Significant improvement of myocardial function following cardiac support device implantation: illustration by two-dimensional strain.

Cardiac support devices (CSD) offer a new therapeutic alternative to patients with end-stage refractory heart failure and severe left ventricle (LV) dilatation. Passive mechanical constraint has been shown to reduce LV dilatation as well as to improve LV function and patient symptoms. Using a new echocardiographic technique to evaluate myocardial strain from bidimensional acquisitions, we describe the case of a patient with significant improvement in global and regional LV functions, as well as LV dyssynchrony following CSD implantation.     

Secondary tumors of the right heart. Echocardiographic aspects. Apropos of 6 cases in the adult

Secondary cardiac tumours are rare but but are now more frequently diagnosed by echocardiography. We report 6 cases of intracardiac metastases affecting the right heart which were diagnosed by 2D echocardiography. In 3 cases, a very mobile, oval-shaped tumour was visualised within the right atrium prolapsing into the tricuspid orifice in diastole like a myxoma but associated in 2 cases with signs of invasion of the inferior vena cava. Two other non-mobile tumours were observed causing massive invasion of the right atrium and the last case was of an infiltrating tumour of the right ventricle resulting in pulmonary infundibular obstruction. In the light of our experience and a review of the literature, it is difficult to distinguish secondary tumours of the right atrium from myxomas especially when the tumours are mobile and when it is impossible to visualise a pedicle inserted on the interatrial septum or tumoral invasion of the inferior vena cava. At the ventricular level, the diagnostic signs differ according to whether there is tumoral invasion of the cavity or infiltration of the muscular wall. These cases illustrate the value of 2D echocardiography in the diagnosis of intracardiac metastases, sometimes even in the absence of clinical signs.     

Value and limitations of transthoracic Doppler echocardiography in the diagnosis of thromboses of mechanical valve prosthesis. Report of 19 cases

The diagnosis of thrombosis of a valvular prosthesis is difficult especially in cases of partial thrombosis. The authors report 19 cases of partial thrombosis of mainly (16 cases) mechanical valve prostheses confirmed by radioscopy and treated either by reoperation or fibrinolysis. Mitral Valve Prostheses: 14 cases (6 Bj?rk, 7 SJM, 1 Carbomedics). All but one case showed significant prolongation of the pressure half time compared with the postoperative reference value. In one case, however, the functional parameters of the prosthesis were normal; the diagnosis was made from the finding of a mobile thrombus on the ventricular surface of the prosthesis. Aortic Valve Prostheses: 5 cases (3 Bj?rk, 1 SJM, 1 Duromedics). Continuous wave Doppler showed significant increases in the velocity of transprosthetic blood flow with respect to the postoperative reference values. Accurate analysis of the mobile elements of the prostheses was usually impossible. These results show that transthoracic Doppler echocardiography remains an excellent method of study and surveillance of mechanical valve prostheses but the limitations of the technique should be familiar to all operators.     

Recurrent thrombosis of an aortic valve prosthesis in a pregnant woman. Treatment with urokinase

A 36 year old woman developed two thromboses on aortic valve prosthesis. The first thrombus at the 14th week of pregnancy was treated with urokinase (2,000 U/kg/h) plus heparin (700-1,000 U/h) over 24 hours and normal wing kinetics were obtained. The second thrombus developed at the 36 th week of pregnancy when the patient was receiving calciparin, and only transient improvement was obtained with similar doses of urokinase hourly over 72 hours. Progressive worsening resulted in higher doses (4,000 U/kg/h) being given without heparin and the thrombus then resolved. The use of urokinase for the first time in this indication allowed therefore, on two occasions and without hemorrhagic complications the cure of this recurrent thrombosis on aortic prosthesis, and the birth, by caesarean, of a healthy baby.     

Left ventricular mass changes with nicardipine therapy in essential hypertension

Summary Eighteen hypertensive patients (13 males, 5 females; age 48±13; diastolic blood pressure >95 mmHg), either previously untreated or who had been off treatment for more than 3 months, underwent M-mode echocardiography before (DO) and after (D90) 3 months of nicardipine therapy (60–90 mg/day). All echocardiograms were read blind, and left ventricular mass (LVM) was calculated (Devereaux's formula). Blood pressure was significantly reduced after 3 months from 167±15/102±8 mmHg on DO to 152±16/92±mmHg on D90 (p<0.001). The reduction in LVM was not significant: 266±95 g on DO, 247±78 g on D90. There was a trend to a higher (although nonsignificant) LVM reduction in patients with left ventricular hypertrophy at entry (–11%, n=11) than in patients without left ventricular hypertrophy (–2%), n=7).     

Is early stent thrombosis an inflammatory disease? A study of 1306 implantations

The authors tried to determine the clinical characteristics and predisposing factors of early stent thrombosis (EST) through the study of 15 patients who had had angiographically diagnosed stent thrombosis within 30 days of the implantation of the stent. The cases were compared to 29 control random patients collected between January 1, 2000 and August 31, 2001. Out of the 1306 patients who had been given coronary stents, 20 of them (1.5%) had an OO.. EST, representing 1.3 per patient. The patients, 12 males and 3 females, had a mean age of 62 + 10.3 years ranging between 46 and 77 years. EST occurred within 7.4 + 3.8 days (2 hours n 29 days) on average, in the left anterior descending branch (10 cases), in the right coronary artery (6cases) or in the left circumflex (3 cases) and finally in the postero-lateral branch (1 case). Stent recanalisation was performed within 3.4 + 2 hours (1-7 hours) on average. In spite of prompt revascularization, the problem progressed to MI in all cases and to subsequent death in 3 cases (20%). Procedure related variables of emergency PTCA, dissection, anatomical type B or C coronary lesions, related WBC count and C- reactive protein were significantly associated with EST while remained a rare event following PTCA. The incidence is low but the prognosis is still poor in spite of early intervention. Other studies are needed to confirm the probable inflammatory nature of this complication.     

Exercise test in athletes

The particularities of exercise tests in athletes concern mainly the exertion protocols adapted to their increased physical capacities and the interpretation of ECG tracing which can sometimes be very special at rest and also misleading during exercise. In the great majority of cases, the test used is both cardiac and pulmonary, in order to assess the aerobic capacities, the maximal aerobic power, and the determination of ventilation thresholds (programming and follow-up of training...). More infrequently, the test is used to detect cardiovascular diseases, especially during a longitudinal follow-up of high-level athletes, or to exclude it in case of cardiovascular symptoms, atypical resting ECG or even in case of suspicion of disease (arrhythmia, cardiac chamber hypertrophy or dilation at echocardiography). In more aged sportsmen (athletes masters), exercise tests performed are usually required for screening coronary heart disease. In this case the test protocols should be more adapted for screening than for the assessment of sportive capacities.     

The right hippocampus participates in short-term memory maintenance of object-location associations

Doubts have been cast on the strict dissociation between short- and long-term memory systems. Specifically, several neuroimaging studies have shown that the medial temporal lobe, a region almost invariably associated with long-term memory, is involved in active short-term memory maintenance. Furthermore, a recent study in hippocampally lesioned patients has shown that the hippocampus is critically involved in associating objects and their locations, even when the delay period lasts only 8 s. However, the critical feature that causes the medial temporal lobe, and in particular the hippocampus, to participate in active maintenance is still unknown. This study was designed in order to explore hippocampal involvement in active maintenance of spatial and non-spatial associations. Eighteen participants performed a delayed-match-to-sample task in which they had to maintain either object-location associations, color-number association, single colors, or single locations. Whole-brain activity was measured using event-related functional magnetic resonance imaging and analyzed using a random effects model. Right lateralized hippocampal activity was evident when participants had to maintain object-location associations, but not when they had to maintain object-color associations or single items. The present results suggest a hippocampal involvement in active maintenance when feature combinations that include spatial information have to be maintained online.