[Spontaneous dissection of the common trunk and principal branches of the left coronary arterial system. Apropos of a case]. / Dissection spontanée du tronc commun et des principales branches du réseau coronaire gauche. A propos d'un cas.

The authors report the case of a 45 year old woman presenting with inaugural anterior myocardial infarction due to spontaneous dissection of the left main and principal branches of the left coronary arterial system. Two attempts of thrombolysis at a one hour interval were made within 6 hours of the onset of symptoms with signs of reperfusion but the ECG and echocardiography showed anterolateral myocardial infarction. A recurrence of chest pain on the fifth day led to emergency coronary angiography. The extent and severity of the observed lesions led to emergency surgical revascularisation with no post-operative complications. Skin biopsy showed signs of dystrophy of the elastic tissues. Angiographic control ten months after surgery showed complete regression of the lesions, especially those of the left main coronary with, however, occlusion of the second segment of the left anterior descending artery and sequellae of anterior myocardial infarction. Treatment of this type of disease is difficult as the outcome is unpredictable and has to be decided case by case.

[Mitral valve prolapse and spasmophilia in the adult]. / Prolapsus valvulaire mitral et spasmophilie chez l'adulte.

75 cases of mitral valve prolapse (MVP) for which no cause was found underwent electromyography (EMG). In 64 cases (85.3%) EMG showed changes suggestive of spasmophilia. The symptoms observed were those already described in this condition. The specific clinical signs of spasmophilia were often elicited with a positive Chvostek sign in 20 out of 30 cases (73.3%). Radiological, echocardiographical and haemodynamic studies underlined the hyperkinetic state of the left ventricle. Biochemical investigations showed a high incidence of low erythrocytic magnesium levels. Chest pain suggestive of angina pectoris, mitral valve prolapse and spasmophilia are frequently associated. The role of the low erythrocyte magnesium on left ventricular hyperkinesis and the production of MVP is discussed.

[Mitral valve prolapse and spasmophilia in children and adolescents]. / Prolapsus mitral et spasmophilie chez l'enfant et l'adolescent.

71 cases of mitral valve prolapse (MVP) in the child and adolescent with an age range of 3 to 20 years were reviewed. The clinical symptoms, electrocardiography and catheter and angiographic data of this mitral abnormality were analysed. A systematic study of the electrocardiogram showed a tendency to spasmophilia in 68% of cases. The serum calcium, phosphate and magnesium levels were normal in 90 to 95% of patients. A reduced erythrocytic magnesium level seems to have been found in some patients. It is interesting to observe the similarity between the clinical signs in MVP and in spasmophilia. These clinical, biochemical and electrocardiographical results justify the systematic investigation of children and adolescents with MVP, with a view to the diagnosis of spasmophilia.

[Sinus arrest: severe complication of intravenous lidocaine]. / L'arrêt sinusal: complication grave de la lidocaïne intraveineuse

Sinus arrest occured after intravenous administration of Lidocaine in therapeutic disage in a patient with coronary artery disease and sinus node disease. This complication of Lidocaine, though rare (this case is the fourth of the literature), induces to use this drug carefully in patients with sinus node disease. Temporary pacing is recommended if Lidocaine must be used in this group of patients.

[2 cases of respiratory assistance with a membrane oxygenator]. / A propos de deux cas d'assistance respiratoire par oxygénateur à membrane

The authors report two cases of artificial ventilation with the assistance of a membrane oxygenator that was used, on the one hand, in the case of a 'malignant pneumopathy' and, on the other hand, in the case of a cardio-respiratory failure after a complete mending of a tetralogy of Fallot. Recovery was obtained in the second case. They specify the method and the watching of anti-coagulation. They insist upon the merit of a re-injection of oxygenated blood into the ascending aorta. They recall the necessity to lay down instructions according to very strict criteria, by taking into account the degree and the visceral repercussions of hypoxia and the reversibility of lung lesions in so far as it is a matter of a very heavy palliative therapy upon whose efficiency it is difficult to pass a judgment.