Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Dec 1995
Review[Supraventricular tachycardia with wide QRS complexes during Vaughan-Williams class I anti-arrhythmic treatment. Diagnostic and therapeutic implications].
The authors report 8 cases of regular tachycardia with wide QRS complexes during treatment with Vaughan-Williams class 1 antiarrhythmic drugs. These antiarrhythmics, prescribed to prevent atrial fibrillation (3 patients) and atrial flutter (5 patients), were flecainide in 4 cases, propafenone in 2 cases and cibenzoline and hydroquinidine respectively associated with digitoxine and propranolol. These wide complex tachycardias were regular atrial tachycardias with 1/1 conduction to the ventricle. ⋯ The recording of a wide QRS complex tachycardia in a patient on class 1 antiarrhythmic therapy for an atrial arrhythmia should alert the physician to 1/1 atrial tachycardia despite morphological electrocardiographic criteria of ventricular tachycardia. The 1/1 atrial tachycardia may be poorly tolerated and require emergency treatment. The preventive association of a drug which slows conduction through the atrioventricular node is not always effective.
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Arch Mal Coeur Vaiss · Dec 1995
Case Reports[Iatrogenic left coronaro-atrial fistula after mitral valve replacement: apropos of a case].
The authors report a case of an iatrogenic fistula between the left circumflex coronary artery and left atrium. The fistula was a complication of reoperation to replace a mitral valvuloplasty annulus by a mechanical hemi-disc prosthesis (Saint Jude Medical). Diagnosis was made by transoesophageal echocardiography and confirmed by coronary angiography. The patient underwent external ligature under cardio-pulmonary bypass.
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The prognosis of thromboembolic disease depends, to a large degree, on the deep venous thrombosis. It is located in the legs in nearly 80% of cases and proximal to the popliteal vein in one out of two patients. It is the cause of recurrence and at longer term, of post-thrombotic disease, the frequency of which contrasts with the rarity of chronic post-embolic cor pulmonale. ⋯ Conversely, distal deep vein thrombosis only requires heparin therapy. Interruption of the inferior vena cava is essential when embolism complicates well-treated deep vein thrombosis or when the thrombosis becomes more extensive despite effective treatment. It is also advisable when pulmonary sequellae are severe, long-term anticoagulant therapy is contra-indicated or when the aetiology of the thromboembolism cannot be determined.
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Transthoracic echocardiography rarely confirms a diagnosis of pulmonary embolism by visualizing a thrombus in the pulmonary artery or right heart chambers. However, easily observed morphological and Doppler abnormalities may result from acute pulmonary hypertension: dilatation of the right heart chambers, a very sensitive and reliable sign of severe pulmonary embolism when the ratio of the right/left ventricular dimension > 0.6: abnormal interventricular septal contraction, a very specific sign of massive pulmonary embolism, and increased systolic pulmonary artery pressure. ⋯ The investigation is rapid and can be carried out at the bedside, allowing confirmation of the diagnosis in two thirds of cases and the institution of thrombolytic or surgical therapy without the need for pulmonary angiography. Doppler echocardiography is also useful for following up the haemodynamic changes and the regression of acute cor pulmonale after thrombolysis.
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Arch Mal Coeur Vaiss · Nov 1995
Review[Indications of partial interruption of the inferior vena cava in pulmonary embolism].
Forty years after the first implantation of caval filters, there is still no indication for implantation validated by a controlled clinical trial. This fact may be explained by our poor understanding of the evolution of thromboembolic disease, especially in certain groups of patients. The absolute contra-indications to heparin therapy would seem to be a logical indication for a caval filter. ⋯ The implantation of a filter would seem to be justified in patients with chronic cor pulmonale after pulmonary embolectomy. The value of a temporary caval filter during thrombolysis has not been demonstrated; there are hopes that temporary filters "of long duration" will provide filtration of the vena cava during vulnerable periods. The results of the first controlled trial (PREPIC) are eagerly awaited and should rationalise the indications of inferior vena cava filters.