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Biomedical subjects

A Piekarski

Publications and source records attributed to A Piekarski.

15 recordsLinked to original sources
PubMed1985

[Tamponade caused by localized compression of the superior vena cava and right atrium after aortic valve replacement under extracorporeal circulation].

The authors report a case of localised compression of the right atrium due to a loculated intrapericardial haematoma after open heart surgery. The patient suddenly developed signs of superior vena caval obstruction during the third postoperative week. The diagnosis was made by 2D echocardiography and superior vena cavography. The authors review the literature and discuss the main clinical features of localised cardiac tamponade, underlying the value of 2D echocardiography in the postoperative management of cardiac surgical patients.

Adult↗
PubMed1984

[Acute myocarditis simulating an anterior infarction rupture. Apropos of 2 cases].

The first case report concerns a 31 year old woman presenting clinically and electrocardiographically as an anteroseptal myocardial infarction complicated by cardiogenic shock with equalization of right heart diastolic pressures. Coronary angiography performed under circulatory assistance was normal. The patient recovered, and clinical examination 4 years after the acute episode is absolutely normal. The second case was a 37 year old man admitted in cardiogenic shock thought to be due to a large anterior myocardial infarct. Catheterisation showed equalization of right heart diastolic pressures. Pericardial aspiration was negative and the most likely diagnosis appeared to be a localised rupture of the heart. The patient underwent emergency cardiac surgery but no infarct scar was observed and opening the pericardium did not improve the haemodynamics. Coronary angiography was carried out at the 24th hour under circulatory assistance and was found to be normal. The diagnosis was corrected to that of acute myocarditis and 5 months after the acute episode clinical cure was confirmed by normal echocardiography and angiography. The only positive aetiological finding in this case was the serology to chlamydia trachomatis which as strongly positive at increasing titres. Chlamydia was isolated from the patient's urethra and a chlamydia trachomatis exocervicitis was also found in the partner. This appears to be the first reported case of chlamydia trachomatis acute myocarditis in the adult.

Acute Disease↗
PubMed1983

Subcostal M-mode computerised echocardiography. An alternative or complementary approach to parasternal echocardiography?

Subcostal M-mode echocardiography has been suggested as a method for assessment of left ventricular size and function. Parasternal and subcostal measurements (direct and derived) of left ventricular function were compared in 30 healthy young subjects. We calculated instantaneous left ventricular diameter and wall thickness every 10 ms for both the subcostal and parasternal approaches using a computer program for echocardiographic digitisation and compensation. All variables were filtered to calculate instantaneous first derivative (velocity) and logarithmic derivative (normalised velocity). The program provided normal values for computerised variables of left ventricular function from the subcostal approach. It was found that there was no identity and no correlation or a poor one between subcostal and parasternal left ventricular internal diameters and volumes. The parietal wall thickness was significantly greater using the subcostal approach, and the comparative velocities study showed striking variations between the two approaches, especially in diastole, where the peak lateral wall thinning rate was 20% lower than the posterior thinning rate. We conclude that for a normal and young population, the subcostal and standard parasternal data cannot be used interchangeably for precise studies of left ventricular function. The subcostal approach, however, provides useful complementary information about lateral wall motion.

Adult↗
PubMed1983

[Adiastole caused by a secondary cardiac hemochromatosis. Successful treatment with an iron chelating agent].

Severe congestive cardiac failure developed in a few weeks in a 44 year old man who had undergone porto-caval anastamosis for post-hepatitis cirrhosis one year previously and then treated for anaemia by repeated blood transfusion and chronic daily oral iron therapy. Infiltrative, congestive and restrictive cardiomyopathy was diagnosed in the presence of global cardiomegaly, electrocardiographic changes (microvoltage, diffuse ST-T wave changes), echocardiographic appearances (dilatation of the left ventricle, with hypertrophic and hypokinetic walls), and hemodynamic signs of adiastole with equalisation of filling pressures at 15 mmHg and a cardiac index of 1,88 l/min/m2. Cardiac haemochromatosis was confirmed by the laboratory (serum iron: 35 mumol/l; siderophilin saturation: 100 p. 100; serum ferritin: 1854 ng/ml; induced siderouria: 51 mg/24 hours) and histological findings (endomyocardial biopsy showing pigment overload). The absence of a family history, of homozygote A3 antigen, of diabetes, of iron overload on hepatic biopsy one year previously, excluded the diagnosis of familial idiopathic haemochromatosis. A secondary form of the disease was diagnosed on a possible genetic predisposition (heterozygote A3 antigen) and on environmental factors (blood transfusions, iron therapy, cirrhosis, alcoholism and perhaps the porto-caval anastamosis. Cardiac haemochromatosis was cured in this case by iron chelating therapy comprising daily subcutaneous infusions of 2 g of desferrioxamine for 2 months. The cure was confirmed by regression of the signs of clinical cardiac failure and of cardiomegaly, the increase in QRS voltages and the near normalisation of the hemodynamic and laboratory findings.

Adult↗
PubMed1982

[Traumatic tricuspid insufficiency with right-left atrial shunt].

A particular form of traumatic tricuspid incompetence with a right-to-left interatrial shunt through a patent foramen ovale is reported. This case and six similar previously published reports have the following features in common: clinically, tricuspid incompetence is associated with cyanosis and raised jugular venous pressure, pulsatile hepatomegaly and a systolic murmur in the subxiphoid region in about haĺf the cases. The ECG showed incomplete or complete right bundle branch block in six of the seven cases, associated with left anterior hemiblock in four cases. The right cardiac chambers were dilated in all cases. Diagnosis may be confirmed by cardiac catheterisation and selective angiocardiography. The outcome and tolerance of the condition depend on the underlying tricuspid lesions. Papillary muscle rupture imposes early surgical intervention. Rupture or elongation of the chordae is compatible with good tolerance over a number of years.

Bundle-Branch Block↗
PubMed1979

[Triple-valve replacements].

34 patients aged between 17 and 62 years underwent triple valve replacement, 14 of whom exclusively with Starr-Edwards prosthesis; 25 patients were operated at Stage III and 4 at Stage IV of the NYHA classification; the operative mortality was 14%, the late mortality 21%. The actuarial survival curve shows 66% survival at 5 years; in all, 21 good results were obtained with a follow-up ranging from 3 months to 11 years (average 41 months). A notable late complication specific to these patients was dysfunction of the tricuspid prosthesis; a gradient across the tricuspid prosthesis was observed in 14 postoperative catheter studies; one of these patients had to be reoperated for thrombosis of a Starr-Edwards tricuspid prosthesis. Analysis of the results of this series suggests that surgery is beneficial, especially when the very precarious preoperative state of these patients is taken into consideration.

Adolescent↗
PubMed1979

[Operated aortic stenosis. Evaluation of the long-term prognosis using clinical and hemodynamic parameters in a series of 249 cases].

The long-term results and the prognostic factors in aortic valve replacement for aortic stenosis were assessed from a series of 249 operated cases (comprising 199 pure or dominant stenosis and 50 mixed aortic lesions) followed up for a maximal period of 9 years. The postoperative survival rate, 71% at 5 years, 62,6% at 8 years, including the operative mortality, is better than in a comparable series of pure chronic aortic incompetence (58% at 5 years) despite a higher average age. In the same age group the difference is significant at the 6th year. However, no difference was observed between mixed aortic disease and aortic stenosis. Irreversible myocardial dysfunction is relatively rare (6,6% of survivors at 1 month, 24% of poor results or late deaths) and much less common than in aortic incompetence of which it represents the main cause of failure. Even in these cases, prolonged symptomatic improvement may be observed. 3 prognostic factors affect the operative and late mortality. They act to variable degrees and independantly of each other. They are : age, cardiomegaly and heart failure. The actuarial 5 year survival is: 81,77% and 53% for under 50, 50 to 65 and over 65 years age group respectively; 88%, 78% and 48% for cardiothoracic ratios of less than 0,50, between 0,50 and 0,58 and greater than 0,58 respectively; 83%, 65% and 47% for patients without signs of heart failure, with a history of pulmonary oedema, and with a history of congestive cardiac failure respectively. These results encourage a liberal attitude towards surgery, even in old patients with severe valvular lesions.

Adult↗
PubMed1978

[Surgically treated chronic aortic valve insufficiency. Long term results. Surgical indications].

The timing of surgery in chronic aortic regurgitation depends to a large extent on the operative results that may be expected in this type of valve disease. In 88 cases of chronic aortic regurgitation submitted to surgery there were 6 operative deaths (6.8%). Five years after operation the actuarial survival was 58% for the whole of the group and 68% for cases of rheumatic aortic regurgitation. Analysis of the causes of failures, late deaths, persistence or recurrence of severe impairment of activity, and of serious disturbances of ventricular rhythm, showed that the most important cause was myocardial dysfunction, which was responsible for two thirds of the bad results. Analysis of the late prognosis as a function of the various pre-operative parameters revealed the bad influence of cardiomegaly as measured by radiological examination (cardio-thoracic ratio and cineangiography) and of disturbances in left ventricular function. The actuarial survival curves showed very significant differences according to whether the cardiothoracic ratio was greater or smaller than 58%, and according to the amount of heart failure pre-operatively. Similarly, an end-diastolic volume index of 240 ml/m2 and an ejection fraction less than. 40 seemed to be serious findings. These facts, taken in conjunction with the natural history of this valve lesion, suggest that the indications for surgery should not only be symptomatic aortic regurgitation but also well tolerated regurgitation in which cardiomegaly, end-diastolic volume and/or the ejection fraction have reached a certain level.

Aortic Valve Insufficiency↗
PubMed1978

[An unusual type of mid-ventricular obstruction. A discussion of the findings].

The authors report a case of left-sided mid-ventricular obstruction which was completely different from the usual type of obstructive cardiomyopathy, and had asymetrical hypertrophy of the septum demonstrable both by angiocardiography and macroscopically. Complete clinical and haemodynamic recovery followed left ventricular myectomy with replacement of the mitral valve (one year's follow-up).

Angiocardiography↗
PubMed1977

[Myxoma of the left atrium diagnosed by pathological examination of an embolism of the aortic bifurcation (author's transl)].

The case reported was a 69-year-old patient with a myxoma of the left atrium presenting as multiple emboli: acute ischaemia of the lower limbs preceded, three months before, by a spontaneously regressive right hemiplegia which, in view of the patient's age, was considered to be a simple manifestation of atherosclerosis. The diagnostic value of the echocardiogram in cases of systemic emboli of undetermined origin is stressed.

Aged↗
PubMed1976

[Diagnostic value of closed thorax pericardial biopsy. 20 cases].

Twenty patients with sub-acute and chronic pericarditis under went closed thorax pericardial biopsy. In three cases the examination brought to light a diagnosis of tuberculosis and in one of a tumoural origin. In 16 cases in which the aetiology was that of a non-specific pericarditis, the value of this examination, integrated into the context, is discussed.

Adult↗