[Endocarditis due to staphylococcus aureus during cardiomyopathy]. / Endocardite à staphylocoque doré au dours d'une cardiomyopathie obstructive.

In a patient suffering from obstructive cardiomyopathy (IHSS), the onset of septicaemia due to staphylococus aureus was accompanied: 1. by the appearance of massive mitral incompetence and of cardiac failure; 2. by a marked reduction in the left intra-ventricular pressure gradient; 3. by acute reversible renal failure (interstitial nephritis); 4. by a glomerulonephritis with immune complexes deposits. After the septicaemia had been treated, replacement of the mitral valve by a disc prosthesis of Lillehei was carried out. Twenty months after the operation, the patient was completely asymptomatic, and catheterisation showed that the left intra-venticular pressure gradient had disappeared, as had the haemodynamic signs of cardiac failure.

Left ventricular compliance in acute myocardial infarction in man.

Left ventricular end-diastolic pressure (P) and volume (V) were measured in 12 patients with acute myocardial infarction. It was assumed that the diastolic P-V relationship was exponential and corresponded to the formula P=be KV. In 7 patients submitted to volume loading, several data points of this relationship were obtained and at zero volume, the mean intercept with the ordinates was 0.037+/-0.015 kPa (SEM) (0.28+/-0.12 mmHg). In the other 5 patients, the P-V curve was plotted through this intercept and the pressure and volume co-ordinates obtained by control. The K coefficient (passive elastic modulus) was greater, and the normalised left ventricular compliance index (dV/VdP) was smaller in the infarct group than in the control group. This suggests decreased left ventricular compliance during the acute phase of myocardial infarction. By comparing left ventricular function curves plotted using either end-diastolic pressure or end-diastolic volume as the stretch index it is possible to evaluate the relative participation of decreased compliance and depressed contractility in global left ventricular function.

Clinical and hemodynamic results of intraortic balloon counterpulsation and surgery for cardiogenic shock.

Forty-two patients with cardiogenic shock (CS) secondary to myocardial infarction were treated with intra-aortic balloon pumping (I.A.B.P.). In 14 patients C.S. was associated with ventricular septal defect (V.S.D.) and in four with mitral regurgitation (M.R.) secondary to rupture of the posterior papillary muscle. All patients were resistant to conventional medical therapy. Shock was reversed in 20 of the 24 patients in C.S. without mechanical complications. After 24 to 48 hours of I.A.B.P., cardiax index (C.I.) increased from 1.38 to 2.00 L./min./M2, systolic arterial pressure (S.A.P.) from 83 to 96 mm. Hg, urinary output (U.O.) from 10 to 56 ml. per hour, and pulmonary wedge pressure (P.W.P.) decreased from 22 to 16 mm. Hg. Three patients treated with I.A.B.P. alone survived more than 1 year; of the 13 patients who were balloon dependent, four have undergone emergency surgical procedures and two were long-term survivors. In all patients with mechanical complications, I.A.B.P. resulted in significant clinical and hemodynamic improvement. P.W.P. decreased from 19 to 15 mm. Hg, and U.O. increased from 13 to 38 ml. per hour while S.A.P. remained unchanged. In patients with V.S.D. the pulmonary/systemic flow ratio (P/S) declined from 3.5 to 2.8; in patients with M.R., "V" wave amplitude decreased by 8 mm. Hg. Emergency surgery was performed in 10 patients with V.S.D. and in three patients with M.R. and there were eight long-term survivors (13 to 27 months). It is concluded that I.A.B.P. is an effective means of supporting the circulation in C.S. Of the 42 patients with C.S. treated by combining I.A.B.P. and emergency surgery, 13(31%) were long-term survivors (20 +/- 6 months).

Comparative efficacy of short-acting and long-acting quinidine for maintenance of sinus rhythm after electrical conversion of atrial fibrillation.

Forty patients with chronic atrial fibrillation, apparently unrelated to any overt heart disease, were randomly allocated to two groups after restoration of sinus rhythm by direct current shock. The patients in group A were given 4 daily doses of quinidine polygalacturonate, while those in group B were given 2 daily doses of a long-acting quinidine preparation, quinidine arabogalactan sulphate. The percentage of early relapses (within the first month following DC shock) was not significantly different in the two groups: 44-4% in group A and 35% in group B (P greater than 0-50). On the other hand, there were fewer late relapses with long-acting quinidine. After 18 months of treatment, 27-8% of patient in group A remained in sinus rhythm, compared with 61% in group B (P less than 0-05). The average amount of quinidine actually ingested by the patients in group A was smaller than that in group B. However, this could not entirely account for the difference observed in the incidence of relapse since with short-acting quinidine the proportion of patients remaining in sinu rhythm was similar whether the dose was decreased or not. The incidence of gastrointestinal side-effects was the same in the two groups and there were no seriou complications that could be attributed to treatment. It is concluded that long-acting quinidine preparations are more effective than conventional quinidine in preventing late relapses of atrial fibrillation.

[Emergency myocardial revascularization with assisted circulation for early extension of infarction]. / Revascularisation myocardique d'urgence sous assistance circulatoire pour extension précoce d'infarctus

In order to reduce the oxygen consumption of the myocardium and preserve the areas around the infarction, still alive but undergoing ischemia, 8 patients with early extension of their infarction were placed under circulatory assistance by intra-aortic counter-pulsation. In 8 patients, the pain disappeared and did not recur, permitting left ventriculography and coronary arteriogrpahy. This examination is often considered high risk, but in no patient in our series, during the acute phase of myocardial infarction, were there any complications. 6 patients underwent operation, and aortic counter-pulsation was used during the post-operative period. In all, eight coronary by-pass operations were carried out and, in one case, part of the ventricular wall was resected. All patients are still alive, none have heart failure or residual angina; the follow-up period is now 2 years for the first case.