[Focal junctional tachycardia in adults. Anatomo-electrophysiological aspects apropos of a case]. / Tachycardie jonctionnelle focale de l'adulte. Confrontation anatomo-électrophysiologique à propos d'un cas.

The authors report the case of a 65 year old patient with focal junctional tachycardia complicating infectious myocarditis which had a fatal outcome. The ECG recordings showed episodes of tachycardia alternating with junctional rhythm at 90/min. There were signs of retrograde conduction. The anatomopathological findings were typical of acquired myocarditic lesions in the lower part of the atrioventricular node with congenital abnormalities, in particular a bifid node and His bundle with an accessory paraseptal atrioventricular bundle. This is the first description, to the best of the authors's knowledge, of junctional tachycardia associated with a latent pre-excitation.

[A rare cause of obstruction of mitral valve prosthesis: periannular fibrosis. Diagnostic by transesophageal echocardiography]. / Une cause rare d'obstruction de prothèse valvulaire mitrale: le pannus fibreux périannulaire. Diagnostic par échocardiographie transoesophagienne.

The authors report a case of dysfunction of a double hemi-disc mitral valve prosthesis due to peri-annular fibrous overgrowth on the atrial side of the prosthesis. Conventional transthoracic Doppler echocardiography showed signs of thrombosis of the prosthesis. Transoesophageal echocardiography allowed a precise diagnosis of the lesions, resulting in immediate surgical referral.

[Early reocclusion after in situ coronary desobstruction either with streptokinase or angioplasty during the acute phase of myocardial infarction]. / Réocclusion précoce après désobstruction coronarienne in situ soit par streptokinase soit par angioplastie à la phase aiguë de l'infarctus du myocarde.

The aim of this study was to assess the incidence of early reocclusion after therapeutic reperfusion of coronary arteries in acute myocardial infarction. Seventy four patients underwent intracoronary thrombolysis and 133 patients had immediate coronary angioplasty. The success rates were 70 per cent and 86 per cent respectively (p less than 0.01) and the degree of residual stenosis was 77 +/- 13 percent and 25 +/- 15 per cent respectively (p less than 0.001). The patients in whom coronary reperfusion was successful, 52 after in situ thrombolysis, 48 after angioplasty alone, and 66 after combined angioplasty and intravenous thrombolysis, underwent coronary arteriography 24 to 36 hours later. Reocclusion was asymptomatic in 46 per cent of cases (13/28) and its prevalence was 16.9 per cent: 25.5 per cent for the right coronary compared with 12.8 per cent for the left anterior descending (p less than 0.05) and 11.7 per cent for the left circumflex artery; reocclusion occurred in 8.6 per cent of patients treated before the 3rd hour compared with 22.9 per cent of patients receiving treatment after the 3rd hour (p less than 0.05). The incidence of reocclusion was 17.3 per cent after intracoronary thrombolysis and 16.7 per cent after angioplasty (angioplasty alone 18.7 per cent; associated with thrombolysis 15.2%). The degree of residual stenosis was nil after intracoronary thrombolysis and 16.3 per cent after angioplasty when the stenosis was insignificant, and 20.5 per cent and 18.8 per cent respectively with stenotic lesions greater than 50 per cent.