Percutaneous brachial approach for transluminal coronary angioplasty.

Transluminal coronary angioplasty from the arm is performed generally with cutdown and brachial arteriotomy. We describe a brachial percutaneous technique for coronary angioplasty, almost similar to the femoral one, with a special focus on the prevention of induced vasoconstriction. Our preliminary results are satisfactory and without complications: 13 procedures in 11 patients have been performed over a 30 month period, with the sheaths left in place for 4-6 h after the procedure. This method could be an easy alternative to the Sones technique for operators who are essentially familiar with the femoral percutaneous arterial approach.

Percutaneous femoral transluminal angioplasty of a right brachial artery occluded after Sones coronary angiography.

A case of percutaneous transluminal angioplasty (PTA) from the groin to a 7-cm right brachial artery occlusion in a 41-year-old man, having previously undergone Sones coronary angiography 2 months earlier, is presented. The post-PTA angiogram shows near-normal reconstitution of the total obstruction, persisting after 6 months with complete loss of collateral circulation. In a case of total obstruction of the brachial artery, femoral PTA should be considered before resorting to surgical treatment.

Cigarette smoking during coronary angiography: diffuse or focal narrowing (spasm) of the coronary arteries in 13 patients with angina at rest and normal coronary angiograms.

To evaluate the acute effects of cigarette smoking on coronary arteries (CA), repeated coronary angiograms were performed in 13 patients with angina at rest and with normal coronary angiograms at basal state, during smoking, and then after methylergometrine (MEM) and after intracoronary nitroglycerin. Smoking induced anginal pain in three patients, triggered spasm (focal narrowing) in six, and/or an abnormal segmental diffuse narrowing (greater than 30%) in eight. The narrowing of the left CA was on average -21 +/- 13% (P less than 0.001), with more important narrowing of the mid-left anterior descending (-29 +/- 19%, P less than 0.001). The mean of the maximal segmental narrowing by patient was -34 +/- 13% (P less than 0.001). MEM produced similar effects and induced focal CA spasms in nearly the same patients at the same sites. Cigarette smoking may induce vasoconstrictive effects on CA in patients with rest angina and normal coronary angiograms. This action is not dose-dependent and may be initiated by less than one cigarette. These observations offer a new perspective for the understanding of the role of smoking in the precipitation of coronary events.

Percutaneous brachial approach using the femoral artery sheath for left heart catheterization and selective coronary angiography.

A percutaneous method via the brachial artery for left heart catheterization and selective coronary angiography is described. The technique uses the sheath intended for the femoral artery, continuously infused and introduced following a particular technique. The procedure was performed with minimal complications over 18 months, with multipurpose "Schoonmaker" or preshaped catheters, in all the patients (37) in whom the femoral approach was contraindicated or failed. When a catheterization must be performed from the arm, this method, without cutdown and arteriotomy and allowing a good distal flow during the procedure, appears to have some advantages over the classical Sones technique or the percutaneous arterial axillary approach.

[Electrocardiogram in the "typical angina of effort with normal arteriography" syndrome]. / L'électrocardiogramme dans le syndrome "angine de poitrine d'effort typique avec artériographie coronaire normale".

This study related to 163 cases of chest pain with the typical clinical features of angina of effort (AE) selected from a continuous series of patients who had carotid arteriography (CA) for anginal pain. These 163 cases were divided into two groups: a study group (SG) consisting of 44 patients with a normal CA, and a control group (CG) which, when patients with ECG evidence of transmural necrosis had been excluded, consisted of 119 cases of coronary artery stenosis, almost all amounting to more than 75 percent. Among those with typical AE (without ECG evidence of transmural necrosis), the proportion of normal CA was 27 percent. It was reduced to 17 percent when those patients with ECG evidence of transmural necrosis were added to the CG. The clinical features of the pain were noted for the SG and the CG, as well as the incidence of "risk factors". By contrast, the SG contained significantly more young subjects and females than the CG (P less than 0.001). The proportion with normal ECGs at reat was the same in the two groups (32 percent). The proportion of non-ischaemic abnormalities of repolarisation was 32 percent in the SG and 18 percent in the CG. Ischaemic abnormalities of repolarisation were present in 23 percent of cases in the SG, and in 49 percent in the CG (p less than 0.01). The exercise test on a bicycle ergometer was carried out for 16 cases in the SG was positive in 7 (44 percent: one male, six females). Of the 33 tests in the CG, a positive response was obtained in 20 (60 percent: 18 males, 2 females) (NS). 37 percent of patients in the SG showed an abnormality of volume or of left ventricular kinetics on arteriography (5 cases) and/or elevation of the end-diastolic pressure before and after arteriography (9 cases). These findings are not significantly different from those in the CG. 9 patients in the SG were studied for myocardial metabolism under pacing: 2 were found to have abnormalities in lactate production.

[Coronary stenosis in angina pectoris with normal resting electrocardiogram]. / Les sténoses coronaires de l'angine de poitrine avec électrocardiogramme normal au repos.

The arteriographic abnormalities found in 104 patients with typical angina pectoris and an electrocardiogram at rest which was normal at the time of arteriography were compared with those of 238 cases with typical angina pectoris, but with an abnormal electrocardiogram (127 having ST/T changes, 111 having transmural necrosis). There was no major difference between the two groups as far as the degree of coronary stenosis was concerned, nor in its extent and distribution. However, by comparison with the group with an abnormal electrocardiogram, very tight stenoses of the three trunks or of one trunk alone were slightly less common in the patients with a normal electrocardiogram; also, for each of the three trunks, the index of the lesion was slightly less raised, and the circumflex and right coronary arteries were slightly less commonly, affected, although the difference was not usually great enough to achieve significance. The action of the left ventricle and/or the value of left ventricular end-diastolic pressure were, however, manifestly better conserved in those with a normal electrocardiogram (p less than 0.001). An aorta-coronary bypass graft is more likely to be indicated in this group of patients.

[Long term results of surgical treatment of obstructive myocardiopathy by intervention on the interventricular septum]. / Résultats à long terme du traitement chirurgical de la myocardiopathie obstructive par intervention sur le septum interventriculaire

An analysis of the results of septal myotomy or myectomy in 26 adults with obstructive cardiomyopathy (OCM) with a mean follow-up period of more than 5 years lead to the conclusion that this treatment brings about, at the price of a mortality rate of about 10%, a sustained improvement in function, a reliable correction of the left ventricular gradient, and an improved long term survival rate by comparison with the rate among patients treated medically.

[Hemodynamic diagnosis of tricuspid insufficiency]. / Le diagnostic hémodynamique de l'insuffisance tricuspide

An analysis and comparison has been made of the value in the diagnosis and assessment of the degree of tricuspid incompetence of the following: the pressure curves of the right side of the heart, intracardiac phonocardiography and the venous dilution curves of ascorbic acid. The study was carried out on 49 patients, and a comparison made with selective right ventricular cineangiography, which was chosen arbitarily as a baseline. The information from the pressure curves and from intracardiac phonocardiography often contains errors of ommission or commission, but that from the venous dilution curves of ascorbic acid came out as the most reliable; these curves do tend to overestimate the degree of regurgitation, but they still allow us to reserve selective cineangiography, which is quantitatively a more precise method, for those cases in which the curves indicate a particularly severe degree of tricuspid incompetence.

[Clinical diagnosis of corrected transposition of the great vessels by bulbo-ventricular inversion]. / Le diagnostic clinique de transposition corrigée des gros vaisseaux par inversion bulbo-ventriculaire

29 cases of corrected transposition of great vessels (CTGV), of which 3 cases were isolated and 26 cases were associated with various malformations were studied. The aim was to make the diagnosis of CTGV were made evident, to differentiate those which came from the associated malformations. The specific signs for CTGV are as follows: 1) a slight systolic ejection murmur at the 2nd or 3rd left intercostal space along the sternal margin; 2) a loud 2nd tone in the same focal zone. Specific radiographic signs are that: 1) the aortic arch comes up to sternal-costal articulation; 2) the inferior left margin has a convex form; 3) in the right oblique-anterior projection it is possible to see 2 imprints on the opaque esophagus, which is represented by the aorta above and pulmonary artery below...