D. Boulmier

Contribution of cardiac MRI in the comprehension of peripartum cardiomyopathy pathogenesis

Pathogenesis of peripartum cardiomyopathy (PPC) is still discussed. We report one case of PPC in which a cardiac magnetic resonance imaging analysis allowed to exclude some classical pathogenesis hypotheses. We would like to emphasize the benefits of cardiac MRI in the comprehension of the mechanism(s) involved in the genesis of PPC.

Acquired Left Ventricular Submitral Aneurysms in the Course of Takayasu Arteritis in a Child

A 9-year-old black African boy was hospitalized for heart failure revealing a severe left ventricular dysfunction associated with dilated cardiomyopathy, two submitral aneurysms, occlusion of the circumflex artery and a giant coronary artery aneurysm on the proximal left anterior descending artery. The boy was coinfected with human immunodeficiency virus and Mycobacterium tuberculosis. Though rare, association of Takayasu arteritis and submitral aneurysm leads to rethinking the pathogenesis of submitral aneurysm and suggests that some of them may be acquired. In our case, a common inflammatory process, possibly triggered by tuberculosis or HIV, may underlie Takayasu and submitral aneurysms.

Predicting the development of in-hospital cardiogenic shock in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: the ORBI risk score

AimsnTo derive and validate a readily useable risk score to identify patients at high-risk of in-hospital ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS).nnnMethods and resultsnIn all, 6838 patients without CS on admission and treated by primary percutaneous coronary intervention (pPCI), included in the Observatoire Régional Breton sur lInfarctus (ORBI), served as a derivation cohort, and 2208 patients included in the obseRvatoire des Infarctus de Côte-dOr (RICO) constituted the external validation cohort. Stepwise multivariable logistic regression was used to build the score. Eleven variables were independently associated with the development of in-hospital CS: age >70u2009years, prior stroke/transient ischaemic attack, cardiac arrest upon admission, anterior STEMI, first medical contact-to-pPCI delay >90u2009min, Killip class, heart rate >90/min, a combination of systolic blood pressure <125u2009mmHg and pulse pressure <45u2009mmHg, glycaemia >10u2009mmol/L, culprit lesion of the left main coronary artery, and post-pPCI thrombolysis in myocardial infarction flow grade <3. The score derived from these variables allowed the classification of patients into four risk categories: low (0-7), low-to-intermediate (8-10), intermediate-to-high (11-12), and high (≥13). Observed in-hospital CS rates were 1.3%, 6.6%, 11.7%, and 31.8%, across the four risk categories, respectively. Validation in the RICO cohort demonstrated in-hospital CS rates of 3.1% (score 0-7), 10.6% (score 8-10), 18.1% (score 11-12), and 34.1% (score ≥13). The score demonstrated high discrimination (c-statistic of 0.84 in the derivation cohort, 0.80 in the validation cohort) and adequate calibration in both cohorts.nnnConclusionnThe ORBI risk score provides a readily useable and efficient tool to identify patients at high-risk of developing CS during hospitalization following STEMI, which may aid in further risk-stratification and thus potentially facilitate pre-emptive clinical decision making.

Hunting rifle shot to the chest: a rare cause of myocardial infarction.

A 46-year-old man without cardiovascular risk factors was shot in the chest with a hunting rifle 1xa0month before this evaluation (Panel A). He underwent emergency surgery for haemorrhagic shock because of right and left ventricular tears. Upon his discharge from the intensive care unit, electrocardiographic changes consistent with apico-lateral infarction were noted, and trans-thoracic …

Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery Presenting in Adulthood: a French Nationwide Retrospective Study

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease usually diagnosed during the first months of life. Without surgical treatment, ALCAPA carries a high mortality risk, and disease presentation in adulthood is rare. We describe the diagnosis and management of patients presenting with ALCAPA in adulthood. This multicenter French nationwide retrospective study included adult patients diagnosed from 1980 to 2014. Eleven adult patients (mean age: 38u2009±u200917 years) were analyzed. All patients were symptomatic, presenting with chest pain, palpitations, heart failure, or syncope. Electrocardiogram was abnormal in 8 (73%) patients. Echocardiogram showed a mildly depressed left ventricular ejection fraction of 50u2009±u200913%, kinetic abnormalities in 5 (45%) patients, and significant mitral regurgitation in 8 (73%) patients. Coronary angiography was performed in 10 (91%) patients and confirmed the diagnosis. Computerized tomography scan, magnetic resonance imaging, and myocardial scintigraphy were performed when deemed necessary. Ten patients underwent reconstructive surgery, but 1 patient was not operated because of age. Four patients experienced postoperative complications including cardiogenic shock, heart failure, renal failure, or additional surgery. After a median follow-up of 2.5 years, all 10 operated patients were alive and asymptomatic, and the nonoperated patient had died at the age of 70 from syncope related to ventricular tachycardia. ALCAPA may be diagnosed in adults. Although complications may occur postoperatively, long-term outcome is favorable in adult patients undergoing surgical correction. Surgery should be discussed as first-line therapy in adults with ALCAPA.

Immediate complete revascularization in patients with ST-segment elevation myocardial infarction and multivessel disease treated by primary percutaneous coronary intervention: Insights from the ORBI registry

BACKGROUNDnRecent studies demonstrated the superiority of complete revascularization (CR) in patients treated by primary percutaneous coronary intervention (pPCI) in ST-elevation myocardial infarction (STEMI).nnnAIMnTo evaluate whether immediate CR improves in-hospital outcomes in patients with STEMI with multivessel disease.nnnMETHODSnData from a prospective multicentre registry including 9365 patients with STEMI were analysed. Patients with multivessel disease and treated with pPCI (n=3412) were included and separated into two groups according to whether immediate CR was performed during the index procedure. The primary endpoint was in-hospital major adverse cardiovascular events (MACE), defined as a composite of all-cause death, non-fatal myocardial infarction, stroke and definite stent thrombosis. Secondary endpoints were individual components of MACE and major bleeding. Multivariable Cox regression and propensity-score adjustment were performed to account for confounders.nnnRESULTSnImmediate CR was performed in 98 patients (2.9%), whereas 3314 patients (97.1%) were incompletely revascularized. The prevalence of severe heart failure (Killip class III or IV) and significant lesions of the left main coronary artery were higher in the immediate CR group (21.6% vs. 13.5% and 24.5% vs. 6.7%, respectively; P<0.001 for both). After adjustment, immediate CR was not associated with reduced rates of MACE (hazard ratio [HR] 0.64, 95% confidence interval [CI]: 0.31-1.35; P=0.24) or all-cause death (HR: 0.52, 95% CI: 0.23-1.16; P=0.11), but with increased risks of definite stent thrombosis (HR: 3.93, 95% CI: 1.12-13.75; P=0.03) and major bleeding (HR: 17.46, 95% CI: 2.29-133.17; P=0.006).nnnCONCLUSIONnImmediate CR did not improve in-hospital outcomes of patients with STEMI with multivessel disease in this analysis. Randomized studies are warranted to elucidate the optimal timing of CR in patients with STEMI.

Diagnosis and/or management of anomalous origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) syndrome in adulthood: A report on twelve cases

30 Diagnosis and/or management of anomalous origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) syndrome in adulthood: A report on twelve cases L. Le Berre a, A. Fraisse b, D. Boulmier c, M. Jimenez d, J. Mansourati e, P. Guerin f a University Hospital of Brest, Brest, France b AP—HM, Hospital La Timone Children’s, Marseille, France c University Hospital of Rennes, Rennes, France d Clinic Saint-Augustin, Bordeaux, France e University Hospital of Brest, Department of Cardiology EA 4324, Brest, France f University Hospital of Nantes, Nantes, France

Opacification d'une veine coronaire lors d'une angiographie ventriculaire gauche avec myographie accidentelle chez une femme de 78 ans porteuse d'un rétrécissement aortique serré

Resume Dans le cadre du bilan dune dyspnee deffort NYHA II, un retrecissement aortique calcifie et serre est decouvert chez une patiente de 78xa0ans. La surface valvulaire aortique fonctionnelle est evaluee a 0,75xa0cm2 a lechocardiographie et il est par ailleurs note dimportantes calcifications mitrales non stenosantes ainsi quune forte hypertrophie ventriculaire gauche. Lors du bilan angiocoronarographique la valve aortique est franchie assez difficilement a laide dun guide droit sur lequel est descendue une sonde pig-tail. Lors de langiographie ventriculaire gauche, un aspect de myographie est observe avec opacification de la veine coronaire interventriculaire posterieure se drainant dans le sinus coronaire. La patiente est restee strictement asymptomatique pendant tout lexamen et les suites ont ete tres simples, sans epanchement pericardique ni nouvelle anomalie parietale du ventricule gauche. La patiente beneficiera quelques semaines plus tard dun remplacement valvulaire aortique sans complication.

Large fistula between right coronary artery and right atrium in a 50 year old asymptomatic woman

A 50 year old asymptomatic woman without prior medical history was found to have a continuous murmur, which was loudest in the lower right parasternal region. Her physical examination and standard ECG were normal. Transthoracic echocardiography revealed mild right ventricular dilatation, with …