[Crenelation of Beall's prostheses in mitral position: apropos of 21 reoperated cases]. / Le crénelage des prothèses de Beall en position mitrale. A propos de 21 réinterventions.

The authors report their experience of 21 revision operations for malfunction of the Beall Surgitool 104 prosthesis used in the mitral position. The incidence and uniformity of the disorders found in the prostheses suggest that these changes are produced inevitably usually during the fourth year. The disc becomes kinked, the mountings eroded, and the teflon ring torn. The clinical features are the onset of heart failure, anaemia, or a thrombo-embolic episode. These three findings may occur individually or in association. The authors do not advise systematic revision surgery, but conclude that close follow-up is essential in the case of all patients who have had a Beall prosthesis. Early signs of failure should be revealed by clinical examination, the level of LDH, and by phonocardiogram and echocardiogram studies. Leaving aside thrombo-embolic episodes and severe anaemia which themselves constitute indications for revision surgery, the decision to replace the damaged prosthesis should be taken as soon as the first signs of cardiac failure are detected.

[Decompensated valvular disease and coarctation. One-stage repair using a median approach with an ascending aorta-abdominal aorta shunt]. / Valvulopathie décompensée et coarctation. Cure en un temps par voie médiane avec dérivation aorte ascendante-aorte abdominale.

The tactical decision in patients with decompensated valvular disease associated with a severe stenosis of the aortic isthmus is always difficult. One stage surgical repair using two separate approaches is a long and high risk procedure. It would seem more logical and safer to treat the lesions in two stages a few weeks apart, the severest lesion being managed first. In the two cases reported. The isthmic stenoses and valvular lesions were of the same severity and made both classical techniques impracticable. Therefore the patients underwent a single stage procedure by a median approach associating valve replacement under cardiopulmonary bypass (mitral and tricuspid in one and aortic in the other case) and an ascending aorta-abdominal aorta dacron conduit. The present postoperative survival periods are 30 and 9 months. The functional result was good (Class 1 and 0) and postoperative angiography has shown the montage to be working satisfactorily. This technique is exceptional but may be useful in borderline cases with decompensated valvular disease and severe isthmic stenosis.

[Painless ST elevation with syncope. Diagnosis by continuous electrocardiography]. / Sus-décalages indolores de ST avec syncopes. Diagnostic par l'enregistrement électrocardiographique continu.

The aetiology of syncope in a 53 year old man was discovered on continuous ambulatory electrocardiography. A ventricular arrhythmia associated with ST elevation was recorded. It proved resistant to medical therapy and a double aorto-coronary bypass graft was performed. Post-operative Holter monitoring showed surgery to have been effective.

[Inidications for multivalve prostheses]. / Les indications des prothèses pluri-valvulaires

The authors consider that the indications for surgery should take into account three unknowns: the natural history of the valvulopathies, our incomplete state of knowledge about the outcome in operated cases, and surgical progress, which may transform the whole subject in a short time. They emphasize the seriousness of the disorders in which mitral incompetence is associated with aortic stenosis and/or incompetence; such cases justify earlier surgery. By contrast, some cases of aortic incompetence, when associated with a predominant mitral valve lesion, may not constitute an indication for valve replacement. Tricuspid annuloplasty is a noteworthy advance which provides a simple answer to some of the problems.

[Human cardiac transplantation. Apropos of a case followed for more than 6 years]. / Transplantation cardiaque humaine. A propos d'un cas suivi depuis plus de six ans

A cardiac transplantation was performed on November 28, 1968. This was the only one undertaken at Marseilles. After a survival period, now exceeding 6 years, the patient has had an almost normal activity. The course of this patient, the follow-up elements, the incidents and complications during this period were analysed. It was insisted upon the interest of following up the coagulation tests for the preclinical detection of rejection or menacing rejection. Practically uninterrupted heparin treatment during the 6 years might have been an element for this prolonged survival.

[Abnormal origin of the left coronary artery from the pulmonary artery. Diagnostic contribution of ultrasonographic technique]. / Naissance anormale de la coronaire gauche a partir de l'artère pulmonaire. Apport diagnostique des techniques échographiques.

We report a case of abnormal origin of the left coronary artery from the pulmonary artery trunk. The original features of this case were its discovery in a young pregnant woman, the normality of basal left ventricular function and the electrocardiogram, the diagnosis by transoesophaegeal echocardiography, and the demonstration of severe myocardial ischaemia by stress echocardiography.