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Biomedical subjects

D Sidi

Publications and source records attributed to D Sidi.

224 records · Page 13Linked to original sources
PubMedDate not supplied

Right ventricular myocardial sinusoidal-coronary artery connections in critical pulmonary valve stenosis.

Ventriculo-coronary arterial connections are frequently observed in pulmonary atresia with intact interventricular septum. Sustained right ventricular hypertension during cardiac morphogenesis is thought to be responsible for persistence of myocardial sinusoidal-coronary artery connections. Considering an unusual observation of ventriculo-coronary arterial connections in a patient with critical pulmonary valve stenosis, we speculate that sinusoidal connections in pulmonary atresia with intact ventricular septum occur not only because it is the only exit for blood from the blind right ventricle, but also because of intrinsic altered morphogenesis of the right ventricle myocardium.

Abnormalities, Multiple↗
PubMedDate not supplied

[Arterial rigidity and endothelial dysfunction in obese children].

Obesity is a cardiovascular risk factor in adults. Poorly is known about effect of obesity on cardiovascular system in children. Mechanical properties of a great elastic trunk, the common carotid artery (CCA) and endothelium function of the brachial artery were studied in 130 obese children (age: 12 +/- 3 years, body mass index (BMI): 29 +/- 5.5 kg/m2, without hypertension (115 +/- 19/58 +/- 8 mmHg). These patients had a vascular high resolution echographical analysis. Cross sectional compliance (CSC), cross sectional distensibility (CSD) and incremental elastic modulus (Einc) were analysed at the CCA site. The brachial artery dilation was measured after hyperthemia (flow mediated dilation, FMD), an endothelium dependent function and after sublingually glyceryl trinitrate (GTNMD), an independent endothelium function. Fat mass composition and distribution were assessed by dual-energy X-ray absorptiometry in 70 patients. In 50 obese patients an oral glucose tolerance test was done to determine insulin resistance. The obese children had significantly lower CSC and CSD than the healthy controls (respectively 0.12 +/- 0.04 vs 0.14 +/- 0.05 mm2.mmHg-1; p < 0.05 and 0.5 +/- 0.2 vs 0.8 +/- 0.4 mmHg(-1).10(-2); p < 0.001). Obese children had higher value than the controls for Einc (2.4 +/- 0.4 vs 1 +/- 0.24 mmHg.10(3); p < 0.001) that correlated poorly with fasting insulin concentrations (r = 0.34; p < 0.06) and BMI (r = 0.34; p < 0.01). FMD was significantly lower in obese children than in controls (6 +/- 3 vs 8 +/- 4%, p < 0.01) without modification of GTNMD (17 +/- 6 vs 18 +/- 7%, NS). These two parameters were respectively correlated with the android fat distribution (r = 0.36; p < 0.01; r = 0.49; p < 0.001). The CCA stiffness of obese children is linked to the amount of the overweight and to insulin resistance. The android fat distribution is related to endothelium dysfunction.

Adolescent↗
PubMedDate not supplied

[Aortic arch shape and flow dynamics].

Post-operative deformation of the aortic arch architecture is associated with an increased risk of hypertension following correction of coarctation. In addition to morphological analysis, MRI allows a functional analysis of the thoracic aorta. We report three examples which illustrate the direct relationship between aortic arch morphology and blood flow in the thoracic aorta.

Adolescent↗
PubMedDate not supplied

[Relationship between aortic arch shape and blood pressure response after coarctation repair].

The mechanisms of secondary hypertension after repair of coarctation of the aorta are not well understood. Abnormalities of the architecture of the aortic arch and their consequences on blood pressure have not been studied. In order to study the relationship between abnormalities or aortic arch architecture and resting blood pressure ninety-four patients without re-coarctation were followed up prospectively from 1997 to 2004 (mean age 16.9 +/- 8.1 years; mean weight 57.5 +/- 18.3 Kg; interval since surgery 16.3 +/- 5.4 years). All underwent MRI angiography of the thoracic aorta which enabled the abnormalities to be classified in 3 groups: gothic arch, crenellated arch and roman arch. Twenty-four patients (25.5%) were hypertensive and 70 (74.4%) normotensive. There were 40 gothic arches (42.5%). 14 crenellated arches (15%) and 40 roman arches (42.5%). Gothic arches were more commonly observed in the hypertensive patients (18/40, [45%, 95% CI 31-62]) than the crenellated arches (4/14, [28.5%, 95% CI 7-48]) or the roman arches (2/40, [5%, 95% CI 2-12]). Only the gothic arch was independently correlated with hypertension on multivariate analysis. The authors conclude that gothic deformation of the aortic arch is an independent predictive factor of hypertension in patients operated for coarctation with an excellent result on the isthmic region. Patients with a gothic appearance of their aortic arch should be followed up closely.

Adolescent↗
PubMedDate not supplied

[Treatment of critical pulmonary valvular stenoses in newborn infants using percutaneous valvuloplasty. Study of 28 cases].

Twenty-eight neonates aged 1 to 21 days with critical pulmonic stenosis were treated by percutaneous valvotomy consisting of balloon dilatation of the stenotic valve by percutaneous catheterization. The right ventricular systolic pressure (RVP) was either the same or higher than the systemic pressure in all cases but 3. In those it was somewhat lower (80%) than the left ventricular systolic pressure (LVP) so that, on the whole, the RVP/LVP ratio, here called rP ranged from 0.8 to 2 (m = 1.41 +/- 0.36). The procedure failed 5 times because of failure to introduce the balloon through the valve (4 cases) or because of an accident (1 case). All failures occurred during the initial phase of our experience with this procedure as the last 20 trials were successful. The procedure was inefficacious in 3 cases (13%) but immediately successful in the other 20 (87%) with a drop in the mean rP to 0.59 +/- 0.17. During the follow-up period, one neonate continued to present with an important degree of cyanosis, due to a poor right ventricular compliance. He had to be operated on. Pulmonic stenosis reappeared in 6 cases who underwent for a second time a percutaneous valvotomy. The procedure was successful in 3 and failed in 3 who eventually required surgery. Overall, the satisfactory results observed after the procedure persisted over time in 13 cases. In conclusion, interventional catheterization has become almost always possible in neonates with critical pulmonic stenosis. If performed under vigorously controlled conditions including an infusion of prostaglandin E1 in cases with severe cyanosis and the use of large diameter balloons, this method is relatively safe and generally efficacious since in 70% of cases it circumvents the need for surgery.

Angioplasty, Balloon↗
PubMedDate not supplied

[Acute pericarditis in meningococcal infection].

A case of acute pericarditis in a 2 1/2 year-old girl is reported. It appeared 3 days after the onset of a meningococcal meningitis which was favourably influenced by antibiotherapy. This pericarditis was immunologic in origin and disappeared within a few days with corticosteroid therapy. Differential diagnosis between purulent versus non suppurative acute pericarditis in patients with meningococcal bacteriemia is discussed.

Acute Disease↗
PubMedDate not supplied

[Interruption of the aortic arch: a neonatal emergency. Report of 50 cases ].

Interruption of the aortic arch, associated with curable cardiovascular anomalies (8 times out of 10) was observed over a period of 8 years in 50 children aged less than 10 days in 80% of cases. They presented with congestive heart failure, with variable degree of shock in most cases, suggesting the diagnoses of left ventricular hypoplasia or coarctation syndrome. Diagnosis was established with ultrasound and angiocardiography. Evolution was lethal in 21 children who were not operated on. 20 children were operated on: before treatment with prostaglandin E1, 9 attempts ended up in 78% immediate mortality and 89% global mortality; after treatment with prostaglandin. E1, these figures were respectively reduced to 45% and 55% (20 cases). This malformation should therefore be recognized as an emergency and then treated with prostaglandin up to surgery.

Alprostadil↗