Connective tissue changes in rheumatic heart disease.

The connective matrix of 17 surgically excised mitral complexes from patients with clinical diagnosis of rheumatic carditis was evaluated by semi-quantitative histopathological, immunohistochemical and ultrastructural parameters. Different and concomitant patterns of loose and dense fibrosis were observed with variable constitution and organization of collagen I, III, IV, procollagen III, laminin, fibronectin and elastin. Loose fibrosis exhibited codistribution of all matrix components, Initial phase of fibrosis was characterized by deposition of all matrix components organized in a network pattern. In dense fibrosis a parallel disposition of type I collagen bundles predominated. In the denser (hyalin) fibrosis, the collagen exhibited abnormalities in fiber diameters and in fiber conformation (hyperfibers) and there was reduction or disappearance of other matrix components. The presence of these different kinds of connective matrix and the ultrastructural alterations in collagen fibers are associated to different stages of fibrosis organization and probably reflect changes in collagen susceptibility to degradation. These morphologic patterns may be related to the evolution (stability or reversibility) of rheumatic sequelae.

[Inferior vena caval return to the left atrium with intact interauricular septum. Apropos of 2 cases surgically treated with success]. / Retour veineux cave inférieur dans l'oreillette gauche à septum interauriculaire intact. A propos de deux cas opérés avec succès.

Two cases of abnormal inferior vena caval return to the left atrium are reported in a 9 year old boy and 13 year old girl. The diagnosis was suspected on the finding of severe cyanosis alone, and the anomalous systemic venous return was correctly identified by angiography of the inferior vena cava. There were three angiographic points of interest in these two cases: the normal position of the inferior vena cava, the absence of a left-to-right interatrial shunt and the presence of a vertical intra-left atrial "membrane" inserted behind the orifice of the inferior vena cava. Surgical correction consisted in resecting the inferior part of the interatrial septum and reconstructing a new septum behind the orifice of the inferior vena cava with a dacron patch in one case and by direct suture in the other. The good surgical result was controlled by angiography in both cases. In the second case, an intrapulmonary shunt due to multiple arteriovenous fistulae demonstrated by contrast echocardiography was responsible for persistent mild cyanosis for a few months after surgery. The long-term clinical results were excellent in both cases. The authors review the literature of this rare malformation due to persistence of part of the right valve of the sinus venosus.

[Epigastric congenital diverticulum of the right ventricle. Resection during the neonatal period (author's transl)]. / Diverticule congénital épigastrique du ventricule droit. Résection en période néo-natale.

The authors relate a neo-natal case of cardiac diverticulum of the right ventricle, reaching the epigastric area and associated with several connected malformations : partial pericardial agenesis, anterior diaphagmatic breach, diastasis of Musc. recti abdominis, skin aplasia in the epigastric area, and, moreover, dextrocardia with Fallot tetralogy. The diverticulum was successful resected in emergency.