[Abnormal origin of 1 of 2 pulmonary arteries from the ascending aorta]. / Naissance anormale à partir de l'aorte ascendante de l'une des deux artères pulmonaires

In relation with 4 cases of anomalous branching of one pulmonary artery from the ascending aorta, the main clinical, angiographic, physiopathologic, therapeutic and embryologic features of this malformation were reviewed. It appeared that the natural history of this malformation is a severe one, and only a corrective surgical treatment is liable to secure survival and cure. This anomaly was also encountered, very rarely, in Fallot's tetralogy, and two cases of this combination were reported.

[Angiocardiographic study of obstructive cardiomyopathies. Attempt to evaluate the role of the interventricular septum and the great mitral valve in the obstructive phenomenon]. / Etude angiocardiographique des cardiomyopathies obstructives. Essai d'évaluation du rôle du septum interventriculaire et de la grande valve mitrale dans le phénomène obstructif

Images of the left ventricles, taken in two planes at ventriculography in 45 established cases of obstructive cardiomyopathy, were subjected to a special type of analysis which allowed certain sectional and angular measurements to be made. In particular we calculated and end-systolic index of obstruction, and two measures of the contribution of the septum and the mitral valve to the subaortic obstruction. It then proved possible to study the part played in the stenosis by the interventricular septum and the mitral valve respectively, and to classify the obstructive cardiomyopathies by these criteria. The orientation of the sigmoid floor also seems to play a vital role in determining the dominance of the septum or the mitral valve. These three factors, when examined together, allow us to conclude that there are fixed factors which determine the existance of obstructive cardiomyopathy, to calculate the degree of mitral contribution to the obstruction, and to realise that the orientation of the sigmoid floor helps us to distinguish the type of obstruction. The combination leads to an angiocardiographic classification of the obstructive cardiomyopathies, and the prognostic and surgical significance of this classification are discussed.

[Diagnostic significance of atrial stimulation in coronary insufficiency. Correlation with the exercise test and/or coronary angiography]. / La valeur diagnostique de la stimulation auriculaire dans l'insuffisance coronarienne. Corrélation avec l'épreuve d'effort et/ou la coronarographie

140 patients underwent atrial stimulation and a triangular exercise test on the bicycle ergometer; coronary arteriography was carried out on 80 of them. Atrial stimulation is slightly more sensitive (74% compared with 68%) and significantly less specific (57% compared with 74%) than bicycle ergometry. It is valuable to combine the two tests as at least one of them is positive in 84% of subjects with a significant coronary lesion (larger than or equal 70%). "False positive" responses during the stimulation test occur especially where the ECG at rest shows evidence of the non-specific repolarisation disorders of coronary insufficiency; but these "false positives" are accompanied by angina during the test significantly less frequently than the true positives. It may be possible, on the basis of the accounts in the literature and on the present analysis, to establish a methodology for the atrial stimulation test which will increase its sensitivity slightly, but which will also increase, more importantly, its specificity. It may also be possible to reach, by progressive 2-minute steps, a rate which is slightly greater than the maximum rate according to Astrand's law, and to take less account of ST depression as a positive criterioe, and more of the appearance of pain; the fact that this pain is angina could be confirmed by a dual test using placebo and trinitrin.

[Stenosis of the trunk of the left coronary artery. Contribution of coronary arteriography and hemodynamic correlations. Apropos of 34 cases]. / Sténose du tronc de la coronaire gauche. Apport de la coronaragraphie et corrélations hémodynamiques. A propos de 34 cas.

From a study of 34 cases, the authors have tried to define the characteristic features of this very specialised type of coronary artery disease. From the clinical standpoint, if the common combination of uncontrolled angina and a past history of myocardial infarction are taken as representative, the basal ECG can in no way differentiate the diagnosis; on the other hand tests on the bicycle ergometer appear to have a good indicative value. Coronary arteriography shows the sharply isolated character of the stenosis of the trunk which is part of the picture of diffuse coronary disease, and the frequency (2 cases out of 3) of total coronary occlusion. The haemodynamic findings are even more variable and unpredictable, and bear no relationship to the degree of trunk stenosis, to the index of the lesion, and to the number of occlusions. However, joint analysis of the index of the lesion and of the degree to which the coronary circulation is compensated or de-compensated allows a better interpretation of the haemodynamic picture.

[Oral contraceptives and myocardial infarct]. / Contraceptifs oraux et infarctus du myocarde.

In the light of four proven cases of myocardial infarction in patients under treatment with hormonal contraceptives, the authors point out: the sudden 'inaugural' appearance of the infarction during a therapeutic course; the appearances of the lesions on coronary arteriography; on 2 occasions a lacunar form on the proximal segment of a main coronary trunk, in one case lesions more redolent of atheroma, and in one case a completely normal vascular tree. These appearances had not changed at follow-up arteriography; the existance in 3 cases of multiple associated risk factors, especially of a mixed type of hyperlipoproteinaemia associated with tobacco consumption. The current relative frequency of coronary episodes in patients with multiple risk factors would seem to point towards caution in prescribing hormonal contraceptive treatment, especially for females of over 35 years of age.

[Vasodilator treatment of left ventricular insufficiency in the acute stage of myocardial infarction]. / Thérapeutique vasodilatatrice dans l'insuffisance ventriculaire gauche de l'infarctus du myocarde en phase aigué.

The haemodynamic effects of two vasodilators (phentolamine and nitroprusside) have been studied in 11 patients who developed acute left ventricular failure during the acute phase of a myocardial infarction. The dose was adjusted to the highest level failing to cause tachycardia (phentolamine: 0.19 to 0.76 mg/mn; nitroprusside: 0.07 mg/mn), and the treatment was maintained for between 5 hours and 8 days. Under these conditions, after one hour a diminution in mean arterial pressure can be observed (from 94 to 82 mmHg, p less than 0.005), as can a decrease in pulmonary arterial diastolic pressure (from 21 to 14 mmHg, p less than 0.001); the cardiac index rises slightly (from 3.1 to 3.51/mn/m2(NS), and the systemic and pulmonary vascular resistance are decreased by 20% and 30% respectively. The index of systolic work does not increase to a significant degree (30.7 to 32.9 g-m-syst-m2), the same work being carried out with smaller filling pressures. Together with the lessened resistance to ventricular ejection, and also, it seems, to a dedrease in venous tone, this beneficial effect has been particularly marked in a case of posterior papillary syndrome with mitral incompetence. As the response varies from individual to individual, constant monitoring of arterial pressure and cardiac rate is vital if the maximum therapeutic effect is to be achieved, particularly in hypertensive patients, in whom tachycardia in response to lowering of the arterial pressure occurs more readily.

[Progressive external ophthalmoplegia and disorders of ventricular conduction. Apropos of 3 recent cases]. / Ophtalmoplégie externe progressive et troubles de la conduction ventriculaire. A propos de 3 nouvelles observations.

The authors report 3 cases with an association of progressive external ophthalmoplegia (OEP) and disordered intracardiac conduction. These cases, and the twenty or so similar ones reported in the literature, show that this association is important for two reasons:--there is a therapeutic importance in that the condition affects young patients, who are at risk from sudden death due to the conduction defect; for this reason electrocardiographic follow-up must be regular, and an intracavitary pacemaker must be introduced definitively at the least indication;--there is a physiopathological importance in that the effect of the myopathies on the myocardium is well known, but most information relates to the diffuse cardiomyopathies, and in only 10% of cases are there conduction defects. By contrast, the conductive tissue appears to be involved in all cases of OEP, while cardiac failure is rare. It seems likely, therefore, that cases of OEP have a pathogenesis different from that of the diffuse myopathies, whether or not these involve the external occular muscles.