In experimental models, the characteristics of beta-adrenoceptors in left ventricular hypertrophy (LVH) due to pressure overload remain controversial and no data are still available in man.We investigated right auricular (RA) and left ventricular (LV) beta-adrenoceptors characteristics (125 I cyanopindolol binding) in two groups of patients undergoing valve replacement without heart failure (LV ejection fraction > 55 %). Height patients with mitral stenosis (mean age : 64 +/- 4 years) and without LVH (LV mass index < 120 g/m2) constitued the control group and 13 patients with aortic stenosis (mean age : 66 +/- 4 years) and LVH (LV mass index > 150 g/m2) the study group. The results are :[GRAPHICS]B-max : maximal number of beta-adrenoceptors in fmol/mg protein ; Kd : dissociation constant in pM ; % B1-AR : percentage of beta 1-adrenoceptors * : NS ; ** : p < 0.05 when compared with the control group.These results show that, in man, LVH due to pressure overload does not induce variation of total number beta-adrenoceptors, but is associated with a selective decrease in left ventricular beta 1-adrenoceptors.

The authors report 35 cases of implantation of a programmable implantable insulin pump, under local anesthesia. This technique allows creation of an subcutaneous pocket and introduction of an intraperitoneal catheter for insulin delivery. The morbidity is mainly due to the catheter which becomes thrombosed by a fibrotic pannus at its tip. We observed only one case of mechanical dysfunction of the pump. Subcutaneous migration is secondary to reoperation without new fixation. With a mean follow-up of 7 months, 75% of the patients are doing well.

In experimental models, the characteristics of beta-adrenoceptors in left ventricular hypertrophy (LVH) due to pressure overload remain controversial and no data are still available in man. We investigated right auricular (RA) and left ventricular (LV) beta-adrenoceptors characteristics (125 I cyanopindolol binding) in two groups of patients undergoing valve replacement without heart failure (LV ejection fraction > 55%). Height patients with mitral stenosis (mean age: 64 +/- 4 years) and without LVH (LV mass index < 120 g/m2) constituted the control group and 13 patients with aortic stenosis (mean age: 66 +/- 4 years) and LVH (LV mass index > 150 g/m2) the study group. The results are: [table: see text] These results show that, in man, LVH due to pressure overload does not induce variation of total number beta-adrenoceptors, but is associated with a selective decrease in left ventricular beta 1-adrenoceptors.

Galinier, M*,†; Senard, J M*; Drean, G*; Valer, P*; Glock, Y‡; Dalous, Ph‡; Roux, D‡; Puel, J†; Montastruc, J L*; Bounhoure, J P† Author Information

Between November 1989 and February 1990, 66 randomized sternotomized patients underwent aortocoronary bypass and were subjected to a sternal scanner in the early postoperative period. Each examination included a manubrial and a sternal body print. At each level, we studied the occurrence of spacing or misalignment of the sternal layers. The 66 patients were subdivided into four groups according to the type of conduit harvested (single left internal thoracic artery or saphenous vein) and the type of material used for the sternal closure (steel wires or nylon yarns). In all cases, adequate early sternal approximation, which is represented by a good alignment as well as by an excellent contact of the sternal layers, was infrequently demonstrated. Moreover, the two abnormalities most often observed were manubrial spacing and sternal body misalignment. The sternal closure technique and internal thoracic artery harvesting had no significant effect on the sternal approximation. To minimize manubrial spacing and sternal body misalignment, we propose that the surgeon should apply three threads through the manubrium, withdraw the shoulder roll beforehand, elevate both of the patient's shoulders, and maintain the two xyphoid layers in the same plane and in fairly close contact during the tightening of the wires.

We describe a new technique for the placing and fixing of extracorporeal circulation cannulae in the heart. Two devices are involved, the first for an atrial or venous return cannula and the second for an aortic perfusion cannula. These allow quick easy cannulation which is very important in emergency surgery.

The authors report 56 patients. 80 years of age or older who had an abdominal aortic aneurysm (AAA): twenty seven were operated upon as emergencies, 7 with intra-peritoneal (Group I) and 20 with retro-peritoneal rupture (Group II). Twenty nine underwent elective surgery (Group III). Renal pulmonary and cardiac disease are frequent in octogenarian patients. The surgical repair consisted of 40 knitted bifurcated grafts and 16 aorto-aortic woven grafts. The overall in-hospital mortality rate is high (28.5%: 16 patients) essentially in "emergency" surgery: 71% for the seven Group I patients and 45% for the twenty Group II patients. The in-hospital mortality rate of 6.9% for the Group III of "elective" procedure is higher than the mortality rate of patients of all ages operated on for asymptomatic AAA in our institution which is 4.3%. Once a patient has been operated on successfully his life expectancy tends to parallel that of a normal population for his age group. These results can be improved with preventive measures such as elective surgery for asymptomatic AAA with a diameter of 6 cm or more. Operative contraindications are severe congestive heart failure, advanced pulmonary disease or neoplastic disease. The age "per se" is not a contraindication to aneurysmectomy. Physiologic rather than chronologic age should determine the selection for AAA in the over-80 age group. CT scans and MR are safe fast and non-invasive preoperative examinations for AAA.

A new instrument has been designed for cardiac surgery. It frees the hands of the surgical assistant and is effective either for valve replacement or coronary graft anastomosis. The use of this instrument makes the operation quicker and easier.

Un support endovasculaire mis en place par voie percutanee peut etre une solution seduisante pour la prevention des occlusions precoces et des restenoses apres angioplastie (ATP). 23 lesions iliaques et 40 lesions femoro-poplitees symptomatiques chez 55 patients ont ete traitees par des endoprotheses de type Wallstent

An endovascular support inserted percutaneously, may represent an attractive solution to prevent early obstructions and recurrent stenoses after angioplasty (ATP). 23 iliac lesions and 40 femoro-popliteal lesions, symptomatic in 55 patients, were treated with endoprostheses of the Wallstent type. For the iliac implantations, it concerned in one case a recurrence after endarterectomy, 13 cases of recurrent stenoses after ATP and 9 cases of immediate failure of the angioplasty. The mean length of the lesions under treatment was 8 cm (extreme values between 4 and 14 cm). For the femoro-opoliteal arteries, the implants concerned lesions ranging between 3 and 7 cm, in 75 p. cent of the cases, and lesions exceeding 7 cm in 25 p. cent of the cases. Three iliac thromboses and six femoro-popliteal thromboses were reported at the beginning of this study; on the contrary, no thrombosis is present in the last 18 patients treated with oral anticoagulants. The rate of recurrent stenosis is low (none at the iliac level and 10 p. cent at the femoro-popliteal level); in all other cases an excellent clinical result was obtained with a mean follow-up of 18 months.

We report the case of a 74-year old man who experienced two transient cerebral ischaemic accidents at 24 days' interval, showing that the isolated calcifications on chordae of the mitral valve posterior leaflet responsible for these accidents were exceptionally malformed. Two-dimensional echocardiography was the key examination, as it revealed a left intraventricular mass beneath the smaller mitral valve leaflet. Having excluded other cardiac causes of cerebral ischaemic accident, and faced with the recurrent character of these accidents, we decided to operate. Surgery confirmed the diagnosis. It consisted of resection of the calcified and ulcerated mass, combined with repair of the smaller mitral valve leaflet. Isolated calcifications of the mitral valve chordae are an exceptional cause of embolic accidents of cardiac origin.