[Evaluation by Doppler echocardiography of hemodynamic profil of mitral bileaflet prothesis. Report on 90 cases]. / Evaluation par echocardiographie Doppler du profil hemodynamique des protheses mitrales. A propos de 90 cas.

From 1981 to 1999 Mitral bileaflet prosthesis was implanted to 90 patients. Doppler echocardiography was performed for these patients between January and March 2002 with a mean deadline of 111 months after the intervention. 36 were women (40%) and 54 were men (60%) the mean age was 41 years (20 - 70 years) The mitral bileaflet prosthesis was a Saint Jude in 65 cases, Jyros 8 cases, Carbomédics 7 cases, Sorin Bicarbon 7 cases, Edwards Duromédics 2 cases et an ON-X in one case. The maximal transprosthetic gradient was 15.7 mm Hg +/- 5.06 (6.25 mm Hg). The mean transprosthetic gradient was 5.6 mm Hg +/- 1.07 (39.5 mmHg). The mean prosthesis functional area 2.37 cm2 +/- 0.44 (1.75 cm2 et 3.60 cm2). Maximal gradient, mean gradient and prosthesis functional area are independent from kind mitral bileaflet prosthesis and from the prosthesis size.

[Mitral valve surgery in the elderly]. / Chirurgie valvulaire mitrale chez le sujet age.

We report a retrospective study about 34 patients operated for on mitral valve between 1981 and 2000. All patients were aged more than 65 years. 82% of them were in the class III or IV of the NYHA. 31 of patients had a valvular mitral replacement (by a mechanical protheses in 24 cases and a biological protheses in 7 cases) and 3 patients had a mitral valve reconstruction. An aortic valve replacement was associated in 7 cases, and a myocardial revascularisation in 4 cases. The early mortality rate was 17,6% and the late mortality was 12%. The high mortality is meanly related to the associate lesions (coronarography) and the prognosis is a better with the improvement of surgical technics and perioperative management.

[Multicenter study of atrial fibrillation]. / La fibrillation auriculaire. Etude multicentrique.

1134 patients presented a first episode of atrial fibrillation (AF) between January 1985 and December 2000. Age average was 58.6 years (15-60). 656 (57.8%) were male and 478 (42.2%) were female. The first etiology of AF was rheumatic carditis (36.1%). AF was idiopathic in 27.7% of cases. Morbi-mortality was significantly higher in patients with AF versus those with sinus rhythm; five years survival was respectively 96% and 85%. Success rate was 70% with electrical cardioversion versus 40% with pharmacological cardioversion. Results of AF reduction was independent of left atrium diameter. Only long standing of AF predicted failure of AF reduction.

[Early and long term results of mitral valvuloplasty]. / Resultats precoce et lointain de la valvuloplastie mitrale.

46 patients underwent Carpentier's mitral valve repair from 1986 through 2000. There were 15 males and 31 females. The mean age was 30 years. The cause of mitral regurgitation was rheumatic in all cases. According to Carpentier's classification, type II was present in 44% of patients, type III in 16% and type II-III in 40%. Left ventricular dysfunction was present in 10.8% of patients. Immediate echec of mitral valve repair occurred in 2.2% of cases. With a mean follow up of 79.6 months, late mortality was 12.2%. The overall result was excellent or good in 52.5% of cases, fair in 21.4% and poor in 26.2%. Deterioration of the result occurred in 18 patients (44% p Predictive factors of poor early and late results were age more than 40 years and a type III mitral regurgitation.

[Mitral valve replacement with a bileaflet prosthesis: results of 112 cases]. / Resultat du remplacement valvulaire mitral par prothese a ailettes. A propos de 112 cas.

We report 112 cases of mitral valvular replacement with bileaflet prothesis. The mean age is 40 ans +/- 3.4 years (9-74 years). 71 (65%) are men and 45 (35%) are women, the main éthiology of mitral disease is rheumatic fever (94.74%). The Saint Jude prothesis is implanted in 70.4% cases. The early post operator mortality is 1.8% it is related on low cardiac output. With a mean follow-up of 110 months, the late mortality is 5.5%. The survey is 97% at 5 years and 94% at 10 years. The rates of thromboembolic and hemorrhagic complications are 6.3% and 9%. We report only one case of infective endocarditis. The rate of réintervention is 5%. By echocardiography the hemodynamic profile of bileaflet prothesis is excellent even with the small size.

[Aortic valve replacement in the elderly]. / Remplacement valvulaire aortique chez le sujet âgé.

We report a retrospective study about 60 patients operated on for aortic valve replacement between 1981 and 2000. All patients were aged more than 65 years. 56.6% of patients were in the class III or IV of the NYHA. The type of the valvular substitute was a mechanical prostheses in 58.3% of cases and a biological prostheses in 41.7%. A mitral geste was associated in 6 cases and a myocardial revascularisatin in 5 cases. The early mortality rate was 15% and the late mortality was 23%. The high mortality is meanly related to the associate lesions (coronaropathy) and the prognosis is a better with the improvement of surgical technics and perioperative management.