Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Jun 1993
Case Reports[Simultaneous thrombosis of the left anterior interventricular and right coronary arteries in a 27 year-old patient with protein S deficiency].
The authors report a case of myocardial infarction in a 27 year old patient by simultaneous thrombosis of the left anterior descending and right coronary arteries in an angiographically normal coronary circulation. The young age of the patient, the absence of the usual risk factors and a normal angiographic network after arterial recanalisation by angioplasty led to the search for a risk factor of thrombosis. This showed a qualitative deficiency of protein S and the absence of any other abnormality of coagulation or fibrinolysis. This case raises the question of a causal relationship between a hereditary protein S deficiency and thrombotic arterial occlusion.
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Arch Mal Coeur Vaiss · Mar 1993
Review[Contribution of transesophageal echocardiography in the diagnosis of intra- and para-cardiac masses].
The authors detected 59 thrombi and 7 intra- or paracardiac tumors in 58 patients in a series of 1,100 transesophageal echocardiography. Twenty-six of the 51 patients with a thrombus were in sinus rhythm; 25 had atrial fibrillation. In 44 cases, the thrombus was single and in 7 cases there were multiple thrombi. ⋯ Two right paracardiac tumours were only visible by transesophageal echocardiography. Transesophageal echocardiography is therefore very useful in the diagnosis of thrombi in the left atrium and auricle, of rare hypodense myxomas and paracardiac tumors. In addition, it enables precise localisation of the site of implantation of nearly all intracardiac tumors.
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Polymorphic ventricular tachycardia is defined as constant change of the QRS morphology. The diagnosis has important etiological, therapeutic and prognostic implications. ⋯ Polymorphic ventricular tachycardia is classified according to the absence or presence of underlying cardiac disease respectively as torsades de pointe with long QT, torsades de pointe with a short coupling interval and catecholamine-induced ventricular tachycardia of childhood on the one hand, and, iatrogenic torsades de pointe, ventricular tachycardia in acute or chronic infarction and other cardiac diseases, on the other hand. Finally, the authors discuss the problem of polymorphic ventricular tachycardia induced by programmed ventricular stimulation.
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Arch Mal Coeur Vaiss · Feb 1992
Review Case Reports[Right atrial thrombosis and severe pulmonary embolism].
Two cases of severe pulmonary embolism associated with right atrial thrombosis are reported. In the first case, fibrinolytic therapy was administered and was thought to be a causative factor in the death of the patient due to massive pulmonary embolism. In the second case, the patient was referred for surgery and two enormous thrombi were extracted. ⋯ These two cases were confronted with the results of the literature. They strongly suggest that echocardiography should be a first-line investigation in severe pulmonary embolism. The detection of right atrial thrombosis modifies the clinical strategy and orientates treatment towards surgical referral when the patient's condition allows it.
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Clinical indications of vena cava interruption are reviewed. During the last few years pulmonary embolism frequency remained high and many new percutaneous vena caval filters became available. These facts probably explain the increasing use of these filters reaching about 10,000 filters each year in France. ⋯ The only admitted indications of vena cava interruption, in case of proximal venous thrombosis, are contraindications to anticoagulation. In other situations no data allow to recommend a cava filter; indication will be discussed on a case by case basis. Prospective controlled studies are greatly encouraged.