[Morphological study by transesophageal echocardiography and clinical aspects of ruptured chordae tendineae in the elderly]. / Etude morphologique par échocardiographie transoesophagienne et aspects cliniques de la rupture de cordages mitral chez le sujet âgé.

Ruptured mitral chordae tendinae is a classical complication of myxomatous mitral valves or Barlow's syndrome. This complication is controversial in non-myxomatous mitral valve. Of 91 consecutive patients with mitral valve prolapse examined over an 18 months period by transthoracic and transesophageal echocardiography, 42 (18 women and 24 men) with an average age of 76 +/- 8 years (60-93 years) had ruptured mitral chordae tendinae. The thickness of the anterior mitral leaflet measured at the distal third of the valve by transesophageal echocardiography enabled the identification of two groups of patients; group I: > 3 mm (24 patients), average 4.8 +/- 0.8 mm and group II: < or = 3 mm (18 patients), average 2.6 +/- 0.3 mm. The diameter of the mitral ring and left atrium, the length of the anterior mitral leaflet, the left ventricular end diastolic dimensions and fractional shortening, were measured by transthoracic 2D echocardiography (mitral ring) and M mode (other parameters). Ruptured chordae were detected in only 13 cases (31%) by transthoracic echocardiography; 38% were asymptomatic and a chance finding at transesophageal echocardiography. No significant difference was observed between the two groups with respect to age, gender presence of hypertension, dimensions of the cardiac chambers, fractional shortening or localisation of the prolapse related to the ruptured chordae. Fifty-eight per cent of patients in group I were in NYHA functional classes 3-4 as compared to 16% in group II (p < 0.02). The size of the left atrium was significantly greater in group I, 51 +/- 8 mm vs 38 +/- 7 mm (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Early constrictive pericarditis after coronary revascularization. Apropos of a case]. / Péricardite constrictive précoce après revascularisation coronaire. A propos d'un cas.

The authors report a case of severe constrictive pericarditis occurring 6 weeks after coronary bypass surgery and in the absence of any other predisposing factor. The diagnosis was confirmed by CT scan and cardiac catheterisation which showed signs of a diastole. The patient died despite early surgical reoperation because of the severity of the pericardial fibrosis.

[Puerperal thrombosis of the right ovarian vein. Clinical and radiological aspects apropos of a case]. / Thrombose puerpérale de la veine ovarienne droite compliquée d'embolies pulmonaires. Aspects cliniques et radiologiques a propos d'un cas.

The authors report the case of puerperal thrombosis of the right ovarian vein complicated by recurrent small pulmonary emboli in a 32 year old woman. The clinical features of this rare condition are reviewed. The echographic, angiographic and CT scan and magnetic resonance imaging abnormalities are described. The authors underline the value of non-invasive radiological investigations for early diagnosis. The patient was rapidly improved by medical therapy with antibiotics and heparin.

Lipid peroxidation and protective enzymes during myocardial infarction.

Fasting blood taken from 34 patients with myocardial infarction, 19 with unstable angina and 40 healthy controls, was analysed for malondialdehyde and erythrocyte detoxification enzymes, superoxide dismutase and glutathione peroxidase. Malondialdehyde concentration was raised in the patients with myocardial infarction during the initial 48 h after an attack, and correlated with the severity of the attack. 12 days after the infarct, malondialdehyde concentrations were lower but still raised. Superoxide dismutase activity was below normal during the initial 48 h post infarct and raised twelve days after. Glutathione peroxidase was reduced after 12 days. Similar, but less marked changes were seen in the patients unstable angina.

[Ventricular tachycardia during theophylline overdose. Apropos of a case of reduction by magnesium chloride]. / Tachycardie ventriculaire au cours d'un surdosage en théophylline. A propos d'un cas de réduction par le chlorure de magnésium.

The authors report a case of ventricular tachycardia (VT) induced by theophylline toxicity in a patient with ischaemic heart disease complicated by left ventricular failure and chronic asthma. Two episodes of VT were reduced by intravenous injection of magnesium chloride. The aggravating role of a moderate magnesium deficiency is suggested by the synergy of hypomagnesemia and theophylline on intracellular calcium fluxes contributing to an accumulation of intracytoplasmic calcium, a situation which has been shown experimentally to generate delayed after depolarisations. The respective roles of the correction of the metabolic deficiency and of the specific antiarrhythmic action related to the calcium blocking effect of magnesium salts at cellular level are discussed.

[Aortic and mitral endocarditis caused by Haemophilus paraphrophilus with abscess of the aortic ring and cerebral embolism]. / Endocardite aortique et mitrale à Haemophilus paraphrophilus avec abcès de l'anneau aortique et embolies cérébrales.

We report the first case of aortic and mitral Haemophilus paraphrophilus endocarditis complicated by abscess of the aortic annulus in a 30-year old man with post-rheumatic mitral regurgitation. We recall the peculiar clinical features and course of this bacterial endocarditis of uncommon origin. We insist, in particular, on the occurrence of cerebral embolism and on the two-dimensional echocardiographic diagnosis of an aortic annulus abscess confirmed at surgery. Cure was obtained by aortic and mitral valve replacement and by the prolonged antibiotic therapy made necessary by the presence of cerebral lesions. After 3 months, there were no neurological sequelae, but doppler-echocardiography showed a persistent washed out pouch the reports of which with the surrounding structures were determined by transoesophageal echocardiography: moderate aortic regurgitation was detected at that level.

[HDL2 and HDL3 cholesterol in men and women in different forms of hyperlipidemia without arterial involvement]. / Etude du cholestérol HDL2 et HDL3 chez l'homme et chez la femme dans différentes formes d'hyperlipidémies sans atteinte artérielle.

The investigation was carried out in one hand on 54 hyperlipidemic men without arterial injury compared to 54 normolipidemic men, on the other hand on 50 hyperlipidemic women compared to 50 normolipidemic women. The hyperlipidemic subjects were separated in IIa, IIb and IV groups, according to WHO classification. Lipoprotein's separation was carried out by sequently ultracentrifugation and HDL2-HDL3 were isolated at a solvant density of 1.125 and 1.21; cholesterol was measured by enzymatic method. We observed a significant decrease of: (Formula: see text) ratio in all hyperlipidemic subjects compared to controls; but no significant variation of HDL2 and HDL3 cholesterol appeared in the three groups of hyperlipidemic subjects compared to controls; on the other hand we noted a HDL2 cholesterol greater in women than in men and this fact seems to prove a favorable action of this fraction in preventing atherosclerosis. The (Formula: see text) ratio remains the most discriminant factor of hyperlipidemia, but the: (formula: see text) ratio seems interesting and HDL2 cholesterol is always higher in women during hyperlipidemia with high risk, IIa and IIb.

Dilated cardiomyopathy and the level of alcohol consumption: a planned multicentre case-control study.

The association between clinical or environmental factors and dilated cardiomyopathy (DCM) has been assessed in a planned case-control study. Patients and controls were men aged between 20 and 65 years, matched for age, profession and geographic location. DCM was defined by strict radiologic and angiographic criteria excluding multiple-vessel coronary disease. Controls were recruited from the surgical centres after excluding diseases usually linked with alcohol or tobacco consumption. Univariate and multivariate analyses were used to ensure adequate techniques for matched pairs. The prevalence of diabetes and hypertension and the exposure to toxic substances, drugs and tobacco was identical in both groups. Alcohol consumption before the onset of first symptoms was higher in patients than in controls (101 vs 64 ml day-1, P less than 0.001); the excess of consumption concerns all kinds of alcoholic beverage (wine, beer, etc.). The relative risk (RR), estimated from the odds ratio, increased only among heavy drinkers (greater than or equal to 110 ml day-1; RR: 7.6, P less than 0.001) with an independent contribution of both wine (RR: 4.7, P less than 0.001) and other alcoholic beverages (RR: 4.1, P less than 0.01). In conclusion, alcohol is a strong risk factor for DCM, but the excess of risk is limited to heavy drinkers and is independent of the type of beverage.

[Left ventricular function in dilated cardiomyopathy. Noninvasive determination of end-systolic stress-diameter and shortening fraction-stress relations]. / Etude de la fonction ventriculaire gauche des cardiomyopathies dilatées. Détermination non invasive des relations contrainte-diamètre et fraction de raccourcissement-contrainte en télésystole.

The ejection fraction and fractional shortening are parameters of left ventricular function dependent on the conditions of load. They are not perfect indices of myocardial contractility. The study of the relationships between stress and diameter and fractional shortening and stress in end-systole provides a better means of assessing the contractile state of the myocardium. The relationships between end-systolic stress-diameter and end-systolic stress-fractional shortening were studied non-invasively in 10 normal subjects (Group I) and 7 patients with severe dilated cardiomyopathy (Group II). End-systolic longitudinal stress of the left ventricle was calculated from Grossman's formula by coupling automatic measurement of blood pressure (cuff method) with simultaneous M mode recordings guided by 2D echocardiography. The line of regression of end-systolic stress-end-systolic diameter was determined in all cases from a series of 14 points obtained after sublingual administration of 10 mg of isosorbide dinitrate. The line of regression of fractional shortening-end-systolic stress was established in both groups by using the values observed under basal conditions and at the peak of action of the isosorbide dinitrate. The following results obtained: Under basal conditions, patients in Group II had greater end-diastolic diameters (69 +/- 8 vs 49 +/- 4 cm, p less than 0.01), greater end-systolic diameters (61 +/- 8 vs 33 +/- 4 mm, p less than 0.001) and higher end-systolic stress (140 +/- 54 vs 67 +/- 13 10(3) dyn/cm2, p less than 0.001). Fractional shortening was lower in Group II than in Group I (12 +/- 5 vs 33 +/- 5%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Fatty acids and lipid peroxidation in experimental atheroma in the rabbit. Role played by silicon]. / Etude des acides gras et de la peroxydation lipidique dans l'athérome expérimental du lapin. Rôle joué par le silicium.

Free fatty acids (FFA) and esterified fatty acids (EFA), lipid peroxidation were analysed in experimental atheroma. Among rabbits receiving cholesterol (formula; see text) compared with controls group in FFA and EFA on plasma and aortas: arachidonic acid in plasma and malonaldehyde (MDA) in plasma and aorta are increased with atheroma and there is a positive correlation between arachidonic acid, MDA, and arterial injury; organo silicic compounds when added to atherogenic diet, had a favorable action about these variations, organic silicon having an antiatheromatous action. Therefore it seems possible that unsaturated fatty acid's peroxidation had an injurious action on arteries in atheroma by discharging toxic endoperoxides; arachidonic acid is probably involved in thromboxane's generation, and consequently in aggregability of blood platelets.

[Ventricular pre-excitation revealed by idioventricular rhythm and large QRS tachycardias. Apropos of an operated case]. / Préexcitation ventriculaire révélée par un rythme idioventriculaire et des tachycardies à QRS larges. A propos d'un cas opéré.

A 15 year old boy presented with palpitations of sudden onset and termination over a two month period. The heart was clinically and radiologically normal. The electrocardiogramme showed sinus rhythm with a short PR interval (0,11 sec) and narrow QRS complexes (0,08 sec) associated with an intermittent escape accelerated idioventricular rhythm (AIVR). During an attack of palpitations a regular tachycardia (250/min) with wide QRS complexes of the same configuration as those of the AIVR (left side delay). The diagnosis of ventricular tachycardia was retained. Endocavitary electrophysiological recording demonstrated preexcitation of the right ventricle associated with accelerated nodal conduction explaining the narrow QRS complexes in sinus rhythm. The wide complex tachycardias initiated and terminated by paired ventricular stimulation were identical to the spontaneous attacks and were attributed to an antidromic reciprocating rhythm. The hypothesis of a rhythm arising from the accessory pathway is suggested. This would explain the identical configuration of the QRS complexes of the AIVR and of the antidromic reciprocating-rhythm and the disappearance of the AIVR after surgical section of the accessory pathway.

[Fatty acid and lipid peroxidation in human atherosclerosis]. / Etude des acides gras et de la péroxydation lipidique au cours de l'athérosclérose humaine.

Plasma fatty acids and lipid peroxidation were studied in human atherosclerosis. Analysis of fatty acids in 16 controls and 32 hyperlipidemic patients showed, in the latter, a decrease in saturated fatty acids, especially palmitic and stearic acids, and an increase in unsaturated fatty acids, especially arachidonic acid. Compared to hyperlipidemic patients without arterial injury, patients with arterial injury exhibit a significant increase in malonaldehyde (MDA). In the former, MDA concentrations are significantly increased compared to controls. Therefore, peroxidation of unsaturated fatty acids may have a deleterious effect on arteries in atheroma, through the release of toxic endoperoxydes and the metabolization of arachidonic acid into thromboxane, which is a platelet aggregator. Lipid peroxidation can also be demonstrated in other diseases: we found very high MDA concentration in 11 alcoholic patients (alcoholic hepatitis, cirrhosis) and 6 patients with inflammatory conditions such as Crohn disease.

[Rupture of the liver secondary to external cardiac massage in a patient with coronary disease : recovery after partial hepatectomy and aortocoronary by-pass (author's transl)]. / Rupture de foie secondaire à un massage cardiaque externe chez un coronairen. Guérison par hépatectomie partielle suivie de pontage aorto-coronaire.

A 55-year-old man developed ventricular fibrillation during an attack of acute Prinzmetal-type angina, and was treated by external cardiac massage and a defibrillator. Hemorrhagic shock due to laceration of the left side of the liver developed 48 hours later. A liver lobectomy was performed. The postoperative course was uneventful enabling a coronarography examination to be followed by an aortocoronary by-pass, good results being still present after one year. Complications of cardiac massage, especially those involving the liver, are discussed, as well as the treatment of traumatic liver lesions.

[Evolution of serum lipids during the first hours of an acute myocardial infarction (author's transl)]. / Evolution du taux des lipides sériques pendant les premières heures suivant la survenue d'un infarctus du myocarde.

The evolution of serum lipids is investigated in 26 patients admitted in a coronary care unit less than 9 hours after the onset of an acute myocardial infarction. Blood samplings are made every 3 hours until the 15th hour after the onset of the infarction. The decrease of total serum lipids concentration is significant at the 9th hour (3rd hour : 8,45 +/- 0,58 g/l ; 9th hour : 7,74 +/- 0,36 g/l) ; that of triglycerides, at the 6th hour (3rd hour : 1,33 +/- 0,17 g/l ; 6th hour : 1,18 +/- 0,21 g/l) ; that of cholesterol is more delayed, at the 9th hour (3rd hour : 2,98 +/- 0,18 g/l ; 9th hour : 2,83 +/- 0,11 g/l). The proportion of alphalipoproteins increases, that of prebetalipoproteins decreases, that of betalipoproteins remains unchanged. There is no difference between the patients who received heparin and those who did not. Total lipids and triglycerides concentrations are lower in the group of patients with complications than in the group without complications.

[Evolution of serum lipids during the first hours of an acute myocardial infarction (author's transl)]. / Evolution du taux des lipides sériques pendant les premières heures suivant la survenue d'un infarctus du myocarde.

The evolution of serum lipids is investigated in 26 patients admitted in a coronary care unit less than 9 hours after the onset of an acute myocardial infarction. Blood samplings are made every 3 hours until the 15th hour after the onset of the infarction. The decrease of total serum lipids concentration is significant of the 9th hour (3rd hour : 8,45 +/- 0,58 g/l ; 9th hour : 7,74 +/- 0,36 g/l) ; that of triglycerides, at the 6th hour (3rd hour : 1,33 +/- 0,17 g/l ; 6th hour : 1,18 +/- 0,21 g/l) ; that of cholesterol is more delayed, at the 9th hour (3rd hour : 2,98 +/- 0,18 g/l) ; 9th hour : 2,83 +/- 0,11 g/l). The proportion of alphalipoproteins increases, that of prebetalipoproteins decreases, that of betalipoproteins remains unchanged. There is no difference between the patients who received heparin and those who did not. Total lipids and triglycerides concentrations are lower in the group of patients with complications than in the group without complications.

[Results of valve replacement with cloth-covered Starr-Edwards ball valve prosthesis (author's transl)]. / Résultat des remplacements valvulaires par prothèse de Starr-Edwards à cage habillée et bille métallique.

Cloth-covered Starr-Edwards prosthesis, was used to replace either the aortic valve (54 cases) or the mitral valve (71 cases), between 1968 and 1978, in an attempt to reduce the incidence of thrombo-embolic complications. Comparative studies using a silastene ball prosthesis during the same period showed that after aortic replacement, the mortality rate during the first month (12 p. cent), late deaths (actuarial survival curves), and most complications (including thrombo-embolin) were not significantly different in the two groups. Hemolysis is significantly greater after the two groups. Hemolysis is significantly greater after replacement with the metallic ball prosthesis; in one patient there was a mechanical change in the material. After mitral replacement, hospital mortality rates (6 p. cent) and the survival curves, after silastene or cloth-covered prostheses, did not differ significantly. Cloth covered mitral valve cause a significantly higher, but compensated rate of hemolysis, a metallic noise heard by 22 p. cent of the patients, and a significant reduction (about 1/5) in the incidence of thromboembolic complications.

The antiatheromatous action of silicon.

Silicon is a constituent of connective and elastic tissues. Administered intravenously or per os in rabbits, it inhibits experimental atheromas normally induced by an atheromatous diet, making atheromatous plaques much rarer and lipid deposits more superficial. Though the mechanism of silicon's antiatheromatous action remains shadowy, the impermeability's rise of the arterial wall is probably not the only influencing factor, because the arterial walls of animals under silicon do show a higher lipid concentration with respect to control animals. The preservation of the structure of elastic fibers, as well as of ground substance, and the absence of an increase in oleic acid in the aortic wall may also explain the rareness of atheromatous plaques.