Biomedical subjects

J Elaerts

Publications and source records attributed to J Elaerts.

At least 73 records · Page 4Linked to original sources

PubMed1991

[Comparative study of 4 ultrasonic methods for evaluating the severity of mitral valve narrowing. Apropos of 36 cases].

Four ultrasound methods of estimating the severity of mitral narrowing (MN) were investigated in a prospective manner in 36 patients who underwent ultrasound-Doppler and catheterization (KT) within a space of 24 hours. The correlation of the mean Doppler and KT gradients was poor: r = 0.56 (n = 36, p less than 0.001). The mitral surface areas (MA), calculated from Gorlin's equation (mean A = 0.98 +/- 0.26 cm2) were successively compared with those obtained using the Hatle equation (A = 220/PHT) and by a planimetric determination. The coefficients of correlation were as follows: r = 0.80 (n = 36) and r = 0.70 (n = 32) (p less than 0.001). There was good correlation between the Hatle equation and the planimetric determination: r = 0.80 (n = 32, p less than 0.001). The continuity equation was carried out 15 times; the second measurement site was aortic in 8 cases and pulmonary in 7 cases. Correlations with the Gorlin equation were scored 0.70 and 0.80 respectively (p less than 0.05). The MA was best estimated by the Hatle equation, which was always technically feasible and not influenced by the presence of atrial fibrillation, mitral valve incompetence of previous commissurotomy. Planimetric determination, which is hampered in the presence of considerable calcification, remains valid after commissurotomy. The ultrasound estimation of the MA was very reliable when the planimetric and Hatle estimations concurred. The results obtained from the continuity equation were reliable; however, this method is slow, unreliable in a context of atrial fibrillation and inapplicable in a context of mitral valve incompetence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

[Prognostic value of exercise angioscintigraphy in coronary disease].

Multivariate survival analysis (MSA) was applied to 97 patients with coronary disease using the Cox model and a stepwise regression procedure. Seventeen variables including data based upon clinical examination, exercise testing (ET), and exercise angioscintigraphy (EAS) as well as coronary arteriography were studied in each patient. During the monitoring period (interval: 1-57 months), 38 patients sustained a cardiac event (recurrence of coronary disease or death). Neither resting left ventricular ejection fraction, nor coronary anatomy were significant prognostic variables. The only two variables identified by MSA were a variable of EAS: corrected ejection fraction at maximum exercise (p less than 0.008), and a variable of ET: maximum heart rate during exercise (p less than 0.03). This study shows that the prognosis of a coronary disease patient can best be assessed by two variables which are both exercise parameters.

Adult↗

PubMed1991

[Doppler echocardiographic evaluation of the efficacy of fibrinolytic treatment of pulmonary embolism].

The efficacy of the fibrinolytic therapy in pulmonary embolism was studied by Doppler echocardiography: the evolution of the cardiac and angiographic changes could be studied in parallel. Thirty patients with severe pulmonary embolism and vascular obstruction greater than 40% (67.2 +/- 9.9%) were examined prospectively by Doppler echocardiography before and after thrombolysis. The following parameters were studied: systolic pulmonary artery pressure calculated from the jet of tricuspid regurgitation and left and right ventricular diameters for the calculation of the ratio of the ventricular dimensions. All patients underwent Doppler echocardiography and pulmonary angiography immediately after thrombolysis. The average improvement of the percentage vascular obstruction was 37%. The hemodynamic and echocardiographic changes were globally favourable. The pulmonary artery systolic pressure fell from 51 +/- 10 to 33 +/- 6.7 to 25.3 +/- 6.3 mm and the ratio of ventricular dimension from 0.87 +/- 0.3 to 0.60 +/- 0.16 (p less than 0.001). Only 4 patients had pulmonary artery systolic pressures over 40 mmHg after therapy compared with 26 before therapy. However, the hemodynamic and angiographic correlations were poor (r = 0.37; p less than 0.001). In the 6 patients in whom treatment was ineffective according to angiographic criteria (less than 20% improvement of vascular obstruction), the echocardiographic changes were small or absent, the improvement in the ratio of ventricular dimensions being less than 20%. However, a satisfactory correlation was observed between the percentage improvement of the ratio of ventricular dimensions and that of vascular obstruction (r = 0.59; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

[Therapeutic value of esophageal stimulation. Factors influencing the results in flutter and atrial tachysystole].

The aim of this prospective study was to identify factors predicting the efficacy of atrial stimulation by esophageal route in 57 nonselected patients between 37 and 88 years of age and admitted for intensive care due to flutter or atrial tachycardia. It was impossible to perform the procedure correctly in 4 patients. The restoration of sinus rhythm was achieved in 28.3% of cases at the end of the procedure and in 47.2% of cases after 24 hours. These results were influenced by the duration of the arrhythmia, the underlying cardiopathy and the diameter of the left atrial, but were not affected by the stimulation parameters.

Adult↗

PubMed1990

[Malignant histiocytofibroma of the heart simulating myxoma of the left atrium].

The authors report a case of malignant fibrous histiocytoma of the left atrium which was excised but rapidly recurred in a 47-year-old woman. Clinical examination, echocardiography and the absence of biochemical abnormalities were in favour of the diagnosis of left atrial myxoma. This report illustrates the clinical similarity between myxoma and sarcoma of the left atrium. Very careful anatomopathological examination of multiple sections of the tumour are necessary to distinguish it from benign tumours, especially myxomas.

Diagnosis, Differential↗

PubMed1990

[Iatrogenic arteriovenous fistula between the internal mammary artery and the innominate venous trunk. Contribution of digital arteriography in the positive and anatomic diagnosis].

The authors report the case of an arterio-venous fistula between the internal mammary artery and the trunk of the innominate vein following puncture of the internal jugular. The clinical signs of this unusual complication led the authors to list the differential diagnoses which should be considered and to draw attention to the importance of digitalized angiography in anatomical diagnosis.

Angiography, Digital Subtraction↗

PubMed1990

[Natural course of type III traumatic chronic dissection in a patient with Marfan's syndrome].

Description of a traumatic dissection of the descending thoracic aorta, occurring in a female patient with Marfan's syndrome, the chronic course of which over more than three years was complicated by retrograde extension to the ascending thoracic aorta, resulting in death by massive aortic insufficiency and pleuro-pericardial effusion. Advantages of clinical and sonocardiographic monitoring of chronic dissections.

Aortic Dissection↗

PubMed1990

[Differential analysis of mitral and tricuspid regurgitation by continuous Doppler].

The following parameters have been measured by continuous Doppler in 40 patients with both mitral failure (MF) and tricuspid failure (TF): effusion time (ET), peak time (PT), maximum effusion speed (S. max), maximum anterograde speed (S. ant), taking into account the cardiac rate and the ejection fraction. Only the S. max. and the S. ant. are significantly different and enable the determination of the effusion origin with a percentage error of about 4%. When a straight line is drawn to joint 3.7 m/s on the ordinate (S. ant) and 5 m/s on the abcissa (S. max), the TF lie below the line and the MF above it. The selection of the sub-groups with low ejection fraction (less or equal to 30%) or with arterial pulmonary hypertension (S. max MF higher or equal to 3 m/s) does not modify the precision of the discrimination. The graph suggested seems therefore to be a rapid and reliable means of characterizing TF in order to assess the arterial pulmonary hypertension of dilated hypokinetic cardiomyopathies.

Adult↗

PubMed1989

[Postoperative hemopericardium compressing the left atrium. Apropos of a case].

We report a case of tamponade due to an effusion of blood which had occurred two weeks after an aorto-coronary bypass and was unusually located behind the left atrium. The effusion, with severe clinical symptoms, was diagnosed by echocardiography and computerized tomography of the chest. These examinations provided an accurate anatomical diagnosis on which the approach route of the emergency operation was based.

Cardiac Tamponade↗

PubMed1989

[Diagnostic, prognostic and therapeutic value of Doppler echocardiography in pulmonary embolism. Apropos of 41 cases].

In 41 patients with acute or recent pulmonary embolus (PE), a prospective study was conducted with cardiac Doppler sonography (CDS). The test is performed first in all patients, then immediately following a treatment fibrinolytics in 10 of them. The PE is confirmed by pulmonary angiography in 39 patients and embolectomy for the 2 patients who presented a mobile thrombus in the right atrium. A tricuspid insufficiency (TI) is almost always recorded by continuous Doppler: the systolic pulmonary artery pressure (sPAP) is calculated from the maximum velocity of the regurgitating tricuspid flow, using Bernouilli's equation. The correlation between Doppler sPAP and sPAP obtained by catheterization is: r = 0.95 (n = 34; p less than 0.001). A severe pulmonary hypertension, corresponding to a TI exceeding 3.5 m/s is related to a pulmonary migration occurring on a pathological heart. There is a satisfactory relationship between the elevation of the Doppler sPAP and the degree of pulmonary obstruction in the "Pe on healthy heart" population: r = 0.6 (n = 29; p less than 0.001). The dilated right ventricle observed on the sonogram (RV) is proportional to the severity of the angiographic image: correlation between the RV/LV ratio and the percentage of vascular obstruction is r = 0.73 (n = 27; p less than 0.001). The drop in the sPAP and the regression of the symptoms of pulmonary heart noted on CDS after fibrinolysis, correspond to a significant improvement of the pulmonary perfusion. The CDS seems to be absolutely necessary in PE because of the major and reliable informations it provides.

Adult↗

PubMed1989

[Comparative study of pulsed and continuous Doppler in the quantification of aortic insufficiency].

31 patients whose mean age was 61 +/- 29 yrs. presenting with aortic regurgitation (AR) benefited from cardiac catheterization which was preceded by Doppler ultrasound examination in a prospective study to compare the diagnostic contributions made by continuous vs pulsed wave techniques respectively in the quantitative assessment of AR, with reference to semi-quantitative angiographic evaluation. Pulsed Doppler analysis involves mapping of the left ventricle in two projections as well as the investigation of blood flow in the aortic isthmus using a suprasternal approach. Collection of continuous wave signals from the cardiac apex makes it possible to measure circulatory deceleration and the half-time of decrease in signal velocity and the protodiastolic pressure gradient. Our results corroborate the reliability of data obtained using continuous-wave Doppler technique in finding significant correlations for each parameter respectively: r' = 0.88 (p less than 0.001); r' = -0.81 (p less than 0.001); r' = -0.75 (p less than 0.001). Values determined by pulsed wave Doppler mapping of the left ventricle appear to be less satisfactory but are significant: r' = 0.68 (p less than 0.001) while measurement of end-diastolic blood flow recorded in the isthmus of the aorta is more highly correlated: r' = 0.84 (p less than 0.01), with the main disadvantage being its limited applicability to a small number of our patients (48%). We thus concluded that continuous-wave Doppler ultrasound is a better technique in the quantitative evaluation of AR, while recalling the essential additional value of pulsed-wave Doppler technique to localize the leakage and of ultrasound to assess its impact on the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

[Subvalvular aortic stenosis discovered after surgical repair of an atrioventricular canal in the adult. Apropos of a case].

The case of an adult female patient in whom subaortic stenosis was discovered 9 months after surgical correction of a partial atrioventricular canal is reported. The authors describe the difficulties encountered in the pre-operative diagnosis of this uncommon association and the paraclinical methods now available, notably echocardiography, that may help overcome these difficulties.

Aortic Valve Stenosis↗

PubMed1988

[Diagnostic and prognostic value of continuous Doppler in pulmonary embolism].

A prospective study of 18 patients admitted to hospital for acute pulmonary embolism confirmed the reliability of continuous wave cardiac doppler as a non-invasive method of evaluating systolic pulmonary artery pressures. These pressures were calculated by applying the simplified Bernoulli equation to the maximal velocity of regurgitant tricuspid flow and compared with the results of cardiac catheterisation and angiography, the percentage of vascular obstruction being assessed using Miller's index. The correlations between the two methods were good, r = 0.96; p less than 0.001, with a standard error of +/- 5.2 mmHg. The correlations between the velocity of tricuspid flow and the percentage of obstruction were less significant (r = 0.65; p less than 0.005) but improved when patients with pre-existing cardiopulmonary disease were excluded. This technique of non-invasive assessment of haemodynamic parameters also helps in evaluating the underlying pathology; tricuspid regurgitation with velocities greater than 3.5 m/s is associated with pre-existing chronic cor pulmonale, information of prognostic interest which would guide therapeutic management.

Acute Disease↗

PubMed1988

[Role of clinical manifestations, the exercise test and exertion angioscintigraphy in the diagnosis of coronary disease. A multivariate study].

Data of clinical examination, exercise electrocardiography and stress radionuclide angiography in 102 patients referred for assessment of chest pain was included in a logistic regression to optimise the diagnosis of coronary artery disease with coronary angiography as the reference investigation. None of the patients had other cardiac problems nor previous myocardial infarction. In the absence of symptoms exercise testing was continued until at least 80 p. 100 of the theoretical maximal heart rate was attained. Each patient was characterised by the value of the logistic function or probability of coronary artery disease. A threshold value corresponding to 80 p. 100 sensitivity was determined by the technique of ROC graphs. The significant variables were: a clinical variable--the type of chest pain as assessed by the clinical history; two radionuclide angiographic variables--the ejection fraction at peak effort and the corrected variation of ejection fraction between rest and stress, that is not taking into account possible decreases at the last increment of exercise. Coronary patients can be identified with an 80 p. 100 sensitivity and 77 p. 100 specificity on these criteria. This specificity is greater than that obtained by clinical examination and exercise electrocardiography alone (65 p. 100). Stress radionuclide angiography may therefore reduce the number of unnecessary coronary angiographies.

Adult↗

PubMed1988

[Validation of a method for measuring the area of aortic stenosis using only continuous Doppler. Value for the surveillance of transluminal aortic valvuloplasties].

Forty patients with aortic valve stenosis underwent continuous wave doppler-echocardiographic exploration followed by catheterization within 24 hours on average. Three methods of aortic functional area calculation, based on the continuity equation principle, were tried and compared with the haemodynamic data. The results of the reference equation (continuity through the whole systole) gave a correlation coefficient r = 0.77 with a standard error (SE) of 0.17 cm2. The continuity equation using only maximum velocity values was less satisfactory: r = 0.69; SE = 0.19 cm2. The simplified equation with an arbitrary 2 cm subaortic diameter and a subaortic velocity obtained by continuous wave doppler recording yielded results that were very similar to those of the reference equation: r = 0.78; SE = 0.16 cm2. It is suggested that this third equation should be used in the follow-up of transluminal aortic valvuloplasties, since its calculation is based only on aortic velocity, which reflects the degree of stenosis, and subaortic velocity, which indirectly reflects left ventricular function.

Adult↗

PubMed1988

[Histiocytoid hemangioma of the heart. Histological and immunohistochemical study of a case].

We present the fourth case report of an histiocytoid hemangioma of the heart, which was found incidentally, as in the other three reported cases, in a 50 year old man during surgery for congenital heart disease. A polypoid sessile reddish tumor with a smooth surface, which measured 2 cm in diameter, was found in the right atrium. No necrosis nor cystic areas were seen. Histologic evaluation revealed a proliferation of histiocytoid or epithelioid cells, whose arrangement varied a great deal within the infiltrate. Sometimes, the cells were isolated but in most places they were arranged in sheets or nests surrounded by connective tissue. Some of these nests were compact whereas in others a lumen formation, frequently occupied by erythrocytes, could be appreciated. A striking feature was the presence of vacuolated tumor cells sometimes assuming a signet-ring configuration. Some large vascular spaces were lined by histiocytoid or epithelioid endothelial cells, many of which protruded into the lumen. Multinucleated tumor cells were occasionally observed. Mitoses were rare (up to 1/10 HPF) and scattered inflammatory cells such as lymphocytes, macrophages, neutrophils and eosinophils were seen. Histologic appearance of our patient's tumor is identical to the histiocytoid hemangioma of Rosai et al., which is an ubiquitous endothelial benign neoplasm.

Heart Neoplasms↗

PubMed1988

[Quantification of chronic aortic insufficiency. Comparison between Doppler ultrasonic diagnosis and the radiocardiogram].

The objective of this study is to quantify aortic insufficiency by comparing pulsated Doppler ultrasonography and radiocardiography used as reference test. Since february 1986, 23 patients were tested with both techniques within 15 days. The Doppler ultrasonography enabled to quantify aortic insufficiency in 4 stages by semi-quantitative mapping of the regurgitation flow of the left ventricle (LV). Radiocardiography (RCG) has enabled the determination of the regurgitation fraction (RF), for each patient. A mean RF was calculated on RCG, for each Doppler stage. The FR difference between each Doppler stage is significant, especially between minimal and severe aortic insufficiency. RCG is the first stage of an isotopic examination, at rest and during stress; it may be followed by Doppler ultrasonography in monitoring patients with aortic insufficiency.

Adult↗

PubMed1988

[Comparison of 3 methods of calculating valve surface by continuous Doppler in the quantitative evaluation of 42 cases of aortic stenosis in adults].

42 patients with a tight, symptomatic aortic stenosis, underwent a Doppler test followed, within approximately 5 days, with catheterization. Non-invasive measurement of the maximal aortic gradient is obtained by applying Bernouilli's formula to the maximum speed. Three methods of evaluation of the valvular areas are compared. The first method derives from Gorlin's formula. The second corresponds to the ratio aortic flow/mean velocity. The third method uses the continuity equation. The results compared with haemodynamic data are as follows: the correlation factor regarding the gradients is: r = 0.72 (EA: 22 mmHg), going from r = 0.74 (EA: 0.11 cm2) for the first method, r = 0.76 (EA: 0.15 cm2) for the second method and r = 0.81 (EA: 0.10 cm2) for the third method. In conclusion, the calculation of the maximum gradients is of good predictive value to differentiate minimal and tight aortic stenoses. Regarding moderate or decompensated aortic stenoses, it is advisable to follow the Doppler with the measurement of the valvular areas. The first two methods are characterized by their practicality and easy realization; the third method is preferable when there is an associated mitral valve disease.

Adult↗