[Coronary arteriography in severe aortic valve disease]

Three hundred and twelve patients with severe aortic valve disease underwent a pre-operative haemodynamic study including coronary arteriography either as routine [age more than 50 years] or because of chest pains, previous myocardial infarction or for patients with risk factors of coronary ath‚rosclerosis. Significant coronary artery disease was present in 9% of all cases. Coronary artery disease was more frequent in patients with angina and in patients with previous myocardial infarction but none of these factors was specific. We conclude that except young patients <40 years old, with no chest pain and no coronary risk factors, coronary arteriography is recommended in patients with severe aortic valve disease before aortic valve replacement

[Percutaneous mitral commissurotomy and left ventricular function in severe mitral stenosis]

The purpose of this study was to determine the immediate effect of percutaneous mitral commissurotomy [PMC] on left ventricular [LV] performance. We studied 30 patients with severe mitral stenosis undergoing successful PMC by cardiac catheterization and angiography before and 5 minutes after PMC. All patients were in sinus rhythm and no patient had hypertention or clinical coronary artery desease. We conclude that the left ventricular end-diastolic volume and the stroke volume increased significatively immediately after PMC because of and increase in LV filling after relieving the mitral mechanical obstruction

[Pulmonary hypertension in heterozygous sickle hemoglobinopathy about one case]

We report the case of a 33- years-girl with SCA and severe PH. She developed six month before admission, non productive couph and dyspnea. Physical examination at admission revealed shortness of breath and right heart ventricular failure. Electrocardiography showed sinus rhythm and an incomplete left bundle branch block. Chest roentgenography revealed cardiomegaly with cardiothoracic index at 0.66 and pulmonary infiltrates. Laboratory tests revealed an anemia with hemoglobin of 7,1 g/dl, white blood cell count of 12500/mm, moderate renal failure [cretininemia=178 micromol/l] and hypoxemia with oxygen pressure of 60 mmHg. Hemoglobin electrophoresis revealed an heterozygous SCA. Echocardiography revealed dilatation of right heart cavities and a systolic pulmonary artery pressure of 60 mmHg. A perfusion lung scintigraphy demonstrated multiple subsegmental perfusion defects. PH is a common complication of adult patients with SCA. Appropriate therapies and strategies for prevention of PH in SCA are unkown. Further research exploring therapies such as oxygen, nitric oxide, prostacyclin and hydroxyurea are indicated