[Myocardiopathies and tricyclic antidepressants. Apropos of 3 cases]. / Myocardiopathies et antidépresseurs tricycliques. A propos de 3 cas.

The authors report three cases of cardiac failure induced or aggravated by chronic tricyclic antidepressant therapy. Tricyclic antidepressants have a negative inotropic effect both when administered acutely or chronically in animals. This action is related to plasma concentrations. However, the association of chronic tricyclic antidepressant therapy and cardiac failure is rare. The implication of these drugs in the cause of cardiac failure requires: --improvement of cardiac failure on withdrawal of therapy, as observed in our three cases; --the presence of underlying cardiac disease, as was the case in our patients; --abnormally high plasma levels of the antidepressant drugs despite normal dosage, as was verified in two of our patients. The measurement of plasma concentrations of antidepressant drugs would seem to be necessary when this form of treatment is to be administered to patients predisposed to cardiac failure.

[Proteins and blood volume after cardiac surgery under ECC and hemodilution]. / Protides et volémies aprés chirurgie cardiaque sous C.E.C. en hémodilution

The variations in protein, bodyweight and circulating blood volume during operation are studied in 18 patients operated under ECC. The frequency of hypovolemia with hypoproteinemia and over hydration of the interstitial medium is confirmed. The prolongation of ECC beyond 120 minutes is accompanied by a considerable reduction in the plasma sector. The frequency of hypovolemia must render the use of diuretics prudent. The existence of hypoproteinemia and interstitial overload suggests the value of albumin perfusions.

[Kidney failure after ectracorporeal circulation in cardiac surgery]. / Insuffisance rénale après circulation extra-corporelle en chirurgie cardiaque

The renal function of 113 patients undergoing cardiac surgery under ECC was studied. In 32 p. 100 of the cases renal involvement was noted which was moderate in 18 p. 100 of the cases, severe in 10 p. 100 of the cases and anuric in 4 p. 100 of the cases. Valvular surgery was complicated once in every three cases by renal involvement, the repair of congenital malformations once out of every two cases, and coronary surgery in 17 p. 100 of the cases. The fall in renal perfusion represents the essential factor in this renal involvement, which should be avoided by the maintenace during ECC of a high output level and a satisfactory perfusion pressure and by the recovery of correct hemodynamics after the intervention.

[Postoperative myocardial infarct after aorto-coronary bypass]. / Les infarctus du myocarde post-opératoires après pontage aorto-coronaire

The incidence (4.3%) of myocardial infarction after aorto-coronary bypass vein graft procedures, and the mechanisms by which they occur, have been analysed in a series of 300 postoperative patients. Very careful case selection for surgery, extreme care in preserving the myocardium throughout the operation, and especially while the coronary anastomoses are being carried out, and attention to detail as they are done all contribute in varying degrees to the prevention of this complication. The particular clinical features and the natural history of this condition of post-operative infarction are recalled.

[Congenital arteriovenous fistula between the left subclavian artery and Pirogoff's venous junction. Surgical closure]. / Fistule artério-veineuse congénitale entre l'atére sous-claviére gauche et le confluent veineux de Pirogoff. fermeture chirurgicale

The authors report a case of arterio-venous fistula between the left sub-clavian artery and Pirogoff's venous junction. There was no past history of trauma, and no associated cardiovascular abnormality. The hemodynamic effects were moderate. Catheterisation and supra-sigmoid aortography permitted us to localise precisely the site of the fistula. Surgical cure was simple and carried out be cervico-sternotomy. This route of approach is broad and safe, providing satisfactory control of all the vascular structures.

[Membrane oxygenators in cardiac surgery: progress]. / L'oxygénateur a membrane en chirurgie cardiaque: un progrès

This study tries to define if the membrane oxygenators are available during cardiac surgery under E.C.C., and if their performance are superior to those of conventional oxygenators. Two series of research are done. In the first one, we compare performance of two membrane oxygenators: the Rhône-Poulenc heart-lung machine (10 cases) and the Travenol TMO Teflo machine (100 cases). The general impression is good: the two proposed systems seem to be perfectly well adapted to surgical utilization conditions, avoiding excessive ventilations and eventually allowing to keep on E.C.C. in postoperative. In the second part of this work, two series of patients are studied, one oeprated under membrane oxygenator (Teflo), the second under bubble oxygenator (Bentley Q 100). Comparative study shows small differences between the two groups. Only the post-operative enzymatic profile is clearly for the membrane oxygenator which also insure a waking and a postoperative recovery of highest quality. These first observations justify to keep on using of membrane oxygenators in cardiac surgery.

[Amiodarone hydrochloride and anesthesia in heart surgery. Use of an injectable form in the correction of peroperative rhythm disorders]. / Chlorhydrate d'amiodarone et anesthésie en chirurgie cardiaque. Utilisation de la forme injectable dans la correction des troubles du rythme per-opératoires

The amiodarone is studied in the context of cardiac surgery to evaluate its anti-arrythmic properties in its injectable form and possible interference with the anaesthetic drugs. Two groups of patients were established: - the first group of 10 patients received the amiodarone per-os in the immediate pre-operative period, - the second group of 19 patients received injectable amiodarone either by direct intraveinous injection at a dose of 5 mg/kg or in I.V. drip for rhytmic irregulatities during surgery. The anti-arrythmic property of the product is confirmed. No incompatibility with the anaesthetics employed (neuroleptanalgesia) was observed. Howerer, a potentialization of the sympatholytic alpha-effects by the anaesthesia is observed. The fall in arterial pressure, when it is measureable, is of the order of a third of the initial value, with a return to the previous level within about ten minutes.

[Surgical correction of septal ruptures after recent acute myocardial infarct]. / Correction chirurgicale des ruptures septales après infarctus du myocarde aigu récent

The problems which are raised by surgical correction of a rupture of the septum complicating an acute myocardial infarction are illustrated by a study of 15 patients admitted for resuscitation. Rarely (3 cases) the anatomical abnormality is well tolerated, and a "planned" secondary operative procedure can then be carried out. More often (12 cases) the severity of the circulatory sequelae makes urgent surgery mandatory; these very severe cases have benefited greatly from advances in medical resuscitation, assisted circulation, and operative techniques.

[Aortocoronary bypass]. / Le pontage aorto-coronaire

Surgical revascularisation of the myocardium by aorto-coronary by-pass, has become in recent years, the operation of choice for the treatment of lesions of coronary arteriosclerosis. The quality of the results observed in our series, of 200 operated patients, and those reported by other authors, is emphasized. The problems raised by extension of this surgery, especially in the precise pre-operative assessment of ventricular function, the optimum material to use for realisatin of the graft and the course of coronary lesions after by-pass operations are then discussed.

[Factors influencing the results of aortocoronary bypass in a homogeneous series of 125 surgical patients]. / Facteurs influençant les résultats des pontages aorto-coronaires. A propos d'une série homogène de 125 malades opérés

A group of 125 patients having undergone aortocoronary bypass by saphenous graft was studied from the point of view of short and medium term results. The following emerged as factors likely to influence these results: --the technique used in the anastamoses and the quality of peroperative myocardial protection; --the presence of hyperlipidaemia; --the restrictive choice of indications in relation to the results of coronary arteriography; --the presence of cardiac insufficiency or an associated valvular lesion. Overall operative mortality was 8 p. cent. Routine ECG's and enzyme studies were carried out to detect postoperative myocardial necrosis. 4 postoperative infarctions without clinical symptoms or signs were detected (2.4 p. cent). 26 patients underwent surgery as an emergency with simultaneous coronary arteriography and surgery in 24. The mortality in this group was not greater (7.6 p. cent) than in the group as a whole. By contrast, mortality was greater in the presence of cardiac insufficiency (25 p. cent) or an associated valvular lesion (16.5 p. cent).