[Contribution of complementary examinations in the diagnosis and treatment of emboligenic cardiopathies. Retrospective study apropos of 46 cases]. / Apport des examens complémentaires dans le diagnostic et dans le traitement des cardiopathies emboligènes. Etude prospective à propos de 46 cas.

The aim of this prospective study was to assess the value of complementary investigations in the diagnosis and follow-up of embolic heart disease. Forty-six patients having presented a systemic embolism cardiac origin underwent a standard work up which included clinical examination, ECG, chest X-ray and 2D echocardiography. Other investigations were carried out in some patients: CT cardiac scan (11 cases), gamma scintigraphy with Indium III labelled platelets (6 cases) and angiocardiography (12 cases). The diagnosis of an embolic cardiac lesion was made after the standard investigations in 82% of cases. The remaining 18% of cases hall had echocardiographic abnormalities and enable the diagnosis of clinically imapparent conditions: mitral valve prolapse, aneurysm of the interatrial septum, valvular calcification and cardiomyopathy. A potentially embolic mass was visualised in 18 patients; 6 valvular vegetations, 12 left atrial or ventricular thrombi. The other specialised radionuclide, angiographic and CT investigations only confirmed the echocardiographic diagnosis of intravavitary thrombosis. These results were confirmed surgically in 19% of cases. This study shows that complementary investigations especially echocardiography, allow diagnosis of latent embolic cardiac lesions, some of which may benefit from surgical treatment. In addition, potentially embolic intracardiac masses may be visualised, so confirming the origin of systemic emboli. When surgery is not indicated, echocardiography is a good method of following up the results of medical treatment in some of these masses.

Pacemaker syndrome with DDD pacing.

DDD pacing may be associated with certain problems similar to those of the pacemaker syndrome. In the absence of mechanical dysfunction, pacemaker-mediated tachycardias have occurred in the presence of VA conduction. The correction of this problem is found in more versatile programming capability. In addition, certain phenomena relating to intraatrial conduction times and the optimal AV delay are discussed.

[Parietal rupture of the heart in the acute phase of a postero-inferior myocardial infarction. Echocardiographic diagnosis, surgical cure]. / Rupture pariétale du coeur à la phase aiguë d'un infarctus du myocarde postéro-inférieur. Diagnostic échocardiographique, guérison chirurgicale.

A 58 year old patient with no previous cardiac history developed a postero-inferior myocardial infarction, complicated at the 6th hour by parietal rupture leading to acute tamponade. This was diagnosed by echocardiography which showed a compressive pericardial effusion containing large thrombi. Surgery under cardiopulmonary bypass was successful and led to good quality survival, maintained for over 6 months. A recent angiocardiographic control showed the absence of coronary artery lesions. This case is exceptionally rare and demonstrates the value of echocardiography in myocardial infarction complicated by sudden cardiovascular collapse. In addition, in this case, the haemorrhagic nature of the pericardial effusion was demonstrated by the visualization of thrombi in the pericardial space. Their presence would seem to be quite specific of parietal rupture.

[Effect of captopril on pulmonary arterial hypertension in congestive heart failure associated with chronic obstructive bronchopneumopathy]. / Effet du captopril dans l'hypertension artérielle pulmonaire au cours de l'insuffisance cardiaque congestive associée à une bronchopneumopathie obstructive chronique.

Acute hemodynamic effects of oral 25 mg of the angiotensin converting enzyme inhibitor captopril were studied in 8 patients suffering from left ventricular failure and severe chronic obstructive lung disease (COLD) with pulmonary hypertension. In all the patients left ventricular failure resulted from a dilated cardiomyopathy. No significant change in right or left ventricular function and a decrease of 10% in arterial blood pressure and total systemic resistances were observed after administration of captopril. It is suggested that patients suffering from left ventricular failure and severe chronic obstructive lung disease will not benefit from administration of captopril.