Real-time 3-D ultrasound acquisition and display for cardiac volume and ejection fraction evaluation.

The objective of this study was to test if three-dimensional (3-D) ultrasound (US) provides accurate determination of the cardiac volumes and ejection fraction. The 3-D device (Model 1-Volumetrics, ) is a 3-D acquisition system using a 2-Mhz matrix probe that insonates the whole cardiac volume in a 4-chamber view and collects the entire backscattered US echoes from this volume within one cardiac cycle. The complete 3-D US information stored in the memory can then be cut into 2-D views of any arbitrary orientation. For volume determination, the best 4-chamber view was selected into the memory, then 6 transverse views were displayed at different depths along the ventricle long axis, and the contour of the ventricle was drawn on each of these views. The left ventricle volume in diastole (LVDV) and the ejection fraction (EF) obtained by 3-D US were compared with those from x-ray and isotopic angiographies, and 2-D echo-time motion (2-D Echo-TM). The variations in stroke volume (SV) during a stand test, measured by 3-D US, and aortic Doppler were compared. The correlation between EF evaluated from 3-D US and x-ray or isotopic angiographies was found to be good (r = 0.80 p < 0.001; r = 0.86 p < 0.001), but lower with 2-D Echo-TM (r = 0.59 p < 0.001). For LVDV, the correlation was acceptable with x-ray angiography (r = 0.75 p < 0.001), but much lower with isotopic angiography and 2-D Echo-TM (r = 0.47 p < 0.001; r = 0.55 p < 0.001). A good correlation was also found between the SV changes measured by 3-D US and aortic Doppler (r = 0.79 p < 0.001).

[Pre-capillary pulmonary hypertension complicating CREST syndrome. Apropos of a case]. / Hypertension artérielle pulmonaire précapillaire compliquant un syndrome CREST. A propos d'un cas.

Pre-capillary pulmonary hypertension was the presenting sign of a CREST syndrome in a 65 year old woman. The diagnosis of this form of scleroderma is based on the association of a number of features (calcinosis, Raynaud's phenomenon, oesophageal dyskinesia, sclerodactylia and telangectasia). Scleroderma is the systemic disease which is usually complicated by pre-capillary pulmonary hypertension. This complication is observed in about 13% of CREST syndromes, but very rarely as severe pre-capillary pulmonary hypertension. The diagnosis of pre-capillary pulmonary hypertension carries a poor prognosis with a 2 year survival rate of about 40%. Treatment is usually with calcium inhibitors but with no effect on prognosis. The use of prostacycline and its analogue, iloprost, is an interesting therapeutic strategy, currently under evaluation. Cardiopulmonary transplantation is the only treatment of very severe forms, despite the progressive character of the condition. All cases of pre-capillary pulmonary hypertension require complete aetiological investigation to exclude a systemic disease, especially a scleroderma and, above all, a CREST syndrome.

[Implantation of coronary stent during the acute phase of myocardial infarction for treatment of dissection or partial result after angioplasty. Immediate results and angiographic follow-up]. / Implantation d'une endoprothèse coronaire en phase aiguë d'infarctus du myocarde pour traitement d'une dissection ou d'un résultat incomplet après angioplastie. Résultats immédiats et suivi angiographique.

Between December 1991 and November 1994, a Palmaz-Schatz stent was implanted in 9 patients aged 57 +/- 14 years during the acute phase of myocardial infarction after primary angioplasty in 7 cases and salvage angioplasty in 2 cases after an interval of 175 mm +/- 62 mn from the onset of infarction, because of threatening dissection (N = 8) or a partial result (N = 1). The success rate of implantation was 100% with residual stenosis (DCI Philips system) measured at 16 +/- 8% (5 to 28%). Anticoagulant treatment comprised heparin, coumadin and aspirin in two cases, and, in the following 7 cases, low molecular weight heparin, ticlopidine and aspirin. There was one death due to cardiogenic shock on the third day despite intraaortic balloon pumping. One patient was operated for a femoral aneurysm. A prophylactic bypass procedure was performed as a semi-emergency in a stable patient. At systematic angiographic control, the residual stenosis was measured at 19 +/- 14% (10 to 43%) without reocclusion. There was no recurrence of ischaemia. The authors conclude that the encouraging results of this short series suggest that despite the highly thrombogenic situation of acute myocardial infarction and despite the context of emergency implantation of a stent. Palmaz-Schatz stent implantation gives good immediate and long-term results with respect to reocclusion and stenosis.

[Comparison of coronary angiography by the left radial and right femoral approach with 4 French catheters]. / Comparaison de la coronarographie par voie radiale gauche et fémorale droite avec des sondes 4 french.

The radial arterial approach has been shown to be valuable for coronary angioplasty. The aim of this study was to evaluate the use of the left radial and right femoral approaches for diagnostic coronary angiography. The authors performed a prospective non-randomised series of consecutive diagnostic coronary angiogrammes with small calibre (4 french) catheters by the left radial (100 patients) and right femoral (100 patients) arteries. The feasibility, results and complications were compared. The study showed that diagnostic coronary angiography with 4 F catheters is feasible with a high success rate, both from the left radial (99%) and right femoral (100%) approaches (NS). The duration of the procedure tends to be longer when the radial approach is used (19.2 +/- 1.3 min) than by the femoral artery (16.3 +/- 1.1 min) (p = 0.06). The duration of irradiation is longer with the radial approach (6.7 +/- 1.2 vs 4.9 +/- 0.9 min) (p = 0.0001). Local complications are minor by either approach (N = 5 vs N = 6 patients; p = NS), and there were no major complications. The tolerance of the procedure was not as good when the radial artery was used (N = 5) compared with the femoral artery (N = 1 patient) because of arterial spasm when the catheters were changed. The authors conclude that the left radial and right femoral arteries can be used routinely for diagnostic coronary angiography with small catheters (4 French). The left radial approach allows immediate mobilisation of the patient but the duration of the procedure and the exposure to irradiation are longer.

[Anterior mediastinal cyst disclosed by protracted thoracic pain]. / A propos d'un kyste du médiastin antérieur révélé par une douleur thoracique prolongée.

The authors report a case of anterior mediastinal cyst discovered incidentally in a 71-year-old man presenting with prolonged chest pain and a history of chronic renal failure secondary to polycystic kidney disease. The diagnosis of these cysts, which are benign congenital tumours usually asymptomatic and with a favourable course, was established by thoracic CT. In difficult cases, magnetic resonance imaging allows precise analysis of pericardial masses. Clinicians should think of this possibility in the presence of an opacity of the cardiophrenic angle associated with chest pain.

Evaluation of left ventricular systolic function by 3D echocardiography: a comparative study with X-ray angiography and radionuclide angiography.

OBJECTIVE: the aim of this study was to evaluate left ventricular systolic function by 3D ultrasound as compared to with radionuclide and X-ray angiographies. METHODS: one hundred and four patients were examinated by 3D ultrasound (3D-US) but only 72 examinations were successful. Thirty patients were investigated by 3D-US, M-mode US or bidimensional (2D) US, and X-ray angiography (group I) and 42 patients were investigated by 3D-US, M-mode, or 2D, and radionuclide angiography (group II). RESULTS: the correlation between ejection fraction (EF) evaluated by 3D-US and reference methods was found to be good and similar for the two groups (r=0.75; P<10(-4) for group I and r=0.76; P<10(-4) for group II). The correlation between EF calculated by conventional 2D-US and by reference methods was lower (r=0.60; P=0.04 for group I and r=0.54; P=0.001 for group II). The correlation between EF evaluated by 3D- and 2D-US was modest (r=0. 55; P=0.001 for the whole group). The correlation between 3D-US left ventricle end-diastolic volume (EDV) and end-systolic volume (ESV) and those evaluated by X-ray angiography was also modest (r=0.33; NS for EDV and r=0.60; P<10(-4) for ESV). The correlations between EDV and ESV in 3D-US, and those evaluated from radionuclide angiography were fairly good and in the same range (r=0.76; P<10(-4) and r=0.87; P<10(-4)). CONCLUSION: the 3D-US system using a rotating probe in an apical view is valuable for evaluation of left ventricular systolic function.