[Diagnostic angiography of antero-apical ventricular aneurysms. Contribution of multiple projections. Apropos of 42 cases]. / Diagnostic angiographique des anévrysmes ventriculaires antéro-apicaux. Apport des incidences multiples. A propos de 42 cas.

The wide variety of definitions covering the term, left ventricular aneurysm, at the present time suggests the need for a radiological description based on pathological findings. The presence of the aneurysm on angiographic images is shown by a persistent left ventricular deformity during diastole causing a pocket separated from the contractile left ventricle by an annular constriction. A study of 42 cases of anterior apical ventricular aneurysms selected according to these criteria and investigated by multiple ventriculographic projections (LAO, RAO, anteroposterior and profile) demonstrated that the right anterior oblique projection alone is insufficient to ensure the diagnosis. An indirect sign suggestive of the diagnosis is a double outline due to the superimposition of aneurysmal and contractile zones. A complementary LAO projection, with or without a profile film, should be performed in order to confirm diagnosis and determine extent of lesion, this conditioning the result of surgery.

[Aortic stenosis in adults: contribution of catheterization to the study of associated lesions. Apropos of 137 cases]. / Le rétrécissement aortique de l'adulte: apport du cathétérisme pour l'étude des lésions associées. A propos de 137 cas.

The results of cardiac catheterisation in 137 cases of pure adult aortic stenosis considered to be isolated after non-invasive investigation (clinical examination, carotid pulse tracing, echocardiogramme) are reported. The authors analyse the reliability and risks of this examination to which they attribute a triple objective; evaluation of the severity of the AS, evaluation of LV and/or mitral valve dysfunction and the assessment of the coronary circulation in patients with angina or in all patients over 54 years of age or with coronary calcifications. The aortic valve was crossed in 89,8 p. 100 of patients. Coronary angiography was attempted in 128 cases (93,4 p. 100) and was successful in 110 cases (85,9 p. 100). The investigation was complicated by one death (0,73 p. 100) and one femoral artery thrombosis, and was complete in only 74 p. 100 of cases. The results showed the aortic stenosis to be isolated in only 84 cases (61,3 p. 100). In the other 53 cases (38,7 p. 100) there was unrecognised associated pathology: mitral valve disease was diagnosed in 14 cases (12,3 p. 100); significant coronary artery disease (greater than 50 p. 100 narrowing) was observed in 34 of the 110 patients in whom coronary angiography was successful (30,9 p. 100). In the last 5 cases, catheterisation showed: two ASDs, one partial abnormal pulmonary venous drainage, one fusiform aneurysm of the aortic isthmus, one abnormal origin of the left anterior descending artery in the right coronary sinus with a pre-pulmonary trajectory. The authors discuss the value of the various methods of preoperative assessment of AS. The relative reliability of the different non-invasive techniques is compared.(ABSTRACT TRUNCATED AT 250 WORDS)

[A new instrument for transfemoral catheterization of stenotic aortic valves (author's transl)]. / Cathétérisme des rétrécissements valvulaires aortiques par voie artérielle fémorale. Apport d'un nouveau cathéter.

Transvalvular passage was successful in 124 out of 144 patients (86.1%). The percentage of success varied according to the lesions: 82% in pure secondary stenosis, 95.7% in predominantly stenotic aortic valve disease, 87.5% in stenosis with other valve lesions, and 100% in congenital stenosis.

[Left ventricular volume measurement. A simple and precise method for calculating the enlargement factor (author's transl)]. / La mesure des volumes ventriculaires gauches. Proposition d'une méthode de calcul du facteur d'agrandissement simple et précise.

A new method is proposed for calculating the enlargement factor in order to measure left ventricular volume. It is based on the grid method of Kasser and Kennedy, modified and simplified by making use of the technical possibilities of their apparatus. The enlargement factor is measured from a graduated scale and reference to a pre-established graph.

New preshaped catheter for investigation of aortic stenosis by femoral approach: a study of 100 cases.

The authors describe their technique of catheterization of the left ventricle in aortic stenosis by a femoral approach based on a newly designed double-curved catheter. The method has been used succcessfully in 87 of 100 consecutive cases. The advantages and drawbacks of the method are discussed.

[Correlations between effort tolerance and the severity of coronary disease. Influence of myocardial lesions]. / Corrélations entre la performance physique des coronariens à l'effort et la sévérité de la maladie coronarienne. Influence des lésions myocardiques.

The influence of coronary and myocardial lesions, defining the severity of the coronary artery disease on effort tolerance was studied in 51 patients. The appearances of the coronary arteriography and ventriculography were compared with the parameters of exercise tolerance: electrocardiographic changes, maximal charge (Cw), total work (TW), maximal systolic arterial pressure (SAP), maximal heart rate, percentage of the theoretical maximal heart rate, double product, exercise capacity index (CEI). The results showed that exercise tolerance (Cw, TW, ECI) and the exercise SAP are mainly affected by the myocardial lesions: patients with very reduced left ventricular ejection fractions and double or triple artery disease have very low indices: average Cw of 60 watts, TW less than 20,000 joules, ECI approximately 50. The SAP only rises slightly. On the other hand, patients with normal or subnormal ejection fractions have much higher indices whatever the state of their coronary arteries; Cw over 80 watts, TW over 30,000 joules, ECI over 80. In addition, major left ventricular dysfunction is associated with ST segment elevation during exercise.

[Secondary coronary fistulas]. / Les fistules coronaires secondaires.

These fistulae are very rare: 8 to 11 p. 100 of all coronary fistulae. Three types are recognised: right coronaro-ventricular, left coronaro-ventricular, and coronao-pulmonary. The two first types are found most frequently in association with a sigmoid atresia on the orifice, and with ventricular hypoplasia in the presence of a functional atrio-ventricular valve. The fistula then serves as a means of ventricular ejection. Of the secondary fistulae, the right coronaro-ventricular type is the most common (73 p. 100). The authors have found 30 cases in the published literature, and add 2 of their own. They have also reviewed the clinical features and the findings on coronary arteriography and post mortem studies on such fistulae. They discuss their etiology, pathogenesis, and physiopathology. Surgical correction involves repairing the fistula in one stage. Fistulae of the left coronaro-ventricular type are exceptions to this rule (9 p. 100), as they are always associated with a rapidly fatal hypoplasia of the left side of the heart. Coronaro-pulmonary fistulae (18 p. 100) are usually found in association with extreme forms of Fallot's tetralogy, and a relatively simple surgical correction can form part of the total correction of the tetralogy.