[Tolerance and prognostic value of Thallium 201 myocardial tomoscintigraphy with dipyridamole in the aged subject]. / Tolérance et valeur pronostique de la tomoscintigraphie myocardique au thallium 201 sous dipyridamole chez le sujet âgé.

The authors present a retrospective study of 46 consecutive patients aged from 70 to 79 years (mean 73.3 +/- 2.5 years) with suspected coronary artery disease who, being unfit for exercise tests, were explored by myocardial scintigraphy with thallium 201 after coronary dilatation with intravenous dipyridamole. The examination was well tolerated by 30 patients. Such classical side-effects as chest pain, malaise, dizziness, headache, flushing, vomiting and transient arrhythmia or repolarization disorders were recorded, but they were not more frequent than in younger subjects. However, the occurrence of severe hypotensive malaise relieved by theophylline in two cases and of angina in about one third of patients with myocardial ischaemia means that the procedure must be performed under close supervision. A fall in blood pressure (-11 mmHg on average) and a rise in heart rate (+8 beats/min on average) were usual. Post-scintigraphy follow-up of patients over a mean period of 11.1 +/- 6.2 months showed that a reversible defect of thallium 201 uptake, due to redistribution, is a highly selective indicator of patients who are particularly exposed to a cardiac accident in the short--or mid-term. Only one out of 26 patients without reversible ischaemia (4 p. 100) subsequently presented with a major coronary event (unstable angina). In contrast, in the group of 20 patients with reversible ischaemia three required early myocardial revascularization; furthermore, five serious accidents (29 p. 100) occurred among the 17 patients who were left under medical treatment, including two sudden deaths, two cases of unstable angina and one case of myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Unruptured aneurysms of the sinus of Valsalva disclosed by syncopal disorders of cardiac excitability. Apropos of 2 cases]. / Anévrysmes du sinus de Valsalva non rompus révélés par des troubles de l'excitabilité cardiaque syncopaux. A propos de deux observations.

Aneurysms of the sinus of Valsalva are rarely diagnosed before rupture into the cardiac cavities which usually leads to the appearance of a continuous murmur and cardiac failure. In the two cases described, the presenting symptom of the aneurysm was syncope due to cardiac hyperexcitability: ventricular tachycardia in the first and paroxysmal tachyarrhythmia in the second case. The presenting symptoms of unruptured aneurysms of the sinus of Valsalva were analysed. In general, they are: uncontinuous cardiac murmurs: either diastolic murmurs of aortic regurgitation, systolic murmurs of mitral or tricuspid regurgitation, or, as in our first case, of obstruction to right ventricular ejection; arrhythmias: the commonest are conduction defects, which can be syncopal; hyperexcitability (especially ventricular) seems to be very care. Echocardiography is a valuable tool for the diagnosis of sinus of Valsalva aneurysms. The appearances of unruptured aneurysms in our two patients are described. The presence of syncopal cardiac hyperexcitability, possibly associated with one of the preceding auscultatory abnormalities is an indication for echocardiography which may lead to the diagnosis of this condition.

[Congenital paravertebral arteriovenous fistulae in children and adolescents]. / Fistules artério-veineuses paravertébrales congénitales de l'enfant et de l'adolescent.

These arteriovenous fistulae (AVF) situated in the paravertebral area present as a murmur which explains their cardiological orientation. They are characterised by the presence of one or more afferent paravertebral arteries giving rise to collateral vessels irrigating the bone marrow. The aim of this study of 13 cases was to study the diagnostic and therapeutic problems, and the evolution of this particular localisation of AVF. Two groups of paravertebral AVF were individualised: - Cervical AVF in which the vertebral artery was always involved (7 cases). Four were simple (only one fistula) and three were complex, having several afferent arteries. Two presented as a rapidly growing vascular tumour. Two caused an asymptomatic angiographic vertebral steal syndrome. Two simple forms were obturated by a detachable balloon and one by surgical excision. Two complex forms were treated by embolisation and surgery. Total closure of the AVF was obtained in all cases without complications. - Dorso-lumbar AVF (6 cases). The afferent vessels are the intercostal (D6 to D8) or lumbar (L2 to L4) arteries. Anatomically, these are extra-medullary fistulae with an extra or intra-vertebral venous drainage. Enlargement in an adjacent conjugating foramen forms a tumour which may narrow the spinal canal (1 case diagnosed by CAT) or erode the vertebral body, so compromising the spinal support. Spontaneous closure of the AVF was observed in 1 case. Three cases were treated surgically with good results; two patients are waiting for embolisation. A review of the literature provides complementary information on the long-term evolution of these AVF and confirms the need for systematic therapy as demonstrated in our study.(ABSTRACT TRUNCATED AT 250 WORDS)

[Right coronary-cardiac fistulae. Anatomic and clinical study, course and therapy. Apropos of 3 new cases]. / Les fistules coronaro-cardiaques droites. Etude anatomo-clinique evolutive et thérapeutique. A propos de trois nouveaux cas.

Three cases of coronary-cardiac fistulae diagnosed in the Cardiologic Unit of the Dijon University Hospital are reported. With reference to these cases current knowledge on this rare condition is reviewed. Symptomatology is variable, with sometimes only a systolic and diastolic murmur on the sternal border, usually with good functional tolerance. A thorough investigation, including left angiography, ascertains diagnosis and shows the exact nature of the lesions. Surgery is almost always advocated as it often ensures good results and avoids delayed complications, which are mainly heart failure by coronary insufficiency, and infectious endocarditis.

[Aortic insufficiency associated with ventricular septal defect and a coronary-right ventricle fistula after bacterial endocarditis: surgical correction of 3 lesions]. / Insuffisance aortique associée à une communication interventriculaire et à un fistule coronaro-cavitaire droite au décours d'une endocardite bactérienne: correction chirurgicale des trois lésions.

The authors report a case of Staph-aureus endocarditis on preexisting aortic incompetence. Two complications were observed during the course of the infection: ventricular septal defect, rare but classical, and coronary-right ventricular fistula, a complication not previously described to the best of the author's knowledge. Before the onset of endocarditis a continuous murmur had not been detected clinically or by phonocardiography. This sign appeared while the patient was receiving effective antibiotic therapy. The diagnosis, suggested by the clinical signs in a patient in cardiac failure, was confirmed by catheterisation. This type of complication, already described in peripheral vessels, may be understood when the extent of the lesions at the right coronary cusp, near the septum and right coronary ostium, are appreciated. A good surgical result was obtained due to early operation of the three lesions.