[Aneurysm of the sinistro-anterior sinus of Valsalva causing coronary insufficiency. Apropos of a case]. / Anévrysme du sinus de Valsalva antéro-gauche responsable d'une insuffisance coronaire. A propos d'un cas.

The aneurysm of the sinistro-anterior sinus of Valsalva (ASASV) can very rarely be disclosed by symptoms of coronary insufficiency. The authors report the case of a 73 old man suffering from unstable angina pectoris, in whom the diagnosis of ASASV was evoked by two-dimensional echocardiography and confirmed by aortography. Coronary angiography revealed an external compression of IVA by the ASASV and allowed to exclude the presence of associated autonomous coronaropathy. The interest of this observation lies in the fact that the preoperative diagnosis was made after the two-dimensional echocardiography allowing the evaluation of the importance and volume of the ASASV. Aortography and coronary angiography are indispensable procedures in the presence of chest pain suspect of coronary insufficiency. These investigations will guide the surgical treatment which should always associate a closure of the aneurysmal neck, an aortic valvular replacement and a bypass of the compressed coronary artery.

[Myocardiopathies and tricyclic antidepressants. Apropos of 3 cases]. / Myocardiopathies et antidépresseurs tricycliques. A propos de 3 cas.

The authors report three cases of cardiac failure induced or aggravated by chronic tricyclic antidepressant therapy. Tricyclic antidepressants have a negative inotropic effect both when administered acutely or chronically in animals. This action is related to plasma concentrations. However, the association of chronic tricyclic antidepressant therapy and cardiac failure is rare. The implication of these drugs in the cause of cardiac failure requires: --improvement of cardiac failure on withdrawal of therapy, as observed in our three cases; --the presence of underlying cardiac disease, as was the case in our patients; --abnormally high plasma levels of the antidepressant drugs despite normal dosage, as was verified in two of our patients. The measurement of plasma concentrations of antidepressant drugs would seem to be necessary when this form of treatment is to be administered to patients predisposed to cardiac failure.

[Systemic embolism and aortic atheroma. Contribution of transesophageal echography. Apropos of a case of systemic embolism caused by cholesterol crystals]. / Embolie systémique et athérome aortique. Apport de l'échographie transoesophagienne. A propos d'un cas d'embolie systémique de cristaux de cholestérol.

Systemic embolisms involving cholesterol crystals sometimes occur following vascular catheterization and may be responsible for a variety of clinical signs. The authors report a case in which the etiological diagnosis included a transesophageal echography (TEE) which revealed atheromatous plaques on the thoracic aorta which were probably responsible for the projections. It is possible that episodes of embolism, either fibrinocruoric or due to the release of cholesterol crystals, arising from the thoracic aorta, have hitherto been underestimated by imaging methods such as scans and angiographs. Further studies with TEE may make it possible to estimate the extent of this disorder.