ABSTRACT
The authors report a case of very large myxoma of the left atrium, original in terms of its mode of discovery, its very calcified appearance, in a totally asymptomatic elderly patient. A complete ultrasound assessment, catheterization, and coronary angiography allowed assessment of the morphology, topography, blood supply and cardiac repercussions of this tumour. Myxoma of the left auricle is the commonest cardiac tumour, with multiple clinical features and presentations. This benign tumour arises from embryonic vestigial remains, usually in the fossa ovale. The present case is original by its unusual mode of discovery in a totally asymptomatic patient.
Subject(s)
Heart Neoplasms/diagnostic imaging , Myxoma/diagnostic imaging , Angiocardiography , Echocardiography, Transesophageal , Female , Heart Neoplasms/pathology , Heart Neoplasms/surgery , Humans , Middle Aged , Myxoma/pathology , Myxoma/surgeryABSTRACT
The dimensions of the cardiac chambers and left ventricular function were studied by echocardiography in 40 patients with homozygous sickle cell disease (SS) and 25 patients with heterozygous sickle cell trait (12 AS, 10 SC, 3 BS) and compared with the same parameters in 30 normal subjects. Patients with homozygous SS disease had significantly larger left atrial (32.2 +/- 6.47 mm vs 26.62 +/- 5.64 mm; p less than 0.001), left ventricular (46.4 +/- 8.49 mm vs 39.97 +/- 5.29 mm; p less than 0.001) and right ventricular (17.95 +/- 5.08 mm vs 15.5 +/- 3.17 mm; p less than 0.02) dimensions: they also had higher indexed myocardial surfaces (11.48 +/- 2.36 cm2/m2 vs 8.21 +/- 1.97 cm2/m2; p less than 0.001) and indexed end diastolic left ventricular volumes (101.84 +/- 22.74 ml/m2 vs 65.05 +/- 10.81 ml/m2; p less than 0.001), a higher cardiac index (4.77 +/- 1.33 l/mn/m2 vs 3.58 +/- 1.08 l/mn/m2; p less than 0.001) and stroke volume (71.77 +/- 32.86 ml vs 49.56 +/- 13.39 ml; p less than 0.001). Peripheral resistances were significantly lower (1341 +/- 469 vs 1626 +/- 368 dynes/s/cm-5; p less than 0.01) as were the velocities of circumferential fibre shortening (VCF) (1.11 +/- 0.20 circ/s vs 1.28 +/- 0.24 circ/s; p less than 0.01). Two thirds of homozygous SS disease patients (27/40) had appearances of an anaemic heart with eccentric left ventricular hypertrophy, normal left ventricular systolic function, an increased cardiac index (5.01 +/- 1.19 l/mn/m2) and low peripheral arterial resistances.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Anemia, Sickle Cell/physiopathology , Heart Ventricles/physiopathology , Adolescent , Adult , Anemia, Sickle Cell/diagnosis , Anemia, Sickle Cell/genetics , Cardiomegaly/diagnosis , Echocardiography , Heterozygote , Homozygote , Humans , Sickle Cell TraitABSTRACT
Twenty six patients with acute (less than 5 days) pulmonary embolism (PE) confirmed by bilateral pulmonary angiography with a Miller index greater than 15 were given tissue plasminogen activator (Alteplase) (rt-PA) intravenously (n = 20) or directly into the pulmonary artery (n = 6). The dosage was 100 mg/7 hours (bolus 10 mg + 40 mg/2 hours + 50 mg/5 hours). Heparin (5000 IV as a bolus and 1000 IV/hour) was associated in all cases. The Miller index decreased from 24 +/- 1 (n = 26) before treatment to 12 +/- 1 (n = 25) (p less than 0.001) after 100 mg of Alteplase, and from 25 +/- 0.4 (n = 14) to 22 +/- 0.5 (n = 14) (p less than 0.001) after 50 mg. The mean pulmonary arterial pressures fell from 30 +/- 2 mmHg to 21 +/- 2 mmHg after 50 mg (n = 26) (p less than 0.001) and to 14 +/- 1 (n = 25) (p less than 0.001) after 100 mg of Alteplase. A decrease in mean pulmonary artery pressures (-22%, p less than 0.001) and total pulmonary resistances (-29%, p less than 0.001) was obtained after one hour of thrombolysis in 12 monitored patients. There were no fatalities. Severe haemorrhage occurred in 6 cases. Therefore, Alteplase induced a rapid dissolution of recent intrapulmonary thrombi without inacceptable haemorrhagic complications. Its action could be particularly beneficial in patients with right ventricular failure due to life threatening pulmonary embolism.
Subject(s)
Pulmonary Embolism/drug therapy , Tissue Plasminogen Activator/therapeutic use , Acute Disease , Adult , Aged , Drug Therapy, Combination , Female , Follow-Up Studies , Hemodynamics/drug effects , Heparin/therapeutic use , Humans , Male , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Wedge Pressure/drug effects , Radiography , Recurrence , Tissue Plasminogen Activator/pharmacologyABSTRACT
The study of two cases of young patients with renal transplants who, successively and a few months after the procedure, presented a thrombophlebitis of the lower extremities (with or without pulmonary embolism), then an acute coronary insufficiency, without any encouraging or triggering factor, raises the hypothesis that this is not a mere coincidence. In fact, in the literature, numerous cardiovascular risk factors) inherent in complicated chronic renal failure, dialysis, steroid therapy and immuno-suppressive treatment (Azathioprime, under these circumstances) were demonstrated. In addition, abnormalities of the platelets aggregation, hemostasis and fibrinolysis, were at the origin of thrombo-embolic accidents. Besides any specific cardiovascular risk factor or any obvious biological anomaly, there is still a predisposition of patients with renal transplants, to arterial as well as venous thrombo-embolic accidents.
