Search PubMed⌕ Search

Biomedical subjects

A Choussat

Publications and source records attributed to A Choussat.

At least 55 records · Page 3Linked to original sources
PubMed1991

[A rare cause of obstruction of mitral valve prosthesis: periannular fibrosis. Diagnostic by transesophageal echocardiography].

The authors report a case of dysfunction of a double hemi-disc mitral valve prosthesis due to peri-annular fibrous overgrowth on the atrial side of the prosthesis. Conventional transthoracic Doppler echocardiography showed signs of thrombosis of the prosthesis. Transoesophageal echocardiography allowed a precise diagnosis of the lesions, resulting in immediate surgical referral.

Aortic Valve↗
PubMed1991

[Complementary transthoracic and transesophageal echo-doppler in the diagnosis of rupture of the sinus of Valsalva in right heart. Apropos of 4 cases].

Aneurysms of the sinus of Valsalva are rare and usually present with rupture communicating with the right heart cavities. Echocardiography is a powerful diagnostic tool in ruptured sinus of Valsalva aneurysms, especially the Color Doppler mode which shows abnormal, continuous flow as a mosaic of colour extending from the aortic root to the right heart cavities. The four case reports describe rupture of the right sinus of Valsalva aneurysm into the right atrium (2 cases) and the right ventricle (2 cases). Transesophageal echocardiography was performed in two cases and provided valuable information by confirming the site of rupture and the length of the diverticulum. The results illustrate the accuracy of Doppler echocardiographic techniques by the transthoracic and transoesophageal approaches in the diagnosis of ruptured sinus of Valsalva aneurysms.

Adolescent↗
PubMed1991

[Pulmonary orifice stenosis: the medical solution. Apropos of 62 cases].

Sixty two patients with moderate or severe stenosis of the pulmonary orifice (SPO) underwent balloon catheter valvuloplasty. Thirty one were aged under 5 years. The mean right ventricle-pulmonary artery trunk (RV-PAT) gradient fell from 75 (+/- 26) to 23 (+/- 10) mmHg (p less than 0.001). All dilatations except one were effective with only a few incidents and no mortality. Six (+/- 2) months later, hemodynamic evaluation of 45 patients (70%) showed stability of the RV-PAT gradient at 26 (+/- 18) as compared with 23 (+/- 11) mmHg. Ten patients required a second dilatation because of a residual gradient of greater than 35 mmHg. The result was favourable in all ten cases, the RV-PAT gradient falling from 53 (+/- 17) to 13 (+/- 8) mmHg (p less than 0.001). This series confirmed the efficacy, reproducibility and safety of this technique which led to a lowering of ventriculo-pulmonary gradient, persistent at six months, to an infra-surgical level, at the price of pulmonary incompetence (27%) which was always well tolerated in the mid-term. This valvuloplasty may be suggested for all cases of SPO with a gradient of greater than 35 mmHg.

Adolescent↗
PubMed1990

Clinical characteristics affecting success or failure of PTCA in patients with multiple vessel disease and poor candidates for surgery.

A special form of complex coronary angioplasty is represented by the extension of indications for percutaneous transluminal coronary angioplasty (PTCA) to patients with multivessel disease (MVD) for whom surgery is not indicated, and thus for whom surgical standby is not available. Over a two-year period, 254 consecutive coronary patients with multivessel disease underwent PTCA under such conditions. These patients could not benefit from surgery for various reasons. Of the 612 arteries involved, 155 were occluded, 47 had been previously bypassed. A distal nonbypassable lesion in one of the three major arteries was found in 244 patients, 61 had suffered from a previous infarct, 24 demonstrated an ejection fraction below 0.40, and in 19 a single patent vessel was found. Fifteen patients were in cardiogenic shock and 69 procedures were undertaken for unstable angina. Of this latter group, 25 emergency PTCA were attempted for refractory unstable angina, and 44 additional emergency procedures were directed to the treatment of acute infarct. A total of 40 intra-aortic counterpulsations were needed. As far as possible the procedure aimed at full revascularization. Immediate outcome is strongly affected by the clinical context, and despite a rather constant initial success rate (88-95%), the procedural mortality (directly related or not) can change dramatically with clinical factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Value of Naito's criteria in the surgical repair of tetralogy of Fallot].

Naito suggested criteria for the optimal reconstruction of the right ventricular outflow tract in total correction of tetralogy of Fallot based on the minimum acceptable diameter of the pulmonary artery. The value of these criteria was assessed in 78 operated patients by haemodynamic measurements at surgery and 6 months after operation. Using these criteria, a ratio of right ventricular/left ventricular systolic pressure less than 0.60 was obtained with the creation of pulmonary regurgitation which was usually moderate. Long-term assessment of these results is required.

Adolescent↗
PubMed1990

[Doppler echocardiographic evaluation of right heart pressure in children with ventricular septal defect].

Thirty seven children with ventricular septal defects (VSD) alone or associated with other malformations were examined by Doppler echocardiography to evaluate systolic right ventricular pressure (SRVP) non-invasively. All patients underwent cardiac catheterisation within 48 hours of the Doppler estimation. The maximum interventricular pressure gradient could be assessed in 32 patients (86%) from the recording of the maximum velocity of the VSD jet using the simplified Bernoulli formula. The SRVP was calculated by subtracting the maximum interventricular pressure gradient from the systolic blood pressure measured by sphygmomanometry. The SRVP estimated by continuous wave Doppler ranged from 24 to 108 mmHg (mean: 60 mmHg) compared with 20 to 109 mmHg (mean: 64 mmHg) at catheterisation. Two types of correlation were sought: 1) between the maximum interventricular pressure gradient measured by Doppler echo and the peak-to-peak LV-RV pressure gradient (r = 0.95; SD = 6 mmHg; Y = 1.03 x X + 1.3); 2) and between the SRVP measured by Doppler and by catheterisation (r = 0.94; SD = 6 mmHg; Y = 1.06 x X + 7.7). These results show that the maximum velocity of the interventricular jet and thereby the SRVP may be accurately measured by Doppler echocardiography in the majority of patients with VSD.

Adolescent↗
PubMed1990

[Value of Doppler color echocardiography in the diagnosis of diastolic mitral insufficiency in severe aortic insufficiency. Report of 2 cases].

The authors report the value of Doppler color flow mapping in the diagnosis of late diastolic mitral regurgitation in two patients with severe post-endocarditis aortic regurgitation requiring rapid surgical intervention. Doppler color flow mapping played an essential part in the management of these cases by helping in the diagnosis of late diastolic mitral regurgitation which is known to carry a very poor prognosis in this context.

Aortic Valve↗
PubMed1989

Pulmonary artery to the left atrium fistula as an unusual cause of cyanosis in the newborn.

A fistula between the pulmonary artery (PA) and the left atrium (LA) is a rare form of congenital heart disease, 34 cases having been described in the literature, all from the right pulmonary artery (RPA). Only six cases were diagnosed in the newborn period. We report such a case, diagnosed at 1 day of age by Doppler echocardiography, with an unusual site of the fistula.

Cyanosis↗
PubMed1989

Aneurysms of the abdominal aorta in the neonate and infant.

We report a case of aneurysm of the infrarenal abdominal aorta from septic umbilical artery catheterization in a one-month old female infant. In spite of spontaneous thrombosis, the patient's course was uneventful. During the five-year follow-up period no further complications developed and operation was not required. Aneurysms of the aorta are rare in the very young and the infrarenal location is rarer. Sixteen other cases published in the literature are reviewed. Etiologic considerations and therapeutic modalities are discussed.

Aorta, Abdominal↗
PubMed1989

[Fulguration of accessory pathways in children. Value of two-dimensional echocardiography].

Six children (4 boys and 2 girls) aged from 3 to 7 years who had an accessory pathway and were suffering from paroxysmal (n = 4) or permanent (n = 2) refractory reciprocating tachycardia underwent transcatheter ablation of the accessory pathway alone in 5 cases and of the normal and accessory pathways in 1 case. Conduction in the accessory pathway was interrupted in 3 cases and sufficiently modified in 2 cases for the attacks of tachycardia to be suppressed by a simple and previously ineffective medical treatment. There was one failure. The authors underline the value of two-dimensional echocardiography in such cases. This technique is useful in the preoperative evaluation, during catheter insertion, and also in the choice of the electrodes to be used, for the ablation itself and in the search for postoperative lesions. Transcatheter ablation seems to be feasible and safe enough to be offered as an alternative to surgery in the treatment of refractory reciprocating tachycardia in children.

Adolescent↗
PubMed1989

[von Willebrand's disease and coronary atherosclerosis. Apropos of 3 cases].

The von Willebrand factor (VWF) is a link in the platelet-vessel wall interaction which plays an essential role in the response of the vessel wall to an atherosclerosis-including aggression. However, can von Willebrand's disease really prevent the development of atherosclerosis? The authors report 3 cases of young men aged 36, 40 and 51 years with atherogenic risk factors and von Willebrand's disease (two mild and one severe form). The three patients developed both atherosclerotic lesions and thrombosis. This would suggest that VWF deficiency does not protect humans from atherosclerosis.

Adult↗
PubMed1989

[Calculation of the pulmonary to systemic flow ratio using echo-Doppler in septal defects--correlation with oximetry].

OBJECTIVE: 1. local validation of a protocol of measurement of pulmonary to systemic flow ratio (QP/QS) by echo-Doppler in children with septal defects; 2. to assess continuous wave Doppler efficacy mainly in those patients where peak pulmonary flow velocity was beyond the Nyquist limit of pulsed Doppler. DESIGN: To correlate QP/QS ratio determined by echo-Doppler with that obtained by cardiac catheterization (oximetric method) performed within 48 hours, in children with isolated septal defects. MATERIAL AND METHODS: The QP/QS ratio was evaluated by pulsed and or continuous wave echo-Doppler in 50 children who were submitted within 48 hours to cardiac catheterization. All children had an intracardiac shunt (12 atrial septal defects--ASD; 26 ventricular septal defects--VSD and 12 atrio ventricular septal defects--AVDS). Identical measurements were performed in a group of 20 children without cardiac malformation--control group. To test inter-observer variability, all the measurement in 31 patients were repeated by a second observer. Pulmonary and aortic flow was calculated as: Q = A x V x ET x CF where, A is the valvular orifice area (cm2), V the mean flow velocity (cm/sec), ET the ejection time (sec) and CF the cardiac frequency (cycles/min). The Doppler beam-flow direction angle in the pulmonary (P) artery and ascending aorta (Ao) was less than 20 degrees. Results were correlated with those obtained by catheterization (oximetric method). RESULTS: We obtained a fairly good correlation with both pulsed wave Doppler (n = 43; r = 0.88; p less than 0.001; y = 0.84x + 0.40) and continuous wave Doppler (n = 50; r = 0.91; p less than 0.001; y = 0.86x + 0.35) or with pulsed wave Doppler in the P artery and continuous wave Doppler in the Ao (n = 43; r = 0.92; p less than 0.001; y = 0.86x + 0.27). In the control group, QP/QS ratio was evaluated by echo-Doppler: pulsed wave Doppler at 1.05 +/- 0.15 (mean +/- DS); continuous wave Doppler at 1.05 +/- 0.12 and, pulsed wave Doppler in the P artery and continuous wave Doppler in the Ao at 1.03 +/- 0.12. There was no significant difference in all three groups to the normal range of 1.00 (p less than 0.01). Inter-observer variability was less than 5.5% (p less than 0.001). CONCLUSION: Pulsed and/or continuous wave echo-Doppler measurements are a reliable noninvasive method in evaluating QP/QS ratio in children with isolated septal defects.

Adolescent↗
PubMed1988

Exclusive double outlet right ventricle with atrioventricular concordance and pulmonary stenosis. Results of reconstructive surgery.

Double outlet right ventricle associated with atrioventricular concordance, pulmonary stenosis and situs solitus of the atria is a subset of double outlet right ventricle related through the surgical treatment. From 1974 to 1985, 14 patients, 5 males, 9 females (mean age 8.9 years, range 13 months-22 years) were operated upon. All patients had infundibular stenosis and normal or large pulmonary arteries. The apex of the heart was to the right in 2 patients, the right and left ventricles were superior and inferior in 2 patients and 1 patient had both anomalies. The ventricular septal defect was subaortic in 11 patients (aorto-mitral discontinuity in 5) and non-committed in 3 patients. Three patients had 2 ventricular septal defects. The aorta was anterior in 3 patients and to the right of the pulmonary artery in 11 patients. All patients, through a transventricular and transatrial approach, had a reconstructive surgery. In 3 patients, an aortic homograft valved conduit was used. One patient had the ventricular septal defect enlarged. There was one early death (7.1%) from high residual right ventricle pressure and no late death. One patient had a transient atrioventricular block. One patient was reoperated upon for a residual ventricular septal defect. All survivors had a good clinical result. Re-evaluation in 8 patients confirmed excellent haemodynamics: the right ventricle to pulmonary artery pressure gradient decreased from 80 mm Hg (range 60-95) preoperatively to 24 mm Hg (range 3-32) postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Coarctation of the abdominal aorta.

Coarctation of the abdominal aorta constitutes a rare group of vascular abnormalities, including segmental stenoses and extended hypoplasia. Hypertension is the usual solitary clinical finding and contrasts with the diversity of anatomic lesions and surgical techniques used for treatment. It is often difficult to determine whether the lesion is congenital or due to Takayasu's aortitis. Three cases of hypoplasia in adolescents are reported. Treatment consisted of an aortoaortic bypass in all cases. Vein angioplasty of the renal arteries was performed concomitantly in one case of inter- and infrarenal hypoplasia associated with stenosis of the two renal arteries. In one of the two cases of suprarenal hypoplasia, the celiac axis was reimplanted after excision of an associated aneurysm. In all three cases, blood pressure returned to normal values without medical treatment.

Adolescent↗
PubMed1988

[Treatment of renovascular arterial hypertension: angioplasty versus surgery].

Percutaneous transluminal angioplasty is being more and more performed as the first choice treatment of renovascular hypertension. However, very few studies are devoted to the comparison of angioplasty versus surgery in treating renovascular hypertension and no one is prospective. A group of 25 patients with renovascular hypertension who underwent surgical treatment in the years 78-82 was compared to a group of 32 patients who underwent transluminal angioplasty in the years 82-86. Age, sex, etiology and severity of the arterial stenosis, blood pressure before treatment were similar in both groups. Average follow up was 44 +/- 33 months in the surgical group (S), 18 +/- 15 months in the angioplasty group (A). In the surgical group, we noticed one death, 20 p. 100 of major complications (thrombosis or stenosis of bypass grafts). In the angioplasty group, there was no death, 82 p. 100 of initial success, 12 p. 100 of major complications which needed surgery, 22 p. 100 of restenosis which were treated with a second angioplasty. Patients were classified as cured (BP less than 140/90 without treatment and perfect renal vascularisation) improved (BP less than 160/100 without treatment or with treatment if reduced and renal artery stenosis less than 50 p. 100), unchanged (BP greater than 160/100 and/or renal artery stenosis greater than 50 p. 100 or thrombosis). (Table: see text). Results are similar in both groups. The simplicity of the procedure, a lower cost and the absence of lethal complications are in favour of the transluminal angioplasty as the first choice treatment of renovascular hypertension.

Adult↗
PubMed1988

[Evaluation of aortic to pulmonary blood flow ratio by Doppler echocardiography in septal defects].

Pulsed Doppler-echocardiography was used to measure systemic and pulmonary blood flows in 22 patients aged from 3 months to 62 years presenting with interatrial (n = 13) or interventricular (n = 9) septal defect. Calculations were based on echographic measurements of aortic and pulmonary orifice areas and on the integral of maximal aortic and pulmonary Doppler velocity curves. Section areas or the arteries, taken as being circular, were deduced from arterial diameter measurements effected above Valsalva's sinus. Doppler velocity curves were recorded at that level, looking for maximal velocities and assuming a flat velocity profile. Blood flow ratios evaluated from Doppler-echocardiography data were compared with data provided by oximetry and showed good correlations (r = 0.92; Y = 0.71x + 0.53; SEE = 0.24). Calculations by categories of lesions showed better results in patients with interatrial septal defect (r = 0.94; Y = 0.73x + 0.507; SEE = 0.22) than in patients with interventricular septal defect (r = 0.83; Y = 0.547x + 0.75; SEE = 0.25). The main difficulties encountered in measuring Doppler-echocardiography blood flow ratios concerned accurate measurement of pulmonary artery diameter, due to problems of lateral resolution, and accurate measurement of turbulent Doppler velocimetry curves. However, this new, non-invasive technique may be useful to determine the best indications for catheterization or even surgery.

Adolescent↗