[Prediction of improvement of left ventricular systolic function by dobutamine echocardiography after recent myocardial infarction]. / Prédiction de l'amélioration de la fonction systolique ventriculaire gauche par échographie à la dobutamine après infarctus du myocarde récent.

Left ventricular ejection fraction is a major prognostic factor of ischaemic heart disease. In the early phase of myocardial infarction, part of the myocardium may be stunned and responsible for marked segmental wall dysfunction which is potentially reversible. The authors studied the potential of low dose dobutamine echocardiography to predict secondary improvement of left ventricular systolic function in 21 patients with recent inaugural myocardial infarction without primary angioplasty. All patients were treated and the investigation was carried out up to 20 micrograms/Kg/min of dobutamine without unwanted side-effects or myocardial ischaemia. The detection of viability by this method was associated with improved wall motion of the affected segments in 74% of cases, most of which had benefited from myocardial revascularisation at control echocardiography performed 8 weeks later. If 4 or more segments were estimated to be viable initially, the left ventricular ejection fraction improved to a value comparable to that obtained at a dosage of 20 micrograms/Kg/min of dobutamine. On the other hand, there was no secondary improvement in 76% of segments estimated to be non-viable whether or not they had been revascularised. The sensitivity, specificity, positive and negative predictive values of low dose dobutamine echocardiography for prediction of myocardial recovery after recent infarction were respectively 71, 79, 74 and 76%. The results of this investigation show prognostic value and could be an aid to the decision concerning revascularisation of patients not having undergone primary angioplasty.

[Comparative evaluation of hydrophilic and standard guide wires for retrograde catheterization of severe aortic stenosis]. / Evaluation comparative des guides hydrophiles versus guides standards dans le franchissement rétrograde des rétrécissements aortiques serrés.

The feasibility and safety of using hydrophilic guide wires were compared with those of standard guide wires for retrograde catheterization of aortic stenosis in a prospective randomised study. The performances of the guide wires were assessed by the time taken to catheterize the aortic valve (minutes) and the duration of radioscopy (minutes: grays). The success of the procedure was defined as presence of the guide in the left ventricle in less than 8 minutes. The two patient groups were comparable with respect to the severity of the aortic stenosis. Two failures of catheterisation were observed in the "standard guide wire" group compared with three failures with the hydrophilic guide wire. The mean catheterisation time of the "standard" group was 2.56 minutes compared with 3.12 minutes with the hydrophilic guide wire (p = 0.35 NS). This result was correlated with the duration of radioscopy and number of groups (respectively p = 0.18 NS and p = 0.5 NS). One case of tamponade and a transient ischaemic cerebral attack were observed in the "standard" group. This study does not show the hydrophilic guide wire to be superior to the standard guide wire for catheterisation of aortic stenosis. However, the hydrophilic guide wires were perfectly innocuous for this procedure.

[Cardiac lymphoma disclosed by ischemic accident. A case report]. / Lymphome cardiaque révélé par un accident ischémique. A propos d'un cas.

We report on the detection of a primitive cardiac lymphoma revealed by a cerebral vascular accident in a context of deterioration of the general state with fever. The diagnosis of the cerebral vascular accident was verified by the brain scan. The echocardiography, in particular the transesophageal ultrasound, suggested the diagnosis of cardiac lymphoma due to the existence of an inhomogeneous multilobar mass invading the right ventricle and largely encompassing the right auricle. The histologic diagnosis of a malignant non-Hodgkin's lymphoma of type B malignancy was confirmed by anatomopathology. The evolution was, unfortunately, rapidly unfavorable, with the patient dying in a state of cerebral suffering despite a combination treatment of chemotherapy and radiotherapy.

[Early postoperative constrictive pericarditis: value of echocardiography. Report of 4 cases]. / Péricardite constrictive postopératoire précoce: intérêt de l'échocardiographie. A propos de quatre observations.

In the present study, four cases of early postoperative constrictive pericarditis have been described which serve as a basis for recalling the current main echographic features of this disorder: pericardial thickening, abnormal septal movement with inspiratory expansion of the right ventricle, respiratory variations in ventricular filling, characteristic modifications in the supra-hepatic pulmonary venous flow, and pulmonary insufficiency. Some hypotheses have also been presented on the possible etiology of this disease. The necessity of making a precise and rapid diagnosis, which should also be confirmed by catheterization to ensure the appropriateness of therapy, has been emphasized. Pericardectomy can determine the long-term prognosis.

[Acute aortic insufficiency]. / Insuffisance aortique aiguë.

Acute aortic insufficiency can now be diagnosed rapidly and accurately thanks to Doppler echocardiography. The etiologies include infectious endocarditis, aortic dissection, bioprosthesis degeneration and thoracic injury. The clinical diagnosis is substantiated by the particular etiological context, dyspnea and pulmonary edema being the main factors involved. Examination includes finding out whether there is a reduction in the first sound, S1 a generally brief apical diastolic murmur. Echocardiography detects the presence of aortic leakage, the acute character of which is confirmed by the findings of a premature closure of the mitral valve, the existence of telediastolic mitral leakage, a restriction in the transmitral flow, and finally, the absence of left ventricular dilatation. An emergency operation is recommended by most authors in the case of acute aortic leakage due to the major risk or mortality resulting from pulmonary edema, ventricular arrhythmias, electromechanical dissociation or cardiogenic shock.

[Dobutamine doppler echocardiography in severe aortic stenosis with left ventricular dysfunction. Comparison with postoperative examination]. / Apport de l'échocardiographie Doppler sous dobutamine dans le rétrécissement aortique serré avec dysfonction ventriculaire gauche. Comparaison aux données postopératoires.

The association of left ventricular dysfunction with aortic stenosis worsens the spontaneous prognosis and increases operative mortality. The aim of this prospective study was to assess the predictive value of dobutamine Doppler echocardiography on the indices of left ventricular contractile function in patients with aortic stenosis and left ventricular dysfunction (LVEF < 0.45) undergoing aortic valve replacement. Eighteen patients, including 9 with coronary artery disease, were included in a protocol consisting of analysis of left ventricular function and of the severity of aortic stenosis before, during dobutamine infusion, and after valvular replacement. The dobutamine was given in progressive increments of 5 micrograms/Kg up to a maximum of 20 micrograms/Kg. During pharmacological stress, the functional aortic valve area increased from 0.46 +/- 0.15 to 0.56 +/- 0.23 cm2. Tolerance of the procedure was good. All but 2 patients improved their postoperative ejection fraction with values equivalent to those observed during the last increment of dobutamine (r = 0.73; p < 0.003). The patients with initial mean pressure gradients > 50 mmHg normalised their LVEF after valve replacement. The authors conclude that dobutamine echocardiography is useful for predicting the values of postoperative left ventricular contractile indices when severe aortic stenosis is associated with systolic dysfunction. It allows evaluation of the expected short term benefits to these indices after aortic valve replacement.

[Extensive mycotic coronary aneurysm detected by echocardiography. Apropos of a case]. / Volumineux anévrisme mycotique coronaire de découverte échographique. A propos d'un cas.

The authors report the case of a large mycotic right coronary aneurysm detected at echocardiography in a 45 year old patient with AIDS. Although emergency surgery was planned, the patient died of rupture of the aneurysm with cardiogenic shock and sudden pericardial tamponade. This case underlines the diagnostic value of echocardiography, by the transthoracic approach for para-cardiac masses and with the transoesophageal probe for accurate localisation and demonstration of the coronary origin. In this case, the CT scan was less useful than transthoracic echocardiography. Coronary angiography confirmed the strongly suggestive echocardiographic diagnosis and helped decide management strategy. Atheromatous coronary aneurysms may be treated by stenting but mycotic aneurysms require surgical management.

[Incidence and predictive factors of mitral insufficiency in surgically treated aortic stenosis. Transthoracic and transesophageal ultrasonographic evaluation]. / Incidence et facteurs prédictifs de l'insuffisance mitrale dans le rétrécissement aortique chirurgical. Evaluation échographique transthoracique et transoesophagienne.

Mitral regurgitation is common in adults with aortic stenosis. When severe, it may aggravate the clinical condition and pose an additional therapeutic problem. The authors studied 40 consecutive patients with severe surgical aortic stenosis prospectively by transthoracic echocardiography and pre-operative transoesophageal echocardiography to determine the incidence, mechanism and degree of mitral regurgitation and its eventual relationship to the aortic stenosis. Mitral regurgitation was detected in all cases when both investigations were taken into consideration. It was usually mild, evaluated grade 2 by measuring the surface of the colour Doppler regurgitant jet, or mild to minimal of transoesophageal echocardiography in 35/40 patients (87.5% of cases). Rarely, a case of significant, autonomous mitral regurgitation (2 cases of valvular dystrophy, 1 pure severe mitral stenosis). On the other hand, calcification of the mitral annulus is common (14/40 patients, 35% of cases). The severity of the regurgitation in univariate analysis was significantly correlated mainly to the age of the patients (p = 0.027). The severity of the aortic stenosis (p = 0.0082) and the parameters related to the effects of stenosis, such as ventricular wall thickness and left atrial size. In multivariate analysis, the severity of the aortic stenosis and of its consequences were confirmed to play a role in the genesis of mitral regurgitation, the severity of which was correlated on transthoracic echocardiography to the aortic valve surface area and the left ventricular ejection fraction and, on transoesophageal echocardiography, to the transvalvular pressure gradient.

[Werner's disease presenting as ischemic mitral incompetence]. / Fuite mitrale ischémique révélant une maladie de Werner.

Werner's syndrome or progeria, described for the first time in 1886, is a rare disease with autosomal recessive transmission, characterized by premature ageing of connective tissues. About 200 cases have since been reported in the literature. Most patients die young, generally from heart failure due to early coronary atherosclerosis [1]. The authors report the case of a 46-year-old woman presenting with cardiovascular abnormalities, unusual for her age, associated with a particular morphotype belonging to Werner's syndrome.

[Peripheral embolic arterial accident due to pulmonary vein thrombosis revealing bronchial carcinoma]. / Accident artériel périphérique embolique par thrombose d'une veine pulmonaire révélant un carcinome bronchique.

The authors report a case of left superior pulmonary vein thrombosis discovered on transoesophageal ultrasonography in the context of aetiological assessment of a systemic vascular accident. This unusual site of a thrombus on an anatomically perfectly normal left atrium led the authors to perform a more detailed assessment, revealing a previously undiagnosed lung cancer on thoracic CT scan.

[Acoustic quantification of right ventricular dimensions and systolic function]. / Estimation par quantification acoustique des dimensions et de la fonction systolique du ventricule droit.

In view of the important prognostic significance of right ventricular systolic function, there have been many non-invasive studies of this subject. The majority of these studies have been limited by difficulties in modelisation of this geometrically complex cardiac chamber. Automatic border detection by acoustic quantification based on the back scatter of ultrasound provides a "direct" method of analysing right ventricular dimensions and functions. The authors undertook a prospective study of 34 patients to evaluate the reliability of this technique in measuring the surfaces and fractional shortening of the right ventricle. The feasibility was 92%. The correlation coefficients between the manual two-dimensional technique and automatic border detection were 0.81 for the end diastolic surface areas, 0.85 for the end systolic surface areas and 0.74 for the fractional shortening. Compared with the isotopic ejection fraction, the correlation coefficient was 0.73. The authors conclude that acoustic quantification is a feasible and reliable technique of measuring right ventricular dimensions and its contractile function.