimizing PCI by ad hoc effective postdilatation.

Adult-onset Still's disease revealed by perimyocarditis and a concomitant reactivation of an EBV infection.

We describe a 17-year-old patient presenting perimyocarditis as the initial manifestation of the adult-onset Still's disease. Corticotherapy was rapidly successful but induced major acute hepatitis in relation with Epstein-Barr virus reactivation. After 1 year, even if the global outcome is favourable, a slightly lowered ejection fraction still persists. Former case reports and differential diagnosis with reactive haemophagocytic syndrome would be discussed.

Reduction of radiation delivered to patients undergoing invasive coronary procedures. Effect of a programme for dose reduction based on radiation-protection training.

BACKGROUND: Exposure of patients to radiation from invasive cardiac procedures is high and may be deleterious. AIMS: To assess the effectiveness of a dose-reduction programme based on radiation-protection training, according to the recommendations of the Euratom Council, the International Commission on Radiological Protection and the French Society of Cardiology. METHODS: In this single-centre survey, dose-area product (DAP, Gy.cm(2)), fluoroscopy time (minutes) and number of runs were evaluated in 3285 consecutive procedures (2077 coronary angiographies [CAs], 1208 percutaneous coronary interventions [PCIs]), performed one year before (2005) and two years after (2006 to 2007) implementation of a programme for radiation dose-reduction. The programme included a 2-day training course in radiological protection for all medical and paramedical staff and recommendations for routine use of low fluoroscopic and acquisition pulse rates (6.25 and 12.5 i/s, respectively), large field size (23cm), maximal collimation and optimal X-ray tube/patient/detector distances. Routine left ventriculography was discouraged. The radial approach was used in>80% of the procedures. RESULTS: Compared with 2005, a significant 50% reduction in DAP was observed in 2006 and 2007 during CA (median [interquartile range] 53 Gy.cm(2) [33-84] vs 26 [16-43] and 21 [14-32], respectively; p<0.0001) and PCI (125 Gy.cm(2) [78-184] vs 49 [31-79] and 44 [27-66], respectively; p<0.0001). Fluoroscopy time and number of runs did not vary significantly in 2006, and decreased slightly in 2007, likely due to an important reduction in rate of left ventriculographies (from 32 to 4%). Inter-operator variability in DAP was reduced. CONCLUSION: Training in radiation protection for interventional cardiologists and use of simple and cost-free dose-reduction techniques were associated with a 50% reduction in radiation exposure to patients undergoing invasive cardiac procedures, without any loss of diagnostic information.