[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.

[Acute post-traumatic aortic insufficiency: transesophageal echocardiography in the diagnosis and therapy of the lesions]. / Insuffisance aortique valvulaire aiguë post-traumatique: apport de l'échocardiographie transoesophagienne pour le diagnostic lésionnel et le traitement.

A 58-year-old car driver suffered a road accident responsible for severe blunt thoraco-abdominal trauma. Transoephageal echocardiography, performed following the secondary development of a diastolic murmur, confirmed the presence of aortic incompetence due to commissural avulsion and guided the surgical treatment, which consisted of commissural suspension under cardiopulmonary bypass via a mini transverse trans-sternal incision. The rarity of acute aortic valve incompetence following non-penetrating thoracic trauma is illustrated by the data of the literature. This lesion is due to either avulsion of a sigmoid cusp or commissure, or laceration of the valvular tissue. Transthoracic echocardiography confirms the reality of aortic incompetence suggested clinically by appearance of a diastolic murmur, but confirmation of the mechanism of the lesions is based on transoesophageal echocardiography which allows perfectly safe and rapid visualization of the mechanism of the valvular lesion, investigation of associated lesions and guidance of therapeutic management.

[Incidental CT discovery of an isolated thrombus in the aortic arch]. / Découverte scanographique fortuite d'un thrombus isolé de l'arche aortique.

The authors report a case of isolated thrombus of the aortic arch discovered incidentally during thoracic CT angiography, complicated by clinical features of embolic renal infarction despite introduction of anticoagulant treatment. This case confirms the value of transoesophageal echocardiography to diagnose and follow these lesions and illustrates the therapeutic approach following discovery of aortic thrombi.

[Effort-induced macroscopic hematuria revealing segmental and congenital absence of inferior vena cava]. / Hématurie macroscopique d'effort révélant une absence segmentaire et congénitale de la veine cave inférieure.

Absence of inferior vena cava (IVC) is an uncommon congenital abnormality with few clinical repercussions. We report the case of a 39 year old man with chronic pelvic pain, in whom a macroscopic hematuria episode occurring during exercise led to the discovery of an echographic pelvic venous stasis syndrome. Abdominal and pelvic computed tomography scanning then magnetic resonance imaging of inferior vena cava revealed absence of the postrenal segment of IVC with azygos continuation and considerable collateral venous derivations, leading to pelvic cavernoma.

[Unusual complication of venous thrombosis of the upper limb: pulmonary hypertension]. / Complication inhabituelle d'une thrombose veineuse d'un membre supérieur: l'hypertension artérielle pulmonaire.

Although less frequent than that of the lower limbs, venous thrombosis of the upper limbs may cause pulmonary embolism. This embolism is usually moderate and facilitated by the delay or absence of anticoagulant treatment. We report the case of a young man who had multiple and recurrent embolism consecutive to thrombosis of the axillary and subclavian veins and who rapidly developed pulmonary arterial hypertension on previously healthy lungs. There was no venous disease of the lower limb. After a more than 2 years' period, the pulmonary arterial hypertension is still moderate, but the patient remains under long-term antivitamin K therapy, this being the only available treatment capable of preventing a deterioration that would result in post-embolic cor pulmonale and ultimately require lung transplantation.