[Spontaneous coronary artery dissection in young male patient with STEMI: Unsuccessful fibrinolysis]. / Dissection coronaire spontanée dans le SCA ST+ chez un homme jeune : échec de fibrinolyse.

Spontaneous coronary artery disease (SCAD) is a particular form of acute coronary syndrome affecting preferentially female patient with few or without traditional cardiovascular risk factors. Male patient is exceptionally concerned by SCAD. We report a case of a young male patient presenting with anterolateral STEMI in relation with SCAD of Left main and left anterior descending artery (LAD). He was initially managed by fibrinolysis, which is then complicated by cardiogenic choc. Coronary angiogram covered by intra-aortic balloon pump (IABP) showed an acute double occlusion of proximal LAD and the ostium of the left circumflex artery (LCX). After thrombus aspirations, the angiographic pattern recalled a SCAD, which is confirmed by OCT (Optical Coherence Tomography). The latter highlighted the intimal flap with true and false lumen involving both Left main and proximal LAD with huge thrombus burden. PCI was then performed successfully with implantation of 3 DES (Drug Eluting Stent). But given the cardiogenic shock persistence despite Dobutamin infusion and IABP, ECMO (Extracorporeal membrane oxygenation) was indicated. Unfortunately, the patient died of haemorrhage during ECMO implantation.

[Vascular complications at the femoral access: impact of the percutaneous closure device Perclose]. / Complications vasculaires de l'abord artériel fémoral: impact du système de fermeture percutanée Perclose.

INTRODUCTION: Vascular complications at the femoral access site is an important factor of morbidity. The aims of this study were to evaluate the efficacy and safety of the percutaneous closure device (Perclose) during interventional cardiology procedures. PATIENTS AND METHODS: All patients with percutaneous closure of the femoral access site by the Perclose system in 2010 were included. We evaluated the indications of the procedures, the success rate of implantation and the bleeding complications according to antithrombotic therapy used. RESULTS: Three hundred and seventy five patients underwent a percutaneous closure by the Perclose system. Acute coronary syndromes with or without elevation of ST segment were the main indications of procedures (74.9%). The success rate of percutaneous closure of the femoral access site was 97.3%. The rate of minor, moderate, and severe bleeding of the entire cohort according to the GUSTO classification was respectively 4.2%, 0.5% and 1%. Bleeding complications were similar in both groups of patients (2.1% vs 7% P=0.122). In case of unsuccessful deployment of femoral closure devices, the risk of bleeding complications range from 4.3% to 60% (P=0.0000036). CONCLUSION: The use of the Perclose system is associated with a low rate of severe bleeding at the femoral access site. However, the failures of percutaneous closure increase the risk of bleeding complications.

[Very late bare-metal stent thrombosis 10 years after the implantation: a case report]. / Thrombose très tardive d'un stent nu dix ans après son implantation : à propos d'une observation.

Very late thrombosis occurring after bare-metal stent (BMS) implantation is a rare complication. It differs from very late thrombosis of drug-eluting stents in terms of both frequency and pathophysiological mechanism. We report a case of very late stent thrombosis of a bare-metal stent 10 years after his implantation for treatment of a myocardial infarction. The patient had a new acute coronary syndrome without persistent ST-segment elevation related to bare-metal stent thrombosis. He was treated by thrombo-aspiration and implantation of a new bare-metal stent.

[Use of drug-eluting stents: impact of French recommendations on the rate of clinical restenosis at 2 years]. / Utilisation des stents actifs : impact des recommandations françaises sur le taux de resténose clinique à deux ans.

AIMS: The drug-eluting stents (DES) reduce restenosis rate compared to bare metal stents. The clinical efficacy is greater in some subgroups of patients at high risk of restenosis. The aim of this study is to evaluate the use of drug-eluting stent based on the recommendations of the French Society of Cardiology and its impact on the restenosis rate at 2 years. METHODS: We included all patients who had coronary angioplasty with stenting in 2008. We evaluated the percentage of drug-eluting stent, the proportion of patients for which the French recommendations have been followed, and the rate of clinical restenosis at 2 years. RESULTS: Four hundred and seventy-nine angioplasties were performed in 2008. The percentage of drug-eluting stents was 21.8%. Acute coronary syndrome with or without elevation of the ST segment were the main indications of angioplasty (67.9%). For the 115 drug-eluting stents implanted in 2008, French recommendations were followed in 93% of cases (107 stents). For 89 patients who received DES, these recommendations were followed in 91% of cases (81 patients). The clinical restenosis rate at 2 years evaluated in 89% of patients was 5.6%. The rate of in-stent restenosis in bare metal and drug-eluting stents were 5.9 and 3.7%. CONCLUSION: The use of DES in our center is characterized by a small rate and a good compliance of the recommendations of the French Society of Cardiology. This strategy is associated with a low rate of restenosis at 2 years of follow-up.

[Very large cardiac tumor revealed by ventricular arrhythmia in a 18-month-old infant]. / Volumineuse tumeur cardiaque révélée par un trouble du rythme ventriculaire chez un nourrisson de 18 mois.

Cardiac tumors are rare in childhood and can be revealed by arrhythmias. We report the observation of an 18-month-old infant who had an episode of ventricular tachycardia (VT) which resulted in a large intramyocardic tumour diagnosis evocating a left ventricular fibroma. A treatment by amiodarone allowed a stable reduction of the VT. The presence of an intracardiac obstruction or uncontrollable arrhythmias would lead to a surgical resection.

[B-natriuretic peptide and cardiological emergencies in childhood]. / Peptide natriurétique de type B et urgences cardiologiques chez l'enfant.

The increase in B-natiuretic peptide (BNP) is well correlated with cardiovascular symptoms in adults. Its use in children is recent and only partially evaluated. The authors undertook a prospective study of BNP concentrations and its kinetics in 54 children with an average age of 15 months (5 days to 11 years) admitted as paediatric emergencies. The symptoms were dyspnoea (60%), shock (15%), suspicion of Kawasaki disease (15%) and other (10%). Twenty children had BNP levels of more than 100 pg/ml related to decompensation of known congenital heart disease in 7 patients (average BNP 462 +/- 323 pg/ml), due to neonatal coarctation in 2 patients (BNP > 3000 pg/ml), due to cardiomyopathy in 6 patients (BNP= 2576 +/- 1215 pg/ml), due to an arrhythmia in 1 patient (BNP= 3754 pg/ml) and to Kawasaki disease in 4 patients (BNP= 521 +/- 448 pg/ml). Thirty-four children had BNP values of less than 100 pg/ml; 29 had no cardiac disease and 5 had known congenital heart disease with other symptoms. Measuring BNP is quick and economical and is a valuable aid in the diagnosis of cardiac dysfunction in symptomatic children in the emergency room. High BNP values seem to be correlated with the severity of the cardiac disease. Low BNP values seem to have a good negative predictive value in children without underlying cardiac disease. The interpretation of intermediary values, especially when there is previous cardiac disease, is more difficult in view of the absence of known threshold values for different haemodynamic situations. Further studies are required to determine the value of this test for the follow-up and setting up of prognostic values in children with congenital heart disease.

[Unusual outcome of mitral valve infectious endocarditis in a premature infant]. / Evolution inhabituelle d'une endocardite infectieuse mitrale chez un prématuré.

The authors report a case of Staphylococcus Aureus infectious endocarditis in a premature baby. Echocardiography on the 8th day of life showed a large vegetation on the anterior mitral leaflet without significant regurgitation. Intravenous antibiotics and platelet antiaggregant therapy were given. At three weeks of age the vegetation split into two, one part attached to the foramen ovale and the other to the anterior mitral leaflet. At one month, the development of severe mitral regurgitation led to surgical valvuloplasty in a 2 kg neonate, the vegetation on the foramen ovale having spontaneously fragmented. The ablation of the mitral vegetation associated with commissuroplasty reduced the mitral regurgitation. At 3 months after surgery, the child was asymptomatic with a minimal mitral regurgitation.

[Cor triatriatum sinister: unusual cause of neonatal respiratory distress]. / Coeur triatrial gauche: une cause inhabituelle de détresse respiratoire néonatale.

We report the case of a newborn presenting with neonatal respiratory distress due to acute pulmonary edema, the underlying diagnosis being cor triatriatum sinister. This rare anomaly can be lethal in the short term. However, it can be completely cured surgically provided that diagnosis is made on time.