[ICD and left ventricular assist device interference: Case report]. / Interférence électromagnétique entre défibrillateur implantable et dispositif d'assistance circulatoire.

Left ventricular assist devices are used for severe chronic heart failure management. Many of these patients have an implantable cardioverter defibrillator (ICD). However electromagnetic interferences are possible between the 2 devices. We report here a case of an interference in a 77 years-old patient. This was associated with an impossibility to communicate with the ICD. We discuss how to manage this situation.

[Cardiac permanent pacemaker after transcatheter aortic valve implantation: A predictive and scientific review]. / Quand implanter un stimulateur cardiaque après remplacement valvulaire aortique percutané ? Revue de littérature.

Transcatheter aortic valve implantation (TAVI) is nowadays a worldwide technique in the field of treating aortic stenosis. One of the main side effects linked to the technique are mostly attached to rhythm disturbances, such as atrioventricular (AV) and intraventricular blocks. Consequently, a pacemaker implantation is often required. That implantation rate is estimated between 8 and 30%, depending on the valve chosen. Thanks to main meta analysis on the subject, it has been managed to isolate the following risks factors for AV block development: preoperative right bundle branch block (RBBB: the most powerful element), complete AV block during the procedure, male gender, a so-called porcelain aorta, the absence of previous valvular surgery, the aortic annulus size (i.e when that size is inferior to the valve's one) and the QRS duration after the procedure (the superior threshold has been set at 128ms for the Corevalve). The currently recommendations advice to implant a pacemaker are as followed: high grade AV block (in the main studies, the implantation occurs within the 5 days after the TAVI), complete and transient AV block during the TAVI, second degree AV block and RBBB associated with first degree AV block. Our article aims to review the arrhythmic issues of TAVI.

[Severe sick sinus syndrome associated with a Werner's syndrome]. / Dysfonction sinusale sévère chez une patiente présentant un syndrome de vieillissement accéléré de Werner.

A 39-year-old woman was explored for recurrent syncopes. She was already known for a Werner's syndrome with symptoms of aging disorders. The explorations revealed an episode of sinusal arrest. A pacemaker was implanted. This case emphasises the relation between Werner syndrome and the development of cardiovascular abnormalities. This pathology should be recalled in young patients with symptoms of aging disorders and cardiovascular abnormalities. Valvular abnormalities, myocardial infarction and stroke are the major complications of Werner's syndrome. This case indicates that a sick sinus syndrome is a rare but possible complication of Werner's syndrome.

[Implantation of coronary stent during the acute phase of myocardial infarction for treatment of dissection or partial result after angioplasty. Immediate results and angiographic follow-up]. / Implantation d'une endoprothèse coronaire en phase aiguë d'infarctus du myocarde pour traitement d'une dissection ou d'un résultat incomplet après angioplastie. Résultats immédiats et suivi angiographique.

Between December 1991 and November 1994, a Palmaz-Schatz stent was implanted in 9 patients aged 57 +/- 14 years during the acute phase of myocardial infarction after primary angioplasty in 7 cases and salvage angioplasty in 2 cases after an interval of 175 mm +/- 62 mn from the onset of infarction, because of threatening dissection (N = 8) or a partial result (N = 1). The success rate of implantation was 100% with residual stenosis (DCI Philips system) measured at 16 +/- 8% (5 to 28%). Anticoagulant treatment comprised heparin, coumadin and aspirin in two cases, and, in the following 7 cases, low molecular weight heparin, ticlopidine and aspirin. There was one death due to cardiogenic shock on the third day despite intraaortic balloon pumping. One patient was operated for a femoral aneurysm. A prophylactic bypass procedure was performed as a semi-emergency in a stable patient. At systematic angiographic control, the residual stenosis was measured at 19 +/- 14% (10 to 43%) without reocclusion. There was no recurrence of ischaemia. The authors conclude that the encouraging results of this short series suggest that despite the highly thrombogenic situation of acute myocardial infarction and despite the context of emergency implantation of a stent. Palmaz-Schatz stent implantation gives good immediate and long-term results with respect to reocclusion and stenosis.

[Angioplasty of the proximal left anterior descending artery outside the acute phase of myocardial infarction. Apropos of a series of 100 consecutive patients]. / Angioplastie de l'artère interventriculaire antérieure proximale en dehors de la phase aiguë de l'infarctus du myocarde. A propos d'une série consécutive de 100 patients.

The indications of percutaneous transluminal coronary angioplasty (PTCA) of the proximal left anterior descending artery (LAD 1) must take into consideration the importance of the threatened myocardial territory in case of complications and the supposedly increased risk of restenosis of this arterial segment. One hundred consecutive patients (average age 59.9 +/- 11.4 years with 77% of men) outside the acute phase of myocardial infarction were included in this retrospective open study from January 1st 1988 to March 1st 1992. There were 76 cases of single vessel. The average left ventricular ejection fraction was 64.8 +/- 12%. During the hospital period, there were no deaths. 1 myocardial infarction despite emergency coronary bypass surgery, and 2 programmed coronary bypass procedures. During follow-up, "clinical restenosis" as defined by the authors was observed in 29.7% of cases; 1 patient died of cardiovascular causes, 18 had a repeat PTCA with a success rate of 100%. The clinical restenosis rate of repeat PTCA was 33%. One patient underwent a third PTCA with a successful outcome. Ten coronary bypass procedures were necessary. Restenosis was more common after PTCA of lesions situated on a bifurcation and when high inflation pressures had to be used. Restenosis was constant after repeat PTCA when the initial restenosis occurred before the 60th day.

[Rheumatoid aortic insufficiency. Apropos of a case treated by mechanical valve replacement. Review of the literature]. / Insuffisance aortique rhumatoïde. A propos d'un cas traité par remplacement valvulaire mécanique. Revue de la littérature.

Rheumatoid valve lesions have been described for a long time in the literature. The authors report a case of rheumatoid aortic incompetence presenting with complete heat failure and treated semi-urgently by mechanical valve replacement. The pathological lesions observed on the aortic valves were pathognomonic of rheumatoid arthritis. Transthoracic echocardiography should be systematically proposed in the context of severe rheumatoid arthritis looking for valvular heart disease.

[Contact dermatitis following cardiac pacemaker implantation]. / Dermite de contact après implantation d'un stimulateur cardiaque.

The authors report a case illustrating the causality between the appearance of contact eczema and the implantation of a cardiac pacemaker. To the authors' knowledge, only 11 cases of eczema secondary to the implantation of a pacemaker have been previously reported, all in dermatological journals. In 60% of caes, the lesions were observed over the pacemaker implantation and the appearance of the rash varied from 2 days to 24 months. The causal allergens were mainly the metallic and plastic components. The physiopathological mechanisms, though not completely understood, are related to cellular immunity and therefore, to delayed hypersensitivity reactions. From the therapeutic point of view, locak steroid applications to limited excema lesions have been suggested but recurrence is common. The only effective treatment is removal of the allergen.

[A rare cause of pure isolated chronic aortic insufficiency: congenital quadricuspid aortic valve. Apropos of 2 cases]. / Une cause rare d'insuffisance aortique pure, isolée et chronique: la quadricuspidie aortique congénitale. A propos de deux cas.

The authors report two new cases of congenital quadricuspid aortic valve complicated by pure, severe, chronic, aortic regurgitation. This abnormality was diagnosed fortuitously at transoesophageal echocardiography in one case and at aortography in the other, and confirmed at surgery. This congenital abnormality was associated with superior displacement of the left coronary ostium.

[Infarction in young women caused by intracoronary thrombosis on angiographically normal arteries: apropos of a case]. / Infarctus de la femme jeune par thrombose intracoronaire sur artère angiographiquement normale; à propos d'un cas.

Myocardial infarction is a rare clinical event in young women. The usual presentation is similar to that of older adults. The authors report a case of anteroseptal infarction in a 24 year old woman presenting with paroxysmal epigastric pain without irradiation with fever, during menstruation. The electrocardiogram was compatible with acute pericarditis. The diagnosis was rectified by echocardiography which showed anteroseptal akinesia. Coronary angiography performed as an emergency showed a radiolucent mobile image in the mid segment of the left anterior descending artery with appearances of a distal embolism which were attributed to thrombosis. Intracoronary thrombolysis was associated with a good outcome.

[Anterior mediastinal cyst disclosed by protracted thoracic pain]. / A propos d'un kyste du médiastin antérieur révélé par une douleur thoracique prolongée.

The authors report a case of anterior mediastinal cyst discovered incidentally in a 71-year-old man presenting with prolonged chest pain and a history of chronic renal failure secondary to polycystic kidney disease. The diagnosis of these cysts, which are benign congenital tumours usually asymptomatic and with a favourable course, was established by thoracic CT. In difficult cases, magnetic resonance imaging allows precise analysis of pericardial masses. Clinicians should think of this possibility in the presence of an opacity of the cardiophrenic angle associated with chest pain.