[Treatment of acute left cardiac insufficiency: a labyrinth without the thread of Ariane?].

The final picture of left ventricular failure depends at least as much upon its four mechanisms of compensation (increase in preload, in afterload, in heart rate and, as an attempt, in myocardial contractility) as upon its primary factor (decrease in contractility). The complexity of all possible combinations between those various factors has good chances to bring about confusion in therapeutics if one doesn't dispose of a method, a kind of Ariane's thread, making it possible (1) to define some wide orientations to start with, and thereafter (2) to state precisely the way out of that labyrinth. This method must be founded on an accurate physiological basis and therefore requires cardiac catheterization.

[Two-dimensional echocardiography. Principles, techniques, and anatomical comparisons].

This article introduces bidimensional echocardiography. The main sections are reviewed. A brief comparison between M-mode and 2 D echocardiography is proposed showing that the two techniques are really complementary to one another.

Left ventricular ejection time in aortic stenosis and insufficiency: 2. Indirect assessment of the severity of the lesion.

The purpose of this work is to reconsider practical value of three prediction formulae of left ventricular ejection time (LVET): the Wood's coefficient, the Weissler's residual and the multivariate residual. Two series of patients are presented: (1) an aortic series of 160 patients, with pure or nearly pure stenosis in 46 cases, pure insufficiency in 57 cases, and stenosis plus insufficiency in 57 cases, and (2) a reference series of 200 patients without aortic disease. All the patients were catheterized, with measurement of cardiac output by Fick's method.

[Left ventricular ejection time in aortic valve diseases. 1. Multidimensional relationship with biometric and physiologic findings].

The purpose of this work is to settle biometrical and physiological factors linked to changes in ejection time in aortic valvular disease. The relationship between the various considered variables is submitted to multivariate statistical analysis, and expressed by a prediction formula. Data are provided by a series of 160 aortic patients whose examination notably includes measurement of cardiac output and of pressures in left ventricle and aorta, a cineangiography in the ascending aorta, and a search for aortic valvular calcifications with an image intensifier.

Total anomalous systemic venous drainage.

Total drainage of systemic blood into the left atrium is an exceptional finding in absence of severe intracardiac malformation. In our patient, a boy 3 years and 4 months old, the left superior vena cava, the inferior vena cava, and the coronary sinus drained into the left atrium; there was no right superior vena cava, and the only associated anomaly was a large atrial septal defect. This rare form of cyanotic congenital heart disease was correctly diagnosed and successfully corrected.

Severe coarctation with similar pressure at four limbs. Clinical, catheterization, angiographic and surgical data of one case.

In patient with severe coarctation of the aorta, arterial pressures were similar at the four limbs due to departure of both subclavian arteries from the descending aorta. The clinical clues to the diagnosis and the hemodynamic, angiocardiographic and surgical data are presented.

Left ventricular ejection time. multiple relation to physiological and biometrical data; prediction of reference standards.

The relationship between left ventricular ejection time, and physiological or biometrical data, is submitted to multivariate statistical analysis. Methodology is intended to attain three objectives: 1) to simulate a controlled-condition experiment in clinical research, by using the statistical method of multiple regression; 2) to get a wide inference of conclusions, by selecting a sample of two hundred subjects whose biological data cover a wide field; 3) to check the really prospective value of results, by applying the formula worked out in a group of a hundred subjects to another independent group of a hundred subjects. The prediction formula of ejection time takes into account: stroke volume, cardiac cycle duration, body height, sex, age, pulse pressure, blood capacity in oxygen, presence or absence of digitalis treatment or atrial fibrillation.