Search

Many interventional treatments have been proposed for intrastent stenosis, in particular by drug-eluting stents, with encouraging results. The aim of this study was to assess the clinical outcome of patients with restenosis of an ordinary uncovered stent treated by a drug eluting stent in a prospective series. The register included 43 patients (50 intrastent restenoses) treated by a drug eluting stent (Cypher or Taxus). The restenosis lesion was focal in 32% of cases with an average length of 14.8 +/- 8 mm and diameter inferior to 2.5 mm in 48% of cases. A Cypher stent was implanted in 44% of cases and a Taxus stent in 56% of cases. After an average follow-up of 6.7 +/- 1.3 months, the major adverse cardiac event rate was 9.3%. It included one transmural infarct in a patient, due to stent thrombosis, and symptomatic restenoses in 3 patients (clinical restenosis rate: 7%). An angiographic control was performed in 15 patients (35%) identifying focal restenosis at the exit of the stent in the 3 symptomatic patients. As in previously reported studies, these results show that with well conducted platelet antiaggregant therapy, the treatment of intrastent restenosis with a drug eluting stent is effective with a low rate of adverse cardiovascular events which compares favourably with previously proposed techniques of management.

Unlabelled: Periprosthetic regurgitation (PPR) is a common complication of mitral valve replacement (MVR). The management of moderate and minor PPR remains controversial. The goal of this prospective study was to determine the incidence, predictors and outcome of PPR discovered using omniplan transoesophageal echocardiography (TEE) performed at the early postoperative period (14.7 days) of MVR with SJM prosthesis. Our study enrolled 56 patients, the mean age was 44.5 +/- 11.9 years. The incidence of PPR was 59% (33 patients). TEE showed one jet in nine patients (27%), two jets in 23 patients (70%) and three jets in one patient (3%). PPR is minor in 24 patients (63%) and moderate in nine patients (27%). No patient developed hemolytic anemia or congestive heart failure. In univariate analysis, diameter of prostheses > 27 mm, number of suture knots < 17 and diameter of prostheses/number of knot ratio > 1.7 independently predicted the presence of PPR. In multivariate analysis only a rapport diameter of protheses/number of suture knots > 1.7 mm is predictif of PPR (odd ratio = 9, P = 0.036). Ninety percent of PPR remained present at six weeks and only 29% were present after 12.5 months., Conclusion: Mild and minor PPR were frequent during the early postoperative period after MVR. The clinical significance and natural history is benign and they do not require any specific treatment.

Seven children with suspected Kawasaki disease were studied by echocardiogram. Coronary abnormalities occurred in all patients, associated with: thrombosis (2 patients) small pericardial effusion (2 patients) poor ventricular function (2 patients), moderate mitral regurgitation (2 patients). Patients received treatment with intravenous gamma globulin, aspirin, and anticoagulant. Echocardiogram abnormalities disappeared between 1 and 26 months after the onset of the disease; only persist coronary hyperechogenecity in 6 patients.

This study was to estimate the Doppler haemodynamic profiles of 56 prosthetic mitral valves (St Jude prosthesis) in the premature post-operating period, to study the correlation of the prosthetic area calculated by Doppler method (continuity equation (CE) and pressure half times (PHT)) and the area of the effective orifice in the post-operating premature period, in 6 weeks and after 6 months. The values of peak gradient and mean gradient at six week and at 12.5 months were not significantly different from those obtained in the premature exam. The prosthetic area calculated by continuity equation (ACE) in the premature postoperative period was significantly different between the various size (p = 0.0001). The (ACE) measured at 6 weeks and late (12.5 months), was not significantly different from that calculated in the premature exam (respectively p = 0.79 and p = 0.8). The (PHT) was very variable even within the different size of the prosthesis, however values measured at six weeks and in the late exam was not different from that calculated in the premature exam. In absence of complications, it seems to us that we can satisfy with using as reference exam data obtained in the premature exam.

Ecchinococcal infestation of the heart accounts for only 0.5-2% of ecchinococcosis cases. A case is reported of right atrial hydatid cyst associated with rheumatic mitral valve disease in a 43-year-old woman. Physical examination and chest X-radiography revealed mitral disease. Transthoracic and transesophageal echocardiography demonstrated a single, large cystic mass of 4 x 4 cm located in the right atrium, and heavily calcified mitral rheumatic disease with commissural fusion. Confirmatory computed tomography and magnetic resonance imaging excluded other extracardiac locations. Radioisotopic lung perfusion scanning and angiographic scanning excluded pulmonary embolism. The patient underwent mitral valve replacement and the hydatid cyst was excised. An intraoperative examination and subsequent pathology confirmed a diagnosis of hydatid cyst.

Unlabelled: Cardiac hydatid cysts are rare and represent 0.5 to 2% off all hydatid cyst in human. We describe clinical and echographic features in 12 patients with cardiac echinococcosis, admitted between 1992 and 2001. Average age was 40 years (16-60 years). The cysts were located in the left ventricle wall (3 patients), right ventricle wall (3 patients) right atrium (3 patients) and pericardial cavity (3 patients). Cardiac Hydatid cyst diagnosis was established by transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) in all cases. Computed tomography and magnetic resonance imaging confirmed echographic finding. All patients were operated. The operation finding confirmed the imaging data. Only one patient died in the post operative period. No recurrence or associated complication were reported in the late follow up., Conclusion: In presence of atypical symptomatology in a patient coming from an endemic area of hydatid cyst the diagnosis of cardiac echinococcosis is possible. TTE and TEE are the imaging procedure of choice and sufficient for the diagnosis of cardiac hydatid cyst. CT and/or MRI provide more information about the extension of echinococcosis diseases in other intra or extrathoracic location.

Unlabelled: The goal of our work was to assess the delays of admission for Acute Myocardial Infarction (AMI) in Sousse (Tunisia) and to identify predictors of these delays. Our prospective survey was led from January 1999 to December 2001; 232 patients with AMI were included. The onset of symptoms usually occurred in the patient's home (80.6%). The chest pain was atypical in 19.4% of cases; 91% of patients directly consulted the emergency departments, whereas the ambulatory emergency services were used in only in 2.2% of cases. Delays of hospitalization in coronary care units were on average too long (14 h 21 min +/- 19 h 16 min). This prolongation was essentially caused by a too long period between onset of symptoms and first patient call. In bivariate analysis, dyslipidemia, diabetes, absence of smoking and an atypical symptoms were associated with prolonged hospitalization delays. However in multivariate analysis, only diabetes and atypical symptoms were independent factors associated with a hospitalization delay of more than 12 h. In 23% of the patients, a prolonged pre-hospital time period prevented the use of thrombolysis., Conclusion: Pre-hospital delays should be shortened by a multidisciplinary action that especially focuses on a better sanitary education of patients to risk.

The purpose of this study was to demonstrate the utility and feasibility of transesophageal echocardiography during percutaneous balloon mitral valvuloplasty (PBMV). 40 patients were included with symptomatic rheumatic mitral valve stenosis with mean age of 31 years. Transoesophageal echocardiographic monitoring allowed an immediate detection of mitral insufficiency in 10 patients. This latter was moderate in eight cases and severe in two cases indicating to stop the procedure. The addition of on-line TEE during PBMV facilitate and confirm the success of the procedure and detect complications.

The aim of this study was to assess the value of the routine multiplane transoesophageal echocardiography (TEE) in the early postoperative period after mitral valve replacement with a Saint Jude Médical (SJM) mechanical prosthesis. This prospective work enrolled 56 patients who have been operated between September 1999 and September 2001, all these patients had a multiplan TEE after 14.7 days (8-29 days) of post-operative. The effect of peri-prosthetic leaks was 59%. They were always minimal and asymptomatic. 68% of them disappeared at the late exam. An asymptomatic intermittent blockage of an leaflet had been noted in one patient. It appears to us today indispensable to achieve a systematic TEE in the early post operative period after mitral valve replacement. This exam remains little aggressive and comfortably supportable by the patient in look of information brought.