[Screening and risk factors of cardiac calcification in hemodialysis: contribution of ultra-fast multi-slice scanner and transthoracic echocardiography]. / Dépistage et facteurs de risque des calcifications cardiaques chez l'hémodialysé : apport du scanner multi-coupe ultra-rapide et de l'échocardiographie transthoracique.

INTRODUCTION: Cardiovascular disease is the first leading cause of death in hemodialysis patients. In this population, cardiovascular calcifications occur at an earlier age and progress faster than in general population. PATIENTS AND METHODS: In order to determine the prevalence and risk factors of cardiac calcifications, 49 patients on chronic hemodialysis were screened in the coronary arteries and cardiac valves by the 64 multi-slice ultra-fast CT and the transthoracic echocardiography. Different clinical and biological parameters were studied by the SPSS 10.0 statistical software to determine risk factors. RESULT: Cardiac calcifications were identified in 81.6% of cases in at least one of the two studied sites. The coronary artery involvement was more common than valvular and concerned 69.4% of cases. The mean Agatston coronary artery calcium score (ACACS) was 331.1 and 522.2 in coronary patients and was correlated to alteration of systolic function of LV (r=-0.287, P=0.045). The severity of CACS was positively correlated with age (r=0.332, P=0.02). Coronary calcifications were associated with cardiovascular risk common to those of the general population (age, male sex, systolic blood pressure, diabetes, history of ischemic heart disease), but also to a lesser quality of dialysis. Valvular calcifications were present in 49% of cases and were correlated with left ventricular hypertrophy (P=0.006). The exclusive involvement of the aortic valve was the most common valvular abnormality. Phosphocalcic and lipid parameters, levels of hemoglobin, CRP and uric acid did not predisposed to cardiac calcifications in our patients. DISCUSSION: In hemodialysis patients, the pathogenesis of cardiovascular calcification is complex and cannot be attributed to a passive process. This process involves several factors that can promote or inhibit calcification. The new multi-slice ultra-fast scanner is a very sensitive method for topographic and quantitative assessment of coronary calcification and is a better alternative to invasive techniques. CONCLUSION: Our study confirms the high prevalence of cardiac calcification in hemodialysis, and highlights the importance of early screening and treatment of predisposing factors.

[Left atrial myxoma: a rare cause of acute occlusion of the aorta. Case report and review of the literature]. / Myxome de l'oreillette gauche : une cause rare d'occlusion aiguë de l'aorte. A propos d'un cas et revue de la littérature.

We present an observation of a 42-year-old patient admitted in urgency for lower limbs weakness followed by paralysis. At physical examination the lower limbs were cold. Pulses of the lower limbs could not be palpated. Color Duplex ultrasonography revealing an embolus occluding both the infrarenal aorta and bilateral iliac arteries. The aortoiliac embolus was removed by balloon endarterectomy through the femoral arteries with evacuation of a transparent, gelatinous embolus followed by extensive fasciotomies. Two-dimensional echocardiography showed a mass in the left atrium. Pathological examination of the material embolic confirmed the diagnosis of the cardiac myxoma. The clinical course was marked by the development of a syndrome of revascularization; death occurred the fourth day of hospitalization. This case highlights the need for pre- and perioperative measures to be taken to overcome hyperkalemia and acute renal failure when revascularizing acute, massive, prolonged ischemia of the lower body.

[Acute myocardial infarction revealing a pheochromocytoma: a case report]. / Infarctus du myocarde révélant un phéochromocytome : à propos d'un cas.

We report a case of a 38-year-old woman with pheochromocytoma admitted to our department for an acute myocardial infarction. The diagnosis of pheochromocytoma was evoked in view of the major pressure variations that appeared secondarily. Pheochromocytoma is mainly medullosurrenal tumour with clinical polymorphism; it can lead to severe cardiovascular disorders. Nevertheless, cardiac involvement is rarely in the foreground. Our clinical case illustrates the importance to evoke the diagnosis of pheochromocytoma in front of atypical manifestations of acute coronary syndrome so as to reduce mortality.