To evaluate the hemodynamic response to upright exercise of heart transplant recipients, we had 10 patients aged 46 +/- 14 years undergo rest and exercise radionuclide ventriculography 6 to 26 (mean, 14) month after orthotopic heart transplantation. Results were compared with those obtained in 18 young subjects, aged 22 +/- 3 years, and 17 older subjects, aged 56 +/- 5 years. Radionuclide ventriculography was performed at rest and at three levels of exercise, representing 50%, 70%, and 90% of the maximal physical workload. At rest, heart rate was higher in transplant patients than in normal subjects, but during exercise, heart rate increased only 33% compared with a 142% increase in the young subjects and a 111% increase in the older group. During exercise, left ventricular ejection fraction increased in the three groups, but, as compared with the transplant group, the increase of ejection fraction was higher in the young group. End-diastolic volume increased both in transplant patients (+16%) and in older subjects (+13%), whereas it decreased (-20%) in the young subjects during exercise. End-systolic volume decreased in the young group and in the transplant group with exercise, and it did not change in the older group. Cardiac index increased throughout the three levels of exercise in the three groups of subjects, but cardiac index was higher during exercise in young and older normal subjects. With exercise, all three groups showed increases in peak filling rates, but young subjects had a significantly higher value compared with the transplant group. Filling fraction in the first third of diastole did not change with exercise in the transplant and the older group but increased in the young group. We conclude that in transplant patients, increase in cardiac index during upright exercise is mediated by an increase in end-diastolic index during submaximal exercise and by increased heart rate and augmented contractility at peak exercise. Early diastolic filling is altered in these patients, and this alteration is independent from the changes in heart rate and cardiac volumes. When compared with normal persons, this pattern of hemodynamic response to exercise is similar to older subjects but differs from young subjects in whom the increase in heart rate and reduction in end-systolic volume are the chief mechanisms of enhancing cardiac index during exercise.

We describe two oesophago-pleural fistulas arriving respectively 40 months and 15 years after pneumonectomia, and two oesophago-bronchial fistulas due to perforated oesophageal diverticula. We evaluate diagnostic methods and discuss etiology of these oesophageal fistulas. Pleural fistulas treatment associate thoracic drainage, direct surgical treatment of the fistula with primary suturing of oesophagus. For oesophago-bronchial fistula treatment, we have made pneumonectomia one time and primary bronchial suturing another. In these two cases, oesophagus was only sutured without pleural or muscular flap. Transient alimentary gastrostomy was made. No fistula recidive of postoperative complication occurred. There is no operative mortality.

Amlodipine, a dihydropyridine calcium antagonist has been examined on the rhythmic activity of isolated human coronary arteries. Amlodipine inhibited both the spontaneous rhythmic activity and the rhythmic activity evoked by prostaglandin F2 alpha and endothelin in isolated human coronary arteries. It also inhibited the contraction evoked by potassium depolarization. The action of amlodipine was characterized by slow onset and voltage dependency.

Orthotopic heart transplantation was performed in a 21-year-old medical student 11 years after left pneumonectomy for a rhabdomyosarcoma. The cardiomyopathy was the result of the administration of doxorubicin (Adriamycin). The surgical procedure was largely facilitated as a result of an in-hospital donor and the absence of major adhesions. The early postoperative course was mainly uneventful. The patient is doing well 9 months after operation, without any episode of rejection or infection.

This study concerns 89 cases of isolated transposition with early surgical repair by auricular transposition of the venous returns. Fairly good results were obtained with an operative mortality rate less than 10%, few postoperative complications, and long-term follow-up without significant worsening of the functional capacities of these patients. From this study, the authors state precisely the present indications for treatment of isolated transposition.

This paper reports the case of cardiac tumor which had been diagnosed as a left atrial myxoma but which later on was identified as being a primary cardiac liposarcoma. The clinical characteristics of cardiac liposarcomas, the problems of differential diagnosis, the prognosis and therapy are reviewed.

The main haemostasis changes observed in a screening study performed in 40 patients who underwent an open heart surgery with extracorporeal circulation (ECC) are: a significant drop in platelet count from the onset of the ECC to the third postoperative day, a decrease of platelet retention and aggregation during ECC with an 8-day persistently increased heparin-neutralizing activity in plasma but not in serum, a moderate decrease of plasma factors I, II, VII-X, X and XIII and a more important drop in factor V which disappears 24 h after ECC, a transitory increase of fibrinolysis during ECC and the lack of FDP elevation in the serum. These disorders require a very good neutralization of the heparin used during ECC. The ratio protamine/heparin can be established by a titration clotting time test. Protamine chloride seems to be more efficacious and to act more quickly than protamine sulfate for the neutralization. An overload in protamine can enhance the hemostatic, biological and clinical disorders. The preventive administration of platelet concentrate immediately after the heparin neutralization contributes to reduce the bleeding disorders related to the quantitative and qualitative platelet defects.

80 adult patients with isolated aortic valvulopathy and cardiac insufficiency have been investigated. Among 10 non operated patients, there has been 9 deaths during a three years follow-up. Among 70 operated patients early mortality is not higher than among patients without cardiac failure, but late mortality is significantly higher (27, 1 p. 100), bacterial endocarditis and sudden deaths being particularly frequent. Subjective improvement is constant among survivors but cardiomegaly and left ventricular hypertrophy do not change much. The authors think aortic valve replacement is beneficial even in patients with cardiac failure.

The main haemostasis changes observed in a screening study performed in 40 patients who underwent an open heart surgery with extracorporeal circulation (ECC) are: a significant drop in platelet count from the onset of the ECC to the third postoperative day, a decrease of platelet retention and aggregation during ECC with an 8-day persistently increased heparin-neutralizing activity in plasma but not in serum, a moderate decrease of plasma factors I, II, VII-X, X and XIII and a more important drop in factor V which disappears 24 h after ECC, a transitory increase of fibrinolysis during ECC and the lack of FDP elevation in the serum. These disorders require a very good neutralization of the heparin used during ECC. The ratio protamine/heparin can be established by a titration clotting time test. Protamine chloride seems to be more efficacious and to act more quickly than protamine sulfate for the neutralization. An overload in protamine can enhance the hemostatic, biological and clinical disorders. The preventive administration of platelet concentrate immediately after the heparin neutralization contributes to reduce the bleeding disorders related to the quantitative and qualitative platelet defects.

Isotopic platelet survival time (PST), platelet count, adhesiveness, aggregation, PF4 release and coagulation parameters were examined in 23 patients with prosthetic heart valves (6 mitral, 10 aortic and 7 mitroaortic Starr Edwards or Bjork valves) treated with or without suloctidil. The patients were distributed in 2 comparative groups : the treated group with 11 patients with VKA (nicoumalone) and suloctidil (600 mg/day) and the control group with 12 patients with VKA alone. The biological parameters were performed before (the 10th postop. day) and 6 weeks after treatment with or without suloctidil. Before treatment were : PST shortened, platelet adhesiveness and aggregation normal and PF4 release, factors I, VIII-C, VIII-R-Ag increased in both groups. After treatment, PST returned to normal in the treated group, but remained unchanged or was more decreased in the control group. Platelet adhesiveness and aggregation were unchanged in both groups. PF4 release was reduced in the treated group and unchanged in the control group. Platelet count, factors I, VIII-C, VIII-R-Ag returned to the preoperative values in both groups. Two severe thromboembolic complications appeared in the control group, none in the treated group.

Twenty-seven cases of ruptured chordae tendineae have been discovered during surgery for mitral regurgitation (9,3 %) : the highest incidence of ruptured chordae tendineae has been found among pure mitral insufficiency (36 %). In thirteen cases, the rupture was isolated, without any other valvular lesion. The syndrome described as characteristic of rupture was present in one third of our patients : isolated cases do not differ clinically from the others but for a more frequent acute evolution. In pure or predominant mitral regurgitation, surgery seems needed when clinical aggravation, acute or progressive, cannot be explained by arrhythmia, anaemia, pulmonary embolism, hyperthyroidism.