Subclinical right ventricular dysfunction in patients with mitral stenosis.

BACKGROUND: Right ventricular (RV) dysfunction is a strong predictor of poor outcomes of patients with mitral stenosis (MS). The aim of this study was to detect a subclinical right ventricular dysfunction in patients with MS. METHODS: We conducted a prospective study from January 2015 to June 2019 in 104 asymptomatic patients with MS (mean age: 46.1 ± 4.27 years), and compared to a group of 52 age and sex matched healthy subjects. Standard and speckle tracking echocardiography were performed; parameters of RV function were measured and compared. RESULTS: Although they were in normal range, RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler and pulsed wave Doppler RV myocardial performance index (MPI) and peak systolic velocity (S') were decreased in patients with MS (p < 0.05). The global RV longitudinal strain (LSGRV) and the longitudinal strain of the free wall of the right ventricular (LSFRV) were lower in patients with MS (p, respectively, at 0.001 and < 0.001), 53.5% (n = 47) of patients had LSFRV < - 20%. A significant difference was noted between LSFRV and 2D strain of the septal wall (p = 0.002). No difference was found between patients with severe MS and moderate MS regarding LSFRV and LSGRV. No correlation between LSFRV and FAC (p = 0.85), MPI (p = 0.62), TAPSE (p = 0.31) and S' (p = 0.78) was found. CONCLUSION: Our study showed the presence of subclinical systolic dysfunction of the right ventricle in patients with MS.

[Right ventricular function after a first episode of pulmonary embolism: Contribution of longitudinal 2D strain]. / Fonction ventriculaire droite après un premier épisode d'embolie pulmonaire : apport du strain 2D.

BACKGROUND: Analysis of right ventricular (RV) function during the acute phase of pulmonary embolism (PE) was widely reported in the literature. However, few studies analysed its function long term after the acute phase. Our aim was to evaluate the RV function long term after a first episode of PE. METHODS: In this study, we compared echocardiographic parameters of right ventricular function in 25 patients with a first episode of non-severe PE for more than six months with 25 healthy controls subject. RESULTS: In the study of RV function, we noted that the mean values of the standard parameters were significantly lower in the EP group compared to the control group but their values remained within the normal range. The global RV longitudinal strain had a mean value lower than the control group statistically significant (-21±4,8% vs. -25±2,4%; P=0,28). The longitudinal strain of the free wall of the RV was altered in the EP group, however, there was no significant difference between the EP group and the control group (-19,4±16% vs. -24±17%; P=0,28). CONCLUSION: This study has shown that there is a systolic dysfunction late after a first episode of PE and this despite the absence of the symptoms and pulmonary hypertension.

[Vitamin C+sodium bicarbonate versus sodium bicarbonate alone in preventing contrast-induced nephropathy]. / Vitamine C+sérum bicarbonaté versus sérum bicarbonaté seul dans la prévention de la néphropathie induite par les produits de contraste.

INTRODUCTION: Contrast-induced nephropathy (CIN) is a common and severe complication in interventional cardiology. OBJECTIVE: The aim of our study was to compare the incidence of contrast-induced nephropathy in two accelerated hydration protocols: the first one by the serum bicarbonate and the second combining the serum bicarbonate and oral vitamin C. METHODS: This is a multicenter prospective, randomized study conducted between October 2012 and May 2013, including 160 patients. RESULTS: The mean age of our study population was 60.8±9.3 years (36-83 years). The two study groups were comparable in terms of cardiovascular risk factors, concomitant medication, and baseline serum creatinine. The CIN incidence was 6.3% in the vitamin C group and 10% in the control group (P=0.38). No significant difference was observed in terms of CIN incidence between the different subgroups analyzed. CONCLUSION: According to our study, ascorbic acid administered orally as part of an accelerated hydration protocol does not reduce the incidence of CIN.

[Endo arterial investigation: suspicious for the cholesterol crystal embolism disease]. / Explorations endo-arterielles: se mefier de la maladie des embols de cholesterol!!

BACKGROUND: Cholesterol crystal embolism (CCE) is a rare disorder which can complicate cardiac catheterization, angiographic studies and cardiovascular surgery. The CCE exposes to a great risk of renal failure and it can even threaten life by means of a multi visceral failing syndrome. AIM: Report a new case of CCE following cardiac catheterization. CASE: We report the observation of a 63-year-old patient who had a coronary angiography via the right femoral artery after a myocardial infarction. This examination has showed a multi-vessel coronary disease. 15 days later, the patient presented purplish and painful discoloration of his toes. The laboratory findings showed a mild inflammatory syndrome and eosinophilia at 700 / microL. There was not a renal dysfunction nor proteinuria nor hematuria. We performed a skin biopsy and made the diagnosis of CCE. Trans oesophageal echography objectified an irregular atherosclerotic plaque in the isthmic aorta. The CT scan revealed a spindle-shaped aneurysm in the end of the abdominal aorta. This aneurysm contains a marginal surrounding thrombosis with high embolic risk. The patient was put under clopidogrel, enoxaparin, simvastatin, colchicine and atenolol and operated successfully. CONCLUSION: The two particularities of this observation are, on one hand, the absence of a renal involvement, which represents the main prognostic factor of the CCE. On the other hand, the CCE has revealed a very unstable aneurysm of the aorta which could be complicated during the cardiac catheterisation. The CCE is a difficult diagnosis that must be remembered before any cardiac catheterisation, because it often reflects unstable aortic atherosclerotic lesions.

[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.

[Mitral stenosis secondary to Hurler's syndrome]. / Rétrécissement mitral secondaire à un syndrome de Hurler.

Valvular disease in mucopolysaccharidosis type I-Hurler (MPS/1H) is relatively common, but mitral stenosis is very rare in this genetic abnormality. The authors describe the case of a 16-year old girl with Hurler's syndrome diagnosed at 4 years of age. The morphological features were characteristic: bridged nose, thickened lips, macroglassia, short neck (gargoylism, short, thick fingers and limitation of brachial and fore-arm flexion. She presented with stage II dyspnoea and paroxysmal nocturnal dyspnoea. Radiological and echocardiographic studies revealed severe mitral stenosis with haemodynamic complications requiring mitral valve replacement. Anatomopathological analysis of the mitral valve confirmed mucopolysaccharide deposits as the cause of this particular case of mitral stenosis.

[Atrial fibrillation]. / Fibrillation auriculaire.

The aim of transesophageal echocardiography (TOE) in atrial fibrillation milieu is to search a cardiac chamber thrombus. In order to establish the indications of TOE and to raise new issues for the echographic prognosis of maintain of sinus rhythm, 40 patients with atrial fibrillation who underwent cardioversion were prospectively screened. All patients had transthoracic and transesophageal echocardiography before procedure to control the absence or disappearing of atrial thrombus (N = 7). All 40 patients underwent a successful cardioversion. Follow-up was done after one, three and six months for both success group (N = 28) and refibrillation group (N = 12). Our study provides evidence that the only predictive echographic factor of maintain of a good result (sinus rhythm) after cardioversion was a systolic velocity peak > 0.25 metir/sec.

[Infectious enterococcal endocarditis associated with Laubry and Pezzi syndrome]. / Endocardite infectieuse a enterocoque sur syndrome de Laubry et Pezzi.

Laubry and Pezzi syndrome is a rare but serious complication of ventricular septal defect that increase the infectious endocarditis risk. Authors report a case of an 18 years old young girl presenting an enterococcus infectious endocarditis associated to Laubry and Pezzi syndrome. Initial course is not favourable requiring a surgical treatment in the acute stage. Bacterial endocarditis combined with Laubry and Pezzi syndrome have a poor prognosis needing observation and strict preventive precautions when a favoring factor is present.

[Contracted endocardial fibroelastosis in children: report of a case]. / La fibroelastose endocardique contractée de l'enfant: a propos d'un cas.

Endocardial fibroelastosis is un uncommon disease and it has a very bad prognosis since fatal evolution is usual before 2 years old. We report the case of a 20 years old woman who is affected with the contracted form of this disease associated with atrial septal defect (ASD) and mitral regurgitation. This disease was discovered by endocardial biopsy when she was 4 years old and underwent surgical resection of endocardial fibrosis, a patch on the ASD and mitral valve replacement. She was rehospitalised 15 years later with heart failure although continuous digitoxin therapy.

[Postpartum myocardial infarct (apropos of a case)]. / Infarctus du myocarde du post-partum (a propos d'un cas).

We report the case of a 26 years old woman, who was hospitalized for an acute anterior myocardial infarction, which happened 17 days after delivery. The culprit lesion was a coronary dissection observed on the coronary angiogram which was performed on the 7th day. This dissection cicatrised spontaneously at the control coronarography performed 3 months later. Conventional medical treatment seems to be sufficient, although the use of thrombolysis in our case was safe and successful.

[Right mid-ventricular stenosis with intact interventricular septum]. / Sténose médio-ventriculaire droite avec septum interventriculaire intact.

Pure infundibular stenosis of the right ventricle is a rare congenital anomaly. Right midventricular stenosis with intact interventricular septum is even rarer. It consists of obstruction of the trabecular zone of the right ventricle by a hypertrophied moderator band with or without abnormal muscle bundles. This anomaly can now be diagnosed by transthoracic echocardiography, while haemodynamic and angiographic diagnosis is reserved for doubtful cases. Two cases of midventricular stenosis are reported. In both patients, the diagnosis was suspected bu ultrasonography which showed a right intraventricular gradient of about 80 mmHg without identifying the exact site (infundibular or midventricular). The diagnosis was corrected by the operative findings. A good postoperative course was observed for both patients.