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The aim of this study was to determine the incidence, angiographic characteristics, clinical consequences, therapeutic implications and evolution of coronary arterial aneurysms after percutaneous transluminal coronary angioplasty (PTCA) based on a series of 13 cases out of a total population of 752 patients undergoing balloon dilatation. Before BTCA, 10 patients had unstable angina and 3 had stable angina. The stenoses were of type A in 6 cases and, more complex, type B, in 7 cases. The results of PTCA were good except in 1 case in which the procedure was complicated by a rudimentary infarct due to an extensive intra mural rupture. The frequency of coronary aneurysms evaluated in a series of 150 patients dilated and controlled systematically was 4 p. 100. This complication was observed relatively late, 2 to 13 months after PTCA. The length of aneurysm ranged from 2 to 13 mm (3.9 +/- 2.9 mm). Nine aneurysms were sacciform and 4 were fusiform. They were isolated in 6 cases and associated with restenosis in 7 cases. The predisposing role of an oversized angioplasty balloon was a probable etiological factor; the balloon/artery ratio was over 1.1 in 4 cases and over 1.2 in 3 cases. Intramural rupture observed at the time of PTCA (8/13 cases) did not seem to be a predisposing factor as the incidence of coronary aneurysm was not significantly different in patients without this complication in the group of 150 patients dilated and controlled systematically by angiography (5.8% vs 3%; NS). In the 6 cases of isolated coronary aneurysm the patients were asymptomatic and were followed up with medical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Between January 1986 and December 1988, 558 patients underwent percutaneous transluminal coronary angioplasty (PTCA) of whom 40 per cent were dilated at the time of diagnostic coronary arteriography. In order to assess the value of this therapeutic strategy we compared the results of 221 patients dilated at the time of diagnostic coronary arteriography (Group 1) with those of 337 patients who underwent deferred PTCA. In Group 1, the incidence of stable angina was lower (26.7% vs 46.3%, p less than 10-5), that of thrombolysed myocardial infarction was higher (24% vs 2.7%, p less than 10-9) and a higher proportion of patients had previously undergone PTCA (29.4% vs 3.2%, p less than 10-9). The proportion of patients with single vessel disease was higher in Group 1 (84.6% vs 74.7%, p less than 0.01) as was that of angioplasty of a single lesion (97.7% vs 88.1%, p less than 10-4). There were fewer dilations of the left circumflex artery in Group 1 (17.2% vs 27.3%, p less than 0.05) which was compensated by a higher number involving the right coronary artery (26.1% vs 15.5%, p less than 0.01). The immediate results were comparable in the two groups with 87.8 per cent primary successes, 3.6 per cent of myocardial infarcts and 1.3 per cent of coronary bypass operations with no fatalities in Group 1. These favorable results encourage the development of PTCA at the time of diagnostic coronary arteriography in the following indications: unstable angina, thrombolysed myocardial infarction and restenosis irrespective of the patient's symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)

Between January 86 and February 88 we attempted percutaneous aortic valvuloplasty in 100 patients. 68 patients could be dilated with hemodynamic success: the aortic valve area increased from 0.52 +/- 0.17 cm2 to 0.78 +/- 0.27 cm2 (p less than 0.001). Cardiac output did not change significantly (4 +/- 1.1 l/mn). In the remaining 32 patients: 8 patients (8%) died in hospital and the morbidity rate was 11%: arterial injury (9), stroke (1) and major cardiac event (1). Sixty patients regarded as initial success were followed for 6 months: 3 patients (5%) died without cardiac events, functional improvement persisted in 41 patients (68%) and clinical failure was observed in 16 patients (27%): 4 patients died and in the remaining 12 patients, the recurrence of symptoms required medical treatment (5), surgery (5) or repeat percutaneous valvuloplasty (2). Echo-Doppler maximum aortic valve gradient was significantly less in improved patients (55 +/- 21 mmHg) than in deteriorated patients (78 +/- 36 mmHg) (p less than 0.02). One year after valvuloplasty: actuarial survival was 74 +/- 6%, clinical improvement was 53 +/- 7% and clinical recurrence was 41 +/- 7%. Thus percutaneous aortic valvuloplasty may be proposed only to non surgical patients.

Six cases of this rare association (7 to 10 p. 100 of Takayasu's disease) are reported. The authors also review 73 previously reported cases. The valvular lesion is usually detected secondarily during follow-up (2/3 of cases), but is observed at the same time as the arterial disease in about 1 out of 5 cases. In rare cases, it may be the presenting feature before the vascular disease becomes clinically apparent. Quantification of the regurgitation may be difficult because of stenosis of the thoracic aorta and the supra aortic vessels. In some cases it is severe and poorly tolerated but has no particular distinguishing features apart from the incidence of aortic wall calcification (ascending aorta to all of the aortic arch). Twenty five anatomical observations (operative or autopsy) are sufficiently well documented to show the mechanism of the aortic incompetence. It is caused by an inflammatory aortitis: valvular lesions were found in 2/3 of cases but other causes may be observed, dilatation of the aortic ring (1 out of 4 cases), disunion of the commissures (1 out of 4 cases) and changes in aortic compliance causing systolic hypertension. Aortic valve replacement is rare (11 cases including 3 personal cases) and sometimes completed by resection of an aneurysmal ascending aorta.

Frequency of PTCA performed at the time of initial coronary angiography has increased to 47% of all PTCA performed in 1988. The aim of this study is to assess the efficacy and safety of this strategy by comparing the results in 2 groups of patients: in group 1 (179 patients), PTCA was performed at the time of initial coronary angiography and in group 2 (549 patients) PTCA was performed, 15 to 30 days after initial coronary angiography. Clinical differences between the two groups concerned: stable angina (25.1% vs 41%; p less than 0.001) and myocardial infarction treated with thrombolytic therapy (23.7% vs 7.7%; p less than 10(-9)). The extent of coronary artery disease was similar in the two groups but the incidence of single vessel PTCA was higher in group 1 (96% vs 90%; p less than 0.01). The immediate results of PTCA were similar and led us to develop this strategy for unstable angina, myocardial infarction treated with thrombolytic therapy, as well as total coronary obstruction and restenosis whatever their symptoms and signs. This strategy requires high quality fluoroscopic and video replay images, and allows a reduction in hospital costs.