Search PubMed⌕ Search

Biomedical subjects

J Acar

Publications and source records attributed to J Acar.

At least 181 records · Page 10Linked to original sources
PubMed1984

[Subvalvular aortic stenosis in adults. Apropos of 31 cases].

The aim of this cooperative study was to analyse the clinical profile of subvalvular aortic stenosis (SVAS) in adults. Thirty one cases were collected : patients aged 17 to 60 years (average 34 years). The diagnosis was confirmed in all patients either at surgery (30 cases) or at autopsy (1 case). The overall incidence of SVAS in patients with fixed obstruction to left ventricular ejection operated in the same period was 3.5%. Associated congenital malformations were detected in 15% of cases but intracardiac shunts were rare. Adult SVAS is a purer malformation than in children, probably because of spontaneous and surgical selection. The anatomical type of stenosing lesion in this series was a subaortic ring or membrane; 45% of patients, usually over 40 years of age (7 out of 9) had localised septal hypertrophy at the level of the diaphragmatic obstruction. The clinical presentation was that of mixed aortic disease with associated stenosis and regurgitation. Over 80% of patients had aortic incompetence diagnosed clinically (26 out of 31 cases) or on aortography (24 out of 25 cases); the regurgitant flow was assessed as mild in 15 cases, moderate in 6 cases and severe in 3 cases. There were obvious valvular lesions at surgery in 19 cases, especially in patients over 40 years of age (8 out of 9 cases). The mechanism was variable : non-specific (8 cases), destructive (6 cases), rheumatic (2 cases) or congenital (3 cases). Bacterial endocarditis was particularly common (26% of cases). Adult SVAS is a particularly difficult clinical diagnosis : the electrocardiogram and chest X-ray are not very informative.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[2-dimensional echography in the preoperative evaluation of mitral stenosis].

2D echocardiography has become one of the most important investigations in the preoperative assessment of mitral stenosis. This study was undertaken to determine the reliability of the information so obtained, by comparison with the surgical appearances. The study population consisted of 104 patients (average age 45 years, 76% women) undergoing open heart surgery for pure mitral stenosis (72%) or mixed mitral valve disease (28%) between 1980 and 1981. All underwent 2D echo using a phased array Aloka SSD 800 80 degrees sector scanner. Cardiac catheterisation was performed in 102 cases and left ventricular angiography in 89 cases. The echocardiogramme was interpreted by an observer who had no knowledge of the surgical results. The mitral surface area, the condition of the valves and subvalvular apparatus and the predictive value of the possible surgical technique were analysed. The 2D echo mitral surface area was estimated by planimetry and quantitatively by using the Gorlin formula during catheterisation and by the surgical description preoperatively. 2D echo was more sensitive than M mode in the detection of severe mitral stenosis (90% vs 73%, p less than 0,01). The 2D echo-Gorlin correlation was quite good (R = 0,70, p less than 0,01) but was worse when the valves were very thickened. When compared with the surgical observations, 87% of the 2D echo data was correct. The thickness of the valves, their amplitude, the diastolic bowing of the anterior leaflet and the presence of calcification were assessed by 2D echo. The echo-surgical results matched perfectly in 76% of cases. The usual cause of error was underestimation of the degree of valvular damage. The valvular bowing and thickness were the most useful signs. Dense, brilliant echos of valvular calcification were found in only 58% of surgically proven cases of valvular calcification, but the error was often related to fine calcification, not visible on fluoroscopy, or to its localisation on the posterior leaflet. The subvalvular apparatus was evaluated in over 93% of patients, a complete study being possible in 73% of them. The 2D echo-surgical correlations were excellent in 90% of the cases in which it had been completely visualised. The chordal thickening was correctly predicted in 79% of cases. The surgical assessment was more pessimistic in 1/3 of cases in which the chordae appeared to be of normal thickness. The length of the chordae was correctly predicted in 68% of cases. The surgical assessment was more pessimistic in 1/2 of cases in which the chordae appeared to be of normal length.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1984

[Should closed-heart mitral commissurotomies still be performed? Apropos of 168 operations, 108 open-heart and 60 closed-heart].

Mitral commissurotomy is known to give good results but the best surgical technique (open heart or closed heart) remains uncertain. Results of open heart commissurotomy (OC), 108 patients (Group I) and closed heart commissurotomy (CC), 60 patients (Group II) were compared. The population comprised 81% females and the average age was 39 +/- 12 years. Only cases of pure or very predominant mitral stenosis (MS) were included. The preoperative state of the patients in Group I was poorer than the one in Group II (repeat commissurotomy 8.3% compared to 1.7%, p less than 0.04; associated mitral regurgitation 41% compared to 27%, p less than 0.04; cardiothoracic ratio 0.54 +/- 0.07 compared to 0.51 +/- 0.06, p less than 0.01). A more complete surgical cure was possible in Group I. Both commissures were liberated in 99% of OC compared to 25% CC (p less than 0.001). Mitral valvuloplasty was associated in 87% of OC (63 cases on the papillary muscles, 21 cases on the chordae tendinae and 60 cases on the mitral annulus). Operative mortality was low and did not differ significantly between the two groups (zero in CC; 1.8% in OC). Overall survival rates were excellent (95% 5 year survival, 85% 7 year survival). The reoperation rate at 5 years was 7.4% and at 7 years, 23.9%, and did not differ with the surgical technique used. The functional result was good (patients in Class I or II of the NYHA classification 84% at 5 years; 75% at 7 years; identical for both groups). Significant late valvular "dysfunction" was rare after OC.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Valve replacement, a possible factor in myocardial deterioration].

Cardiopulmonary bypass (CPB) may be a cause of myocardial damage in a small number of patients undergoing valve replacement (4 out of 1576 valve replacements). The responsibility of CPB can only be presumed when: the degree of myocardial dysfunction after surgery can be quantified, other causes of myocardial dysfunction are excluded. the type of valvular disease is taken into consideration. Variations in load after correction of certain lesions (mitral regurgitation) makes changes of LV systolic function difficult to interpret. The first case concerned a 23 year old patient operated for aortic regurgitation (Björk prosthesis) under local and general hypothermia and followed-up for 1 year after surgery. Ventricular extrasystoles and left bundle branch block were observed during surgery and radiological and echocardiographic LV dilatation persisted with deterioration of echographic, isotopic, haemodynamic and angiographic parameters of LV function: ejection fraction fell from 62% before surgery to 35% with diffuse hypokinesia and persistent LV dilatation (191 vs 188 ml). In the absence of prosthetic valve dysfunction, associated valve lesions or coronary artery disease, LV deterioration was attributed to CPB and inadequate myocardial protection. In two other cases (60 and 62 years) correction of aortic stenosis (Starr 1260) with coronary perfusion was followed by cardiac failure with left bundle branch block, deterioration of LV function, and death after 3 years in one case and precarious survival at 10 years in the other. In a fourth case (mixed mitral valve disease corrected by a Starr prosthesis under aortic clamping), the variation of cardiac load before and after surgery made changes in LV function difficult to interpret. (ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Traumatic left ventricular aneurysm disclosed by systemic emboli. Value of platelet labelling with indium].

The authors report a case of traumatic left ventricular aneurysm, presenting with recurrent cerebral embolism, 36 years after a thoraco-brachial bullet wound. The 58 year old man had no symptoms of angina or particular cardiovascular risk factors. The ECG showed changes of chronic anterior wall infarction, observed 10 years previously on a routine preoperative recording. There was a calcified circular para-apical shadow on chest X-Ray. The antero-apical region showed hypofixation on myocardial scintigraphy, and hypokinesia on isotopic angiography. The coronary arteries were normal. Indium III platelet marking revealed a focus of hyperfixation within the left ventricle. At surgery, a true calcific para-apical left ventricular aneurysm was discovered, containing a fresh thrombus. This lesion was resected. Peroperative Indium III platelet test confirmed that the thrombus was the site of high uptake. The surgical result was good at 6 months follow-up. This case illustrates: the value of the Indium test which would appear to be a very specific and sensitive method of detecting intraventricular thrombi. This test, which appreciates the thrombotic activity of intracardiac masses is a useful complement to other non-invasive methods such as 2D echocardiography; the special characteristics of post-trauma left ventricular aneurysms which are rare, often diagnosed late, at the time of complications such as systemic embolism, commonly pose medico-legal problems, and for which surgical treatment seems to be indicated in symptomatic patients.

Blood Platelets↗
PubMed1984

[A case of acquired immunodeficiency syndrome (AIDS) in a homosexual].

There is increasing number of cases of acquired immune deficiency syndrome (AIDS) and in France there have been about 100 cases. The authors report one case who died within 10 months. The patient presented a Pneumocystis carinii pneumonia, extensive peri-anal herpes, gastro-intestinal candidiasis and, in the final stage, severe diarrhoea. In the context of this case, the authors review the principal manifestations of this new clinical entity.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Reproducibility study of the pharmacokinetics of amikacin, gentamicin and tobramycin; a three-way crossover study.

The hypothesis that the pharmacokinetics of amikacin are more predictable than those of gentamicin or tobramycin was studied. In a three-way crossover design 58 volunteers received 7.5 mg/kg amikacin by iv infusion and either 1.5 mg/kg or 1 mg/kg gentamicin and tobramycin. The mean half-life and mean serum concentration at 1 h for each drug was determined. No consistent significant difference was found between the pharmacokinetics of amikacin and the other two drugs.

Amikacin↗
PubMed1983

[Aortic insufficiency and Takayasu disease].

Six cases of this rare association (7 to 10 p. 100 of Takayasu's disease) are reported. The authors also review 73 previously reported cases. The valvular lesion is usually detected secondarily during follow-up (2/3 of cases), but is observed at the same time as the arterial disease in about 1 out of 5 cases. In rare cases, it may be the presenting feature before the vascular disease becomes clinically apparent. Quantification of the regurgitation may be difficult because of stenosis of the thoracic aorta and the supra aortic vessels. In some cases it is severe and poorly tolerated but has no particular distinguishing features apart from the incidence of aortic wall calcification (ascending aorta to all of the aortic arch). Twenty five anatomical observations (operative or autopsy) are sufficiently well documented to show the mechanism of the aortic incompetence. It is caused by an inflammatory aortitis: valvular lesions were found in 2/3 of cases but other causes may be observed, dilatation of the aortic ring (1 out of 4 cases), disunion of the commissures (1 out of 4 cases) and changes in aortic compliance causing systolic hypertension. Aortic valve replacement is rare (11 cases including 3 personal cases) and sometimes completed by resection of an aneurysmal ascending aorta.

Adolescent↗
PubMed1983

[Aneurysm of the interauricular septum and operated left-right shunt. Echocardiographic aspects].

The echocardiographic appearances of a patient with a rare congenital malformation, interatrial septal aneurysm (IASA) associated with a hemodynamically significant left-to-right shunt, are described. A 52 year old man with Noonan's syndrome was admitted to hospital for atrial flutter with right heart failure, which, on investigation, led to the diagnosis of a rare type of atrial septal defect; 2D echocardiography showed an isolated aneurysm of the interatrial septum; cardiac catheterisation demonstrated a significant left-to-right (5 volumes of oxygen per 100 ml). The patient underwent surgery which confirmed the presence of a multiperforated aneurysm of the interatrial septum in the region of the fossa ovalis. This abnormality was resected and the interatrial defect closed; there were no postoperative complications and the cardiomegaly regressed significantly. The authors underline the M mode and 2D appearances of this condition; although it may be difficult on M mode examination to distinguish an IASA from other conditions giving rise to mobile intra-right atrial echos, such as Chiari's malformation, tricuspid valve vegetations, intraatrial tumour or thrombus or Eustachian valve, 2D examination using different incidences and contrast injections generally confirms the diagnosis. Surgery is often necessary after the detection of this echocardiographic abnormality: the surgical indications are described.

Echocardiography↗
PubMed1983

[Recurrent ejection of aortic valve prostheses. Apropos of 22 case reports].

Twenty two cases of recurrent perivalvular leaks in aortic valve prostheses were reviewed in a multicentre cooperative study. From 1963 to 1978, 22 patients, mean age 39 years, underwent aortic valve replacement; 18 patients had aortic regurgitation, 6 due to infective endocarditis, and 4 patients had calcific aortic stenosis. Eight Starr-Edwards, 6 Smeloff-Cutter, 2 Braunwald-Cutter, 3 Björk, 1 Lillehei-Kaster and 2 bioprostheses were inserted. All 22 patients had to be reoperated for perivalvular leaks due to active or previous infective endocarditis in 7 cases. The prostheses implanted (3 reinsertions, 19 valve replacements) were 10 Starr-Edwards, 4 Smeloff-Cutter, 5 Björk, 1 Lillehei-Kaster, 1 Magovern and 1 bioprosthesis. All 22 patients had further perivalvular leaks, 6 caused by infective endocarditis, and 15 patients underwent a third operation. The prostheses implanted this time (2 reinsertions, 13 valve replacements) were 4 Starr-Edwards, 3 Smeloff-Cutter, 7 Björk and 1 bioprosthesis. Four patients had a third perivalvular leak, and 2 patients a fourth perivalvular leak. The first and second episodes of perivalvular leak were detected early in over half the cases. They were associated with cardiac failure, angina and hemolysis in 20 to 45% of cases. The average period between the first and second operations, and the 2nd and 3rd operations were 15 months and 9 months respectively. Overall, 11 patients died (50%), 4 due to cardiac failure and 3 of sudden death; 3 patients have been lost to follow-up (14%), and there are 8 survivors (36%) with a mean follow-up period of 5 years. However, the mortality rate when the cause of perivalvular leak was infective, was 82%, and only 18% when the cause was mechanical. The factors which favour recurrent perivalvular leaks are infection (30% of cases) and technical difficulties related to the poor quality of the aortic ring (calcification, dystrophy or dilatation). The prevention of this complication depends on careful peroperative technique, the use of certain surgical bypass techniques, a constant battle against infection, and regular examination of operated patients.

Adult↗
PubMed1983

[Hemodynamic and angiographic results following surgical correction of mitral insufficiency. Apropos of 51 repeated catheterizations].

The benefits of surgical correction of mitral incompetence were assessed in 51 patients by comparing pre and postoperative catheter and quantitative angiographic results. The mean age of the patients was 43.5 +/- 12.3 years. The mitral lesions were elongation or ruptured chordae (27 cases), valvular perforation due to endocarditis (1 case) and the usual rheumatic disease in 23 cases. Hemodynamic investigation was carried out on average 2 months before operation and 29 +/- 22 months after surgery. The following angiographic parameters were measured : indexed end diastolic and end systolic volumes (EDV and ESV), ejection fraction (EF), myocardial mass (MM) and its ratio to EDV (hypertrophy coefficient : HC) and the geometry of the ventricle as assessed by diastolic and systolic coefficients of excentricity (DE and SE). Surgery comprised 13 mitral valvuloplasties and 38 valve replacements. Patients who suffered perioperative myocardial infarction or who had a residual valvular lesion were excluded from the study. After surgery, the hemodynamic state was considerably improved with a significant decrease in pulmonary capillary pressures (11 +/- 5 compared to 17 +/- 6 mmHg, p less than 0.09) and mean pulmonary artery pressures (19 +/- 7 compared to 27 +/- 11, p less than 0.01) and increase in cardiac index (2.8 +/- 0.7 compared to 2.3 +/- 0.6 l/min/m2, p less than 0.01). There was an associated decrease in ventricular volumes (EDV : 115 +/- 44 compared to 165 +/- 43, p less than 0.01) (ESV : 60 +/- 39 compared to 77 +/- 22, p less than 0.001). The reduction in myocardial mass was less spectacular (129 +/- 40 compared to 148 +/- 32, p less than 0.01) with a resulting increase in the HC (1.10 +/- 0.26 compared to 0.88 +/- 0.17, p less than 0.001). The geometry of the LV was less spherical in diastole (DE 0.76 +/- 0.08 compared to 0.70 +/- 0.08, p less than 0.001) and in systole (SE = 0.83 +/- 0.06 compared to 0.77 +/- 0.08, p less than 0.001). The EF fell slightly but this was not statistically significant (0.51 +/- 0.13 compared to 0.53 +/- 0.09 NS). The surgical result of 14 patients with PCP greater than or equal to 13 mmHg was considered hemodynamically incomplete, and this was confirmed by a lower cardiac index than in the remaining 37 patients (2.4 +/- 0.5 compared to 3.0 +/- 0.7, p less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1983

[Unusual development of ventricular aneurysms. Echocardiographic diagnosis].

Two cases of posterior left ventricular aneurysms compressing the left atrium diagnosed by 2D echocardiography are reported. The diagnosis was made on visualisation of an abnormal intra-left atrial cavity, contiguous with the mitral ring, exhibiting systolic expansion, which could not be opacified by peripheral venous injection of echo-contrast.

Adult↗
PubMed1983

[Myxoma of the left atrium and advanced renal failure].

A 34 years old woman with a history of childhood rheumatic fever presented with a number of episodes of systemic embolism over a 10 years period attributed to mitral stenosis despite long-term anticoagulant therapy. All preoperative electrocardiograms showed sinus rhythm. After one episode of recurrent embolism (brain, limbs) requiring femoral embolectomy, she developed oligo-anuric renal failure and needed 21 days of hemodialysis. She made a full recovery. Several years later, she presented with chronic progressive renal failure. The diagnosis of left atrial myxoma was eventually made at echocardiography: surgical excision was successful. Periodic hemodialysis was started six months later. The authors use this case to illustrate unusual presentations of myxoma and above all their vascular complications; the possibility of embolic renal disease leading to advanced renal failure is discussed, a complication of left atrial myxoma which seems to be very rare.

Adult↗