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In a 41-year old man hospitalized for investigation of a systolic ejection murmur, echocardiography revealed an apical (17 mm) and, chiefly, a mid ventricular (38 mm) myocardial hypertrophy resulting in a true stricture at that level. During systole the mid ventricular area became obstructed, dividing the left ventricule into an apical akinetic chamber and a proximal hyperkinetic chamber. Left ventriculography confirmed this abnormality and catheterization showed a left intraventricular pressure gradient of 60 mmHg. Although left coronary arteriography proved normal, myocardial radionuclide scanning at exercise displayed apical necrosis which resulted in a peculiar haemodynamic behaviour well demonstrated by doppler ultrasound. The apex of the left ventricle was filled in two stages: first, during atrial contraction, giving at doppler (mid ventricular sample) a positive flow with a speed of 1m/sec during 120 ms; then, during the isovolumetric period, giving a positive flow with a speed of 1m/sec during 60 ms. The apex drained during systole and protodiastole, giving a negative mid ventricular obstruction flow with a speed of 4 m/sec with protosystolic and mesodiastolic reinforcement.

The authors report the case of a 35-year old woman with normal heart who voluntarily poisoned herself by swallowing 6 grams of naftidrofuryl. She developed disorders of atrioventricular conduction and a ventricular-like arrhythmia with collapse which resolves after mechanical ventilation. Data from the literature indicate that naftidrofuryl possesses class I electrophysiological properties which must not be ignored and which account for the cardiac effects observed in this particular case and in cases of parenteral overdosage already reported. By analogy with class I antiarrhythmic agents, treatment of naftidrofuryl poisoning with disorders of conduction could include the administration of molar sodium lactate.

To assess the feasibility of percutaneous mitral commissurotomy, we undertook dilatation of mitral stenosis in 26 adults. The procedure was unsuccessful in six patients (hemopericardium in one, and five failures). In 20 patients (mean age: 41 +/- 13 years) the procedure was successful. We used a single balloon (Trefoil 3 X 12 mm) in eight patients and two balloons in 12 (Trefoil 3 X 10 mm + 19 mm). After valvuloplasty, valve function was improved: the mean transvalvular gradient decreased from 14 +/- 4 mm Hg to 7 +/- 2 mm Hg (P less than 0.001) and valve area increased from 1.1 +/- 0.2 cm2 to 2.2 +/- 0.4 cm2 (P less than 0.01). In a patient with severe valvular and subvalvular disease, mitral regurgitation increased from grade I to grade III. From this preliminary series, we conclude firstly that percutaneous valvuloplasty is feasible in adults with mitral stenosis, and secondly, that it results in a significant improvement in valve function with a low incidence of complications.

Percutaneous transluminal balloon valvuloplasty for mitral stenosis represents an alternative method of treatment to standard surgical procedures of open or closed commissurotomy as well as valve replacement. In this overview, our results will be reported with respect to derivation of a summary of indications and contraindications for the procedure. Valvuloplasty for mitral stenosis was carried out in 62 patients, mean age 43 +/- 17 years, 48 women and 14 men. In 14 of the patients surgical procedures had been performed previously including an open or closed commissurotomy or isolated aortic valve replacement. Nine patients were in NYHA class II, 50 in class III and three in class IV. Markedly impaired motion of the valve and calcification was present in 15 patients. In 47 patients, the valve motion was relatively good and associated with mild changes in the subvalvular apparatus in 29 and marked changes in 18. In 54 patients the valvuloplasty was carried out with a combination of two balloon catheters, one 3 X 10 mm trefoil catheter and a single-balloon catheter of 15 mm (n = 16) or 19 mm (n = 38) diameter. Both catheters were inserted via the right femoral vein. The procedure required an average of one and one-half hours. Before and after valvuloplasty, complete right heart catheterization with oxymetric determinations were carried out to detect possible shunts at the atrial level and left ventriculography for detection of mitral regurgitation was performed in addition to echocardiography and Doppler examinations with continuous, pulsed-wave and color Doppler studies.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors report a case of isolated and well tolerated cor triatriatum in a 38-year old man without significant history admitted for aetiological diagnosis of atrial fibrillation. Echocardiography displayed the left intra-atrial septum and the openings of the 4 pulmonary veins in the proximal chamber, but there was no evidence of associated anomaly. Colour-coded doppler examination visualized a single systolo-diastolic trans-septal jet. As the maximum velocity of the jet at pulsed doppler velocimetry was 1.1 m/s, the maximum instantaneous gradient could be estimated at 5 mmHg. The mean gradient was estimated at 2.6 mmHg, which showed that the ostium caused little stenosis. All these data were confirmed by cardiac catheterization. Since the malformation was well tolerated, both functionally and haemodynamically, it was decided not to operate.

The authors report 3 cases of post-infarction left ventricular aneurysm with localised rupture into the pericardium. The patients (3 men aged 54, 58 and 67 years old) had left ventricular aneurysms (2 anterior, I posterior) which ruptured early, between the second and tenth week. All presented with cardiogenic shock. The diagnosis was made by 2D echocardiography (I case) or by pericardial aspiration and angiography (2 cases). Good results were obtained by surgical evacuation of the hemopericardium and resection of the ventricular aneurysm with a follow-up of 3 to 12 months. The rarity of these cases is underlined: only three other similar cases appear to have been previously reported.

Between February, 1986 and October, 1987 percutaneous aortic valvuloplasty was attempted in 78 patients: 25 men (32 p. 100) and 53 women aged from 61 to 89 years (mean 79.5 years). All patients were symptomatic; 9 were in class II, 49 in class III and 20 in class IV of the NYHA classification. The decision to try percutaneous valvuloplasty was determined by the high surgical risk associated with age (over 75 in 87 p. 100 of the patients), poor physiological condition or concurrent pathology, or by refusal of surgery. 70 dilatations could actually be made (90 p. 100) either by the brachial route (n = 39) or the femoral route (n = 18) or the transseptal route (n = 7) or by a combined brachial and femoral route which enabled the double balloon technique to be used (n = 6). The procedure comprised 5.6 +/- 3 inflations and lasted for 58 +/- 29 min. The diameter of the largest balloon utilized was greater than 20 mm in 75 p. 100 of the cases. Dilatation reduced the aortic gradient from 62 to 28 mmHg (p less than 0.001) without altering the cardiac index (2.36 to 2.32 l/min/m2) and significantly increased the aortic valve area from 0.49 to 0.76 cm2 (p less than 0.001). At the end of the procedure the aortic valve area was greater than 0.7 cm2 in 63 p. 100 and greater than 1 cm2 in 14 p. 100 of the patients. Five patients had to be operated upon within the month following dilatation (3 after technical failure, 2 for poor functional results).(ABSTRACT TRUNCATED AT 250 WORDS)

An exceptional case of triple intracardiac thrombosis (right atrium and right and left ventricles) is reported. The 21-year old male patient without significant previous history was admitted in a state of acute circulatory failure, with blood pressure 80/45 mmHg and a left ventricular end-diastolic diameter of 74 mm. Echocardiography showed dilated cardiomyopathy with low output pattern and demonstrated the presence of three large intracavitary thrombi: the first one was attached to the lateral wall of the right ventricle and occupied most of the apex; the second one, with multiple lobes, was located in the left ventricle, and the third thrombus was appended to the roof of the right atrium. The severity of the patient's condition made it necessary to implant an artificial heart (Jarvik's heart), and this was followed, 15 days later, by cardiac transplantation. Pathological examination of the explanted heart confirmed the presence of the three thrombi and of a cardiomyopathy of undetermined origin. This is first case of this type published so far.

Thirty six adults with severe mitral stenosis underwent attempted percutaneous mitral commissurotomy. The valvuloplasty could not be performed in 6 cases; post-transseptal haemopericardium (1 case), inability to cross the mitral valve or the septum (5 cases). Therefore percutaneous commissurotomy was performed in 30 cases; the average age was 43 +/- 17 years (range 20-79 years). Eight patients had undergone previous valve surgery; 24 patients were very symptomatic (NYHA Classes III or IV). The valvuloplasty was performed with a single balloon in 22 cases and by simultaneous inflation of two balloons in 8 cases. Moderate mitral regurgitation present before the procedure was significantly aggravated in 2 cases leading to secondary surgery. In the other patients percutaneous commissurotomy led to a clear-cut haemodynamic improvement; the transvalvular pressure gradient fell from 15 +/- 4 to 6 +/- 2 mm Hg, p less than 0.01 and mitral valve surface area increased from 1.1 +/- 0.2 to 2.2 +/- 0.4 cm2, p less than .001. The best results were obtained with the double balloon technique in patients with little valve destruction. Percutaneous mitral valvuloplasty is therefore a tempting alternative to closed heart mitral commissurotomy in pure mitral stenosis with pliable valves. Larger series with a longer follow-up are needed to assess the morbidity and long-term results of this technique.

The authors report the case of a post-traumatic ventricular septal defect diagnosed after the detection of a systolic murmur in a 39 year old man, 18 months after a car accident. Two-dimensional echocardiography and angioscintigraphy showed an abnormal cavity at the apex of the heart. At cardiac catheterisation there was a moderate left-to-right ventricular shunt through this cavity. There were no traumatic or atheromatous lesions of the coronary arteries. The operative appearances were of stunned myocardium which had caused a dissecting haematoma of the cardiac apex which ruptured into both ventricular cavities. The lesions were corrected surgically and the systolic murmur disappeared.

Principal general manifestations of Recklinghausen's disease are outlined, with emphasis on cephalic lesions, particularly cranio-orbital localizations responsible in a large number of cases for lysis of greater wing of sphenoid. This is associated, amongst other complications, with ophthalmologic sequelae. A clinical case is presented, allowing discussion of the two essential problems raised by cranio-orbital neurofibromatosis: 1) conservation or not of the eye during necessary surgical treatment and 2) the course of the disease which is always progressive.

We report a case of carcinoid heart disease which was remarkable on three scores: --the value of echocardiography which enabled us to diagnose the disease; --the usefulness of cardiac doppler examination which provided non-invasive haemodynamic evaluation of lesions of the four valves; --the presence of moderate involvement of the right heart, which is classical from the point of view of anatomopathology but is often missed clinically and was ascertained in that case by doppler-echocardiography.

Use of a silicone menton endoprosthesis appears to be a seductive alternative to menton osteotomy for profile reconstructions of a certain type, whether pure or associated with orthognathic treatment. A strict surgical technique is essential, particularly a limited incision and median and low situated positioning. The advantages and inconveniences of this procedure are described and the need for very selective choice of patients emphasized.

This study concerns 51 cases of mitral valve prolapse demonstrated on bidimensional 4 cavities sonography according to Gilbert's criteria and aims to determine the frequency of the associated valvular involvement, anatomically with sonography and functionally with the Doppler test. Sonography demonstrates a tricuspid valve prolapse in 79 p. cent of the cases and an aortic valve prolapse in 10 p. cent. The Doppler test demonstrates a tricuspid leakage in 52 p. cent of the cases, a pulmonary leakage in 62 p. cent, and an aortic leakage in 18 p. cent. The myxoid degeneration found in 60 p. cent of the cases is a major factor in the occurrence of complications, especially progressive cardiac insufficiency (A). The myxoid degeneration defines therefore the "isolated prolapse disease" as opposed to "the prolapse without myxoid degeneration" which is a pure sonographic entity and probably a variation of the normal (A). This cardiac insufficiency occurs late during the 6th or 7th decade and is due to mechanical factors: prolapse, chords rupture and annular dilatation.