ABSTRACT
INTRODUCTION: There is little information on the frequency, physiopathology and management of extra-cerebral manifestations of N. meningitidis meningitis. Articular, pleural and pericardial involvement is occasionally reported with a symptomatology that can be delayed with regard to the initial diagnosis. OBSERVATIONS: In two patients in whom the diagnosis of meningococcal meningitis had been confirmed, the progression was towards a recurrent pericarditis up until the 4th month after the initial episode of infection in the first case and pericarditis with tamponade and surgical draining in the second. However, the final outcome was favourable for both patients following treatment with non-steroidal anti-inflammatories (NSAIs). COMMENTS: The incidence of pericardial involvement is unknown. The distinction has to be made between purulent pericarditis, more frequent in children, and the inflammatory pericarditis that is often of late onset. The indication for surgical draining must be dominated by the clinical hemodynamic impact. The indication for NSAIs and/or acetyl-salicylic acid is not codified (doses, duration), but in the two cases reported here we would privilege NSAIs.
Subject(s)
Meningitis, Meningococcal/complications , Pericarditis/etiology , Pericarditis/pathology , Adolescent , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Disease Progression , Drainage , Female , Humans , Male , Middle Aged , Pericarditis/microbiology , Recurrence , Treatment OutcomeABSTRACT
Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital abnormality with a poor prognosis in the newborn. Adult forms are, therefore, very rare, presenting with angina, cardiac failure or sudden death. The authors report the case of a 41 year old woman who was asymptomatic until admitted as an emergency after ventricular fibrillation. Coronary angiography established the diagnosis. Despite the absence of reversible ischaemia on exercise myocardial scintigraphy, the patient underwent coronary bypass surgery of the left anterior descending artery with a pediculated internal mammary artery graft and closure of the left coronary ostium on the pulmonary artery. The echocardiographic abnormalities regressed within a few weeks. An automatic defibrillator was not implanted. The physiopathology of this rare cardiac lesion, the mechanisms of sudden death and the different techniques of surgical repair are discussed.
Subject(s)
Abnormalities, Multiple/diagnosis , Coronary Vessel Anomalies/complications , Death, Sudden/etiology , Pulmonary Artery/abnormalities , Adult , Female , HumansABSTRACT
BACKGROUND AND AIM OF THE STUDY: Few long-term data are available on the Carpentier-Edwards Standard bioprosthesis in the mitral position. As for other bioprostheses, patient age at the time of implant is the main risk factor for structural deterioration, but no published report has analyzed the life-span of these bioprostheses with respect to this parameter. METHODS: A series of 139 patients who underwent mitral valve replacement with the Carpentier-Edwards Standard bioprosthesis between 1978 and 1987 was reviewed. Mean age at implant was 59.6+/-14.7 years (range: 17-79 years). Follow up was 98.4% complete; total follow up was 1,078.7 patient-years (pt-yr) (mean 8.4+/-4.1 years). Mean follow up in the subgroup of patients alive at the time of the survey was 10.4+/-3.4 years. RESULTS: Structural valve deterioration (SVD) occurred in 30 patients, with mean time to onset of deterioration 9.0+/-2.7 years (median 8.7 years). This time was independent of age at the time of implantation. Analysis by age group (< or =35, 36-50, 51-60, 61-65, 66-70, >70 years) showed deterioration to be more frequent in younger subjects (linear rates 7.9, 6.0, 3.3, 2.4, 0.6 and 0.4% pt-yr, respectively). Over the age of 65 years, the risk of SVD no longer varied with age, and was a rare complication. CONCLUSION: The mean time to onset of SVD was independent of patient age at the time of implant. After 65 years, the risk of SVD was low, without any significant variation. The Carpentier-Edwards Standard bioprosthesis may be used in the mitral position in subjects aged over 65 years, and with a low risk of deterioration.
