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Biomedical subjects

B Gallet

Publications and source records attributed to B Gallet.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Expansion and remodelling of the left ventricle after myocardial infarction].

The remodelling of the left ventricle after myocardial infarction results from the expansion of the infarcted zone in the acute phase and the dilation of the healthy zone of the left ventricle which complicates the initial expansion. It brings about an increase in the left ventricular volume which is a major pejorative prognosis factor after myocardial infarction. The expansion, defined by the dilation and parietal stricture of the infarcted zone, complicates about 30 p. cent of the infarctions and appears in the first hours of the infarction. It is favoured by the transmural nature of the infarction, by its extent and its previous topography, and by arterial hypertension. It is accompanied by a higher mortality rate, increases the risk of parietal rupture, exposes to post-infarction aneurysm and to intraventricular thrombi, and initializes the ventricular remodelling, factor of secondary cardiac failure. The dilation of the healthy zone of the left ventricle is observed mainly in case of initial expansion. Its importance increases with the size of the infarction. It corresponds to the volume overload secondary to the increase in the telediastolic parietal constraint of the left ventricle. The remodelling of the left ventricle after infarction is limited by captopril, and possibly by the restoration of the blood flow in the artery responsible for the infarction. Captopril, administered in the first weeks following the infarction, limits the dilation of the left ventricle in man as well as in animals. This beneficial effect is due to a decrease in the post-load of the left ventricle. Captopril improves the survival after infarction in animals, but its effect on the post-infarction mortality in man is still under study.

Animals↗
PubMed1989

Massive systemic amyloidosis associated with light-chain deposition disease.

A 72-year-old woman presented with rapidly progressive renal failure and multiple myeloma. The patient died 6 months later of severe hepatic insufficiency. The light-microscopic, immunological and ultrastructural findings showed widespread kappa-light-chain deposits including the kidneys, liver, spleen, heart, lungs, tongue, ovary, pancreas and bone marrow associated with massive AL amyloid deposits in the same organs and in the thyroid gland. The concurrent presence of two different deposits is very unusual and the possible mechanisms for such an association are discussed.

Aged↗
PubMed1989

[Evaluation of pulmonary arterial hypertension by Doppler echocardiography in chronic respiratory insufficiency].

The usefulness of doppler-echocardiography for the assessment of pulmonary arterial hypertension in patients with chronic respiratory failure was evaluated in 24 consecutive patients with chronic obstructive lung disease. Seventeen of these 24 patients (71 p. 100) who had tricuspid valve regurgitation analysable by the continuous wave doppler technique were selected as study group; they included 15 men and 2 women aged from 33 to 78 years (mean 63 years). The highest maximum velocity value (method A) or the maximum velocity value averaged on several cycles (method B) of the tricuspid regurgitation jet was used to calculate the right ventriculo-atrial pressure gradient, using Bernouilli's equation. Right atrial pressure was determined by three methods: haemodynamic measurement, clinical evaluation or attribution of an arbitrary 10 mmHg value. The pulsed doppler study of the pulmonary ejection flow included measurement of the acceleration time and calculation of the acceleration time/ejection time ratio. The usual echocardiographic parameters were measured. Catheterization was performed 2.5 days on average after the doppler study. Correlations between doppler examination and catheterization to evaluate the right ventricular systolic pressure were significant (p less than 0.001) and better with method B than with method A. Depending on the method employed to evaluate the right atrial pressure, the correlation coefficients obtained with method B were: 0.93 (haemodynamic measurement), 0.91 (clinical evaluation) and 0.88 (arbitrary value of 10 mmHg). The right ventricular systolic pressure evaluated by doppler ultrasound using method B and by clinical evaluation of the right atrial pressure was 47 +/- 12 mmHg (22 to 70 mmHg), as against 51 +/- 13 mmHg (28 to 74 mmHg) measured by catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Myocardial infarction during or after exertion related to sports. Clinical and coronary angiographic analysis of 10 cases].

The purpose of this study was to analyse characteristic of myocardial infractions that occur during, or immediately after sport-related exertion in subjects who are neither athletes nor professional sportsmen and who undergo coronary angiography. Ten cases where myocardial infraction developed during (n = 3) or immediately after (n = 7) a game were studied retrospectively. All patients were men aged from 21 to 61 years (mean 48.8 years); 8 of them were smokers and 5 had hypercholesterolaemia. The sports practised were tennis (3), cycling (2), football (2), skiing (2) and weight-lifting (1). The infarction was inferior or basal in 5 cases, lateral in 1 case and anterior or anteroseptal in 4 cases. Coronary lesions involved one vessel in 6 and two vessels in 2 patients aged from 47 to 61 years. They were absent in 2 patients aged 24 and 26 respectively, with methylergonovine-induced spasm in one case. The outcome over a 2.9 years follow-up period was favorable, except for one death 6 months after the infarction (patient aged 24, normal coronary arteries, spasm). The outstanding features in this study are: (1) the occurrence of infraction during the recovery period and the noxious role played by smoking; (2) the contrast between the presence of atherosclerotic coronary lesions in middle age subjects and their absence in younger subjects (infarction due to spasm or thrombosis?), and (3) the possible usefulness of an exercise test in sport players of more than 40 years of age.

Adult↗
PubMed1988

[Acquired systemo-pulmonary fistula after pleurectomy responsible for a continuous thoracic murmur].

Systemo-pulmonary fistulae are rare. The case of a 27 year-old man, hospitalized for exploration of a continuous thoracic murmur, is reported. A right pleurectomy had been performed 2 years previously because of a recurrent spontaneous pneumothorax, and no murmur was present at that time. Angiography showed a systemo-pulmonary fistula with the right internal mammary artery and branches of the right axillary artery as afferent vessels, and the right pulmonary arteries and veins as efferent vessels. Blood gases measurements demonstrated a left-right shunt. The acquired nature of the fistula was suspected because of the history of right pleurectomy and the acquired nature of the murmur. There was no indication for surgery because of the complexity of the fistula and the absence of symptoms.

Adult↗
PubMed1987

[Intrapulmonary right-left shunt associated with liver cirrhosis: diagnosis by contrast echocardiography].

The hypoxaemia associated with hepatic cirrhosis is classically attributed to an intrapulmonary shunt caused by small vascular abnormalities. Severe hypoxaemia (47 mmHg) associated with dyspnoea, cyanosis and clubbing was observed in a 57-year old man who presented with cirrhosis of the liver. At contrast echocardiography, a right-to-left shunt was demonstrated by the appearance of microcavities in the left atrium and ventricle after peripheral intravenous injection of the contrast medium. The intrapulmonary location of the shunt was determined by a 4 cardiac cycles interval between the arrival of the microcavities in the right heart and their appearance in the left heart. The right-to-left shunt was confirmed by the pure oxygen ventilation test and by pulmonary perfusion scintigraphy with radiolabelled albumin microaggregates. Pulmonary angiography proved normal. Thus, contrast echocardiography is capable of diagnosing right-to-left shunts associated with hepatic cirrhosis and to demonstrate their intrapulmonary location.

Arteriovenous Malformations↗
PubMed1986

Cardiac complications after bone marrow transplantation. A report on a series of 63 consecutive transplantations.

Cardiac complications related to bone marrow grafting were investigated in a group of 63 patients undergoing bone marrow transplantation (57 autologous, 6 allogeneic) in the transplant unit of Hôpital Saint-Antoine (Paris, France) between February 1977 and October 1983. The pregraft regimen was cyclophosphamide, 6-thioguanine, cytosine arabinoside, and CCNU (TACC) in 39 cases, cyclophosphamide (CY) associated with whole-body irradiation in 16 cases, and multiple chemotherapeutic agents in 8 cases. The study was retrospective in 49 patients, and prospective in 14. The morbidity was 43% and the mortality 9%. There were 6 fatal cases of cardiomyopathies and/or pericarditis, 14 nonfatal cases of heart failure, 7 nonfatal cases of pure pericarditis, and 32 arythmias including 14 bradycardias, diversely associated on a total of 27 patients. Cyclophosphamide and/or TACC/cyclophosphamide, 6-thioguanine, cytosine arabinoside, and BCNU (BACT) were the factors basically responsible for the cardiac toxicity. The best-defined entity was an acute fatal cardiomyopathy with associated pericarditis of which we report three additional cases. The best predictors of CY toxicity were the daily weight (a gain of more than 2 kg for more than 48 hours) and the electrocardiogram (a decrease of more than 14% in the sum of the QRS complexes in the standard leads on the fourth day of chemotherapy). Routine echocardiography confirmed the high incidence of subclinical cardiac abnormalities and their reversibility. It would seem that radiotherapy and anthracyclines play a secondary role. Currently, we consider that cardiac toxicity is one of the most important limiting factors for bone marrow transplantation. We suggest, therefore, that the transplantation should be done as early as possible and preference should be given whenever possible to whole-body irradiation over high-dose chemotherapy combinations such as TACC.

Adolescent↗
PubMed1986

[Left ventricular function in dilated cardiomyopathy. Noninvasive determination of end-systolic stress-diameter and shortening fraction-stress relations].

The ejection fraction and fractional shortening are parameters of left ventricular function dependent on the conditions of load. They are not perfect indices of myocardial contractility. The study of the relationships between stress and diameter and fractional shortening and stress in end-systole provides a better means of assessing the contractile state of the myocardium. The relationships between end-systolic stress-diameter and end-systolic stress-fractional shortening were studied non-invasively in 10 normal subjects (Group I) and 7 patients with severe dilated cardiomyopathy (Group II). End-systolic longitudinal stress of the left ventricle was calculated from Grossman's formula by coupling automatic measurement of blood pressure (cuff method) with simultaneous M mode recordings guided by 2D echocardiography. The line of regression of end-systolic stress-end-systolic diameter was determined in all cases from a series of 14 points obtained after sublingual administration of 10 mg of isosorbide dinitrate. The line of regression of fractional shortening-end-systolic stress was established in both groups by using the values observed under basal conditions and at the peak of action of the isosorbide dinitrate. The following results obtained: Under basal conditions, patients in Group II had greater end-diastolic diameters (69 +/- 8 vs 49 +/- 4 cm, p less than 0.01), greater end-systolic diameters (61 +/- 8 vs 33 +/- 4 mm, p less than 0.001) and higher end-systolic stress (140 +/- 54 vs 67 +/- 13 10(3) dyn/cm2, p less than 0.001). Fractional shortening was lower in Group II than in Group I (12 +/- 5 vs 33 +/- 5%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Postpartum myocardial infarction with normal coronary arteries. Apropos of a case].

A case of painless anteroseptal and high lateral wall infarction presenting as cardiogenic shock with pulmonary oedema 24 hours after childbirth complicated by severe post partum haemorrhage with a coagulation defect, is reported. Coronary angiography performed one month later was normal, with a negative ergometrine provocation test. The authors review five previous reports in the medical literature, and discuss the possible physiopathological mechanisms which, alone or in association could have operated in the reported case.

Adult↗
PubMed1986

[Circumflex artery originating from the right anterior sinus of Valsalva: benign anomaly or a factor in myocardial ischemia? Apropos of 2 cases].

The abnormal formation of the circumflex artery from the right anterior sinus of Valsalva is generally considered benign and without any particular ischemic risk. Two cases are reported of myocardial ischemia in the region of the abnormal artery. In both cases an unstable angina was associated with objective criteria (electrocardiographic and isotopic) of myocardial ischemia. In one case the circumflex artery presented marked proximal stenosis compatible with the development of accelerated atherosclerosis. In the other case the circumflex artery was free of any stenosis and the ischemic manifestations observed seem to be due to the abnormal origin of the vessel only. Certain cases of the circumflex artery anomaly can, therefore, be complicated by myocardial ischemia, and the benign nature of the anomaly needs to be re-examined.

Coronary Disease↗
PubMed1985

Atrial septal aneurysm--a potential cause of systemic embolism. An echocardiographic study.

Atrial septal aneurysm is an uncommon condition. Between 1981 and 1984 10 cases of atrial septal aneurysm were diagnosed by real time cross sectional echocardiography performed in 4840 patients. The aneurysm was associated either with mitral valve prolapse (three patients) or with atrial septal defect (three patients) or occurred in isolation (four patients, two of whom had had a previous embolic event leading to the diagnosis of atrial septal aneurysm by cross sectional echocardiography). During cross sectional echocardiography the aneurysm appeared as a localised bulging of the interatrial septum, which was best seen in the subcostal four chamber view and in the parasternal short axis view at the level of the aortic root. The aneurysm either protruded into only the right atrium (five patients) or moved backwards and forwards between the right and the left atria during the cardiac cycle (five patients). This motion pattern might be related to changes in the interatrial pressure gradient. The two patients who had had a systemic embolism were given anticoagulant treatment, but none underwent surgery. It is concluded that the true prevalence of atrial septal aneurysm might have been underestimated before the routine use of cross sectional echocardiography, that cross sectional echocardiography enables definitive diagnosis of this condition by a non-invasive technique, and that an atrial septal aneurysm should be suspected and looked for by cross sectional echocardiography after an unexplained systemic embolism.

Adolescent↗
PubMed1985

[Electrophysiological effects of intravenous sotalol. Relation with plasma levels].

The object of this study was to confirm the electrophysiological effects of sotalol, a betablocker which increases the duration of the action potentials of myocardial cells, and to investigate the relationship of these effects with the doses used and plasma concentrations (PC) of the drug. 13 patients (23 to 72 years) were divided into 3 groups: Group 1 (n = 5): 0.6 mg/kg; Group 2 (n = 4): 1.2 mg/kg; and Group 3 (n = 5): 1.8 mg/kg. Measurements were performed before and 35 minutes after starting a 15 minute intravenous infusion of sotalol. At all doses, sotalol decreased the heart rate (HR), increased the corrected sinus node recovery time (CSNRT), prolonged the effective refractory periods (ERPA) and functional refractory periods (FRPA) of the right atrium. Atrioventricular conduction was depressed; prolongation of AH at an imposed rate of 100/min, prolongation of the nodal refractory periods (ERPN and FRPN), and an earlier Wenckebach point. The corrected QT interval (QTc) and ventricular refractory period (ERPV) increased. The QRS complexes and HV intervals were unchanged. Increases of CSNRT, AH, ERPN, FRPN, QTc, and ERPV were observed after the first dose (Group 1). At the dose of 1.8 mg/kg (Group 3) all parameters were modified (except the QRS and HV). All patients increased their ERPV by more than 20 p. 100. The parameters which illustrated the dose-effect relationship were the HR, ERPA, FRPN, and CSNRT. The PC of sotalol measured 60 minutes after starting the infusion were 0.58 +/- 0.23 microgram/ml (Group 1), 0.78 +/- 0.32 microgram/ml (Group 2) and 1.73 +/- 0.43 microgram/ml (Group 3).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Myocardial infarction in young subjects].

The annual incidence of myocardial infarction (MI) before 40 years of age is 10 times less frequent than that in patients of all ages, and 10 times less frequent in women than men. The severity and extensiveness of lesions demonstrated by coronary arteriography are significantly less in a young patient with an infarction than an elderly patient. Significant isolated coronary artery stenosis is encountered 10 times more frequently before age 35 than after age 50; 15 percent of young patients have no significant stenosis and 8 to 14 percent have entirely normal coronary artery circulation, depending on the study. There appears, then, to be two pathogenetically distinct varieties of MI in the young patient: approximately one-half of cases exhibit multiple sclerosis seen with typical coronary artery atherosclerotic disease; the remainder, which are almost specific for young patients, represent a single obstruction due most often to the rapid development of a thrombosis on an otherwise normal vascular tree. Coronary artery spasm resulting in complete arterial occlusion is certainly involved, nevertheless its frequency must be further defined.

Adult↗
PubMed1984

[Myocardial infarction in the young subject: a medium-term clinical and coronary angiographic study in 40 patients under 36 years of age. Comparison with coronary angiographic data of myocardial infarction in patients after 50 years of age].

A series of 40 myocardial infarctions, occurring in patients under 36 years of age was studied retrospectively (Group I: mean age 31.3 years). The medium term results of coronary angiography in this group were compared with those of 60 myocardial infarctions after 50 years of age (Group II: mean age 56.6 years). Group I had a clear male predominance (92.5%), a high incidence of smoking (69%), hypercholesterolaemia (69%); myocardial infarction was the first manifestation of their disease in 54% and it was often extensive (42%). A comparative angiographic study between the two groups showed: 1) Less widespread lesions in Group I, as assessed by the number of main arteries stenosed (p less than 0.001), the coronary index (p less than 0.01) and the mean coronary score using Friesinger's method (p less than 0.01). 2) A higher incidence of subnormal coronary angiogrammes in Group I (absence of 50% stenosis) (15%) and of single vessel disease (40%): compared with Group II in which multivessel disease was observed in 86.5% of cases. 3) Collateral circulation was less common in Group I (p less than 0.01). On the other hand, a comparative study of regional and global left ventricular function showed no difference between the two groups. Two subgroups were distinguished in Group I: in one subgroup, multiple lesions similar to those found in Group II, suggestive of premature coronary atherosclerosis (52.5%); the other group (47.5%) presented unilocular lesions i.e. focal mono-arterial lesions compatible with other causes of infarction (thrombosis and/or spasm). These patients were younger (p less than 0.05) and had significantly fewer cardiovascular risk factors (p less than 0.01). Despite the fact that the coronary lesions were limited, the myocardial damage was comparable with the other groups as the collateral circulation was much less developed (p less than 0.02). These appearances were only observed in 3.5% of patients in Group II. The study of the angiographic outcomes of these two types of lesions should show a difference and could contribute to the understanding of their mechanisms.

Adult↗
PubMed1979

Apperceptive signals demonstrating the dynamic disturbance of myocardial ischemia.

Analog pressure signals (catheter-tip manometers) from the left atrium, left ventricle, and aorta and a flow signal from the arota were obtained in 25, open-chest, anesthetized dogs in which 115 episodes of ischemia were produced in an area of the left ventricle subtended by the distal left anterior descending coronary artery and its last major diagonal branch. The left ventricular pressure and its first derivative (dP/dt) were displayed as an X-Y loop. The character of this loop went through a unique series of dynamic changes in 110 of the 115 ischemic episodes, indicating that this is a useful tool for monitoring myocardial ischemia. Spectrum pairs of the above signals were analyzed with digital computational transfer functions in 14 ischemic episodes of three experiments and preliminary assessment reveals unique pole and zero changes in many pairs during each episode which also may prove to be a useful indicator of the hemodynamic disturbance incurred during myocardial ischemia.

Analog-Digital Conversion↗