[Long term results of heart valve replacements by prostheses].
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Biomedical subjects
Publications and source records attributed to P Penther.
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The data of the macroscopical-anatomical examination of 14 cases of cardiac rupture (10 women, 4 men) complicating acute myocardial infarction were compared with those obtained at autopsy, with the same protocol, in 31 cases of myocardial infarction which resulted in death before the 30th day after the onset. Many anatomical facts separated both groups from each other (size, aspect, limits of myocardial necrosis, state of the coronary arteries). Eventual surgical conclusions might be drawn from this study.
Silent mitral incompetence due to partial dislocation of the Starr-Edwards valve, leading to an apparently unexplained cardiac failure, has been observed in two patients, one two months and the other 35 months postoperatively. There was a fatal outcome in the first patient, no operation being carried out. Cardiac catheterisation with arteriography of the left anterior descending artery established the diagnosis, and led to a successful reoperation in the second case. It is therefore essential to carry out a haemodynamic and angiocardiographic investigation of any case who, after an initial trouble-free interval post-operatively, develops a deterioration of function which cannot be explained.
The morphologic patterns observed in 37 cases of myocardial infarction seem to depend on two factors: 1. The time factor, making it possible to contrast the homogeneous, simple or complex forms with the unhomogeneous forms, the age of which is difficult to assess. 2. The extension factor of infarction which makes the unhomogenous patterns very complex in the cases in which necrosis exceeded 30%. In other words, it seems that in these cases, histological examination does not make it possible to date with accuracy the onset of myocardial infarction, except in very early or very late stages.
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Twenty-nine patients with isolated (18) or predominant (11) mitral insufficiency were treated by mitral annuloplasty. This post-operative follow-up study, lasting from 3 to 5(1/2) years (average 48 months), resulted in the following conclusions. The clinical, radiological, and electrocardiographic conditions usually followed a parallel course. Initial good results were maintained for up to 4 years in only 16 patients. Subsequent deterioration was related to progression to mitral stenosis (2 patients), recurrence of severe mitral insufficiency (13 patients), occurrence (5 patients) or recurrence (8 patients) of tricuspid insufficiency. Poor results were more often observed in the eldest patients, with conspicous pre-operative cardiac enlargement, atrial fibrillation, and long-standing cardiac failure. The indications for annuloplasty are reduced and apply primarily to mitral insufficiency without obvious cardiac enlargement, with normal sinus rhythm, and with short-standing congestive cardiac failure.
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