Fatal postpartal dissection of all coronary arteries in an in vitro-fertilized woman

Myocardial infarction complicates approximately 1 in 10,000 pregnancies [1]. Coronary artery dissection is the leading cause of pregnancy-related myocardial infarction during the postpartum period. Proposed etiologies include altered endocrine status, hemodynamic stress, eosinophilic inflammatory infiltrate, and disruption of vasa vasorum. Definitive diagnosis is made by coronary angiography. Treatment has not been well defined. Strategies include medical management, stenting, and coronary artery bypass grafting. Here, we report the postpartal dissection of all 3 coronary arteries and of the left main coronary in an in vitro-fertilized, 40-year-old woman who, after giving birth to a newborn by cesarean section, presented with myocardial infarction and required urgent coronary artery bypass surgery. Spontaneous coronary dissection that predominantly affects young women is rare and is often dramatic. One-third of the cases occur during pregnancy or in the postpartum period. Our case report is unique; postpartum coronary artery dissection in a patient of any age that was fertilized in vitro is very rare.

[Cardiac conduction disorders in athletes: diagnosis and management]

BACKGROUND

The sino-atrial or atrio-ventricular conduction disturbances are commonly seen in athletes. They are due to predominant effect of the parasympathetic tone.

AIM

To describe the physiological cardiac adaptation to physical exercises and to specify the limits of this activity in front of persons with conduction abnormalities.

METHODS

Review of literature and lecture of recommendations.

RESULTS

conduction disturbances in athletes disappear during physical activities. Their frequency is variously reported in literature. These disorders should be well considered particularly when they are priors to sport practice and need definitive implantable devices. Such decision must be taken after a detailed evaluation of the nature of the physical activity wished and the conduction disturbance type.

CONCLUSION

The decision to allow competition should be take after a careful evaluation of the conduction disorder and the type of sport.

Clinical and electrophysiological profile of Brugada syndrome in the Tunisian population

BACKGROUND

Most clinical studies of the clinical profile of Brugada syndrome (BS) have been conducted in either Asia, Europe, or America and their applicability to North African populations is largely unknown. The aim of the study was to analyze the clinical profile of BS in Tunisian patients.

METHODS

The clinical and follow-up data of 24 patients (22 men, mean age: 40.8 ± 13.7 years) were collected since 2002. Baseline characteristics, morbidity, and mortality data were obtained from medical records.

RESULTS

One patient (4.16%) survived sudden cardiac death (SCD), four patients (16.3%) had syncope, and 19 patients (79.1%) were asymptomatic. Eleven patients (45.8%) had a family history of SCD. Twenty patients showed a spontaneous coved-type ST-segment elevation on electrocardiogram and after medical challenge on the four remnants. An electrophysiological study was performed in 15 of 24 patients (62.5%), during which ventricular fibrillation was induced in six patients (40%); three of the six patients were previously asymptomatic. An implantable cardioverter defibrillator (ICD) was implanted in 14 patients (58.3%). After a mean follow-up of 26 ± 21 months, one patient died from a noncardiac cause and one patient (with a history of aborted SCD) received an appropriate shock from his ICD. None of the asymptomatic and noninducible patients experienced a cardiac event.

CONCLUSIONS

BS is present in the North African population and is probably under-recognized. Tunisian patients with BS share with their western and Asiatic counterparts similar clinical profile.

[Sirolimus-eluting stent in the prevention of restenosis in small coronary arteries]

BACKGROUND

Angioplasty of coronary arteries with a small diameter (commonly defined as diameter inferior than 2.75 mm) is associated with a high rate of restenosis and revascularization. Since the use of Drug Eluting Stents (DES) and considering their good results on simple lesions compared to other techniques (balloon dilation and bare metal stents), many studies have also demonstrated the superiority of DES in reducing restenosis and revascularization of complex lesions in particular lesions on coronary arteries with small diameter.

AIM

Assessment of this revascularization procedure.

METHODS

Our study is a prospective one carried on between june 2002 and august 2006, involving a cohort of 299 patients. Patients are divided into 2 groups: group I: 175 patients with 220 lesions on coronary arteries with small diameter treated by 233 sirolimus DES (Cypher) and group II: 124 patients treated by 136 angioplasty of coronary arteries with diameter superior than 2.75 mm using 179 DES.

RESULTS

During hospitalisation, there was no significant difference in MACE between the 2 groups. Nevertheless, 2 patients among the first group had no angioplasty because of unsuccessful progression of the balloon through the lesion and the absence of atherectomy in our center. All patients having acute thrombosis during hospitalization and presenting with ST elevated acute coronary syndrome had successful urgent revascularization with TIMI 3 flow. The mid-term follow-up (12 months) concerned 157/174 patients in group I and 113/123 patients in group II. We observed a higher mortality and non fatal myocardial infarction in group I without statistically significant difference.

CONCLUSION

despite the complexity of the lesions on coronary arteries with small diameter and despite the association with several risk factors in particular diabetes, the use of DES reduces the MACE specially secondary revascularisations thus improving early and midterm prognosis.

[Infective endocarditis on probe of pacemaker]

Infective endocarditis is an uncommon but potentially lethal complication of permanent cardiac pacing. Infection is mainly caused by local contamination during the implantation procedure. The most frequently detected causative microorganisms were staphylococci. The clinical presentation is often atypical causing prolonged diagnostic delay. Bacteriological data and visualisation of neostructures consistent with vegetations on transoesophageal echocardiography, strongly suggest pacemaker lead infection. Management is based on a combined approach using both prolonged antibiotic treatment and early complete device explantation. Percutaneous techniques are currently the method of choice for lead extraction but it is not without possible complications. Antibiotic prophylaxis in order to reduce infection risk related to pacemaker implantation is widely recommended.