Biomedical subjects
Publications and source records attributed to G Grollier.
In one patient percutaneous transluminal coronary angioplasty was complicated by coronary artery perforation of the left anterior descending coronary artery with light pericardial effusion. The outcome was favorable without either pericardiocentesis or emergency surgery.
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A 59 year old man was admitted to hospital with a non-transmural anterior myocardial infarction. Recurrent angina pectoris eight days after the initial infarction was investigated by cardiac catheterisation, which showed moderate anterior hypokinesis and proximal occlusion of the left anterior descending coronary artery. The distal part of this vessel was opacified via collaterals from the right coronary artery. Percutaneous transluminal coronary angioplasty was attempted during the same catheterisation; good positioning of the balloon catheter was confirmed by the use of retrograde opacification of the distal part of the left anterior descending coronary artery via the collateral vessels and dilatation was safely achieved. Opacification of the contralateral coronary artery may be a useful and safe positioning of guide wire system or balloon dilatation catheter when dilatation of a totally occluded coronary artery is attempted.
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The authors report the results of 8 cases of percutaneous transluminal coronary angioplasty of occluded arteries: the artery concerned was the proximal segment of the left anterior descending artery in 5 cases and the proximal segment of the right coronary artery in 3 cases. All patients had unstable angina with a very positive exercise stress test. The conservation of viable myocardium was the result of an excellent collateral circulation from the controlateral vessel in all patients. In 7 out of the 8 cases, the guide wire and dilating balloon were correctly positioned by opacifying the distal segments of the occluded artery by injection of contrast into the controlateral artery. Almost simultaneous injection of the occluded and controlateral vessels allowed evaluation of the length of the occlusion. Controlateral opacification disappeared immediately after adequate recanalisation to reappear during inflation of the balloon. These cases show that in patients with chronic coronary occlusion, opacification of its distal segments by injection of contrast into the controlateral vessel seems to be helpful and without risk to the patient.
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Explore the source record for details and available documents.
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We report the observation of a 62-year-old patient who was admitted for unstable angina. A prolonged chest pain (more than two hours) with a major electrocardiographic lesion in the posterior leads needed an urgent coronary arteriography in order to attempt a recanalization. Antecedents of arteriopathy of the lower limbs with aortobifemoral bypass required an axillary artery right side approach. A selective right coronary opacification showed complete occlusion at the junction of segments 1 and 2. An intracoronary injection of isosorbide dinitrate relieved a coronary spasm and allowed a complete visualization of the right coronary artery. This appeared to be very atherosclerotic with several severe narrowings, and a subocclusive lesion at the site of the initial occlusion. Percutaneous transluminal coronary angioplasties (PTCA) were performed and led to real 'restructuring' of the right coronary artery. The clinical outcome was excellent without recurrent angina pectoris. An angiographic control performed 6 months after PTCA demonstrated the persistence of the coronary recanalization and an evident improvement of the segmental contractility. This report emphasizes the role of coronary spasm in the genesis of myocardial infarction and shows that PTCA may be performed as a first approach at the acute phase of myocardial infarction; to our knowledge it is the first PTCA performed by an axillary approach at the acute stage of myocardial infarction.
A case of fatal septicemia with Selenomonas sputigena in an immunocompromised patient is reported. The patient had a lung abscess from which the septicemia is believed to have originated. In contrast to the only other case reported in the literature, the isolate from our patient was characterized by very slow and difficult growth.
A 67 year old woman was admitted for assessment of asymptomatic aortic stenosis. A large left atrial myxoma was demonstrated by 2D and M mode echocardiography. Coronary angiography was performed as part of the investigation of the aortic stenosis and showed that the tumour depended on the right coronary artery for its blood supply. Careful frame-by-frame study showed the presence of a true right coronary-left coronary fistula through the tumour. The authors discuss the different clinical presentations of left atrial myxomas and their vascularisation in the rare cases in which it has been described.
The authors report the case of a 53 year old patient who had undergone triple coronary bypass surgery for unstable angina. Recurrence of chest pain 4 months after surgery led to control coronary angiography which showed severe stenosis of the proximal and distal parts of the aorto-right coronary graft. Endoluminal dilatation was performed a few days later but, during angiography, complete occlusion of the graft was observed. This was repermeabilised without difficulty and a "remodelling" of the graft was carried out. The outcome was favourable with the complete regression of symptoms. The following alternatives to surgery are discussed: in cases of thrombosis which usually occur in the month following surgery, fibrinolysis may be attempted with a high success rate but a significant risk of haemo-pericardium: in cases of fibrous proliferation of the intima leading to stenosis or occlusion, endoluminal dilatation seems to be the procedure of choice, but this must always be carried out under surgical cover.
The authors report the case of a patient with acromegaly. The clinical history was dominated by left ventricular failure, for which acromegaly was the only evident cause. The cardiac index, pulmonary arterial pressure and the average pulmonary capillary pressure were measured before ablation of the hypophyseal tumour; the measurements were repeated 3 months and 8 years later. The postoperative course followed two phases: transient improvement of the haemodynamic parameters, then relapse of cardiac failure. This case confirms the possibility of a true cardiomyopathy during acromegaly; but the fact that the cardiac failure did not regress despite the decreased growth hormone levels was unusual and raises several physiopathological hypotheses.
Two rare mechanical complications of right ventricular infarction are reported: myocardial dissection and rupture of the RV free wall. The diagnosis was made by 2D echocardiography in both cases. Myocardial dissection resulted in the formation of an oblong, expansive, intraparietal space. The rupture of the RV free wall was visualised as a breach of the continuity of the ventricular wall. These cases underline the importance of 2D echocardiography in the acute phase of myocardial infarction for the diagnosis of these complications.
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The authors report the case of unusual auscultatory findings, multiple systolic clicks, in a patient with a Starr-Edwards model 1 260 aortic valve replacement, six years after the implantation. The aetiology of this anomaly appears to be incorrect positioning of the prosthetic valve ring.
The authors report a case of rupture of the free wall of the right ventricle, diagnosed by two dimensional echocardiography. This examination revealed an intrapericardial clot associated with a fissure of the diaphragmatic wall of the right ventricle. This case emphasises the value of two dimensional echocardiography in the acute phase of myocardial infarction for the diagnosis of complications which require urgent surgical treatment.