[Metastasis stimulating a myocardial infarction]. / Métastase simulant un infarctus du myocarde.

A patient with a history of bronchial carcinoma was admitted to the coronary care unit with chest pain suggestive of infarction and an ECG showing changes compatible with acute lateral wall infarction. The coronary arteries were shown to be normal and echocardiography revealed an intracardiac mass which MRI confirmed to be a direct extension of the pulmonary tumour. Echocardiography should be performed systematically in patients with chest pain and ECG changes of ischaemia who also have progressive oncological disease.

[Right-to-left interatrial shunt with normal pulmonary pressures after pneumonectomy. Apropos of a case with severe cyanosis following left pneumonectomy]. / Shunt droite-gauche auriculaire à pressions pulmonaires normales après pneumonectomie. A propos d'un cas de cyanose sévère à distance d'une pneumonectomie gauche.

Atrial septal defects usually give rise to left-to right in the absence of obstruction of the pulmonary outflow tract or pulmonary hypertension. The authors report a case of atrial septal defect with a right-to-left shunt despite normal pulmonary pressures at catheterisation in a 56 year-old-man who had undergone left pneumonectomy 6 months previously. The shunt was responsible for major arterial desaturation aggravated by the left lateral or dorsal decubitus position. Surgical closure of the defect resulted in cure with disappearance of cyanosis and normalisation of blood gases. The physiopathological mechanisms of these right-to-left shunts with normal pulmonary pressures are discussed with reference to previously reported cases in the literature.

Doppler analysis of the left venting line: an effective and simple technique to control heart de-airing.

Air embolism is still a major risk of open-heart surgery. Different techniques of air removal have been established, even though none is completely effective. Since 1989 the authors have used a new technique to avoid air passage into the left vent line when the left heart cavities are open. A specially designed probe attached to a vascular Doppler analyser is fixed to the left vent tubing. Air passage is detected by a characteristic acoustic signal. Air removal procedures are continued until no audible signals are detected. This technique was carried out in 150 open left heart operations in which there were no clinical signs of air embolism. To validate this procedure, simultaneous assessment of air removal was made using transoesophageal echocardiography (TEE) and carotid Doppler (CD) in six patients. When Doppler signs of air in the left vent disappeared, TEE revealed that a small amount of air was still present in two patients; carotid Doppler showed only minimal passage of air bubbles in three patients after left vent removal while the heart was freely ejecting. These results demonstrate that this technique is a reliable method of assessing air removal, which is especially useful when de-airing is difficult during reoperation.

[Coronary vasospasm: a cause of sudden death. Case report of reversible heart arrest with spontaneous coronary spasm documented by angiography]. / Le spasme coronaire: une cause de mort subite. A propos d'un cas d'arrêt circulatoire réversible avec spasme coronaire spontané angiographiquement documenté.

The authors report a case of cardiac arrest occurring in a patient who had just entered the catheter laboratory for coronary angioplasty. Opacification of the left coronary artery revealed a proximal occluding double spasm unrelated to the distal stenoses for which angioplasty had been requested. Resuscitation and antispastic therapy with intracoronary injection of a nitrate derivative resulted in a complete recovery without any sequellae. The role of coronary spasm in sudden death and the value of the ergometrine test in patients with coronary stenosis are discussed.

[Accessory mitral tissue responsible for left ventricular outflow obstruction. Reports of 7 cases]. / Tissu mitral accessoire responsable d'une gêne à l'éjection du ventricule gauche. A propos de 7 cas.

The authors report the medico-surgical experience of Marie Lannelongue hospital of a rare condition: accessory mitral valve tissue. Seven patients aged 2 to 28 years (average: 8.7 years) had left ventricular outflow obstruction due to accessory mitral valve tissue. The diagnostic was not obvious clinically and was based on the association of echocardiographic and angiographic data. This condition was associated with another intra-cardiac malformation in 6 of the 7 patients. Surgical treatment included resection of the accessory mitral valve tissue by an aortic or combined aorto-left atrial approach, together with correction of the associated intracardiac abnormality. The postoperative results were excellent with the regression of the ventriculo-aortic pressure gradient and the physiological integrity of the mitral valve.

[Surgical treatment of chronic pulmonary embolism using thromboembolectomy under extracorporeal circulation and deep hypothermia--a new approach route. 3 cases]. / Traitement chirurgical des embolies pulmonaires chroniques par thrombo-embolectomie sous circulation extracorporelle et hypothermie profonde--nouvelle voie d'abord. Trois observations.

The authors, who have successfully performed thrombectomy of the pulmonary artery under extracorporeal circulation and deep hypothermia in three patients, wish to draw attention to the principal factors of success. The decision to operate, as accepted by most surgeons, rests on the patient's functional status (stage III or IV) and on the presence of a systolic pulmonary arterial pressure exceeding 50 mmHg. Deep hypothermia combined with circulatory arrest seems to be the best method, as it improves visual control, thereby avoiding damage to the endothelium or fracture of the distal thrombi during thrombectomy. Finally, a new approach route (severing of the superior pulmonary vein, opening of the pulmonary artery and use of Volmar-Sisteron strippers) makes it possible to remove the entire thrombus, thus obtaining an almost normal pressure in the pulmonary artery. In all three patients, the complications that are mostly due to intrabronchial haemorrhage by disruption of the endothelium, fracture of the distal thrombus or pulmonary artery contusion were avoided.

Aberrant right subclavian artery aneurysm: report of a case and review of the literature.

Aneurysms of an aberrant subclavian artery are rare. They are usually secondary to atherosclerosis. Dysphagia is the most common presenting symptom. The diagnosis of these lesions is most easily established by CT scan. Biplane arteriography is necessary in order to clearly analyze the aortic arch and its branches. Surgical resection is usually indicated. Numerous procedures have been proposed to treat these lesions and controversy exists concerning the best surgical technique. We treated a patient who suffered from an aneurysm of an aberrant subclavian artery. The surgical technique is detailed as well as a review of all the cases of the literature.

[Perirenal prosthesis in traumatic ruptures. Apropos of a case]. / Prothèse périrénale dans les éclatements traumatiques. A propos d'un cas.

A polyglactin mesh wrapping was used to unite the four fragments of a severely ruptured kidney. The operation was performed on the twelfth day after the trauma. One year postoperatively, the clinical biological and urographic results are excellent.