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Coronary artery stent infection with mycotic aneurysm is a rare life-threatening complication following coronary angioplasty, usually requiring surgical intervention. Reaching and confirming the diagnosis remains the most challenging aspect of this complication. We describe an unusual case of bare metal stent infection and coronary artery aneurysm in the setting of tricuspid valve infective endocarditis, resulting in ST elevation myocardial infarction, with a favorable outcome after primary angioplasty and antibiotic therapy. In the current era of growth of coronary stent implantation, it’s important for clinicians to consider and to prevent such potentially fatal events. The diagnosis process remains difficult and requires the association of multiple clinical, biological and imaging parameters. Although treatment modalities tend to favor surgery, we showed that coronary angioplasty could be a successful alternative solution.

The purpose of this article is to illustrate a rare case of a pericardial hemangioma of the right atrioventricular groove of incidental discovery in a tennis player who presented with cough and dyspnea and was treated by surgical excision with a favorable outcome. We also report the role of cardiac magnetic resonance imaging (MRI) in the diagnosis and management of this pericardial tumor.

Nalezeni pseudoaneurysmatu mezižeberni tepny během koronarografickeho vysetřeni představuje vzacnou, avsak potencialně smrtelnou komplikaci a vyžaduje zvlastni pozornost, aby bylo možno vcas stanovit diagnozu. Popisujeme připad pacienta, u něhož se během vysetřeni perkutanni koronarografii vytvořilo pseudoaneurysma mezižeberni tepny a který přežil diky rychle stanovene diagnoze, urgentni peci a důsledne monitoraci jeho stavu.Ucebni cil: Zajistit, aby si lekař byl vědom možnosti takove komplikace, a byl tak schopen stanovit rychle diagnozu i poskytnout odpovidajici lecbu.

Background: Although drug-eluting stents (DES) for percutaneous coronary intervention have dramatically reduced the incidence of in-stent restenosis, their deployment for large-size coronary lesions is still controversial because of problems such as prolonged dual antiplatelet therapy, late in-stent thrombosis and costs. Aim: This study sought to evaluate the safety and effectiveness of drug-eluting stents (DES) compared to baremetal stents (BMS) for patients with large coronary vessels ≥ 3.5 mm. Methods: This is a retrospective case-control comparative study conducted in the cardiology A department of the university hospital Fattouma Bourguiba in Monastir. A total of 77 consecutive patients (80 lesions) who underwent, between October 2003 and March 2014, successfully DES implantation were compared to 73 consecutive patients (84 lesions) who were treated with BMS in large coronary vessels ≥ 3.5 mm. Results: The average age in our population was 59.7 ± 11.3 years with a male majority without any significant difference between the two groups. The DES group contained significantly more patients with diabetes (67.5% vs. 38.1%; p

During radiofrequency (RF) delivery, lesion volume is highly dependent on contact force (CF). It has recently been shown that changes of bipolar electrogram (EGM) predict transmurality. We hypothesized that there is a correlation between CF and EGM criteria of transmural lesion (TL) during RF.We prospectively studied consecutive 512 RF applications from atrial fibrillation ablation procedures. A force-sensing ablation catheter (Tacticath(®), Endosense) was used to continuously measure CF and force-time integral (FTI) during each RF application. Distal bipolar EGM was analysed before, during, and after each RF application. Depending on initial EGM morphology, transmurality of lesions was defined by: (i) disappearance of the positivity after RF when there was QR morphology, (ii) diminution75% of the positivity when there was QRS morphology, or (iii) disappearance of the R' positivity when there was RSR' morphology. Electrogram criteria were validated by electrophysiologists blinded to force measurements. Force-time integral was higher in TL than in non-transmural lesions (NTLs): 652 ± 248 vs. 212 ± 140 gs (P0.001). Mean CF per RF pulse was higher in TL than in NTL: 26.3 ± 12.5 vs. 11.3 ± 10.3 g (P0.001). The best cut-off to predict TL was an FTI ≥ 392 gs [sensitivity 0.89, specificity (Sp) 0.93, positive predictive value (PPV) 0.98, and negative predictive value 0.67] and a higher FTI (700 gs) warrants transmurality of RF atrial lesions (100% Sp and PPV).Contact force and FTI during RF are correlated with TL. During RF delivery, a target FTI392 gs can be used as an endpoint.

Persistent left superior vena cava (PLSVC) can be incidentally detected during pacemaker implantation from the left pectoral side. Optimal site pacing is technically difficult, and lead stability of the right ventricle (RV) can lead to such a situation. We describe a case of successful single-chamber pacemaker implantation in a 76-year-old woman with a PLSVC and concomitant agenesis of the right-sided superior vena cava, after failed attempts with the conventional procedure. The pacemaker had been working well after 12 months of follow-up.

Introduction La maladie renale chronique est tres repandue et associee a des resultats mediocres a court et a long terme chez les patients atteints de cardiopathie ischemique. Les donnees relatives a ces patients ne sont pas frequentes car ils sont generalement exclus des essais cliniques randomises. L’objectif de ce travail etait de decrire les caracteristiques cliniques et l’evolution intra-hospitaliere des insuffisants renaux presentant un infarctus du myocarde (IDM). Patients et methodes C’est une etude retrospective incluant les patients hospitalises pour IDM entre janvier 1995 et decembre 2016. La clairance de la creatinine (Clcr, exprimee en mL/min/1,73 m2) a ete calculee par la formule de MDRD. On a reparti les patients en 4 groupes ; groupe 0 : Clcr > 90 (groupe de reference ; n = 414), groupe 1 : Clcr entre 90 et 60 (n = 708), groupe 2 : Clcr entre 60 et 30 (n = 322) et groupe 3 : Clcr Resultats Notre etude a inclus 1502 patients avec une moyenne d’âge de 60,2 avec ± 16,6. Chez les groupes 2 et 3, la prevalence de l’HTA et du diabete etait plus elevee alors que celle du tabagisme etait plus faible (p 96 % ; p Discussion Les maladies renales chroniques representent un facteur de risque independant et puissant de mauvaise evolution clinique en cas de cardiopathie ischemique. Conclusion L’insuffisance renale s’associe a des presentations cliniques atypiques au cours de la phase aigue de l’infarctus du myocarde. Elle est associee a une morbi-mortalite intra-hospitaliere elevee ce qui necessite une attention particuliere chez ce groupe de patients.

Introduction La perturbation du metabolisme glucidique est frequente au cours du syndrome coronarien aigu avec susdecalage de ST (SCA ST + ). L’objectif de ce travail etait d’etudier la relation entre l’hyperglycemie et les resultats cliniques et angiographiques apres angioplastie coronaire en cas de SCA ST+. Patients et methodes On a inclus retrospectivement 399 patients presentant un SCA ST+ entre 1995 et 2015 et qui ont beneficie d’une angioplastie primaire ou de sauvetage. On a compare les resultats cliniques des patients ayant une HG (HG+ : n = 150) avec ceux sans HG (HG− : n = 249) et les resultats chez les diabetiques et les non diabetiques. HG a ete definie par une glycemie a l’admission > 11 mmol/L. Resultats Dans le groupe HG+, le succes de l’angioplastie etait plus faible (86 % vs. 92 %, p = 0,05) avec des taux plus faibles de resolution du segment ST a 24 heures (47,3 % contre 61,4 %, p = 0,006), une mortalite plus elevee (20 % contre 10,4 %, p = 0,008), une insuffisance cardiaque tardive plus elevee (32 % contre 18,1 %, p = 0,001) et des arythmies ventriculaires plus frequentes (16 % vs. 6,8 %, p = 0,01). Dans ce groupe, ces resultats etaient similaires quel que soit le statut diabetique et le diabete n’a pas predit la mortalite intrahospitaliere (p = 0,64). Chez les patients non diabetiques (n = 260), l’HG etait associee a une taille d’infarctus plus grande (p = 0,001). Conclusion Ces resultats suggerent l’importance de l’evaluation de la glycemie dans le SCA ST+ meme chez les non-diabetiques et l’effet benefique d’un controle glycemique strict.

Introduction During radiofrequency (RF) ablation procedures, lesion volume is highly dependent on contact force (CF). It has recently been shown that bipolar electrogram (EGM) recording predict lesions’ transmurality. We hypothesized that there is a correlation between CF and EGM criteria of transmural lesion during RF. Methods We prospectively studied all 524 RF applications in 8 ablation procedures for atrial fibrillation (7) and atrial flutter (1). A force sensing 3.5 mm-tip ablation catheter (Tacticath®, Endosense) was used to continuously measure CF and force-time integral (FTI) during each RF application. Distal bipolar EGM was analyzed before, during, and after each RF application. Depending on initial EGM morphology, transmurality was defined by 1) disappearance of the positivity after RF when there is QR morphology, 2) diminution >75% of the positivity when there is QRS morphology and 3) disappearance of the R’ positivity when there is RSR’ morphology. Two electrophysiologists blinded to force measurements validated each EGM criteria. Results Mean FTI was higher in EGM-defined transmural lesions (ETL) than in EGM-defined non-transmural lesions (ENTL): 652±248 gs vs. 212±139 gs (p 392 gs was best predictive of transmurality (Se=0.89, Sp=0.93, AUC=0.95), and an FTI>700 gs always resulted in a transmural lesion on EFM criteria (Sp=100%, PPV=100%). Conclusion CF and FTI during RF are correlated with transmurality of atrial lesions during ablation and a minimum FTI of 392 gs should always be aimed during RF delivery in order to obtain transmural lesions. Download : Download full-size image Figure – FTI's predictive value for transmural lesions

BackgroundRenal artery stenosis (RAS) is a strong independent predictor of mortality in patients (pts) with coronary artery disease (CAD).Aim of studyTo develop and validate a score predicting RAS in patients with CAD.MethodsThree hundred consecutive pts (50 females) with significant CAD underwent abdominal aortography following coronary angiography to screen for significant RAS defined as luminal narrowing of > 50%. Univariate and multivariate analyses were performed comparing pts with and without RAS. Significant factors associated with RAS were included in constructing a score that predicts RAS.The score was internally validated in pts randomly selected from the entire study group (validation group; n=103), using ROC curves and the Hosmer-Lemeshow goodness-of-fit test.ResultsTwenty-seven pts (9%) had a significant RAS. Univariate predictors of significant RAS were: age > 65 years (OR=4.5, p < 0.0001), hypertension (OR=3.6, p=0.001), and female gender (OR=3.6, p=0.015). We found a tendency of more prevalent renal insufficiency (37.1% vs. 21.5%; p=0.05) and the presence of 2 or more significant CAD lesions (70.4% vs. 50.9%; p=0.05) in pts with RAS.Multivariate analysis showed that age > 65 years (OR=4.1%, 95% CI=1.6-10.3, p=0.003) and hypertension (OR=3.1, 95% CI=1.2-7.7, p=0.015) were independent predictors of RAS. The ranged from 0 to 7: 2 points for age > 65 years and hypertension 1 point for female gender, renal insufficiency, and > 3-vessel disease). Internal validation showed a good performance (ROC curve = 0.79 and Chi2 Lemeshow = 3.45). For a score < 2, the negative predictive value is 98%. Applying this criteria, 48.3% of our population would not require systematic abdominal angiography.ConclusionThe performance of our predictive score was good, and significant reduction in the need to perform systematic abdominal aortography could be expected with the use of this score.

RésuméUne tachycardie ventriculaire peut être dite « épicardique » si le foyer, ou son circuit, comprend une portion épicardique, rendant par là même son ablation possible par une approche épicardique. Les étiologies sont multiples et seront présentées successivement dans cet article. La cartographie épicardique a révolutionné l’approche et la prise en charge du diagnostic et de l’ablation par cathéter des tachycardies ventriculaires. Elle a permis de mieux comprendre certains échecs de l’approche ablative endocardique. La ponction péricardique en dehors de tout épanchement et à titre purement diagnostique n’est pas sans danger mais doit maintenant faire partie des techniques utilisées de façon routinière dans les centres spécialisés de rythmologie.SummaryA ventricular tachycardia may be referred to as epicardial if its focus, or part of its circuit encompasses the epicardium. Various ætiologies are described in this article. Epicardial mapping has revolutionized the diagnosis and management of VT, and has allowed understanding of failures of the endocardial approach in many instances. The pericardial approach is not devoid of risks but has become a major tool in the electrophysiologist armamentarium.

Introduction Limited data exist on the efficacy and safety of remote magnetic navigation (RMN) ablation of iatrogenic left atrial flutter (LAF) occurring after atrial fibrillation (AF) ablation. Methods LAF ablation procedures (proc) were reviewed. Patients (pts) were divided into 2 groups (gr): RMN gr if proc were performed remotely using the Niobe system (Sterotaxis) and conventional gr (CON) if proc were performed with manually driven catheters. Open-irrigated 3.5 mm-tip catheters were used in all pts. Activation LA maps were realized in all pts using Carto or EnSite). Acute (defined as sinus rhythm- SR- resumption during ablation) and long-term (defined as SR maintenance) proc success, proc duration, fluoroscopy and radiofrequency (RF) times, and the mechanism of arrhythmias were studied. Results In 46 pts (38 males, 60.8±10.19 y) 57 LAF ablation proc were performed. Age and LA size were similar. Activation maps showed: a unique macro-reentrant circuit 46%, multiples successive macro-reentrant circuits 26%, focal pulmonary vein tachycardia 9%, micro-reentrant circuit 19%. Results are showed in the table. Complications occurred in 3 proc: 1 in the RMN gr (groin hematoma) and 2 in the CON gr (1 transient ischemic attack and 1 cardiac perforation with tamponade). Perimitral flutter that occurred at any stage of the proc was associated with significantly higher rate of acute failure (persistent perimitral flutter at the end of the proc, both gr): 44% vs 12% for other types of flutter, p=0.02. RMN (n= 25) CON (n= 32) p Acute success 80% 78% 0.86 Proc/pt 1.2±0.5 1.2±0.8 0.74 Long-term success (follow-up 12.5±11.3 months) 81% 66% 0.44 Fluoroscopy 748±377 s 1086±772 s 0.05 Proc time 236±68 min 201±72 min 0.06 RF time 1291±880 s 1181±897 s 0.70 Conclusion As compared to manual proc, RMN guided ablation for LAF after AF ablation provides comparable acute and long-term success rate but is potentially safer.