[Pregnancy in patients with prosthetic heart valves]. / Grossesse et prothese valvulaire cardiaque.

In women with prosthetic heart valves, pregnancy carry a risk for both mother and fetus, requiring an obstetrical and cardiological management at an optimal level. We performed a systematic review of the literature to estimate the maternal and fetal complications and in order to offer pregnant women carrying a prosthetic heart valve the most practical approach enabling reduction of these risks. As there are no available controlled clinical trials, larger prospective studies are needed to provide guidelines for effective antithrombotic therapy.

[Prognostic value of high-sensitivity C-reactive protein in assessing intrahospital outcome of unstable angina]. / L'intérêt de la CRP ultrasensible dans l'évaluation du pronostic intrahospitalier de l'angor instable.

Inflammation has been shown to play an important role in the pathogenesis of unstable angina. CRP has been demonstrated to be a reliable marker of prognosis is unstable angina. The aim of this study was to investigate the prognostic value of CRP in assessing short outcome of unstable angina. Our study is a prospective double blinded one. We measured CRP in 33 consecutive patients admitted for unstable angina at the 24th and 48th hour. The mean age is 60 years (30 to 84 years). There were 22 men and 11 women. 8 patients were included in class I of Braunwald classification, 5 were in class II and 20 in class III. 14 patients presented cardiac events. The CRP mean value was significantly higher among these patients (12 mg/l vs 5 mg/l, p < 10.4). Patients having a CRP > or = 3 mg/l have a higher risk of developing complications (66% vs 13%, p = 0.002). Elevation of CRP predicted poor outcome of intrahospital evolution with a sensitivity of 86%, a specificity 68%, a positive and negative predictive values of 66% and 86%. The CRP in our preliminary study is an independent risk factor of early outcome of unstable angina. In association with clinical scores and other cardiac markers will lead to a better identification of high risk patients.

[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.

[Hydatid pulmonary embolism]. / Embolie pulmonaire hydatique.

Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of hydatid heart cyst or the opening of a visceral hydatid cyst often in the liver into the venous circulation. We report a case of 60 years old woman, admitted to hospital for acute heart pulmonale due to fistulization of an hepatic hydatid cyst into the inferior vena cava.

[Pacemaker infections]. / Infection sur materiel de stimulation cardiaque definitive.

Infectious complications following pacemaker implantation are not common but can be particularly severe. The reported incidence varies from 0.5 to 5% in the literature. The duration of the procedure and repeat procedures are considered to be predisposing factors. The main cause of these infections is thought to be local contamination during the implantation. The commonest causal organism is staphylococcus. Because the presentation may be atypical, the diagnosis is often confirmed by transesophageal echocardiography which is the investigation of choice for imaging a vegetation on an endocavitary pacing lead in cases of infectious endocarditis. The seriousness of this infection requires early diagnosis and adapted treatment including double bactericidal antibiotherapy and complete ablation of the material. Systematic preoperative prophylactic antibiotic therapy is recommended.

[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.

[Mitral valve prolapse and sudden death: a case report]. / Prolapsus valvulaire mitral et mort subite: à propos d'une observation.

Mitral valve prolapse (MVP) is a common disorder that, in general, has a good prognosis. Rare occasions of sudden death have been reported in patients with MVP and it is presumed that the basis of sudden death is arrhythmias. We report a case of a 47 years old men affected by MVP complicated by ventricular arrhythmias and sinoatrial block; who died suddenly from ventricular tachycardia. The pathophysiology and risk factors of sudden cardiac death in MVP are discussed.