A new dynamic 3D virtual methodology for teaching the mechanics of atrial septation as seen in the human heart.

Learning embryology remains difficult, since it requires understanding of many complex phenomena. The temporal evolution of developmental events has classically been illustrated using cartoons, which create difficulty in linking spatial and temporal aspects, such correlation being the keystone of descriptive embryology. We synthesized the bibliographic data from recent studies of atrial septal development.

Diagnosis, management, and follow-up of systemic venous drainage via a single left superior caval vein into the left atrium.

A 15-month-old boy presented with asymptomatic hypoxaemia due to right-to-left venous shunting via a left superior caval vein emptying into the left atrium, in absence of right superior caval vein. The diagnosis, suspected by contrast echocardiography, was confirmed by computed tomography and angiography. The child underwent surgical correction of the systemic anomalous return by tunnelling the left superior caval vein towards the right atrium.

[Valve replacement for aortic regurgitation associated with rheumatoid arthritis: a series of 5 cases].

Between 30 and 50% of patients with rheumatoid arthritis (RA) have cardiac involvement but only 2 to 10% have clinical manifestations. The authors report the results of a retrospective study of 5 cases of aortic regurgitation (AR) requiring valve replacement. There were 4 women and 1 man with an average age of 48.

[Early non-obstructive thrombosis of mechanical mitral valve prostheses].

Transoesophageal echocardiography has shown a high incidence on non-obstructive thrombosis after mitral valve replacement with a mechanical prosthesis. The unpredictable outcome and the period during which the complication arises make treatment difficult. The aim of this study was to assess the tolerance and efficacy of the association of long-term heparin and oral anticoagulation, as recommended in this indication.

Three-dimensional reconstruction and morphologic measurements of human embryonic hearts: a new diagnostic and quantitative method applicable to fetuses younger than 13 weeks of gestation.

Improvements in the diagnosis of congenital malformations explain the increasing early termination of pregnancies. Before 13 weeks of gestation, an accurate in vivo anatomic diagnosis cannot currently be made in all fetuses with current imaging instrumentation. Anatomopathologic examinations remain the gold standard to make accurate diagnoses, although they reach limits between 9 and 13 weeks of gestation.

[Recurrent pericarditis during meningococcal meningitis. 2 case reports].

Introduction: There is little information on the frequency, physiopathology and management of extra-cerebral manifestations of N. meningitidis meningitis. Articular, pleural and pericardial involvement is occasionally reported with a symptomatology that can be delayed with regard to the initial diagnosis.

[Value of the association of D-dimer measurement and the evaluation of clinical probability in a non-invasive diagnostic strategy of pulmonary embolism].

New diagnostic tools in suspected pulmonary embolism complete the classical diagnostic strategy of pulmonary scintigraphy and pulmonary angiography to limit the indications of these two invasive investigations. In a prospective series of 204 consecutive patients with suspected pulmonary embolism the association of D-dimer measurement and clinical probability was assessed for the exclusion of the diagnosis of pulmonary embolism. The D-DI Liatest is a new generation, unitary, rapid and quantitative latex test with a comparative diagnostic performance to that of the reference ELISA test, and well adapted to emergency situations.

[Pregnancy and congenital heart disease].

Congenital cardiopathies currently represent the majority of cardiac anomalies observed during pregnancy. The latter leads to significant haemodynamic modifications which can sometimes be poorly tolerated in the case of severe cardiopathy. However, as a rule pregnancy is generally well supported if the functional state of the patient beforehand is satisfactory (class I or II of the NYHA).

[Platypnoea-orthodeoxia syndrome. Diagnosis, etiology, treatment].

Platypnoea-orthodeoxia (P.O.) syndrome is the association of dyspnoea and arterial oxygen desaturation aggravated in the erect position and relieved in the supine position.

[Right atrial compressive aneurysm with favorable outcome after surgery at the age of 1 month].

Right atrial aneurysms are uncommon and often revealed by arrhythmia. We report a case of right atrial aneurysm which required an early management and its follow up during one year. The abnormality was detected at 32 weeks gravida during a systematic echography.

[Heparin therapy in pregnant women].

The prescription of heparin during pregnancy is an uncommon situation but a difficult one to manage because there are no reported therapeutic trials. The main indications are thromboembolic disease, valvular or congenital heart disease, cardiac arrhythmias and patients at high risk of thrombosis with blood clotting disorders. Non-fractionated heparin is the commonest form of anticoagulation in these circumstances as it does not cross the placental barrier; there are no teratogenic or haemorrhagic risks to the foetus.

[Patient information and coronary angiography: experience of the Rennes group].

The object of this study was to assess the degree of patient information of subjects referred for coronary angiography and their reaction to a detailed protocol of information. The enquiry was performed in 3 stages: an oral evaluation of the degree of information with a standardised questionnaire; the giving of written documents from the French Federation and Society of Cardiology mentioning the risks of the procedure; the continuation of the interview with evaluation of the degree of satisfactions with the information provided. Two hundred and thirty one patients referred by cardiologists for non-urgent coronary angiography were interrogated (175 men, 56 women; mean age 63 years, range: 27-83 years).

Long-term follow-up of percutaneous vena cava filters: a prospective study in 100 consecutive patients.

Objectives: the long-term outcome in following insertion of inferior vena cava (IVC) filters remains unclear.

Design: prospective study.

Material And Methods: one hundred consecutive patients received percutaneous vena cava filters between 1988 and 1993.

Early prenatal management of a fetal ventricular tachycardia treated in utero by amiodarone with long term follow-up.

Fetal cardiac arrhythmias are one of the causes of intra-uterine congestive heart failure and non-immune hydrops fetalis leading to fetal death. As ventricular tachycardia (VT) is rarely diagnosed in utero, it leads to emergency deliveries. We report a prenatal diagnosis of fetal tachycardia at 20 weeks of gestation associated with non-immune hydrops fetalis.

[Pregnancy and anticoagulant therapy. Indications and strategies].

Anticoagulant therapy is sometimes required during pregnancy either for the prevention of thromboembolic disease, for patients already on long-term antithrombotic treatment (for valvular prostheses) or for the prevention of complications of risk factors such as hereditary or acquired thrombophilia. Pregnancy is in itself a hyper-coagulable condition and the risk of thromboembolic complications is raised. Anticoagulation is a risk to the mother and to the foetus, and the management (heparin or vitamin K antagonists, respective doses) must be adapted to the underlying pathology and the stage of pregnancy.

[Papillary fibroelastoma: a cardiac tumor rarely reported in children].

Papillary fibroelastoma is a seldom reported tumour. It usually occurs in adults and develops on the aortic and mitral valves. It is not different of giant Lambl excrescences and differential diagnostic can be difficult with the myxoma.

[Comparison of apical and infundabular pacing in patients with primary dilated or ischemic cardiomyopathy].

Dual chamber pacing has been proposed as an alternative treatment to patients with cardiac failure refractory to optimal medical therapy. The influence of the site of ventricular pacing was studied in 15 patients with an average age of 68.7 +/- 8.

[Fetal echocardiography].

Cardiac malformations are the most frequent and serious fetal malformations. However their prenatal diagnosis is the less easy. Fetal echocardiography is the main diagnostic tool; in addition it is helpful for the therapeutic orientation.

[Indications of partial interruption of the inferior vena cava in pulmonary embolism].

Forty years after the first implantation of caval filters, there is still no indication for implantation validated by a controlled clinical trial. This fact may be explained by our poor understanding of the evolution of thromboembolic disease, especially in certain groups of patients. The absolute contra-indications to heparin therapy would seem to be a logical indication for a caval filter.