Long-term efficacy of dynamic cardiomyoplasty. Clinical, ultrasonic and haemodynamic evidence in one case.

We report one case of successful cardiomyoplasty in a 21-year-old male and its beneficial effects as assessed by clinical examination, Doppler echocardiography, phonocardiography, haemodynamic and angiographic evaluation at 1 year. Long-term efficacy of this procedure on left ventricular function was confirmed by these techniques.

[Progression from hypertrophic obstructive cardiomyopathy to dilated cardiomyopathy. Apropos of 4 cases].

Four cases of hypertrophic obstructive cardiomyopathy diagnosed on clinical, phonomechanographic, echocardiographic and haemodynamic criteria progressing to dilated cardiomyopathy are reported. This evolution was observed over a number of years (up to 20 years) and was accompanied by a clinical aggravation in all cases with 2 deaths and atrial fibrillation in 3 of the 4 cases. The signs of intraventricular obstruction [systolic murmur, bulge on the carotid pulse tracing, systolic anterior motion of the mitral valve (SAM) and intraventricular pressure gradient] disappeared as the left heart chambers dilated with a reduction in ventricular wall motion and parietal thinning but no change in myocardial mass.

Contribution of the dynamic phonocardiography to the valvular heart disease diagnosis: an expert system study.

The contribution of pharmacodynamic tests to the diagnostic accuracy of phono-mechanocardiography was tested by means of an expert system, in order to make an objective evaluation. In 198 valvular heart disease patients, the use of dynamic tests significantly improved the rate of diagnostic success, thus confirming the usefulness of dynamic phono-mechanocardiography.

[Surgical mitral valvuloplasty and dynamic left ventricular obstruction syndrome].

The "dynamic" left ventricular outflow obstruction syndrome, which is found in 4.5 to 11 p. 100 of patients who underwent mitral valve repair by Carpentier's technique, seems to be due to the association of two different sets of circumstances.

[Phono-mechanographic evaluation of aortic stenoses. Contribution of the B1-maximum murmur/B1-B2 index].

The diagnostic value of phonomechanography in valvular aortic stenosis was reassessed with a rarely used index, the ratio S1-maximum intensity of the systolic murmur/S1-S2, or Thiron's index, the author of which only studied the correlations with the aortic transvalvular pressure gradient. The results obtained by the author being considered inconclusive, we decided to examine its correlations with aortic valve surface area calculated with the Gorlin's formula. The study was carried out in 38 patients with pure aortic stenosis, in whom 4 phonomechanographic parameters, the corrected left ventricular ejection time (Meiners), the carotid pulse half peak time, the S1-maximum intensity of the murmur interval and Thiron's index, were compared with the transvalvular pressure gradient and the aortic valve surface area at catheterisation.

[Current role of phonomechanocardiographic recording in the diagnosis of heart valve diseases].

Phonocardiography (and auscultation) provide many accurate diagnoses of valvular heart diseases, when they are fully developed and give rise to a typical murmur. Echocardiography displays its mechanism, in most cases (leaflet thickening, ruptured chordae tendinae, vegetations, prolapse). Assessment of their severity is based on analysis of the systolic time intervals on the one hand, and on echocardiographic measurements on the other, i.

Effect of propranolol on left ventricular relaxation in hypertrophic cardiomyopathy: an echographic study.

Many authors have shown that hypertrophic cardiomyopathy (HCM) is often associated with diastolic abnormalities. The purpose of this study was to determine the effect of propranolol on left ventricular isovolumic relaxation time (IVRT) measured by echocardiography in 20 patients with hypertrophic cardiomyopathy under basal conditions and under increasing doses of propranolol (160 mg, 320 mg, and 480 mg per day) and in two control groups, 10 patients with aortic stenosis, and 10 normal subjects. IVRT was less than 50 msec in all normal subjects, while it was always above this limit in aortic stenosis (77 msec +/- 8, p less than 0.

[Aortic and mitral valve bioprostheses. Normal and pathological M mode echocardiographic aspects].

The M mode echocardiographic recordings of 52 normal mitral bioprostheses (NMB), 7 pathological mitral bioprostheses (PMB), 30 normal aortic bioprostheses (NAB) and 10 pathological aortic bioprostheses (PAB) were reviewed. In normal bioprostheses a significant correlation was observed between the echocardiographic and the "specified" diameters, the diastolic and systolic slopes and the amplitude of anterior motion of the support. In NMB, the end-systolic diameter of the left ventricular outflow tract depended on the "specified" diameter of the bioprosthesis.

Contribution of pharmacologic tests to the diagnosis of left ventricular regurgitations and obstructions: a phono-echocardiographic confrontation.

Pharmacologic interventions--procedures akin to exercise tests--facilitate, and sometimes permit, the diagnosis of left ventricular regurgitations and obstructions. Particularly when, at rest, the resulting murmur a) is soft or atypical (or absent) and, b) reflects a disease combining both mechanisms (obstruction and regurgitation) during systole. In these circumstances, the echocardiogram may be nondiscriminating or incomplete, and the pharmacologic tests difficult to carry out and to interpret with this technique.

[Myocardial infarction in the young subject: a medium-term clinical and coronary angiographic study in 40 patients under 36 years of age. Comparison with coronary angiographic data of myocardial infarction in patients after 50 years of age].

A series of 40 myocardial infarctions, occurring in patients under 36 years of age was studied retrospectively (Group I: mean age 31.3 years). The medium term results of coronary angiography in this group were compared with those of 60 myocardial infarctions after 50 years of age (Group II: mean age 56.

[Obstructive hypertrophic myocardiopathy and Osler's endocarditis].

Four cases of bacterial endocarditis (BE) complicating hypertrophic obstructive cardiomyopathy (HOCM) were observed between 1978 and 1980. The causal organism was a streptococcus in all cases and the portal of entry, dental. The mitral regurgitation (MR) observed in HOCM as an epiphenomenon of the obstruction became autonomous in 2 patients as shown by phonocardiography with methoxamine.

[Comparative evaluation of phonocardiogram and echocardiogram in mitral valve prolapse diagnosis (author's transl)].

In order to determine the correlation between echocardiography (ECHO) and phonocardiography (PHONO) in the evaluation of the Mitral Prolapse Syndrome (PM), 87 subjects with echo or phono criteria of PM were studied using both techniques. The phonocardiographic criteria used for PM diagnosis were the presence of a telesystolic click and/or a telesystolic murmur. The echocardiographic criteria were a telesystolic or holosystolic posterior movement of a mitral leaflet continuously seen through systole or of both mitral leaflets seen in part of systole.

[Spontaneous development of obstructive myocardiopathies].

49 cases of obstructive cardiomyopathy (37 of the sporadic type, 12 of the familial type), confirmed by phonomechanocardiographic, haemodynamic and/or angiographic investigation and followed up for more than 5 years (mean 7.5 years) without surgical intervention, form the basis of a study on the natural history of this condition. There were 19 deaths (39%), of which 7 were of the familial type (58%) and 12 of the sporadic type (32%).

[Long term results of surgical treatment of obstructive myocardiopathy by intervention on the interventricular septum].

An analysis of the results of septal myotomy or myectomy in 26 adults with obstructive cardiomyopathy (OCM) with a mean follow-up period of more than 5 years lead to the conclusion that this treatment brings about, at the price of a mortality rate of about 10%, a sustained improvement in function, a reliable correction of the left ventricular gradient, and an improved long term survival rate by comparison with the rate among patients treated medically.

[Correlation between the angiographic appearance and the left intraventricular gradient in obstructive myocardiopathy. Apropos of 42 cases].

42 patients who were given the diagnosis of obstructive cardiomyopathy (OCM) on the basis of a basal left intraventricular systolic gradient equal to or in excess of 20 mmHg were divided into two groups, according to the angiocardiographic appearances (in the right anterior oblique projection) of the left ventricular cavity during systole. In 20 cases the appearances were those of a typical obstructive cardiomyopathy. In the other 22, despite the presence of a fairly large left intraventricular gradient, the appearances on angiocardiography were closest to those described for the non-obstructive cardiomyopathies with diffuse myocardial hypertrophy.