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Biomedical subjects

J C Daubert

Publications and source records attributed to J C Daubert.

At least 91 records · Page 5Linked to original sources
PubMed1985

[Left ventricle-right atrium communications acquired in bacterial endocarditis].

Three cases of acquired LV-RA communication during bacterial endocarditis are reported. The causal organisms were Staphylococcus aureus and Streptococcus. The endocarditis complicated aortic valve disease in 2 patients and a congenital aneurysm of the membranous interventricular septum in the third case. Perforation of the septal abscess was preceded by 1st and 2nd degree AVB in all cases associated with bursts of intrahisian tachycardia in 1 case. The clinical presentation was that of an acute VSD; LV-RA communication was diagnosed by the radiological demonstration of systolic expansion of the RA, by 2D echocardiography using constant and Doppler techniques which gave the exact diagnosis in 1 case, by oximetry showing a large left-to-right shunt situated in the RA, and finally by selective left ventriculography. Surgery is essential and urgent and comprises repair of the fistula by two patches, one atrial shown on via a right atrial approach and the other ventricular via aortotomy associated with correction of the valvular lesions. Third degree AVB is observed in all cases, due to the anatomical location of the His bundle and requires permanent pacing. Good results were observed in 2 cases with follow-up periods of 14 and 48 months respectively.

Acute Disease↗
PubMed1985

[Tricuspid insufficiency in biventricular myocardial infarct].

Tricuspid insufficiency (TI) has already been reported as a possible complication of biventricular infarction. However, in the absence of large study groups, this condition is not well known. This paper reports the results of 2 studies: a retrospective study of 91 biventricular infarcts, identified by haemodynamic criteria, and a prospective study of 23 consecutive patients (belonging to the previous group) in whom selective right ventricular cineangiography was performed in the acute phase. The following conclusions were drawn: moderate to severe TI is very common during the first days of infarction (30%/39%); the diagnosis is simple, based on non invasive, very sensitive (89%) and specific (100%) haemodynamic criteria; it is associated with a much more severe clinical and haemodynamic presentation and with a higher mortality in the acute phase (37% vs 6.2% in the global study); the poor prognosis does not persist in the long term; regression is common (2/3 to 3/4 of cases) and angiographic data suggests that it is often related to a transient ischaemic papillary muscle dysfunction. Acute paralysis of the right atrium may also play a major role; the TI remains unchanged only in rare cases and may then be responsible for a chronic right ventricular dysfunction and then raise the question of surgical intervention.

Adult↗
PubMed1985

[Severe hypoxemia due to a right-to-left shunt at the atrial level caused by an infarction of the right ventricle].

The authors report the case of a biventricular inferior myocardial infarction complicated in the acute phase by massive tricuspid regurgitation and a right-to-left interatrial shunt through a patent foramen ovale; this resulted in severe hypoxaemia. The diagnosis was made by contrast 2D echocardiography which showed ventriculo-atrial regurgitation and the passage of microbubbles from the right to the left atrium leading to opacification of the left ventricule: right heart catheterisation with oxymetry and selective right ventriculography confirmed the diagnosis. The hypoxaemia became less severe as the haemodynamic conditions improved. This is one possible mechanism of severe hypoxaemia in the acute phase of myocardial infarction and should be excluded routinely in this situation as it can have important prognostic and therapeutid implications.

Blood Gas Analysis↗
PubMed1984

[Hemodynamics and M mode echocardiography of the consequences of ventriculo-atrial conduction in the human].

A haemodynamic and M mode echocardiographic study of 57 patients hospitalised for chronic, symptomatic 2nd or 2rd degree AV block was carried out after 3 periods of pacing, each lasting 2 hours : 1) sequential AV pacing ( SAV ) with a 200 ms delay, considered as the mode of reference; 2) sequential ventriculo-atrial pacing ( SVA ) with the same sequential delay, recreating equivalent conditions of 1/1 ventriculo-atrial conduction (VAC); 3) ventricular pacing (V) recreating complete AV dissociation ( CAVD ). The pacing rate was the same for each patient (89 +/- 9/min). In comparison with SAV , SVA caused much worse haemodynamic changes than V : large increases in mean atrial pressures (+161% and +64% in RAP and PCP respectively); "canon" atrial A waves which were poorly tolerated (mean amplitude 14 mmHg and 18 mmHg on the RA and PCP waves respectively); in some cases, a large fall in blood pressure was observed due to the failure of systemic resistances to increase and compensate for the constant decrease in pump function (mean reduction of 23% of cardiac index; 29% of LV work index). These changes are much more pronounced in diseased than in healthy hearts, especially in the presence of mitral or tricuspid regurgitation. Echocardiography showed the main cause of these haemodynamic changes to be a reduction in ventricular filling with significant reductions in LV systolic and diastolic dimensions, changes in the mitral valve echos (reduction in the opening and closing velocities, delayed closure), probably related to a decrease in transvalvular blood flow, and decreased regional contractility of the interventricular septum. These observations justify an increase in the indications of modes of pacing maintaining permanent atrio-ventricular sequence (VVI pacing at slow rates; AAI pacing, DVI or DDD pacing in cases of abnormal AV conduction with VAC, especially in cases of sick sinus syndrome with permanent bradycardia). These modes of pacing are particularly beneficial when the electrical abnormality is associated with a decompensated cardiac lesion, or with decreased ventricular compliance or mitral regurgitation.

Adolescent↗
PubMed1984

[Infarction of the right ventricle].

Anatomical studies have confirmed that isolated right ventricular and anterior biventricular infarcts are rare. However, RV extension is found in 36 to 50 per cent of cases of postero-inferior infarcts, which confirms the findings of invasive and non-invasive investigations which detect acute RV dysfunction with the same frequency after this type of infarct. It is difficult to create right ventricular infarction experimentally because of the relative protection against ischaemia of the RV. In man, this condition almost always implies an associated thrombosis of the proximal right coronary artery and significant stenosis of the IVA, which justifies the broad indications for coronary angiography. The two major haemodynamic consequences of right ventricular infarction are due to original pathophysiological mechanisms: the adiastole seems to be due to a limitation of RV dilatation by the pericardium, the reduced output is due to faulty LV filling as a result of RV systolic dysfunction and associated factors such as the absence of efficient and synchronous atrial systole secondary to AVB (60%) or to acute right atrial paralysis. The choice of treatment is based on these pathophysiological data. The diagnosis of infarction of the RV is straightforward, often suggested on clinical examination (RVI syndrome: reduced output in 45% of cases) and the surface E.C.G. (ST-T depression 1 mm in V3R-V4R-V5R). The diagnosis is confirmed by more sophisticated investigations which can evaluate the degree of systolic dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography↗
PubMed1983

[M-mode echocardiographic study of right ventricular involvement in the acute phase of inferoposterior myocardial infarction].

The aim of this study was to assess the value of a non-invasive technique, echocardiography, in diagnosing RV extension during the acute phase of myocardial infarction. Forty patients with an acute infero-posterior infarct were divided into two groups according to the presence (Group A) or absence (Group B) of RV akinesia on angiography. M mode echocardiography was carried out from two positions: left parasternal, for the study of quantitative parameters: RV and LV diameters, wall thickness and excursion, VCF and fractional shortening, mitral and tricuspid valve morphology, aortic and left atrial dimensions; subxostal: for the study of one parametere: RV inferior wall motion assessed as normal or akinetic. A comparative statistical study including a group of 35 controls was carried out. The results showed at comparable values in both groups, that patients in Group A had lower global LV function, hypokinesia of the LV posterior wall with minor changes in the mitral valve echo and LA dimension; akinesia of the RV inferior wall, a direct and specific sign of RV infarction, was observed in 50 p. 100 of cases; in comparison with the other two groups, despite large individual variations, there was a significant increase in RV diameter (p less than 0,001) and RV/LV diameter (p less than 0,001), and in the amplitude of systolic motion of the RV anterior wall (p less than 0,05 and p less than 0,01). Other qualitative signs were inconstant: paradoxical septal motion (7/20), pericardial separation (3/20), tricuspid B point (5/20). Dilatation of the RV was inconstant (50 p. 100 of cases) but its association with paradoxical septal motion was indicative of significant tricuspid incompetence. Akinesia of the RV inferior wall seemed to be of prognostic value: RVEDP and the extent of angiographic RV akinesia were greater in its presence (p less than 0,05). There was a slight correlation between RV dimensions (RV diameter and RV/LV diameters) and the extent of angiographic RV akinesia (R = 0,50, p less than 0,05) and with cardiac index (R = 0,60, p less than 0,05). This study shows that M mode echo provides positive direct signs of RV infarction in about 50 p. 100 of cases. The sensitivity of the technique is therefore relatively low. However, it does distinguish the more severe forms of biventricular infarction, especially when complicated by tricuspid incompetence.

Adult↗
PubMed1983

[Prospective study of the diagnostic and prognostic criteria of right ventricular involvement in the acute phase of inferoposterior infarction].

Right ventricular involvement has been shown to be common in the acute phase of infero-posterior myocardial infarction. The aim of this prospective study was to assess the diagnostic and prognostic value of the different criteria obtained by clinical and paraclinical methods of investigation. Forty patients (35 men, 5 women: mean age 57,1 years) admitted consecutively with this type of transmural infarct without any other cause of acute or chronic volumic or barometric overload of the RV were investigated. In addition to clinical data, the following paraclinical investigations were carried out during the first three days of admission: ECG and vectorcardiogramme (VCG); transaminase levels (SGOT and SGPT), creatinine phosphokinase (CPK), alpha HBDH, serum creatinine, blood gases (pO2), M mode and 2 D echo, right heart catheterisation and cardiac output estimations, selective RV and pulmonary cineangiography centered on the LV in the monoplane 30 degrees LAO projection. Two groups of twenty patients were identified, comparable in age and sex, according to the angiographic extension of akinesia of the RV inferior wall: Group A: extensive akinesia (greater than or equal to 30 p. 100), Group B: very localised or no akinesia (less than 30 p. 100). Analysis of the results showed a number of features characterising patients in Group A: the high incidence of initial shock (45 p. 100 (A)/0 p. 100 (B] and signs of RV failure (85 p. 100/0 p. 100), higher SGOT, SEPT (p less than 0,05) and alpha HBDH (p less than 0,02) but not of CPK; much higher serum creatinine (p less than 0,01) and lower p02 (p less than 0,05); the ECG showed a high incidence (85 p. 100) and specificity (95 p. 100) of ST-T elevation in V3R and V4R, and also 2nd or 3rd degree AV block (60 p. 100/5 p. 100): there were no characteristic VCG changes. Catheterisation showed very significant increases (p less than 0,001) of mean RA, and RV end diastolic pressures, of the RA/mean pulmonary capillary pressure ratio and of Yu's index. There was a moderate increase in PCP (p less than 0,01), a drop in right ventricular systolic work index (RSSWI); adiastole was very common (90 p. 100) and very specific (95 p. 100); angiography showed an increase in RV end diastolic and end systolic volumes (p less than 0,05) and a fall in RV ejection fraction (p less than 0,05) but with a lot of individual variations; there were no significant differences between the two groups as regards the volumes, ejection fractions and p. 100 akinesia of the LV.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1982

[Torsade de pointes. Apropos of 54 cases].

A retrospective study of 54 torsades de pointe cases in a cardiology department enabled us to specify the main characteristics of this serious arrythmia often observed in intensive care units: --the diagnostic criteria: more than the pattern of tachycardia attack, late ventricular premature beats and particularly QT prolongation are necessary for proper diagnosis. These two criteria allow us to differentiate between torsades de pointe and multiform ventricular tachycardia with similar morphology especially in acute myocardial ischaemia; --their clinical repercussion: the shortness of circulatory arrest related to the spontaneous end of the arrythmia explains that the torsades de pointe often result in short faintings. Nevertheless, they may degenerate into ventricular fibrillation (17 p. 100) which, in cases of recurrence, induced four deaths in this study; --there are many possible aetiologies often associated (30 p. 100) in the same patient. Their research must be exhaustive in each case. The chronic bradycardias especially the atrioventricular blocks of two or three degree whether continuous or not are often responsible (57 p. 100). Then, the metabolic disorders, essentially hypokalaemia and constant drug administration (antiarrythmic agents belonging to group I of Vaughan William's classification, some antianginal drugs, vasodilatator drugs) are often chief causative agents. Other aetiologies are rare. In 9 p. 100 of cases, no aetiological factor is found; --the best treatment is to suppress aetiological factors, to stop the administration of antiarrhythmic drugs; torsades de pointe must be controlled by increasing the heart rate; pace maker stimulation is the best way of making QT shorter and thus of synchronizing ventricular depolarization.

Adolescent↗
PubMed1982

[Hemodynamic and biological effects of bromocriptine in essential hypertension].

Central dopaminergic dysfunction has been suggested as the cause of essential hypertension. Agonist dopaminergic substances (AD) possess documented anti-hypertensive properties. We studied the cardiovascular effects of a single oral dose of 10 mg of Bromocriptine (Br) in untreated subjects with essential hypertension. A number of hemodynamic and biological parameters (direct blood pressure, pulmonary arterial and capillary pressures, cardiac index, heart rate, right ventricular and left ventricular work indices, systemic arterial and pulmonary vascular resistance, plasma renin activity, prolactin, and circulating Br levels) were measured before and after ingestion of the drug (at I, 1,5, 2, 3, 4, 5, 6, 8, 10 and 12 hours). Despite great individual variability, under the experimental conditions, Br displayed a strong anti-hypertensive action. The fall in blood pressure was early (Ist our) progressive, stabilising between the 3rd and 6th hour and prolonged (12 hour). This response was independent of the basal blood pressure with basal plasma renin activity (R = 0.64; p less than 0.05) but not with the prolactin level. The left ventricular work index underwent a similar change. Systemic arterial resistance fell, but this occurred after the fall in blood pressure. There was an independent and significant fall in pulmonary arterial pressure and pulmonary vascular resistance. The prolactin level fell very quickly and remained low throughout the 12 hours. There was an excellent correlation between the direct blood pressure and prolactin level (r = 0.97; p less than 0.01). Plasma renin activity rose after the third hour to reach a maximum at the 8th hour. There was a weak correlation between the blood pressure and plasma renin activity (r = 0.65, p less than 0.05). The serum Br level varied from patient to patient but reached a maximum at 1 hour, remaining stable until the 6th hour before decreasing. There was a correlation between the plasma renin activity and prolactin levels at each dosage (r = 0.66; p less than 0.005). The hemodynamic effects of Br are similar to those of central anti-hypertensive agents. The changes in plasma renin activity are comparable to those observed in central dopaminergic dysfunction. The excellent chronological correlation between the change in blood pressure and prolactin level is compatible with the hypothesis of this type of dysfunction in essential hypertension, if the inhibition of prolactin is accepted as a central dopaminergic effect of bromocriptine.

Adult↗
PubMed1981

[Value of serum myoglobin in acute myocardial infarction. Kinetic study].

The rise in serum myoglobin (MGB), total CPK (CKT) and its MB isoenzyme (CK - MB) was studied and compared over the first three days of acute myocardial infarction (AMI) and correlations were sought between the peak values of these three parameters and haemodynamic and biological indices of left ventricular function. Blood was taken from MGB (radio immunological technique), CKT and CK - MB (spectrophotometry) estimation every 2 hours for 24 hours and then every 6 hours up to the 72nd hour in 36 patients with AMI less than 12 hours old. On admission, this protocol was completed by a haemodynamic study (right heart pressures, systemic blood pressure, cardiac output measurement by thermodilution), arterial gases and ECG recordings. The average delays before the pathological rise, the maximal peak value and the return to normal were significantly shorter (p less than 0.001) for MGB (2, 6 and 25 hours) than for CK - MB (5,16 and 34 hours) or CKT (5,21 and 57 hours). The sensitivity of the diagnosis of myocardial infarction was not significantly higher with MGB than CKT or CK - MB either in the whole group (sensitivity of 91.6 p. 100 for MGB and 86.1 p. 100 for CKT and CK - MB) or in a subgroup of ten patients without transmural infarction (70 p. 100 for MGB compared with 60 p. 100 for CKT and CK - MB). A significant correlation was found between the peak values of MGB (p less than 0.02) and CK- MB (p less than 0.02) and the indices of left ventricular function (PCP, PAO2 and LVSWI). This was not observed with CKT. In conclusion, apart form technical problems which remain unresolved time-consuming investigation), serum MGB gives a much earlier and as sensitive a biochemical diagnosis of AMI as CKT and CK - MB. MGB and CK - MB are much better prognostic indicators than CKT as judged by the indices of left ventricular function. Finally, MGB estimation should be of particular value in the diagnosis of secondary extension of infarction.

Acute Disease↗
PubMed1979

[Traumatic myocardial infarct].

Two cases of traumatic, closed chest, myocardial infarction in two young patients, aged 18 and 19 years respectively, are reported. They illustrate the two possible physiopathological mechanisms of this affection: in the first case, myocardial contusion after thoraco-abdominal trauma by crushing, probably complicated by a subendocardial tear of the inferior wall of the left ventricle, with a spontaneous favourable outcome; in the second case, a transmural myocardial infarction was observed secondary to a coronary lesion (? tearing of the adventitia of the left anterior descending artery) complicated by the early development of a large antero-apical aneurysm. Haemodynamic and arrhythmic complications necessitated infarctectomy and aorto coronary bypass surgery on the 35th day. The pathological lesions and their outcome are examined with respect to these two cases. The diagnostic, therapeutic and medieolegal problems associated with this condition are also discussed.

Adolescent↗