[Variant angina: what to think in 2011?]. / Angor spastique : quel regard en 2011 ?

Spastic angina is considered rare but its prevalence is probably underestimated especially in case of atherosclerotic coronary lesions. Its diagnosis remains important due to its poor prognosis and therapeutic characteristics. We report three clinical cases illustrating two different clinical presentations and the problem of diagnosis of spastic angina. We performed a review of the literature essentially concerning commonly used diagnosis means and especially provocative testing for coronary spasm. This test needs to be adapted to the evolution of techniques and uses of coronary angiography in 2011, particularly the wide spread use of radial approach. Therefore new recommendations are needed, specifying the terms of provocative testing and establishing clear diagnosis criteria including clinical, electrocardiographic and angiographic data. Such guidelines would probably help to better diagnose and treat these patients in our practice.

[Mid-term echographic evaluation of systolic function after cardiac transplantation]. / Evaluation échographique à moyen terme de la fonction systolique après transplantation cardiaque.

The aim of this study was to analyse variations in left ventricular mass (LVM) and systolic function after cardiac transplantation and to evaluate eventual changes induced by the onset of systemic hypertension (HT). In a retrospective study, we selected the echocardiographic examinations of 42 patients performed at the end of the first month (M1), sixth month (M6), and at the end of follow-up (ME) after cardiac transplantation. The patients were divided into two groups (NT: n = 14; HT: n = 28) depending on whether hypertension occurred during follow-up. The average duration of follow-up was 12.8 +/- 6 months; this was comparable in the two groups. Mild left ventricular hypertrophy was observed from the first postoperative examination: M1 = 193 +/- 50 g; M6 = 199 +/- 62 g; ME = 197 +/- 45 g (NS). The hypertrophy was constant with time and related to wall thickening; it was associated with an increased left ventricular fractional shortening (FS) which decreased with time especially in the NT group (average/42 patients: M1 = 0.38 +/- 0.09; M6 = 0.34 +/- 0.08; ME = 0.35 +/- 0.05; p = 0.03 between M1 and ME). The influence of hypertension on the development of LVH and wall thickening was negligible. The role of transplant rejection should be considered: the repetition of episodes of rejection was less marked than the histological severity of rejection. The role of other factors (ischaemia, persistent haemodynamic abnormalities) is a matter of discussion.

[Intraoperative evaluation of mitral valve reconstruction using two-dimensional contrast echocardiography]. / Evaluation per-opératoire de la plastie mitrale par l'échocardiographie bidimensionnelle de contraste.

20 patients who underwent reconstructive surgery for mitral regurgitation were peroperatively investigated by contrasted bidimensional echocardiography using intraventricular injection of 20 ml of physiologic saline. Before the valvuloplasty, the peroperative quantitation of mitral leakage was in all cases closely correlated with the data obtained preoperatively. After the mitral reparation, three groups of patients could be observed: group I (12 cases): absent or minimal regurgitation (0-+); group II (5 cases): moderate mitral regurgitation (++); group III (3 cases): marked regurgitation ( - +) necessitating an immediate ECC. In two cases it was possible to improve successfully the valvular function, in the third case valvular replacement was necessary. The correlation between the data of peroperative contrasted echography at one hand and the clinical examination and the postoperative paraclinical investigations on the other hand was excellent in all cases. Thus the contrasted bidimensional peroperative echocardiography represents a reliable method for predicting the immediate results of mitral reconstructive surgery.

[Compressive hemopericardium of the right atrium after cardiac surgery]. / Hémopéricarde compressif de l'oreillette droite après chirurgie cardiaque.

Between June 1983 and September 1984, 3 patients operated for mitral valve disease presented with acute right heart failure due to right atrial compression. Emergency echocardiography did not show pericardial separation around the ventricles but in the apical 4 chamber view severe right atrial compression by an extracardiac mass was observed. Emergency surgery was performed in all three cases to evacuate a localised haemopericardium despite the absence of pericardial fusion. These cases of acute right ventricular failure underline the importance of multiplying the number of echocardiographic views in order to detect localised pericardial effusion. The diagnosis should be made as soon as possible as clinical deterioration may be rapid despite effusions of small volume. The main differential diagnoses are right atrial thrombosis and acute postoperative pulmonary embolism. In these cases of localised tamponade, the clinical signs are the result of vena caval compression or extrinsic compression of the tricuspid orifice. The preferential localisation of the haemopericardium around the right atrium is difficult to explain. It is probably related to the low pressures in this region. The echocardiographic appearances of this condition have been established allowing reliable diagnosis.

[Value of echocardiography in heart surgery]. / Intérêt de l'échocardiographie en chirurgie cardiaque.

Between October 15th 1981 and January 31st 1982, 297 echocardiogrammes were performed in the department of cardiac surgery at Broussais Hospital, 31 of which were requested and carried out as emergency procedures by day or night, 187 pre- or postoperatively and 79 in the out-patient clinic. M mode and 2D echocardiographies were performed at the bedside when necessary, namely in the intensive care unit pre- and postoperatively. The examination was performed by trained personnel, both in the out-patient clinic and in the intensive care unit. In the 31 cases in which the examination was requested as an emergency, the information obtained practically always contributed to establishing the right diagnosis and to correct therapeutic intervention. In 24 cases, the emergency occurred in the post-operative period: 18 cases of cardiac failure, of which echocardiography contributed to the indication of reoperation in 4 cases, the contra-indication of reoperation in 11 cases, and the need for emergency catheter studies in 2 cases. In one case the examination was unnecessary. In 6 other cases, suspected intracardiac thrombosis was excluded. There were 7 requests for emergency echocardiography in the preoperative period and the information obtained contributed to the indication for emergency surgery in 3 cases, and guided the operative strategy. The need for urgent surgery was refuted in 3 cases. The examination was unnecessary in 1 case. The results of echocardiography were very reliable. It does not seem to have provided any misleading information; the examination was incomplete in only 10% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of single ventricle by direct atriopulmonary anastomosis without tube or valve. Apropos of a case operated on]. / Traitement du ventricule unique par anastomose antrio-pulmonaire directe sans tube ni valve. A propos d'un cas opéré.

A case of single ventricle with pulmonary stenosis operated at 20 years of age by direct atrio-pulmonary anastamosis is presented. This procedure in contrast to classical techniques does not use an intraventricular patch or a valved ventriculo-pulmonary conduit. It is an adaptation of the Fontan technique initially proposed for tricuspid atresia. The operation consisted of closing the right atrioventricular orifice with a piece of Dacron, suturing the pulmonary valves (which were stenosed) and connecting the right atrium and pulmonary artery by a direct anastamosis using the auricle. The clinical result remains satisfactory one year after surgery: the cyanosis has regressed, the functional tolerance is perfect, there is no hepatomegaly and the patient is in sinus rhythm. The technique is very simple and involves less risk to the His bundle than intraventricular septalisation. It should be reserved to cases of single ventricle with low pulmonary pressures and resistance without cardiac failure. The long-term prognosis depends on the tolerance of the right atrium and is, at present, unknown.