[2-dimensional echocardiography of congenital obstruction of left ventricle inflow. Apropos of 25 cases]. / Echocardiographie bidimensionnelle des obstacles congénitaux au remplissage du coeur gauche. A propos de 25 cas.

Twenty-five cases of left ventricular inflow obstruction in children aged 4 months to 11 years were investigated by two-dimensional echocardiography and cineangiography. The results of 2D echo were compared with the operative appearances in 15 cases and the pathological findings in three cases. This series included 5 cases of cor triatrium and 20 of congenital mitral stenosis, 3 of which were associated with a supramitral ring. Abnormalities of the mitral papillary muscles were the main cause of congenital mitral stenosis in this series (12 cases); there were 6 cases of single papillary muscle and 6 cases with two closely situated or fused papillary muscles. These abnormalities of the mitral papillary muscles were demonstrated on the transverse left ventricular views obtained from the parasternal or subcostal regions. All the papillary muscle abnormalities diagnosed by 2D echo were confirmed at autopsy or surgery. Cases of mitral stenosis due to short and thickened chordae were demonstrated on parasternal long axis views. Hypoplasia of the mitral ring was visualised on long axis or apical views. The supramitral ring was demonstrated on the parasternal long axis or apical four chamber views, as an abnormal echo situated just above the mitral valve in the left atrium. All three cases in this series were correctly diagnosed by 2D echocardiography. Nineteen of the 20 congenital mitral stenoses were associated with other cardiac malformations (14 coarctations of the aorta, 9 aortic stenoses, 4 ventricular septal defects) which were also detected by 2D echocardiography.

[Comparison of quantitative data from two-dimensional echocardiography and anatomical examination in mitral stenosis]. / Comparaison des données quantitatives de l'échocardiogramme bidimensionnel et de l'examen anatomique dans la sténose mitrale.

This prospective study was undertaken to assess the results of 2D echocardiography in the assessment of valvular and subvalvular lesions in mitral stenosis. The echocardiographic findings (E) were compared with peroperative and laboratory anatomical examination of the excised valve (A). The following criteria were compared: 1) planimetry of mitral valve surface area, 2) mobility of the anterior leaflet, assessed anatomically by the flexibility of the tissue, and echocardiographically by the amplitude of early diastolic excursion, 3) length of anterior and posterior leaflets, 4) presence of calcification, 5) length of the longest tendinae chordae, measured from the papillary muscle to the insertion of the valve, 6) thickness of the thickest tendinae chordae attached to each leaflet. Echocardiography was carried out preoperatively by two different operators without knowledge of the haemodynamic and later anatomical findings. The anatomical results were taken as reference. Mitral valve surface area measured by both methods was comparable (A = 0,96 +/- 0,28 cm2; E = 1,04 +/- 0,33 cm2, N = 17, t = NS) and a good correlation was found between the two measurements (r = 0,79; p less than 0,01). 2D echo assessed the loss of valvular mobility by limitation of early diastolic opening of the AML with a sensitivity of 71 p. 100 and a specificity of 70 p. 100. Measurement of valve length of the anterior (N = 14) and posterior leaflets (N = 15) may be difficult in the presence of severe calcification. The results of both measurements were comparable. AML, 25,2 +/- 1,9 mm (A) and 24,6 +/- 2,1 mm (E); PML, 13,9 +/- 1,9 mm (A) and 14,2 +/- 2,2 (E) correlated well, r = 0,71 and r = 0,71 respectively (p less than 0,01).(ABSTRACT TRUNCATED AT 400 WORDS)

[Anatomic study of the right ventricular inferior wall. Search for the optimal site for implanting epicardial pacing electrodes]. / Etude anatomique de la paroi inférieure du coeur limitée au ventricule droit. Recherche du meilleur emplacement pour l'implantation des électrodes épicardiques de stimulation cardiaque.

The inferior wall of the right ventricle was studied to determine the optimal site of implantation of epicardial pacing electrodes. The hearts of 10 patients without cardiac disease, aged 57 to 84 years, who died in Broussais hospital, were studied. The hearts were washed, weighed (300 to 550 g) and placed in a formol solution to which was added half its volume of Larsen's solution. They were then examined and cut in sections about 0,8 cm thick, perpendicular to the long axis of the heart. Each section was drawn and the thickness of the inferior right ventricular wall measured. The inferior wall of the right ventricle is shaped like a right angled triangle limited medially by the inferior interventricular groove, posteriorly by the atrioventricular groove (containing the right coronary artery), and laterally by the right free border. The surface area of the triangle varies between 14 and 34 cm2, a fatty border is always observed, and, in 5 out of 10 cases, vessels (arteries and veins) run in a randomised fashion across its surface. The inferior wall is very irregular on section, appearing craggy and cavernous with sudden variations of 1 to 10 mm in thickness due to the many 2nd and 3rd order trabeculations. In the muscular zone near the interventricular septum, the thickness varies from 2 to 10 mm, but only 10 out of 70 measurements were less than 4 mm. In the middle and central zones, only 34 out of 182 measurements were less than 4 mm thick. On the other hand, at the apex and right border of the heart, the values fell to 7 mm and parts of the anterior right ventricular wall was as thin as 0,5 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

[Dissection of the ascending aorta after aortic valve replacement]. / Dissection de l'aorte ascendante après remplacement valvulaire aortique.

Three patients who underwent aortic valve replacement had dissection of the ascending aorta 7 months, 2 years and 15 years after surgery. This is a rare complication of aortic valve replacement (11 reported cases). Its incidence estimated from the literature would appear to be less than 1% of all aortic valve replacements. It occurs in both cases of stenosis and regurgitation (4 aortic regurgitations, 2 aortic stenosis, 5 mixed aortic valve disease) and is seen in ball and cage (7 cases), tilting disc (3 cases) and bioprosthesis (1 case). Six of these patients had hypertension. The role of the initial surgery for valve replacement in secondary aortic dissection is discussed. Aortic clamping and cannulation can cause immediate dissection but may also damage the aortic wall, leading to the risk of secondary dissection. An aneurysm of the ascending aorta was observed in 5 Cases at surgery; in 3 cases, the aorta was dilated without true aneurysm; in 3 other cases the aorta was considered to be macroscopically normal. The integrity aorta is sometimes difficult to confirm and a macroscopically normal of the aorta may have fragile aortic walls, especially in cases of aortic regurgitation due to valvular dysplasia and forms frustres of Marfan's syndrome, and are associated with a risk of secondary dissection. The appearances of the aorta at aortic valve replacement influence the choice of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Chronic constrictive pericarditis complicating an apparently stable rheumatoid arthritis. Report of a new case (author's transl)]. / Péricardite chronique constrictive compliquant une polyarthrite rhumatoïde apparemment stabilisée. A propos d'un nouveau cas.

The authors report a case of constrictive pericarditis complicating an apparently stable sero-negative rhumatoïd arthritis, a rarely described pathological association. The patient had a serious polyserositis due to an extremely marked and inflammatory pericardial constriction. The rhumatoïd origin was confirmed by pericardial effusion, histological and immunofluorescent studies. The inflammatory pericardial process rendered pericardiectomy virtually impossible and resulted in a fatal outcome.

[Constrictive pericarditis complicating quiescent rheumatoid arthritis (author's transl)]. / Péricardite constrictive compliquant une polyarthrite rhumatoïde biologiquement stabilisée.

A brief report is given of an extremely rare case of pericardial constriction in a patient with quiescent sero-negative rheumatoid arthritis. Pericardectomy was only partially completed as it was impossible to divide the bands joining the peri- and epicardium.

[Prospective etiologic survey on apparently primary nonobstructive myocardiopathies in adults. 57 cases, excluding ischemic cardiopathies]. / Enkquête étiologique prospective sur les myocardiopathies non obstructives présumées primitives de l'adulte. 57 observations, cardiopathies ischémiques exclues.

A prospective study into the aetiology of presumed primary non-obstructive cardiomyopathy was carried out in 57 patients who had no lesions of the trunk of the coronary artery; one case of haemochromatosis and one of amyloidosis were found. Excluding these two cases of cardiomyopathy which were in fact secondary, most of the others were associated with manifestations or with complications of myocardial diseases (two pulmonary emboli and one case of jaundice) or pathology associated with it. Investigation into possible infection, biochemical abnormalities and dietary indiscretion (alcohol, colza oil), were unfruitful. Electromyographic changes of the "myositic" type were very common. The bicycle ergometry test was often interrupted through fatiguing of the peripheral muscles. These findings suggest that the muscular abnormalities may not be limited to the heart. The cost of an enquiry of this type has been investigated.

[Changes in the aortic prosthesis surgical risk]. / Evolution du risque opératoire des prothèses aortiques.

Between May 1963 and December 1976, 889 patients underwent single valve aortic replacement by prosthesis. Hospital (30 day) mortality fell, with an exponential decrease (r = 0.94, p less than 0.01) to 4 per cent in 1976. Early risk factors are studied, taking into account the changes affecting them respectively over the time period considered. The average age of the patients increased but did not significantly affect operative mortality. Cardio-thoracic ratio, sex and the duration of extracorporeal circulation had little or no prognostic value. Only classification in class IV of the N.Y.H.A. and the type of valvular disease (severe incompetence) were of clearly pejorative significance. Most deaths occurred early in a context of signs of poor cardiac output, severe disturbances of ventricular rhythym, visceral (digestive) syndromes and/or thrombotic complications. They were characterised at autopsy by sub-endocardial haemorrhagic lesions. The prevalence of these lesions and that of early deaths appeared to decrease with techniques for myocardial protection during the operation.

[Prinzmetal's angina. Histological study of peroperative coronary specimens. Apropos of 2 cases]. / Angor de Prinzmetal. Etude histologique coronaire de prlèvements per-opératories. A propos de deux cas

The results of histological examination of two coronary artery biopsy specimens removed at operation are presented. There were unusual findings, especially of a highly cellular and oedematous fibroblastic endarteritis, of the lack of calcification, and of the presence of marked medial sclerosis. These unusual histological findings are the result of solitary variable stenoses of the coronary arterial tree, and very different from the histological findings in the atheromatous lesions which are usually found when Prinzmetal's angina is super-imposed on lesions which are multiple and diffuse.