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Biomedical subjects

J Boschat

Publications and source records attributed to J Boschat.

At least 91 records · Page 5Linked to original sources
PubMed1983

[Acquired interventricular communication and false left ventricular aneurysm caused by non-penetrating trauma of the thorax].

A 48 year old man, victim of a serious road traffic accident (multiple limb fractures, closed trauma of the left hemithorax) was immediately diagnosed as having a systolic regurgitant murmur. The initial ECG recordings showed anterior subepicardial ischemia, and later, a low antero-septal and apical infarction. The hemodynamic status progressively deteriorated, leading to catheterisation 7 months after the accident showing an inferiorly situated VSD (oxymetry and dye dilution techniques). Angiography visualised the traumatic rupture of the lower part of the septum and an inferior posterior left ventricular aneurysm. AT surgery, the septal rupture was repaired by a Dacron patch and a false aneurysm was plicated. The patient was asymptomatic after surgery, and control catheterisation and angiography one year later showed the absence of a residual shunt and good movement of the inferior posterior left ventricular wall. The lesional mechanisms associated instantaneous septal rupture by deceleration, contusion of the apex and progressive development of an inferior posterior wall false aneurysm.

Diagnosis, Differential↗
PubMed1983

[Sick sinus syndrome: comparative study of atrial and ventricular stimulation tests].

Subjects with a ventriculo-atrial block and normal sinus function exhibit acceleration of the sinus rhythm during incremental right ventricular pacing; this acceleration is nor observed or is hardly visible in patients with sinus node dysfunction. Incremental right ventricular pacing up to 150/min was performed in 16 patients with ventriculo-atrial block (Group A) referred for investigation of sinus node dysfunction and the results compared with the classical tests of atrial pacing (Strauss'graph, atrio-sino-atrial conduction time, sinus node recovery time). The same tests were carried out in 19 patients without sinus node dysfunction (Group B). In the latter group, sinus rhythm exceeded 80/min during right ventricular pacing at 150/min and the rate increased with respect to the basal rhythm was always greater than 10/min. In Group A premature atrial pacing gave abnormal results in 4 cases, sinus node recovery times were abnormal in 15 cases, and rapid right ventricular pacing abnormal in all cases (sinus rhythm less than 80/min and/or rate increase of less than 10/min). There was no relation between the increased sinus node recovery time and the degree of rate increase during rapid ventricular pacing. Incremental right ventricular pacing, therefore, seems to be a new method of investigating sinus node function but complementary studies are required to determine its limitations, the exact mechanism and to try to widen its application to subjects without ventriculo-atrial block.

Aged↗
PubMed1983

[Evaluation of cardiac function by external polygraphic recordings. Comparison with angiography].

Good correlations have been reported between angiographic ejection fraction and indices of left ventricular function obtained by external polygraphic recordings. We studied 104 coronary or normal patients undergoing angiography within 24 hours of external polygraphic recordings. The angiographic ejection fraction was compared with three external indices in each case: the Weissler index (PEP/ET), the normalised derivation of a calibrated apex cardiogram (ds/dt/s) and the ejection fraction calculated from the apex cardiogram (EF apex). The angiographic ejection fraction was calculated after measuring left ventricular end diastolic and end systolic volumes in the 30 degrees RAO projection by a method derived from Dodge's. No correlation was found between the angiographic ejection fraction and any of the external indices. Analysis of our results and of those previously reported lead us to the following conclusions: --systolic time intervals are very sensitive to stress, imposing recording conditions which are difficult to meet in hospital surroundings, --a good quality apex cardiogram can only be obtained in a small percentage of patients, --the apex cardiogram reflects a mechanical phenomenon due to displacement of the apex beat and cannot therefore be assimilated to changes in cardiac volume, --the ds/dt/s index is difficult to calculate without a sophisticated computer. Therefore, these methods of external recording are not suitable for routine medical practice.

Adult↗
PubMed1981

Response of normal and abnormal sinus node to right ventricular stimulation.

Right ventricular pacing at progressively increasing rates was performed in 25 patients with complete ventriculoatrial block, before and after autonomic blockade with intravenous propranolol and atropine. At the end of each ventricular pacing stage a right intraatrial electrogram and electrocardiographic leads were simultaneously recorded. The relation between right ventricular pacing and atrial rates was studied from the recordings obtained at each pacing stage in both group I, 8 patients with sick sinus syndrome, and group II, 17 patients with normal sinus function. Right ventricular pacing was associated with an increment in atrial rate that ws significantly smaller (probability [p] less than 0.001) in patients in group I (mean +/- standard error of the mean 8 +/- 6 beats/min) than in group II (mean 25 +/- 10 beats/min). The maximal atrial rate reached during right ventricular pacing exceeded 80 beats/min in all patients in group II but remained less than 74 beats/min in patients in group I. Because autonomic blockade did not significantly influence the preceding results, it is concluded that a mechanical effect on the sinus node may explain this phenomenon.

Adult↗
PubMed1981

[Calcifications of the trunk of the left coronary artery in coronary disease. Anatomical study].

Calcification of the left main coronary artery (LCA) was found, with an equal sex distribution, in 30 out of 145 patients (21%) at autopsy. A series comprising 68 males and 77 females in whom death resulted from myocardial infarction (111 cases) or ischaemic heart disease (34 cases). The condition is rare before the sixth decade but becomes more frequent after the seventh decade of life. The incidence was the same in lethal anterior and posterior infarction (15% and 16% respectively). It was more common in ischaemic heart disease (38%, p less than 0,005). Significant narrowing of the LCA was found in 26 cases (87%) but this was only less than 70% in 11 cases. When the total number of LCA stenoses (calcified and non calcified: 39 cases) was considered, only two thirds had associated calcification. This was, therefore, only a moderately sensitive index of LCA stenosis. Calcification, nearly always circumferential, was usually situated on the second portion of the LCA. Its division was involved in all cases, the calcification extending to the initial segments of the left anterior descending artery (LAD) and left circumflex artery (CX). Calcification of the LCA was always associated with calcification of the LAD, 78% of which had stenotic lesions. Calcification of the CX and right coronary arteries was practically constant, the average percentages of occlusion being 72% and 68% respectively. On anatomical criteria, myocardial revascularisation surgery could only have been proposed in about 20% cases, and this would only rarely have been total. It is concluded that calcification of the LCA usually corresponds at least anatomically, to severe, diffuse multivessel coronary artery disease.

Aged↗
PubMed1981

[Coronary disease in homozygous twins. Respective roles of heredity and environment].

Two 44 year old female homozygote twins presented with cardiac ischaemia due to coronary atheroma, at 39 years of age and 43 years of age, respectively. The coronary risk factors (hypertension, cigarette smoking, hypercholesterolaemia, obesity, oral contraception) were comparable in both cases. Although presenting at different times, the electrocardiographic changes were in the same territory and coronary angiography showed a similar anatomical and lesional distribution. The literature is reviewed with respect to these cases to try to determine the respective roles of heredity and the environment in the initiation and progression of coronary atheroma.

Adult↗
PubMed1981

[Effect of exercise on serum lipoproteins in 270 healthy men (author's transl)].

A group of two hundred seventy healthy patients aged 20 +/- 2 years endured a progressive physical program during eleven days. The caloric expense was an amount of 4,500 kcal for a ration of 4,200 kcal (+ 33%). When we compared the results of the start and end of this procedure, we found a high loss of weight (68,46 kg instead of 69,34, p less than 0,001), a total cholesterol reduction (4,33 mmol/l instead of 4,75, p less than 0,001), decrease of LDL-cholesterol (2,48 mmol/l instead of 3,15) and of triglycerides (1, 07 mmol/l instead of 0,81, p less than 0,0001); a raise of HDL cholesterol (1,06 to 1,11 mmol/l, p less than 0,01).

Adult↗
PubMed1980

[Recent myocardial infarction. Study of sinus function].

The ECGs of 70 consecutive patients hospitalised for a first transmural myocardial infarction (MI) (28 anterior, 42 posterior) were analysed prospectively and systematically during the acute phase. Endocavitary electrophysiological studies (EEP) were performed on the 21st day. The following conclusions were drawn: --Sinus bradycardia in the acute phase was observed in 18 cases (26 p. 100). Its cause is uncertain and its occurrence has no relation to the site of infarction. The single case of sinoatrial block (SAB) was recorded in a patient with a posterior MI. --EEP were normal in 18 patients who had sinus bradycardia during the acute phase; EEP was clearly pathological in the case with SAB. --There was no statistical difference in the incidence of pathological EEPs (p greater than 0,05) in anterior (4 out of 28 patients) and posterior (5 out of 42 patients) MI.

Adult↗
PubMed1979

Regional left ventricular function assessed by contrast angiography in acute myocardial infarction.

The relationship of segmental left ventricular (LV) wall motion abnormalities to LV function 2-6 days after acute transmural myocardial infarction (MI) was investigated in 45 patients by quantitative contrast ventriculography. Patients were divided into four classes according to the MIRU criteria. Segmental wall motion was assessed by determining the percentage of systolic shortening (deltaS) along nine hemiaxes and the extent of akinetic or dyskinetic abnormally contracting segments (% ACS) expressed as a percentage of end-diastolic perimeter. When compared with that in 17 normal control-subjects, the LV end-diastolic volume was increased only in patients in class III and class IV; the LV end-systolic volume increased progressively from normal through class IV. Ejection fraction had a negative linear correlation with %ACS (r = 0.97). The size of ACS was larger in anterior (34 +/- 14%) than in inferior MIs (23 +/- 7%), resulting in greater LV dysfunction. However, for a comparable size of ACS, infarct location alone did not influence LV function parameters. In the noninfarcted zone, deltaS was increased when the size of ACS was less than 25% and reduced when the size of ACS was greater than 25%. Thus, the size of ACS is a major determinant of LV dysfunction in acute MI. The compensatory mechanisms operate either through an augmented mechanical function of residual myocardium when the infarct is small, or through the Frank-Starling mechanism when the infarct is large.

Angiocardiography↗
PubMed1979

[Left ventricular cineangiography in the convalescent phase of a 1st myocardial infarct. Influence of coronary lesions].

80 patients with a primary myocardial infarction (32 anterior and 48 posterior) underwent cardiac catheterisation and angiography (coronary arteriography and selective left ventricular cineangiography) within 12 months of infarction. Analysis of the results of catheterisation and angiography showed: -- Diffuse coronary artery narrowing to be more frequent in patients with posterior infarction. Significant stenosis of the left anterior descending artery was observed in half these cases; -- No correlation between the results of cardiac catheterisation and the distribution of the coronary artery lesions. Changes of ventricular contraction are essentially related to the infarct size and much less to the quality of the healthy myocardium as far as can be appreciated by the usual haemodynamic methods in both anterior and posterior myocardial infarction.

Adult↗
PubMed1979

[Acute posterior myocardial infarction involving the right ventricle. Anatomical study].

Thirty patients who died in the acute phase of an inaugural posterior myocardial infarction were classified in two groups: group A, 14 cases, and group B, 16 cases without extension to the right ventricle. The autopsy examination showed the following differences. In group A: 1. The right coronary artery (RCA) gave off the posterior descending artery in all cases; 2. The RCA had diffuse atheromatous change in 10 cases (p less than 0,05); 3. Total occlusion of the RCA by thrombosis was constant (p less than 0,01) and was always proximal to or near the origin of the right marginal artery (p less than 0,001); 4. Postero-septal extension was constant and nearly always transmural (p less than 0,001).

Adult↗