[Atrial septal defect type ostium secundum at the age of 40 or more. Apropos of 86 cases with hemodynamic exploration]. / CIA du type OS à l'âge de 40 ans ou plus. A propos de 86 cas explorés hémodynamiquement.

The authors propose a haemodynamic classification for ASD, taking into account the very frequent drop in systemic blood pressure which is observed in this disease in elderly people. The authors examine the clinical signs and the clinical course in terms of this haemodynamic classification and they stress the mitral abnormalities and the arrhythmias. 56% of patients were followed up for a mean of 6 years for non-operated patients and almost 10 years for operated patients. The pathophysiology of ASD is discussed. It appears to be very dependent on left ventricular function. The operation needs to be discussed in terms of the haemodynamic findings, even in elderly subjects and in almost asymptomatic subjects.

Myocardial hypertrophy, rate of change of free wall thickness and directional components of ventricular power in man.

The diastolic (Vd) and systolic volumes, the average free wall diastolic thickness (hd) and left cardiac cavity pressures were determined in 25 subjects using monoplan angiography. Ten subjects presented a normal angiogram (NA), 5 a myocardiopathy with predominant dilatation (MCD), 4 a myocardiopathy with predominant non obstructive hypertrophy (MCH), and 6 a volume overload (VO). All the subjects had a normal coronary-cineangiogram. Myocardial volume (Vw) and systolic thickness were calculated from hd and from end-diastolic and end-systolic internal dimensions. The degree of myocardial hypertrophy was estimated from the value of Vw/Vd. The directional components of the total systolic elemental power due to thickening (average radial power : Pr) and to midwall circumferential shortening (average equatorial power : Pe) were calculated for each subject. Patients with NA, with MCD and with VO presented a positive linear correlation between Pr/Pe and Vw/Vd (r = 0.90). Patients with MCH were clearly below the regression line defined by the other groups. This relationship suggests that the contribution to the total power due to the thickening component is greater with increasing cardiac hypertrophy, except in the case of subjects showing an "inappropriate" hypertrophy.

Detection of residual myocardial function in acute transmural infarction using postextrasystolic potentiation. A computerized angiographic study.

Twelve subjects without clinical or hemodynamic heart failure, admitted for a first untreated anterior transmural myocardial infarction, were evaluated within the first 24 hours after the onset of symptoms. Pulmonary angiography was performed while a right ventricular extrastimulus was delivered every fourth beat at 50% of the RR interval to systematically analyze the basal and the postextrasystolic left ventricular frames. Left ventriculograms were quantitatively processed to determine the ejection fraction (EF) and the percentage of the end-diastolic circumference showing hypokinetic (%HK) or akinetic (%AK) areas. Left ventricular angiography was performed 1 month later in all cases at the same paced atrial heart rate to compare this final angiogram to the basal and the electrically induced postextrasystolic initial beats. During the 1-month period of the study none of these subjects had complications such as recurrent chest pain, heart failure or rhythm disturbances, and no drug administration was necessary. Comparing the basal cycle of the initial angiogram and the final cycle, a poor correlation was found between the corresponding values of EF (r = 0.34), %HK (r = 0.38) and %AK (r = 0.48). The correlations were much better when a comparison was made between the postextrasystolic cycle of the initial angiogram and the final cycle (EF, r = 0.84; %HK, r = 0.96; %AK, r = 0.95). These results indicate that, from the first day after a TMI, the analysis of the postextrasystolic frame allows accurate estimation of the final left ventricular function and regional wall motion abnormalities. Postextrasystolic potentiation may be useful in the acute state of transmural infarction to discriminate potentially reversible ischemic from definitely jeopardized areas.

["Windkessel" and coronary debit]. / "Windkessel" et débit coronaire.

The aim of this study was to support the hypothesis that aortic distensibility, resulting in a Windkessel effect of the high pressure compartment, may influence coronary blood flow, principally in the subendocardial layers. A hydraulic model of the arterial circulation including a branch representing the coronary circulation, was constructed. A pump giving pulsed flow with ejection parameters and cycle adjusted so as to produce almost physiological pressure curves, was used. Measurements of "coronary" flow were made with aortic models of the same dimension but of different compliance. The output of the ventricular pump and the hydraulic resistance of the model being constant, considerable variations in coronary flow were observed. With the most rigid aorta (compliance: 0,005 cm3/mm Hg) coronary flow was only 1% of the output of the ventricular pump. With a more distensible aorta (compliance: 0,6 cm3/mm Hg) coronary flow rose to 18% of the pump's output. These results were obtained under conditions very different from those present in vivo: however, they do raise the question of whether an alteration in the mechanical properties of the aorta due to ageing or disease can have an appreciable influence on coronary blood flow.

[Ventricular tachycardia in bursts. Electrophysiological and therapeutical study]. / Tachycardies ventriculaires en salves. Etude électro-physiologique et thérapeutique.

22 patients with salvoes of ventricular tachycardia were investigated electrophysiologically and pharmacologically to determine the mechanism of the arrhythmia. The appearance of the ventricular complexes was suggestive of a septal origin. The arrhythmia appeared to occur and regress within precise limits of sinus rhythm. 24 hour ECG recording and endocavitary stimulation techniques showed its essentially variable character, but occasionally a fixed coupling interval with the first extrasystole was observed, suggesting the presence of an unprotected parasystolic focus. The repetition of the extrasystolic activity, which could be triggered and terminated at will, is explained by phenomena of delayed after potentials. The results of the systematic investigation of the effects of quinidine-like drugs, beta-blockers and verapamil do not invalidate these hypotheses and show a difference of degree but not of nature between the two populations A and B of patients classified according to the quantitative character of the extrasystolic activity over 24 hours (more or less than 1000/hour). The observation of intermediate forms with simple extrasystoles and other forms with sustained tachycardia extends the significance of these results to many forms of ventricular arrhythmia.

[Angiographic frame-by-frame computerized evaluation of overall and regional left ventricular wall motion (author's transl)]. / Evaluation de la cinétique de la contraction ventriculaire gauche globale et régionale. Etude angiographique image par image sur mini-ordinateur.

This paper describes a semi-automated quantitative method to evaluate left ventricular overall and regional wall motion. Left ventricular (LV) outlines are digitized on a frame-by-frame basis using a sonic graf/pen interfaced with a 9845 HP minicomputer. A high fidelity simultaneous LV pressure recording is also digitized. The overall myocardial pump and muscle function are expressed by the projections of the pressure-volume-flow and of the mid-wall equatorial stress-length-velocity relationships. The dynamic regional wall motion is quantitated using a radial coordinate method. The centers of mass of serial frames are superimposed, and the apical anti-clockwise rotation is corrected. The regional wall motion (RWM) and the rate of change of the RWM are calculated with this method, and the results plotted as a single hard copy output. This method permits evaluation of the effect of segmental wall dysfunction on total cardiac performance during different portions of the cardiac cycle. The relationships between the time course of LV pressure and stress and the dynamic RWM can also be studied in subjects with segmental contraction abnormalities.

[Pregnancy in women wearing a heart valve prosthesis: 5 case histories (author's transl)]. / Grossesse chez les femmes porteuses de prothèse valvulaire cardiaque. A propos de 5 grossesses.

The study of a personal series of five pregnancies and the review of 130 cases published enabled us to recall the physiological, clinical and therapeutic sides of the "pregnancy-heart valve prothesis" combination. Maternal mortality remains at 3%; morbidity, essentially in the form of haemorragic or thrombo-embolic accidents, comes to 45%. We insist on the importance of a pregnancy planned and accepted both by the cardiologist and the obstetrician as contraception is a difficult problem with these patients, classical oestroprogestative methods and intra-uterine devices being too much of a risk. An intake of a progestagen in small doses combines efficiency with innocuity.