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Biomedical subjects

J Gatau-Pelanchon

Publications and source records attributed to J Gatau-Pelanchon.

At least 19 recordsLinked to original sources

[Cardiomuscular lysosomal glycogenosis in adults without known enzyme deficiency. A cause of familial myocardiopathy and lysosomal glycogen overload with normal acid maltase].

An unusual form of familial myocardiopathy is reported. The disease affected siblings entering adulthood and presented as subclinical skeletal muscle and patent cardiac muscle lesions. Quadriceps muscle biopsy performed in a young man who subsequently died of cardial failure revealed excessive lysosomal glycogen storage, as in type II glycogenosis, but biochemistry showed normal enzymatic activity. In a sister with hypertrophic myocardiopathy only leucocytes were examined; they also showed normal enzymatic activity. Other clinical manifestations of this form of familial myocardiopathy are hypoglycaemia and moderate skeletal muscle involvement. At histology, the image is that of Pompe's disease, but the acid maltase level is normal. The condition seems to be transmitted as an autosomal dominant trait.

Adult↗

Alternate ventriculo-atrial Wenckebach conduction during ventricular tachycardia.

Although pacing-induced ventriculo-atrial (VA) Wenckebach conduction has been previously described, the occurrence of this phenomenon during ventricular tachycardia has received little attention. The latter is defined as 2:1 VA block in which the conducted beats show progressive lengthening of VA conduction until the sequence is terminated by two or three blocked ventricular beats. This phenomenon was observed in a 16-year-old boy who underwent electrophysiologic study for ventricular tachycardia as a late complication of surgical correction of tetralogy of Fallot. During pacing-induced ventricular tachycardia with a morphology similar to that of the spontaneous tachycardia, 8:4 alternating VA block was observed. This sequence suggested that the AV node was the site of block, the 2:1 block being located at the upper level, and the VA Wenckebach block at the lower level. Alternate VA Wenckebach conduction appears as a possible cause of variation in atrial depolarization intervals during ventricular tachycardias with short cycle lengths.

Adolescent↗

[Sequential double demand programmable stimulation in the treatment of resistant supraventricular tachycardia. Long-term results].

Asynchronous pacing at a rhythm slower than that of the tachycardia (underdrive) is an established procedure for the reduction of supraventricular tachycardia. Simultaneous or sequential stimulation depolarising two parts of the circuit (atrium and ventricle) has a greater chance of reducing the tachycardia than stimulation of a single chamber. Five patients with supraventricular tachycardia resistant to antiarrhythmic therapy were treated by sequential pacing in the underdrive mode. Electrophysiological investigations showed a bundle of Kent to be responsible for the ECG appearances of Wolff-Parkinson-White (3 cases) with retrograde conduction only (concealed WPW) in 2 cases. One patient was able to put a stop to his attacks by the application of a magnet over the pulse generator. In four patients, a newly designed pulse generator, based on this concept, was implanted with the property of automatic detection of tachycardia (defined as a heart rate faster than 150/min) triggering almost simultaneous pacing of the coronary sinus and right ventricle (sequential interval of 65 ms) in the asynchronous mode at 77 bpm. The results were reviewed with a follow up of 6 to 36 months. This pulse generator was shown to be effective in both the reduction and prevention of episodes of supraventricular tachycardia. Sequential double demand pacing is a valuable and useful method of treating reentrant tachycardias associated with the WPW syndrome or concealed Kent bundles. It provides an alternative to surgery when the effective refractory period of the Kent bundle is long. Present advances in the field of cardiac pacing will probably result in a widening of the indications for this mode of therapy.

Adult↗

[Mitral valve prolapse and spasmophilia in children and adolescents].

71 cases of mitral valve prolapse (MVP) in the child and adolescent with an age range of 3 to 20 years were reviewed. The clinical symptoms, electrocardiography and catheter and angiographic data of this mitral abnormality were analysed. A systematic study of the electrocardiogram showed a tendency to spasmophilia in 68% of cases. The serum calcium, phosphate and magnesium levels were normal in 90 to 95% of patients. A reduced erythrocytic magnesium level seems to have been found in some patients. It is interesting to observe the similarity between the clinical signs in MVP and in spasmophilia. These clinical, biochemical and electrocardiographical results justify the systematic investigation of children and adolescents with MVP, with a view to the diagnosis of spasmophilia.

Adolescent↗

[Mitral valve prolapse and spasmophilia in the adult].

75 cases of mitral valve prolapse (MVP) for which no cause was found underwent electromyography (EMG). In 64 cases (85.3%) EMG showed changes suggestive of spasmophilia. The symptoms observed were those already described in this condition. The specific clinical signs of spasmophilia were often elicited with a positive Chvostek sign in 20 out of 30 cases (73.3%). Radiological, echocardiographical and haemodynamic studies underlined the hyperkinetic state of the left ventricle. Biochemical investigations showed a high incidence of low erythrocytic magnesium levels. Chest pain suggestive of angina pectoris, mitral valve prolapse and spasmophilia are frequently associated. The role of the low erythrocyte magnesium on left ventricular hyperkinesis and the production of MVP is discussed.

Adult↗

[The mitral apparatus and surgery of sub-valvular aortic stenosis].

The authors present three eases of subvalvular aortic stenosis caused by an abnormality of the mitral valve mechanism which required placement of a prosthetic valve. They describe the types of mitral valve abnormality which are reported in the literature to have caused obstruction to the aortic outflow tract. They analyse the criteria for diagnosis of this condition, and the surgical treatment. The placement of a prosthetic mitral valve does not always remove the obstruction to the aortic outflow, especially if there is an abnormality in the position of the mitral ring.

Adolescent↗

[Treatment of rhythm disorders by fenoxedil hydrochloride].

Fenoxedil chlorhydrate (FC), which is used as a treatment for cerebral circulatory failure and peripheral vascular disease, has been given to 100 patients with a cardiac arrhythmia: atrial fibrillation (78 cases), atrial flutter (4 cases), atrial tachysystole (2 cases), ventricular extrasystoles (12 cases), and supraventricular extrasystoles (4 cases). FC has been prescribed alone, or as a complement to current anticoagulant or digitalis treatment; combination with prenylamine, amiodarone, dysopyramide or a drug of the quinidine group must always be avoided, and the potassium level checked and corrected if necessary before treatment. In 78 cases of atrial fibrillation, the authors found that sinus rhythm was restored in 58 (74.4%); four cases of flutter were restored, and one case out of two of atrial tachycardia. In case of supraventricular and ventricular extrasystoles the results are less clear, and merit a further study with a larger number of cases. The electrocardiographic disorders encountered in this series have been evaluated: lenghthening of the QT interval, disorders of atrioventricular conduction, sinus inhibition. They were either produced by or aggravated by the FC. No cases of axis deviation were encountered. The authors make mention of the complications observed by other authors, but draw a distinction between the prescription of FC in cases of cerebral vascular insufficiency, without previous knowledge of the exact cardiac status of the patient (otherwise there is a risk of severe accidents), and the use of FC in cases of arrhythmia which have undergone full assessment before the drug is used. According to this study, FC appears to be a very effective anti-arrhythmic agent, but its use demands very rigorous clinical and electrocardiographic supervision.

Anti-Arrhythmia Agents↗

[Early repair of congenital cardiopathies under extracorporeal circulation. Apropos of 158 surgical cases under the age of 5].

A great number of congenital heart diseases are now amenable to treatment before school age. A homogeneous experience of 158 cases operated upon made it possible to make the follow remarks:--The operative mortality before the age of 1 year remains high, in view of the difficulties of ressuscitation, but mainly because of the severity of the heart disease to treat. --Between the ages of 1 and 5 years, the risk decreased with experience, and for the heart diseases most frequently encountered, lethality fell to 2.8% for the last 4 years. One may thus accept to perform, not only necessity operations, but principle operations before school age. The schematic indications in relation with each heart disease were analysed.

Cardiac Surgical Procedures↗

[Electrocardiogram after complete repair of tetralogy of Fallot].

207 cases of Fallot's tetralogy having undergone complete surgical correction have been studied in this work as regards the electrocardiographic changes induced by surgery. The observed anomalies were the following: --Intraventricular conduction disturbances --179 cases (86,5%) --Atrio-ventricular block --33 cases (16%) --Arrhythmias --29 cases (14%) --Myocardial infarction patterns --6 cases (2.9%). In the atrioventricular conduction disturbances, right complete bundle-branchblock was most frequently observed (126 cases, 70.4%). In 22 cases, it was combined with left anterior hemiblock, the onset of which seemed to be favoured by the previous existence of a minor left anterior hemiblock. Of the 33 cases of atrio-ventricular block which started during operation or immediately afterwards, 13 will remain permanent, 10 of which were of a high degree, requiring implantation of an intracorporeal pacemaker in 8 cases. No case of block started later on, the cases of delayed block being in fact recurrences of transient blocks which had appeared during or immediately after the operation. The candidates to sudden death by paroxysmal block are therefore patients who had a transient block during of following operation, especially if they had besides bilateral bundle-branch block. The arrhythmias were on the whole devoid of danger. 6 cases of myocardial infarction (2.9%) were observed; their incidence is therefore not negligible.

Arrhythmias, Cardiac↗