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Biomedical subjects

E Aliot

Publications and source records attributed to E Aliot.

At least 127 records · Page 7Linked to original sources
PubMed1985

[Hemorheologic disorders in the threatened myocardial infarct syndrome].

Haemorrheological disturbances have already been described in ischaemic heart disease. However, it has not been established whether these changes are secondary to the ischaemia and/or myocardial infarction or whether they play a role in initiating or sustaining the haemodynamic abnormalities which cause infarction. We report our results observed in 14 patients aged 48 to 75 years admitted to the coronary care unit with a diagnosis of acute coronary insufficiency defined as typical persistent anginal pain resistant to glyceryl trinitrate associated with specific ECG changes (without pathological Q waves or increased serum CPK concentrations). Blood samples were obtained on admission for determination of: haematocrit, total blood viscosities at different levels of shear with the patients hematocrit and with corrected hematocrits, total blood filtrability, plasma viscosity and plasma albumin fraction. All patients received 800 mg lidocaine, 40 mg chlorezepate, adequate anticoagulant doses of heparin and a specific antianginal drug: amiodarone, nifedipine or diltiazem. Six patients had a favourable outcome and were discharged from the Coronary Care Unit without myocardial infarction (Group I); the remaining 8 patients (Group II) developed documented changes of myocardial infarction between the 12th and 4th day after admission (see the Table in the text). The haemorrheological parameters on admission of the two patients groups were compared. The abnormalities observed were significantly more severe in the group developing myocardial infarction. This suggests that these changes may play a major role in initiating conditions leading to myocardial necrosis. These observations confirm the results of other workers who have also shown a relationship between the severity of infarction and the incidence of haemodynamic complications and changes in blood viscosity and filtrability.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

[Some comments apropos of 120 cases of transluminal coronary angioplasty].

UNLABELLED: Between April 1980 and November 1982, 120 patients underwent transluminal coronary angioplasty (TCA) by Gruntzig's technique (128 attempts on 132 vessels). Immediate results were evaluated by: the transstenotic pressure gradient (disappearance of a systolic gradient, mean residual gradient less than 15 mmHg); angiographic improvement (at least 25 p. 100) with less than 50 p. 100 residual stenosis. Success was confirmed by symptomatic and electrocardiographic improvement, the comparison of radio-isotopic studies (Thallium myocardial scintigraphy or tomography; global and regional left ventricular contractility by Technetium radioangiography) at rest and if possible during exercise before TCA and 2 and 6 months after TCA. The incidence of primary success was 72 p. 100 (stable angina: 67,2 p. 100, unstable angina 79,4 p. 100 NS); recurrence was observed in 16/69 of controlled patients (23,1 p. 100); 7 secondary TCA were performed with 5 successful results, leaving 16 p. 100 "permanent" recurrences in this series. There were 2 deaths (1 electromechanical dissociation, 1 rupture of the balloon with dissection due to dysfunction of a new manometer), 5 rudimentary infarcts (transient Q waves and/or slight enzymatic elevation), 6 infarcts (5 anterior, 1 posterior), 4 acute coronary insufficiencies (total regression after surgery). There were 11 immediate (9 as an emergency) and 9 secondary aorto-coronary bypass operations. There were 2 femoral artery repair procedures. IN CONCLUSION: certain technical procedures are relatively easy; successive utilisation of a 2 then a 3,7 mm balloon in severe or excentric stenoses for instance. Nine stenoses became occluded without infarction between coronary angiography and the TCA procedures: 2 were recanalised by the guide wire (and then dilated). Therefore, in very severe stenoses TCA should be performed rapidly, even straight away. TCA is associated with some risk to the patient: experienced operators and immediate surgical cover are essential. Initial evaluation of results should be careful: measurement of the pressure gradient is often erroneous (damping of pressure wave, transmission of ventricular pressure); automatic measurements show an overestimation of the degree of stenosis of more than 60 p. 100. Stress radioisotopic studies seem to be the most satisfactory way of assessing the outcome. Medium term results are encouraging: the majority of patients return to work, but this took too long. The ideal theoretical indication remains rare.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1984

[Late ventricular tachycardia after surgical correction of congenital cardiopathy. Impact, severity and predictive factors].

A group of 6 patients operated for Fallot's tetralogy (4 cases) or a similar congenital cardiac malformation (2 cases) were studied to assess the prevalence, severity and predictive factors of late post-operative ventricular tachycardia. These 6 patients were compared with a control group of 44 patients undergoing complete correction of Fallot's tetralogy. The age at operation (6 +/- 2 years), the length of follow-up (8 +/- 2.5 years) and surgical technique were comparable in both groups. The clinical parameters and results of non-invasive investigations (resting ECG, Holter monitoring) were compared. The first attack of tachycardia occurred on average 3 years after surgery. A triggering factor was found in 3 cases (a blow on the chest--2 cases--, general anaesthesia--1 case). These postoperative tachycardias are characterised by poor clinical tolerance, a tendency to recur, resistance to therapy and reserved prognosis. They are significantly commoner in patients operated late and in those with a poor haemodynamic result: right ventricular systolic pressure greater than 60 mmHg and recurrence of the ventricular septal defect. The combination of ventricular tachycardia and a poor haemodynamic result is associated with a mortality rate of 33 p. 100. The functional status of the patient, conduction defects and the surgical technique used were not predictive of ventricular tachycardia. The detection of a ventricular arrhythmia on the resting ECG, and, particularly, on Holter monitoring, and the induction of ventricular tachycardia by ventricular stimulation should lead to treatment against malignant ventricular arrhythmias and sudden death. The choice of anti-arrhythmic agent may be guided by endocavitary stimulation techniques to assess its efficacy.

Child↗
PubMed1984

[Long-duration electrocardiographic recording in 33 patients with obstructive cardiomyopathy].

A prospective study of arrhythmias was performed in 33 patients with hypertrophic cardiomyopathy with obstruction by Holter monitoring. The aim of the study was to assess the incidence of "occult" arrhythmias in this condition and to establish a "profile" of high risk patients from clinical, echocardiographic and haemodynamic data. The Holter monitoring demonstrated asymptomatic arrhythmias in 31 of the 33 patients (94%). A supraventricular arrhythmia was detected in 15 cases (45%), including 7 episodes of supraventricular tachycardia (21%). Ventricular arrhythmias were observed in 28 patients (85%), including 5 episodes of ventricular tachycardia (15%). Some patients presented several types of arrhythmia. A number of patients with arrhythmia including short bursts of ventricular tachycardia were asymptomatic during Holter monitoring; conversely, other patients complained of dizziness or syncope but had no arrhythmias. A retrospective study of clinical, echocardiographic and haemodynamic data showed no difference between patients with and patients without arrhythmias. Medium-dose betablocker therapy (propranolol, 110 mg/day) did not seem to protect patients with hypertrophic cardiomyopathy with obstruction from arrhythmias. We conclude that Holter monitoring should form part of the routine evaluation of patients with cardiomyopathy with obstruction, and that potentially dangerous arrhythmias should be treated by anti-arrhythmic agents other than betablockers. This attitude could reduce the incidence of syncope and eventually decrease the risk of sudden death in this condition.

Adult↗
PubMed1984

[Retrospective study of the role of systematic coronarography in patients with heart valve diseases].

The aim of this study was to assess retrospectively the valve of routine coronary angiography in the investigation of patients with valvular heart disease. Between 1978 and 1981, 598 patients over 40 years old underwent left heart catheterisation with routine coronary angiography. In the group with a medical history of angina or infarction (N = 149), there were 49 cases (33%) of severe coronary artery disease (greater than or equal to 70%) and 17 cases of moderate coronary artery disease (11%); of the 49 patients with severe lesions, 2 died after catheterisation, 8 were considered to have too high an operative risk because of their coronary disease and 19 were operated. Valve replacement was associated with a procedure for myocardial revascularisation in 15 cases. In the group without angina (N = 449), severe coronary lesions were much less common (3.6%) and only 5.1% had moderate coronary disease. Severe coronary lesions were found more frequently in certain sub-groups: Stage IV dyspnoea (9%), patients over 65 years of age (11.5%), and coronary calcification (24%). Of the 39 patients without angina and over 50% narrowing on coronary angiography, 17 underwent isolated valve surgery, and 9 underwent combined valvular and coronary surgery (2% of catheterised patients without angina; 3.5% of patients operated without angina. These results show that routine coronary angiography is fully justified in patients with valvular heart disease and a history of angina as vital information is obtained in a high proportion of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Esophageal M mode echocardiography].

M mode echocardiography may be difficult or even impossible from the standard transducer positions (parasternal or subcostal) in obese, broncho-emphysematous patients and subjects with thoracic malformations. For this reason, the authors used the oesophageal route. A 2.25 MHz unfocused 11 mm diameter transducer was attached to a wire enabling it to be orientated. The patients were asked to swallow this probe after local anaesthesia. The aortic ring served as a landmark for other cardiac structures. The technique was well tolerated and no complications ensued. Fifty seven patients were examined: echocardiography from the standard positions was of mediocre quality in 55%. Excellent recordings were obtained by the oesophageal route, of the aortic ring (Ao, 100% of cases), of the aortic cusp opening (ACO, 92% of cases) and of the anterior mitral leaflet (AML, 96.5% of cases); the recording of the left ventricle was more difficult (LV, 45.5% of cases). Exceptionally good recording were obtained of the right heart. Correlations between the measurements made from the oesophageal and standard positions were excellent with respect to the aortic structures (Ao: r = 0.92; ACO: r = 0.92) and LV dimensions (systolic: r = 0.82; diastolic: r = 0.87). The correlations between the measurements of DE mitral valve amplitude, EF slope and left atrial dimension were mediocre (r = 0.63, r = 0.72 and r = 0.69, respectively). In 6 cases, this recording technique enabled a precise diagnosis to be made. Oesophageal echocardiography is simple and well tolerated and should effectively complete the arsenal of cardiological ultrasonic techniques.

Echocardiography↗
PubMed1982

[Bidirectional ventricular tachycardia (arguments in favor of reentry)].

Bidirectional ventricular tachycardia, defined as the rapid alternation of the QRS complexes with successive opposing axial deviation, is a rare arrhythmia. In the rare cases which have undergone endocavitary investigations, an infrahisian origin has generally been proved. However, the mechanism of these tachycardias remains poorly understood and is discussed with respect to a new case. Bidirectional tachycardia occurred in a 79 year old woman with previous diaphragmatic and anterior wall infarction. It was a wide QRS tachycardia at 180/min with a succession of ventriculogrammes of opposing axis in the frontal plane and permanent right bundle branch block over the right precordium. The two types of tachycardia were observed, monomorphic type A or Type B or a combination of the two realising an A-B bidirectional tachycardia. The origin of these episodes, which occurred on a background of atrial tachycardia at about 100/min, was ventricular as shown by the absence of a His potential before the ventricular complexes in tachycardia. The presence of ventricular extrasystoles with relatively fixed coupling intervals, and the results of endocavitary investigation were suggestive of a reentry phenomenon ventricular extrastimuli were capable of transforming the bidirectional into monomorphic tachycardia and vice versa; this suggests that A was at times the origin of a reentry B, but protected by A, tachycardia B could be sustained. In the light of previously reported cases with documented endocavitary investigation and this new case, it seems possible to talk in terms of true "bidirectional ventricular tachycardia", a tachycardia whose mechanism is obscure but certainly not univocal.

Aged↗
PubMed1979

[The incidence of concealed accessory atrioventricular pathways in paroxysmal junctional tachycardias].

Forty patients with normal resting ECGs and a history of paroxysmal junctional tachycardia underwent endocavitory electrocardiography. Accessory atrioventricular pathways were demonstrated in 34 patients (82.5%), 14 of whom (35%) had Kent bundles. The ventriculo-atrial conduction time during ventricular stimulation was constantin 85% of the 40 patients but increased after injection of striadyne (ATP). This may suggest a reentry circuit partially bypassing the atrioventricular node.

Adenosine Triphosphate↗