[Right-left auricular shunt caused by patent foramen ovale at a multi-purpose intensive care unit. Apropos of 3 cases]. / Shunt auriculaire droite-gauche par foramen ovale perméable en réanimation polyvalente. A propos de trois observations.

Three cases of symptomatic right-to-left interatrial shunt through a patent foramen ovale were detected in the course of a case of paradoxical embolism related to a massive pulmonary embolism, a case of refractory hypoxemia after cardiopulmonary bypass and a case of refractory hypoxemia in a patient with tricuspid endocarditis. According to anatomic studies, the incidence of patent foramen ovale is 25-30% in healthy people. In that case any pathological event generating an increase in the right atrial pressure higher than the left atrial pressure may induce a right-to-left shunt with systemic arterial desaturation and possible paradoxical embolization. The reported cases emphasize the advantage of ultrasonic examinations (contrast sonocardiography, pulsated or coloured Doppler) to show the right-to-left atrial shunt. The demonstration of this acquired shunt requires appropriate measures in order to reverse the atrial gradient. Sometimes a specific therapy is required such as caval filter insertion in case of pulmonary embolization or surgical closure of foramen ovale in some patients.

[Transesophageal stimulation in the treatment of atrial flutter and tachysystole. Factor influencing immediate results]. / La stimulation transoesophagienne dans le traitement du flutter et de la tachysystolie auriculaire. Facteurs influençant les résultats immédiats.

The effectiveness and safety of transoesophageal atrial pacing in the treatment of atrial flutter and tachycardia have been well demonstrated. The purpose of this study was to determine the factors that could influence the results of this method at the end of the procedure. Seventy-seven transoesophageal atrial pacings were performed in 62 unselected consecutive patients with either flutter or atrial tachycardia. The following parameters could be evaluated in 55 patients: date of onset of the arrhythmia, echocardiographic diameter of the left atrium, maximum amplitude of oesophageal atrial potentials, voltage and frequency of stimuli in the last stage of pacing. Our results can be summarized as follows: In both flutter and atrial tachycardia taken globally, conversion to sinus rhythm was obtained in 37 p. 100 of the cases, and conversion to atrial fibrillation in 46.7 p. 100 of the cases. The failure rate was 19.4 p. 100; all failures were due to lack of atrial capture during pacing. The main factor or transoesophageal atrial capture is voltage. Patients must be able to tolerate the voltage needed for capture. In the case of flutter, when capture was achieved a normal-sized left atrium and a high maximum amplitude of oesophageal atrial potentials were factors indicating that conversion to sinus rhythm could be expected. This, however, did not apply to atrial tachycardia. -- Whatever the type of tachyarrhythmia, the more recent its onset the easier its reduction.

[Tolerance and prognostic value of Thallium 201 myocardial tomoscintigraphy with dipyridamole in the aged subject]. / Tolérance et valeur pronostique de la tomoscintigraphie myocardique au thallium 201 sous dipyridamole chez le sujet âgé.

The authors present a retrospective study of 46 consecutive patients aged from 70 to 79 years (mean 73.3 +/- 2.5 years) with suspected coronary artery disease who, being unfit for exercise tests, were explored by myocardial scintigraphy with thallium 201 after coronary dilatation with intravenous dipyridamole. The examination was well tolerated by 30 patients. Such classical side-effects as chest pain, malaise, dizziness, headache, flushing, vomiting and transient arrhythmia or repolarization disorders were recorded, but they were not more frequent than in younger subjects. However, the occurrence of severe hypotensive malaise relieved by theophylline in two cases and of angina in about one third of patients with myocardial ischaemia means that the procedure must be performed under close supervision. A fall in blood pressure (-11 mmHg on average) and a rise in heart rate (+8 beats/min on average) were usual. Post-scintigraphy follow-up of patients over a mean period of 11.1 +/- 6.2 months showed that a reversible defect of thallium 201 uptake, due to redistribution, is a highly selective indicator of patients who are particularly exposed to a cardiac accident in the short--or mid-term. Only one out of 26 patients without reversible ischaemia (4 p. 100) subsequently presented with a major coronary event (unstable angina). In contrast, in the group of 20 patients with reversible ischaemia three required early myocardial revascularization; furthermore, five serious accidents (29 p. 100) occurred among the 17 patients who were left under medical treatment, including two sudden deaths, two cases of unstable angina and one case of myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Coronarography in the study of myxoma. Apropos of a case diagnosed by this technic]. / Apport de la coronarographie dans l'étude des myxomes. A propos d'un cas diagnostiqué par cette technique.

In a 59 years old woman presenting a rudimentary picture of myocardial infarction, ventriculograms confirm a limited necrosis and coronarography shows an abnormal vascular image, evoking an intracardiac tumor, while the arteries are free of atherosclerosis or thrombosis on angiography. Although auscultation and echography are normal, the diagnosis of myxoma will be confirmed by angiocardiography, then by surgery and pathology. The advantage of selective coronary angiography in myxomas is considered with 24 cases from the literature having undergone this examination, including 20 cases, among which ours, which present an aspect of "tumoral vascularisation". The particularities of coronarography (aneurysms, embolic obstruction, origin and aspect of hypervascularisation) are analyzed. This technique appears very useful, not only to detect a complication of the tumor or an associated coronaritis, but also to help in the diagnosis of myxomas in cases where angiocardiography or mostly echocardiography are deficient.

[Unruptured aneurysms of the sinus of Valsalva disclosed by syncopal disorders of cardiac excitability. Apropos of 2 cases]. / Anévrysmes du sinus de Valsalva non rompus révélés par des troubles de l'excitabilité cardiaque syncopaux. A propos de deux observations.

Aneurysms of the sinus of Valsalva are rarely diagnosed before rupture into the cardiac cavities which usually leads to the appearance of a continuous murmur and cardiac failure. In the two cases described, the presenting symptom of the aneurysm was syncope due to cardiac hyperexcitability: ventricular tachycardia in the first and paroxysmal tachyarrhythmia in the second case. The presenting symptoms of unruptured aneurysms of the sinus of Valsalva were analysed. In general, they are: uncontinuous cardiac murmurs: either diastolic murmurs of aortic regurgitation, systolic murmurs of mitral or tricuspid regurgitation, or, as in our first case, of obstruction to right ventricular ejection; arrhythmias: the commonest are conduction defects, which can be syncopal; hyperexcitability (especially ventricular) seems to be very care. Echocardiography is a valuable tool for the diagnosis of sinus of Valsalva aneurysms. The appearances of unruptured aneurysms in our two patients are described. The presence of syncopal cardiac hyperexcitability, possibly associated with one of the preceding auscultatory abnormalities is an indication for echocardiography which may lead to the diagnosis of this condition.

[Congenital paravertebral arteriovenous fistulae in children and adolescents]. / Fistules artério-veineuses paravertébrales congénitales de l'enfant et de l'adolescent.

These arteriovenous fistulae (AVF) situated in the paravertebral area present as a murmur which explains their cardiological orientation. They are characterised by the presence of one or more afferent paravertebral arteries giving rise to collateral vessels irrigating the bone marrow. The aim of this study of 13 cases was to study the diagnostic and therapeutic problems, and the evolution of this particular localisation of AVF. Two groups of paravertebral AVF were individualised: - Cervical AVF in which the vertebral artery was always involved (7 cases). Four were simple (only one fistula) and three were complex, having several afferent arteries. Two presented as a rapidly growing vascular tumour. Two caused an asymptomatic angiographic vertebral steal syndrome. Two simple forms were obturated by a detachable balloon and one by surgical excision. Two complex forms were treated by embolisation and surgery. Total closure of the AVF was obtained in all cases without complications. - Dorso-lumbar AVF (6 cases). The afferent vessels are the intercostal (D6 to D8) or lumbar (L2 to L4) arteries. Anatomically, these are extra-medullary fistulae with an extra or intra-vertebral venous drainage. Enlargement in an adjacent conjugating foramen forms a tumour which may narrow the spinal canal (1 case diagnosed by CAT) or erode the vertebral body, so compromising the spinal support. Spontaneous closure of the AVF was observed in 1 case. Three cases were treated surgically with good results; two patients are waiting for embolisation. A review of the literature provides complementary information on the long-term evolution of these AVF and confirms the need for systematic therapy as demonstrated in our study.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pseudotumoral mitral endocarditis. Diagnostic and therapeutic problems apropos of a case report with review of the literature]. / L'endocardite mitrale pseudo-tumorale. Problèmes diagnostiques et thérapeutiques à propos d'une observation avec revue de la littérature.

The authors report an observation of infectious endocarditis of the mitral valve with voluminous pseudo-tumoral growth. The developmental, symptomatic and etiological characteristics of this form of endocarditis were specified through a review of the literature. Echocardiography provides the best means of early detection of these large vegetations but it is not always easy to distinguish them from other left intra-auricular tumors, more especially as several cases of infectious myxoma have been described. Spontaneous development of mitral endocarditis is very harmful, as are infected left intra-auricular tumors, and surgical treatment of these disorders seems essential as soon as the infectious process has been arrested.

[Diagnosis of left proximal coronary stenosis using 2-dimensional echocardiography]. / Diagnostic des sténoses coronariennes gauches proximales par échocardiographie bidimensionnelle.

The value of two-dimensional echocardiography (2DE) in the diagnosis of proximal left main coronary artery disease was assessed in 63 patients in whom 2DE was performed and interpreted before coronary angiography. The diagnosis of coronary artery disease depended on two groups of criteria, one group based on the lumen of the artery and the other, on the arterial wall. Eighty three pre cent of the investigations were interpretable. The bifurcation of the left main coronary artery was visualised in 23% of cases. 2DE was positive in 8 of the 10 cases (80%) in which coronary angiography showed stenosis of the left main coronary or the very proximal part of the left anterior descending arteries. There were two false negative results (20%). When coronary angiography did not show left main coronary stenosis (42 cases), 2DE was also negative in 39 cases (92%); there were 3 false positive results (7%), one due to calcification and other two to errors in appreciation of the criteria of stenosis. These results show that 2DE is useful before coronary angiography in identifying cases of possible left main stem or proximal left anterior descending disease providing the diagnostic criteria of coronary stenosis are strictly observed.

[Amiodarone and hyperthyroidism]. / Amiodarone et hyperthryroïdie.

22 cases of hyperthyroidism occurring during or following treatment with amiodarone are reported and compared with more than 15 cases in the literature. The specific clinical features of these cases of hyperthyroidism are presented and the problems in interpretation of the laboratory thyroid function tests are discussed. A study of the course of these cases reveals a number of prognostic factors. Finally, the authors describe the practical management of this form of hyperthyroidism.

[Right coronary-cardiac fistulae. Anatomic and clinical study, course and therapy. Apropos of 3 new cases]. / Les fistules coronaro-cardiaques droites. Etude anatomo-clinique evolutive et thérapeutique. A propos de trois nouveaux cas.

Three cases of coronary-cardiac fistulae diagnosed in the Cardiologic Unit of the Dijon University Hospital are reported. With reference to these cases current knowledge on this rare condition is reviewed. Symptomatology is variable, with sometimes only a systolic and diastolic murmur on the sternal border, usually with good functional tolerance. A thorough investigation, including left angiography, ascertains diagnosis and shows the exact nature of the lesions. Surgery is almost always advocated as it often ensures good results and avoids delayed complications, which are mainly heart failure by coronary insufficiency, and infectious endocarditis.

[Aortic insufficiency associated with ventricular septal defect and a coronary-right ventricle fistula after bacterial endocarditis: surgical correction of 3 lesions]. / Insuffisance aortique associée à une communication interventriculaire et à un fistule coronaro-cavitaire droite au décours d'une endocardite bactérienne: correction chirurgicale des trois lésions.

The authors report a case of Staph-aureus endocarditis on preexisting aortic incompetence. Two complications were observed during the course of the infection: ventricular septal defect, rare but classical, and coronary-right ventricular fistula, a complication not previously described to the best of the author's knowledge. Before the onset of endocarditis a continuous murmur had not been detected clinically or by phonocardiography. This sign appeared while the patient was receiving effective antibiotic therapy. The diagnosis, suggested by the clinical signs in a patient in cardiac failure, was confirmed by catheterisation. This type of complication, already described in peripheral vessels, may be understood when the extent of the lesions at the right coronary cusp, near the septum and right coronary ostium, are appreciated. A good surgical result was obtained due to early operation of the three lesions.

[Open study of bromapezan in ambulatory and psychiatric hospital patients (author's transl)]. / Etude ouverte du bromazépam chez des patients ambulatoires et hospitalisés en milieu psychiatrique.

Psychiatrists working in hospital and in private practice took part in co-operative trial aimed at evaluating the effectiveness and safety of bromazepam. The study was of the open type and involved 10 hospital patients and 20 ambulatory patients. The same protocole was followed for each patient. Twenty-five patients (including 5 in hospital) had anxiety neurosis; the remaining 5 had anxiety following weaning from alcohol. The anxiolytic effects of the drug, determined by means of Hamilton's anxiety scale and overall clinical judgement, were generally found to be satisfactory. The effective doses ranged from 1 to 3 tablets per day in ambulatory patients and from 3 to 5 tablets per day in hospital patients. The main side-effects were related to unwanted sedation; they only occurred with the higher doses and rarely interfered with the beneficial effects of bromazepam.

[Fibroblastic constrictive endocarditis. Apropos of a form localized in the left ventricle]. / Endocardite constrictive fibroblastique. A propos d'une forme localisée au ventricule gauche

The authors report a case of a localised form of this strange disorder which was confined to the left ventricle, and in which the diagnosis was tentative for a long time. In this case it was possible to carry out a removal of the fibrous plaque after opening the apex of the left ventricle, the mitral valve being preserved, as described by Dubost; the functional and haemodynamic results of this procedure were very satisfactory.