[Early surgical treatment of a septal perforation complicating a posterior infarct. Value of the diaphragmatic left ventricular approach]. / Cure chirurgicale précoce d'une perforation septale compliquant un infarctus postérieur. Intérêt de l'abord ventriculaire gauche diaphragmatique.

The authors report the case of a 53 year old patient who required operation on the 5th day after postero-inferior myocardical infarction for a poorly tolerated perforation of the ventricular septum. In discussing this case, they recall that the results for surgical repair of septal perforations complicating myocardial infarction are poorer when the infarction is posterior than when it is anterior. They suggest that this difference in prognosis is in large part due to the customary use in postero-inferior infarcts, of the right transventricular approach, which does not allow the infarct to be resected at the same time as the septum is closed. They finish by recommending the systematic use of a diaphragmatic approach to the left ventricle, including resection of the infarct, for all cases of septal perforations with posterior infarction in which surgery is necessary.

[Massive mitral insufficiency due to spontaneous and isolated rupture of a posterior papillary muscle. Echocardiographic study, treatment by assisted circulation and prosthetic valve replacement]. / Insuffisance mitrale massive par rupture spontanée et isolée d'un muscle papillaire postérieur. Etude échocardiographique, traitement par assistance circulatoire et remplacement valvulaire prothétique.

The authors report a case of a patient of 72 years of age in whom the sudden onset of severe left ventricular failure led to the discovery of massive mitral incompetence. The diagnosis of rupture of the posterior papillary muscle of the mitral valve, which was suggested on clinical and echocardiographic grounds, was confirmed at operation. This was carried out after 72 hours of assisted circulation by counter-pressure, and consisted of a replacement by a prosthetic valve. The authors emphasise, in the light of this case, the importance of echocardiography by ultrasound in the early diagnosis of this type of acute mitral incompetence, clarify the signs, and emphasise the part played by assisted circulation with an intra-aortic balloon in the treatment of this condition.

[Real-time cross-sectional echocardiography using a mechanical sector scanner (author's transl)]. / Echocardiographie bidimensionnelle, en temps réel, avec transducteur oscillant.

Ultrasonic one-dimensional echocardiography have proven extremely useful these last years in cardiac diagnosis. However, it allows only, structures lying along a narrow ultrasonic beam, to be visualized. In order to state more precisely the spatial relationship of the various cardiac structures, some two-dimensional systems, which displays the heart by constructing a plane image composed of many straight lines have been perfected. The authors, using such a system, specify its principal technical and clinical aspects and comment from iconographics documents and from their experience with more than 100 explorations, its advantages.

[Rupture of the free wall of the left ventricle during myocardial infarct. Contribution of echocardiography to its diagnosis. Surgical cure]. / Rupture de la paroi libre du ventricule gauche au cours d'un infarctus du myocarde. Apport de l'échocardiographie au diagnostic. Guérison chirurgicale

Parietal rupture of heart is one of the most dramatic complications in the acute stage of myocardial infarction. Generally it is fatal within few seconds or minutes. The authors report a case of rupture of the left ventricle into the free pericardial cavity, occurred at the 13th hour of an anterior infarction and surgically repaired with favourable result. On this occasion they emphasize the contribution of echocardiography to the diagnosis of cardiac rupture and the exceptional complexion of this case, which, to their best knowledge, is the third to have survived left ventricular rupture associated with ischemic heart disease, more than two months.

[Intravenous nitroglycerin as vasodilator therapy in acute myocardial infarction (author's transl)]. / Traitement vasodilatateur par la trinitrine intraveineuse à la phase alguë de l'infarctus du myocarde.

Thirteen patients with left ventricular failure complicating acute myocardial infarction were treated with intravenous nitroglycerin. The hemodynamic criterium for admission to this study was a pulmonary capillary wedge pressure greater than 15 mm Hg. All patients received intravenous nitroglycerin at infusion rates sufficient to lower pulmonary capillary wedge pressure by an average of 15 mm Hg, corresponding to the optimal left ventricular filling pressure in acute myocardial infarction. During this study, heart rate did not vary significantly; pulmonary capillary wedge pressure decreased from 24 +/- 0,7 to 15 +/- 0,8 mm Hg (p less than 0,001), mean arterial pressure from 95 +/- 5 to 80 +/- 4 mm Hg (p less than 0,005), mean right atrium pressure from 8,7 +/- 1 to 4,6 +/- 0,8 mm Hg (p less than 0,001), systemic vascular resistance index from 36,4 +/- 2 to 29,6 +/- 2 mm Hg/mm-1/l/m2 (p less than 0,005). Cardiac index increased from 2,5 +/- 0,2 to 2,7 +/- 0,1 l/mn/m2 (p less than 0,025) and stroke work index did not vary significantly. These data indicate that nitroglycerin provides a significant improvement of cardiac performance, more through reduction of preload than through reduction of afterload, the later being however significant. This study points out that intravenous nitroglycerin is a most efficient drug in patients with left ventricular failure complicating acute myocardial infarction.

[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.