[Auriculoventricular block disclosed in the exercise test].

Sixteen patients, 14 of whom described stress related symptoms, present a severe atrio-ventricular block (A-V B), identified during a stress test while the ECG at rest showed a 1/1 atrioventricular conduction (AV). The electrophysiological study (EPS) creates the A-B Block through atrial stimulation and specifies the location of the A-V B: intra-hissian in 8 patients (7 with small QRS an 1 with widened QRS) and infra-hissian in 8 patients (all with widened QRS). Non-invasive methods constitute the prime approach in the diagnostic work-up of stress symptoms.

[Leiomyosarcoma of the pulmonary artery. Apropos of a case].

The authors report a case of sarcoma of the pulmonary artery in a 41 year old woman hospitalised for syncope on effort associated with effort dyspnoea. Chest Xray and echocardiography were "normal", leading to referral for pulmonary scintigraphy and angiography which showed multiple intravascular filling defects in the pulmonary arterial tree. A tumour implanted on a pulmonary valve was discovered at exploratory thoractomy.

Haemodynamic benefit of a rate-adapted A-V delay in dual chamber pacing.

In dual chamber pacing, an improvement of exercise capacity is expected when the atrial refractory period is shortened, because the 2/1 point is increased. This objective can be achieved by greatly reducing atrioventricular delay (AVD) on exercise. Are such variations (up to 100-120 ms) detrimental from a haemodynamic standpoint? This study was performed to analyse this particular aspect of DDD pacing.

Failure of the exercise test to predict the anterograde refractory period of the accessory pathway in Wolff Parkinson White syndrome.

Modifications of the delta wave on the surface ECG during an exercise stress test were compared to electrophysiological variations in accessory pathway (AP) refractoriness and in AV node conduction, during intravenous isoproterenol infusion in ten patients with WPW syndrome. In one patient, the delta wave persisted unchanged at the end of exercise and, with isoproterenol, there was a greater reduction in the AP anterograde effective refractory period (AERP) than in AV node conduction time. In three patients, the delta wave became less and less apparent but without completely disappearing; in these patients, the slight reduction of the AERP in the accessory pathway with isoproterenol was comparable to the reduction in AV node conduction time, explaining the progressive fusion between the two activation fronts.

[Proximal migration of a caval filter. Apropos of a case].

We are reporting of proximal migration, intracardiac, of a percutaneous caval filter (LEM type), resulting in the death of the patient. It is a true, early (1st week) migration after accurate positioning, opposite L4, and not an incident of insertion.

Critical analysis of cineangiographic criteria for diagnosis of arrhythmogenic right ventricular dysplasia.

Biplane 30-degree RAO and 60-degree LAO RV selective cineangiography was performed in 21 patients with significant ventricular arrhythmias (ventricular tachycardia in 14, salvos in three, and complex PVCs in seven) and a high presumption of arrhythmogenic RV dysplasia (ARVD), and in a control group of 10 presumed normal individuals. Comparing the two series revealed the lack of specificity of some angiographic images usually reported as suggestive signs of ARVD, such as slow dye evacuation of RV during the levophase and deep fissuring in the anterior wall with a "pile of plates" image. Inversely, localized morphologic and contraction abnormalities in the RV free wall were more sensitive and specific signs for diagnosis of ARVD; these were localized akinetic or dyskinetic bulges sometimes giving a true image of aneurysm (90%), wide and deep fissuring of the apex or of the inferior wall (33%), and large areas of akinesia.

[Mid-term outcome of acute right ventricular dysfunction in biventricular myocardial infarction. Hemodynamic and cineangiographic studies].

This study was designed to evaluate the mid-term outcome of the right ventricular (RV) dysfunction which characterizes infarction of both ventricles in the acute phase. Thirteen patients hospitalized for inaugural posterior or infero-posterior infarction extending to the right ventricle (haemodynamic and cineangiographic diagnosis) were explored in the acute phase and 4 months later by right heart catheterization and selective cineangiography of the right ventricle in a 30 degrees RAO projection. The results were compared with those obtained in a control group.

[Measurement of right ventricular volume by cineangiography. Validation of monoplane analysis compared with biplane].

It is demonstrated that right ventricular volumes can be measured accurately by biplane cineangiography using the Simpson's rule or various area-length methods. In order to validate the single plane approach a biplane (30 degrees RAO-60 degrees LAO) right ventricle (RV) cineangiography was performed in 10 adults investigated for chest pain without coronary artery disease or any other heart disease. RV volumes (EDV: end-diastolic; ESV: end-systolic; SV: stroke volume) and EF (ejection fraction) were measured by biplane and single plane analysis with the same area-length method using the pyramide with triangular base as geometric model (Ferlinz).

Physiological relationship between AV interval and heart rate in healthy subjects: applications to dual chamber pacing.

The purpose of this paper is to specify the mathematical relationship between spontaneous AV interval (AVI) and heart rate (HR), the amplitude and rate of variation of AVI, and the physiological factors likely to affect these characteristics. Ten patients with healthy hearts were studied. Two catheter electrodes were positioned in the right atrium and at the tip of the right ventricle respectively, allowing the detection of endocardial signals.

[Evaluation of coronary lesions in biventricular inferoposterior infarction].

Fifty-two patients with primary transmural infero-posterior infarcts underwent right heart catheterisation on admission to hospital and coronary angiography between the 7th day and 4th month after onset of symptoms. The patients were divided into two groups A (N = 34) with signs of right ventricular dysfunction on admission indicating biventricular infarction, and B (N = 18) without right ventricular dysfunction classified as isolated LV infarction. No significant differences were observed between the two groups with respect to: global and regional LV function; the incidence of single, double and triple vessel disease; the incidence and location of right coronary artery thrombosis; the incidence and location of lesions of the left coronary tree (LCA, LAD, Cx); the extent of coronary disease (Gensini score); the dominant artery (right coronary/circumflex), the frequency and quality of revascularisation of distal vessels.

[Left ventricle-right atrium communications acquired in bacterial endocarditis].

Three cases of acquired LV-RA communication during bacterial endocarditis are reported. The causal organisms were Staphylococcus aureus and Streptococcus. The endocarditis complicated aortic valve disease in 2 patients and a congenital aneurysm of the membranous interventricular septum in the third case.

[Severe hypoxemia due to a right-to-left shunt at the atrial level caused by an infarction of the right ventricle].

The authors report the case of a biventricular inferior myocardial infarction complicated in the acute phase by massive tricuspid regurgitation and a right-to-left interatrial shunt through a patent foramen ovale; this resulted in severe hypoxaemia. The diagnosis was made by contrast 2D echocardiography which showed ventriculo-atrial regurgitation and the passage of microbubbles from the right to the left atrium leading to opacification of the left ventricule: right heart catheterisation with oxymetry and selective right ventriculography confirmed the diagnosis. The hypoxaemia became less severe as the haemodynamic conditions improved.

[Tricuspid insufficiency in biventricular myocardial infarct].

Tricuspid insufficiency (TI) has already been reported as a possible complication of biventricular infarction. However, in the absence of large study groups, this condition is not well known. This paper reports the results of 2 studies: a retrospective study of 91 biventricular infarcts, identified by haemodynamic criteria, and a prospective study of 23 consecutive patients (belonging to the previous group) in whom selective right ventricular cineangiography was performed in the acute phase.

[Fissuration of post-infarction left ventricular aneurysms. 2 surgically treated cases].

The authors report two cases of fissures of a left ventricular aneurysm diagnosed on the 8th and 21st days following an anterior myocardial infarction. In both cases, the clinical presentation consisted of a new episode of pain associated with a low cardiac output syndrome and adiastole. The diagnosis was confirmed by the simultaneous discovery of a pericardial effusion and a left ventricular aneurysm on echocardiography and cardiac catheterisation.

[Hemodynamics and M mode echocardiography of the consequences of ventriculo-atrial conduction in the human].

A haemodynamic and M mode echocardiographic study of 57 patients hospitalised for chronic, symptomatic 2nd or 2rd degree AV block was carried out after 3 periods of pacing, each lasting 2 hours : 1) sequential AV pacing ( SAV ) with a 200 ms delay, considered as the mode of reference; 2) sequential ventriculo-atrial pacing ( SVA ) with the same sequential delay, recreating equivalent conditions of 1/1 ventriculo-atrial conduction (VAC); 3) ventricular pacing (V) recreating complete AV dissociation ( CAVD ). The pacing rate was the same for each patient (89 +/- 9/min). In comparison with SAV , SVA caused much worse haemodynamic changes than V : large increases in mean atrial pressures (+161% and +64% in RAP and PCP respectively); "canon" atrial A waves which were poorly tolerated (mean amplitude 14 mmHg and 18 mmHg on the RA and PCP waves respectively); in some cases, a large fall in blood pressure was observed due to the failure of systemic resistances to increase and compensate for the constant decrease in pump function (mean reduction of 23% of cardiac index; 29% of LV work index).

[Prospective study of the diagnostic and prognostic criteria of right ventricular involvement in the acute phase of inferoposterior infarction].

Right ventricular involvement has been shown to be common in the acute phase of infero-posterior myocardial infarction. The aim of this prospective study was to assess the diagnostic and prognostic value of the different criteria obtained by clinical and paraclinical methods of investigation. Forty patients (35 men, 5 women: mean age 57,1 years) admitted consecutively with this type of transmural infarct without any other cause of acute or chronic volumic or barometric overload of the RV were investigated.

[M-mode echocardiographic study of right ventricular involvement in the acute phase of inferoposterior myocardial infarction].

The aim of this study was to assess the value of a non-invasive technique, echocardiography, in diagnosing RV extension during the acute phase of myocardial infarction. Forty patients with an acute infero-posterior infarct were divided into two groups according to the presence (Group A) or absence (Group B) of RV akinesia on angiography. M mode echocardiography was carried out from two positions: left parasternal, for the study of quantitative parameters: RV and LV diameters, wall thickness and excursion, VCF and fractional shortening, mitral and tricuspid valve morphology, aortic and left atrial dimensions; subxostal: for the study of one parametere: RV inferior wall motion assessed as normal or akinetic.

[Exercise tests before and after aortocoronary bypass].

A stress test was performed before and after by-pass grafts in 83 patients. Post-operatively, the number of painful stress tests fell from 68 to 28. Whatever the initial clinical picture (stable angina, anterior or inferior infarct), the improvements is significantly better when all of the lesions have been by-passed.

[Hemodynamic and biological effects of bromocriptine in essential hypertension].

Central dopaminergic dysfunction has been suggested as the cause of essential hypertension. Agonist dopaminergic substances (AD) possess documented anti-hypertensive properties. We studied the cardiovascular effects of a single oral dose of 10 mg of Bromocriptine (Br) in untreated subjects with essential hypertension.

[Torsade de pointes. Apropos of 54 cases].

A retrospective study of 54 torsades de pointe cases in a cardiology department enabled us to specify the main characteristics of this serious arrythmia often observed in intensive care units: --the diagnostic criteria: more than the pattern of tachycardia attack, late ventricular premature beats and particularly QT prolongation are necessary for proper diagnosis. These two criteria allow us to differentiate between torsades de pointe and multiform ventricular tachycardia with similar morphology especially in acute myocardial ischaemia; --their clinical repercussion: the shortness of circulatory arrest related to the spontaneous end of the arrythmia explains that the torsades de pointe often result in short faintings. Nevertheless, they may degenerate into ventricular fibrillation (17 p.