[Frequency of angiographic restenosis after 6 months and long-term outcome of coronary angioplasty]. / Fréquence des resténoses angiographiques à 6 mois et devenir à long terme après angioplastie coronaire.

Five hundred patients with a mean age of 59 years were followed up for an average of 32 months after coronary angioplasty. All patients were included in a prospective study comprising coronary angiography at 6 months for 379 patients (91% primary successes). The long-term outcome was evaluated by a questionnaire or telephone interview in all cases. The global primary success rate was 84.4% in this series. The primary failures include 1.8 fatalities, 0.6% myocardial infarction, 2% emergency coronary bypass surgery and 11.2% without immediate clinical consequences. At 6 months, there were 48% of restenoses (182/379 patients) and 28% underwent immediate repeat angioplasty (141/500 patients) with a primary success rate of 91%. After the repeat angioplasty, the restenosis rate was 43% but this varied according to the time from the first restenosis: 60% when the interval was short (under 2 months) compared with 21% when the interval was 6 months (p < 0.01). The actuarial survival rates at 4 years were 95% after successful angioplasty 96% after uncomplicated failures or medically treated restenosis and 98% after bypass surgery. The predictive factors for secondary death were age of over 70 years, previous non-thrombolized myocardial infarction and complications of angioplasty. The long-term outcome was good despite the 48% 6 months restenosis rate requiring revascularisation procedure in 73% of cases.

[Left ventricular ejection impediment during mitral valve replacement. Apropos of a case after insertion of a Carpentier-Edwards bioprosthesis]. / Gêne à l'éjection ventriculaire gauche lors des remplacements valvulaires mitraux. A propos d'une observation après mise en place d'une bioprothèse de Carpentier-Edwards.

Left ventricular ejection impediment is one of the complications of mitral valve replacement, especially in case of isolated mitral stenosis with small left ventricle. The use of a "low profile" valve does not prevent this complication. The diagnosis is based on catheterization but the advent of the ultrasound-Doppler may make it easier.

[Quantitative evaluation of myocardial ischemia using imaging methods]. / Evaluation quantitative de l'ischémie myocardique par les méthodes d'imagerie.

Secondary prevention of myocardial infarction includes all measures likely to reduce morbidity and mortality after the infarction. It is a highly heterogeneous concept applied to a highly heterogeneous disease. The natural history of myocardial infarction, which must be known to determine the frequency of critical events and hence devise a trial, is incomplete particularly since treatment capable of altering this history (aorto-coronary bypass, thrombolysis) have been introduced. Future trials in secondary prevention of myocardial infarction must concentrate on such important questions as: can the possibilities of reperfusion be extended as regards the acute phase, and which preventive measures are useful to patients at high risk post-infarction? The A.P.S.I. study (acetolol in the secondary prevention of myocardial infarction) is an example of study aimed at answering the second question.

[Bepridil and torsades de pointes. Apropos of 11 cases]. / Bépridil et torsades de pointes. A propos de 11 observations.

The authors report 11 cases of spikes occurring under bepridil treatment. It concerns an elderly population, predominantly female, receiving most of the time 300 mg of bepridil. The frequency of associated hypokalemic or arrhythmic medications is emphasized. The comparison of these results to those from other series in the literature, enables to propose precautions for the use of this molecule.

[Pneumopathy caused by amiodarone. An often unrecognized iatrogenic entity]. / Pneumopathie à l'amiodarone. Une entité iatrogène sovent méconnue.

Three cases of interstitial pneumopathy secondary to amiodarone are reported, in addition to almost 200 cases previously published in the literature. The main clinical, radiological, biological and evolutive characteristics are reminded in emphasizing the advantages of bronchioalveolar irrigation. Some factors seem to be predisposing, without any definite proof however. They are: high daily dosage, long term treatment, high cumulative dose, concomitant ingestion of another anti-arrhythmic medication, especially in elderly patients, and in patients who, before any treatment, presented a decreased total pulmonary capacity and a CO transfer capacity lower than 80 p. cent of the theoretical values. Discontinuation of amiodarone and administration of steroids usually produce a rapid regression of the clinical and radiological symptoms.