Annales de cardiologie et d'angéiologie
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Ann Cardiol Angeiol (Paris) · Jan 1987
Case Reports[Tricuspid endocarditis with right-left auricular shunt through a patent foramen ovale].
The authors report the case of a tricuspid endocarditis secondary to Streptococcus bovis with important regurgitation and severe hypoxemia secondary to a right-left atrial shunt through a patent foramen ovale, requiring a surgical treatment which included the replacement of the tricuspid valve and closure of the dehiscence in the inter-atrial septum. The presence of a patent foramen ovale in the course of a tricuspid endocarditis has been exceptionally reported. This diagnosis deserves to be evoked in case of an unexplained hypoxic condition or a systemic embolism complicating a tricuspid endocarditis. The report emphasizes the advantage of ultrasonic examinations (contrast sonocardiography, pulsated Doppler) in order to demonstrate this right-left atrial shunt in addition to the data collected about the tricuspid valve.
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The authors study the sensitivity, the specificity and the predicting value of Frank's sign (presence of a groove at the level of the earlobe) on a group of 172 patients undergoing a clinical examination, an EKG at rest and effort, and a selective coronary arteriogram for suspicion of coronary disease. The criteria retained for the diagnosis of coronary disease is the presence of stenosis superior or equal to 75 p. cent in one of the three main coronary vascular trunks. Statistical studies using the CHI 2 test reveal a highly significant association between Frank's sign and coronary disease (p less than 0.001). ⋯ Frank's sign is correlated neither with the gravity of the coronary disease, nor the duration of the angina, nor with any of the risk factors studied here: tobacco, hypercholesterolemia, arterial hypertension, diabetes, obesity. Frank's sign is therefore considered as a marker of the coronary disease, independent of risk factors but frequently associated with them. If its absence does not permit in any way to exclude the diagnosis of coronary disease, its presence corresponds in three quarters of the cases to an established coronary disease within a symptomatic population.(ABSTRACT TRUNCATED AT 250 WORDS)