[2-dimensional echography in the preoperative evaluation of mitral stenosis]. / Apport de l'échographie bidimensionnelle dans l'évaluation préopératoire des sténoses mitrales.

2D echocardiography has become one of the most important investigations in the preoperative assessment of mitral stenosis. This study was undertaken to determine the reliability of the information so obtained, by comparison with the surgical appearances. The study population consisted of 104 patients (average age 45 years, 76% women) undergoing open heart surgery for pure mitral stenosis (72%) or mixed mitral valve disease (28%) between 1980 and 1981. All underwent 2D echo using a phased array Aloka SSD 800 80 degrees sector scanner. Cardiac catheterisation was performed in 102 cases and left ventricular angiography in 89 cases. The echocardiogramme was interpreted by an observer who had no knowledge of the surgical results. The mitral surface area, the condition of the valves and subvalvular apparatus and the predictive value of the possible surgical technique were analysed. The 2D echo mitral surface area was estimated by planimetry and quantitatively by using the Gorlin formula during catheterisation and by the surgical description preoperatively. 2D echo was more sensitive than M mode in the detection of severe mitral stenosis (90% vs 73%, p less than 0,01). The 2D echo-Gorlin correlation was quite good (R = 0,70, p less than 0,01) but was worse when the valves were very thickened. When compared with the surgical observations, 87% of the 2D echo data was correct. The thickness of the valves, their amplitude, the diastolic bowing of the anterior leaflet and the presence of calcification were assessed by 2D echo. The echo-surgical results matched perfectly in 76% of cases. The usual cause of error was underestimation of the degree of valvular damage. The valvular bowing and thickness were the most useful signs. Dense, brilliant echos of valvular calcification were found in only 58% of surgically proven cases of valvular calcification, but the error was often related to fine calcification, not visible on fluoroscopy, or to its localisation on the posterior leaflet. The subvalvular apparatus was evaluated in over 93% of patients, a complete study being possible in 73% of them. The 2D echo-surgical correlations were excellent in 90% of the cases in which it had been completely visualised. The chordal thickening was correctly predicted in 79% of cases. The surgical assessment was more pessimistic in 1/3 of cases in which the chordae appeared to be of normal thickness. The length of the chordae was correctly predicted in 68% of cases. The surgical assessment was more pessimistic in 1/2 of cases in which the chordae appeared to be of normal length.(ABSTRACT TRUNCATED AT 400 WORDS)

[Hemodynamic evaluation of Ionescu-Shiley pericardial bioprostheses]. / Evaluation hémodynamique des bioprothèses péricardiques de Ionescu-Shiley.

36 patients with a total of 39 pericardial Ionescu-Shiley bioprostheses (20 aortic, 13 mitral and 3 double valve replacements) were studied. The population consisted if 12 women and 24 men with an average age of 33 +/- 11 years. The control was performed on average 7 +/- 4 months after surgery. At the time of investigation all patients were in functional classes I or II of the NYHA. The average cardio-thoracic ratio was 0.51 +/- 0.05. The catheter data showed a mean pulmonary capillary pressure of 10 +/- 2.7 mmHg, a mean cardiac index of 3.2 +/- 0.9 l/min/m2, a mean end diastolic volume of 132 +/- 33 ml/m2 and a mean ejection fraction of 0.53 +/- 0.12. Haemodynamic data was obtained under basal conditions and during intravenous infusion of isoproterenol. The average transvalvular pressure gradient was measured by transseptal catheterisation. The cardiac output was measured by dye dilution and the functional surface area calculated using the Gorlin formula (k = 44.5 for the aortic valve and k = 31 for the mitral valve). Perivalvular leaks were excluded by selective left ventriculography or aortography. The average transvalvular pressure gradients for the aortic valve prostheses (no 19 = 1, no 21 = 4, no 23 = 3, no 25 = 7, no 27 = 8) were 17 +/- 7 mmHg for no 19 and 21, 12 +/- 5 mmHg for no 23 and 25, and 9.7 +/- 2.7 mmHg for no 27.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intramural hematoma of ileum during anticoagulant therapy: study by double contrast intestinal transit (author's transl)]. / Hématome intramural de l'iléon sous traitement anticoagulant exploré par transit du grêle en double contraste.

Observation of a 52 years old man who is treated by anticoagulant who presents a subocclusive syndrome caused by an intramural hematoma of ileum. The radiological features are described in double contrast. Interest of the double contrast intestinal transit is discussed.

[Real-time cross-sectional echocardiography. Application in the measurement of the surface area of the mitral orifice in cases of stenosis or of double involvement of the valve (author's transl)]. / Echocardiographie bidimensionnelle en temps réel. Application à la mesure de la surface de l'orifice mitral en cas de rétrécissement ou de double atteinte de cette valvule.

Two-dimensional echocardiography in real time has proved in recent years to be a very valuable means of investigation in cardiology, in particular in the area of valve disease and congenital cardiac malformations. The present study concerns a group of 20 patients with essentially stenosing mitral disease, studied by two-dimensional echocardiography using mechanical sector scanner. The authors report their experience of the method in the measurement of the surface area of the mitral orifice from echotomographic sections obtained in protodiastole in a plane perpendicular to the long axis of the left ventricle and passing through the free edge of the mitral cusps. Fifteen of these patients being then treated by valve replacement, the area measured were compared with those found in the operative specimens. In 14 cases out of 15 (93%), despite the concomitant existence of appreciable mitral incompetence in 9 cases out of 15, the surface areas did not differ by more than 0.23 cm2 (coefficient of correlation = 0.990). These results confirmed that two-dimensional echocardiography in real time is a reliable method for the direct measurement of the mitral orifice area in the presence of stenotic type disease of the valve and even in the presence of associated mitral regurgitation.