Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · May 2002
Review[Platypnoea-orthodeoxia syndrome. Diagnosis, etiology, treatment].
Platypnoea-orthodeoxia (P. O.) syndrome is the association of dyspnoea and arterial oxygen desaturation aggravated in the erect position and relieved in the supine position. Initially considered very rare (20 cases reported over fifty years) and occurring essentially in patients having undergone pneumonectomy, it in fact occurs much more frequently if only it is looked for (20 extra cases reported in a single year). ⋯ Exceptionally the shunt is situated at the vascular or pulmonary parenchymal level. Poor tolerance of P. O. syndrome justifies a therapeutic procedure; this is usually closure of the septal fault with an occluder introduced percutaneously; the results are generally highly spectacular.
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Arch Mal Coeur Vaiss · Feb 2002
Review[Evaluation of the cardiac risks in non-cardiac surgery in patients with heart failure].
Cardiac insufficiency represents a major risk factor in patients about to undergo non-cardiac surgery. The post-operative mortality is linked to the severity of the pre-operative functional impairment: rising from 4% in NYHA class 1 to 67% in class IV. The operative risk is greater when the cardiac insufficiency is more disabling, the patient is older (> 70 years) and if there is a history of acute pulmonary oedema and a gallop bruit on auscultation. ⋯ The risk of post-operative cardiac complications is low in the absence of the 9 risk factors defined by Goldman, as is an ischaemic syndrome (angina on light physical activity, unstable angina, myocardial infarction). Certain risk factors (jugular congestion, gallop bruit, recent myocardial infarction, non-sinus rhythm, extrasystoles, aortic stenosis) obviously require appropriate treatment beforehand. The sometimes difficult process demands a dialogue between the cardiologist and the surgeon, the recognition of the risk of surgery in a given centre, and the opinion of the patient duly informed of the terms of the discussion about him.
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Arch Mal Coeur Vaiss · Jan 2002
[Very long-term outcome of 68 vena cava filters percutaneously implanted].
Between January 1987 and December 1991, 68 consecutive patients aged 71.5 +/- 12.0 years underwent percutaneous implantation of a vena caval filter, mainly the LGM (N = 64). Fifty seven patients had pulmonary embolism, 61 had deep vein thrombosis of the lower limbs. The average follow-up interval was 4.9 +/- 3.3 years (7.0 +/- 2.7 years for the patients still alive). ⋯ There was a significant correlation between closure on plain abdominal X-ray and caval thrombosis and between recurrent deep vein thrombosis and caval thrombosis. The frequency of long-term complications after implantation of a caval filter in this study suggests that interruption of the vena cava should be reserved for the only validated indications in the presence of a formal contra-indication to or failure of anticoagulant therapy. Other indications require evaluation with prospective randomised trials.
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Arch Mal Coeur Vaiss · Dec 2001
Case Reports[Lyme disease presenting as infarction pain. A case report].
Lyme's disease is a multi-system condition due to infection with a spirochete (Borrelia Burgdorferi), transmitted by a tick. Cardiac involvement, which is not systematic, usually presents with transient atrioventricular block of varying degree. The authors describe an unusual presentation of the cardiac involvement of Lyme's disease with chest pain resembling an acute coronary syndrome in a 32 year old man. The characteristic skin lesion (erythema migrans), the positivity of IgM serology, the myocardial scintigraphic results and the negativity of the work-up of other causes of this pain led to a diagnosis of myocarditis, the outcome of which was favourable with treatment by amoxycillin (3 g/day, orally).
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Arch Mal Coeur Vaiss · Nov 2001
Review[Fibrinolysis in myocardial infarction with EKG elevation. Optimization of myocardial reperfusion by treatment with antithrombotic agents].
In the case of acute coronary syndrome with prolonged ST elevation on ECG showing an acute coronary obstruction, the urgent institution of fibrinolysis is a widely validated treatment. Since the first placebo controlled studies with streptokinase until the development of bolus administration rt-PA varieties, fibrinolytic agents have lowered mortality. Associated anti-thrombotic drugs are multiplying in parallel. ⋯ Pentasaccharide seems attractive. The place of hirudine and its derivatives in the acute phase of MI appear limited after the results of the HERO-2 trial, associating hirulog and streptokinase, with the earlier studies also having been disappointing. The GPIIbIIIa blockers in association with a half dose of fibrinolysis do not aggravate the intracerebral haemorrhagic risk before 75 years old and clearly reduce hospital morbidity in infarction, at the price however of an increase in transfusions.