[Björk-Shiley-Monostrut prosthesis of the aortic valve. Mid-term development]. / Prothèse de Björk-Shiley-Monostrut en position aortique. Evolution à moyen terme.

From July 84 to June 88, 100 patients underwent an isolated aortic valve replacement by a Monostrut-Björk-Shiley prosthesis. Fifty-one had calcified aortic stenosis, 24% aortic insufficiency, 25% mixed aortic lesions. Pre-operatively, their mean age was 57 years, 68% were male, 46% were in NYHA class II or IV, 43% had angina, all were in sinus rhythm. Operative mortality was 4%. All the survivors were followed-up for a mean period of 22 months (6 to 58) with a cumulative follow-up of 183 patients-years. All patients were placed on a long-term regimen of anticoagulant therapy. Two late deaths occurred (1 myocardial infarction, 1 cerebral hemorrhage). The 4 years survival rate was 94%. Postoperative functional results were excellent. Nearly all patients were asymptomatic. Concerning valve related complications: the 4 years actuarial rate of patients free from thromboembolism, hemorrhage, valve thrombosis, periprosthetic leakage and endocarditis were respectively 97%, 97%, 100%, 100% and 100%. No patient were reoperated on. Valvular function was evaluated by mean transprothetic gradient on echo-doppler (61 cases) and by the calculation of the valvular area with transseptal catheterization (21 cases). For small sizes prosthesis (annulus diameter of 19 or 21 mm), medium size prosthesis (23 or 25 mm), large size prosthesis (27 to 29 mm), mean transprothetic gradient were respectively 16, 10 and 6.9 mmHg and valvular aortic area were respectively 1.5, 1.9 and 2.4 cm2. Mid term results of the Monostrut-Björk-Shiley prosthesis on aortic position are good with a low rate of valve related complications and good hemodynamic results, even with the small valve size.

[Value of correction by receiving gains in the determination of mitral valve surface area by two-dimensional echocardiography]. / Intérêt de la correction par les gains à la réception dans la détermination de la surface mitrale en échocardiographie bidimensionnelle.

Distorsion due to inappropriate gain settings interferes significantly with the measurement of mitral valve surface area by 2D echocardiography. The problem is general and applies equally to all makes of echocardiographs whether they are mechanical or phased array scanners. The measured mitral surface area may even be false if the level of the recording gain is disregarded. We established a graph of the global distorsion of a system comprising an Aloka SSD 800 phased array sector scanner and a Tektronics hard copy recorder using a "tissue-equivalent" model and only varying the level of gain. Using these results a computerised program for automatic correction of the mitral surface area, with respect to the gain level used, was developed. The program was validated on a series of 56 patients with mitral stenosis by comparison with the catheter results obtained with the Gorlin formula, peroperative and pathological findings on resected valves. With this echo system in the zone of gain settings studied there was a significant underestimation of the uncorrected surface area. After correction, the distinction between severe and moderate stenosis was better and an improved correlation with the anatomical surface area was obtained. It would therefore appear necessary to calibrate the system used taking both the echocardiography and the recorder into account. Despite certain limitations, we believe that distorsion curves could be established using "tissus-equivalent" models.

[Risk factors in mitral valve replacements]. / Facteurs de risque des remplacements valvulaires mitraux.

The authors report 137 isolated mitral valve replacements carried out between 1966 and 1975, with an operative mortality of 13.1%. Certain risk factors are demonstrable:--from the clinical point of view: previous cardiac surgery, 3 or more attacks of cardiac failure, a prolonged preoperatives course, atrial fibrillation, and cardiomegaly on the X ray. The combination of these risk factors is very serious as when three or more risk factors are operative at the same time, the mortality is 40%. Reduced ventricular function preoperatively was an essential factor governing operative mortality; improved results follow earlier indications for surgery.

[Outcome of corrected and uncorrected tricuspid insufficiency after repair with prostheses in mitral and mitro-aortic valve diseases. Apropos of 159 cases]. / Evolution de l'insuffisance tricuspidienne, corrigée ou non, après réparation par prothèses des valvulopathies mitrales et mitro-aortiques. A propos de 159 cas.

This is a study of 159 patients with tricuspid incompetence (TI) associated with a mitral or mitro-aortic valve defect. The mean age of the patients at operation was 25.5 years. The TI was left untreated in 84, corrected by semi-circular annuloplasty in 39, and corrected by a prothesis in 28, by a Carpentier ring in 6, and by Kay's plasty in 2. The 33 early deaths (21%) are regrettable. The long-term outlook was studied with a mean follow-up period of 26 months. The overall mortality rises, if these are included, to 42 (26%). By comparing the preoperative findings in those with good and poor results, we have been able to identify a certain number of risk factors: a preoperative course of greater than or equal to 6 years, a number of attacks of cardiac failure greater than or equal to 3, a cardiothoracic ratio greater than or equal to 0.70, a mean right atrial pressure greater than 12, a mean pulmonary arterial pressure of greater than or equal to 50. Severe TI is also a poor prognostic factor. If the three groups of patients are compared, bearing in mind the fact that their preoperative state was very similar, and that the TI was either left untreated or repaired by annuloplasty or prosthesis, it appears that such a correction improves neither the surgical mortality nor the long-term prognosis. It therefore seems to us that a functional TI can be treated expectantly since its resolution depends more on the unified treatment of the whole underlying disorder and on the state of the myocardium than on any localised correction of the TI.

[Long-term outcome of valve prostheses. Apropos of 299 operated patients]. / Evolution à long terme des prothèses valvulaires. A propos de 299 malades opérés.

The authors report a series of 299 operated cases betwen 1966 and August 1975. The operative mortality was 16%, usually a result of low output states and arrhytmias. Long-term survival was 74% at 3 years and 64% at 6 years, being better in those with only one valve replacement. The late results were very good taken as a whole. The few poor results were associated especially with a degenerating myocardium. The mitral group were favoured with a better 5 year survival rate and by clinically, and above all haemodynamically severe tricuspid incompetence. Thromboembolic complications, which are a major hazard, were favoured by irregular and inadequate anticoagulant therapy. In patients under 20 it would seem possible to stop after 6 months' effective treatment. Children have had generally better results than adults, probably because of the better state of their myocardium.