[Intracoronary administration of antithrombotic agents via a perfusion balloon catheter in patients with ST-segment elevation myocardial infarction presenting with massive intraluminal thrombus and failed aspiration].

Background: Massive intracoronary thrombus is associated with adverse procedural results including failed aspiration and unfavourable reperfusion. We aim to evaluate the effect of the intracoronary administration of antithrombotic agents via a perfusion catheter in patients with ST-segment elevation myocardial infarction (STEMI) presenting with a large thrombus burden and failed aspiration.

Methods: We retrospectively analyzed the thrombus burden, the TIMI grade flow, and the myocardial Blush in 25 consecutive STEMI patients with a large thrombus burden and failed manual aspiration, who received intracoronary infusion of glycoprotein IIb/IIIa inhibitors (N=17) or bivalirudine (N=8) via a 6F-infusion catheter (ClearWay™ RX) RESULTS: Mean age was 67±14 years, 16 patients (64 %) presented with anterior STEMI, and 7 (28 %) with cardiogenic shock.

A strategy for addressing aspirin hypersensitivity in patients requiring urgent PCI.

Aspirin is key to the treatment of acute myocardial infarction, particularly if stent implantation is considered. In patients with a history of hypersensitivity to aspirin, the optimal management of ST-segment elevation acute myocardial infarction is unclear. We suggest a strategy for addressing this problem by performing percutaneous coronary intervention with antiplatelet therapy by intravenous glycoprotein IIb/IIIa receptor blockers and performing rapid oral desensitization in the ensuing hours, once the patient has stabilized.

[Optical coherence tomography applied to vessels: a bright future].

Optical Coherence Tomography (OCT) is a new imaging technique recently applied to coronary and is based on the diffusion and reflection of an infrared spectrum. With a resolution 10 times higher than that of IVUS, it allows an analysis of the atherosclerotic plaque and its components, indicating its possible vulnerable character, and can identify the culprit lesion and the presence of thrombus in the course of acute events. It allows quality control of good apposition of stents to the wall and essentially tracks the downstream dissection.

[Detection of induced myocardial ischemia during stress cardiovascular magnetic resonance].

In the past decade, cardiovascular magnetic resonance (CMR) has evolved considerably. Its clinical applications enable the diagnosis and prognostic assessment of patients with ischemic heart disease. CMR is safe, with absence of any ionizing radiation, and offers the greatest information from a single test, allowing the assessment of myocardial morphology, myocardial function and viability.

[Are very old patients good candidates for percutaneous coronary intervention? A monocentric retrospective study].

Aim: To determine the feasibility of percutaneous coronary intervention (PCI) in very old patients.

Background: The elderly are a growing population with a high prevalence of ischemic heart disease and then subsequent possibility to benefit from coronary interventions.

Method: We have conducted a retrospective study using our PCI database since January 2000.

In flight auscultation: comparison of electronic and conventional stethoscopes.

Objectives: The ability to auscultate during air medical transport is compromised by high ambient noise levels. The aim of this study was to assess the capabilities of a traditional and an amplified stethoscope (which is expected to reduce background and ambient noise) to assess heart and breath sounds during medical transport in a Falcon 50 plane.

Methods: A prospective, double-blind, randomized study was performed.

Adjusted weight anticoagulation for radial approach in elective coronarography: the AWARE coronarography study.

Aims: To evaluate the feasibility and safety of an anticoagulation adapted regimen for transradial coronary angiography.

Methods And Results: We randomly assigned 162 consecutive patients who benefited from an elective transradial approach for coronarography to receive either a standard dose of 5,000 IU heparin or 50 IU/kg with an upper limit of 5,000 IU. Patients under anti-vitamin K therapy were excluded.

[Radial difficulties during percutaneous coronary intervention].

The transradial approach is the main route in France to perform percutaneous coronary intervention, reaching nearly 60% of the cases in 2008. Its proven benefit in reducing bleeding complications and therefore its impact on morbidity and mortality are now well documented. However, a definite learning curve is necessary in relation with specifics challenges.

Suspected acute coronary syndrome in a theater of operations: first management, medical evacuation, and final diagnosis: experience of the French Medical Army.

Objective: to evaluate the treatment of the acute coronary syndrome (ACS) among soldiers stationed on a theater of operations by structures usually conceived to treat combat-related trauma.

Methods: We performed a retrospective study involving the whole medical evacuations out of a theater of operations to the benefit of the French Armed forces, for a suspected diagnosis of ACS.

Results: 35 patients were included in this study with 20 for a diagnosis of persistent ST-Segment Elevation Myocardial Infarction (STEMI).

[Coronary angioplasty in octogenarians].

Coronary angioplasty is the most frequent method used for coronary revascularisation. Recommendations about its application are well-established. The elderly are a growing population with a high prevalence of ischaemic heart disease, especially with unstable presentation.

[A myocardial infarction complicated with mitral anterior papillary muscle rupture during long-term corticotherapy].

The authors report anterolateral papillary muscle rupture, occurring in a 67-year-old patient admitted for acute coronary syndrome. Mitral regurgitation, a rare but dramatic complication of myocardial infarction, is most often a consequence of posterior papillary muscle rupture. The 'protection' of the anterior papillary muscle is associated with vascularization via a dual coronary artery supply.

Evaluation of heart failure management in a Military Hospital.

Purpose: Evaluate heart failure management in a Military Hospital in 2005.

Methods: Retrospective audit of 46 case records of patients hospitalised with heart failure within the framework of an accreditation procedure.

Results: The left ventricular ejection fraction was evaluated in 85% of cases during the reference hospital stay.

[Vascular approaches and closure devices for percutaneous coronary intervention].

The choice of a transradial or transfemoral approach remains a pivotal decision in percutaneous coronary angioplasty. We discuss here the varying criteria leading to a rational choice in the arterial access choice. Since the emergent transradial approach in France has led to a dramatic reduction in local vascular complications, we also discuss the remaining place of femoral approach and the usefulness of femoral percutaneous closure devices.

[Saphenous graft angioplasty].

In our daily practice the rate of saphenous graft angioplasty is less than 5%. This kind of angioplasty is more complex with a higher rate of complications in known fragile patients. Some technical trips and tricks are necessary to easily perform these angioplasties.

[Cardiac toxicity of catecholamines. Report of two cases].

Introduction: The role of catecholamines in the cardiac expression of pheochromocytoma is well-known. The physiopathology of the syndrome of Tako-tsubo remains more unclear.

Exegesis: We describe 2 clinical cases of acute coronary syndrome with left ventricular dysfunction and no coronary artery stenosis.

[Increased secretion of Nt-proBNP immediately after percutaneous coronary intervention: about 90 cases].

Nt-proBNP have emerged as useful biomarker for the diagnosis and prognostic of heart failure but also recently in acute coronary syndrome. Myocardial ischemia is probably an important stimulus for Nt-proBNP release. Transient myocardial ischemia is inducing by balloon inflation during percutaneous coronary intervention (PCI).

Transcrystalline melt migration and Earth's mantle.

Plate tectonics and volcanism involve the formation, migration, and interaction of magma and gas. Experiments show that melt inclusions subjected to a thermal gradient migrate through olivine crystals, under the kinetic control of crystal-melt interface mechanisms. Exsolved gas bubbles remain fixed and eventually separate from the melt.

Osmium isotope heterogeneity in the constituent phases of mid-ocean ridge basalts.

Radiogenic isotope variations in mid-ocean ridge basalts (MORB) are commonly attributed to compositional variations in Earth's upper mantle. For the rheniumosmium isotope system, constituent MORB phases are shown to possess exceptionally high Re/Os (parent/daughter) ratios, consequently radiogenic 187Os is produced from the decay of 187Re over short periods of time. Thus, in the absence of precise age constraints, Os isotope variations cannot be unambiguously attributed to their source, although Re-Os isotope data for constituent minerals can yield crystallization ages, details of equilibration, and initial Os isotope values that relate directly to the mantle source.