[Left auricular hypertrophy in aortic stenosis in adults]. / L'hypertrophie auriculaire gauche dans le rétrécissement aortique orificiel de l'adulte.

Left atrial hypertrophy (LAH) was noted from the electrocardiograms of 72 of 98 adult patients (81%) who underwent hemodynamic evaluation of calcified aortostenosis (CAS). The relations between LAH and clinical, echographic and hemodynamic findings are specified. The frequency of LAH was not higher in cases of a history of hypertension, angina pectoris, lipothymia or exercise-induced syncope. In contrast, dyspnea was more frequently associated with LAH (84%) than not (17%). An approximately linear relation was seen between LAH and the mean pulmonary capillary pressure, the mean rate of circumferential decrease (RCF), the coefficient of muscle rigidity (ks of Mirsky), the left ventricular mass (LVM) and the left ventricle-aorta gradient. LAH is, therefore, a frequent sign in patients presenting CAS. Its origin is multifactorial, with a predominance of increased mean capillary pressure in cases of clinical signs of poor safety.

[Left auricular dilatation in calcified aortic stenosis in adults]. / Dilatation auriculaire gauche dans le rétrécissement aortique orificiel calcifié de l'adulte.

Two groups of patients of comparable age, one comprising 12 subjects without detectable cardiac disease and the other comprising 38 patients with calcific aortic stenosis (CAS) underwent clinical, electrocardiographic, echocardiographic and haemodynamic studies to assess the degree and significance of left atrial hypertrophies in CAS. The volume of the left atrium (LA) was globally increased in CAS (maximum volume 68 per cent: 26/38) and LA ejection fraction was decreased in 60 per cent of patients (23/38). However, the maximum volume was only moderately greater than that of normal subjects (+38 per cent). The most specific non-invasive investigation for left atrial assessment is echocardiography. There was a linear relationship between LA angiographic volume and echocardiographic antero-posterior dimension (r = 0.43; p less than 1 x 10(-2)). The duration of the P wave in S2 was a specific (75 per cent) but relatively insensitive (27 per cent) sign of LA dilatation in pure CAS. On the other hand, the Morris index based on the surface of the P terminal force in V1 was quite sensitive (77 per cent) but not very specific (25 per cent). The maximum LA volume was not related to left ventricular volume, the severity of CAS, diastolic indices of compliance or left ventricular mass. However, the minimum LA volume (after atrial systole) was related to left ventricular end diastolic (r = 0.35, p less than 0.05) and end systolic volume (r = 0.34, p less than 0.05). The LA ejection fraction was inversely related to mean pulmonary capillary pressure (r = 0.34, p less than 5 x 10(-2).(ABSTRACT TRUNCATED AT 250 WORDS)

[Anti-arrhythmic effects of intravenous magnesium sulfate in paroxysmal supraventricular tachycardia]. / Effets antiarythmiques du sulfate de magnésium intraveineux dans les tachycardies supraventriculaires paroxystiques.

The anti-arrhythmic effects of intravenous magnesium sulfate, on bouts of supraventricular tachycardia (SVT) secondary to reentry phenomenon, are evaluated in twelve patients undergoing an electrophysiological testing, because of paroxysmal SVT, the pathway of which is an intranodal reentry (eight patients) or includes an atrio-ventricular accessory route (orthodromic SVT: four patients). At the completion of the basic testing, a stable SVT is induced and an intravenous bolus of 3 grams of magnesium sulfate is administered in three minutes. The length of the SVT cycle is significantly increased from 349 +/- 71 ms to 394 +/- 70 ms (p 0.001). The injection of magnesium relieves the SVT in less than five minutes in three patients (intranodal reentry: two cases; accessory pathway: one case), or an efficacy of 25 p. cent. No incident is reported following administration of the product; but the functional tolerance may be considered as poor, mainly consisting of flushing sensations of brief duration. This study demonstrates the antiarrhythmic properties of intravenous magnesium sulfate during bouts of SVT; however, its efficacy appears moderate at the dose mentioned.

[Rheumatic involvement of the tricuspid valve. Anatomical types and possibilities of dilatation]. / Les atteintes rhumatismales de la valve tricuspide. Etude des types anatomiques et des possibilités de dilatation.

In 194 cases of rheumatic cardiac valve diseases (41 men, 153 women), macroscopic examination singled out 21 lesions of the tricuspid valve (11 p. 100). These lesions were found exclusively in women and were always associated with a mitral valve disease (18 cases) or a mitral and aortic valve disease (3 cases). The fairly uncommon tricuspid valve lesions were of two different types, the incidence of which did not seem to be influenced by age. There were 7 cases of moderately tight (n = 5) or tight (n = 2) stenosis (TS) and 14 cases of tricuspid valve disease (TD), where a moderately tight stenosis coexisted with a varying degree of regurgitation (TR). In subjects with pure TS the three commissures were regularly fused by fibrosis, whereas the only lesion of the tricuspid leaflets was thickening of their free border. In TD the commissural fusions were less extensive, but the fibrous thickening was retractile and invaded the entire leaflet. The other anatomical data (perimeter of the tricuspid annulus, condition of the right cardiac cavities, heart weight, etc.) were approximately the same in both types. On anatomical specimens, percutaneous dilatation seemed possible only in pure TS; TD did not lend itself to this of treatment. In most cases two-dimensional echocardiography combined with doppler ultrasound can provide an accurate evaluation of the lesions from which can be deduced roughly the possibilities of percutaneous valvuloplasty limited to pure TS.

[Anterior infarction of the left ventricle and infarct of the posterior wall of the right ventricle caused by thrombosis of the anterior interventricular artery]. / Infarctus antérieur du ventricule gauche et infarctus de la paroi postérieure du ventricule droit par thrombose de l'artère interventriculaire antérieure.

The association: anterior infarction of the left ventricle-posterior infarction of the right ventricle, is a rare entity. The authors report the case of a 64 year-old woman, who died on the fifth day of an extended anterior myocardial infarction, present on electrocardiograms; there were however immediate signs of right heart failure unexplained by a pericardial effusion. At the autopsy, the unusual length and distribution of the anterior interventricular artery which was completely obstructed near its origin by a thrombosis occurring on a severe atheromatous and calcified stenosis, explain this association.

[Narrow and calcified aortic valve stenosis in subjects in their 8th and 9th decades. An anatomic study of 64 cases]. / Les sténoses aortiques orificielles serrées et calcifiées des sujets des 8e et 9e décennies. Etude anatomique de 64 observations.

Anatomical data obtained from 64 patients aged from 70 to 86 years with calcified and tight aortic orifice stenosis (functional area less than 1 cm2) were divided into three types according to the macroscopic appearance of the aortic valve: (1) tricuspid valve without commissural fusion: 44 cases (18 men, 26 women, mean age 76 years); (2) tricuspid valve with commissural fusion: 12 cases (8 men, 4 women, mean age 72 years); (3) calcified congenital bicuspid valve: 8 cases (6 men, 2 women, mean age 73 years). Thus, the distribution of patients by sex became the same starting from the eighth decade of life. Calcified aortic orifice stenosis (CAOS) of degenerative origin was the most common lesion (69 p. 100), with a strong female predominance. There were several differences between degenerative CAOS and bicuspid valve stenosis on the one hand and aortic orifice stenosis with commissural fusion on the other hand. In the first group, calcification did not involve the free edge of the aortic cusps, large calcifications of the mitral ring were extremely frequent, and there was little or no aortic regurgitation. Moreover, the aortic ring clearly was wider in cases with bicuspid valve. In patients with degenerative CAOS and bicuspid valve, attempts at digital dilatation by the left ventricular route succeeded in most cases in obtaining a fairly important widening of the aortic orifice by compression and/or disruption of the valvular calcium deposits, without causing significant regurgitation of injuring the valve; the cusps recovered some mobility.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tight calcified aortic valve stenosis in adults aged from 50 to 69. Anatomical study of 50 cases]. / Les sténoses aortiques orificielles serrées et calcifiées de l'adulte de 50 à 69 ans. Etude anatomique de 50 observations.

The results of anatomical examination in fifty patients aged from 50 to 69 years presenting with calcified and tight aortic stenosis are reported. The calcifications were located mostly on the aortic side of the valves, and the aortic orifice area was less than 1 cm2. The macroscopic features of the aortic valve system fell into three categories: bicuspid valve in 28 patients (21 men, 7 women), trivalve orifice with commissural adhesion (calcified in every case) in 21 patients (18 men, 3 women), and trivalve orifice without commissural adhesion in 1 patient (a 68-year old man). Male predominance was obvious (40/50; 80 p. cent). From an analysis of the various anatomical data recorded three differences emerged: the aortic annulus was wider in cases with bicuspid valve (P less than 0.01); the calcifications did not involve the free border of the valves in cases with bicuspid valve or trivalve orifice without commissural adhesion, but they involved this free border in 1 out of 2 cases with trivalve orifice and commissural adhesion; the aortic stenosis was minimal to moderate in all cases with trivalve orifice and commissural adhesion. In patients of that age group, the main cause of stenosis was bicuspid valve which seemed to be congenital in all cases. Dilatation with the finger through the left ventricle - which cannot by any means be assimilated to inflation of a balloon passed into the aortic orifice - resulted in significant opening of the aortic orifice by compression and/or disruption of the calcareous formations in patients with bicuspid valve.(ABSTRACT TRUNCATED AT 250 WORDS)

[Positive inotropic agents. Generalities and classification]. / Les inotropes positifs. Généralités et classification.

The aim of inotropic therapy is to increase the force of myocardial fibre shortening by improving the availability of calcium to the contractile proteins. Digitalis remains the most widely used drug, but its positive inotropic effects are weak and the therapeutic index is low. Dobutamine is the most useful catecholamine because the most cardioselective and it induces the least increase in myocardial oxygen consumption. There are three groups of new inotropic agents: sympathomimetics: pirbuterol and prenalterol are effective in the short term but tolerance is usually observed within a few weeks. Salbutamol and terbutaline have only been assessed in acute studies, phosphodiesterase inhibitors (MDL 17043, MDL 19025) are powerful inotropic agents in the short and medium term. ARL 115 has mainly been studied by parenteral administration, Amrinone has a largely unknown mode of action, but is a very effective positive inotropic drug; its side-effects limit it as age. However, its derivative, milrinone, seems to be more inotropic and less toxic. The new inotropic drugs currently under assessment are active in the short term but their long-term efficacy and side-effects are still little known. The ideal inotropic agent remains to be discovered.