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Biomedical subjects

J Kachaner

Publications and source records attributed to J Kachaner.

245 records · Page 14Linked to original sources
PubMedDate not supplied

[Treatment of critical pulmonary valvular stenoses in newborn infants using percutaneous valvuloplasty. Study of 28 cases].

Twenty-eight neonates aged 1 to 21 days with critical pulmonic stenosis were treated by percutaneous valvotomy consisting of balloon dilatation of the stenotic valve by percutaneous catheterization. The right ventricular systolic pressure (RVP) was either the same or higher than the systemic pressure in all cases but 3. In those it was somewhat lower (80%) than the left ventricular systolic pressure (LVP) so that, on the whole, the RVP/LVP ratio, here called rP ranged from 0.8 to 2 (m = 1.41 +/- 0.36). The procedure failed 5 times because of failure to introduce the balloon through the valve (4 cases) or because of an accident (1 case). All failures occurred during the initial phase of our experience with this procedure as the last 20 trials were successful. The procedure was inefficacious in 3 cases (13%) but immediately successful in the other 20 (87%) with a drop in the mean rP to 0.59 +/- 0.17. During the follow-up period, one neonate continued to present with an important degree of cyanosis, due to a poor right ventricular compliance. He had to be operated on. Pulmonic stenosis reappeared in 6 cases who underwent for a second time a percutaneous valvotomy. The procedure was successful in 3 and failed in 3 who eventually required surgery. Overall, the satisfactory results observed after the procedure persisted over time in 13 cases. In conclusion, interventional catheterization has become almost always possible in neonates with critical pulmonic stenosis. If performed under vigorously controlled conditions including an infusion of prostaglandin E1 in cases with severe cyanosis and the use of large diameter balloons, this method is relatively safe and generally efficacious since in 70% of cases it circumvents the need for surgery.

Angioplasty, Balloon↗
PubMedDate not supplied

[Clinical evaluation and treatment of rhythm and conduction disorders in the fetus].

Fetal echocardiography, including simultaneous and ventricular M mode scans, allows the diagnosis of arrhythmias by studying the relationships between atrial and ventricular contractions. It also assesses cardiovascular tolerance by looking at pericardial or peritoneal effusion, left ventricular contraction and by measuring blood velocity in systole and diastole in umbilical arteries by Doppler techniques. We report here our experience on 221 arrhythmias found out of 1344 fetal echocardiographies performed since 1983. Bradycardia without atrio-ventricular dissociation in otherwise healthy fetuses were excluded since they are physiologic when moderate and transient. In addition, 180 out of our 221 cases had transient premature beats and were also excluded. It remained thus only 41 cases with true significant abnormalities of the fetal rhythm or conduction. Bradycardia with atrio-ventricular block and low ventricular rate was found in 15 fetuses. Ventricular rate was the first risk factor, since the tolerance was poor under 60 beats per minute (b/m). In this group, 9 cases were associated with cardiac malformations: mainly atrio-ventricular discordance, atrio-ventricular canal, double inlet ventricle. In the 6 other, the heart was normal and in only one, an immunologic disorder was found in the mother. Cardiovascular tolerance and gestation age were the two determinants for deciding on early delivery. In all cases, the newborn was referred to a pediatric cardiology center where specific measures (artificial pacing or simple follow-up) were undertaken.(ABSTRACT TRUNCATED AT 250 WORDS)

Amiodarone↗
PubMedDate not supplied

[Interruption of the aortic arch: a neonatal emergency. Report of 50 cases ].

Interruption of the aortic arch, associated with curable cardiovascular anomalies (8 times out of 10) was observed over a period of 8 years in 50 children aged less than 10 days in 80% of cases. They presented with congestive heart failure, with variable degree of shock in most cases, suggesting the diagnoses of left ventricular hypoplasia or coarctation syndrome. Diagnosis was established with ultrasound and angiocardiography. Evolution was lethal in 21 children who were not operated on. 20 children were operated on: before treatment with prostaglandin E1, 9 attempts ended up in 78% immediate mortality and 89% global mortality; after treatment with prostaglandin. E1, these figures were respectively reduced to 45% and 55% (20 cases). This malformation should therefore be recognized as an emergency and then treated with prostaglandin up to surgery.

Alprostadil↗