[Quantitative evaluation of myocardial ischemia using imaging methods]. / Evaluation quantitative de l'ischémie myocardique par les méthodes d'imagerie.

Secondary prevention of myocardial infarction includes all measures likely to reduce morbidity and mortality after the infarction. It is a highly heterogeneous concept applied to a highly heterogeneous disease. The natural history of myocardial infarction, which must be known to determine the frequency of critical events and hence devise a trial, is incomplete particularly since treatment capable of altering this history (aorto-coronary bypass, thrombolysis) have been introduced. Future trials in secondary prevention of myocardial infarction must concentrate on such important questions as: can the possibilities of reperfusion be extended as regards the acute phase, and which preventive measures are useful to patients at high risk post-infarction? The A.P.S.I. study (acetolol in the secondary prevention of myocardial infarction) is an example of study aimed at answering the second question.

[Short and intermediate-term hemodynamic study at rest and during exercise of cardiac insufficiency treated by captopril]. / Etude hémodynamique, au repos et à l'effort, à court et moyen termes, de l'insuffisant cardiaque traité par captopril.

Administration of 25 mg of captopril to 10 patients with heart failure (NYHA II, III) produces at rest after 60 min bradycardia (-7 per cent, p less than 0.01), hypotension (-8 per cent) and improvement of the preload (-30 per cent, p less than 0.01). This effect is still apparent after two months of treatment where PAP is decreased by 20 per cent (p less than 0.05). A prolonged effect of captopril is present in these 10 patients. The capacity to perform a muscular exercise on an ergometric bicycle is prolonged by 10 per cent (p less than 0.01) on the first day and by 18 per cent (p less than 0.01) after two months of treatment. This improvement seems to be related to improvement of the hemodynamic parameters, especially of preload indices. In 5 patients, lactacidemia, the arterio-venous difference and the extraction coefficient of O2 were studied at rest and during exercise. No significant difference are noted after the treatment with the inhibitors of conversion enzymes.

[Automatic quantitative analysis of myocardial tomography thallium-201 scintigraphy]. / Analyse quantitative et automatique de la tomoscintigraphie myocardique au thallium 201.

An automatic and quantitative analysis method for tomographic scintigraphy was applied to 104 patients with myocardial infarction (anterior 37, inferior 67, lateral 20, involving 2 territories in some cases). All patients underwent exercise and redistribution scintigraphy and coronary arteriography which served as reference. Two types of tomographic sections were used: 2 short axis sections exploring the left ventricle at different levels, and 1 apical section at a right angle with the first ones. A circumferential analysis program studied the isotopic activity of each section and drew an activity profile curve which was compared with those obtained in normal subjects. Exercise curves proved superior to redistribution and wash-out curves and were therefore used exclusively. Two sectoring methods for territories with infarcts were defined: conventional sectoring, which gives a 90 degrees angle to the anterior region and a 180 degrees angle to the inferior lateral region, and real sectoring established from the scintigraphic abnormalities observed in patients whose infarction was not accompanied by significant lesions in other territories. Real sectoring divides the territory into two regions (anterior and infero-lateral) and determines the extension territory and the territories specific to each necrotic region. The sensitivity and specificity of these two methods for the diagnosis of necrosis and the detection of a significant abnormality (greater than 70% stenosis, or necrosis) in a territory other than the one with infarct were compared. In the diagnosis of infarction: conventional sectoring sensitivity 92%, specificity 46% for anterior infarcts, 94% and 25% for inferior and lateral infarcts; real sectoring 94% and 63% respectively for anterior infarcts, 92% and 68% for inferior infarcts.(ABSTRACT TRUNCATED AT 250 WORDS)

[Obstacle to left ventricle ejection after mitral valvular replacement with a Carpentier-Edwards bioprosthesis. Apropos of 2 cases]. / Obstacle à l'éjection du ventricule gauche après remplacement valvulaire mitral par bioprothèse de Carpentier-Edwards. A propos de 2 cas.

Impairment of the left ventricular ejection induced by a mitral prosthesis remains an infrequent complication, perhaps because it often is unrecognized. This complication would mainly be seen with ball prostheses or standard bioprosthesis used in mitral valve replacements with a small ventricle. Two cases have been recently reported during mitral valve replacement. The two patients were successfully re-operated upon, one after five weeks and the second immediately after the first procedure. A review of the literature enable to specify the etiology and diagnostic criteria with the assistance of Doppler-sonocardiography. Early re-operation may prevent death, often due to a post-operative myocardial dysfunction.

[Bepridil and torsades de pointes. Apropos of 11 cases]. / Bépridil et torsades de pointes. A propos de 11 observations.

The authors report 11 cases of spikes occurring under bepridil treatment. It concerns an elderly population, predominantly female, receiving most of the time 300 mg of bepridil. The frequency of associated hypokalemic or arrhythmic medications is emphasized. The comparison of these results to those from other series in the literature, enables to propose precautions for the use of this molecule.

[Pneumopathy caused by amiodarone. An often unrecognized iatrogenic entity]. / Pneumopathie à l'amiodarone. Une entité iatrogène sovent méconnue.

Three cases of interstitial pneumopathy secondary to amiodarone are reported, in addition to almost 200 cases previously published in the literature. The main clinical, radiological, biological and evolutive characteristics are reminded in emphasizing the advantages of bronchioalveolar irrigation. Some factors seem to be predisposing, without any definite proof however. They are: high daily dosage, long term treatment, high cumulative dose, concomitant ingestion of another anti-arrhythmic medication, especially in elderly patients, and in patients who, before any treatment, presented a decreased total pulmonary capacity and a CO transfer capacity lower than 80 p. cent of the theoretical values. Discontinuation of amiodarone and administration of steroids usually produce a rapid regression of the clinical and radiological symptoms.

[Left ventricular ejection impediment during mitral valve replacement. Apropos of a case after insertion of a Carpentier-Edwards bioprosthesis]. / Gêne à l'éjection ventriculaire gauche lors des remplacements valvulaires mitraux. A propos d'une observation après mise en place d'une bioprothèse de Carpentier-Edwards.

Left ventricular ejection impediment is one of the complications of mitral valve replacement, especially in case of isolated mitral stenosis with small left ventricle. The use of a "low profile" valve does not prevent this complication. The diagnosis is based on catheterization but the advent of the ultrasound-Doppler may make it easier.