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Biomedical subjects

C Cabrol

Publications and source records attributed to C Cabrol.

At least 253 records · Page 14Linked to original sources
PubMed1981

Surgical treatment of ventricular tachycardia guided by ventricular mapping in 23 patients without coronary artery disease.

Twenty-three patients with resistant ventricular tachycardia not related to coronary artery disease underwent surgical treatment guided by ventricular mapping. The patients were grouped according to radiological and anatomical findings. Group 1 (13 patients) had arrhythmogenic right ventricular dysplasia. Group 2 (3 patients) had left ventricular aneurysm. Group 3 (2 patients) had nonobstructive myocardiopathy. Group 4 (5 patients) had normal-appearing hearts. At operation all patients underwent ventricular mapping when in sinus rhythm and during ventricular tachycardia. The rationale of operation was ventriculotomy or cryosurgery at the site of origin of ventricular tachycardia or exclusion, resection, or undermining of arrhythmogenic areas where delayed potentials were observed. Four patients died during the perioperative period, 3 of low-output failure and 1 from bleeding. Ventricular tachycardia recurred immediately after operation in 4 patients, 3 of whom died during the perioperative period. Ventricular tachycardia recurred late in 5 patients. Three had only episodic, unsustained runs of tachycardia. Two were well controlled by drugs. All patients with ventricular tachycardia situated over the free wall of the ventricles had inducible ventricular tachycardia and had good surgical results. Three out of 5 patients with ventricular tachycardia situated in the septum had poor surgical results. Septal ventricular tachycardia needs a better surgical approach to the septum and a suitable surgical concept.

Adult↗
PubMed1981

[Myxomas of the right atrium. Apropos of 3 cases. Review of the literature].

The authors report 3 cases of right atrial myxoma and review 88 other cases in the literature managed by surgery. The first personal case, in a 74 year old patient, illustrate the dramatic consequences of tumour engagement in the tricuspid orifice, in this instance cardiac arrest during catheterisation justifying emergency surgery. The second case exemplifies the diagnostic value of echocardiography: the correction of an erroneous diagnosis of pericarditis. The third case shows that some forms may be totally asymptomatic, the tumor being diagnosed on clinical examination and confirmed by echocardiography. In their review of the literature, the low overall incidence of primary cardiac tumours, of which myxoma is the most common, is emphasised. A right atrial localisation is found in only 25% cases. 88 surgical reports have been published since Bahnam's original attempt at surgical cure under cardiopulmonary bypass. Myxoma may occur at any age but it usually presents between the ages of 30 and 60. Some familial forms have been reported. The presenting symptoms are protean but usually point to an obstacle in the right heart chambers. They may be summarized as follows: 1. Isolated right ventricular failure without left heart disease may be observed in large tumours (reported in 50% of cases). 2. Simulating pericarditis (25% of cases) with a low grade pyrexia (25% of cases). 3. Paroxysmas of cardio respiratory distress of variable severity (a few cases). Clinical examination, chest x-ray and ECG are not diagnostic but do show non-specific changes which are of value in drawing attention to the heart and leading to echocardiography. This confirms the diagnosis by showing abnormal mobile echos in the right atrium prolapsing into the right ventricle in diastole. Angiography serves only to confirm these appearances. Surgery is the treatment of choice, and preferably with the shortest possible delay. It offers definitive cure at a minimal risk to the patient.

Adult↗
PubMed1981

[Idiopathic aneurysm of the left ventricle. Apropos of 4 cases operated on with success].

Over a period of 3 years, 4 cases of idiopathic left ventricular aneurysm, 3 white females and one coloured male aged 34, 53, 29 and 47 years respectively, were observed. All presented with paroxysmal ventricular or supraventricular tachycardia, which, in one case, was severe enough in itself to justify surgery. On angiography, large left ventricular aneurysms bordering the mitral annulus and responsible for moderate mitral regurgitation in two patients were demonstrated. Aneurysmectomy was only possible in 2 cases, the other two having pericardial adhesions with a risk of uncontrollable haemorrhage during dissection being managed by suture of the neck of the aneurysm. The surgical results were very satisfactory, especially with respect to the arrhythmias with a follow-up of 48, 24, 15 and 9 months respectively. In a review of the literature, 93 cases of idiopathic left ventricular aneurysm were analysed, less than 20 of which have been managed surgically. Left ventricular aneurysms seem to be large fibrotic structures located at the border of the mitral, or, less commonly, below the aortic annulus. It is important to differentiate them from congenital left ventricular diverticuli which are usually located at the apex, have muscular walls and are therefore contractile. The aetiology of these aneurysms is unknown: the possible role of myocardial infarction may be excluded as the coronary arteries are always normal on angiography and at autopsy. The relatively young age of the patients is also an argument against this hypothesis. Other suggested causes such as syphilis, tuberculosis, Chagas' disease, non-specific myocarditis, sarcoidosis and thoracic trauma may also be excluded. Surgery seems to be indicated in cases complicated by resistant arrhythmias, peripheral embolism or when the aneurysm increases rapidly in size.

Adult↗
PubMed1981

[Abdominal complications of heart surgery].

Abdominal complications after cardiac surgery (excluding "medical" jaundice) are rare. Twenty six cases were observed out of a total of 7 847 operations (0.33%) performed between 1973 and 1980. The causes were very diverse; the most common being gastroduodenal ulceration, usually acute (9 cases). Other cases included intestinal (3 cases of postoperative ileus, 4 cases of mesenteric infarction, 2 cases of necrosing enterocolitis), biliary (2 cases of acute cholecystitis) and splenic pathology (2 cases of splenic infarction, one associated with necrosing enterocolitis). Anticoagulant therapy was implicated in 3 cases. Diagnosis is difficult in the immediate postoperative period, some complications only being recognised at autopsy. The clinical signs may be misleading and the interpretation of complementary investigations difficult. Therefore, the possibility of abdominal complications must be kept in mind, especially in patients with one or more predisposing factors. Excluding accidents due to anticoagulant therapy the following factors were associated with an increased risk of abdominal complications: previous history of gastro intestinal pathology (ulcer, gall stone, alcoholism) the nature of the underlying cardiac disease (coronary artery and aortic valve disease), cardiopulmonary bypass, and, above all, per- and postoperative incidents: hypovolaemia, low output syndrome (half the patients in this series) respiratory and infectious complications. The inappropriate use of vasoconstricting agents may also play a role. The majority of abdominal complications seemed to be related to ischaemia and anoxia in the splanchnic territory, which explains the important role of the preceding factors. The prognosis of abdominal complications after cardiac surgery was poor, mortality reaching 50 to 100% in some causes: in this series, 12 of the patients died. This justifies certain prophylactic measures: strict selection of patients, diagnosis and treatment of associated abdominal pathology before operation, prevention of low output states, respiratory and infectious complications ... and careful examination of the abdomen after operation to ensure the early diagnosis and treatment of complications, should they develop.

Acute Disease↗
PubMed1981

[Aneurysm of the azygos vein].

A case of azygos vein aneurysm is described. It is a very rare condition, this being the tenth reported case. The patient presented with superior vena cava obstruction and underwent successful surgical cure. This congenital malformation is practically always latent. The aneurysm is usually diagnosed after the discovery of a mediastinal mass on routine chest X ray. Although its variations in size with position and respiration are characteristic, angiography would seem to be essential to confirm its aneurysmal nature and the anatomical relationships. Surgery is usually simple and should be proposed even to asymptomatic patients because of the risk of thromboembolism.

Aneurysm↗
PubMed1981

[Tendinous hyperlipoproteinaemic xanthomatosis associated with supravalvular aortic xanthomatosis (author's transl)].

A 56-year-old woman with familial heterozygous type II hyperlipoproteinaemia and tendinous xanthomas, presented the unusual findings of acquired supravalvular aortic stenosis associated with a congenital stenosis of the orifice. Analysis of clinical, paraclinical, and particularly pathological data confirmed the existence of several associated lesions: congenital hypoplasia of the aortic ring and proximal aorta, calcified valve stenosis probably increased by the dyslipidaemia, and finally and principally, supravalvular stenosis formed of a veritable circular rim of atheromatous material, making up a second haemodynamic obstacle. It is probable that the pre-existing congenital aortic lesions in this case, apart from the hyperlipoproteinaemia, account for the observation, not previously reported in a heterozygous type II hyperlipoproteinaemia, of massive supravalvular atheromatous deposits. This latter of acquired lesion is described in 9 cases reported in the literature with a homozygous form of familial hypercholesterolaemic xanthomatosis, the atheromatous deposits in the proximal aorta appearing earlier in these patients, and in the absence of pre-existing anatomical anomalies.

Aorta↗
PubMed1981

Complete replacement of the ascending aorta with reimplantation of the coronary arteries: new surgical approach.

Thirty patients had total replacement of the ascending aorta with reimplantation of the coronary arteries, 20 for a fusiform aneurysm of the ascending aorta and 10 because of a dissection of the ascending aorta, of which there were acute. All had associated aortic insufficiency. The technique consists of implantation, within the aneurysmal sac, of a Dacron prosthesis containing a Björk-Shiley aortic valve. The coronary orifices are anastomosed to the tubular Dacron prosthesis by means of a second smaller Dacron tube. The aneurysmal pouch is then closed over the entire appliance and a fistula between the aneurysmal sac and the right atrial appendage is created to drain oozing from the prosthesis. The operative mortality was 10% (three deaths) and the late mortality has been 14.8% (four deaths). The deaths, early and late, have been confined to the first 10 cases, during which time the technique was being developed. There has been no mortality among the last 20 patients. The 23 survivors followed for an average of 19 1/2 months (range 6 months to 5 1/2 years) are in NYHA Functional Class I (21) or II (two). The technical modifications utilized in this series have simplified the operation and permit the proposal of this technique for aneurysm involving the entire ascending aorta.

Adult↗
PubMed1980

[Double aortic arch with coarctation. Apropos of a case].

One case of double aortic arch with coarctation is reported. Anatomically, partial atresia of the anterior arch presented as a Kommerel's diverticulum; the coarctation was situated on the dominant posterior arch just proximal to the origin of the subclavian artery. This malformation had been diagnosed clinically during childhood. The operative indications were increasingly severe hypertension with associated left ventricular hypertrophy, and dramatic epistaxis from a nasal angioma which necessitated repeated arterial embolisation. The surgical treatment comprised the insertion of a prosthetic tube from the brachiocephalic trunk, proximal to the coarctation, to the descending thoracic aorta distal to the coarctation. The immediate operative result was excellent with return of normal peripheral pulses and blood pressure. The diagnostic difficulties of this malformation and its associations with other vascular malformations are emphasised. The surgical indications are discussed and the different techniques reviewed:--resection and end-to-end anastomosis,--tubular prosthesis,--associated procedures for double aortic arch. The choice of technique depends on the age of the patient, the anatomical conditions (double arch, coarctation, collateral circulation), and the quality of the aortic wall (atheroma).

Aorta, Thoracic↗
PubMed1980

[Prophylactic intra-aortic balloon pumping in the surgery of the left main coronary artery].

92 significant stenoses of the left main stem artery (LCA) underwent revascularisation procedures by aorto-coronary venous bypass grafting. Three groups of patients were identified. Group I comprised 11 stenoses of the LCA associated with lesions of at least three other coronary vessels and a subtotal stenosis of the LCA. These patients underwent systematic prophylactic intra-aortic balloon counter-pulsation (IACP) when they were taken off cardiopulmonary bypass. Group II comprised 47 patients with stenosis of the LCA and at least three coronary vessels. IACP was required in 6 cases in whom difficulty was experienced at the end of cardiopulmonary bypass, or after haemodynamic decompensation. Group II comprised 33 stenoses of the LCA which were isolated or associated with lesions of 1 or 2 vessels. The operative risk increased with the severity of the coronary lesions associated with LCA stenosis. 6 p. 100 deaths occurred in Group III, compared to 21 p. 100 in Group II (p = 0.06). the use of IACP before the onset of possible haemodynamic decompensation improved the operative prognosis of stenosis of the LCA associated with lesions of at least three coronary vessels. Mortality in Group I was 0 p. 100, compared to 21 p. 100 in Group II (p = 0.09). Prophylactic IABP also seemed to decrease the number of perioperative infarctions: Group I, 16 p. 100, Group II, 36 p. 100, but p > 0.01. analysis of global mortality (12 cases) showed that 50 p. 100 patients (6 cases) had ejection fractions of less than 0.50. In agreement with other authors, we found that systematic IABP improved the operative prognosis in stenosis of the LCA. However, we do not advocate its use in every case. A selection of high risk patients seems a reasonable objective. The severity of the coronary lesions associated with LCA stenosis is statistically a good criteria of selection. The incidence of left ventricular hypokinesis with an ejection fraction less than 0.50 in the deceased patients, is a factor in favouring the use of prophylactic IACP in left ventricular dysfunction.

Arterial Occlusive Diseases↗
PubMed1980

[Aneurysms of the azygos vein].

A case of aneurysm of the arch of the greater azygos vein is reported. This extremely rare congenital anomaly appears as a large rounded opacity in the anterosuperior mediastinum. Though diagnosis may be suspected by the variations in size according to the period of observation and the position of the patient, if can only be confirmed by angiography, to eliminate an aneurysm of the superior vena cava or one of azygos vein from obstruction of the inferior vena cava.

Aneurysm↗