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Purpose: Patients with severe aortic stenosis (AS) and paradoxical low flow (PLF) (indexed stroke volume 50%, have worse outcome compared to those with AS but normal flow. Moreover, Prosthesis-Patient Mismatch (PPM) (indexed prosthetic valve effective orifice area< 0.85cm2/m2) after aortic valve replacement (AVR) is a predictor of higher mortality. However, the impact of PPM in patients with PLFAS on long-term survival is unknown. Our aim was to analyze the prevalence and the impact on long-term survival of PPM in patients with PLFAS. Methods: 667 consecutive patients (age 74±8 years, 42% female, AVA 0.69±0.16 cm2) with preserved LVEF who underwent AVR for severe AS at our institution between 2000 and 2010 were included in this study. Patients were divided into 4 groups according to the presence/absence of PLF at cardiac catheterization and presence/absence of PPM following AVR and we compared short and long-term survival between these groups. Results: Among the 667 patients, 26% had PLFAS and PPM occurred in 54% of patients after AVR. Compared to patients with no PLF & no PPM (36% of the total cohort), those with PLF & PPM (15%) were significantly older, with more comorbidities. The 30-day mortality did not differ between the PLF- PPM and no-PLF-no PPM group. The 10-yr survival rate was significantly reduced in the PLF-PPM (37±9%) group compared to no PLF-no PPM (70±5%; p=0.003). In multivariate analysis adjusting for all predictors of survival, concomitant presence of PLF & PPM was an independent predictor of survival (HR= 2.68 95% CI: 1.5-4.4; p=0.0003) ![Figure][1] 10-year survival according to PPM/PLF Conclusion: In this catheterization-based study, patients with PLF and PPM have worse outcome when compared to those without these 2 conditions. [1]: pending:yes

The search for a cancer is part of the classical investigation of unexplained venous thrombosis. Arterial thrombosis associated with neoplasia is more rare. The authors report two cases in which arterial thrombosis was the final event of their malignant disease. The first case had abacterial thrombotic endocarditis and disseminated intravascular coagulation at the origin of multiple thrombotic complications. The initially unknown cancer was a pancreatic adenocarcinoma. The second case presented with acute occlusion of the iliac artery after ablation of a malignant melanoma. Despite embolectomy with a Fogarty catheter and effective anticoagulation, the thrombosis recurred several times at the same site. The clinical features and the mechanisms of these two cases suggestive of Trousseau's syndrome are discussed.

A man aged 41 years with a clinical diagnosis of cardiomyopathy and hepatic insufficiency was found, on angiocardiography, to have a mass, presumably a thrombus, within the left ventricle. A second angiocardiogram performed five days later showed that the thrombus had disappeared. The mechanism invoked was more probably an increase of spontaneous fibrinolysis as described in cirrhotic patients, perhaps helped by heparin, rather than ejection of the mass from the ventricle with silent embolisation somewhere in the systemic circulation.

Ventricular tachycardia by branch to branch reentry is a rare arrhythmia. It occurs in cardiomyopathies associated with conduction defects. During tachycardia a His potential precedes each QRS complex which usually has a left bundle branch block appearance. The authors report two familial cases of ventricular branch to branch tachycardia (son and mother) without cardiomyopathy. The diagnosis of Steinert's disease was made post-mortem in these two patients. In cases of branch to branch ventricular tachycardia, the diagnosis of myotonic dystrophy should be excluded. Conversely, endocavitary electrophysiological investigation with ventricular stimulation should be proposed for symptomatic patients (dizzy spells, syncope) to diagnose branch to branch ventricular tachycardia, even in cases with conduction defects which could also explain the symptoms.