Annales de cardiologie et d'angeiologie最新文献

Iatrogenic coronary dissections are rare but potentially serious. Their management is complex, particularly if the dissection occurs without an angioplasty guide in the arterial lumen. In this context, angiography alone is insufficient, and endocoronary imaging is essential (using optical coherence or IVUS) to guide angioplasty when necessary (guide in the true lumen, coverage of the tear). We report here the case of an iatrogenic dissection of the right coronary artery treated with OFDI guiding.

Percutaneous treatment of para-prosthetic valve leaks (PVL) is an alternative to redo surgery. Based on the clinical case of an unusual aortic para-prosthetic leak closure (PVLc), are presented successively the diagnostic difficulties of PVL, the modalities of therapeutic choice, the main technical steps of PVLc followed by a review of results and complications.

Introduction

Undifferentiated pleomorphic sarcoma (UPS) is a very rare malignant primary cardiac tumor with a poor prognosis.

Observation

A 34-year-old woman complained of dyspnea evolving in a febrile context with altered general condition: Transthoracic echocardiography (TTE) revealed a left intra-atrial mass measuring 51/26 mm in diameter. A thoracic computed tomography (CT) revealed a mass occupying the left atrium measuring 42/28/34 mm, associated with two pulmonary metastases. The cardiac mass was resected and the postoperative suites were fatal. Histological diagnosis was UPS.

Conclusion

We present an atypical case of invasive UPS, which was surgically resected and scheduled for radio-chemotherapy with a fatal outcome.

We present the case of a 53-year-old patient with history of hypertension and dyslipidemia, admitted for effort-induced angina. Coronary angiography revealed two-vessel disease with severe stenosis of the LAD- Diagonal bifurcation (MEDINA 1-1-1). This lesion was considered complex regarding the severe stenosis of the bifurcation core, the angulation <45°, and the severity and length of the diagonal lesion. The procedure was planned according to a TAP technique. The flow in the diagonal was however lost after stenting the main vessel causing an ST elevation with chest pain. It was subsequently recovered using the rescue jailed balloon technique before re-crossing the stent struts of the LAD using a Gaia First® (Asahi) guidewire. The aim of this case report is to illustrate some pitfalls that can be encountered in bifurcation percutaneous interventions and to present technical solutions to solve difficult side branch access issues through a literature review.

Introduction

In heart failure with preserved left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) has a diagnostic and prognostic value. This study aimed to identify the factors associated with the alteration of strain in heart failure with preserved left ventricular ejection fraction.

Methods

This study was carried out in patients with heart failure and preserved LVEF seen in the echocardiography laboratory of the DAX hospital center from 1^st January to 31^st October 2022. Patients with altered GLS < −16% (cases) were compared to controls (GLS ≥ −16 %) matched by age group and sex.

Result

During this period, 31 cases and 31 controls were recruited. The average age of the cases was 81.3 ± 11.8 years with a female predominance (51.6%). Alteration of left ventricular GLS was associated with history of coronary artery disease (OR 5.93, CI 95% [1.16–30.25], p = 0.04), very high cardiovascular risk (OR 19.6, CI 95% [1.90–201.63], p = 0,03), an interventricular septum thickness greater than 12 mm (OR 7, CI 95% [1.59–30.80], p = 0,00) and the presence of hypertrophic cardiomyopathy (p = 0.00).

Conclusion

GLS alteration was associated with history of coronary artery disease, very high cardiovascular risk, an interventricular septum thickness greater than 12 mm and hypertrophic cardiomyopathy. The knowledge of these factors could be interesting to improve the risk stratification and the management of heart failure with preserved LVEF.

We present here a case of documented paraprosthetic valvular leak following TAVI treated medically initially. This led to a poorly tolerated hemolytic anemia. We were able to correct this paraprosthetic valvular leak by a postdilation of the TAVI valve with a good result and uncomplicated follow-up.

An 81-year-old patient was referred for left atrial appendage closure. Anatomical LAA analysis by CT scan showed an inverted chicken wing morphology. The procedure was performed through i an infero-anterior transseptal puncture and led to “sandwich” closure strategy using an AMPLATZER AMULET 25 mm device. Despite successful deployment of the occluder, a hemopericardium soon developed related to an iatrogenic LAA perforation/partial rupture and leading to major hemodynamic instability. After pericardocentesis, it was decided to inject activated thrombin into the pericardial sac to achieve in situ hemostasis. This strategy enabled coagulation of the hemopericardium and cessation of active bleeding, without recourse to surgical treatment.

Transcatheter aortic valve implantation (TAVI) has established as a gold standard in the treatment of elderly patients with severe aortic stenosis. Vascular access marks the first step in a TAVI procedure where the transfemoral access is preferred. Therefore, vascular complications are one of the main concerns of operators. With the increasing number of TAVIs performed, the focus is on the prevention and management of vascular complications. Illustrated by a clinical case, this article attempts to review the main vascular complications, their management and how to prevent them.

Coronary artery anomalies (ANOCOR) are congenital anomalies with various anatomical forms. Percutaneous treatment can be offered in certain situations, most often to address associated atherosclerotic disease or, more rarely, to correct a congenital stenosis. Due to the frequent difficulties of catheterization, percutaneous coronary interventions for ANOCOR are recognized as complex procedures. A thorough anatomical understanding facilitates the identification of the connection site and the initial ectopic course of an ANOCOR during coronary angiography. Selecting an appropriate catheter is a crucial step in the procedure. There is a higher prevalence of atherosclerotic disease along retroaortic courses compared to other ectopic courses. When treating atherosclerotic stenosis downstream of an ectopic course, techniques typically used for complex coronary procedures can be helpful. While angioplasty for congenital stenosis is technically feasible, its role in management algorithms remains to be defined. Currently, this type of percutaneous treatment may be offered to right ANOCOR with interarterial course in adults over 35 years old and with ischemic symptoms or myocardial ischemia.

High calcified PCI are challenging because immediate and follow-up results are not optimal. We recommend using a specific preparation of these lesions, especially using atherectomy which can itself provide complications. We illustrate our comments with a clinical case where we have decided to treat a long-calcified lesion from left main to distal left artery descending with a specific preparation according orbital atherectomy. Procedure was complicated by a coronary perforation with favorable evolution. This case allows to report how to prevent a such complication and to remember how should we have to treat it.