[Late outlet strut fracture of an aortic Björk-Shiley and embolization of the prosthetic disc]. / Fracture tardive de montant externe d'une valve de Björk-Shiley en position aortique et embolie du disque prothétique.

A new case of late fracture of an outlet strut in a convexo-concave Björk-Shiley valve is reported. The fracture occurred 6 years after aortic implantation of the valve and was responsible for aorto-iliac embolization by the prosthetic disc and death of the patient from cardiogenic shock. This not uncommon complication of the Björk-Shiley valve prosthesis is usually ascribed to the relative fragility of its outlet strut welded to the metallic ring and subjected to strong pressures. Although most cases were observed within the first two years of prosthetic valve insertion, and mainly with valves manufactured in 1981 and 1982, our case and a few others demonstrate the possibility of late rupture. Cardiologists must be aware of this possible complication, since in some favourable cases it can be diagnosed at an early stage and the patient's life can be saved by an emergency operation.

[Arterial hypertension in black patients]. / L'hypertension artérielle du sujet noir.

Arterial hypertension in blacks seems to present a few peculiarities in comparison to that of caucasians, whether it is from the epidemiological point of view: greater frequency of the disease, more severe prognosis; from the physiopathological point of view with especially a definite prevalence of HBP with low renin and inflation of the plasma volume and increased tendency to sodium retention, or finally from the therapeutic point of view, since randomized studies have demonstrated that black patients respond better to diuretics than to beta-blockers. Currently, it is impossible to explain these differences in a simple fashion: is it a genetic factor or, on the contrary, environmental factors? Perhaps the response lies between those two extremes.