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Biomedical subjects

J Acar

Publications and source records attributed to J Acar.

At least 199 records · Page 11Linked to original sources
PubMed1983

[Role of surgery in the treatment of chronic aortic insufficiency].

The long-term prognostic factors which determine the indications for surgery are studied on the basis of a series of 198 cases operated for chronic aortic incompetence, in terms of their influence on the actuarial long-term mortality rate due to heart disease and irreversible myocardial dysfunction. The mortality in the first month after surgery is 5 per cent. The factors which significantly modify the long-term outcome of operated patients are clinical (cardiomegaly, degree of preoperative heart failure, ventricular extrasystole, functional grade) and haemodynamic (mean pulmonary artery pressure, end-systolic and-end diastolic left ventricular pressures, left ventricular ejection fraction). Multifactorial studies have shown that ventricular dilatation is the most important prognostic factor. Left ventricular function is severely altered, even in patients with few or no symptoms, but, in the absence of marked functional disturbance, the prognosis is usually good, whatever the repercussions on the myocardium. Surgery should be performed routinely in patients with severe functional disturbance, in the absence of reliable individual criteria capable of predicting when the indications have been exceeded. Surgery is also legitimate in patients with few or no symptoms when investigations reveal severe effects on the left ventricular function.

Adolescent↗
PubMed1983

[Anticipation of surgical results in calcified aortic stenosis as a function of age].

The effects of age on the risks and results of heart valve replacement are often discussed in aortic stenosis, a degenerative condition of elderly patients. We assessed this factor in a study based on two groups of patients operated consecutively between 1968 and 1980. Group A comprised 127 patients of over 65 years of age (range 66 to 79 years, mean 70 +/- 3 years), and Group B: 259 patients of less than 65 years of age (21 to 65 years, mean 53 +/- 9 years). Preoperative assessment showed a higher proportion of women and significantly more severe lesions in Group A: a greater number of patients in functional class 3 or 4, cases of congestive cardiac failure, greater cardiac volumes, lower cardiac index. The incidence of coronary artery disease was also higher. A greater number of aortic valve bioprostheses was used in Group A. Operative mortality was significantly higher in Group A (15 p. 100, compared to 6 p. 100 in Group B: p less than 0.01). The influence of age was independent of other risk factors as shown by a multifactorial analysis taking several prognostic factors into account simultaneously. Long term survival was significantly lower in Group A, but their life expectancy did not differ from that of a control group. The causes of postoperative or late death were the same in both groups. At the end of the 6th year, 66 p. 100 of the survivors of surgery in Group A were in functional classes I or II compared to 77 p. 100 in Group B (NS). These results justify this type of surgery in elderly patients, even at advanced stages of their disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1982

[Value of correction by receiving gains in the determination of mitral valve surface area by two-dimensional echocardiography].

Distorsion due to inappropriate gain settings interferes significantly with the measurement of mitral valve surface area by 2D echocardiography. The problem is general and applies equally to all makes of echocardiographs whether they are mechanical or phased array scanners. The measured mitral surface area may even be false if the level of the recording gain is disregarded. We established a graph of the global distorsion of a system comprising an Aloka SSD 800 phased array sector scanner and a Tektronics hard copy recorder using a "tissue-equivalent" model and only varying the level of gain. Using these results a computerised program for automatic correction of the mitral surface area, with respect to the gain level used, was developed. The program was validated on a series of 56 patients with mitral stenosis by comparison with the catheter results obtained with the Gorlin formula, peroperative and pathological findings on resected valves. With this echo system in the zone of gain settings studied there was a significant underestimation of the uncorrected surface area. After correction, the distinction between severe and moderate stenosis was better and an improved correlation with the anatomical surface area was obtained. It would therefore appear necessary to calibrate the system used taking both the echocardiography and the recorder into account. Despite certain limitations, we believe that distorsion curves could be established using "tissus-equivalent" models.

Adult↗
PubMed1982

[Bacterial endocarditis on a mitral prosthesis with negative blood cultures. Case evolving over a 3 year period in the absence of fever].

A 38 year-old man, operated upon two years previously for combined mitral and tricuspid valve disease of rheumatic origin, presented with signs of a severe biological inflammatory syndrome, and a mild proliferative glomerulonephritis (normal complement with exclusively mesangial deposits of IgM, Clq, and C3 on immunofluorescence), which developed slowly over a period of 3 years in the absence of any fever. Blood cultures were always negative, and prolonged antibiotic therapy on two occasions had no effect on the clinical or biological picture. Mitral prosthesis replacement was necessary 6 months after the onset of the affection, a second leakage 16 months later leading to rapidly fatal heart failure. Pathological examination confirmed the presence of an endocarditis at the zone of insertion of the prosthesis. The slow progression of the disorder in this case, and the absence of fever, emphasize diagnostic difficulties of certain cases of endocarditis, due to low virulence germs, that progress under cover of a generalized disease of renal expression. The value of renal biopsy, which provided almost specific indications in the present case, is also stressed.

Adult↗
PubMed1982

High plasma antidiuretic hormone in patients with cardiac failure: influence of age.

Plasma antidiuretic hormone (ADH) was greater in patients with cardiac failure than in healthy subjects. Plasma ADH increased significantly with age in both groups. Covariance analysis showed that the difference between patients and controls occurred whatever the age. Plasma sodium and plasma osmolality were lower in cardiac patients than in healthy subjects. This showed that increase in plasma ADH observed in patients was inappropriate since it coexisted with inhibitory levels of plasma osmolality. Plasma creatinine was greater in cardiac patients than in healthy subjects and for each group in elderly than in young people. But there was no significant correlation between plasma ADH and creatinine. This suggested that increase in plasma ADH observed in cardiac failure was due more to an augmented release than to a diminished catabolism. No clear influence of etiology, severity, length of the disease and treatment with diuretics could be demonstrated.

Adolescent↗
PubMed1981

Study of platelet diameter distribution in patients with valvular heart disease and with prosthetic heart valve replacement.

We have studied the platelet count and the megathrombocyte index (MI), or percentage of platelets that have a diameter greater than 2.9 micrometers, in 100 patients with valvular heart disease. The mean platelet count is significantly lower than in controls (p less than 0.0005) and the MI is significantly increased (p less than 0.01). No difference was observed in these two parameters according to the variety of the valvular heart disease. 45 of the same patients were studied after prosthetic heart valve replacement. Our results show a significant elevation of platelet count and a significant decrease of MI compared with the presurgical values in all groups except in the mitral one in which MI remains increased. This work demonstrates the presence of platelet abnormalities which reveal a compensated thrombocytolytic state in patients with valvular heart disease and its partial correction after aortic, but not mitral, valve replacement.

Adolescent↗
PubMed1981

[Chronic disseminated intravascular coagulation in a case of ventricular aneurysm. Correction by low-dose heparin].

A case of intravascular coagulation in a patient with a very large ventricular aneurysm is reported. Biological signs of defibrination with a low serum fibrin of 0,80 g/1, thrombocytopaenia of 80,000/mm3 and the presence of soluble complexes and FDPs were detected after recurrent haematuria. Low dose heparin (0,15 to 0,20 ml x 2/day by subcutaneous injection) led to normalisation of the fibrinogen levels, increased the platelet count and reversed the consumptive coagulopathy. Each withdrawal of heparin (5 attempts over 16 months) led to a biological relapse. At the final withdrawal of therapy, the biological abnormalities remained minor; the consumption of fibrinogen and platelets was well compensated. Similar cases have been published in aortic aneurysms with and without dissection, but the association with a cardiac aneurysm has not been reported previously. The physiopathological mechanism of the coagulopathy is discussed and the authors suggest routine study of the coagulation system in all patients with cardiac aneurysms. This case illustrates the efficacity of moderate doses of heparin in a patient with "biological hypercoagulability" well documented by laboratory investigations.

Chronic Disease↗
PubMed1981

[Postoperative false aneurysm of the heart due to infection: successful surgical treatment (author's transl)].

A false aneurysm of the left ventricle was successfully operated upon in a patient who had developed postoperative purulent pericarditis after resection of a post-infarction ventricular aneurysm 5 months previously. The authors describe the clinical, anatomical, radiological, and ultrasonographic characteristics of false aneurysms, which occur more frequently after myocardial infarction than postoperatively. Other, more rare causes are described, as well as recent data reported in published literature. The role of infection in certain postoperative forms is emphasized. Apart from angiography, non-invasive methods such as bidimensional ultrasonography and angioscintigraphy play an important role in establishing the diagnosis, avoiding explorations which are not without risk in debilitated patients. The frequency with which rupture of false aneurysms is observed, in contrast with true aneurysms, entails early recognition and operation on a regular basis, even when signs of intolerance are absent.

Angiocardiography↗