[Trans-septal catheterization. Technic and indications]. / Cateterismo transettale. Tecnica e indicazioni.

We report our experience with transseptal catheterization of the left side of the heart via the right femoral vein. This technique was attempted in 50 patients undergoing left heart catheterization for hemodynamic evaluation of aortic valve stenosis (15 patients) and prosthetic valves (35 patients). The importance of some manoeuvres, especially within the right atrium, to avoid some of the most usual complications, like cardiac or aortic perforations, intramyocardial injection of contrast medium, and embolization of left atrial masses, is underlined.

[Prevention of gastroduodenal complications in coronary surgery. Usefulness of preoperative fiberoscopy]. / Prévention des complications gastro-duodénales de la chirurgie coronarienne. Intérêt de la fibroscopie pré-opératoire.

Fiberoscopic examination of the oesophagus, stomach and duodenum was carried out in 60 coronary disease patients prior to aorto-coronary bypass. Lesions of the upper digestive tract were detected in one-third of the patients; half of them were asymptomatic. The management of these cases depended upon the urgency of the cardiovascular operation. In 17 cases, a 1-month treatment of the digestive lesions with antacids and cimetidine was instituted immediately after fiberoscopy, and revascularization was performed 8 days later. In 3 cases, the cardiovascular operation was postponed; after 1 month of treatment only one patient had active lesions on control fiberoscopy and had to undergo digestive surgery prior to aorto-coronary bypass. No gastroduodenal complications of cardiovascular surgery was observed in this series.

[Treatment of recent traumatic ruptures of aortic isthmus (author's transl)]. / Traitement des ruptures traumatiques récentes de l'isthme de l'aorte.

We recommand the following procedure: --positionment of the patient allowing the simultaneous approach of left pleural cavity and left femoral vessels. --aortic liberation far away of the isthm, in a diffuse hematoma. --medullar protection by femoro-femoral extra corporeal circulation. --recovery of aortic continuity either by direct suture or by interposition of an prosthetic tube, the sutures being largely supported by mediastinal cellular tissue. We have used this technique in 5 patients, with a good result in all cases.

[Left ventricular function in chronic obstructive pulmonary disease after decompensation (author's transl)]. / Fonction ventriculaire gauche de l'insuffisant respiratoire chronique au décours d'une décompensation aiguë.

13 patients with chronic obstructive pulmonary disease (COPD) were studied for left ventricular function immediately after acute decompensation. Parameters of right and left ventricular function were measured. Mean pulmonary wedge pressure (Paw) was elevated (11.9 mm Hg) but there was no correlation between Paw and left ventricular end-diastolic pressure (LVEDP). The indices of left ventricular contractility were in the normal range. In 4 patients, LVEDP was too high. A correlation was established between RVEDP and LVEDP. Left ventricular compliance, as studied by the index of Diamond and Forrester, was abnormal. Two conclusions are discussed: (1) in COPD, Paw cannot indicate left ventricular dysfunction; (2) alteration of left ventricular compliance is possibly related to an elevation of RVEDP.

[Haemodynamic data, blood gas measurements and coagulation disorders in acute respiratory failure of patients with chronic lung disease (author's transl)]. / Données hémodynamiques, gazométriques et troubles de l'hémostase chez les insuffisants respiratoires chroniques en décompensation aiguüe.

24 subjects with chronic obstructive pulmonary disease were investigated in the course of acute respiratory failure defined by hypoxaemia, hypercapnia and respiratory acidosis. Haemodynamic data of right heart catheterization and coagulation tests were particularly studied. 12 of these subjects had right heart failure defined by a rise of right ventricular end-diastolic pressure above 10 Torr. Coagulation tests brought evidence of consumption coagulopathy in 8 patients, 7 of whom had right heart failure. Data suggest a significant correlation between right heart failure and coagulation disorders in patients with acute exacerbation of chronic obstructive pulmonary disease. These disturbances, accompanied by reduction of pulmonary vascular area, could be in part related to the presence of microthrombi in pulmonary arterial vessels.

[2 cases of respiratory assistance with a membrane oxygenator]. / A propos de deux cas d'assistance respiratoire par oxygénateur à membrane

The authors report two cases of artificial ventilation with the assistance of a membrane oxygenator that was used, on the one hand, in the case of a 'malignant pneumopathy' and, on the other hand, in the case of a cardio-respiratory failure after a complete mending of a tetralogy of Fallot. Recovery was obtained in the second case. They specify the method and the watching of anti-coagulation. They insist upon the merit of a re-injection of oxygenated blood into the ascending aorta. They recall the necessity to lay down instructions according to very strict criteria, by taking into account the degree and the visceral repercussions of hypoxia and the reversibility of lung lesions in so far as it is a matter of a very heavy palliative therapy upon whose efficiency it is difficult to pass a judgment.

[2 cases of chylothorax caused by catheterization of left large venous trunks]. / A propos de deux cas de chylothorax consécutifs a des cathétérismes des gros troncs veineux gauches

The authors present two cases of almost certain catheterization of the thoracic duct, by infusion catheters placed in the large veins at the base of the neck (once in the left internal jugular, once in the left subclavian). Their clinical manifestaztions are the existence of a rapidly progressive pleural effusion, apart from the abnormal course of the catheter. Removal of the catheter is sufficient to lead to the disappearance of the symptomatology, so that it is difficult to speak of an accident as such, but rather of an incident. These incidents could be avoided by systematic radiography from the time that the catheter is placed in position or the positioning of the latter under control by brilliance amplifier.