[Left auricular myxoma and myocardial infarction]. / Myxome auriculaire gauche et infarctus du myocarde.

The authors report the case of a 40 year old man with a postero-inferior myocardial infarction. Echocardiography showed a large left atrial myxoma. Coronary angiography performed 20 days after the onset of infarction was completely normal. The tumour was successfully removed surgically. The authors review the literature of this rare association (20 reported cases) which were commonly observed since the widespread use of echocardiography and coronary angiography. These investigations have improved the understanding of the physiopathology of this association. One of the possible hypotheses of diastolic mitral obstruction by the tumour was the probable mechanism of infarction in this case due to prolonged impaired coronary filling due to low cardiac output.

[Coronary disease with normal coronarography in the black Africans: epidemiological and clinical data in 31 cases. Role of abnormal hemoglobins]. / Maladie coronaire à coronarographie normale chez le Noir africain: données épidémiologiques et cliniques dans 31 cas. Rôle des hémoglobines anormales.

The authors studied 31 cases of coronary artery disease with normal or minimally diseases coronary arteries in black Africans, 29.8% of 104 coronary patients undergoing coronary angiography in this series. These 31 cases comprised 16 cases of infarction, 10 cases of angina, 3 ventricular aneurysms and 2 cases of silent ischemia in diabetic patients. Twenty-five patients were men (80.6%). There were 6 women (19.3%) two of whom presented in the post-partum period. The average age of these patients was 45 years (males: 47.7 years; females: 41.8 years). The following risk factors were noted: smoking (60%), hypertension (25.8%), obesity (29%), diabetes (12.9%), serum cholesterol (average 2.15 g/l), serum triglycerides (average 1.25 g/l). The risk index per patient was 1.29. In comparison with coronary patients with angiographic coronary lesions (n = 73), the patients with normal angiography were significantly younger, comprised more females and had fewer risk factors (especially hypertension and diabetes), though this was not statistically significant. The prevalence of inaugural infarction was 81.2% in the cases of infarction with normal coronary arteries. These infarcts may be complicated by ventricular aneurysm formation. Spontaneous spasm was observed in 3 out of 31 patients (9.6%) at coronary angiography. A provocative test was performed in only 2 cases and 1 was positive. This deserves further study and may have therapeutic implications. The authors emphasise the high incidence of hemoglobin S or C traits (57.1%). These heterozygotic hemoglobinopathies could be a risk factor in these coronary patients with normal coronary angiography.

[Spontaneous coronary artery dissection: apropos of a case with associated spasm and regression of the dissection]. / La dissection coronaire spontanée: à propos d'un cas avec spasme associé et régression de la dissection.

The authors report the case of a 34 year old woman with postpartum myocardial infarction due to spontaneous coronary dissection of the distal circumflex artery. A spontaneously regressive spasm of the right coronary artery was also observed. The outcome with heparin, glyceryl trinitrate and calcium antagonist therapy was favourable. Over one year later, coronary angiography showed total resolution of the dissection and a large aneurysm of the inferior and septal walls of the left ventricle. This case is an example of post-partum spontaneous coronary dissection, in a particular vascular context. There are, however, other causes of spontaneous coronary artery dissection (atherosclerosis, eosinophilic syndrome...). Spasm may aggravate the consequences of coronary artery dissection and cause worse myocardial damage. The medical treatment, especially with regards to thrombolytic therapy, requires further codification.