[Congenital ventricular septal defect with late detection. Apropos of a case in an adult]. / Communication interventriculaire congénitale de découverte tardive. A propos d'une observation chez l'adulte.

The authors report the case of a congenital interventricular communication discovered in a 75 year-old female patient. The shunt was identified on the cardiac Doppler and confirmed by catheterization. It was a type IIa interventricular communication which decompensated in the course of a pulmonary embolism. This case points out how rare is the diagnosis of congenital interventricular communication made during adulthood, and emphasizes the advantage of the Doppler in the diagnosis of ventricular shunts.

[Postoperative hemopericardium compressing the left atrium. Apropos of a case]. / Hémopéricarde postopératoire comprimant l'oreillete gauche. A propos d'un cas.

We report a case of tamponade due to an effusion of blood which had occurred two weeks after an aorto-coronary bypass and was unusually located behind the left atrium. The effusion, with severe clinical symptoms, was diagnosed by echocardiography and computerized tomography of the chest. These examinations provided an accurate anatomical diagnosis on which the approach route of the emergency operation was based.

[Comparative study of pulsed and continuous Doppler in the quantification of aortic insufficiency]. / Etude comparative des Dopplers pulsé et continu dans la quantification des insuffisances aortiques.

31 patients whose mean age was 61 +/- 29 yrs. presenting with aortic regurgitation (AR) benefited from cardiac catheterization which was preceded by Doppler ultrasound examination in a prospective study to compare the diagnostic contributions made by continuous vs pulsed wave techniques respectively in the quantitative assessment of AR, with reference to semi-quantitative angiographic evaluation. Pulsed Doppler analysis involves mapping of the left ventricle in two projections as well as the investigation of blood flow in the aortic isthmus using a suprasternal approach. Collection of continuous wave signals from the cardiac apex makes it possible to measure circulatory deceleration and the half-time of decrease in signal velocity and the protodiastolic pressure gradient. Our results corroborate the reliability of data obtained using continuous-wave Doppler technique in finding significant correlations for each parameter respectively: r' = 0.88 (p less than 0.001); r' = -0.81 (p less than 0.001); r' = -0.75 (p less than 0.001). Values determined by pulsed wave Doppler mapping of the left ventricle appear to be less satisfactory but are significant: r' = 0.68 (p less than 0.001) while measurement of end-diastolic blood flow recorded in the isthmus of the aorta is more highly correlated: r' = 0.84 (p less than 0.01), with the main disadvantage being its limited applicability to a small number of our patients (48%). We thus concluded that continuous-wave Doppler ultrasound is a better technique in the quantitative evaluation of AR, while recalling the essential additional value of pulsed-wave Doppler technique to localize the leakage and of ultrasound to assess its impact on the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

[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.