[Corynebacterium diphtheriae endocarditis complicated by septic arthritis and cerebral abscess]. / Endocardite à Corynebacterium diphtheriae compliquée d'arthrites septiques et d'abcès cérébral.

The authors report a rare case of the mitis type Corynebacterium diphteriae endocarditis on a prosthetic valve complicated by septic arthritis and cerebral abscess. The authors underline the importance of regular transoesophageal echocardiographic control and underline the diagnostic value of ultrafast computed tomography for the diagnosis of aortic annular and interventricular septal abscesses in patients with mechanical prosthetic valves.

[Struma cordis: right intraventricular ectopic thyroid]. / Struma cordis: Thyroïde ectopique intraventriculaire droite.

The authors report the case of a benign tumour composed of hyperplasic thyroid tissue in the right ventricle, diagnosed in a 43 year old woman by echocardiography after a syncopal episode. The outcome was favourable with a 13 year follow-up after surgery.

[Left coronaro-ventricular fistula after septal myectomy]. / Fistule coronaro-ventriculaire gauche après myectomie septale.

The authors report the case of a 17 year old patient operated for valvular aortic stenosis associated with severe hypertrophy of the interventricular septum. The operation consisted of aortic valve replacement and septal myectomy. Color-flow imaging in the postoperative period showed a coronary artery--left ventricular fistula in the region of the septal myectomy. In view of the small size of the fistula on echocardiographic examination and the absence of a codified strategy of management of acquired coronary left ventricular fistula after surgery, a simple Doppler echocardiographic follow-up was proposed in this case.

[Demonstration of muscular activity in the human aorta. Effects of trinitrin]. / Mise en évidence d'une activité musculaire au niveau de l'aorte humaine. Effet de la trinitrine.

The human thoracic aorta is usually considered to be a purely elastic vessel. Transoesophageal echo-cardiography (TEE) provides a new approach to study the mechanical properties of the descending aorta. The aim of the study was to evaluate the reproducibility and accuracy of M mode recordings of the human descending thoracic aorta and to appreciate the changes produced by an infusion of glyceryl trinitrate (GTN). The reproducibility of M mode recordings was studied in vitro on plexiglass tubes of different calibre, and also in vivo, the inter and intra-observer error was estimated to 0.6% in vitro and 1% in vivo. The accuracy of the method was evaluated in vitro by comparing the measured values (MV) with the actual diameters of the plexiglass tubes (T): MV = 1.012T + 0.9; r = 0.99; SE = 0.8 mm. The systolic and diastolic diameters of the descending thoracic aorta were measured in 8 healthy volunteers by TEE, before and during continuous intravenous infusion of GTN at a rate of 0.9 mg/hr and then 1.35 mg/hr after a 10 minutes interval. Systolic and diastolic blood pressures were recorded automatically every minute. The results showed a very significant increase in the systolic (from 20.3 +/- 0.7 to 20.9 +/- 1.3 and 22.1 +/- 2.2 mm) and diastolic diameters of the aorta (from 18.3 +/- 0.7 to 19.1 +/- 1.4 and 20.1 +/- 2.4 mm) despite a fall in systolic blood pressure (from 121.3 +/- 7.7 to 114.5 +/- 6.6 and 108.4 +/- 5.4 mmHg). This study shows that TEE is a reliable and reproducible method of measuring the diameter of the human descending thoracic aorta.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiac pathology in human immunodeficiency virus infection]. / Pathologie cardiaque au cours de l'infection par le virus de l'immunodéficience humaine.

Clinical cardiac manifestations are rare in the course of acquired immunodeficiency syndrome (AIDS), but cardiac lesions can be found at autopsy in 60% of cases. Myocardium and pericardium are the most frequently involved. Cardiac involvement in opportunistic infections, Kaposi's sarcoma, and non Hodgkin's malignant lymphomas usually reflects systemic dissemination of the disease. Idiopathic myocarditis and hypertrophic cardiomyopathy may also occur and may be related to human immunodeficiency virus. Dysautonomia and drug-induced cardiac lesions have also been reported. Cardiac involvement of acquired immunodeficiency syndrome in children is characterized by possible lesions of conduction tissue.

[Role of the renin-angiotensin system in arterial hypertension with aortic coarctation in young adults]. / Rôle du système rénine--angiotensine dans l'hypertension artérielle de la coarctation aortique de l'adulte jeune.

The renin-angiotensin system (RAS) was evaluated in 7 hypertensives with pure isthmic coarctation of the aorta. RAS was studied under basal conditions, standing, after saralasine (a specific angiotensin II antagonist) and after acebutolol (a cardioselective beta-blocker and an inhibitor of renin secretion). Plasma volume was measured by radio isotopic methods and cardiac catheterisation was performed to assess the pressure gradient across the coarctation. On a normal salt diet on orthostatism, plasma renin activity (PRA) was increased in 5 patients and normal in the other 2. After moderate salt depletion, saralasine injection caused a significant fall in diastolic blood pressure (89,2 +/- 4,4 to 77,3 +/- 6,6 mmHg; p < 0,02) with an associated rise in PRA (5,7 +/- 4,4 to 17,1 +/- 9,1; p < 0,01). There was no correlation between these two parameters or their variations. The test was negative in two patients. The antihypertensive effect of acebutolol was moderate due partly to the absence of salt depletion. Inhibition of renin secretion by acebutolol was significant (4,7 to 1,95 +/- 1,10 ng AI/ml/h; p < 0,02) but did not correlate with variations of arterial blood pressure. There was no correlation between the antihypertensive effect of saralasine and acebutolol (R = 0,51). Plasma volume (n = 5) was almost always increased (47,15 +/- 5,4 ml/kg). No correlations were observed between the different levels of PRA, plasma volume, and the systolic and/or diastolic gradient. In conclusion, this study underlines the limitations of isolated peripheral assessment of PRA and the acebutolol test. On the other hand, the effectiveness of saralasine, a specific RAS antagonist, and the demonstration of the effective participation of this system associated with the usual increase in plasma volume, seems to liken coarctation of the aorta to the single kidney Goldblatt experimental model.

[Arrhythmias following closure of atrial septal defects. Apropos of 300 cases]. / Les troubles du rythme après fermeture des communications inter-auriculaires. A propos de 300 cas.

In a series of 300 cases whose atrial septal defects were closed (268 with ostium secundum, 27 with ostium primum, and 5 cases with both), arrhythmias were found in 60%. These were usually slow supraventricular arrhythmias caused by substitution (51%), and less commonly rapid supraventricular arrhythmias (27%), extra-systoles (16%), disorders of atrio-ventricular conduction of second and third degree and disorders of the auricle (6%). Conduction disorders were significantly more common (p less than 0.001) after closure of ostium primum (37%) than after closure of an ostium secundum (4.5%). Arrhythmias are most common during the first week (56%), and are usually of the slow type, and during the three succeeding weeks are markedly less frequent (31%) with a higher proportion (p less than 0.001) of the rapid type. No one anatomical type of ASD was complicated with arrhythmia more than the others. The slow type of arrhythmias occurred in the high ASDs, and the fast type especially amongst elderly patients. Longterm follow-up showed arrhythmias in 28% of patients with an ostium secundum defect. The factors influencing arrhythmias were age, cardiac enlargement, and the mean pulmonary arterial pressure. Arrhythmias were just as common in cases with a small shunt.

[Long-term results of palliative operations and complete cure of tetralogy of Fallot]. / Résultats à long terme des interventions palliatives et de la cure complète dans la tétralogie de Fallot.

714 cases of Fallot's tetralogy have been encountered over the last thirty years. A closed heart operation was undertaken in 472 patients. The mean age at operation was 5,1 years. In 87% of cases, a Blalock-Taussig anastomosis was carried out. The operative mortality was of the order of 3%. The operative risk was almost three times as large before the age of two years as after. The patients benefit by a demonstrable improvement of function after this operation, but it does not protect them from the complications of the condition (cervica abscess, Osler's disease, cerebro-vascular accidents) or from death. Open heart surgery was carried out in 403 patients. 161 as a primary procedure, and 242 after an initial palliative operation. The mean age at operation was 13.3 years. The operative mortality was 15%. The functional improvement was striking, and the patients appeared to be protected from the usual sequelae of the condition. On the other hand they cannot always be considered as cured: 16 died some time after the operation; 37% had pulmonary incompetence; 15% had a residual BSD; 8% had a block of both bundles, and 3% had a definitive atrio-ventricular block.

[Valve replacement in case of a partial atrioventricular canal. A propos of 17 cases]. / Remplacement valvulaire en cas de canal atrio-ventriculaire partiel. A propos de 17 cas.

In 17 patients with a partial form of atrioventricular canal, at least one valve was replaced. The mitral valve was the most commonly affected (16 cases), sometimes in association with the tricuspid valve (5 cases) or the aortic valve (1 case); the tricuspid valve alone was replaced in one case. 7 cases were ranked as operative deaths, and the longer term mortality was of 4 cases. The factors leading to this high mortality figure are discussed. The future treatment policy for this condition is discussed.

[Spontaneous and post-surgical outcome of incomplete forms of atrio-ventricular canal]. / Evolution spontanée et post-chirurgicale des formes incomplètes de canal atrio-ventriculaire.

125 patients with an incomplete type of atrioventricular canal defect (AVC) were followed up over a very long period. A study of the changes in parameters which are not open to great variability has allowed a more precise approach to the spontaneous and postoperative course of this congenital cardiac defect. The fact that the condition is usually well during the first three decades is not a justification for witholding operation; complications occur after the thirtieth year, and the operative risk becomes greater. Although only 41 patients in this series underwent surgery, we have been able to assess the surgical results and, as has been reported in the literature, these appear to be good. It is therefore necessary to extend the indications for surgery to include all the incomplete forms of AVC defect, and especially to operate during childhood or adolescence in order to minimise the risks of surgery.

[Subvalvular aortic stenosis, dysmorphic familial syndrome and peripheral muscular disease]. / Rétrécissement aortique sous-valvulaire, syndrome familial dysmorphique et maladie musculaire périphérique

Two related cases are reported, those of two sisters aged 7 and 13, who had an aortic subvalvular stenosis in the form of a fibro-muscular channel, associated with mitral incompetence, a triangular facies with a pointed chin, pinched lips, a divergent squint, hypertelorism, a mask-like face, normal intelligence, and a peripheral muscular disorder with arthrogriposis. The description of such a combination of malformations is original, and this is discussed.

[Atrial spetal defects of the ostium secundum type with mitral valve insufficiency. Apropos of 31 cases]. / Communications interauriculaires de type ostium secundum avec insuffisance mitrale. á propos de 31 observations

31 cases of ASD with mitral incompetence have been reviewed. The aetiology of the mitral incompetence is most frequently congenital, contrary to the classical view. The usual mitral defect is a combination of gaping of posterior commissure with a narrow valvular opening. The usual angiocardiographic picture is one of prolapse of the mitral valve. One of the characteristic findings, which has already been reported in the literature, is of redundant valve tissue, with myxomatous degeneration (one case confirmed histologically). Surgery is indicated in every case. Conservative mitral surgery gives satisfactory results in the mid-term.

[Left juxtaposition of the atria. Apropos of a case with dextroversion, transposition of great vessels, bilateral conus, interventricular communication and pulmonary atresia]. / Juxtaposition gauche des auricules. A propos d'une observation avec dextroversion, transposition des gros vaisseaux, conus bilatéral, communication interventriculaire et atrésie pulmonaire

Report of one case of a woman aged 29 years with a severe cyanotic congenital heart disease complicated by brain abscess. The diagnosis of left juxtaposition of the atria combined with dextroversion, a d-transposition of the large vessels and a vestricular septal defect was done pre-operatively. An attempt at a Rastelli's operation was followed by immediate death. The post-mortem examination confirmed the pre-operative diagnosis and demonstrated besides a double conus and a pulmonary atresia. The juxtaposition of the atria was underlined.