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[Acute mitral incompetence of ischemic origin (author's transl)].

Clinical findings and results of treatment in 17 patients with acute mitral incompetence are described. The lesions were secondary to a recent myocardial necrosis causing severe cardiac failure (shock, or acute left ventricular failure), and the presence of mitral incompetence was confirmed by right catherization (15 cases) and/or left ventricular angiography (13 cases). The anatomical lesions are described in 14 cases: rupture of the posterior mitral papillary muscle in 7 cases, and acute dysfunction of the muscle in 7 other cases. Eight patients were treated by an intra-aortic balloon to assist circulation, and 14 were given vasodilators (phentolamine, trinitrin) associated in 5 cases with positive inotropic drugs. Surgical treatment was given (mitral valve replacement) in 7 cases. The respective effects of vasodilators and circulatory assistance are discussed, as well as the indications for, and results of urgent surgical treatment (6 successes in 7 operations).

Acute Disease↗

Mechanical problems in the use of the intra-aortic balloon.

Although there are many complications in the use of the intraortic balloon (IAB) support device, they are relatively benign compared to the benefits of the device. The purpose of this paper is, firstly, to review a protocol in the safe use of this device, and secondly to remind enthusiastic users of the IAB that the use of this method is not always as benign as we would like it to be. Rarely reported findings at postmortem examination in two patients who died in cardiogenic shock are described. The aorta of one of the two cases in this report had a longitudinal tear which involved only the intima and extended from the common femoral artery to well above the renal arteries. In the second case, the balloon tip had entered at the bifurcation of the aorta in a subintimal manner and had re-entered well below the renal arteries, to be relocated in the proper site in the descending aorta.

Aortic Dissection↗

[Working organs of actuating devices for assisted circulation].

Business ends of operating mechanisms for assisted circulation, based on the principle of contrapulsation, must satisfy a number of requirements on which the safety and the effectiveness of their performance depend. Among these of particular importance are the working volume of the arrangement, correct conformity of the balloon and aorta diameters and also the duty cycle of the arrangement.

Assisted Circulation↗