[Atrial fibrillation following coronary artery bypass grafting: predictors and mid- term outcome]. / La fibrillation atriale aprés chirurgie de pontage aortocoronaire: facteurs prédictifs et pronostic àà moyen terme.

BACKGROUND: Atrial fibrillation (AF) is a frequent complication after coronary artery bypass grafting (CABG) which increase morbidity and hospitalization length. AIM: To identify the predictors of atrial fibrillation and its repercussion on hospital and mid-term outcomes in patients undergoing (CABG). METHODS: We undertook a retrospective review of the data of 224 patients undergoing CABG. The mean age of the patients was 60.8 years. Atrial fibrillation was diagnosed from serial postoperative electrocardiogram. RESULTS: Twenty two patients developed postoperative atrial fibrillation. Multivariate analysis showed that only: age, left circumflex stenosis, sternal wound infection and low cardiac output were predictors of AF following CABG. Hospital mortality was similar in the two groups (5% Vs 9.6 % P=0.7). CONCLUSION: In our study, the incidence of post-CABG atrial fibrillation was 9.8%. Multivariate predictors were age, left circumflex lesion, sternal wound infection and low cardiac output. Hospital mortality and mid-term outcome were similar in the two groups.

[Coronary artery bypass grafting in diabetic patients: early and mid-term outcomes]. / La chirurgie du pontage aorto coronaire chez les diabétiques : Résultats immédiats et à moyen terme.

BACKGROUND: The outcome of coronary artery bypass grafting (CABG) in diabetic patients has traditionally been worse than in nondiabetic patients. Recent studies have suggested an improvement in outcome in diabetic patients undergoing CABG. However, the direct impact of diabetes on mortality and morbidities following CABG remains unclear. AIM: To evaluate the early and mid term outcomes of diabetic patients compared to non-diabetics following CABG. METHODS: We retrospectively analyzed the data of 228 CABG patients from January 2005 to December 2010: one hundred and twenty-six diabetics and 102 non-diabetic.Diabetic patients were more likely to be female(27% Vs 12.7% P=0.009) were less smoker (55.6% Vs 80.4% P<0.0001) with higher rate of three vessel disease(67.5% Vs 42.2% P=0.005) compared to non-diabetics. RESULTS: Hospital mortality was significantly higher among diabetic patients (16% Vs 4.1% P=0.005).Length of care unit stay was more important (2.3 days Vs 2.1 days P=0.048) , but with a similar rate of sternal wound infection even after bilateral internal thoracic artery grafting. After 28 months mean follow- up, mid-term survival of diabetics was significantly decreased compared to no-diabetics (91% Vs 99% p<0.001) .However, Event-free survival was similar in the two groups (76% Vs 80% p=0.82). CONCLUSION: These results suggest that diabetes is associated with poorer early and mid-term outcomes following (CABG).

[Single versus bilateral internal thoracic artery grafts for multi vessel coronary artery bypass grafting: mid-term results]. / Mono-pontage versus pontage bilatéral mammaire interne : Résultats immédiats et à moyen terme.

BACKGROUND: The issue of superiority of single internal thoracic artery grafting versus bilateral internal thoracic artery grafting remains unresolved. AIM: The aim of this study was to compare the early results and midterm outcome of single and bilateral internal thoracic artery grafting for multivessel coronary artery bypass grafting. METHODS: Between January 2005 and March 2010, 196 patients underwent primary coronary artery bypass grafting with at least one internal thoracic artery grafts. Early results and Outcomes of patients undergoing single internal thoracic artery (SIMA) plus saphenous vein grafting (n=145) and bilateral internal thoracic artery (BIMA) plus saphenous vein grafting (n=51) were obtained at a mean followup of 29 months. RESULTS: Patients with bilateral internal thoracic artery grafting were younger, had less hypertension, higher left main disease and better Euroscore than patients undergoing single internal thoracic artery grafting. In-hospital mortality was similar for the two groups: 6.9 % for patients undergoing SIMA versus 5.9 % for those undergoing BIMA (p=0.8). Sternal wound infection was also similar (2.8% versus 3.9% p=0.68). Mid-term mortality was (4% VS 4.8% p=0.71) and event free survival probability at 28 months was 75% for the single-graft group compared with 85.7% for the bilateral-graft group (P =0.46). CONCLUSION: Our study found similar early and mid-term clinical outcomes for patients undergoing SIMA plus saphenous vein grafting and those undergoing BIMA plus saphenous vein grafting for multivessel coronary artery bypass grafting.

Echocardiographic marker for bland-white-garland syndrome in adult.

Bland-White-Garland syndrome, also known anomalous origin of the left main coronary artery, is a rare congenital malformation. The authors report the case of a 51-year-old woman with anomalous origin of the left main coronary artery from the pulmonary artery. A prominent large ostium of the right coronary artery and intercoronary "steal" collaterals should raise suspicion for this pathology and subsequently guide a step-by-step echocardiographic approach to identify the left main coronary artery from the pulmonary artery.

[A rare cause of myocardial infarction: carbon monoxide intoxication]. / Une cause rare d'infarctus du myocarde: l'intoxication au monoxyde carbone.

We describe a 34-year-old man who suffered an acute myocardial infarction after carbon monoxide domestic exposure. The coronary angiogram was normal. The necrosis is explained in part by a severe coronary spasm. The purpose of this work was to assess the pathophysiology and the treatment of this rare cause of myocardial infarction.

[Congenital coronary aneurysm. Three case reports]. / Anevrysmes coronaires congenitaux. A propos de trois observations.

Congenital coronary aneurysms are an unusual anatomical entity. Their prognosis appears to be particularly dependent on the presence or absence of aneurysm thrombosis. We report three cases of congenital coronary aneurysms, diagnosed in one case after myocardial infarction. Two patients were treated successfully by an exclusion of the aneurysm and coronary bypass and the third patient was treated medically. The aim of this study is to discuss the clinical features, prognosis and management of this disease.

[New indications for cardiac pacing]. / Les nouvelles indications de la stimulation cardiaque.

Over the past decades, the pacemakers have become the standard treatment for patients with symptomatic sinus node disease or high grade atrioventricular block. With the development of pacemaker technology, attempts have been made to apply pacing to the treatment of problems other than symptomatic bradycardia. These problems include pacing to prevent atrial arrhythmia, improve hemodynamic function and to prevent neurocardiogenic syncope. The aim of modern pacing is not only reducing mortality but also improving quality of life and reducing morbidity. Ongoing studies will help to identify better the patient population that benefits most of this treatment.

[Myocardial infarction by complete thrombosis of the common coronary trunk. Two case reports]. / Infarctus du myocarde par thrombose complète du tronc commun coronaire. A propos de deux observations.

Complete thrombosis of the left main coronary artery is a rare angiographic finding. It carries a very high mortality rate related to cardiogenic shock; malignant arrhythmia or sudden death. We report two case of a 37 and 65 years old women, admitted to our hospital with complete occlusion of the left main coronary responsible of anteroseptal myocardial infarct. The revascularisation consisted in surgical treatment in one case and percutaneous angioplasty in the second patient. The aim of our study is to discuss the different therapeutic approaches and the prognosis of this affection.

[Evaluation of thoracic aortic atherosclerosis by transesophageal ultrasonography: value and limits as predictive factor of coronary disease]. / L'évaluation de l'athérosclérose de l'aorte thoracique par l'échographie transoesophagienne: ses intérêts et limites comme facteur prédictif de l'atteinte coronaire.

Atherosclerotic disease in the aorta is associated with a high risk of cardiovascular events. This prospective study was conducted to correlate the presence of aortic plaques in the thoracic aorta detected by transesophageal echocardiography (TEE) and angiographically significant coronary artery disease. The presence of aortic plaques on TEE had a sensitivity of 97%, a specificity of 80% and positive and negative predictive values of 89% and 94%. Univariate logistic regression revealed that aortic plaques were the most significant independent predictor factor of coronary artery disease compared to other risk factors. This study reveals that the thoracic aortic plaques detected by TEE is a strong predictor of the presence and the severity of coronary artery disease.