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Among 1000 French cardiologists, the ECART study investigated drug prescription in 1041 patients with coronary heart disease, before and after percutaneous coronary interventions. The baseline drug prescription rate CAD patients were the following: beta-blockers 96%, antiplatelets agents 85%, statines 56%, nitrates 36%, calcium blockers 26% and ACE inhibitors 8.7%. The main changes in patients having undergone PCI were: a significant increase in antiplatelets agents (to 97%), ACE inhibitors (to 29%) and statins (to 94%), a significant decrease in nitrates (to 23%). The calcium blockers rate remains unchanged at 26%. Those results are discussed in the field of evidence based medicine and are compared with data from previous drug prescription studies in post myocardial infarction or in secondary prevention.

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.

The scope of this study is a comparison of three functional classifications: the New York Heart Association classification, the Duke University classification, and the specific activity scale we propose. The NYHA classification is subjective, difficult to reproduce and poorly correlated to the functional capacity measured ergometrically (duration of exercise and/or VO2). A new classification must therefore be proposed. A specific activity scale adapted to our national requirements appears to be the best solution. Our study covered 15 successive days. All patients suffering from congestive heart failure who were examined over this period were included. 700 liberal cardiologists took part in this study. 2353 patients were reviewed, mean age 69 (58% male, 42% female). Heart failure was of an ichaemic origin in 37% of cases, idiopathic in 25% and due to hypertension in 25%. Symptomatology was left sided in most cases. Among NYHA Class IV patients, 75% belonged to Class IV of the specific activity scale (SAS) (23% Class III, 1% Class II), and 88% of the Duke classification (10% Class III, 1% Class II). For NYHA Class III patients, 80% were SAS Class III (5% Class IV, 13% Class II), and only 38% (42% Class IV and 16% Class II) of the Duke classification. Regarding NYHA Class II patients, 74% were SAS Class II (21% Class III and 4% Class I), and 26% of the Duke classification (39% Class I, 29% Class III and 3.6% Class IV). Finally, among NYHA Class I patients, 60% were SAS Class I (34% Class II, 5% Class III), and 74% of the Duke classification (11% Class II and 13% Class III).(ABSTRACT TRUNCATED AT 250 WORDS)

A case of a 24 year-old man in whom, following acute pulmonary oedema complicating hypertension known for a period of three years, stenosis of the thoraco-abdominal aorta produced by a large calcification within a zone of the aorta with an inflammatory appearance was demonstrated. This case is included within the context of the aortic syndrome. Operation led to normalisation of blood pressure immediately afterwords, but there was moderate hypertension 56 months later.

This study summarizes the results in 107 patients with triple valve procedures (TVP) performed between 1972 and 1983. Forty-five patients underwent double valve replacement with tricuspid annuloplasty, and 62 simultaneous triple valve replacement. The hospital mortality was 19.6% (21 patients) and was influenced by: the preoperative functional class: 4.7% (1 of 22 patients) in class II, 13.7% (7 of 51) in class III and 37.2% (13 of 35) in class IV (p less than 0.05). the urgency of operation: 13.2% in elective operations (11 of 83 patients) and 41.6% for emergencies (10 of 24) (p less than 0.02) the type of tricuspid procedure: 15.5% for annuloplasty (7 of 45 patients), 21.1% for bioprosthetic replacement (11 of 52) and 30% for mechanical valve replacement (3 of 10) (p less than 0.05). Other factors such as patient age, right ventricular systolic pressure (RVSP) and type of myocardial protection had no significant influence. The late mortality was 9% per patient-year (18 patients, 9 of whom died in the first year), the majority related to cardiac causes. The 5-year survival rate was 53%. It appears that the survival rate is higher if the patient is in preoperative functional class II (55%), the right ventricular pressure is below 60 mmHg (67%), and if the operation is performed electively (57%). The findings suggest that surgery should continue to be offered to such patients.

50 children who had beneficied of repair of Fallot's tetralogy with a follow up of 2 to 11 years, were psychologicaly and physicaly evaluated. Work capacity tests were performed in 12 cases. Children with early repair (before 5 years of age) have a very better result. Preliminary palliative treatment cause worse results. Physical capacities are normal in the majority of children. Work capacity is not different from normal children. Repair before school age is the best way for a normal life.

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.

Two techniques of plastic surgery are currently used to treat tricuspid insufficiency: a prosthetic reductor or a continuous running suture. In the technique advocated here a double continuous suture is inserted into the tricuspid annulus, one running from the antero-septal to the antero-external commissures and the other, from the postero-septal to the antero-external commissures. When these two sutures are tied separately, the circumferences of the two parts of the annulus, which are diversely dilated, can be reduced. The authors have used this technique in 141 patients and a Carpentier's annulus in 41 patients. Perioperative mortality and 5-year survival were the same in both series, but the incidence of postoperative atrioventricular block was much lower in the first one. Another advantage of the double continuous suture technique is that foreign material is reduced to a minimum.

The authors report the case history of the first patient in the world to have survived 18 and a half years with a heart transplant. This survival was marked by several episodes of rejection during the early years and various other incidents. The pathology encountered was primarily iatrogenic: diffuse osteoporosis sometimes limited the patient's activity. Two skin cancers and a lung cancer were diagnosed and treated. The patient died from progressive respiratory failure with pulmonary hypertension and signs of right ventricular failure. Pathological examination revealed a subnormal myocardium with a certain amount of overloading of the coronary arteries, confirmed the lung cancer and pulmonary hypertension and, most importantly, revealed the presence of nodular regenerative hepatic cirrhosis responsible for ascites during the last few months of life and a renal adenocarcinoma. These last two lesions are observed in immunosuppressed patients. The authors pay tribute to this patient who led an active and devoted life in the service of others.

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.