[Development of left intraventricular thrombi. Monitoring by two-dimensional echocardiography and scintigraphy with indium 111-labelled platelets]. / Evolution des thrombi intraventriculaires gauches. Surveillance par échocardiographie bidimensionnelle et scintigraphie aux plaquettes marquées à l'indium 111.

Two-dimensional echocardiography and indium 111-labelled platelet scintigraphy have proved helpful in the diagnosis of left intraventricular thrombosis. In this study, both methods were used to investigate the time-related changes undergone by such thrombi in 30 patients (26 with myocardial infarction, 4 with dilated cardiomyopathy) who presented with left intraventricular thrombosis diagnosed by echocardiography and systematically explored by indium scintigraphy. These 30 patients were divided into 2 groups depending on whether the initial scintigraphy was positive (group I, 19 patients) or negative (group II, 11 patients). The follow-up (mean 21.6 months) was clinical and paraclinical, with control echocardiography repeated at 1.5 and 8.5 months in both groups and control scintigraphy at 1.5 month in group I patients. At the 1.5 month echocardiography, the intraventricular thrombosis persisted in 14/16 examinations in group I patients and in only 2/10 examinations in group II patients (p less than 0.01). At the 1.5 month scintigraphy, performed in 16/19 group I patients, this examination had become negative in 8 cases, whereas the 2D-echocardiography remained positive. During the follow-up period 4 patients in group I had an embolic accident, as against none of the group II patients (p less than 0.01); 3 of these 4 patients had persistent uptake at control scintigraphy. At echocardiography, only a protrusion image seemed to be predictive, as it was present in 3 of 4 patients with embolic accident.(ABSTRACT TRUNCATED AT 250 WORDS)

[Infectious endocarditis, complication of mitral valve prolapse]. / L'endocardite infectieuse, complication du prolapsus valvulaire mitral.

Among 77 patients with bacterial endocarditis on native valves explored by echocardiography, 12 (7 male, 5 female, mean age: 50 years) presented with mitral valve prolapse. This condition is relatively common, being found in 15.5% of patients with bacterial endocarditis and in 32% of those with mitral valve endocarditis. Two-dimensional TM echocardiography showed the mitral valve prolapse in every case and, in 11/12 cases, a vegetation associated with a varying degree of thickening of the valve due to myxoid degeneration. Although cardiac signs were sometimes minimal. Ten hemocultures were positive: 7 for streptococci, 2 for staphylococci and 1 for Hemophilus para-aphrophilus. Two patients died of cerebral haemorrhage, and there were 2 cases of hemiplegia, 4 cases of transient left ventricular failure and 2 cases of spleen embolism. These findings suggest that prophylactic treatment of bacterial endocarditis should be undertaken in patients with mitral valve prolapse and signs of myxoid degeneration at echocardiography.

[Hypertrophic myocardiopathy. Course and prognosis. 60 cases]. / Myocardiopathie hypertrophique. Evolution et pronostic. Soixante observations.

The evolution of 60 cases of hypertrophic cardiomyopathy over a mean period of 6.3 years is described. The cases were separated according to echo-cardiographic findings into 4 categories: obstructive cardiomyopathy (29 cases), asymmetrical septal hypertrophy (22 cases), diffuse cardiomyopathy (6 cases) and apical cardiomyopathy (3 cases). A number of complications occurred during the follow-up, consisting of cardiac failure (20 cases), embolic accident (9 cases), aortic endocarditis (1 case) and arrhythmia (32 cases including 12 cases of supraventricular arrhythmia and 20 cases of ventricular arrhythmia). Five patients died suddenly. These data are compared with those obtained from the literature in an attempt to determine the main prognostic factors in hypertrophic cardiomyopathy.

[Uni- and bidimensional echocardiography in the etiologic diagnosis of precordial pain]. / Contribution de l'échocardiographie uni-et bidimensionnelle au diagnostic étiologique des précordialgies.

The distinction between precordial pain of cardiac origin and pain of extra-cardiac origin is a daily problem. We wanted to study the value of echocardiography in this difficult diagnostic problem. In a series of 148 patients admitted to the unit in 1982 for chest pain. 104 were investigated by echocardiography and coronary angiography. In 36 per cent of patients, the echocardiogram was normal and was unable to predict the presence or absence of coronary artery disease. Further investigations seem to be justified in these cases. In 57 per cent of cases, the echocardiogram was abnormal, suggestive of a cardiac cause for the pain. The demonstration of a disorder of segmental kinetics in the left ventricle is suggestive of coronary artery disease, which is detected 82 per cent of cases and is a good indication for coronary angiography. The other abnormalities detected, mitral valve prolapse, hypertrophic cardiomyopathy and dilated cardiomyopathy are rarely associated with coronary artery disease, which was found in 0, 13 and 14 per cent of cases, respectively. Initially, these abnormalities may be sufficient to explain the symptomatology. Pericardial detachments are associated with coronary artery lesions in 50 per cent of cases and should be very carefully monitored.

[Detection of intracardiac thrombi by scintigraphy with indium111-labeled platelets. Correlation with 2-dimensional echography and cardiac scanning]. / La détection des caillots intracardiaques par la scintigraphie aux plaquettes marquées à l'indium 111. Confrontation avec l'échographie bidimensionnelle et la scanographie cardiaque.

The aim of this study was to use scintigraphy with Indium III marked platelets to detect intracardiac thrombi. Platelet marking was performed with the patient's own platelets and Indium III oxinate. The date was recorded and treated with a gamma-camera-computer system. The results obtained in 45 patients (36 male, 9 female, aged 38 to 80 years, mean age 61 years) were compared with those of 2D echocardiography in all cases, and with CAT in 30 cases. Seventeen patients (13 myocardial infarcts, 2 cardiomyopathies with dilatation, 2 mitral stenoses) were considered to have intracardiac thrombi on platelet scintigraphy with foci of hyperfixation increasing with time, clearly distinguishable from circulating cardiac activity. Sixteen of these cases had appearances of thrombosis on 2D echo (14 left ventricle, and 2 left atrium) and 12 cases had a triple positive result (2D echo, CAT and platelet scintigraphy). One patient had positive platelet scintigraphy and negative 2D echo and CAT. In the 24 cases with negative platelets scintigraphy, an intracardiac thrombus was demonstrated by 2D echo and CAT scanning in 2 cases. Two out of 4 patients with transient hyperfixation had appearances of a large chronic thrombus on 2D echo and CAT. The efficacy of therapy was monitored in 3 patients on heparin and 4 patients on platelet antiaggregants. These results show that platelet scintigraphy is a highly specific method of detecting intracardiac thrombi. It is less sensitive than 2D echo because it depends on the haematological activity of the thrombus, making it a useful technique for assessing the efficacy of therapy.

[Detection of left intraventricular thrombi in the acute phase of myocardial infarction by 2-dimensional echocardiography. Apropos of 103 cases]. / Détection des caillots intra-ventriculaires gauches à la phase aiguë de l'infarctus du myocarde par l'échocardiographie bidimensionnelle. A propos de 103 cas.

Two-dimensional echocardiography (2D echo) was performed in 103 patients (94 men, 9 women, aged 35 to 76 years; mean 55,4 years) during the acute phase of primary myocardial infarction in order to detect left ventricular thrombi (LVT). This investigation was carried out between the 7th and 30th days with an 84 degrees phased array sector scanner. A total of 17 LVT were visualised, all at the apex of the left ventricle. There factors seemed to predispose to this condition: --the site of infarction: LVT were more common in anterior (16/56) than inferior infarcts (1/47) (p less than 0,001); --the extent of the necrosis: LVT occurred in 13/30 antérior infarcts when the akinesia involved at least two antero-apical segments, compared to only 3/26 when the necrosis was less extensive (p less than 0,05); --cardiac failure in anterior myocardial infarction: LVT were found in 11/21 cases with cardiac failure and in only 5/35 without cardiac failure (p less than 0,01). The outcome of 45 patients was assessed by 2D echo 3 to 12 months after the acute episode (mean 7,6 months). Control echo was unchanged in 35 patients (15 inferior, 20 anterior infarcts) without LVT. In 10 patients with LVT treated by oral VitK antagonists, the thrombus disappeared in 5 cases without embolism; it decreased in volume in 3 cases and persisted unchanged in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)