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The epidemiological data on cardiac insufficiency in cardiology are very scarce. Therefore, with its members the National College of French Cardiologists has conducted a survey in order to evaluate the clinical, biological and therapeutic characteristics of cardiac insufficiency patients, and thus the possible seasonal variations, and to compare them to the current recommendations and to the data from a previous survey with the same methodology performed in 1994. During each season of the year 622 cardiologists recruited the first 5 cardiac insufficiency patients who had been stable for at least three months. 8618 observations were analysed. The results showed 68% are male with an average age of 70 years, with an ischaemic aetiology in 47% of cases, hypertensive in 23%, and in NYHA stage II or III in 94% of cases. The left ventricular ejection fractions are < 30% in 22% of cases, between 30 and 50% in 62% of cases, and > or = 50% in 16% of cases (20% in those over 78 years). Medical treatment includes diuretics in 78% of cases, with 28% of patients on spironolactone, angiotensin converting enzyme inhibitors (ACE inhibitors) in 82% of cases, betablockers in 29% of cases; ACE inhibitors and betablockers are clearly prescribed more often than during the previous 1994 survey but at doses often lower than the recommendations. Lastly, there are no seasonal variations in prescriptions.

78 patients with one or more prosthetic heart valves were reoperated on between 1972 and 1978, and comprised 12% of the work load of valvular surgery. There were two postoperative periods in which the incidence of reoperation was high: the first year, 38%, and the period between the 5th and the 8th year, 41%. The main causes of reoperation could be divided into two groups: those common to all valves with paravalvular leaks (25%), endocarditis (12%) being the principal causes, and those associated with particular valves: deterioration of Beall prosthesis 33%, and thrombosis mainly affecting the Bjork and Beall prostheses (25%). The operative mortality was 12%. The fact that urgent operation is required in severe cases is underlined. In the light of these results, the surgical indications of reoperation should be discussed at an earlier stage. These indications are based essentially on the clinical condition of the patient and objective confirmation by further investigation should not delay the operation, which, in our experience, has never been unnecessary.

A cardiac transplantation was performed on November 28, 1968. This was the only one undertaken at Marseilles. After a survival period, now exceeding 6 years, the patient has had an almost normal activity. The course of this patient, the follow-up elements, the incidents and complications during this period were analysed. It was insisted upon the interest of following up the coagulation tests for the preclinical detection of rejection or menacing rejection. Practically uninterrupted heparin treatment during the 6 years might have been an element for this prolonged survival.

Operated upon in November, 1968, the last survivor of heart transplant recipients in those times has died on May 11, 1987, having survived 18 years and 6 months. The active life of this patient, however, was marred by episodes of graft rejection during the first post-operative years and by various incidents. It was mainly the complications of the immunosuppressive treatment that hampered his activities (osteoporosis) and provoked his death. Post-mortem examination confirmed that the heart was in good condition, found an active bronchial epithelioma and revealed iatrogenic lesions, namely adenomas, adenocarcinoma of the kidney and "regenerative" nodular hyperplasia of the liver with portal hypertension. Such lesions are observed in patients under long-term treatment with immunosuppressants. A "sleep apnoea" syndrome might have accounted for the formation of pulmonary hypertension lesions. The authors wish to pay their respects to this man who devoted himself to the service of other men.