[Mitral stenosis and acute hemolytic anemia after mitraclip]. / Sténose mitrale et anémie hémolytique aiguë après mitraclip.

Mitraclip corrects mitral regurgitation in a less invasive way than cardiac surgery. These procedures are becoming widespread with the emergence of new complications. We report a rare case of mitral stenosis associated with acute hemolytic anemia after mitraclip treatment in an 82-year-old patient. The cause of this stenosis in our case is linked to the placement of two clips and an increase gradient in post-procedure. The mechanism of hemolysis could be due to the persistence of mitral leaks resulting in strong collisions against the clip.

[Anemia in patients with acute coronary syndrome in the Vichy Hospital center]. / Anémie chez les patients avec syndrome coronarien aigu au centre hospitalier de Vichy.

INTRODUCTION: Objectives were to determine the clinical, epidemiological and biological profile of the patients suffering from acute coronary syndrome and presenting the anaemia, the determinants of variation of the haemoglobin rate, and to estimate the impact of the anaemia on the prognosis of these patients. PATIENTS AND METHODS: Retrospective and observational study conducted in the cardiology department of Vichy Hospital in France. All patients with acute coronary syndrome admitted from 31 of October 2015 to 30 of April 2016 were selected. The patients were followed for 1 month. The anaemia was defined by: less than 13g/dL in man and less than 12g/L in woman (WHO definition). Biological markers were taken at the admission. Factors associated to the haemoglobin rate were analysed by multivariate linear regression and those associated to the mortality within 30 days were analysed by logistic regression. RESULTS: Among 251 included patients, there were 180 males and 71 females with the average age of 67 years. 94 patients had ST elevation myocardial infarction (STEMI), 116 had Non ST myocardial infarction (NSTEMI) and 41 had unstable angina. Haemoglobin value was known in 238 patient's, among whom 44.1% were anaemic (105/238). The anaemia was more frequent in women. The tobacco was less frequent; High blood pressure, renal failure, malnutrition, subclinical atherosclerosis, lower limb arteritis and the inflammatory syndrome were more frequent in patients with anaemia. They presented more complications. The age (P=0,003), the pulsed pressure (P=0,007), LVEF (P=0,005), the albumin (P=0,010), Creatine kinase (CK) level (P=0,048) and of CRP (P=0,011), were linear factors of variations of the haemoglobin rate (R2=0,955). Ten patients died during the follow-up. The multivariate analysis revealed the anaemia as independently associated with the mortality in 30 days (Odds Ratio 3,69; P=0,02). CONCLUSION: Anaemia is frequent in patients with an ACS, and it is associated with a particular clinical and biological profile. The patients with anaemia have a mortality rate in 30 days higher than the patients without anaemia.

[Interest of emergency coronary computed tomography for exclusion of coronary artery disease in patients with acute chest pain and low to intermediate risk]. / Intérêt du coroscanner en urgence pour l'exclusion de la maladie coronaire chez les patients souffrant de douleur thoracique à risque faible ou intermédiaire.

PURPOSE: To demonstrate the usefulness of the multislice computer tomography coronary angiography (CCTA) in patients with suspected acute chest pain without electrical changes or enzyme rise, and with low cardiovascular risk. PATIENTS AND METHODS: Fifty-three patients at low or intermediate risk for coronary artery disease, who were admitted in the emergency department for an acute chest pain, and who underwent a CCTA, were included in the study. Results of the CCTA were classified as normal, non-obstructive stenosis (≤ 50% stenosis in diameter), obstructive stenosis (> 50% stenosis in diameter). The mortality was assessed during a 4-years follow-up period. RESULTS: Mean age was 61 years (36-86), 43% of patients were women. The CCTA was normal in 35 patients (66%), seven patients (13%) had non-obstructive stenosis and 11 (21%) had obstructive stenosis. In the group of normal CCTA, 8.5% of patients were admitted in cardiac intensive care unit, 57.1% in the non-obstructive stenosis and 90.9% in the group of obstructive stenosis. No deaths occurred during the 4-year follow up in the group of patients with normal CCTA. CONCLUSION: This study confirms the negative predictive value of CCTA for the diagnosis of coronary artery disease and for further clinical events in patients at low or intermediate risk referred to emergency department for an acute chest pain.

[Contribution of magnetic resonance imaging in diagnosis of pericardial mesothelioma: a case report]. / Apport de l'imagerie par résonance magnétique au diagnostic du mésothéliome péricardique: à propos d'un cas.

Pericardial mesothelioma is a rare form of pericardial tumor. The invasive investigations such as biopsy make the diagnosis. Non-invasive imaging techniques provide valuable information about its diagnosis and its clinical impact. We report here the results of magnetic resonance imaging of pericardial mesothelioma in a 65-year-old woman. The originality and purpose of this case is to illustrate the additional value of magnetic resonance imaging that should be systematically performed when assessing this pathology.

[Pseudo-aneurysm of mitro-aortic continuity: a rare complication after aortic valve replacement]. / Le pseudo-anévrisme du trigone fibreux aorto-mitral : une complication rare du remplacement valvulaire aortique chirurgical.

Pseudo-aneurysm of the fibrous continuity zone between the aortic and mitral valves, the so-called "mitral-aortic intervalvular fibrosa" is a rare complication of acute infective endocarditis, rarely after an aortic valve replacement. We report the case of a large pseudo-aneurysm occurred in a 70-year-old man, who had a history of surgical aortic valve replacement 3 years before. There were no biological or clinical evidence for infective acute endocarditis. The originality of this observation can be summarized in three points: the late onset after surgery, the absence of any infectious context and the chronic nature of pseudo-aneurysm, without any complication during a follow-up of 12 months. Transesophageal echocardiography remains the best diagnostic tool.

[Outpatient laparoscopic cholecystectomy]. / Cholécystectomie par laparoscopie en ambulatoire.

UNLABELLED: OUTPATIENT LAPAROSCOPIC CHOLECYSTECTOMY: The laparoscopic technique is the procedure of choice for cholecystectomy. This procedure is done on ambulatory setting in the United States and Europe but no experience was reported in France. AIM OF THE STUDY: To report the organisation and results of our initial 100 consecutive patients operated for a laparoscopic cholecystectomy on an outpatient basis. PATIENTS AND METHODS: After assessment of the prevention of pain and nausea or vomiting after laparoscopic cholecystectomy on hospitalized patients, a prospective trial was done on our first 100 patients for outpatient laparoscopic cholecystectomy on routine basis. RESULTS: During the period, 27.4% of patients were entered on an ambulatory basis. 72% of patients did not need any medication post-operatively in the structure. 17 patients were admitted: in five cases, decision was done pre-operatively, one patient went back home against medical advising; in three cases, peroperatively, and in 10 cases postoperatively. Four patients were readmitted between the fifth and sixteenth post-operatoire day. CONCLUSION: An adequate organisation for day case surgery, a good selection of patients on medical, surgical and environmental criteria, simple procedures to prevent pain or nausea vomiting post-operatively allow use to assert that hospitalisation is unjustified for laparoscopic cholecystectomy in a quater of patients.