[Sirolimus eluting sent in the prevention of restenosis in small coronary arteries]

Angioplasty of coronary arteries with a small diameter [commonly defined as diameter inferior than 2.75 mm] is associated with a high rate of restenosis and revascularization. Since the use of Drug Eluting Stents [DES] and considering their good results on simple lesions compared to other techniques [balloon dilation and bare metal stents], many studies have also demonstrated the superiority of DES in reducing restenosis and revascularization of complex lesions in particular lesions on coronary arteries with small diameter. Assessement of this revascularization procedure. Our study is a prospective one carried on between june 2002 and august 2006, involving a cohort of 299 patients. Patients are divided into 2 groups: group I: 175 patients with 220 lesions on coronary arteries with small diameter treated by 233 sirolimus DES [Cypher] and group II: 124 patients treated by 136 angioplasty of coronary arteries with diameter superior than 2.75 mm using 179 DES. During hospitalisation, there was no significant difference in MACE between the 2 groups. Nevertheless: 2 patients among the first group had no angioplasty because of unsuccessful progression of the balloon through the lesion and the absence of atherectomy in our center. All patients having acute thrombosis during hospitalization and presenting with ST elevated acute coronary syndrom had successful urgent revascularization with TIMI 3 flow. The mid-term follow-up [12 months] concerned 157/174 patients in group land 113/123 patients in group II. We observed a higher mortality and non fatal myocardial infarction in group I without statistically significant difference. despite the complexity of the lesions on coronary arteries with small diameter and despite the association with several risk factors in particular diabetes, the use of DES reduces the MACE specially secondary revascularisations thus improving early and midterm prognosis

[Overview on the management of vasovagal syncope]

Prerequis: Vasovagal syncope [VVS] is the most common type of syncope. Despite its benignity, quality of life may be severely affected in a significant proportion of highly symptomatic patients

Aim was to review achral knowledgement concerning vasovagal syncope, to assess the utility of diagnostic investigation and report the updat therapeutic management

Methods: An electronic search of the relevant literature was carried out using medline. Key words used for the final search were "Vasovagal syncoe" "pathophysiology" "diagnosis" "tilt-table testing", "imlantableloop recorder", "treatment", "tilt training", isometric muscle tensing", "cardic pacing"

Results: A typical history of VVS is usually sufficient to make the diagnosis without any additional testing. Further testing is required when the diagnosis remains uncertain. Approaches to treatemtn are largely empirical and this is due to our lack of understanding of the pathopysiology. The management of VVS is often limited to reassuring and advising how to avoid predisposing factors with behaviour modification. For patients with recurrent episodes of syncope and premonitory symptoms, a conservative nondrug approach such a isometric muscle tensing should be considered. Tilt training can also be considered first-line therapy in motivated patients. Nevertheless, if patients still experience sudden reccurrent and unpredictable episodes of syncoep, a more aggressive treatment strategy is required with need of a prophylactic pharmacologic therapy. Various forms of medical treatment have been proposed but there are limited data from randomized controlled trials to support their effectiveness. The role of cardiac pacing is controversial and its indication should be restricted to patients over the age of 40 with severe recurrent syncope that is refractory to other therapies and in whom episodes include a substantial bradycardic component

Chronic heart failure: place of œchocardiographie-doppler in the evaluation of the risk of mortality

Chronic heart failure [CHF] is a major cause of morbidity and mortality. Despite recent improvements in the management of this condition, the overall prognosis remains poor. Echocardiography is the most useful test in the evaluation of systolic and diastolic function and has also a prognostic value. The aim of this study is to determine echocardiographic predictors of mortality in patients with CHF. We followed 100 patients with a diagnosis of CHF over an average period of 44 +/- 40.5 months. We compared echocardiographic parameters in survivors and non survivors. Four variables predicted death: LVEF <35% [p=0.001], TDE <150ms [p=0.001], E/A ratio >2 [p=0.05] and E/Ea ratio >10 [p=0.008]. Doppler echocardiography has a central role in the evaluation of patients with CHF. It provides valuable prognostic information by combination of several parameters

[Cor triatrium sinister sinister symptom free in adulthood]

Cor triatrium sinister is a rare congenital disease [0,1% of cases of congenital heart disease]. Cor triatrium is recognized by the finding of an abnormal fibromuscular membrane that subdivise the left atrium into posterosuperior and anteroinferor chambers. This anomaly creates an obstacle to the venous pulmonary flow. Depending on the severity of obstruction, cor triatrium may be symptomatic in childhood but it can be symtom free even in adulthood. Diagnosis of this abnormality has been easy supported by transthoracic and transoesophageal echocardiography. Treatment is easy to perform and consists in surgical definitive correction in symptomatic patients. We report a case of a 31-year-old man in whom a non obstructive cor triatrium was discovered while evaluation for an atrial fibrillation secondary to a hyperthyroidism. According to this rare case we try to evaluate the severity and the outcome of this disease relating the literature data

[Which place for VDD mode single electrode pacemaker?]

VDD mode single electrode pacemaker is a technique of cardiac stimulation which preserves auriculo-ventricular synchronism using a single electrode. Its importance has decreased because of the numerous satisfactions previous by the DDD mode. We describe our experience with this mode and we discuss the advantages, limits and indications of this mode of cardiac stimulation

[Homocysteinaemia and degenerative complications in non insulin dependent diabetes mellitus]

Type 2 diabetes mellitus [non insulin-dependent diabetes mellitus: NIDDM] is known to be associated with degenerative complications. Although, the pathophysiology of such complications is well known, the role of homocysteine [Hey] is still discussed.The aim of the present study was to evaluate the relationship between the homocysteine levels and the NIDDM related complications in a group of NIDDM patients. Our study population consisted of 41 NIDDM patients including 13 subjects [G1] without complications [group controls], 17 patients [G2] with microangiopathy and 11 patients [G3] with coronary deficiency. Plasmatic homocysteine, glycemia, glycated haemoglobin [HbAIC] and lipid parameters were assessed in all patients. Our results showed that mean levels of plasmatic homocysteine were within the normal range [10.4 +/- 3.3 micro mol/l, 9.9 +/- 5.5 micro mol/l and 14.8 +/- 10.4 micro mol/l in G1, G2 and G3 respectively]. Nevertheless, moderate hyperhomocysteinaemia was found in 36% in the coronary group [G3], 17.3% in patients with microangiopathy [G2] and 7.7% in controls.These preliminary results showed that cardiovascular complications in NIDDM patients may be related to high levels of homocysteine

torsade de pointes a couplage court: Notre experience et revue de la litterature.

We present three cases of short-coupled variant of torsade de pointes with review of the literature. These women presented with syncope or presyncope due to torsade de pointes initiated by a short-coupled premature ventricular beat and without evidence of prolonged QT. There were no electrolyte disturbances in all cases, no apparent structural heart disease in two cases and a mild interventricular septum hypertrophy in the other case. One patient took spiramycin and metro nidazole and another was taking pheniramin and lincomycin without any evidence of cause to effect relationship. One patient responded to verapamil but died suddendly after 44 months of follow-up. The two others. Received implantable cardioverter-defibrillators and verapamil per os. They still alive 46 and 54 months later. Short-coupled variant of torsade de pointes have a high incidence of sudden death, so it is very important for physicians to identify and treat it promptly, long-term verapamil treatement is effective but still insufficient and patients should be considered for implantable cardioverter-defibrillator therapy

Contraced endocardial fibroelastosis in childhood: about one case

Endocardial fibroelastosis is un uncommon diseases and it has a very bad prognosis since fatal evolution is usual before 2 years old. We report the case of a 20 years old woman who is affected with the contracted form of this disease associated with atrial septal defect [ASD] and mitral regurgitation. This disease was discovered by endocardial biopsy when she was 4 years old and underwent surgical resection of endocardial fibrosis, a path on the ASD and mitral valve replacement. She was rehospitalised 15 years later with heart failure although continuous digitoxin therapy