[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.

[Tako-Tsubo syndrome during normal human immunoglobolin perfusion]. / Syndrome Tako-tsubo au décours d'une perfusion d'immunoglobuline humaine normale (Tégeline(®)).

This is a case of an 82 year old female patient with myasthenia gravis, who following treatment with Human Normal Immunoglobulin (Tegeline(®)), developed dyspnoea, chest pain without cardiac insufficiency, inverted T wave on ECG with slight increase in Troponine T 0.43ng/mL (<0.2ng/mL normal value in our hospital) and marked increase in Pro-BNP 4900 (Nl≤450pg/mL for an age greater than 65 years old). Her coronary angiogram showed hypokinesia of apical area but was otherwise normal. Also, MRI ruled out inflammatory and ischemic cardiac diseases. The most likely diagnosis for us was Tako-Tsubo syndrome in relation with injection of Human Normal Immunoglobulin (Tegeline(®)) according to the Mayo clinic criteria.

[Myocardial infarction after voluntary intoxication by drug interaction between dipyridamole and aspirin]. / Infarctus du myocarde après intoxication volontaire par l'association acide acétylsalicylique et dipyridamole.

A 60-year-old male presented a myocardial infarction after a voluntary overdose of Asasantine(®) started after strokes. He took chronically this association and some psychotropic drugs with vasodilator effects. After an intake of 40 tablets, he presented a cardiogenic shock with a myocardial infarction confirmed by biological samples, EKG, echocardiography and angiocoronarographie. No recent change of his treatment was found and symptoms regressed when dipyridamole was stopped while other vasodilators drugs were continued. Chronological analysis of events led us to suspect dipyridamole as a starter of the myocardial infarction secondary to a coronary artery steal reinforced by the vasodilator effect of combined treatments, in a patient at risk of ischemia. This case shows that, in such particular conditions, a change in dipyridamole dosage can induce a myocardial infarction even if its blood level remains in the therapeutic range.

[Diagnostic schelf: a case of pulmonary embolism with ST elevation]. / Embolie pulmonaire massive et sus décalage du segment ST dans les dérivations antérieures : piège diagnostic.

Some pulmonary embolism may present electrocardiogram changes, which suggest the diagnosis of myocardial infarction. We report the case of a patient with such a confounding presentation. In this patient, the wrong diagnosis of myocardial infarction led to a primary coronarography which was normal and finally, echocardiogram gave us the key leading to a fibrinolitic treatment which improved the patient.

[Hemolytic anemia following mitral valve surgery]. / Anémie hémolytique dans les suites d'une plastie valvulaire mitrale.

Mitral valvuloplasty which is currently the most popular surgical procedure in MVD may be complicated mostly by restenosis or valvular leakage. Hemolysis occurs less frequently and by far less commonly than in prosthetic valves but deserves to be known. Delay between valvuloplasty and hemolytic anemia occurrence may vary within a wide range (from some weeks to several years as in the case we report here). A careful follow-up of the patients who undergo MV repair will help to identify this complication which is related not to the size of the regurgitation flow but to the velocity of the jet. Surgery is the unique treatment of this kind of anemia.

[Myocarditis or subendocardial myocardial infarction: role of MRI illustrated by a case report]. / Myopéricardite ou nécrose sous-endocardique: apport de l'imagerie par résonance magnétique illustré par un cas clinique.

A 50-year-old male patient treated with mesalazine for Crohn's disease was admitted in our unit for a chest pain, associated with nonspecific ST depression or ECG and troponin elevation. Coronarography showed minimal changes while SPECT imagery suggested a posterobasal subendocardial infarction, so that the diagnosis was unclear between ischemic disease and mesalazine-induced myocarditis. Eventually, MRI demonstrated clearly a subendocardial posterior infarction eliciting the diagnosis of mesalazine-induced myocarditis. This case report illustrates, in our opinion, that MRI is of invaluable interest in evaluating the characteristics of myocardium, and must be the cornerstone in the diagnosis of myocardial diseases.