Late results with bioprosthetic valves in the elderly.

Aim: We report the long-term outcome of aortic and mitral bioprostheses in patients over 65 years of age at the time of implantation. The aim was to determine actuarial patient survival, causes of death, and the rate of documented primary structural deterioration.

Methods: One hundred ten patients > or = 65 years of age (mean, 73.

Bioprosthetic valve replacement in the elderly.

One hundred and ten patients aged more than 65 years (mean, 73.4; range, 65-82) underwent successful bioprosthetic valve replacement (aortic, n = 71; mitral, n = 32; both, n = 7) from 1979 to 1985. The valve was pericardial in 39 cases and porcine in 78.

[Mid-term results of bioprosthesis in patients over 65 years].

Between 1979 and 1985, 79 patients over 65 years of age (mean 70.8; range 65-82 years) underwent valvular replacement with a bioprosthesis (aortic: 48, mitral: 26, aortic and mitral: 5). Of the 84 valves implanted, 56 were porcine and 28 were pericardial bioprostheses.

["White-coat" effect in 35 consecutive patients with hypertension. Quantification method, role of physician-patient dialogue].

The "white coat" effect, an alarm reaction to the presence of a doctor, is an important cause of blood pressure variability, the frequency, amplitude and mechanisms of which are only partially understood. In order to evaluate these factors, a prospective study was undertaken in 35 consecutive patients referred for assessment of clinical hypertension. The alarm reaction was investigated during the consultation, at the time of interrogation, in periods of silence, in the sitting and upright positions.

[Can patients with severe left ventricular dysfunction be treated by coronary artery bypass surgery?].

Forty three men and 3 women, with an average age of 59 years (13 to 78 years) underwent aorto-coronary bypass surgery despite severe left ventricular dysfunction (ejection fraction < 35%); 96% of the patients had previous infarction; 60% (N = 28) had unstable angina, 52% (N = 24) had had pulmonary oedema or an episode of congestive cardiac failure. The average ejection fraction was 29 +/- 4%, range 17 to 35%. Thirteen patients had ventricular aneurysms, 4 had grade 3 or 4 mitral regurgitation.

[Clinical and angiographic results of delayed revascularization by angioplasty or bypass after intravenous thrombolysis in myocardial infarction].

Between 1988 and 1990, 150 patients treated for an infarction by intravenous thrombolysis underwent coronary arteriography. Sixty seven were managed by revascularisation by angioplasty (n = 49) or bypass (n = 18) more than 48 hours after thrombolysis. In this delayed revascularisation group, the time before initial fibrinolysis was 114 +/- 55 minutes.

[Doppler parameters of systolic function and heart rate].

This prospective study had two aims, to study the Doppler parameters of left ventricular systolic function with respect to heart rate, and to determine the influence of ischaemic heart disease on these variations. The Doppler indices (velocity time integral, maximum velocity and average acceleration of systolic flow in the left ventricular outflow tract) were measured and averaged over 3 beats after digitization: the measurements were repeated in 30 patients under basal conditions and after 2 minutes transoesophageal atrial pacing at 150 beats/min. These 30 patients were divided into 3 groups: group 1 control subjects with normal coronary arteries, n = 13, EF = 71 +/- 8.

[Holter electrocardiography before and after coronary angioplasty. Angiographic correlation after 24 hours and 6 months].

Myocardial ischaemia was searched for by Holter monitoring before and after coronary angioplasty with primary success in 31 patients. Control angiography was performed at 24 hours and 6 months after angioplasty. Twelve patients had signs of myocardial ischaemia before angioplasty (cumulated ischaemia: 743 minutes).

[Prognosis of ischemic mitral valve insufficiency].

Seventy-nine patients with ischemic mitral regurgitation were followed up for a period of 20 +/- 8 months. The risk of death increased with age and cardiac failure at the time of inclusion. The risk of cardiac events increased with these factors and also with raised serum creatinine and decreased echocardiographic fractional shortening.

[Late occlusive thrombosis of mitral prosthesis with sinus rhythm. Report of two surgically treated patients].

Two cases are reported of late occlusive thrombosis of a mitral bioprosthesis with sinus rhythm. Two men were concerned (40 and 54 years of age), hospitalized for acute pulmonary oedema which was resistant to medical treatment, 3 years after replacement of a mitral valve (Carpentier Edwards No. 31 and Liotta No.

[Is the prognosis of non-thrombolysed inferior infarction benign?].

Between 1978 and 1983, 2,970 coronary angiographies were performed at the Cardiology Clinic of Necker Hospital; 220 survivors of an initial Q-wave inferior infarction who had not received thrombolytic therapy were selected. The ejection fraction was 55 +/- 11 per cent, and the indexed end diastolic left ventricular volume was 108 +/- 29 ml/m2. The left anterior descending artery was diseased in 57 per cent of cases.

[Auricular flutter disclosing cardiac tumor].

It is unusual that an atrial flutter reveals a tumor of the atrium. Two cases are reported: one occurred in a patient with a myxoma of the left atrium, the other was found in a patient with a non-hodgkinian lymphoma of the right atrium. The diagnosis was made possible by sonocardiography in both cases.

[Restenosis after transluminal coronary angioplasty. Clinical and therapeutic aspects].

To assess the incidence and clinical presentation of restenosis after successful coronary angioplasty, and the short- and mid-term results of its treatment, 160 patients, who underwent a first coronary angioplasty between May 1987 and December 1988, were closely monitored. Restenosis is defined as a loss of 50% or more of the initial gain in area and/or 30% or more in diameter, or chronic coronary occlusion. These criteria were met in 43 patients (27%) within 5.

[Kingella denitrificans endocarditis on an aortic valve prosthesis].

Kingella denitrificans is a Gram-negative bacillus which does not grow readily on the usual media. This organism, normally a commensal of the upper airways, may exceptionally be responsible for endocarditis. We report here the sixth case known in the literature.

[10-year outcome of aortocoronary bypass. Apropos of a consecutive series of 114 patients].

The cases of 114 consecutive patients undergoing saphenous vein coronary bypass surgery over 10 years ago were reviewed. The perioperative mortality was 2.6% and the incidence of non-fatal myocardial infarction in the same period was 6.

[Drug-induced cardiovascular complications].

Many drugs, including those prescribed in cardiology, can induce adverse cardiovascular side effects. Most of the anti-arrhythmia drugs have a negative inotropic action and proarrhythmic effects. Estroprogestative contraceptive drugs favor thromboembolitic events and increase the incidence of hypertension.

[Annulo-ectasing disease of the aorta: apropos of 10 cases].

Ten patients were investigated and operated for severe aortic regurgitation due to dystrophic aortic dilatation. This is the third commonest cause of pure aortic regurgitation (18 p. 100) operated at Necker Hospital during the same period.

[Fitness for sports of patients with Wolff-Parkinson-White syndrome].

The fitness of patients with Wolff-Parkinson-White syndrome to indulge in sporting activities is a practical cardiology problem. The major risk is sudden death due to atrial fibrillation deteriorating to ventricular fibrillation. This risk is small or even theoretical, but signing a fitness certificate engages the clinician's responsibility.

[Clinical and developmental aspects of 1-vessel right coronary atheroma. Therapeutic consequences].

This study analysed the clinical profile, prognosis and consequences on left ventricular function of isolated obstructive atherosclerosis of the right coronary artery in order to establish the indications of percutaneous angioplasty. The inclusion criteria were at least one stenotic lesion greater than 75 p. 100 of a dominant or equilibrated right coronary artery and exclusion of stenosis of the other coronary vessels.

[Acute degenerative mitral insufficiency caused by rupture of the chordae in the elderly patient].

Five cases of degenerative mitral incompetence due to rupture of the chordae tendinae in patients over 70 years of age were reviewed to determine the clinical features of this pathology which is not rare in elderly patients. Chordal rupture usually involves the posterior leaflet and is a sign of generalised disease of the mitral apparatus of two main types: myxoid infiltration or pellucid degeneration. Although the clinical syndrome of rupture is rare (10 p.

[Lipomyxosarcoma of the pulmonary veins extending into the left atrium. Repetitive surgical treatment].

The case reported here of a 54-year old woman with lipomyxosarcoma of the pulmonary veins successfully excised is the first in the literature. The initial symptoms were febrile left ventricular failure with pulmonary oedema and haemoptysis. The diagnosis was made by angiocardiography.

[Myocardial infarction caused by electric injury. Value of coronarography].

The authors report the case of a 54 year old surgeon who received an electric shock from his diathermy equipment. The shock caused an anteroseptal myocardial infarction complicated by an apical aneurysm. The clinical course was followed up by myocardial and cavitary scintigraphy.