[Rotablator and endoprosthesis on the left main coronary trunk]. / Rotablator et endoprothèse sur tronc commun de la coronaire gauche.

A 78 year old woman with unstable angina due to significant stenosis of the left main coronary artery and occlusion of the right coronary artery was treated medically for 29 months because of a surgical contraindication. Resistance to drug therapy led to referral for complex angioplasty of the left main, left anterior descending and left circumflex arteries, successively by rotablator and balloon angioplasty. An immediate elastic recoil on the left main coronary artery led to implantation of a Palma-Schatz stent. There were no complications and the patient is asymptomatic twenty months later.

[Thromboembolic disease in patients aged 80 and over. Diagnostic and therapeutic strategies]. / La maladie thromboembolique chez la personne âgée de 80 ans et plus. Stratégies diagnostiques et thérpeutiques.

The aim of this retrospective study of 50 deep vein thromboses (DVT) of the lower limbs in patients aged 80 and over (35 women, including 2 with bilateral DVT and 13 men), mean age 83.37 +/- 2.72, hospitalised in a department of cardiology, was to assess the diagnostic value of ultrasound investigations, clinical parameters and results of treatment of thrombo-embolic disease in this age group. High DVT were found in 76 per cent of cases and pulmonary embolism occurred in 52.1 per cent of cases, its incidence increasing with age. One third of DVT were asymptomatic and presented as pulmonary embolism, the predominant clinical feature being edema in the absence of other signs. The existence of atrial fibrillation was associated in 90 per cent of cases with a pulmonary embolism. Venous Echo-Doppler is also the key investigation in the diagnosis of thrombo-embolic disease. Cardiac Echo-Doppler seems particularly useful in the diagnosis of pulmonary embolism when more than 40 per cent of the vascular bed is cut off. Thrombolytic treatment remains possible after the age of 80 in life-threatening situations. Overall hospital mortality remains high (10.4 per cent) and appears to be due chiefly to the onset of a pulmonary embolism which is not thrombolyzed since considered insufficiently serious or occurring in a situation in which fibrinolysis is theoretically contra-indicated.

[Spontaneous dissection of the distal anterior interventricular artery during intravenous thrombolysis]. / Dissection spontanée de l'artère interventriculaire antérieure distale observée au décours d'une thrombolyse intraveineuse.

A case is reported of spontaneous coronary dissection in a 55-year-old patient with an anterior myocardial infarction treated by intravenous thrombolysis. The angiographic appearance was highly characteristic with successive opacification of the true then the false channel involving the entire distal third of the anterior interventricular artery. The outcome was immediately favourable. Spontaneous dissection of coronary arteries is rare. The etiology is discussed and there is not standard management approach.

[Neurological disorders disclosing auricular myxoma: 3 cases]. / Troubles neurologiques révélateurs d'un myxome auriculaire: trois cas.

We report 2 cases (n. 1 and 2) of cerebral infarction caused by a left atrial myxoma, and 1 case (n. 3). of dementia associated with a large left atrial myxoma. Cerebral emboli and neurological symptoms which can occur prior to cardiac obstructive and/or systemic signs require echocardiography. The cardiac post-operative condition was dramatically improved in cases revealed by an hemiplegia.

[Jet intravenous injection of erythromycin lactobionate. A possible cause of the occurrence of crisis in torsade de pointe]. / Injection en flash intraveineux de lactobionate d'érythromycine. Une cause possible de survenue d'accès de torsade de pointe.

The authors report one case of torsade de pointe which occurred immediately after fast intravenous injection of a 1-gram dose of erythromycin lactobionate in a female patient who had undergone surgical replacement of the mitral and triscuspid valves 24 hours before. The responsibility of erythromycin was strongly suggested by the clinical data (syncope), electrocardiographic findings (electrocardiogram typical of torsade de pointe, slow rhythm and lengthened QT interval in the basal ECG) and the chronology of the sequence of intravenous injection of the antibiotic and the rhythm disorder. A literature search revealed six similar cases. Its seems that the arrythmogenic property of this drug is related to abnormally elevated serum levels following rapid administration.

[Acute occlusion of the renal artery caused by an embolism of cardiac origin. Treatment by in situ thrombolysis]. / Occlusion aiguë de l'artère rénale par une embolie d'origine cardiaque. Traitement par thrombolyse in situ.

An intra-arterial infusion of streptokinase successfully dissolved a large thrombus of the renal artery in a 54-year old male patient with old-standing mitral stenosis. This case illustrates the effectiveness of fibrinolysis in situ. This method provides complete arterial recanalization and preserves the renal function, thus enabling surgical embolectomy to be performed.

[Diagnostic value of exercise tomoscintigraphy with thallium 201 in patients with complete left branch block]. / Valeur diagnostique de la tomoscintigraphie d'effort au thallium 201 chez les patients porteurs d'un bloc de branche gauche complet.

Eighteen patients with rate-dependent (n = 5) or chronic (n = 13) left bundle branch block underwent thallium 201 exercise SPECT and selective coronary arteriography. 15 patients showed significant septal or anteroseptal perfusion defects on the exercise scintigrams, but in only 4 of them did the coronary disease involve the left anterior descending artery (LAD) (n = 3) or the left main coronary artery (n = 1). Among patients with normal scintigrams, one had right coronary artery stenosis. Test performance in detecting individual coronary artery stenosis greater than 70 p. 100 was: sensitivity 80 p. 100 (4/5) and specificity 15 p. 100. In patients with left bundle branch block, T1 201 SPECT was indeterminate for LAD disease due to reversible septal perfusion defect. We conclude that the usefulness of stress thallium 201 SPECT in patients with left bundle branch block is very limited.

[Development of left intraventricular thrombi. Monitoring by two-dimensional echocardiography and scintigraphy with indium 111-labelled platelets]. / Evolution des thrombi intraventriculaires gauches. Surveillance par échocardiographie bidimensionnelle et scintigraphie aux plaquettes marquées à l'indium 111.

Two-dimensional echocardiography and indium 111-labelled platelet scintigraphy have proved helpful in the diagnosis of left intraventricular thrombosis. In this study, both methods were used to investigate the time-related changes undergone by such thrombi in 30 patients (26 with myocardial infarction, 4 with dilated cardiomyopathy) who presented with left intraventricular thrombosis diagnosed by echocardiography and systematically explored by indium scintigraphy. These 30 patients were divided into 2 groups depending on whether the initial scintigraphy was positive (group I, 19 patients) or negative (group II, 11 patients). The follow-up (mean 21.6 months) was clinical and paraclinical, with control echocardiography repeated at 1.5 and 8.5 months in both groups and control scintigraphy at 1.5 month in group I patients. At the 1.5 month echocardiography, the intraventricular thrombosis persisted in 14/16 examinations in group I patients and in only 2/10 examinations in group II patients (p less than 0.01). At the 1.5 month scintigraphy, performed in 16/19 group I patients, this examination had become negative in 8 cases, whereas the 2D-echocardiography remained positive. During the follow-up period 4 patients in group I had an embolic accident, as against none of the group II patients (p less than 0.01); 3 of these 4 patients had persistent uptake at control scintigraphy. At echocardiography, only a protrusion image seemed to be predictive, as it was present in 3 of 4 patients with embolic accident.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intravenous thrombolysis in myocardial infarction. Influence of the quality of the anticoagulation on the early recurrence rate of angina or infarction]. / Thrombolyse intraveineuse dans l'infarctus du myocarde. Influence de la qualité de l'anticoagulation sur le taux de récidives précoces d'angor ou d'infarctus.

In this retrospective study the data of 70 patients treated with streptokinase in the acute phase of myocardial infarction were reviewed in search of a possible relation between recurrent ischaemic events and degree of anticoagulation. All patients had received a 30 mn infusion of streptokinase 1.500.000 units within a mean 175 mn period from the initial symptoms. They were followed up clinically (signs of angina or infarction), angiographically (coronary arteriography within 5.5 days on average) and biochemically (daily measurements of TCA values and blood fibrinogen concentrations). Fifteen recurrent ischaemic events (21.4 p. 100), including 6 attacks of angina and 9 myocardial infarctions, were observed. Angiography showed that the artery responsible for the initial infarction was occluded in 23.6 p. 100 (13/55) of patients without recurrent ischaemic accident. This figure rose to 46.6 p. 100 in patients who suffered a new anginal attack (7/15; NS) and up to 77 p. 100 in those who developed a new myocardial infarction (7/9; p less than 0.01). Biochemical data showed that 13 recurrent ischaemic accidents occurred when the APTT values were lower than 1.5 (176 measurements), as against 2 when these values were higher than 1.5 (359 measurements) (p less than 0.01). These two recurrent ischaemic accidents took place when fibrinogen concentrations abruptly rose above 1 g/litre. These results demonstrate that poor quality anticoagulation is responsible for the occurrence of recurrent ischaemic events within days of thrombolysis for acute myocardial infarction. They prompt the authors to recommend anticoagulation with heparin started at an early stage and carefully adjusted by means of repeated biochemical essays.

Comparison of two-dimensional echocardiography with scanography and indium-111 platelet scintigraphy in detection of intracardiac thrombi.

The authors compare three diagnostic-imaging methods (two-dimensional-echography, heart scans and indium-111 platelet scintigraphy) used in the detection of intracardiac thrombi in 82 patients. They attempt to define their respective diagnostic values in the presence of left ventricular and atrial thrombi.