Coronary aorto-ostial stenosis analysed by multislice computed tomography: a new tool for percutaneous coronary intervention?

AIMS: Conventional quantitative coronary angiography approaches are limited to quantify complex aorto-ostial stenosis. Multislice CT was able to detect and classify coronary plaques, compared with intravascular ultrasound (IVUS). The aim of the present study was to determine the accuracy of multislice computed tomography (CT) in addition to conventional angiography to identify aorto-ostial coronary stenosis characteristics before revascularisation. METHODS AND RESULTS: Patients with coronary ostial stenosis were selected for the study. All patients had selective coronary angiography and retrospectively ECG-gated multislice CT (Siemens AG, Munich, Germany). IVUS was performed in patients with ambiguous ostial stenosis revealed by angiography. Forty significant aorto-ostial lesions (38 patients) were analysed by two independent observers in comparison with an expert consensus blinded or not to the coronary CT data sets. Using CT in addition to angiography permitted observers to obtain a strong agreement for assessment of calcified lesions (kappa value 0.75), a good agreement for aortic plaques location and ideal stent position in aorto-ostial coronary stenosis. CONCLUSIONS: This study shows that CT associated with an angiogram allows a better identification of aorto-ostial plaques morphology and ideal stent position in aorto-ostial coronary stenosis before angioplasty.

Reduction in spasm with a long hydrophylic transradial sheath.

OBJECTIVES: We aimed to assess the efficiency of a long hydrophilic sheath in reducing radial spasm for transradial approach. BACKGROUND: Despite a lower access site complication rate, cardiac catheterization using transradial approach is not widely used. Radial spasm is one of the main issues for transradial angiography and percutaneous interventions. We assumed that radial artery protection using a long hydrophilic-coated sheath would reduce radial spasm compared to a bare short sheath. METHODS: Three hundred and fifty one patients (pts) admitted for transradial coronary angiography ± percutaneous coronary interventions were randomly assigned to a long hydrophilic-coated or a short sheath (control group). Primary end point was the occurrence of a radial spasm defined by significant patient pain evaluated by scale score (>4) or significant catheter frictions during manipulation. Procedure failure, radial occlusion, and local complications were also assessed. RESULTS: Radial spasm was significantly reduced when using the long-coated compared to the short sheath in 7 (4%) vs. 32 pts (18%) P < 0.001. No difference was found regarding procedure failure respectively 1.2% vs. 0.6%, local complication 0.6% vs. 1.2%, and radial occlusion 3.5% vs. 3.5%. CONCLUSION: Radial artery protection using the long hydrophilic-coated sheath was efficient in the prevention of radial spasm for transradial approach. © 2010 Wiley-Liss, Inc.

[Cardiac amyloidosis revealing multiple myeloma]. / Amylose cardiaque révélatrice d'un myélome multiple.

INTRODUCTION: Amyloidosis is a rare disease characterized by an extracellular accumulation of a protein polysaccharid complex (Amyloid). Cardiac involvement is considered as a major prognostic factor. OBSERVATIONS: We report the case of two women, hospitalized for heart failure. The diagnosis of cardiac amyloidosis was suggested by echocardiography: Left ventricular concentric hypertrophy and typical amyeloid infiltration with hyperechoic, shiny and granite-like aspect of the interventricular septum. The histological confirmation was obtained by gastric biopsy in the first case and biopsy of the salivary glands in the second revealing an amyloidosis AL. This cardiac amyloidosis was secondary to multiple myeloma: monoclonal Gammopathy with immunoglobulin Lambda in the first and Kappa in the second, and the presence of a plasmocyte infiltration in the sternal puncture. CONCLUSION: Amyloidosis is a rare pathology, the cardiac involvement is frequent in the type AL and can occur with or without clinical manifestations. Echocardiography should be systematic in patients with confirmed amyloidosis.

[Correlation of clinical and angiographic morphology in unstable angina]. / Corrélations cliniques et angiocoronarographiques au cours de l'angor instable.

The goal of this study was to compare the clinical presentation and angiographic morphology of patients having an unstable angina pectoris. A total of 321 patients were consecutively studied and underwent cardiac catheterization, mean age 59 + 6 years. According to Braunwald classification, class III was predominant (58%) On coronary angiography, 148 patients had single vessel disease, double-vessel in 92 and triple-vessel in 64. Morphology of coronary artery lesions was classified according to Ambrose's classification, 100 patients had simple lesions (type I or IIA), 204 patients had complex lesions (type IIB, III, intracoronary thrombus or total occlusion). Thoracic rest pain (class III) or postinfarction angina (class C), were associated with the presence of complex lesions. This subgroup of high risk patients would benefit from either Glycoprotein IIb/IIIa blockers with an early revascularisation strategy.

[Role of low-molecular-weight heparin in acute coronary syndromes]. / Place des héparines de bas poids moléculaire dans les syndromes coronariens aigus.

Looking to their efficiency in the treatment of venous thrombosis and the problems caused by non fractioned heparins (NFH) in the treatment of acute coronary syndromes, several studies were realised to prove the interests of fractioned heparins (FH) as good alternative therapeutics in acute coronary syndromes. A fist attempt, FRISC study, showed that dalteparin was superior to the placebo given in patients receiving aspirin (75 mg daily). In the FRIC study the pursuit of dalteparin between the sixth and the fortieth day, at a low dose, don't give benefits compared to aspirin given simply. Enoxaparin seems to be superior to the NFH in ESSENCE and TIMI IIB studies:--In ESSENCE study witch was included 3171 patients with unstable angina or non Q wave myocardial infarction and all patients received aspirin, enoxaparin compared to NFH reduced significantly the combined risk of death, myocardial infarction, recurrent ischemia and the need of revascularisation. These benefits persisted after a year of the study:--TIMI IIB study realised in 3910 patients confirmed the results of ESSENCE study. Furthermore, their proved efficiency in unstable angina and the non Q wave myocardial infarction, a recent study published this year (2002) concluded that the use of FH, in patients with myocardial infarction and receiving fibrinolytic treatment (streptokinase), was associated of a less frequent major adverse cardiac evenment (MACE) than in patients receiving NFH.

[Sinus node dysfunction in a "healthy heart" in an infant. A case report]. / Dysfonction sinusale à "coeur sain"chez l'enfant. A propos d'un cas.

Sinus node dysfunction (SND) is a rare cause of bradycardia in children without structural heart disease. However the association between (SND) and abnormality of atrio-ventricular conduction, is more uncommon. We report a case of a child 23 months old, admitted in the cardiology department for a symptomatic bradycardia. Routine ECG and 24-h-Holter monitoring showed atrioventricular junctional rhythms with minimal rates of 24 bpm and episodes of asystole with a maximal duration of 3.7 seconds. The children was implanted with a permanent VVIR mode pacemaker to relieve his symptoms. During a follow-up period of four years, the child developed syncope, the epicardial pacing lead was broken and atrioventricular block was observed. A second pacemaker was inserted by a subclavicular vein, and was programmed in VVIR mode.