[Disproportionate pulmonary arterial hypertension and lung respiratory diseases: distinctive clinical, hemodynamic and prognosis of patients versus primary pulmonary arterial hypertension]. / Hypertension artérielle pulmonaire disproportionnée : caractéristiques et pronostic d'une cohorte de patients niçois référés au laboratoire d'échocardiographie.

OBJECTIVES: To characterize and compare patients with disproportionate PH versus patients with primary pulmonary arterial hypertension (PAH). METHODS: All patients referred to our cardiology unit for echocardiography from November 2006 to May 2008 and who have been followed by our pneumologist were screened for severe PH (i.e mean arterial pulmonary pressure>35-40 mmHg at rest). Patients were excluded if a factor that could influence pulmonary hemodynamics was present. We investigated these patients by pulmonary function tests, echocardiography and right heart catheterisation. RESULTS: We reported 16 cases of severe PH in stable patients (n=8, chronic obstructive pulmonary disease-emphysema) and 13 patients with PAH. Our findings suggest that the patients with disproportionate PH had right heart dysfunction similar to that observed in PAH. But their outcomes were more severe. It seemed that specific vasodilatator therapy was not efficient.

[Impact of biochemisty on the duration of treatment for pulmonary embolus]. / Impact de la biologie sur la durée du traitement d'une embolie pulmonaire. Le point de vue du clinicien.

Can the biochemical evidence for "new thrombophilic factors" influence the duration of AVK treatment following the occurrence of a first pulmonary embolus? Certainly for the classic but very rare antithrombin defects as well as for the existence of circulating anticoagulant. Possibly for protein C and S defects. On the other hand, the existence of a heterozygotic "Leiden" mutation of factor V, or factor II, and an increase of factors VIII, IX, or XI, do not at present warrant a change in AVK prescription. In effect, in the case where the existence of a thrombogenic state implies a prolongation of AVK treatment with its significant potential complications, it is indispensable that the risk/benefit ratio is well founded, which is not the case for these "new" thrombophilic states. The coexistence of several of these new biochemical anomalies (for example the association of a factor V and factor II mutation) probably represents an excess risk of thrombosis, but in this situation the reasoning remains the same. On the other hand, faced with a confirmed recurrence, the studies in the literature tell us that very long term treatment should be debated independently from the biochemical results. It is conceivable that there are biochemical anomalies (sometimes quite frequent which should be viewed as "normal variants") which, although they have great significance for improving the understanding of venous thrombo-embolic disease, do not at present warrant a change in our therapeutic protocols. Another facet of the problem concerns the use of D-dimers following the first months of AVK treatment in order to possibly distinguish patients at low risk of recurrence. The first results of this approach are interesting, but require confirmation before they can be used in practice.

Clinical epidemiology of venous thromboembolic disease. Results of a French Multicentre Registry.

OBJECTIVE: Between July 1992 and December 1994, 16 French hospital centres, mainly cardiological, participated in a non-controlled observational study on venous thromboembolic disease. The objective of this survey was to collect data concerning the current status of pulmonary embolism and deep venous thrombosis. PATIENTS: During this period, 547 patients were included: 446 with deep venous thrombosis and 387 with pulmonary embolisms. RESULTS: Mean age of patients was 63 +/- 21 years. There were no significant differences between the sexes. Pulmonary embolism and deep venous thrombosis tended to occur more frequently during the autumn and winter. In 30% of cases, prior deep venous thrombosis or pulmonary embolism was noted. No cause was found for the condition in 47% of cases. Ultrasound (echocardiography and/or venous ultrasound) was the most frequently requested investigation. Intravenous heparin remains the most widely used treatment (76%). Oral anticoagulation was begun before day 3 in less than 31% of cases. Thrombolytic treatment was used in 20% of pulmonary embolism cases, but was rarely prescribed for deep venous thrombosis (2.2%). The hospital recurrence rate (12/547 cases) was fairly low. The search for occult malignancy, performed in 48% of cases, seems to remain one of the major concerns of physicians. The combined pulmonary embolism and deep venous thrombosis mortality rate was 4.4%, while the death rate for pulmonary embolism alone was 6.2%.

Congenital heart disease diagnosed in Guadeloupe.

An epidemiologic survey of congenital heart disease was performed in Guadeloupe, French West Indies, during the 3-year period 1988-1990. This survey, the first on congenital heart disease from the Caribbean, found an overall rate of 6.08 congenital heart disease cases per 1,000 live births, a high rate of hypoplastic left heart disease, and a rate of coarctation of the aorta similar to rates reported in developed countries.

PIP: Between January 1988 and December 1990 health workers referred 139 infants suspected of heart disease to a skilled pediatric cardiologist at the University Hospital of Pointe-a-Pitre, Guadeloupe. The physicians considered patent ductus arteriosus of prematurity to be a congenital heart disease if it still existed after the neonatal period. The incidence of congenital heart disease was 6.08 cases/1000 live births with a sex ratio of 1:1. 12% of chromosomal abnormalities, especially Down's syndrome. Physicians diagnosed 92% of all cases in the 1st year of life. 35% (49 infants) went to the Pediatric Cardiologic Department of Hospital Necker in Paris, France, to undergo catheterizations. 32 of these infants also underwent chest surgery. Prevalence of coarctation of the aorta (3.1/10,000 live births) essentially equalled that of developed countries. The prevalence of hypoplastic left heart disease was considerably higher than the rate in the literature (3.5/10,000 live births vs. 0.5-2.7/10,000 live births). It was the 4th ranking congenital heart disease in this population (5.7% of all cases). All the infants with hypoplastic left heart disease died.

Gongenital heart disease diagnosed in Guadeloupe

An epidemiologic survey of congenital heart disease was performed in Guadeloupe, French West Indies, during the 3-year period 1988-1990. This survey, the first on congenital heart disease from the Caribbean, found an overall rate of 6.08 congenital heart disease cases per 1 000 live births, a high rate of hypoplastic left heart disease, and a rate of coarctation of the aorta similar to rates reported in developed countries

Gongenital heart disease diagnosed in Guadeloupe

An epidemiologic survey of congenital heart disease was performed in Guadeloupe, French West Indies, during the 3-year period 1988-1990. This survey, the first on congenital heart disease from the Caribbean, found an overall rate of 6.08 congenital heart disease cases per 1 000 live births, a high rate of hypoplastic left heart disease, and a rate of coarctation of the aorta similar to rates reported in developed countries