[Non ST elevation acute coronary syndromes and normal coronary angiography: is it truly good news?]. / Coronarographie normale au cours des syndromes coronariens aigus non ST+: une fausse bonne nouvelle?

Among 10% of all patients presenting with non ST elevation acute coronary syndromes (ACS), coronary angiography do not show non lesions at all (50%) or mild atheromatous stenosis (50%). ACS without angiographic stenosis are more prevalent in female sex and young patients but can be seen in older ones and in men. Pathogenic mechanisms include acute evolution of vulnerable non-significant plaques and endothelial dysfunction. In hospital and mean term prognosis is not as benign as expected. Six months deaths and myocardial infarction incidence is around 6%. Numerous rehospitalizations due to ischemic recurrences are also very often seen. Therefore, such surprising coronary angiograms do not preclude a fair follow-up. These patients need a careful therapeutic strategy.

[Feasibility and results of transcatheter treatment of patent foramen ovale associated with atrial septal aneurysm. Experience of a general hospital in Mulhouse, France]. / Faisabilité et résultats de la fermeture percutanée des foramens ovals perméables avec anévrisme du septum interauriculaire. Expérience du centre hospitalier général de Mulhouse.

OBJECTIVE: To evaluate the results and the feasibility of the technique of percutaneous closing of patent foramen oval (PFO) with Atrial Septal Aneurysm (ASA) among young patients having presented a cryptogenic cerebral ischemia. PATIENTS AND METHODS: Eighteen patients: 14 cryptogenic stroke and 4 TIA with a broad PFO (rank III) and an important ASA (excursion higher than 15 mm) at transesophageal echocardiography (TEE). The average age is 48.2 years: man 61%, women 39%. The patients have little cardiovascular risk factor (0.83/patient) and 38% presented recurrent thromboembolic events. Percutaneous closing is carried out under general anaesthesia with TEE and Amplatzer devices implantation. A control TEE is carried out 6 months after closing. RESULTS: No complication occurred at the time of the procedures. After 72 hours, one patient presented a major complication: one arteriovenous fistula requiring a surgery. Five patients presented a minor complication: two non complicated femoral hematoma, two atrial arrhytmias and one asymptomatic secondary displacement of the device without need for surgery. Seven-teen patients had TEE at six months: the shunt disappeared for 95% from the patients, no thrombus was found. No recurrent thromboembolic event appeared for the 18 patients (median follow-up 19.2 months). CONCLUSION: The installation of a technique of percutaneous closing of the PFO+ASA is safe and effective.

[Acute myocardial infarction with cardiogenic shock following stress echocardiography: case report]. / Infarctus myocardique aigu compliqué de choc cardiogénique après échocardiographie de stress: à propos d'un cas.

Acute myocardial infarction is a rare complication of dobutamine stress echocardiography (DSE). We report the case of a 60-year-old man with moderate apical sequela of a myocardial infarction (MI) which had an inferior MI complicated with cardiogenic shock and circulatory arrest two hours after a positive DSE in that very circulatory topography. Emergency coronarography objectivizes a dissection of the circumflex artery. The patient required a circulatory assistance device. He survived the episode and left the hospital with 50% left ventricular ejection fraction.