Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Feb 2003
Case Reports[Isolated carcinoid tumor of the ovary disclosed by tricuspid insufficiency].
A 68-year old woman was hospitalised because of isolated right heart failure. Doppler echocardiography revealed severe tricuspid regurgitation with thickened, shortened, hypomobile leaflets. Pulmonary valve was thickened with mild pulmonary regurgitation. ⋯ In this circumstance, carcinoid cardiac lesions may develop in the absence of hepatic metastases because the venous blood from the ovaries drains into the inferior vena cava without hepatic first past effect. Surgical resection of primary ovarian carcinoid tumor is often curative and the prognosis depends mainly on the cardiac condition. The diagnosis of carcinoid syndrome should be discussed in patients with organic tricuspid regurgitation without left valvular disease.
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Arch Mal Coeur Vaiss · Feb 2003
Case Reports[Sudden death disclosing abnormal origin of the left coronary vessel from the pulmonary artery trunk].
Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital abnormality with a poor prognosis in the newborn. Adult forms are, therefore, very rare, presenting with angina, cardiac failure or sudden death. The authors report the case of a 41 year old woman who was asymptomatic until admitted as an emergency after ventricular fibrillation. ⋯ The echocardiographic abnormalities regressed within a few weeks. An automatic defibrillator was not implanted. The physiopathology of this rare cardiac lesion, the mechanisms of sudden death and the different techniques of surgical repair are discussed.
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Arch Mal Coeur Vaiss · Feb 2003
[Variations of the profile of infective endocarditis in France. Results of an epidemiologic survey carried out during a year].
Since the first modern clinical description of the infective endocarditis by Osler at the late 19th century, the profile of this disease never stopped changing, which has been well described by several epidemiological studies, especially the one performed in France in 1991. The aim of this study was to update data obtained in 1991 on the epidemiology of infective endocarditis in France. This is a transversal survey conducted between January and December 1999 in all hospitals of 6 French regions representing 26% of the whole population (16 million inhabitants). ⋯ The in-hospital mortality was at 16%. Compared to the 1991 study, this one highlights a decrease of endocarditis incidence in patients with known cardiac disease (20.6 cases per million vs. 15.1 cases per million, p < 0.001) and a decrease of the incidence of endocarditis due to oral streptococci, which is partially counter-balanced by an increase of the proportion of endocarditis due to D-group streptococci (5.3 cases per million vs. 6.2 cases per million, p = 0.67) and to staphylococci (4.9 cases per million vs. 5.7 cases per million, p = 0.97), an increased rate of surgery in the in-hospital period (31.2% vs. 49.7%, p < 0.001), a decrease of hospital mortality (21.6% vs. 16.6%, p = 0.008). Even though the global incidence of endocarditis did not change significantly, this study highlights important modification in the infective endocarditis profile, especially concerning the culprit agents, the underlying cardiac disease, the therapeutic strategies engaged and the prognosis.
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Arch Mal Coeur Vaiss · Jul 2002
Comparative Study[Comparison of central pulse pressure estimated from pulse wave propagation velocity and carotid pulse pressure measured by applantation tonometry].
Pulse pressure (PP) corresponds to the difference between arterial systolic blood pressure and diastolic blood pressure. Central PP seems to be a stronger coronary risk marker than brachial PP. Central PP can be estimated by aortic PP measured non invasively by aplanation tonometry of the carotid artery. The aim of this study was to compare 2 methods of estimation of aortic PP: estimation from Pulse Wave Velocities (PWV) and by aplanation tonometry of the carotid artery. Estimation from PWV is based on the non uniform transmission of the PP i.e. the amplification of PP from the aorta to brachial artery, through arteries of increasing impedance. ⋯ The PWV estimated PP is larger than the central PP measured at the carotid level by aplanation tonometry. The difference is larger in cardiovascular event free subjects than in patients on hemodialysis.
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Arch Mal Coeur Vaiss · May 2002
Case Reports[Placement of an implantable defibrillator via the endocavitary route in a patient presenting with a univentricular heart and a Glenn anastomosis].
We report the observation of a female 45 year old patient presenting with a post-surgery complex congenital cardiopathy, associated with serious ventricular rhythm disorders necessitating the placement of an implantable defibrillator. The palliative surgery performed (cavo-pulmonary Glenn anastomosis) does not allow the usual access to the right ventricle via the superior vena cava. The different possibilities for defibrillator implantation are discussed. These include associating a surgical approach to introduce the bipolar probe with subcutaneous tunnelling to connect the probe to the box.