[Severe hemolysis complicated by renal insufficiency in a patient with mitro-aortic bioprostheses and review of the literature]. / Hémolyse sévère compliquée d'insuffisance rénale chez un patient avec bioprothèses mitro-aortiques et revue de la littérature.

The authors report a very rare case of massive haemolytic anaemia complicated by renal failure in a patient with a double aortic and mitral bioprosthesis. The haemolysis was attributed to degeneration of the aortic bioprosthesis causing turbulent flow, aggravated by associated infectious endocarditis. The essential condition for haemolysis is a change in blood flow through the valve by degeneration or other associated pathology. The haemolytic anaemia completely regressed after aortic valve replacement as did the renal failure.

Genetic diversity in the Iberian Peninsula determined from mitochondrial sequence analysis.

We have analysed 302 bp of the first hypervariable region of the mitochondrial D-loop in 271 individuals from different regions of the Iberian Peninsula and 85 individuals from Algeria. The Basque population is significantly different from neighbouring populations in terms of overall levels of diversity. This is because the majority of sequences in the Basques are restricted to the lineage group defined by the CRS (Cambridge Reference Sequence) and its derivatives although, like other Iberian populations, they showed a unimodal distribution of pairwise sequence differences. The timing of divergence of populations within Iberia points to a shared ancestry of all populations in the Upper Palaeolithic. Further genetic subdivision is apparent in Catalonia and Andalusia, with increased genetic diversity in the latter. Lineage diversity comparisons of Iberian populations with European (Tuscan) and North African (Algerian) populations shows the Iberian Peninsula to be more similar to other European populations, although a small number of Iberian lineages can be traced to North Africa.

[Adult pulmonary valvular stenosis, major stenosing right ventricular hypertrophy and tricuspid insufficiency. Apropos of 2 cases]. / Sténose valvulaire pulmonaire vieillie, hypertrophie ventriculaire droite sténosante majeure et insuffisance tricuspidienne. A propos de 2 observations.

2 cases of severe pulmonary valvular stenosis in two young adults aged 21 and 29 years respectively are presented. Despite the degree of stenosis (4 mm jet), the right ventricular pressures did not exceed systemic pressures because of severe tricuspid regurgitation. This dominated the clinical and anatomical findings, causing aneurysmal dilatation of the right atrium and displacement of the tricuspid valve to the left. The diagnosis of Ebstein's anomaly was raised in one case but excluded by echocardiography and angiocardiography. In spite of the severity of the symptoms and peripheral clinical signs, surgery of the right ventricular outflow tract, tricuspid valvuloplasty and resection of part of the right atrium led to a complete and rapid cure, confirmed by catheterisation one month after operation.

[Aortic and mitral valve bioprostheses. Normal and pathological M mode echocardiographic aspects]. / Bioprothèses valvaires aortiques et mitrales. Aspects échocardiographiques TM normaux et pathologiques.

The M mode echocardiographic recordings of 52 normal mitral bioprostheses (NMB), 7 pathological mitral bioprostheses (PMB), 30 normal aortic bioprostheses (NAB) and 10 pathological aortic bioprostheses (PAB) were reviewed. In normal bioprostheses a significant correlation was observed between the echocardiographic and the "specified" diameters, the diastolic and systolic slopes and the amplitude of anterior motion of the support. In NMB, the end-systolic diameter of the left ventricular outflow tract depended on the "specified" diameter of the bioprosthesis. Paradoxical septal motion was observed in 78 p. 100 of cases. In PMB, the velocity of anterior leaflet opening was significantly increased (p less than 0.001). The end-diastolic internal left ventricular dimension was also increased (p less than 0.01). A significant correlation was found between left ventricular fractional shortening and maximal leaflet separation (p less than 0.05). Normal septal motion was more common (p less than 0.05). In 5 cases of prosthetic valve dysfunction with mitral regurgitation the maximal leaflet separation was greater than normal (p less than 0.001), the diastolic slope of the support was increased (p less than 0.05) and diastolic vibrations of thickened irregular leaflets were observed. Systolo-diastolic vibrations with chaotic leaflet motion were characteristic of cusp tear and/or eversion. Stratified echos behind a support with reduced leaflet excursion was observed in one case of partial thrombosis: a thickened systolic echo with reduced diastolic excursion was observed in a case of degenerative stenosis. The review of 10 PAB showed a reduced amplitude of systolic excursion of the anterior support in cases of aortic regurgitation (p less than 0.05). Systolic vibrations of the cusp were not specific and were observed in normal cases. In severe valvular regurgitation mitral and/or septal diastolic fluttering was observed. Systolic excursion of the cusps was reduced in cases of relative stenosis due to an inappropriately small sized bioprosthesis. Thickening of the diastolic cusp echos was observed in cases of degenerative stenosis. Ventricular dilatation and reduced septal and free wall motion were dysfunction.

[Hemodynamic aspect of infundibular hypertrophy of pulmonary valve stenosis]. / Aspect hémodynamique de l'hypertrophie infundibulaire des sténoses valvulaires pulmonaires

Reactional infundibular hypertrophy in pulmonary valve stenosis is usually assessed on the catheterization curves obtained in the infundibulum and in the inflow tract of the right ventricle. It is usually indicated by a peculiar pattern of the infundibular curve: its descending branch is more rapid than in the inflow tract and is slightly curvilinear. This deformity is the more marked the more intense the hypertrophy. Simultaneously a mid-late systolic murmur is recorded into the infundibulum the more intense and high-pitched the more marked the hypertrophy. Comparison with the angiocardiographic data and the operative findings showed a good correlation.