[Evaluation of management of infarction in the Franche Comté province by the use of the Franche Comté Cardiology Registry, May 2005-May 2006]. / L'évaluation des pratiques professionnelles pour la prise en charge des infarctus en Franche-Comté. Expérience d'une évaluation à l'échelle régionale par l'utilisation des données du registre franc-comtois de cardiologie, mai 2005-mai 2006.

RATIONALE: The management of acute infarction often necessitates a network of organisation between different centres, thus making it the object of an evaluation of professional practices (EPP). We report the experience in the Franche Comté province of an EPP at a regional level in the management of infarction. METHODS: All of the patients admitted to 10 of the 11 centres in the region were included in a prospective survey. Quality indicators for acute and chronic care were defined, as well as scores, on the basis of use of treatments specified in guidelines. RESULTS: Between May 2005 and May 2006, 1,170 patients were admitted. The patients' risk levels and quality scores were calculated. The rate of use of the quality indicators was higher in our survey than that observed in all of the published studies, except for the use of betablockers. The quality of care could therefore be considered as highly satisfactory. Comparison between the centres revealed some differences. Even after adjustment for the risk score on admission, the quality score for acute care was related to mortality at 1 month. CONCLUSIONS: An EPP is possible for the management of infarction, on a regional scale such as in the province of Franche Comté. The acute quality score turned out to be an independent factor for mortality. The indicators showed that the quality of care was highly satisfactory, even though more progress could be made in the prescription of betablockers.

[Two-dimensional echocardiography of ventricular aneurysm. Study of 38 cases with angiographic correlation]. / L'échocardiographie bidimensionnelle de l'anévrysme ventriculaire. Etude de 38 cas avec corrélation angiographique.

This is a study of the data supplied by cross-sectional echocardiography in the diagnosis of post-infarction aneurysm. It involves 38 confirmed cases of myocardial infarction. The clinical, electrical, radiological and echocardiographic data (in M mode) were specified. Right anterior oblique ventriculography showed 21 posterior and 17 anterior aneurysms (4 antero-lateral, 5 apical, 8 antero-apical), and 14 mitral regurgitations. Cross-sectional echocardiography using a (30 degrees or 90 degrees) mechanical sector scanner allowed the study of the kinetics of 6 segments following 5 viewing angles: one longitudinal, two transversal, two apical. Each segment was classified according to its shape and motion: akinetic, dyskinetic or aneurysmal, and the papillary muscles of the mitral valve were assessed as normal or pathological (dense and motionless on the echogram). 35 of the 38 aneurysms seen at angiography, were detected by cross-sectional echocardiography; in one case the diagnosis could not be made for technical reasons; in two cases echocardiography was in favour of akinesia. An abnormal papillary muscle was observed in the 14 cases of mitral insufficiency. The causes of error in localisation were considered. In conclusion, cross-sectional echocardiography appears to be an excellent atraumatic procedure for the diagnosis of aneurysms and papillary muscle dysfunction.

[Pulmonary arterial hypertension and primary biliary cirrhosis]. / Hypertension artérielle pulmonaire et cirrhose biliaire primitive.

The authors report a case of the association of primary biliary cirrhosis and pulmonary hypertension presenting with syncopal complete atrioventricular block. The clinical, aetiopathological and therapeutic aspects of this pathology are reviewed with special emphasis on the value of early diagnosis of the pulmonary hypertension in cases of unusual dyspnoea in patients with primary biliary cirrhosis especially those of an age when they could benefit from liver-heart-lung transplantation.

[Acute respiratory distress syndrome in the initial phase of myocardial infarction in adults]. / Le syndrome de déstresse respiratoire aiguë de l'adulte à la phase initiale de l'infarctus du myocarde.

Four patients developed an acute respiratory distress syndrome characterised by clinical and radiological signs of pulmonary oedema, a protein-rich oedema, severe hypoxemia refractory to oxygen therapy, contrasting with normal left ventricular filling pressures and indicating increased permeability of the alveolo-capillary membrane, 24 to 72 hours after the onset of acute myocardial infarction. After having excluded the usual causes of the acute respiratory distress syndrome, the authors suggest that acute myocardial infarction, especially when extensive, may cause a lesion of the alveolo-capillary membrane by an unknown mechanism. Treatment consisted in mechanical ventilation with positive expiratory pressures in 3 cases and with continuous positive pressure during spontaneous respiration in the third patient and in relay with controlled ventilation in the other two. These techniques of ventilation improved the hypoxemia and led to complete cure in all cases without evolution to pulmonary fibrosis. In addition to mechanical ventilation, all patients were given systematic antibiotic therapy because of the possibility of an infectious etiology while waiting for the results of microbiological and serological testing and because of the high risk of superinfection which plays an essential part in the outcome of the condition. The immediate response to treatment was favourable in all cases. One patient died suddenly of cardiogenic shock two weeks after this episode. The other patients are still alive 39, 38 and 20 months after infarction. The importance of the diagnosis of the acute respiratory distress syndrome in the acute phase of myocardial infarction resides in its therapeutic implications which are quite different to those of cardiogenic shock.(ABSTRACT TRUNCATED AT 250 WORDS)

[Coronary lesions in myocardial infarction]. / Bilan lésionnel coronarien dans l'infarctus du myocarde.

The authors analyse the coronary lesions in 285 patients with primary myocardial infarction (164 anterior, 121 inferior infarcts) undergoing coronary angiography an average of 4 months after infarction. The statistical study of the analytical table of the lesions according to severity and site, demonstrated a significant difference in each group (p less than 0,001): --there was a very clear dominance of occlusion of the LAD artery in anterior infarction but severe narrowing (greater than or equal to 70%) was observed mainly on the right coronary and left circumflex arteries; --in inferior infarction, the incidence of occlusion was higher on the right coronary artery and severe narrowing was divided between the LAD and left circumflex arteries. Controlateral, double or triple vessel disease was present in 74% of anterior and 85% of inferior infarcts. There were many more patients with double and triple vessel lesions than with single vessel disease. Residual angina gave no indication of the extension of the lesions in anterior infarction but patients with this complication after inferior infarction had a higher rate of triple vessel disease. Stress testing is exploitable in inferior infarction but did not give any discriminating results. In this series, angina and stress testing only allowed triple vessel disease to be suspected in patients with inferior infarction. A coronary arteriographic study, by showing the severity and controlateral extension of the lesions, comparable in primary anterior and inferior infarction, gives important prognostic information and allows assessment of surgical possibilities.

[Course and prognosis of primary hypertrophic cardiomyopathies]. / Evolution et pronostic des cardiomyopathies primitives hypertrophiques.

33 patients with hypertrophic cardiomyopathy were followed for a mean duration of 48 months. 29 of them were reviewed; 6 had died, including 4 with a familial form belonging to two different families. No cases of sudden death were observed. The mortality rate was 4 p. cent at 1 year, 11 p. cent at two years and 21 p. cent at 5 years. The clinical course was marked by a functional deterioration in one-third of cases and, one echocardiography, by an increase in the diastolic diameter of the left ventricle and in the thickness of the septum, independent of the clinical course. Subjects from "high risk" families have a very poor prognosis (4 deaths out of 7 patients at an average age of 25). These families present major conductive disturbances on the electrocardiogram and a very marked parietal hypertrophy on the echocardiogram. No other prognosis factor independent of the familial aspect was revealed.

[Annulo-aortic ectasia]. / Maladie annulo-ectasiante aortique.

On the basis of a literature review and the study of 18 cases, the authors examine annuloaortic ectasia, which involves dilatation of the fibrous ring of the heart at the aortic orifice, marked by aortic regurgitation and dystrophic aneurysm of the ascending aorta. The authors noted a predominantly muscular disorder (14 males, 4 females) often detected from an assessment of aortic regurgitation without clinical, radiologic or specific electrical features. The value of echocardiography and Doppler echocardiography is clearly apparent from the diagnosis of the disease, monitoring of progress, selection of patients for invasive pre-operative explorations and post-operative surveillance. The developing gravity of this disease is stressed, rapid repercussions in the left ventricle intervening more than complications due to ectasia itself. This indicates the urgency of complete replacement of the whole ascending aorta and of the aortic valve with reimplantation of coronary arteries as in the Bentall or Bentall-Cabrol surgical intervention, seven cases of which have been reported with satisfactory results.

[Course and prognosis of primary hypertrophic cardiomyopathies]. / Evolution et pronostic des cardiomyopathies primitives hypertrophiques.

33 patients with hypertrophic cardiomyopathy were followed for a mean duration of 48 months. 29 of them were reviewed; 6 had died, including 4 with a familial form belonging to two different families. No cases of sudden death were observed. The mortality rate was 4 p. cent at 1 year, 11 p. cent at two years and 21 p. cent at 5 years. The clinical course was marked by a functional deterioration in one-third of cases and, on echocardiography, by an increase in the diastolic diameter of the left ventricle and in the thickness of the septum, independent of the clinical course. Subjects from "high risk" families have a very poor prognosis (4 deaths out of 7 patients at an average age of 25). These families present major conductive disturbances on the electrocardiogram and a very marked parietal hypertrophy on the echocardiogram. No other prognosis factor independent of the familial aspect was revealed.