[Severity of aortic ring abscess complicated by cardiac conduction abnormalities]. / Sévérité des endocardites abcédées du manchon aortique compliquées d'anomalies de la conduction.

OBJECTIVE: To determine clinical features, management and prognosis of cardiac conduction abnormalities (CCA) complicating abscessed endocarditis. METHODS: We have analysed clinical, microbiologic and echocardiographic datas, therapies and outcome of cardiac abscesses complicated by CCA in patient hospitalized between 1995 and 2001 in our centre. RESULTS: Above 35 cardiac abscesses, six men (mean age 62 years) had CCA complicating six aortic ring abscesses (4 on native valve and 2 on prosthetic valve) with four cases of interventricular septal involvement and fistulization. Severe heart failure is present four times, a septic cerebral embolization twice. Streptococcus and Staphylococcus prevail. Complete atrioventricular block (AVB) reveals endocarditis twice and complicates the evolution three times. Trifascicular block (first degree AVB, left anterior fascicular block and complete right bundle branch block) revealed recurrence of endocarditis. Two patients were treated medically: one died quickly (complete AVB pre-mortem), and the other one had favourable issue (paroxystic complete AVB). Four patients had surgery with temporary pacemaker in three cases (one died) then definitive pacemaker in two cases. At 26.5 month (7-50), the four survivors had no recurrence of endocarditis. CONCLUSION: Severe CCA are classical in aortic ring abscessed endocarditis and associated with increased mortality. Immediate transfert in a dentre with cardiac surgery is necessary. Definitive cardiac pacing can be performed early without leads infection.

[Isolated pleural amebiasis: about one case in France]. / Amibiase pleurale isolée.

INTRODUCTION: Isolated pleural amebiasis is exceptional in the world and specially in France. CASE REPORT: We report a case of acute isolated pleural amebiasis in a 56 year old man who did not travelled in endemic countries for the 20 past years. Chocolate-colored pus from the pleural puncture suggested the diagnosis. Positive amebic serology and above all, trophozoites (Entamoeba histolytica) in the pleural liquid confirmed the diagnosis of pleural amebiasis. Drainage was required and metronidazole was introduced. Other antibiotics were necessary to treat bacterial co-infection, which is frequent. Of interest, a nurse developed an acute intestinal amebiasis probably infected by pleural pus, an indirect confirmation of diagnosis. CONCLUSION: This diagnosis should be suspected even in low endemic areas in case of infectious pleurisy resistant to traditional antimicrobial regimens.

[Myocardial infarction in a child with an anomalous left coronary artery arising from the right coronary sinus. Value of echocardiography]. / Infarctus du myocarde chez un enfant et anomalie de naissance du tronc coronaire gauche du sinus coronaire droit. Apport de l'échocardiographie.

An anomalous left coronary artery arising from the right sinus of Valsalva with a trajectory between the aorta and the main pulmonary artery is a rare isolated congenital anomaly carrying a high risk of sudden death and of acute myocardial ischaemia, especially in children and young adults in a context of exercise. It is usually a post-mortem finding. The authors report the rare case of a 12 year old child who suffered acute myocardial infarction on exercise due to this condition. The diagnosis was made in the acute phase by echocardiography. Surgical correction was performed as this is the only means of prevention of sudden death of an ischaemic recurrence. Effort syndromes in children or young adults should lead to a request for echocardiographic examination to exclude the diagnosis in a non-invasive manner as well as those of hypertrophic cardiomyopathy or congenital aortic stenosis.