[Aneurysm of the interatrial septum. Apropos of a retrospective study of 41 cases]. / Anévrysme du septum interauriculaire. A partir d'une série rétrospective de 41 cas.

The authors undertook a retrospective study of 41 patients in whom an atrial septal aneurysm (ASA) had been diagnosed at transoesophageal echocardiography performed for ischaemic cerebrovascular events in 26 cases. No significant differences in this size, thickness or mobility of the ASA or the associated cardiac abnormalities were demonstrated in this context. However, patients presenting with cerebrovascular accidents were older, had several cardiovascular risk factors and more cardiac arrhythmias. These arrhythmias were usually related to other cardiac pathology such as ventricular hypertrophy or chronic cor pulmonale. Moreover, the probability of the cerebrovascular accident being related to the ASA was only acknowledged in 11 cases. These results mean a certain degree of discretion in diagnostic investigation and therapeutic management of these cases.

[Hypertrophic cardiomyopathy with left ventricular dynamic obstruction syndrome in hypertensive adult patients]. / Myocardiopathie hypertrophique avec syndrome d'obstruction dynamique du ventricule gauche chez l'adulte hypertendu.

Seven adult patients with old and severe arterial hypertension were found to have hypertrophic cardiomyopathy with left ventricular obstruction demonstrated by an isoproterenol test. Whenever feasible, confirmation that systolic obstruction of the left ventricular outflow tract was due to anterior systolic movement of the mitral valve was obtained. Echocardiography revealed a number of ultrasonic features (asymmetrical septal hypertrophy, small left ventricle and clear-cut reduction of the left ventricular outflow tract) which put these cases closer to the primary hypertrophic cardiopathy group than to the hypertensive cardiomyopathy group, with a similar history of hypertension. Detecting this group is facilitated by the use of vasoactive drugs in patients with these echocardiographic features. This is important since there is a risk of poor tolerance to vasodilators, notably nitrates, which may suddenly reveal the left ventricular dynamic obstruction syndrome. These patients are also exposed to paroxysmal atrial fibrillation.

[Rendu-Osler-Weber disease. Diagnostic and therapeutic assessment by angiography]. / Maladie de Rendu-Osler-Weber. Evaluation diagnostique et thérapeutique par l'angiographie.

The principal manifestation of Rendu-Osler-Weber disease is epistaxis, associated multiple mucocutaneous localizations generally being asymptomatic. Full advantage does not appear to have been taken of the various possible treatments of epistaxis: though they are all palliative, certain of them provide aleatory effects in relation to others (surgery or radiotherapy and embolization). In consequence, embolization should be the initial procedure, and should be repeated whenever necessary and possible, for all epistaxis requiring hospitalization for transfusion. Results of embolization are improved when no previous therapy has been applied, when the disease has not advanced, and when few localizations, even asymptomatic, exist in the head and neck region. Results are independent of the sex, the duration of the disease, the chronicity of the bleeding episodes, and their frequency and severity. The most effective solution in the majority of cases is probably the association of treatment of the hemorrhagic syndrome with basic estrogen therapy of the disease process.