[Non-ST elevation acute coronary syndrome: CRAC register experience]. / SCA sans sus ST chez le nonagénaire : expérience du CRAC.

PURPOSE: To compare the clinical, angiographic, therapeutic and prognostic characteristics of nonagenarians presenting with non-ST elevation acute coronary syndrome with those of patients under 90 years of age. METHODS: We used the CRAC register database including 6 catheterization laboratories in the Center Val-de-Loire region. Only patients with positive-troponin non-ST elevation ACS included in the registry from 2014 to 2017 were selected for epidemiological and procedural data. Regarding antiplatelet therapy, hospital and one-year follow-up data, only patients in the 2014-2015 period were analyzed. RESULTS: From January 1st, 2014 to December 31st, 2017, 5.964 patients with a positive-troponin non-ST ACS, including 133 nonagenarians (2.2%) were included in the CRAC registry. Arterial hypertension and the history of coronary angioplasty were more common among nonagenarians. They present more multivessel and left main disease. The use of the bare metal stent was predominant in 2014-2015 and then became marginal in 2016-2017. Clopidogrel was the most widely used anti platelet and more than one in two nonagenarians remain on dual therapy after 12 months. One-year stroke and hospital and one-year mortality were higher in this age group. CONCLUSIONS: Nonagenarians with a positive-troponin non-ST elevation ACS have more severe coronary artery disease and a poorer prognosis than those younger than 90 years of age.

[Potential pro-thrombotic effects of cyclooxygenase-2. inhibitors Two cases pf myocardial infarction]. / Effet pro-thrombotique potentiel des inhibiteurs de la cyclo-oxygénase de type 2. A propos de deux observations d'infarctus du myocarde.

Type 2 cyclo-oxygenase inhibitors are new anti-inflammatory drugs with better gastrointestinal tolerance than traditional non-steroidal anti-inflammatory drugs. They have no platelet anti-aggregant effects and there is still some discussion as to whether this new therapeutic class has any pro-thrombotic effects. The authors report two cases of myocardial infarction in patients considered to be at low risk treated by type 2 cyclo-oxygenase inhibitors.

Partial rupture of the tricuspid valve after extraction of permanent pacemaker leads: detection by transesophageal echocardiography.

Traumatic lesions of the tricuspid valve complicating pacemaker lead extractions appear to be rare. We report two cases of partial rupture of the tricuspid valve, following apparently uneventful extraction of permanent ventricular leads, resulting in severe regurgitation and, in one case, chronic heart failure. TEE was useful to identify the traumatic mechanism of tricuspid regurgitation (TR) and the extent of valvular lesions in these patients. Such etiology should be suspected, and TEE performed, in patients developing TR or heart failure late after lead extraction.

[Anatomoclinical study of aortic insufficiency in atrophic polychondritis. Apropos of a case]. / Etude anatomo-clinique de l'insuffisance aortique au cours d'une polychondrite atrophiante. A propos d'une observation.

The authors report the anatomo-clinical features of aortic insufficiency complicating atrophic polychondritis, a rare inflammatory disease affecting mainly cartilaginous tissues. This case illustrates the inflammatory changes of the aortic wall, particularly progressive during this disease, responsible for aortic insufficiency and aneurysmal dilatation of the ascending aorta which required aortic valve replacement and prosthetic replacement of the ascending aorta. Histological analysis showed inflammatory lesions of the aortic wall comparable to the cartilaginous lesions described in this condition and suggesting a common physiopathogenic mechanism.