[Prognostic significance of second and third degree atrioventricular block in acute inferior wall myocardial infarction]. / Valeur pronostique du bloc auriculoventriculaire du deuxième et du troisième degré au cours de la phase aiguë de l'infarctus du myocarde inférieur.

High degree atrioventricular block complicates inferior wall acute myocardial infarction in 10 to 15% of cases. Its significance is still controversial. In this study, we have analysed 152 observations of acute inferior wall myocardial infarction during hospitalisation period. The mean age of our patients is 60 years, 48.7% of them have received fibrinolytic treatment. Second or third degree atrioventricular block was detected in 33 cases (21.7%). Mortality is higher in inferior wall myocardial infarctions with atrioventricular block than in those without atrioventricular block (12% versus 2.5%, p < 0.05). Hemodynamic complications like cardiogenic shock due to the extension of the infarction to the right ventricle and left ventricle insufficiency are more frequent (18% versus 3.4%, p < 0.01 and 12% versus 3.5%, p < 0.01 respectively). It appears that the infracted mass of myocardium is larger in case of atrioventricular block, this is assessed by comparing the average value of the peak of creatine Kinase in the two groups with and without atrioventricular block (1534 IU versus 1096 IU, p < 0.02) and by considering the rate of low ejection fraction (EF < 40%) in each group (44.6% versus 16%, p < 0.01). In our study, we note that thrombolysis does not affect the incidence of atrioventricular block (19% and 24% in thrombolyed and not thrombolyzed patients respectively) but it seems that thrombolysis improves the outcome of these patients. The occurrence of atrioventricular block in acute inferior wall myocardial infarction is related to the presence of an important right coronary artery that is occluded, the recanalisation of this vessel leads often to rapid regression of the block that is no longer pejorative.

[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.

[Indications for definitive cardiac stimulation]. / Indications de la stimulation cardiaque definitive.

Within less than a half-century, after the early rising of cardiac pacing, we witness a dramatical in crease of its indications. After the initial aim, which was to prevent transient ischaemic events, and sudden death due to bradycardia, some more physiological objectives have--progressively appeared, such as improvement of patient's quality of life, and optimization of the cardiac performance to fulfill the metabolic needs. The indications of cardiac pacing are nowadays extended to the fields of haemodynamics and rythmology. Numerous studies are advocating the interest of the cardiac pacing in pathologies such as obstructive and dilated cardiomyopathies specially for the improvement of the NYHA functional status, life comfort and effort sustain. On another hand, newly discovered antiarrhythmic virtues of atrial pacing are of a great interest for a certain type of atrial fibrillations such as vagal induced fibrillations, atrial diseases and atypical flutters. For conclusion: after becoming mandatory for bradycardias, cardiac pacing is conquering new indications on the fields of arrhythmias and cardiomyopathies. Within a close future, scientific evidences could definitely validate çardiac pacing using on these new fields.

[Endocavitary implantation of a permanent pacemaker in the contralateral side of right pneumonectomy: a case report]. / Implantation endocavitaire d'un stimulateur cardiaque définitif du côté controlatéral à une pneumonectomie droite: à propos d'une observation.

The definitive endocardial stimulation is easy to install, allows a stable position of the leads, and a satisfactory stimulation thresholds for a long period. The epicardial approach is reserved for some rare indications including infectious contexts. The endocardial approach has been considered for a 67 years man with a complete AV block and an atrial fibrillation. This patient had undergone a right pneumonectomy 15 years before. A VVIR pacemaker has been implanted successfully by an internal jugular vein approach, and connected to a passively fixed unipolar lead. Because of the right ventricle deformation which made it unrecognizable, even by angiography means, we had to face major difficulties to position the lead. The epicardial approach should be considered even if a direct unique lung controlateral approach is easier than homolateral, because it allows us a quick ventricular access under the view control.

[Place of definitive cardiac stimulation in cardiomyopathies and atrial arrhythmia]. / Place de la stimulation cardiaque definitive au cours des cardiomyopathies et des arythmies atriales.

Definitive cardiac stimulation ralatually used for brady cardia are going to be in the third millennium the specific therapy of arrhythmia and cardiomyopathy. In the last 10 years, may progress occur in the use of cardiac stimulation as hemodynamic therapy of obstructions hypertrophic and dilated cardiomyopathies resistant to conventional medical treatment. Moreover auricular stimulation present antiarrhythmic effects in some atrial arrhythmias as auricular fibrillations auricular diseases and atypical flutters. It confirmed by prospective multicentric randomized trials cardiac stimulation may represent in the future a good physiopathologic and efficient treatment free from the side effects of drugs that remain partially active. These perspectives needs to be modulated by the known and acceptable risks of a definitive cardiac stimulation.

[Dilated cardiomyopathy secondary to acromegaly]. / Cardiomyopathie dilatée secondaire à une acromégalie.

In acromegaly, dilated cardiomyopathy is rare. Indeed, arterial hypertension, coronary artery disease and hypertrophic cardiomyopathy are more common. The authors report a case of a 42-years-old man with dyspnea (class III NYHA) and palpitations. The cardiac echography showed a dilated cardiomyopathy. The investigations revealed an acromegaly as an etiology. Diagnosis was based on patient morphotype, a high level of growth hormone (GH) and a pituitary adenoma detected by magnetic resonance imagery. This case is characterized by the absence of arterial hypertension and hypertrophic cardiomyopathy. The coronary angiography was normal. Consequently, in this particular case, dilated cardiomyopathy seems specific to acromegaly.