Faux anévrisme de la voie d’éjection du ventricule droit compliquant une endocardite infectieuse après réparation d’une cardiopathie congénitale

A case of an enormous false aneurysm of the right ventricular outflow tract due to infective endocarditis is reported in a 12-year old girl who underwent Rastelli repair of congenital heart disease with reconstruction of the right ventricular outflow tract by bovine jugular vein graft (Contegra). The false aneurysm was associated to desinsertion of the patch of the ventricular septal defect and compresses the right ventricle leading to heart failure and shock. Surgical treatment was performed in emergency but the child died after surgery. Infectious false aneurysm of the right ventricle after surgical reconstruction of the right ventricular outflow tract is very rare. At our knowledge, only three cases have been reported in the literature. We report here another case.     

Right heart catheterization in advanced systolic heart failure. What are the most useful haemodynamic parameters for risk stratification?

Central Illustration: Summary of the main results of the study. Haemodynamic independent predictors of major events in our study population and survival curves in subgroups divided according to baseline PVR, RAP and mPAP after the inotropic challenge. 2: mortality; B: baseline; IC: inotropic challenge; mPAP: mean pulmonary arterial pressure; PA: pulmonary arterial; PAP: pulmonary arterial pressure; PAPP: pulmonary arterial pulse pressure; PPAPP: per cent of proportional PAPP; PCWP: pulmonary capillary wedge pressure; PVR: pulmonary vascular resistance; RAP: right atrial pressure; SHF: systolic heart failure; TPG: transpulmonary pressure gradient; WU: Wood units.

     

Right ventricular infarction caused by isolated right ventricular branch occlusion: a case report

It is rare to observe right ventricular infarction caused by isolated right ventricular branch occlusion. Isolated right ventricular infarction accounts for less than three percent of all cases of infarction. Generally, it is associated with occlusion of a non dominant right coronary artery or of a right ventricular branch. ECG can be misleading with ST segment elevation in anterior leads. We describe a patient admitted for chest pain with ST segment elevation in leads V1 to V3 associated with ST segment elevation in leads V3R and V4R. Coronary angiography demonstrated isolated total occlusion of the right ventricular branch. Thus, right precordial leads need to be done in every patient presenting with ST segment elevation in precordial leads V1 to V3 and not only in inferior myocardial infarction.     

Communication aux ayants droit du dossier du malade décédé

The Act of March 4, 2002 allowed the transmission of medical information concerning a deceased person to his heirs in three situations. The insurance companies, on the basis of this section of the Code of public health, require systematic transmission of the minutes of hospitalization (CRH). What should be done on the basis of rules governing professional secrecy and (on the basis) of jurisprudence in this area? As the professional confidentiality constitutes a legitimate interest, it is possible in some cases to refuse the transmission of CRH by writing a detailed/circumstantial medical certificate.     

Impact of adjuvant radiotherapy on biological and clinical parameters in right-sided breast cancer

PurposeIn patients with right-sided breast cancer (BC) the liver might be partially irradiated during adjuvant radiotherapy (RT). Thus, we performed a prospective observational study to evaluate the dose delivered to the liver, and its potential biological impact.Patients and methodsWe enrolled 34 patients with right-sided BC treated with adjuvant RT. The RT schedules were either the Canadian (42.5 Gy in 16 fx) or standard fractionated (50 Gy in 25 fx) regimen respectively with 9 (26.5%) and 25 (73.5%) patients each, ± a boost of 10–16 Gy. Each patient had a complete blood count and liver enzymes analysis, before starting and during the last week of treatment.ResultsA significant decrease in white blood cells and thrombocytes counts was observed during RT. We observed a significant correlation between certain hepatic parameters and the volume of the irradiated liver and/or the mean liver dose. A significant correlation between the volume of the right lung and the liver mean dose was found (P = 0.008). In the bivariate analysis, a significant correlation between fatigue and the white blood cell count's evolution was observed (P < 0.025).ConclusionWith the standard RT technique, incidental irradiation of the liver was documented in a large number of patients, and some significant hepatic parameters alterations were observed, without an apparent clinical impact, but this study cannot exclude them. The liver mean dose was correlated with the right lung volume suggesting that deep inspiration breath hold (DIBH) techniques may represent a way to decrease the liver dose. These findings need to be evaluated in further larger studies.