Anomalous right coronary artery from the pulmonary artery

Morgane Slaedts(1), MD, Alain Poncelet(2), PhD, Stéphane Moniotte(1), PhD Published in the journal : December 2018 Category : Cardiovasculaire

The anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital heart disease, with an incidence of 0.002%. Often asymptomatic upon childhood, the diagnosis is easily missed, with the anomaly often diagnosed incidentally. Nevertheless, ARCAPA may lead to myocardial ischemia or sudden cardiac death, even in early childhood.

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“Autoresuscitation” after cardiac arrest: the Lazarus phenomenon

Michèle J. Yerna (1), Cristian R. Tarta (1), Juline A. Verjans (2), Renaud A. Verjans (2), Amir S. Aouachria (3) Published in the journal : December 2018 Category : Cardiovasculaire

The Lazarus phenomenon is characterized by spontaneous recovery of circulation after cessation of cardiopulmonary resuscitation. The pathophysiological mechanism is still unknown. We have reported the case of a 61-year-old man who collapsed owing to cardiac arrest after anaphylactic shock in relation to hymenoptera bites. Advanced life support was initiated within 10 minutes, and an alternation of shockable and non-shockable rhythms was observed over 60 minutes. Following intravenous administration of 14mg epinephrine and six external electric shocks, treatment was stopped. Monitoring system was maintained, and 5 minutes later, a spontaneous return of electrical activity with palpable pulse was noted. Despite an aggressive treatment, the patient died 12 hours later from refractory shock.

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Atrioesophageal fistula after radiofrequency ablation: a rare and often fatal complication

Emilie Evrard (1), Dan Gusu (2), Pierre Hausman (3), Denis Glorieux (4) Published in the journal : December 2018 Category : Cardiovasculaire

The atrioesophageal fistula (AEF) is a rare complication of the atrial fibrillation (AF) ablation procedure. This complication is mostly fatal, with a mortality rate exceeding 80% (1), while its incidence does not exceed 0.3% (1). It is the second cause of death after tamponade following this procedure (2). The AEF results from the proximity between the esophagus and left atrium (3), as well as fromthermal esophageal mucosal lesions (4). We have here reported the case of a 65-year-old man who developed neurologic and septic symptoms 31 days after a second AF ablation. Upon admission, a cerebral scanner revealed a small ischemic lesion in the right temporal lobe. Initially hospitalized in a stroke unit, the patient was then transferred to an ICU because of his rapid neurologic deterioration. Upon the intubation maneuver, massive hemorrhaging from an upper digestive site occurred, with patient reanimation required. Confronted with an unknown diagnosis, a gastric endoscopy was performed, revealing two sluices on the anterior esophagus surface, opposite the left atrium. Thoracic CT scan corroborated the AEF diagnosis with an air bubble observed in the mediastinum, between esophagus and left atrium. Nevertheless, the patient died owing to massive cerebral air embolism.

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