Archives des maladies du coeur et des vaisseaux
-
Arch Mal Coeur Vaiss · Apr 1991
[Temporary caval filter allowing diagnosis and fibrinolytic therapy in patients suspect of massive pulmonary embolism].
The authors propose a therapeutic strategy enabling diagnosis, treatment and prevention in the same clinical procedure based on a series of 8 patients presenting with signs of massive pulmonary embolism (acute cardiorespiratory distress, shock, loss of consciousness, and/or cardiac arrest). A removable vena cava filter is rapidly introduced percutaneously via a brachial, femoral or jugular vein, and opened in the inferior vena cava. Using the same catheter and without a second venous puncture, pulmonary angiography and cavography are performed by digitised angiography using a small quantity of contrast medium (40 ml, 12 ml/sec). ⋯ The temporary caval filter was removed in all cases but 3 patients required a definitive filter because of the persistence of life-threatening venous thrombosis. Seven of the 8 patients survived their pulmonary embolism. This approach is rapid, saves time, and spares the patients from more invasive procedures.
-
Arch Mal Coeur Vaiss · Apr 1991
Review[Thrombosis of mechanical heart valve prosthesis. Value of transesophageal echocardiography in the study of mitral valve prosthesis].
Forty-three consecutive patients with mechanical valve prostheses underwent transthoracic and transoesophageal echocardiography for suspected thrombolic prosthetic valve dysfunction. The results of these investigations were compared with those of cineradiography and the clinical outcome. The diagnosis of thrombosis was retained in 11 of the 43 patients (10 mitral and 1 aortic valve prostheses). ⋯ The cineradiography gave false negative results in 6 cases. In conclusion, these cases underline the undeniable value of transoesophageal echocardiography in occlusive or non-occlusive thrombosis of a mitral valve prosthesis. This investigation should be undertaken whenever there is the least suspicion of thrombosis of the prosthesis.
-
Arch Mal Coeur Vaiss · Apr 1991
Case Reports[Bilateral renal embolism during thrombolytic therapy with tissue-type plasminogen activator in a patient with thrombosis of the left ventricle].
The authors report a case of bilateral renal embolism during thrombolytic treatment in the acute phase of myocardial infarction in a 77 year old patient in whom echocardiography had shown a left ventricular thrombus. After reviewing the literature, the risk of embolic complications of thrombolytic therapy would seem difficult to evaluate because of the difficulty of diagnosis, but they exist irrespective of the type of thrombolytic agent used.