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Biomedical subjects

J B Bouhour

Publications and source records attributed to J B Bouhour.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Effect of cardioversion of atrial fibrillation on left ventricular function in dilated cardiomyopathy. A multicenter study].

A group of 73 patients with idiopathic dilated cardiomyopathy were followed up for an average of 22 +/- 7 months to assess the medium term evolution of echocardiographic parameters of left ventricular function and, in particular, the consequences of cardioversion of atrial fibrillation. Seventy nine per cent of patients presented with cardiac failure. Left bundle branch block was observed in 20% and ventricular arrhythmias were frequent in 31%, complex in 62% with episodes of non-sustained ventricular tachycardia in 10% of cases. Left ventricular dilatation was greater in patients with complete left bundle branch block (p less than 0.003). Atrial fibrillation was present in 14 patients (19%) who were generally older than the rest of the study population (p less than 0.02) and was associated with less severe left ventricular dysfunction (p less than 0.01). Return to sinus rhythm was obtained in 9 patients. Echocardiographic data was obtained in 64 patients after an average of 6.2 +/- 1.7 months. Left ventricular function improved during the follow-up period and returned to normal in 12% of cases. Reduction of atrial fibrillation to sinus rhythm was the only predictive factor of normalisation of left ventricular function (p less than 0.02). The changes in left ventricular end diastolic dimension and fractional shortening was less marked in the group of 56 patients in sinus rhythm or chronic atrial fibrillation (normalisation of left ventricular function in 8% of cases) than in the group of 8 patients in which atrial fibrillation was converted to sinus rhythm (normalisation of left ventricular function in 50% of cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Comparison of magnetic resonance imaging, echocardiography and catheterization in the diagnosis of congenital heart diseases].

The authors compared the diagnostic value of magnetic resonance imaging (MRI), echocardiography and cardiac catheterisation with angiography in 66 patients with congenital heart disease, to determine a diagnostic strategy in the use of these methods of cardiac imaging. The patients were 8 days to 44 years old. The congenital cardiac malformations were classified in three groups: 29 isolated vascular malformations (Group 1), 17 isolated intracardiac malformations (Group 2) and 20 complex malformations (Group 3). MRI was performed in all patients using a high field (1.5 tesla) magnet and spin-echo sequences in multiple incidences. The results were compared with those of echocardiography in 60 patients and/or cardiac catheterisation in 39 cases. Technical evaluation of MRI showed images of diagnostic quality in 62/66 cases (93.9%). MRI provided a diagnostic contribution in 56 cases (85%) which was less important in intracardiac malformations than in the other groups (p less than 0.05). In comparison with other imaging techniques, globally, the diagnostic value of MRI was lower than that of cardiac catheterisation (p less than 0.005) but there was no significant difference between MRI and echocardiography. When the type of malformation was taken into account, MRI was not as useful as catheterisation and echocardiography for the diagnosis of isolated intracardiac malformations (p less than 0.01) but gave comparable results in other malformations. On the other hand, MRI associated with echocardiography was more useful (p less than 0.05) than catheterisation in the diagnosis of complex congenital lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Analysis of predictive factors of mortality in dilated cardiomyopathy. A cooperative study by the Cardiomyopathy Working Group].

UNLABELLED: An analysis of factors predictive of mortality was undertaken in a group of 201 patients with dilated cardiomyopathy (163 men, 38 women; average age 46 +/- 11 years) using a multivariate analysis (Cox's model) of 51 clinical electrocardiographic, echocardiographic and haemodynamic parameters. The average follow-up period was 57.1 +/- 29.9 months. Fifty-six patients died and the probability of 5-year survival was 77 +/- 3 per cent. The best predictive factor of survival was determined by the combination of the following parameters: presenting symptom: pulmonary oedema, peripheral oedema, syncope; duration of symptoms before inclusion into the study; left ventricular end diastolic volume; left ventricular end diastolic dimension; systolic pulmonary artery pressure. A quantitative score "S" was calculated which enabled identification of 3 subgroups: A (S less than 4.5); B (4.5 less than S less than 6); C (S greater than 6). The probability of 5-year survival was 90 +/- 5 per cent in Group A, 84 +/- 4 per cent in Group B and 53 +/- 7 per cent in Group C. IN CONCLUSION: global survival was relatively long in this patient population with dilated cardiomyopathy at different stages of evolution; the combination of factors related to clinical severity, left ventricular dilatation, systolic pulmonary artery pressure and duration of symptoms allows identification of a subgroup of patients with a poor prognosis.

Adult↗
PubMed1990

[Pseudo-angina pain of esophageal origin. Results of functional study and value of the balloon distention test].

In patients with angina-like chest pain, the diagnostic value of esophageal investigations has not been definitively established. The aim of this study was to assess the diagnostic value of different esophageal investigations in 45 patients (group I) with angina-like chest pain for which a cardiac origin had been previously excluded. These investigations included esophageal manometry, Bernstein test, edrophonium test, balloon distention test, and 24-hour pH monitoring (with event marker). These patients were compared to two control groups: a) 9 subjects with documented coronary disease (group IIa), and b) 9 healthy volunteers (group IIb). Abnormal results were observed in 37 patients in group I (82 percent), and in 4 patients in group IIa (44 percent). In group I, manometry was abnormal in 29 percent of patients and pH monitoring in 41 percent; provocative tests were positive in 10 percent, 15 percent, and 38 percent for the Bernstein test, edrophonium test, and balloon distention test respectively. Esophageal origin of the pain was shown to be likely in 36 percent of patients in group I. These results confirm the high incidence of functional abnormalities of esophagus in patients with angina-like chest pain. They also confirm the diagnostic value of the different provocative tests and especially the balloon distention test.

Adult↗
PubMed1989

[Fetal supraventricular tachycardias and their treatment. Apropos of 23 cases].

The management of fetal heterotopic tachycardias is reviewed from a cooperative study involving 23 cases treated by French Pediatric Cardiology Centers at Angers, Brest, Nantes, Rennes and Tours. There were 17 cases of supraventricular tachycardia (SVT), 5 of flutter and 1 of atrial tachycardia. Seventeen mothers were given an antiarrythmic treatment. They all received Digoxin by mouth, with either Propranolol in 2 cases, Sotalol and Verapamil in one case each. In 5 cases 2 or more other drugs were associated. There was a good in utero response in 12 cases. Among the 23 patients, 5 died, all with hydrops fetalis at the time of diagnosis of SVT. Finally 2 newborns were successfully treated at the time of delivery by a direct puncture of the umbilical cord.

Anti-Arrhythmia Agents↗
PubMed1988

Detection of myocarditis during the first year after discovery of a dilated cardiomyopathy by endomyocardial biopsy and gallium-67 myocardial scintigraphy: prospective multicentre French study of 91 patients.

The purpose of this study was to assess the frequency of inflammatory lesions in the myocardium of subjects with dilated cardiomyopathy and to determine if there was any correlation between the results of two methods of evaluation, one (endomyocardial biopsy) invasive and the other (gallium-67 scintigraphy) noninvasive. Of 115 subjects recruited in seven centres, 91 met the inclusion criteria (left ventricular dilatation greater than or equal to 100 ml m-2 and ejection fraction less than 55% with normal coronary arteriography) and had endomyocardial biopsy (mean five specimens) and Ga-67 myocardial scintigraphy after several days. Scanning was considered doubtful 19 times and positive 13 times. The histologic count of mononuclear cells in the myocardial interstitium in 20 fields was greater than 5 cells field-1 in only four cases. No correlation was found between the two methods. Subjectivity in the choice of the criterion of positivity of Ga-67 scintigraphy and difficulties in identifying lymphocytes upon pathological examination were the major problems encountered. Despite limitations, both techniques suggest that cellular infiltrates are minimal and quite infrequent in dilated cardiomyopathy.

Adolescent↗
PubMed1987

[Medical treatment of hypertrophic myocardiopathy. Comparison of propranolol and verapamil].

It remains difficult to make a reasoned choice between betablockers and calcium antagonists in the medical treatment of hypertrophic cardiomyopathy. In order to help in making this choice, we compared the effects of 320 mg of propranolol and 480 mg of verapamil, prescribed in a random order for an average period of 2.5 months in 24 patients. In 15 patients the two therapeutic sequences were preceded and followed by a clinical examination and an exercise stress test after withdrawal of all treatment. The overall functional status correlated to oxygen consumption was unchanged by the two drugs, but patients felt better more often with verapamil. These was no significant change in maximal power developed during exercise testing although verapamil increased it by 9 p. 100 throughout with a corresponding increase in oxygen consumption. Two parameters were significantly changed by both drugs: the maximal heart rate fell from 161 +/- 22 to 122 +/- 18 with propranolol, and to 145 +/- 28 with verapamil; the oxygen pulse (equivalent to the systolic index) increased from 10.9 +/- 2.2 to 14.8 +/- 3.9 with propranolol, and to 13.7 +/- 2.4 with verapamil. There were no changes in the blood pressure profiles during exercise. Side effects were observed with both drugs; muscular weakness was the biggest problem with propranolol and sinus node dysfunction with verapamil.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Dilated cardiomyopathy and the level of alcohol consumption: a planned multicentre case-control study.

The association between clinical or environmental factors and dilated cardiomyopathy (DCM) has been assessed in a planned case-control study. Patients and controls were men aged between 20 and 65 years, matched for age, profession and geographic location. DCM was defined by strict radiologic and angiographic criteria excluding multiple-vessel coronary disease. Controls were recruited from the surgical centres after excluding diseases usually linked with alcohol or tobacco consumption. Univariate and multivariate analyses were used to ensure adequate techniques for matched pairs. The prevalence of diabetes and hypertension and the exposure to toxic substances, drugs and tobacco was identical in both groups. Alcohol consumption before the onset of first symptoms was higher in patients than in controls (101 vs 64 ml day-1, P less than 0.001); the excess of consumption concerns all kinds of alcoholic beverage (wine, beer, etc.). The relative risk (RR), estimated from the odds ratio, increased only among heavy drinkers (greater than or equal to 110 ml day-1; RR: 7.6, P less than 0.001) with an independent contribution of both wine (RR: 4.7, P less than 0.001) and other alcoholic beverages (RR: 4.1, P less than 0.01). In conclusion, alcohol is a strong risk factor for DCM, but the excess of risk is limited to heavy drinkers and is independent of the type of beverage.

Adult↗
PubMed1986

[Fatal form of pericardo-myocarditis in Wissler-Fanconi syndrome].

The Wissler-Fanconi syndrome is an inflammatory disease of unknown origin, similar to Still's disease, a systemic form of juvenile arthritis. The long-term evolution is marked by recurrent febrile exacerbations, sometimes complicated by pericardo-myocarditis which usually resolves without sequellae. The authors report a case with chronic pericardo-myocarditis progressing over a 7 year period to refractory congestive cardiac failure.

Adult↗
PubMed1986

[Experimental study of the subacute toxicity of mitoxantrone and doxorubicin in rats (subcutaneous and/or intraperitoneal route)].

The aims of this study were to compare experimentally the subacute cardiotoxicity of a new anthracycline, mitoxantrone (MIT) with doxorubicin (ADM), the reference anthracycline drug. Seventy nine male rats were divided into 5 groups receiving one of the drugs or a placebo by subcutaneous (SC) or intraperitoneal (IP) injection, each week for 13 weeks. The surviving rats were sacrificed at the 21st week. Group I comprised 16 rats which received 2 mg/kg AMD-IP. The mortality rate was 50% between the 14th and 18th week. Twelve of the 16 cases had a haemorrhagic ascites. The heart was normal macroscopically and on light microscopy. However, electro microscopy showed moderate myocytic degeneration. Group II comprised 16 rats which received 0.6 mg/kg MIT-IP. Morality was 100% at the 11th week. Groups III and IV comprised 32 rats; half of the animals were given 0.6 mg/kg MIT-SC and the other half 0.4 mg/kg MIT-SC. The results were identical: good clinical tolerance, normal macroscopy. Three cases of lymphocytic myocarditis and in 4 out of 8 cases very mild myocardial degeneration on electron microscopy. Group V comprised 15 rats which were given NaCl 9% SC or IP; there were no complications. These results show that mitoxantrone given IP produced major peritoneal toxicity. On the other hand, it was well tolerated when given SC and only produced mild myocardial degenerative changes.

Animals↗
PubMed1985

[Treatment of hypertrophic cardiomyopathy].

The treatment of hypertrophic cardiomyopathy is first and foremost symptomatic, its aim being to counteract dyspnea, angina pectoris, syncopes and lipothymias, palpitations. In therapy, use is made of beta-blockers, propranolol in particular at moderate or high doses, which are often efficacious but readily cause muscular asthenia. Calcium antagonists, especially verapamil, are a therapeutic alternative, often more efficacious but exposing the patient to the risks of iatrogenic effects which are sometimes serious and may even be fatal. Surgical myomectomy is another alternative, the functional results of which are remarkable, more often than not, but the mortality at surgery, although declining progressively, is not negligible and leads to this approach being used only in cases not responding to medical treatment as when infra-aortic septal hypertrophy is accompanied by an "obstruction". The second type of therapeutic approach is the treatment and prevention of rhythmic disorders which are an integral part of the risk of sudden death. Reduction of auricular fibrillation must play a role in the prevention of thrombo-embolic disease. Ventricular arrhythmias, especially sustained attacks of ventricular tachycardia systematically detected by ambulant ECG, ought to be prevented by anti-arrhythmics: beta-blockers, in combination or not with anti-arrhythmics of class I, amiodarone, propafenone, etc.

Adrenergic beta-Antagonists↗
PubMed1985

[Ergospirometry after repair of Fallot's tetralogy].

Ergospirometry was performed in 19 children and adolescents operated for tetralogy of Fallot (TOF) to assess their exercise capacity compared to an active non sportive control group. The test was carried out on a treadmill with measurement of oxygen consumption cycle by cycle throughout exercise. In comparison with the control group, the patients had: a working capacity which was normal or reduced by 30 to 40 p. 100; a decrease d'oxygen consumption (-30 to 40 p. 100) throughout exercise and at maximal effort: this corresponds to a lower stroke volume secondary to the absence of physical activity during childhood and/or residual cardiac lesions; abnormal chronotropism: the test was stopped at a lower heart rate corresponding to a fall in oxygen uptake during exercise, or to an increase in the systolic ejection period probably due to right ventricular dysfunction or to the patient reaching maximal ventilation; decreased maximal ventilation capacity due to a lower tidal volume and a higher respiratory rate. This type of ventilation increases to role of the dead space and may be related to progressive "pulmonary dysfunction" or secondary to residual cardiac lesions. These different parameters cannot be assessed by simple ergospirometry: the test must be coupled with an evaluation of ventilatory function on effort in order to control and evaluate the long term functional results and the aptitude of these patients to regular physical activity.

Adolescent↗
PubMed1984

[Long-term evaluation, physical and sports activities after correction of Fallot's tetralogy].

The aim of this study was to assess the result of surgical repair of Fallot's tetralogy (FT) and to advise physical and sporting activities. Thirty-two patients (20 boys and 12 girls) underwent correction of FT either before 4 years of age (14 cases) or after (18 cases). The patients were assessed on average 7.5 years postoperatively (range 4 to 13 years). All but one were class I of the NYHA classification. Radiological cardiomegaly was observed in 3 cases (CTI greater than 0.55). Sinus rhythm was present in all cases: 27 out of 30 had complete right bundle branch block without bifascicular block. Holter monitoring was performed in 22 cases: occasional monomorphic VES (1 to 15/hour) were observed in 7 cases. Frequent polymorphic VES were observed during exercise in one adult. Echocardiography and cardiac catheterization revealed pulmonary regurgitation and right ventricular dilatation in over half the cases, with an infundibular aneurysm in 2 cases and a residual pressure gradient of 55 and 66 mmHg in 2 other cases requiring reoperation. Left ventricular function was satisfactory in all cases. Treadmill exercise testing was performed in 28 patients. However, for statistical analysis 12 boys aged 7 to 15 years were compared with 11 controls of the same age. There was a significant decrease in maximal O2 consumption, of CO2 excretion, of ventilation, of heart rate, of work developed and total work in the operated patients. Clinical assessment and complementary investigations are essential 5 to 10 years after correction of FT to detect latent abnormalities and to better advise patients on physical and sporting activities.

Adolescent↗
PubMed1984

[Aortic sigmoid cusp anomaly: rare cause of myocardial infarction in children].

A three and a half year old child with no previous medical history died, 20 hours after extensive anterior myocardial infarction. Post-mortem examination showed an abnormal aortic valve: the cusps were thick, indurated and white in colour. The free edge of the left antero-lateral cusp was higher than that of the other two cusps and presented a discrete thickening which overlapped the superior border of the left coronary ostium, obstructing the orifice at its thickest part. The other two cusps were tipped by fibrous spurs, one of which partially obstructed the right coronary ostium which was slightly narrowed at its origin. A review of the literature on aortic pathology causing coronary obstruction revealed rare cases of malignant disease and, more commonly, malformations usually associated with supravalvular aortic stenosis. This case might illustrate a partial and atypical form of supravalvular aortic stenosis.

Aortic Valve↗