Intermittent fasciculoventricular pathway: ECG and electrophysiologic findings, clinical implications.

Although fasciculoventricular (FV) pathways never participate into tachycardia circuits, they give rise to ventricular pre-excitation of variable magnitude which can be source of ECG misinterpretation when associated to other supraventricular rhythm disorders. We report an intermittent FV pathway coincidentally unmasked during an electrophysiologic study performed for a symptomatic supraventricular tachycardia (atrial tachycardia). The clinical context, ECG and EP findings, and therapeutic options are described.

Long-term safety and efficacy of slow pathway ablation in patients with atrioventricular nodal re-entrant tachycardia and pre-existing prolonged PR interval.

The association of atrioventricular nodal re-entrant tachycardia (AVNRT) and pre-existing prolonged PR interval is unusual. Radiofrequency (RF) ablation in such patients may be associated with an increased risk of immediate and delayed AV block. The aim of our study is to assess the long-term efficacy and safety of slow pathway ablation in this population.

[Validation of the therapeutic role of amlodipine in 31,946 French hypertensive patients].

Amlodipine, a dihydropyridine calcium channel blocker (CCB), with a long duration of action, has been the subject of numerous controlled studies which showed its effectiveness and good tolerance in arterial hypertension in once-daily doses. We report the results of a large, multicentric, French, prospective phase IV study which evaluated the effectiveness and tolerance of amlodipine administered at a rate of 5 to 10 mg in only one daily dose. We also assess the evolution of the quality of life after 12 weeks of treatment among 31,946 hypertensive patients followed up to the ambulatory stage by general practitioners.

Transcranial Doppler detection of cerebral microemboli during left heart catheterization.

The role of transcranial Doppler ultrasonography (TCD) in individual risk assessment of embolic complications and the development of prevention strategies during coronary angiography remains to be determined. The purpose of this study was to assess the prevalence, time of occurrence and potential significance of microembolic signals (MES) detected with TCD during femoral left heart catheterization. TCD monitoring of the right and left middle cerebral artery was performed in 51 consecutive patients (36 men, 15 women) who were referred for coronary angiography.

Successful conservative surgery of acute ascending aortic dissection occurring during coronary angiography.

We reported the case of an acute aortic dissection complicating right guiding catheter manipulation during engagement in the right coronary ostium. Despite absence of hemodynamic deterioration, dissection progressed rapidly from the sinus of Valsalva to the ascending aorta along its entire length. At surgery, performed in emergency, the aorta was not dilated and the aortic wall did not appear pathologic.

Combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after acute reperfused myocardial infarction.

Objective: To evaluate the combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after myocardial infarction.

Design: Myocardial contrast echocardiography was performed in patients with acute myocardial infarction shortly after successful coronary reperfusion (TIMI 3 patency) by direct angioplasty. Collateral flow was assessed before coronary angioplasty, and contrast reflow was evaluated 15 minutes after reperfusion.

[Low-dose dobutamine echocardiographic assessment of reversible contractile dysfunction (myocardial stunning) after myocardial infarction].

Low dose (5 to 10 micrograms/min) dobutamine echocardiography was used to predict the presence of reversible contractile dysfunction (myocardial stunning) after myocardial infarction successfully revascularised in the acute phase of primary angioplasty. The investigation was undertaken in 40 patients, 4 +/- 1 days after inaugural myocardial infarction. The left ventricle was divided into 16 segments.

Myocardial viability assessed by dobutamine echocardiography in acute myocardial infarction after successful primary coronary angioplasty.

Dobutamine echocardiography (5 and 10 microg/kg/ min) was performed in 40 patients 4 +/- 1 days after acute myocardial infarction reperfused by primary coronary angioplasty. The left ventricle was divided into 11 segments. Reversible myocardial dysfunction was indicated by a decrease in at least 2 grades in the total segmental score.

[Traumatic tricuspid insufficiency. Apropos of 2 cases].

The authors report two cases of tricuspid regurgitation by a ruptured anterior papillary muscle secondary to non-penetrating thoracic trauma. In the presence of suggestive clinical and electrocardiographic abnormalities (systolic murmur, right heart failure, right bundle branch block), echocardiography confirmed the tricuspid regurgitation, showed its mechanism and excluded any other intracardiac lesions. Tricuspid annuloplasty was performed in both cases because of the persistence of failure or degradation of the patient's clinical condition.

[Floating thrombus in the right atrium and severe pulmonary embolism. Value of intravenous thrombolysis].

Mobile right atrial thrombi carry a high risk of pulmonary embolism which may be massive and are a medical emergency. Although surgery is commonly indicated, treatment with intravenous thrombolytics is an alternative and was successful in 4 out of 6 cases reported by the authors. Six patients, admitted for severe pulmonary embolism confirmed by pulmonary scintigraphy (6 cases) and by angiography (2 cases), underwent echocardiography which demonstrated a mobile right atrial thrombus.

Heart transplantation for terminal congestive heart failure in an acromegalic patient.

Dilated hypokinetic cardiomyopathy in an acromegalic patient is an uncommon event. Specific hormonal therapy with octreotide (a somatostatin analogue) is now recognized as able to improve cardiac failure. A case of worsening of cardiac function under such a therapy is described in this report.

[Hemorrhage of the brain after therapeutic fibrinolysis. 11 cases].

Ten cases of cerebral hemorrhage and one of intraspinal subdural hematoma after thrombolytic therapy are reported. Six patients were treated with streptokinase, four with rt-PA and one with a combination of both drugs. The incidence was 0.

[Aneurysm of a saphenous vein aortocoronary graft. Apropos of a case presenting with a presternal mass and review of the literature].

A 61 year old man was admitted with a pulsatile pre-sternal swelling ten years after saphenous vein coronary-artery bypass grafting. The precise diagnosis of this vascular tumor was not established despite various investigations. At reoperation, an aneurysm of the saphenous vein graft, eroding the sternum, was found.

[Aneurysm of the aorto-coronary venous bypass. Apropos of a case disclosed by a pre-sternal mass and a review of the literature].

A 61 year old man was admitted with a pulsatile pre-sternal swelling ten years after saphenous vein coronary-artery bypass grafting. The precise diagnosis of this vascular tumor was not established despite various investigations. At reoperation, an aneurysm of the saphenous vein graft, eroding the sternum, was found.

[Carotid artery thrombosis and myocardial infarction in nephrotic syndrome].

The authors report the case of a 18 year old man with a chronic corticosteroid-refractory nephrotic syndrome complicated by carotid artery thrombosis and myocardial infarction. Thromboembolism is one of the most serious complications of the nephrotic syndrome. Serious clotting factor disturbances are observed: changes in platelet function (hyperaggregability) increased plasma zymogens and cofactors, increased plasma fibrinogen, abnormalities of the fibrinolytic system and acquired deficiencies of coagulation inhibitors.

[Post-radiation coronary diseases. Presentation of 7 cases and review of the literature].

Coronary lesions are one of the complications of mediastinal radiotherapy; they are more uncommon, at least in their clinical expression, than the involvement of the pericardium, but they are interesting by their gravity and occurrence in young patients (35 years old, in an average). We are reporting 7 cases in addition to the 53 already recorded in the literature. The neoplasm which led to the radiation treatment is, in 85 p.

[Multiple congenital coronaro-left ventricular fistulas. Apropos of 7 cases].

Multiple congenital coronary-left ventricular fistulae (CLVF) are rare (4.5% of all coronaro-cardiac fistulae, the same incidence as isolated CLVF); data obtained from 7 personal and 25 previously reported cases, showed that this anomaly, is diagnosed at coronary angiography performed for anginal chest pains in 2 out of 3 cases; cardiac auscultation was usually normal but the basal ECG was pathological in 3 out of 4 cases; the electrical changes suggested myocardial ischaemia in 20 out of 24 cases. However, exercise stress testing was negative in 47% of cases.

[Proximal and peripheral coronaro-pulmonary fistulae. Apropos of 10 cases].

Coronaro-pulmonary fistula (CPF) is a rare congenital malformation comprising about 17 p. 100 of coronaro-cardiac fistulae. The authors report a series of 10 cases of CPF diagnosed in over 6 000 coronary angiographic studies.

[Auricular flutter after cardiothoracic surgery. Treatment by auricular stimulation using the esophageal approach].

Transoesophageal atrial pacing was used in 10 patients to interrupt post-operative atrial flutter after cardio-thoracic surgery. The method was successful in all cases. The arrhythmia was converted directly into sinus rhythm in 8 patients and into atrial fibrillation followed by spontaneous reversion to sinus rhythm in 2 patients.

[Cardiological aspect of Kearns' syndrome. Apropos of 3 cases, with histopathological study of the conduction tissue in one of them].

Three cases of Kearns syndrome are reported. The neuro-ophthalmological signs were comparable with ophthalmoplegia, pigmentary retinal degeneration and polymorphic neuro-muscular and sensory deficits. The electrocardiological signs were observed 2-4 years after the onset of the condition; the cause of death in each case was related to complete heart block.

[Kidney parenchymatous hypoplasia and arterial dysplasia in adult arterial hypertension. Data of selective renal arteriography].

Analysis of a further series of 125 consecutive unselected adults who were admitted to hospital with hypertension has advanced the study of arterial abnormalities and parenchymal hypoplasia, as demonstrated by selective renal arteriography, further in the direction of the parenchyma. An index of arterioparenchymal thinning is described. The authors list the features and incidence of polar arteries arising from the aorta (46%), polar arteries of non-aortic origin (31%), stenosing dysplasia (26%) and other arterial malformations, as well as biapical hypoplasia (67%), monofocal hypoplasia (37%), and the main types of renal dysgenesis (30%) which they found.