Archives des maladies du coeur et des vaisseaux最新文献

{"title":"[Mitral commissurotomy during pregnancy].","authors":"A Bennis,&nbsp;M Bennani,&nbsp;N Elhaitem","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The physiological hemodynamic changes of the circulation during pregnancy are the main cause of mitral stenosis (MS) decompensation. In pregnant women with MS, the blood volume increase, tachycardia and the obstacle to left ventricular filling are responsible of post-capillary pulmonary hypertension (PF). This hemodynamic stress associated to other conditions can trigger acute pulmonary edema or even cardiogenic shock leading eventually to an unacceptable maternal and fetal death. The percutaneous mitral commissurotomy (PMC) has been tested with success during pregnancy, with excellent short- and mid-term results. We report our experience on seventy patients requiring PMC during the third trimester of pregnancy, between March 1998 and June 2006. The PMC was successful in sixty nine out of seventy patients. All of them improved their NYHA class of that least one stage. None of them kept a residual mitral surface<1.5 cm2. The PMC permitted a spectacular clinical and hemodynamic improvement, and the course of pregnancy until end of term occurred in almost all cases.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"861-4"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27103405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Bi-tachycardia and ischemic cardiopathy (following myocardial infarction)].","authors":"O Marçon,&nbsp;B Brembilla-Perrot","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>The association of supraventricular tachycardia (SVT) and ventricular tachycardia (VT) is not common. The aim of this study was to evaluate its incidence and possible predisposing factors in patients with a history of myocardial infarction (MI), in order to correct them.</p><p><strong>Methods: </strong>Out of 359 patients consecutively recruited for spontaneous VT occurring at least one month after the acute phase of an MI, 33 were noted to have a possible association of SVT with VT. These patients underwent the following investigations: Holter recording, left ventricular ejection fraction (LVEF) measurement, and electrophysiological studies including programmed atrial and ventricular pacing.</p><p><strong>Results: </strong>The LEVF was 37.5+/-11%. An SVT was induced in 21 patients and a VT in 31 patients. Following investigation, the presumed factor predisposing to the two tachycardias was considered to be initiation of an SVT associated with rapid nodal conduction to the ventricle (Wenckebach point 210+/-23/mn) in 12 patients, branch to branch re-entry in 4 patients, reversible rhythmic dilated cardiomyopathy in 4 patients, an ischemic factor in 8 patients, post-operative period in 1 subject, infundibular VT in 1 subject, and an undetermined mechanism in 3 patients. The specific treatment of each of the identified etiologies usually prevented the recurrence of VT with the exception of one patient who had further VT during defibrillator recording, independent of any SVT.</p><p><strong>Conclusion: </strong>The association of SVT with VT is rare because it was only noted in 9% of subjects who presented with spontaneous VT following myocardial infarction; This incidence is debatable, and could be an underestimate due to the fact that diagnosis is difficult. Several presumed predisposing factors are implicated and should be actively sought.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"853-60"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27106418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Significance of the contralateral approach combined with venous deocclusion in a case of biventricular defibrillator implantation].","authors":"P Jacon,&nbsp;A Benhalima,&nbsp;F Thony,&nbsp;P Defaye","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The authors report the case of a patient in whom a biventricular defibrillator was successfully implanted from the right, following a failed approach from the left. The patient had chronic thrombosis of the subclavian vein, and this procedure was only possible after venous deocclusion and the positioning of an endoprosthesis. The authors underline the significance of the contralateral approach in case of difficulties in inserting pacing devices, as well as the complementary benefits of interventional radiological procedures in order to allow vascular access in cases of chronic venous thrombosis.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"883-6"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27103409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Echocardiographic factors predictive of restoration and maintenance of sinus rhythm after reduction of atrial fibrillation].","authors":"A Ben Khalfallah,&nbsp;I Sanaa","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is the most common cardiac arrhythmia. While the arrhythmia was initially thought to be little more than a nuisance, it is now clear that AF has a significant negative impact on quality of life and a corresponding increase in both morbidity and mortality.</p><p><strong>Objective: </strong>The aim of this study was to identify Doppler echographic patterns that allow prediction of atrial fibrillation reduction and maintenance of sinus rhythm within 12 months.</p><p><strong>Patients and methods: </strong>One hundred and thirty patients having permanent atrial fibrillation, recent (51) or chronic (79) are included in the study, excepting those with valvular heart disease or thyroid dysfunction. The mean age was 63.5 +/- 11.3 years. Both transthoracic and transoesophageal echocardiography was performed using a Philips SONOS 5500 Echograph, before cardioversion. Were studied: end diastolic and systolic left ventricular diameters, left ventricular ejectionnal fraction, left atrial area (LAA), left atrial diameter, left atrial appendage area and peak emptying velocities of the left atrial appendage (PeV). Sinus rhythm was re-established in 102 patients (44 having recent and 58 chronic atrial fibrillation). Sinus rhythm was maintained for 12 months in 79 patients.</p><p><strong>Results: </strong>Within the echographic parameters studied, the left atrial area (LAA) and peak emptying velocities of left atrial appendage (PeV) before cardioversion were the best predictors of restoration of sinus rhythm. On monovariate analysis, SOG is significantly lower and PicV is significantly higher in patients whose sinus rhythm had been restored in comparison with those with permanent atrial fibrillation. (Mean SOG: 27.7 +/- 7.62 vs. 34 +/- 7,6 cm2, p<0.0001; Mean PicV: 44 +/- 15.8 vs. 31.4 +/- 13,7 cm/s, p<0.0001). This difference was maintained on multivariate analysis (p=0.002 for SOG and p=0.005 for PicV). In patients with recent atrial fibrillation, only left atrial area can predict on mono and multivariate analysis (p=0.05, OR=0.5, IC=0.36 à 3.56), re-establishing of sinus rhythm whereas in patients with chronic atrial fibrillation, peak emptying velocity of left atrial appendage predict better re-establishing of sinus rhythm (p=0.04, OR=1.29, IC=0.12 à 4.23). The threshold values of LAA and PeV for conversion of atrial fibrillation into sinus rhythm are respectively 25 cm2 and 20 cm/sec. In patients who converted into sinus rhythm; LAA predict maintenance of sinus rhythm at the end of 12 months of survey (p=0.04) with a threshold value of 25 cm2. In the subgroup of patients admitted with chronic atrial fibrillation, PeV predicts better the maintenance of sinus rhythm (p=0.05) with a threshold value of 60 cm/sec, p=0.06; whereas LAA remains better in patients with a recent atrial fibrillation. (p=0.02).</p><p><strong>Conclusion: </strong>In addition to the anatomic study of cardiac structure and the search o","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"745-52"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27104710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protecting the acutely ischemic myocardium beyond reperfusion therapies: are we any closer to realizing the dream of infarct size elimination?","authors":"R Tissier,&nbsp;M V Cohen,&nbsp;J M Downey","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients currently treated for acute myocardial infarction receive reperfusion therapy as their only anti-infarct intervention. Although pharmacologic agents have been evaluated in the past for their ability to salvage ischemic myocardium when administered at reperfusion, until very recently none has demonstrated clear efficacy in clinical trials. However, a new generation of interventions has emerged which protects the heart by activating the reperfusion-induced salvage kinase (RISK) pathway. Unlike the disappointing results documented with previously touted putative cardioprotective agents, the preclinical experience with these newer interventions is very consistent indicating that there is a high likelihood that they will be effective clinically. Ischemic postconditioning, which also acts by activating the RISK pathway, has shown marked reduction in infarct size in small-scale trials. Finally, if a strategy for rapidly cooling the heart can be devised so that the in-hospital normothermic ischemic time can be significantly reduced, then infarct size can be even further decreased. In our opinion it is well within our reach using existing technologies to see the day when infarction can be virtually eliminated in the patient with acute coronary occlusion.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"794-802"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27106411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Regarding the consensus between the French Society of Cardiology and the French Neuro-Vascular Society about closure of the permeable oval foramen].","authors":"Jean-Claude Daubert,&nbsp;France Woimant","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"727"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27105937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Dilated cardiomyopathy and syncope: management].","authors":"B Brembilla-Perrot","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Syncope occurring in patients with primary dilated cardiac disease has several causes: ventricular tachycardia (VT), a major severe cause of this diagnosis, occurring however only in one third of cases. The other causes are supraventricular tachycardia, bradycardia and vagal hyperactivity. The management depends on the etiology of syncope in one hand and the severity of the cardiac disease and other comorbidities in the other hand. In 2007, a patient with life expectancy exceeding one year, without irreducible heart failure but with a known and stable altered left ventricular ejection fraction (LVEF)<30%, will probably benefit of non-drug technology for the treatment of syncope (defibrillator with or without resynchronization), possibly in association with the treatment of another identified etiology, such as ablation or anti-arrhythmic treatment of a supraventricular tachycardia. In a patient with LVEF>30%, the electrophysiology exploration remains the most reliable recommended investigation for identifying the cause of syncope prior to discuss the implantation of a portable Holter device, indicated when the electrophysiology study is negative and syncope repeating.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"782-6"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27104716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Assessment of myocardial function and perfusion by MRI two days and four months after acute myocardial infarction revascularised by primary angioplasty].","authors":"B Noël,&nbsp;M-C Morice,&nbsp;A Kokis,&nbsp;J Garot,&nbsp;P Dumas,&nbsp;Y Louvard,&nbsp;O Tavolaro,&nbsp;M Lévy,&nbsp;T Lefèvre","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The extent of gadolinium enhancement assessed by cardiac MRI is an accepted marker of myocardial necrosis. The correlation between late enhancement and other parameters of infarct size after myocardial infarction have previously been described. However, the prognostic value of the extent of late enhancement in terms of myocardial recovery remains controversial especially in revascularised infarcts analysed by early MRI. In order to clarify this question the authors compared the results of MRI at two days and four months after myocardial infarction benefiting from early revascularisation. Between July 2002 and November 2004, the authors included patients with myocardial infarction treated by primary angioplasty and examined by MRI (Siemens Symphony 1.5 T) at two days and three to five months after myocardial infarction. The left ventricular ejection fraction, volume, mass and wall thickness were measured. Perfusion at first passage (PP) and late enhancement were analysed after injection of 20 cc of gadolinium. An eight segment short axis model was used for PP and analysis of late enhancement. Each segment was assessed for transmural or subendocardial hypoperfusion for PP assessment and the wall thickness with late enhancement (1-25%, 26-50%, 51-75%, and 76-100%) was measured to calculate the percentage of myocardial mass showing late enhancement. Thirty-nine patients (thirty three men) were included. The average age was 59 +/- 10 years. TIMI III flow was obtained in all but one (TIMI II) patient. Cardiac MRI was performed 2.1 +/- 1.5 days and 4.6 +/- 1.7 months after myocardial infarction. The ejection fraction increased from 48.7 +/- 12.6% to 54.2 +/- 11.1%, p<0.05, and was related to infarct size (p<0.01). Forty-eight per cent of dysfunctional segments at the initial MRI improved their contractility and the extent of transmural late enhancement was inversely correlated with wall thickening at initial (p<0.01) and four month MRI (p<0.01). The PP improved significantly (regression from 9.5 +/- 8.2% to 2.8 +/- 4.1% of segments with abnormal myocardial perfusion, p<0.01). The late enhancement with respect to total myocardial mass decreased from 20.0 +/- 10.7% to 13.0 +/- 8.1%, p<0.01). Despite restoring TIMI III flow, early myocardial reperfusion is incomplete and improves in the medium term. The authors also observed a reduction in late enhancement at four months, indicating that the results immediately after myocardial infarction may overestimate the infarct size and that this sign does not represent necrotic tissue alone but also viable myocardium with a potential for recovery.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"729-35"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27105938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac sodium channel Nav1.5 and its associated proteins.","authors":"H Abriel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The main cardiac voltage-gated Na+ channel, Nav1.5, plays a key role in generation of the cardiac action potential (cardiac excitability) and propagation of the electrical impulse in the heart (cardiac conduction). During the past decade, numerous mutations in SCN5A, the gene, encoding Nav1.5, were found in patients with different pathologic cardiac phenotypes such as the congenital long QT syndrome type 3, Brugada syndrome, and progressive cardiac conduction defect (or Lenègre-Lev disease). These mutations define a sub-group of Nav1.5 / SCN5A-related cardiac channelopathies. Recent works have suggested that Nav1.5 is part of several multi-protein complexes located in different membrane compartments of the cardiac cells. In some instances, the genes of these regulatory proteins were also found to be mutated in patients with inherited forms of cardiac arrhythmias. The proteins that associate with Nav1.5, and form these complexes, can be classified as 1) anchoring/adaptor proteins, 2) enzymes interacting with and modifying the channel, and 3) proteins modulating the biophysical properties of Nav1.5 upon binding. The purpose of this short article is to review the proposed roles of these interactions. These recent observations indicate that the expression level, cellular localization, and activity of Nav1.5 are finely regulated by complex molecular mechanisms that we are only starting to elucidate.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"787-93"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27104717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Consensus about indications of endovascular closure of the patent foramen ovale after an ischemic brain stroke].","authors":"J-F Albucher, P Chaine, J-L Mas, T Moulin, G Rodier, A Cohen, G Derumeaux, J-R Lusson, M-C Malergue, C Rey","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 9","pages":"771-4"},"PeriodicalIF":0.0,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27104714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}