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Biomedical subjects

A Choussat

Publications and source records attributed to A Choussat.

At least 73 records · Page 4Linked to original sources
PubMed1988

[Recurrent thrombosis of an aortic valve prosthesis in a pregnant woman. Treatment with urokinase].

A 36 year old woman developed two thromboses on aortic valve prosthesis. The first thrombus at the 14th week of pregnancy was treated with urokinase (2,000 U/kg/h) plus heparin (700-1,000 U/h) over 24 hours and normal wing kinetics were obtained. The second thrombus developed at the 36 th week of pregnancy when the patient was receiving calciparin, and only transient improvement was obtained with similar doses of urokinase hourly over 72 hours. Progressive worsening resulted in higher doses (4,000 U/kg/h) being given without heparin and the thrombus then resolved. The use of urokinase for the first time in this indication allowed therefore, on two occasions and without hemorrhagic complications the cure of this recurrent thrombosis on aortic prosthesis, and the birth, by caesarean, of a healthy baby.

Adult↗
PubMed1987

Long-term results after the Fontan operation for tricuspid atresia.

Between 1968 and 1977, 32 patients who underwent the Fontan operation for tricuspid atresia at Bordeaux, France, or Leiden, The Netherlands, survived at least 1 year after surgery. These patients were evaluated clinically 7 to 16 years (mean 8.9 years) after surgery by review of clinical records, questionnaire, or direct examination. There were five deaths: one during arrhythmia, the second sudden and unexplained, and three others after reoperation. Four of the five patients had evidence of obstruction of the atriopulmonary or atrioventricular conduit. There were eight reoperations. Two were for residual atrial septal defects, one for an atrial septal defect and an intrapulmonary arteriovenous fistula, and one for a residual ventricular septal defect. The other four were reoperated for severe conduit or homograft obstruction. One of these four also had a residual shunt, severe mitral regurgitation, and reduced left ventricular function. One patient was found to have left ventricular dysfunction 3 months after surgery, which persisted. Another patient had left ventricular dysfunction unmasked after successful mitral annuloplasty for severe mitral regurgitation. No other patients had clinical evidence of left ventricular dysfunction. Recurrent supraventricular tachycardia occurred in four patients and was eventually fatal in one patient with associated conduit obstruction. Of the 27 survivors, 13 are in NYHA class I, 13 are in class II, and one is in class III. We conclude that clinical results of the Fontan operation remain good in most patients 7 to 16 years after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Obstruction of the left coronary branch. Ergometric, hemodynamic and angiographic findings].

The authors present 6 personal cases of complete obstruction of the left main stem coronary artery and review the main epidemiological, clinical, ergometric, haemodynamic, angiographic and therapeutic data concerning this condition which is uncommon (0.66% of patients who underwent coronary angiography for angina in this series). This series had a number of special features. Clinical symptoms were moderate, consisting of exercise-induced aggravated angina, except in one patient with a history of anterior infarction complicated by regressive initial heart failure with residual angina. For this reason, all patients were able to perform a standard exercise-test on an ergometric bicycle without any problem. As the exercise test revealed major abnormalities, extreme precautions were observed when coronary angiography was performed, but no incident occurred in any of the 6 patients. Haemodynamic data were normal in 4 cases and altered in 2 cases. The important role played by collateral circulation must be stressed; it is probably under evaluated at arteriography. The absence of lesion of the right coronary artery is thought to facilitate the development of a collateral vascular network. Five patients were operated upon, made an uneventful recovery and were followed up for 19, 42, 17, 5 and 2 months respectively: all were symptom-free under medical treatment. In 3 out of these 5 patients who underwent a post-operative exercise-test all parameters showed excellent results; however, the 4th patient proved unadaptable to exercise, and ECG showed persistent ischaemia due to a very poor distal coronary bed; in the 5th patient, under diltiazem, the results on ischaemia and on the circulatory signs of heart failure were very good.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Anomalous origin of the left coronary artery. The form in infants].

Twenty-four cases of anomalous origin of the left coronary artery from the pulmonary artery are reported. These cases were collected over 27 years divided into three 9-year periods according to the years of the initial studies. The clinical aspects and diagnostic investigations (notably echocardiography, myocardial radioisotope imaging and various angiographic procedures) are reviewed; aortography seems to be, even now, the best exploratory method. Treatment is analyzed according to the periods of observations. From the earliest cases it may be concluded that ligation proved ineffective in infants and medical treatment often failed. Progressively, medical treatment with digitalis (now better controlled), potassium-sparing diuretics and vasodilators has become more effective. On the other hand, direct reimplantation of the left coronary artery onto the aorta has become the preferred surgical procedure. Among the 8 most recent cases (seen between 1977 and 1986), 4 were cured by medical treatment under the age of 3 and subsequent reimplantation. In the other 4 patients asystolia responded to medical treatment, and these children are now awaiting reimplantation.

Coronary Angiography↗
PubMed1987

[Aneurysms of the atrial septum. From diagnosis to treatment. Apropos of 33 consecutive cases].

Although rare, aneurysms of the atrial septum are the object of a renewed interest, for they are found with an ever increasing frequency due to technical advances in echocardiography and they have been blamed for a number of disorders, including arrhythmias and embolic accidents. We report here a series of 33 consecutive cases of atrial septal aneurysm discovered by two-dimensional echocardiography over a 5-year period. There were 21 children and 12 adults. In children, the aneurysm was usually associated with a congenital heart disease (17/21 cases). Spontaneous closure was observed in 3 cases where that disease was an isolated septal defect. In adults the aneurysm was usually isolated, but it was complicated by repeated transient ischaemic accidents in 3 patients. No arrhythmia ascribable to the aneurysm was observed.

Adolescent↗
PubMed1987

[Current aspects of Ebstein's disease].

Ebstein's disease is a rare affection which is more and more frequently discovered since the advent of sonocardiography. As a matter of fact, except in the loud but less frequent neonatal forms, Ebstein's disease appears, most of the time, in the first three decades of life under various, misleading forms. The diagnosis is, today, greatly facilitated by bi-dimensional sonocardiography. This technic enables in fact to precisely define, in typical forms, the different abnormalities of the entire tricuspid valve complex; however, there are also atypical forms which should not be ignored. The prognosis of Ebstein's disease is dominated by rhythm disorders, which should be systematically looked for, and will benefit from modern treatments, and cardiac insufficiency. In this field, recent surgical techniques have also greatly improved so that surgery should be considered as soon as the symptoms become worse (Class III of NYHA).

Ebstein Anomaly↗
PubMed1986

[TM and bidimensional echocardiography of subvalvular aortic stenoses].

28 children (age: 7.5 +/- 4.6 years) and five adults with a subvalvular aortic stenosis were evaluated by TM and bidimensional echography. Long axis parasternal and apical two cavities-aorta views seem the most reliable to determine the anatomical varieties (type I in diaphragm: 25 cases; type II fibromuscular: 5 cases; tunnel: 1 case; isolated mitral abnormalities: 2 cases). 24 patients were catheterized. Among the various echocardiographic parameters that were measured, the ratio parietal thickness/left ventricular diameter in telesystole appears best correlated to the hemodynamic gradient (r = 0.65).

Adolescent↗
PubMed1986

Isolated ventricular inversion with situs solitus: successful surgical repair.

A 7-month-old infant with ventricular inversion without transposition of the great arteries in situs solitus, associated with a ventricular septal defect, is reported. When the infant was 13 months of age, successful surgical repair was undertaken by performing an intraatrial transposition of venous return using the Senning procedure and by closing the ventricular septal defect with a patch. The postoperative course was uneventful except for a well-tolerated complete heart block. No systemic valve incompetence appeared during the 53 months of actual follow-up. A complete review of the literature suggests that this is the sixth reported instance of successful repair. Injury of the abnormally located conduction tissue is regarded as the most threatening complication.

Angiocardiography↗
PubMed1986

[Prevalence, significance and prognosis of ventricular arrhythmia in 236 cases of dilated myocardiopathy].

The prevalence on ECG, Holter monitoring and stress testing and the prognosis of ventricular arrhythmias were assessed in 236 patients with dilated cardiomyopathy (DCM). This diagnosis was confirmed by haemodynamic and coronary angiographic criteria in 218 cases. Analysis of ECG recordings confirmed the high incidence of ventricular extrasystoles (VES) which were observed in 56% of cases, with doublets in 28% and salvoes in 5% of cases. Sustained VT was observed in 5 cases before the diagnosis was established and in 9 cases during follow-up. Ventricular fibrillation was documented in 8 patients without overt cardiac failure. Holter monitoring over 24 hours (N = 76) showed less than 30 VES per hour in 32% of cases, greater than 100 per hour in 36% of cases, predominantly diurnal in 36% of cases, doublets in 40% of cases and salvoes in 15% of cases. A significant correlation was observed (p less than 0.01) between repetitive activity and the frequency of VES. Exercise stress testing (N = 113) showed aggravation of the ventricular arrhythmia in 28% cases. Of the 72 clinical and paraclinical variables that were analysed, the group of patients with VES and doublets on ECG had lower left ventricular ejection fractions and higher pulmonary pressures. Eighty patients died of cardiac causes during follow-up of 38.8 +/- 27 months. Taking into account the haemodynamic differences, the presence of doublets on the ECG was a poor prognostic factor in subjects with ejection fractions greater than 40% (p less than 0.06); this was even more significant when greater than 50% (p less than 0.027).(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1985

Anomalous origin of the right pulmonary artery from the ascending aorta: successful surgical repair.

A case of isolated anomalous origin of the right pulmonary artery from the ascending aorta with severe pulmonary hypertension is reported. Surgical repair was achieved by anastomosis of the anomalous vessel to the pulmonary artery trunk using a continuous absorbable suture. Special emphasis is laid on the favorable postoperative evolution of the pulmonary hypertensive disease following the successful repair. The poor natural history of this uncommon congenital defect if untreated makes early corrective surgery imperative.

Adult↗
PubMed1985

[Prevalence, signification and prognosis of auricular arrhythmia in dilated myocardiopathies. Apropos of 236 cases].

A population of 236 patients with dilated cardiomyopathy (DCM) was studied and followed up for an average of 38.8 +/- 27 months. The most common atrial arrhythmia was atrial fibrillation (AF) which was observed in 27 p. 100 of cases. Patients with AF (n = 43) and without it (n = 193) at the time of diagnosis were compared: the subjects with AF were older (p = 0.036), had a higher left ventricular ejection fraction and lower end diastolic pressures (p = 0.022). AF was associated with mitral valve prolapse (p = 0.007) and with signs of adiastole (p = 0.0015); the most significantly correlated variable was echocardiographic dilatation of the left atrium (p = 0.0012). AF was the presenting symptom of DCM in 13 cases (5.5 p. 100); in 10 cases (4 p. 100) it was the main clinical and therapeutic problem, realizing an arrhythmic form of DCM. Electrical conversion was successful in 7 out of 11 patients with a 2 year follow-up: 3 patients remained in sinus rhythm for over 6 years and have no clinical symptoms, posing the problem of the dominant if not exclusive underlying role of AF in these cases of DCM. An example illustrated by several echocardiographic examinations is presented. Embolic complications were observed in a quarter of the cases with AF and this arrhythmia was present in half the patients with embolic phenomena. However, the prognosis in the groups with and without AF was not significantly different.

Adult↗
PubMed1984

Prosthetic valve endocarditis: diagnosis and prognosis.

From 1972 to 1982, 22 patients were admitted for prosthetic valve endocarditis on homografts (3), bioprostheses (2) or mechanical prostheses (17). Staphylococcus epidermidis was the most common aetiologic agent in early-onset endocarditis and streptococci in late-onset. Echo-cardiographic or cinefluoroscopic findings enhanced diagnosis mainly in advanced stages of the disease. Despite medical therapy and prompt reoperation in most cases, mortality remains high: 66%, 80% in the early group, 50% in the late group; the prognosis was definitely improved, however, by surgical treatment.

Bioprosthesis↗
PubMed1984

Radionuclide angiocardiography in the diagnosis of congenitally corrected transposition of the great arteries.

Congenitally corrected transposition of the great arteries (CTGA) may constitute a pitfall for interpretation of radionuclide angiocardiography, since the two anatomic discordances cancel each other from a physiologic point of view. However, the unusual shape of the ventricles (due to ventricular discordance) and the relative position of the great arteries (due to transposition) can allow a clear scintigraphic diagnosis, especially for CTGA with mild or absent associated congenital anomalies. Five cases are described. Gated cardiac blood pool imaging is particularly helpful since it permits multiple views, allowing a more detailed study of the scintigraphic signs.

Adolescent↗
PubMed1984

Radionuclide studies in postoperative evaluation of the Fontan procedure.

Radionuclide studies were performed on 12 patients who had had a Fontan operation for cyanotic congenital heart disease, six of whom had undergone a prior palliative Glenn procedure. The patients without prior Glenn anastomoses were studied by radionuclide first-pass angiocardiography, using a right antecubital vein injection of 99mTc pertechnetate. The patients with Glenn anastomoses required two injections, one by femoral vein to study the Fontan procedure, using bolus injection of 99mTc pertechnetate or microspheres, and the second by right antecubital vein to study the Glenn anastomosis and right lung, using a bolus of microspheres. Gated cardiac blood-pool scintigraphy was used to measure right atrial and left ventricular ejection fraction in three patients. In nine patients, contrast angiography confirmed that these techniques allowed recognition of residual right-to-left shunts, right atrial stasis, right atrial outflow obstructions, left ventricular dysfunction, and right lung arteriovenous fistulas. Noninvasive radionuclide methods seem to be dependable in the postoperative evaluation of patients after the Fontan procedure. First-pass angiocardiography is most helpful in evaluating the dynamics and distribution of blood flow, especially the right atrial output, and gated blood-pool scintigraphy offers a better evaluation of right atrial and left ventricular contraction, so both supply complementary information.

Adolescent↗
PubMed1984

Aortic valve homografts in the surgical treatment of complex cardiac malformations.

From April of 1968 to March of 1983, the surgical treatment of complex congenital cardiac malformations requiring an extracardiac conduit for their correction was performed with aortic valve homografts or aortic valved homograft conduits sterilized and preserved in our hospital. Our experience concerns 93 patients in whom a total of 103 aortic valve homografts were implanted. Ages of the patients ranged from 7 months to 36 years (mean 11.6 years). The aortic valve homografts were used from the right atrium to the pulmonary arteries or right ventricle (right atrium-dependent conduit), from the venous ventricle to the pulmonary arteries (ventricle-dependent conduit), or in the pulmonary orifice and in the superior and/or inferior venae cavae. There were 25 early and nine late deaths (36.5%), none of them related to the aortic valve homograft. The clinical follow-up of the 59 survivors (1 month to 15 years, mean 4.3 years) evidenced neither dysfunction of the aortic valve homograft nor thromboembolism or hemolysis; 93% of the patients are in New York Heart Association Class I or II. Control cardiac catheterization in 53 patients evidenced a pressure gradient in only 14 ventricle-dependent conduits. In seven patients with serial control catheterizations after 5 to 10 years, the pressure gradient had not increased.

Adolescent↗
PubMed1983

Repair of tricuspid atresia in 100 patients.

One hundred consecutive patients with situs solitus of the atria and tricuspid atresia have undergone surgical repair since 1968. In patients with ventriculoarterial concordance, a nonvalved Dacron conduit or an aortic valve homograft was interposed between the right atrium and right ventricular outlet chamber. In patients with ventriculoarterial discordance, an aortic valve homograft established continuity between the right atrium and pulmonary artery. Among 73 patients with ventriculoarterial concordance, the hospital mortality rate was 11% (eight deaths), and in 27 patients with ventriculoarterial discordance, it was 15% (four deaths). Before 1974, the year of operation was a significant determinant of hospital mortality (p less than 0.001). Thereafter, the hospital mortality declined and is currently 3.7%. In 82 patients with ages ranging from 4 to 16 years, there were six deaths (7.3%) whereas there were six deaths (33.3%) in 18 patients less than 4 or more than 16 years (p less than 0.001). Mode of ventriculoarterial connection and type of repair did not influence significantly the hospital mortality. There were six late deaths due to infection (two), reoperation (two), heart failure (one), and sudden death (one). Regardless of the mode of ventriculoarterial connection, use of a homograft valve produced better results, i.e., more asymptomatic patients (NYHA Class I) (p = 0.0168) and higher postoperative exercise capacity. Postoperative catheterization data and angiocardiographic measurements in patients with ventriculoarterial concordance demonstrated significant advantages with the interposition of a homograft valve between the right atrium and outlet chamber. Of 82 surviving patients, 94% are in NYHA Class I or II.

Adolescent↗