[Value of cibenzoline in the preventive treatment of recurrent atrial arrhythmia]. / Intérêt de la cibenzoline dans le traitement préventif des arythmies auriculaires récidivantes.

Cibenzoline is a Vaughan-Williams class I anti-arrhythmic with properties intermediate between subclasses IA and IC which limit the incidence of proarrhythmic effects. These specific properties of the drug facilitate the prescription of cibenzoline in cardiology, particularly for the prevention of recurrent atrial arrhythmia: fibrillation, flutter, atrial tachycardia. This study demonstrates that cibenzoline is effective in these indications, since only 23% of the patients had relapsed after 6 months. This efficacy, combined with the good tolerance of the treatment, makes it possible to recommend the prescription of cibenzoline as a first-line treatment for the prevention of atrial arrhythmia. It represents an effective and safe option.

[Aortic dissection with normal aortography and x-ray computed tomography. A diagnostic trap not to be ignored]. / Dissection aortique avec aortographie et scanner normaux. Un piège diagnostique à ne pas méconnaître.

We are reporting the case of a 63 y.old patient whose initial clinical examination and ultrasonographic data had led to the diagnosis of acute aortic dissection. Only an emergency surgical procedure was able to confirm the diagnosis, after failure of angiography and CT-scan to do so. In the light of this example, we are presenting a reminder of the sensitivity of various paraclinical examinations, classically accepted to establish this diagnosis.

[Comparison of 3 methods of calculating valve surface by continuous Doppler in the quantitative evaluation of 42 cases of aortic stenosis in adults]. / Comparaison de trois méthodes de calcul de surface valvulaire par le Doppler continu dans l'évaluation quantitative de 42 rétrécissements aortiques de l'adulte.

42 patients with a tight, symptomatic aortic stenosis, underwent a Doppler test followed, within approximately 5 days, with catheterization. Non-invasive measurement of the maximal aortic gradient is obtained by applying Bernouilli's formula to the maximum speed. Three methods of evaluation of the valvular areas are compared. The first method derives from Gorlin's formula. The second corresponds to the ratio aortic flow/mean velocity. The third method uses the continuity equation. The results compared with haemodynamic data are as follows: the correlation factor regarding the gradients is: r = 0.72 (EA: 22 mmHg), going from r = 0.74 (EA: 0.11 cm2) for the first method, r = 0.76 (EA: 0.15 cm2) for the second method and r = 0.81 (EA: 0.10 cm2) for the third method. In conclusion, the calculation of the maximum gradients is of good predictive value to differentiate minimal and tight aortic stenoses. Regarding moderate or decompensated aortic stenoses, it is advisable to follow the Doppler with the measurement of the valvular areas. The first two methods are characterized by their practicality and easy realization; the third method is preferable when there is an associated mitral valve disease.

Diagnostic value of stress radionuclide angiography in coronary artery disease: a comparison of different interpretation criteria.

In order to compare different criteria in the interpretation of stress radionuclide angiography (SRNA) 96 patients with suspected coronary artery disease (CAD) were investigated by both SRNA and coronary arteriography. The result of coronary arteriography was taken as the gold standard for the diagnosis of CAD. Left ventricular ejection fraction (LVEF) was measured at each step of the stress study using the equilibrium radionuclide technique. The diagnostic value of eight interpretation criteria based on the evolution of global LVEF during stress were compared with each other, using the ROC technique. The best diagnostic criterion proved to be the normalized increase of LVEF proposed by Goris. The most commonly used criteria, LVEF increase and LVEF measured at maximal exercise, were not optimal. In the whole population of patients, the best criterion had a sensitivity of 85% for a specificity of 80% and a specificity of 83% for a sensitivity of 80%. In the population, following exclusion of patients with preceding myocardial infarction, the specificity was 74% for a sensitivity of 80% and a sensitivity of 74% for a specificity of 80%. Thus, the choice of interpretation criteria is very important in order to optimize the sensitivity and specificity of this diagnostic test.

[Evaluation of pulmonary systolic arterial pressures by continuous Doppler in tricuspid regurgitation in adults. Apropos of 43 cases]. / Estimation des pressions artérielles pulmonaires systoliques par le Doppler continu en présence d'une fuite tricuspide chez l'adulte. A propos de 43 cas.

Forty-three hospital patients with tricuspid regurgitation were prospectively explored by continuous wave Doppler ultrasound to determine their pulmonary systolic arterial pressure. In the absence of pathology of the pulmonary orifice this value corresponds to the sum of the right atrioventricular systolic gradient calculated by Bernoulli's equation DP = 4V2 from the tricuspid regurgitation and the right atrial pressure evaluated by clinical examination. The values obtained are compared with the results of right heart catheterization. Our study showed good correlation (r = 0.90) with a standard error of 8.2 mmHg, the main source of effort being the clinical quantification of right atrial pressure. These results confirm that pulmonary systolic arterial pressure can reliably be measured by this method in the presence of tricuspid regurgitation. The method is of considerable interest in permanent pulmonary hypertension or in emergencies.