[Skeletal muscle efficiency in heart failure].

Heart failure is associated with modifications of skeletal muscle cells, which could participate in the exercise limitation of the patients. However, the mechanical efficiency of the skeletal muscle has not been fully evaluated in these patients. We therefore measured VO2 during prolonged exercise (15 min) at constant load to obtain stable conditions.

Subxiphoid pericardiocentesis guided by contrast two-dimensional echocardiography in cardiac tamponade: experience of 110 consecutive patients.

Aims: We evaluated echo-guided pericardiocentesis with contrast study in cardiac tamponade management.

Patients And Methods: From 1982 to 1998 we performed pericardiocentesis in 110 patients (56 +/- 14 years old). Subxiphoid approach was used in 109.

Aneurysms of saphenous vein grafts as late complication of coronary artery bypass surgery: successful exclusion by percutaneous transcatheter embolization.

We report a case of a 71-year-old man with a long coronary artery disease history and two sets of coronary artery bypass grafts. He developed large aortocoronary saphenous vein graft aneurysms in the two grafts from the first set of aortocoronary saphenous venous 20 years later. During the previous 3 years, the aneurysms grew in diameter from 22 to 50 mm.

[Aortic dissection at 6 months gestation in a women with Marfan's syndrome. Simultaneous Bentall intervention and cesarean section].

A 31 year old woman with Marfan's syndrome had a dilatation of the aortic root (55-60 mm at the beginning of pregnancy). Pregnancy was continued with beta-blocker therapy and with regular echocardiographic follow-up. The aortic dilatation increased (62-65 mm) at the last control and, at the 34th week of pregnancy, the patient suffered a dissection of the ascending aorta.

Diagnosis of saphenous coronary graft aneurysm by spiral computed tomography.

We report two cases of coronary saphenous vein graft aneurysms diagnosed by spiral computed tomography.

Persistent preload defect in severe sepsis despite fluid loading: A longitudinal echocardiographic study in patients with septic shock.

Study Objective: To investigate the rate of recovery from septic shock in patients with suspected left ventricular (LV) preload deficiency and LV systolic dysfunction.

Design: A monitoring period was defined by the need for inotropic/vasopressor support, and LV function was assessed daily during this period by bedside two-dimensional echocardiography (2D-ECHO).

Setting: University hospital ICU.

Hemodynamic effects of medical antishock trousers during mechanical ventilation.

Purpose: To compare the hemodynamic effects of medical antishock trousers (MAST) inflation in mechanically ventilated patients with normal and poor left ventricular function.

Methods: Twelve patients requiring respiratory support were divided into two groups according to baseline transesophageal echocardiography (TEE) measurements: normal left ventricular dimensions and fractional area of contraction (FAC=61 +/- 5%) (n=7) and dilated cardiomyopathy with reduced FAC (21 +/- 1%) (n=5). All patients were studied when two successive levels of load (mild load by inflation of the leg compartment of MAST at 50 cmH2O and high load by adding the abdominal compartment of MAST inflated at 30 cmH2O) were applied.

Central pulse pressure is a major determinant of ascending aorta dilation in Marfan syndrome.

Background: In patients with Marfan syndrome (MFS), brachial pulse pressure (PP) has been recognized as a risk factor for aortic dilatation, leading to aortic dissection, the main cause of premature death. However, the relationships between aortic PP, aortic stiffness, and aortic root dilation have not been investigated. Our main objective was to determine whether central PP, which takes into account wave reflections and aortic stiffness, is a better determinant of ascending aorta diameter than brachial PP in MFS patients.

[The echocardiographic examination in adult cardiomyopathy].

Echocardiography allows distinction between the diastolic dysfunction of hypertrophic or restrictive cardiomyopathies and the systolic dysfunction of dilated cardiomyopathy. The diagnosis and prognosis may be deduced from echocardiographic parameters. In hypertrophic cardiomyopathy systolic function is normal and there is asymmetric left ventricular hypertrophy (> 13 mm) associated with a reduced diastolic dimension and atrial dilatation resulting from diastolic dysfunction.

[Tamponade in patients with systolic left ventricular dysfunction. An atypical presentation].

Background: Left ventricular failure has been described following surgery due to localized compression of the left ventricle and in case of diastolic left ventricular dysfunction after pericardiotomy or pericardiocentesis.

Case Reports: Global heart failure was observed in 3 patients with dilated cardiopathy who developed tamponade. Systolic left ventricular dysfunction was caused by ischemic heart disease in one patient and secondary to anthracyclin chemotherapy in the two others.

[Evaluation of echo-guided pericardiocentesis in cardiac tamponade].

Between April 1982 and December 1995, 78 consecutive patients with an average age of 57 +/- 13 years underwent echo-guided pericardiocentesis in the intensive care unit for poorly tolerated pericardial effusions. The patients were admitted to the cardiology departments of Ambroise-Paré Hospital at Boulogne (n = 44). Gilles-de-Corbeil Hospital at Corbeil-Essonnes (n = 31) and Val-de-Grâce Hospital in Paris (n = 3).

[The value of transesophageal echocardiography for the diagnosis of pulmonary embolism with acute pulmonary heart disease].

Transoesophageal echocardiography is a method of visualising intracardiac thrombi and could therefore be useful for the diagnosis of pulmonary embolism, but its diagnostic value is unknown. The authors carried out a prospective study with this diagnostic tool in massive pulmonary embolism. The study protocol was to perform transthoracic echocardiography in patients with suspected acute pulmonary embolism and then to perform transoesophageal echocardiography when there were signs of acute cor pulmonale.

Does positive end-expiratory pressure ventilation improve left ventricular function? A comparative study by transesophageal echocardiography in cardiac and noncardiac patients.

Study Objectives: Positive end-expiratory pressure (PEEP) has been proposed to improve cardiac output in patients with left ventricular (LV) dysfunction. This study was designed to compare quantitative global and regional LV performance in response to PEEP in patients with normal and poor LV function.

Design: A prospective clinical trial.

Left main coronary artery compression during primary pulmonary hypertension.

Primary pulmonary hypertension (PPH) is often associated with angina-like chest pain, the mechanism of which is controversial. A 37-year-old woman with severe PPH and angina had transient ischemic ECG changes and reversible anterior perfusion defect on 201thallium scintigraphy. Coronary angiography revealed severe stenosis of the left main coronary artery (LMCA) and otherwise normal vessels.

[Effects of active synchronized prolonged coronary perfusion in the animal].

The efficacy of a system of active diastolic synchronised coronary perfusion was studied during prolonged balloon angioplasty in 8 sheep. In the first part of the study (group 1) including 5 animals, the aim was to study the effects of high and constant flow (48 ml/min) for 90 minutes perfusion on haemolysis, the arterial wall and the perfused myocardium. The second part of the study (group 2), including 3 animals, assessed whether flow adapted to the extent of the vascular bed perfused (24 to 40 ml/min) could protect the myocardium for an interval of 60 minutes.

Relation of functional improvement in congestive heart failure after quinapril therapy to peripheral limitation.

Angiotensin-converting enzyme inhibitors have been shown to increase maximal muscle blood flow in parallel to peak VO2 in patients with congestive heart failure (CHF). Whether this increase shifts factors limiting peak aerobic capacity from periphery (skeletal muscle or vessels) to central factors (cardiac or respiratory) is unknown. Comparison of peak oxygen consumption (VO2) obtained during leg cycling (VO2 leg) with peak VO2 obtained during combined leg cycling and arm cranking (VO2 arm + leg) allows determination of the relative role of central or peripheral factors.

[Doppler echocardiographic investigation of cardiomyopathies].

There are three types of cardiomyopathy: hypertrophic, dilated and restrictive. The diagnosis and prognosis of these three types may be assessed from Doppler echocardiographic data. In hypertrophic cardiomyopathy, the diagnostic criterion is parietal hypertrophy.

Fibulin-2: genetic mapping and exclusion as a candidate gene in Marfan syndrome type 2.

Fibulin-2 (FBLN2) is a new extracellular matrix protein that has been considered a candidate gene for Marfan syndrome type 2 (locus MFS2) based on chromosomal colocation at 3p24.2-p25 and disease phenotype. In the absence of polymorphic markers reported for FBLN2, direct sequencing of the gene was performed and two intragenic polymorphisms were identified.

Coronary reserve: concept and physiological variations.

When myocardial oxygen consumption (MVO2) is constant, coronary blood flow is largely independent of coronary perfusion pressure within the limits of autoregulation. The relationship is described by a slightly rising plateau, the level of which depends on the value of MVO2. After maximum arteriolar vasodilatation (hyperaemia) coronary blood flow is no longer autoregulated and varies linearly with perfusion pressure.

Dynamic cardiomyoplasty: effect of discontinuing latissimus dorsi muscle stimulation on left ventricular systolic and diastolic performance and exercise capacity.

Objectives: This study sought to assess the short-term effect of discontinuing latissimus dorsi muscle stimulation on left ventricular systolic and diastolic performance and exercise tolerance in patients with improved functional status by cardiomyoplasty, in whom latissimus dorsi muscle was fully conditioned.

Background: Cardiomyoplasty has consistently improved the functional status of patients, but the short-term effect of latissimus dorsi muscle contraction has not been assessed in these patients.

Methods: Right-heart catheterization, Doppler-echocardiography and maximal exercise testing with expired gas analysis were performed in 10 patients with congestive heart failure who had undergone cardiomyoplasty at least 6 months earlier.