[Myocardial infarction revealing an antiphospholipid syndrome in a 27-year-old woman]. / Infarctus du myocarde révélant un syndrome des antiphospholipides chez une jeune femme de 27 ans.

We report the case of a 27 year old woman, with no vascular risk factors other than moderate smoking, admitted for a first acute anterior myocardial infarction. Emergency coronarography detected an isolated thrombosis, localised at the level of the middle section of the anterior inter-ventricular artery in an otherwise normal coronary network. Angioplasty of the artery with direct stenting was performed successfully and the follow up was uncomplicated. The diagnosis of primary antiphospholipid syndrome was made on the association of a raised level of anti-cardiolipin antibodies and the absence of elements in favour of an associated connective tissue disorder.

[Doppler echocardiographic study of arterial distensibility. Comparison with ambulatory arterial pressure monitoring]. / Etude par échocardiographie doppler de la distensibilité artérielle. Comparaison avec la mesure ambulatoire de la pression artérielle.

UNLABELLED: Echocardiography Doppler (ED) is a common tool in hypertension to assess left ventricular (LV) mass or LV function. Echography doppler is also available to assess some arterial distensibility (AD) indexes, but it is less frequently used. The aim of this study is to compare AD indexes obtained from échographie doppler with timing of Korotkoff sound (QKd interval), obtained from ambulatory blood pressure monitoring (APM). Sixty-two patients with or without cardiac diseases were prospectively enrolled, except those with left bundle branch, atrial fibrillation or pacemaker. Echography doppler study collected timing of abdominal pulse (QtAA), interval time between Q ECG and the foot of doppler wave velocity in abdominal aorta pulse wave velocity (PWV) between two points of descending thoracic aorta; and Stroke index. APM study collected simultaneous usual pressure indexes (systolic diastolic, pulse pressure) instantaneous and over 24 h, and QKd interval times between Q ECG and diastolic Korotkoff sound instantaneous and over 24 h. Absolute AD Index (Burton index) was defined as Stroke index/pulse pressure. QtAA intra observer variability was the coefficient of variation (mean/SD). QtAA inter observer variability was QtAA assessments by two observers. RESULTS: QtAA was correlated with QKdi (r = 0.78; p < 0.001) and QKd24 h (r = 0.64; p < 0.001). PWV was correlated with QKdi (r = 0.35; p = 0.009), but not with QKd24 h (r = 0.17; p = 0.24, NS). Burton index was correlated with QKdi (r = 0.48; p < 0.001), and QKd24 h (r = 0.53; p < 0.001). CONCLUSION: Echography doppler may provide some arterial distensibility indexes. Among these indexes, QtAA is easy to obtain and well correlated with QKd. However, further studies are needed to assess normal and pathological values.

[Aorta-left ventricular relationship evaluated by Doppler echocardiography and ambulatory arterial prsesure monitoring]. / Etude du couple aorte-ventricule gauche par échocardiographie Doppler et mesure ambulatoire de la pression artérielle.

UNLABELLED: Arterial distensibility is one of the components of afterload. Arterial distensibility, left ventricular (LV) mass and LV function are closely linked. The aim of this study is to describe the relations between LV mass LV function and arterial distensibility evaluated by echography Doppler (échography Doppler) and ambulatory monitoring pressure. Sixty-two patients with or without cardiac disease were prospectively enrolled excepted those with atrial fibrillation, left bundle branch block pace maker, or valvulopathy. Echography Doppler study collected stroke volume, LV diameters and wall thickness, ejection time (ET) and preejection time (PET); were calculated ejection fraction (EF), systolic pressure/systolic diameter ratio, LV mass index (LVMI), relative wall thickness ratio (e/r). AMP collected usual pressure datas and QKd, time interval between QECG and diastolic Korotkoff sound, instantaneous, over 24 h (i, 24 h), and for a pressure of 100 mm Hg and a heart rate of 60 bpm (QKd 100-60). RESULTS: QKd 24 h was correlated with LVMI (r = 0.40, p = 0.006) and e/r (r = 0.32, p = 0.028). QKdi was correlated with EF (p < 0.001, r = 0.65), with systolic pressure/systolic diameter ratio (p < 0.001, r = 0.75), and with ET/PET (r = 0.56, p < 0.001). When PET was withdrawn from QKd, no correlation exist between QKd-PET and LV function index, excepted QKd-PET versus systolic pressure/systolic diameter (r = 0.46, p = 0.005). CONCLUSION: QKd is not only an arterial distensibility index but also a LV function index, because PET is included in it. Echography Doppler and AMP are available and common tools to study the aorta/LV relationship.

[Comparison of two indices of arterial distensibility: temporal apparitions of Korotkoff sounds and pulse wave velocy. A Doppler echocardiography and ambulatory blood pressure monitoring study]. / Comparaison de deux indices de distensibilité artérielle: le temps d'apparition des bruits de Korotkoff et la vélocité de l'onde de pouls. Une étude par échocardiographie-Doppler et mesure ambulatoire de pression artérielle.

Arterial distensibility, one of the factors influencing afterload, plays a role in the development of left ventricular hypertrophy. The QKd, the delay before the perception of the Korotkoff sounds, is an index of arterial distensibility available from ambulatory blood pressure monitoring. The pulse wave velocity (PWV), another index of arterial distensibility, can be measured by Doppler echocardiography. The aim of this study was to compare these two indices with haemodynamic parameters of arterial distensibility and to determine their relationship to left ventricular geometry and function. Sixty-two consecutive patients, with and without cardiac disease, underwent simultaneous Doppler echocardiography and ambulatory blood pressure monitoring. A correlation was observed between QKd and PWV (N = 53, p = 0.007, r = 0.37). The QKd and PWV were correlated to the absolute index of arterial distensibility (systolic index/pulse pressure) (N = 51, p < 0.001, r = 0.48). QKd was correlated with indices of left ventricular function such as EF (N = 55, p < 0.001, r = 0.66) or the systolic pressure/end systolic dimension ratio (N = 54, p < 0.001, r = 0.75). When the ejection time was subtracted from QKd, only the end systolic pressure/end systolic dimension remained significantly correlated (N = 37, p = 0.005, r = 0.40). The authors conclude that PWV and QKd were correlated and were also correlated with indices of arterial distensibility. QKd is a composite index of left ventricular function and arterial distensibility. Doppler echocardiography and ambulatory blood pressure monitoring provide a non-invasive assessment of the aorta/LV couple.

[Aneurysm of the interatrial septum and right-to-left shunt during biventricular infarction. Diagnosis by transesophageal echocardiography]. / Anévrisme du septum interauriculaire et shunt droite-gauche au cours d'un infarctus biventriculaire. Diagnostic par échographie transoesophagienne.

A right-to-left shunt during infarction with right ventricular extension is a rare and recently described complication. It results from opening of a foramen ovale due to increased right heart pressures. The authors describe another case occurring in a patient with an interatrial septal aneurysm, the diagnosis of which was made by transoesophageal echocardiography.

[Has prenatal diagnosis of transposition of great vessels changed its prognosis?]. / Le diagnostic anténatal de la transposition des gros vaisseaux a-t-il modifié son pronostic?

Neonatal anatomical correction of transposition of the great arteries (TGA) has transformed the prognosis of this condition but the diagnosis must be made rapidly. The aim of this retrospective study was to evaluate the benefits of antenatal diagnosis on the outcome of TGA. The cases of 50 consecutive neonates with TGA with or without ventricular septal defect hospitalised between 1989 and 1996 were reviewed. All these children underwent anatomical correction of their malformation in the neonatal period. In seventeen of the children the diagnosis was made in the antenatal period at a gestational age of 28.7 +/- 5 weeks of amenorrhea and the other 33 had a postnatal diagnosis at 6.2 +/- 13 days. The clinical and echographic features were identical in the two groups. The risk factors of mortality for the whole population were a Yacoub type B or C coronary disposition, an intramural coronary course, difficulties in reimplantation of the coronary arteries and/or peroperative haemodynamic failure. In the authors' experience, the time of diagnosis (antenatal or postnatal) did not had on the management and prognosis of TGA. Studies with larger population groups are probably necessary to demonstrate the possible benefits of antenatal diagnosis.