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Biomedical subjects

E Brochet

Publications and source records attributed to E Brochet.

50 records · Page 3Linked to original sources
PubMed1991

[Detection of coronary disease before valve surgery. Contribution of myocardial scintigraphy with dipyridamole].

The detection of coronary disease before valve surgery remains difficult in the absence of coronary arteriography. The contribution of myocardial scintigraphy with dipyridamole (MS-DP) was studied in 34 consecutive patients with valve disease (11 mitral and 23 aortic) with a mean age of 63 +/- 11 years having undergone coronary arteriography before valve surgery. Coronary arteriography was performed because of angina (21 cases) or age (women greater than 50, men greater than 40). Positive criteria of coronary disease were the presence of at least one frank and clearly visible fault of myocardial perfusion (MS-DP positive) and at least one stenosis of greater than 70 per cent by coronary arteriography. Coronary disease existed in 13 patients (38 per cent). Ten patients (29 per cent) had a positive MS-DP. The sensitivity and specificity of MS-DP in detecting coronary disease were 69 per cent and 95 per cent respectively. Its positive predictive value was 90 per cent. MS-DP was negative in all asymptomatic patients (19 per cent of them having coronary disease) and in 11 symptomatic patients (18 per cent of them having coronary disease). The low positive predictive value of angina (52 per cent) increased to 90 per cent when combined with a positive MS-DP. Because of relatively low sensitivity, basing indications for coronary arteriography before valve surgery on the results of MS-DP cannot be advised.

Adult↗
PubMed1991

[Ventricular arrhythmia following thioridazine poisoning].

The authors report a case of acute thioridazine (Melleril) poisoning with manifestations of polymorphous ventricular rhythm disturbances in the form of torsades de pointes, with an impaired conscious level. The opportunity is taken to review the electrocardiographic changes and cardiac complications linked to the quinidine-like effect of Melleril.

Amiodarone↗
PubMed1989

Early isonitrile SPECT in acute myocardial infarction: feasibility and results before and after fibrinolysis.

Early 99Tcm-labelled methoxy-isobutyl-isonitrile (MIBI) SPECT was performed in 14 patients with suspected acute myocardial infarction (AMI). The radiopharmaceutical was administered immediately upon admission to the intensive care unit and before any diagnostic confirmation. Then, if decided, thrombolytic therapy was started. Cardiac imaging was performed 1 h later, and as there is no significant re-distribution, the pictures still showed the pre-treatment MIBI uptake. In three cases acute myocardial infarction was not confirmed. For one of them, the result was normal and this patient was ultimately considered to have had a transient ischaemic event. The two other cases had acute chest pain with a previous history of myocardial infarction (MI) and a pathological MIBI SPECT. In the 11 cases with confirmed first AMI significant perfusion defect was seen. For every patient a new MIBI injection with a control SPECT was repeated 72 h after admission. Eight patients were seen 1 h 15 min to 3 h 15 min after the onset of chest pain and had thrombolytic therapy. Defects were always in agreement with coronary angiography and 2D echocardiography performed in the same period. After thrombolysis, control SPECT showed no recovery in three cases, partial recovery in four, and nearly complete recovery in one. Using this technique, it was then possible to get high quality myocardial perfusion imaging without delaying treatment of AMI. This preliminary series suggests that MIBI SPECT may be useful in accurately showing the size and location of the immediate perfusion defect, and in assessing the response to emergency therapy of AMI, especially thrombolysis.

Adult↗
PubMed1988

[Late outlet strut fracture of an aortic Björk-Shiley and embolization of the prosthetic disc].

A new case of late fracture of an outlet strut in a convexo-concave Björk-Shiley valve is reported. The fracture occurred 6 years after aortic implantation of the valve and was responsible for aorto-iliac embolization by the prosthetic disc and death of the patient from cardiogenic shock. This not uncommon complication of the Björk-Shiley valve prosthesis is usually ascribed to the relative fragility of its outlet strut welded to the metallic ring and subjected to strong pressures. Although most cases were observed within the first two years of prosthetic valve insertion, and mainly with valves manufactured in 1981 and 1982, our case and a few others demonstrate the possibility of late rupture. Cardiologists must be aware of this possible complication, since in some favourable cases it can be diagnosed at an early stage and the patient's life can be saved by an emergency operation.

Aortic Valve↗
PubMed1988

[Influence of the distribution of collateral circulation on left ventricular segmental kinetics].

Correlations between left ventricular segmental kinetics and collateral circulation patterns were studied in 292 patients with coronary disease (182 women, 274 men: mean age 54 years). Left ventricular segmental kinetics were analyzed qualitatively by angiography (10 segments were individualized on RAO and LAO projections) and rated as normal, hypokinetic, akinetic or aneurysmal. The type of collateral circulation observed (contralateral, homocoronary and homolateral) and the number of collateral vessels were recorded. Collateral circulation was present in 49 p. 100 of the patients and in 29 p. 100 of the 587 pathological arteries (i.e. more than 50 p. 100 stenosis) identified. 89 p. 100 of the occluded arteries were revascularized by collateral circulation, the latter being effected by 213 collateral vessels (mean: 1.41 +/- 0.36 vessel per occluded artery). Collateral circulation through 1, 2 or 3 collateral vessels was noted in 62 p. 100, 35 p. 100 and 3 p. 100 respectively of the cases. Collateral circulation was contralateral in 51 p. 100, homocoronary in 33 p. 100 and homolateral in 16 p. 100 of the cases. Normal or hypokinetic segments in the territory of an occluded artery were more frequent in the presence (43 p. 100) than in the absence (31 p. 100) of collateral circulation, but the difference was not significant. They were also more frequent in three-vessel patients (59 p. 100) than in one-vessel (21 p. 100; p less than 0.01) or two-vessel (37 p. 100; p less than 0.05) patients in the presence of collateral circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Collateral Circulation↗
PubMed1984

[Value of echocardiography in heart surgery].

Between October 15th 1981 and January 31st 1982, 297 echocardiogrammes were performed in the department of cardiac surgery at Broussais Hospital, 31 of which were requested and carried out as emergency procedures by day or night, 187 pre- or postoperatively and 79 in the out-patient clinic. M mode and 2D echocardiographies were performed at the bedside when necessary, namely in the intensive care unit pre- and postoperatively. The examination was performed by trained personnel, both in the out-patient clinic and in the intensive care unit. In the 31 cases in which the examination was requested as an emergency, the information obtained practically always contributed to establishing the right diagnosis and to correct therapeutic intervention. In 24 cases, the emergency occurred in the post-operative period: 18 cases of cardiac failure, of which echocardiography contributed to the indication of reoperation in 4 cases, the contra-indication of reoperation in 11 cases, and the need for emergency catheter studies in 2 cases. In one case the examination was unnecessary. In 6 other cases, suspected intracardiac thrombosis was excluded. There were 7 requests for emergency echocardiography in the preoperative period and the information obtained contributed to the indication for emergency surgery in 3 cases, and guided the operative strategy. The need for urgent surgery was refuted in 3 cases. The examination was unnecessary in 1 case. The results of echocardiography were very reliable. It does not seem to have provided any misleading information; the examination was incomplete in only 10% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMedDate not supplied

MRI and cine MRI of asymmetric septal hypertrophic cardiomyopathy.

OBJECTIVE: This study was designed to determine MR and cine MR characteristics of asymmetric septal hypertrophic cardiomyopathy and to correlate MR and cine MR features with the severity of left ventricular outflow tract obstruction. MATERIALS AND METHODS: Ten consecutive patients with asymmetric septal hypertrophic cardiomyopathy [resting obstructive (n = 3), latent obstructive (n = 4), nonobstructive hypertrophic (n = 3)] and five healthy volunteers underwent MRI and cine MRI. Oblique two chamber and four chamber views were obtained in all cases. RESULTS: In the 10 patients, the mean +/- SD end-diastolic myocardial thickness was 22.7 +/- 6.3 mm in the basal septum and 13 +/- 3.9 mm in the posterolateral wall with a ratio of 1.76 +/- 0.30; the corresponding values were 10.6 +/- 1.1, 10.4 +/- 1.1, and 1.02 +/- 0.08 mm, respectively, in five healthy volunteers. The mean systolic thickening of the basal septum was 22 +/- 12%. This value was 49 +/- 4% in the five healthy volunteers. In resting obstructive hypertrophic cardiomyopathy, septal wall thickness was > or = 25 mm with a systolic thickening of 10%. A systolic anterior motion of the mitral valve was demonstrated in four patients with resting subaortic pressure gradients ranging from 28 to 120 mm Hg. A signal void area was demonstrated within the left ventricular outflow tract during systole in the seven patients with obstructive cardiomyopathy. This signal void area reached its maximum during early systole in the most severe obstructions and during midsystole in the less severe obstructions. CONCLUSION: In patients with asymmetric septal hypertrophic cardiomyopathy, gross correlation was demonstrated between severity of obstruction and several MR and cine MR features including increased end-diastolic thickness of the septal wall, decreased systolic thickening of the septal wall, systolic anterior motion of the mitral valve, and signal void area within the left ventricular outflow tract during systole.

Adult↗
PubMedDate not supplied

Cine MRI of mitral regurgitation in planes angled along the intrinsic cardiac axes.

OBJECTIVE: This prospective study was designed to evaluate the mechanism and severity of mitral regurgitation (MRG) by means of cine MRI using planes angled along the intrinsic cardiac axes. MATERIALS AND METHODS: In 25 patients with MRG, analysis of the direction, extent, and distribution of left atrial signal void area was performed on both two chamber and four chamber cine MRI views. Cine MRI features including qualitative grading, maximal length of regurgitant jet, and ratio of regurgitant jet area to left atrial area were compared with the results of color flow Doppler (CFD) mapping (n = 25), angiography (n = 20), and regurgitant fraction as determined at catheterization (n = 15). RESULTS: In the four chamber view, cine MRI demonstrated central extension of regurgitant jet (n = 8) in cases with dilatation of valve annulus or retraction of both mitral valve leaflets, anterior extension (n = 8) in cases with prolapse of the posterior leaflet, and posterior extension (n = 7) in cases with prolapse of the anterior leaflet or retraction of the posterior leaflet. In two cases of mild MRG with small signal void area, evaluation of mechanism was not feasible. The results of cine MRI and angiographic qualitative gradings were the same in 19 of the 20 patients and differed by one grade in the other patient. In the 25 patients, maximal length of the regurgitant jet was well correlated with both regurgitant jet area and ratio of the jet area to the left atrial area as determined by CFD mapping (r = 0.91, r = 0.85, p < 0.0001, respectively). In 15 patients the maximal length of regurgitant jet was correctly correlated with regurgitant fraction determined at catheterization (r = 0.76, p < 0.001). CONCLUSION: Cine MRI by means of planes angled along the intrinsic cardiac axes allows assessment of both the mechanism and the severity of MRG.

Adult↗