[Diagnosis of a metastatic valvular tumor in a living patient]. / Tumeur métastatique valvulaire diagnostiquée du vivant du malade.

INTRODUCTION: The discovery of an endocardial mass always raises the question of its nature. Infectious endocarditis is the most frequent cause, but others diagnoses must be considered. EXEGESIS: We report a case of endocardial metastasis originating from an upper respiratory tract epidermoid carcinoma in a 48-years-old man. The diagnosis was established while the patient was alive, and survival at the time of writing is 8 months. This case report provides an opportunity for discussion of the differential diagnosis when confronted with an endocardial tumor, i.e. bacterial endocarditis, non-bacterial thrombotic endocarditis, primary cardiac tumors, metastatic osteogenic sarcoma and Libman-Sachs endocarditis. CONCLUSION: Non bacterial thrombotic endocarditis and valvular metastasis should be considered upon discovery of a valvular tumor, in the context of neoplastic disease. The prognosis of endocardial metastasis is poor, but early diagnosis and appropriate management should eventually prolong survival.

Performance of recipient hearts after heterotopic transplantation.

Twenty-two heterotopic heart transplantations were performed, in 19 of which the evolution of the recipient heart was estimated. Within the first postoperative hours the recipient heart was often more effective than the donor heart. The discrepant rhythm between the 2 hearts did not result in any pathological findings. The increased pressures in the recipient's right heart always decreased, sometimes within several weeks. The left atrial volume was found to be reduced while left ventricular contraction was sometimes unchanged, sometimes improved and in a few cases showed definite improvement with a mean decrease of the ultra-sound diastolic diameter of 20 mm on echocardiography. The technique of heterotopic systems seems to be a useful indication for end-stage cardiomyopathies with pulmonary hypertension (class IV) which is generally considered a contraindication for orthotopic heart transplantation.

[Anatomical and hemodynamic evolution at midpoint follow-up with the assisted heart in heterotopic heart transplantation. Apropos of 21 cases]. / Evolution anatomique et hémodynamique à moyen terme du coeur assisté dans la transplantation cardiaque hétérotopique. A propos of 21 observations.

Between November 1978 and March 1985, 27 cardiac transplant operations were performed at the Arnault Tzanck Institute; Barnard's heterotopic method was used in 21 cases. In 16 cases, follow-up was prolonged to assess the effects on the assisted receiving heart. In the first postoperative hours the receiving heart is often more effective than the graft. There were no pathological consequences due to the two different rhythms. The increased pressures in the right cavities of the receiving heart decreased but sometimes this look several weeks. The volume of the left atrium decreased. Left ventricular contraction was unchanged in some cases but in others it improved significantly. This was accompanied by an average decrease of 20 mm in echocardiographic left ventricular end diastolic internal dimension. This technique of heterotopic assistance seems particularly suitable for advanced stages of cardiomyopathy with stage IV pulmonary hypertension.

[Monitoring and rehabilitation of heterotopic cardiac transplantation patients during the period of convalescence]. / Surveillance et réadaptation des transplantés cardiaques hétérotopiques à la période de convalescence.

Heterotopic cardiac transplantation is a procedure performed in patients with severe pulmonary hypertension. Surgery is usually preceded by a long period of inactivity. This paper reports the results of a programme of cardiac readaptation, the complications observed, the improvement obtained and the problem replated to the absence of graft innervation. Eight patients who underwent heterotopic cardiac transplantation underwent the readaptation programme. This began with an exercise ECG on which the physical training programme was based. Sessions of respiratory and muscular physiotherapy were also arranged during the same period; a second exercise ECG was performed at the end of the programme to assess progress. Clinical, biological, electrocardiographic and echocardiographic parameters were carefully monitored. The results of the final exercise ECG showed the average maximal work capacity to be 90 watts for 3 minutes. The average increase in heart rate on effort was 25.92%. This was significantly higher than the resting heart rate (p less than 0.01). Two complications were observed during the programme: ventricular fibrillation of the cardiac graft and graft rejection on the 35th postoperative day, diagnosed by echocardiography. Progression of exercise capacity was observed in all patients. The two patients who made the least progress were those who underwent the fewest sessions of physical readaptation. This improvement was mainly related to peripheral muscular fitness. The training programme was well tolerated by all patients; the principal factor limiting an increase in cardiac output on effort was the absence of graft innervation. The heart rate can only be increased by two mechanisms: an increased venous return and raised concentrations of circulating catecholamines.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transluminal coronary angioplasty. Experience apropos of 155 procedures]. / L'angioplastie coronaire transluminale. Expérience à propos de 155 procédures.

The authors report their experience of transluminal coronary angioplasty (TCA) from February 1980 to November 1983. 140 patients underwent TCA and 155 procedures were performed. The mean age was 55 years (range 33 to 74 years). Clinically, the patients presented with Stage I angina in 26 cases (18 p. 100), Stage II in 18 cases (13 p. 100), Stage III in 24 cases (17 p. 100) and Stage IV in 72 cases (52 p. 100), according to the NYHA Classification. 23 patients (16.5 p. 100) underwent combined thrombolysis - TCA. The coronary artery disease was limited to a single vessel in 135 cases (96 p. 100) and involved 2 vessels in 5 cases (4 p. 100). The overall results showed a 71 p. 100 primary success rate. There were no fatalities. The incidence of myocardial infarction was 3 p. 100 (5 patients) and emergency coronary bypass surgery was necessary in 16 patients (10 p. 100). The results in two groups of patients were compared: Group A: 69 patients treated with a conventional balloon catheter. Group B: 86 patients treated with a balloon catheter with a guide wire. The coronary stenosis was catheterised in 73 p. 100 of patients in Group A, and 90 p. 100 of patients in Group B (p less than 0.01). The primary success rate was 56 p. 100 in Group A and 83 p. 100 in Group B. The use of this new material improves the primary success rate and also makes more distal, anatomically atypical lesions, accessible.

[Action of digoxin on systolic and diastolic time intervals. An echocardiographic study in infants]. / Actions de la digoxine sur les intervalles de temps systoliques et diastoliques. Etude échocardiographique chez l'enfant.

The effects of digoxin on systolic and diastolic time intervals were studied in 25 children and infants the majority of whom had congenital heart disease by M mode echocardiography. The recordings were performed before and after the administration of digoxin. Serum digoxin levels were measured to confirm therapeutic dosage. After digoxin, the right and left ventricular pre-ejection periods, the duration of the corrected electromechanical systole and the Weissler indices decreased, and the isovolumic relaxation periods increased. The ventricular ejection times were unchanged except for the corrected right ventricular ejection time which was only slightly decreased. Our results concerning left ventricular systolic time intervals are in agreement with other studies in children. As no other studies of the effects of digoxin on the right ventricular systolic time intervals, or of the right and left isovolumic relaxation time are available, confirmatory studies are required. The decrease in the right and left pre-ejection periods, electromechanical systole and the Weissler indices, is interpreted as being related to the positive inotropic effect of digoxin whilst the increase in isovolumic relaxation reflects only a decrease in preload. This study allows a better understanding of the effects of digoxin on the different phases of the cardiac cycle and a better appreciation of its action potential.

[Monodimensional echographic study of echogenic masses in the left ventricular outflow tract in aortic valve insufficiencies. Apropos 5 cases]. / Etude échographique monodimensionnelle des masses échogènes de la chambre de chasse du ventricule gauche lors des insuffisances aortiques. A propos de 5 observations.

The presence of a mass in the left ventricular outflow tract is often a sign of severe pathology. The authors report 4 cases illustrating this echocardiographic diagnosis. In bacterial or mycotic endocarditis these masses suggest either aortic valve vegetations or prolapse of an aortic cusp. Two causes may be observed in patients with aortic bioprostheses: paravalvular leak with rocking of the sewing ring and destruction of the bioprosthetic cusps. In the 4 cases presented hemodynamic and angiographic investigations were contra indicated because of the risk of embolism of bacterial vegetations. Echocardiography gave precise diagnosis of the causal disease process and led to early surgical cure. Correlations between the anatomical and echocardiographic appearances are described and discussed.