[Changes in left ventricular dP/dt during transluminal coronary angioplasty]. / Modifications de la dP/dt ventriculaire gauche au cours de l'angioplastie transluminale coronaire.

The authors studied changes of LV dP/dt during transcutaneous coronary angioplasty (TCA). The aim of the study was to detect the alterations of LV function during coronary occlusion and to evaluate the immediate effects of PCA on myocardial function. Six patients with incapacitating angina and isolated left anterior descending disease were successfully treated by TCA using Gruntzig's technique. The study protocol included several recording sequences per patient during the phases of balloon inflation at progressively increasing pressures from 2 to 10 hours. Each sequence comprised a recording under basal conditions and every 5 seconds during inflation (20 seconds) and deflation (45 seconds) of the following parameters: heart rate, aortic and LV pressures, positive and negative peaks of LV dP/dt, and the intracoronary pressure gradient at the beginning and the end of each sequence. The first part of the results based on 27 recorded sequences analysed the bad effects of myocardial ischaemia; coronary occlusion induced a significant fall (p less than 0.01) in the positive and negative peak dP/dt values and on elevation (p less than 0.01) in LV end diastolic pressure, without affecting LV systolic pressure or heart rate. These changes have the following characteristics: they are early, occurring within seconds of coronary occlusion; they affect LV contraction and relaxation simultaneously, but the effects are more marked on LV relaxation; the severity is proportional to the duration of occlusion; they are totally reversible; the disturbances of relaxation return to normal more quickly than those of contraction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Coronary intramural ruptures caused by transluminal angioplasty. Incidence, significance and development controlled by coronary angiography]. / Les ruptures intramurales coronaires induites par l'angioplastie transluminale. Incidence, signification et évolution contrôlée par coronarographie.

The authors report their experience of coronary intimal rupture (CIR) observed at control angiography performed at the end of transluminal angioplasty in a series of 150 cases. This lesion was observed in 34 p. 100 of cases. Two subgroups were established according to the presence (Group I: 51 cases) or absence of CIR (Group II: 99 cases) in order to try and identify any predisposing factor. The following features were compared in each group: age, sex, number of risk factors, duration of the disease, its severity, the site and morphology of the lesions (calcification, length, excentric or concentric) on the artery dilated and the technique used (number of inflations, maximal pressure, guidable catheter). The only significant feature associated with CIR was the morphology of the stenosis. Intimal rupture was statistically more frequent when the stenosis was long, calcific and excentric (p less than 0.05). The excentric character was highly predictive of CIR +/- 0.02) and even of complicated CIR (p less than 0.01). The CIR was complicated in 10 cases (19.6 p. 100) with a higher incidence than in the rest of the population (p less than 0.05). These complications were immediate presenting as attacks of angina leading on to 4 myocardial infarctions (7.8 p. 100) but no deaths. The treatment consisted in an attempt to redilate the artery with effective angioplasty in 3 out of 4 cases. Medical therapy alone was sufficient in 2 cases and 4 patients underwent coronary bypass. There were no complications in cases of initially asymptomatic intimal rupture. The 6 months outcome was controlled by coronary angiography in 131 angioplasties.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term outcome of a patient with hypertrophic obstructive cardiomyopathy treated by alcohol septal transcoronary ablation]. / Suivi à long terme d'une patiente atteinte de cardiomyopathie obstructive traitée par alcoolisation septale.

We report here the long term follow-up of the first french case, at our knowledge, of alcohol septal transcoronary ablation in March 1998 in Clinique Ambroise Paré in an 76 year-old woman. This patient was in NYHA III-IV functional class and at control outflow gradient was 100 mmHg. She was prior treated with high dosis of beta-blockers then DDD-pacemaker with no effects on symptoms. The technique used was the one described by Sigwart and al., with injection of 3 cm3 of ethyl alcohol in the first septal branch, after checking decrease of gradient during occlusion of septal branche with balloon angioplasty. After alcohol ablation, the gradient decreased immediately to 15 mmHg and disappeared at long-term follow up. Three years and half after the procedure, no complication occurred, the patient remains asymptomatic and the control echocardiography shows interventricular septal reduction of thickness from 22 to 12 mm.

[Phonomechanograms of patients with the Bjork aortic valve prosthesis]. / Etude des phonomécanogrammes chez les malades porteurs d'une prothèse de Björk en position aortique

A survey, with consecutive phonocardiograms, of the function of 75 Björk aortic valve prostheses has enabled us to examine the basic components of the opening and closure sounds of this type of replacement; these are usually made up of multiple components in varying combinations. This diversity underlies the importance of an early postoperative recording to act as a baseline. In addition, 2 cases of malfunction presented with only the classical phonocardiographic changes.

[Aortic stenosis in adults: contribution of catheterization to the study of associated lesions. Apropos of 137 cases]. / Le rétrécissement aortique de l'adulte: apport du cathétérisme pour l'étude des lésions associées. A propos de 137 cas.

The results of cardiac catheterisation in 137 cases of pure adult aortic stenosis considered to be isolated after non-invasive investigation (clinical examination, carotid pulse tracing, echocardiogramme) are reported. The authors analyse the reliability and risks of this examination to which they attribute a triple objective; evaluation of the severity of the AS, evaluation of LV and/or mitral valve dysfunction and the assessment of the coronary circulation in patients with angina or in all patients over 54 years of age or with coronary calcifications. The aortic valve was crossed in 89,8 p. 100 of patients. Coronary angiography was attempted in 128 cases (93,4 p. 100) and was successful in 110 cases (85,9 p. 100). The investigation was complicated by one death (0,73 p. 100) and one femoral artery thrombosis, and was complete in only 74 p. 100 of cases. The results showed the aortic stenosis to be isolated in only 84 cases (61,3 p. 100). In the other 53 cases (38,7 p. 100) there was unrecognised associated pathology: mitral valve disease was diagnosed in 14 cases (12,3 p. 100); significant coronary artery disease (greater than 50 p. 100 narrowing) was observed in 34 of the 110 patients in whom coronary angiography was successful (30,9 p. 100). In the last 5 cases, catheterisation showed: two ASDs, one partial abnormal pulmonary venous drainage, one fusiform aneurysm of the aortic isthmus, one abnormal origin of the left anterior descending artery in the right coronary sinus with a pre-pulmonary trajectory. The authors discuss the value of the various methods of preoperative assessment of AS. The relative reliability of the different non-invasive techniques is compared.(ABSTRACT TRUNCATED AT 250 WORDS)

[Correlations between effort tolerance and the severity of coronary disease. Influence of myocardial lesions]. / Corrélations entre la performance physique des coronariens à l'effort et la sévérité de la maladie coronarienne. Influence des lésions myocardiques.

The influence of coronary and myocardial lesions, defining the severity of the coronary artery disease on effort tolerance was studied in 51 patients. The appearances of the coronary arteriography and ventriculography were compared with the parameters of exercise tolerance: electrocardiographic changes, maximal charge (Cw), total work (TW), maximal systolic arterial pressure (SAP), maximal heart rate, percentage of the theoretical maximal heart rate, double product, exercise capacity index (CEI). The results showed that exercise tolerance (Cw, TW, ECI) and the exercise SAP are mainly affected by the myocardial lesions: patients with very reduced left ventricular ejection fractions and double or triple artery disease have very low indices: average Cw of 60 watts, TW less than 20,000 joules, ECI approximately 50. The SAP only rises slightly. On the other hand, patients with normal or subnormal ejection fractions have much higher indices whatever the state of their coronary arteries; Cw over 80 watts, TW over 30,000 joules, ECI over 80. In addition, major left ventricular dysfunction is associated with ST segment elevation during exercise.

[Multinodular hepatic angioma: a rare cause of neonatal asystole. A case and review of the literature]. / L'angiome hépatique multinodulaire: cause rare d'asystolie néo-natale. Une observation et revue de la littérature.

The clinical findings in a case with a diffuse multinodular type of angioma of the liver are reported. The clinical picture was typical: the appearance after the first week of a severe congestive failure mimicking a congenital heart disorder, of the left to right shunt type, with gross hepatomegaly of the "vascular" type with a systolo-diastolic murmur, but with no cutaneous evidence of angioma. The very severe prognosis during the first months of life of patients with this malformation, as illustrated by the 58 deaths out of the 78 cases reported in the literature, indicated ligature of the hepatic artery before the age of one month. The satisfactory outcome (with a nine months follow-up) for this case, as for the three other operated cases in the literature, leads us to conclude that this operation is indicated after a detailed arteriographic examination has been made, and provided that the other anatomical conditions are favourable.

[Secondary coronary fistulas]. / Les fistules coronaires secondaires.

These fistulae are very rare: 8 to 11 p. 100 of all coronary fistulae. Three types are recognised: right coronaro-ventricular, left coronaro-ventricular, and coronao-pulmonary. The two first types are found most frequently in association with a sigmoid atresia on the orifice, and with ventricular hypoplasia in the presence of a functional atrio-ventricular valve. The fistula then serves as a means of ventricular ejection. Of the secondary fistulae, the right coronaro-ventricular type is the most common (73 p. 100). The authors have found 30 cases in the published literature, and add 2 of their own. They have also reviewed the clinical features and the findings on coronary arteriography and post mortem studies on such fistulae. They discuss their etiology, pathogenesis, and physiopathology. Surgical correction involves repairing the fistula in one stage. Fistulae of the left coronaro-ventricular type are exceptions to this rule (9 p. 100), as they are always associated with a rapidly fatal hypoplasia of the left side of the heart. Coronaro-pulmonary fistulae (18 p. 100) are usually found in association with extreme forms of Fallot's tetralogy, and a relatively simple surgical correction can form part of the total correction of the tetralogy.

[Endomyocardial biopsy as a method of surveilling adriamycin cardiac toxicity. 28 biopsies in 26 patients]. / Place de la biopsie endomyocardique comme méthode de surveillance de la toxicité cardiaque de l'adriamycine. 28 biopsies chez 26 patients.

The aim of this study was to evaluate the role of endomyocardial biopsy in the surveillance of toxic, latent cardiomyopathy secondary to adriamycin (ADM) therapy, and to assess its value by comparison with non-invasive investigations such as echocardiography. Twenty six patients underwent endomyocardial biopsy and echocardiographic measurement of the fractional shortening of the left ventricular internal diameter after a total dose of 150 to 520 mg/m2 of ADM. Interstitial fibrosis was observed in 8 of the 20 interpretable cases on light microscopy (6 moderate, 2 severe). There were no cellular changes. Slight focal myofibril degeneration was observed in 8 cases, and vacuolisation corresponding to mild dilatation of the sarcoplasmic reticulum was observed in 9 cases out of the 22 technically interpretable cases on electron microscopy. In contrast to the findings of interstitial fibrosis, cellular degeneration correlated significantly with the total dose of ADM (p less than 0,01). We conclude that this histological study confirms the fact that myocardial changes are rare and slight with doses of less than 520 mg/m2 of ADM and that non-invasive techniques are adequate for follow-up until this dose is reached.

[Gamma-angiography in the diagnosis of akinesia and dyskinesia after myocardial infarction]. / Apport de la gamma-angiographie au diagnostic des akinésies et des dyskinésies après infarctus du myocarde.

A one year prospective double blind trial included all patients with myocardial infarction and clinical, electrocardiographic or radiographic signs of left ventricular aneurysm. All 36 patients underwent ventriculography and radionuclide angiocardiography in the same projections: right anterior oblique, antero-posterior, left anterior oblique and left lateral. The angiographic diagnosis of left ventricular aneurysm was based on the finding of a deformation of the ventricular contour persisting in diastole; 22 patients were classified as having a left ventricular aneurysm and the 14 others had akinesia alone. The radionuclide diagnosis of left ventricular dyskinesia was based on the finding of the following 3 criteria in at least one projection: crossing of the systolic and diastolic isocontours; over 4 p. 100 of LV pixels having a negative ejection fraction; the dephased infarcted region having a movement separate from that of the remaining healthy myocardium. None of the clinical criteria of inclusion allowed diagnosis of LV aneurysm when compared with the results of ventriculography. The results of radionuclide and conventional ventriculography correlated 100 p. 100 in the diagnosis of severe contractile abnormalities. When compared with ventriculography, radionuclide angiocardiography had a specificity of 95 p. 100 and a sensitivity of 86 p. 100 for the diagnosis of aneurysm. The only false negative was a non-surgical septal aneurysm. The multiplication of the incidences of examination increases the sensitivity of the results of radionuclide angiography.

[Myocardial biopsy in congestive myocardiopathies of apparently primary origin]. / La biopsie myocardique dans les myocardiopathies congestives en apparence primitives

38 patients with congestive cardiomyopathy of apparantly primary origin had a myocardial biopsy. The histology of the fragment of myocardium was studied both by light microscopy and electron microscopy. The results were compared with those from 3 "control" cases and with 16 cases of congestive asystole secondary to a known cause. The non-specific patternss which were observed were of 3 types: patterns of degeneration, pattern of hypertrophy, and interstitial fibrosis. Chronic alcholism had no modifying effect on the ultrastructure. Finally, the group in which the morphology was altered had a higher mortality, but the prognostic significance of the degree of severity of the morphological change must be treated with caution in each individual case.

[Endomyocardial biopsy. Innocuousness and clinical value. A 5-year experience]. / La biopsie endomyocardique innocuité et intérêt clinique. Une expérience de cinq ans

The authors present their experience of the endomyocardaial biopsy procedure by Konno's technique; they have carried out 180 biopsies in 94 subjects. When the person taking the biopsy is experienced, the procedure is trouble-free, and yields tissue fragments of good quality which are suitable both for histological study and for study of ultrastructure. Biopsies from 47 cases of primary congestive cardiomyopathy have formed the basis of a precise histological study, and have been compared with the findings of a control group comprising various cardiac defects and three normal hearts. The diagnostic and prognostic value of the method are discussed.

[Beneficial effects of coronary transluminal angioplasty on resting left ventricular systolic function]. / Effets bénéfiques de l'angioplastie transluminale coronaire sur la fonction systolique ventriculaire gauche de repos.

Resting left ventricular systolic function was studied by cardiac catheterisation before and 6 months after effective transluminal coronary angioplasty (TCA) to evaluate the myocardial effects of this procedure. The global left ventricular systolic function was assessed by measuring ventricular volumes, the ejection fraction, the mean velocity of circumferential fibre shortening (m VCF) and mean normalised systolic ejection rate (MNSER). The regional function was studied by dividing the left ventricle into 8 regions using the Stanford radial model and measuring the percentage shortening and velocity of circumferential fibre shortening (VCF). These parameters were obtained from selective left ventriculography filmed at 100 frames/second in the RAD plane. Left ventricular function was analysed from the whole of systolic ejection and then sequentially during each third of systole (early-mid-and end systole). The 10 patients studied had an average age of 45 years. Coronary angiography was performed for unstable angina (6 cases), stable angina (3 cases) and post-infarction angina (1 case). Except for 1 patient with associated LAD and right coronary disease they all had single vessel disease. TCA was performed on the LAD artery in 8 cases, on a dominant left circumflex artery in 1 case and on a right coronary artery in 1 case. The efficacy was demonstrated by angiographic reduction of the degree of stenosis (85 to 25 p. 100 immediately after TCA, and 30 p. 100 at control angiography at 6 months), and by a reduction of more than 40 p. 100 in the average transstenotic pressure gradient.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intimal coronary fibrous dysplasia and Prinzmetal's angina]. / Dysplasie fibreuse intimale coronaire et angor de Prinzmetal.

It is currently considered as exceptional for there to be arterial pathology other than atheroma in Prinzmetal angina. The authors have found five cases of coronary fibrous dysplasia in the literature. They add a case, in a woman, of intimal fibrous dysplasia diffusely involving the three main coronary vessels. Coronary arteriography showed that spasm of the right coronary artery was the cause of attacks with the clinical and electrocardiographic features of Prinzmetal angina. The whole coronary tree was otherwise normal angiographically and also macroscopically at autopsy. The dysplasia was only discovered by histological study of serial sections of the three coronary vessels. Histological examination showed no evidence of an atheromatous lesion. The authors place these coronary artery lesions within the general classification of arterial fibrous dysplasias. It remains hypothetical whether there is a relationship between the occurrence of spasm and this very special histological feature of the coronary artery wall.

[Cardiac transplantation at the University Hospital Center of Nantes. 2 years' experience]. / Transplantation cardiaque au CHU de Nantes. Deux ans d'expérience.

Between March, 1985 and April, 1987, 25 orthotopic heart transplantations were performed in 20 men and 5 women aged from 17 to 58 years (mean 42 years) on account of cardiomyopathy (n = 15), ischaemic heart disease (n = 6) or miscellaneous lesions (n = 4). The immunosuppressive treatment consisted of antilymphocyte serum and corticosteroids during 10 days; cyclosporine was introduced on the 7th day and continued thereafter in association with low-dose corticosteroid therapy. Endomyocardial biopsies were performed. Acute rejection, responsible for 2 deaths (one on the 10th day, the other in the 10th week), usually occurred within the first 3 months. Infections were frequent and often serious, resulting in one death in the 7th week. One out of patients had to be treated for arterial hypertension, and 3 patients presented with renal impairment (blood creatinine over 200 mumoles/l). The actuarial survival rate at 2 years is 84 p. 100. More than one-half of the patients have resumed social and occupational activities.

[Treatment of a severe coronary artery spasm, refractory to complete denervation of the heart (autotransplantation)]. / Traitement d'un spasme artériel coronaire sévère, réfractaire par dénervation complète du coeur (autotransplantation).

The case reported is that of a 49 year old man with very severe Prinzmetal angina due to spasm of the left circumflex artery. Despite intensive medical treatment he continued to suffer frequent attacks with atrioventricular block. As plexectomy was not possible in this case, complete cardiac denervation was performed. After surgery, he had no further attacks and continuous ECG monitoring showed no ischemic phenomena. Nevertheless, a stress test was still able to induce spasm of the same artery which was painless but associated with ECG changes. Eighteen months postoperatively, resting angina recurred with positive stress tests giving painful attacks. Four hypotheses are discussed: 1) the local factor was very important, with a zone of hyperactivity on the left circumflex artery, 2) one of the mechanisms of coronary artery spasm could be the nervous stimulation of this zone, 3) this zone was insensitive to nervous stimulation after autotransplantation but remained sensitive to methylergometrine, 4) the recurrence of resting angina and painful symptoms on stress testing suggests the possibility of reinnervation of the heart, as has been shown after cardiac transplantation, the autonomic nervous system does not play the role generally attributed to it in the genesis of spasm.

[Percutaneous transluminal angioplasty of the terminal abdominal aorta. Apropos of a case with a review of the literature]. / Angioplastie transluminale percutanée de l'aorte abdominale terminale. A propos d'une observation avec revue de la littérature.

The indications and results of peripheral arterial angioplasty have now been well defined. The application of this technique to lesions of the infra-renal abdominal aorta has not been particularly controversial up until now but very few cases have been reported in the literature. The authors report a new case using the technique of a double balloon inserted into the two femoral arteries. Apart from the advantages of angioplasty, this technique appears to avoid the risk of impotence inherent with aorto-iliac surgery. The use of Road-Mapping simplifies the problems of detection, position, and adaptation of the balloon and reduces the duration of the procedures.

[Left ventricular volume measurement. A simple and precise method for calculating the enlargement factor (author's transl)]. / La mesure des volumes ventriculaires gauches. Proposition d'une méthode de calcul du facteur d'agrandissement simple et précise.

A new method is proposed for calculating the enlargement factor in order to measure left ventricular volume. It is based on the grid method of Kasser and Kennedy, modified and simplified by making use of the technical possibilities of their apparatus. The enlargement factor is measured from a graduated scale and reference to a pre-established graph.

[The value of Mackenzie and Harries's technique in detecting pleural thickenings: results of a systematic study in 64 patients exposed to the risk of asbestosis (author's transl)]. / Intérêt de la technique de Mackenzie et Harries dans le dépistage des épaississements pleuraux. Résultats d'une enquête systématique chez 64 patients exposés au risque asbestosique.

The authors stress the difficulty of detecting pleural thickenings due to asbestos by radiography, before the late stage when calcification appears. Using Mackenzie and Harries's technique, they radiographed 64 subjects working in the naval shipbuilding yard in Nantes, who had previously been examined by radiophotography. Their results confirmed the superiority of the 45 degrees oblique incidence for demonstrating patches of pleural thickening in those areas where they occur most frequently. The value of this early detection is purely social and occupational at the present time, as it cannot be used to give a prognosis as to the possible appearance of a more serious lesion such as mesotheliomas.

[Atheromatous coronary artery disease: value of a study of calcification during assessment (author's transl)]. / Intérêt de l'étude des calcifications dans le bilan de la maladie artérielle coronaire athéromateuse.

Correlations between calcifications and stenoses observed on coronarography were studied in 200 patients with coronary heart disease and calcifications in the coronary arteries. There was a very close relationship (p less than 0.0005) between the number of calcified and stenosed main coronary vessels. Calcification in the circumflex and right coronary vessels is a specific sign of stenosis. There was a high frequency of poor arterial beds distal to the stenoses when these were calcified. It is considered that the detection of coronary calcification by means of a brilliance amplifier constitutes one of the most effective non-invasive methods for assessing coronary artery disease.