Search PubMed⌕ Search

Biomedical subjects

J Kachaner

Publications and source records attributed to J Kachaner.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Purulent pericarditis in children: a 15 year-experience].

BACKGROUND: Purulent pericarditis is rare in developed countries, but its prognosis is regarded as serious. Early diagnosis and appropriate treatment should prevent complications. PATIENTS: Among the 119 pericarditis without congenital cardiopathy admitted in our pediatric cardiology unit between 1979 and 1994, 19 were purulent. The mean age of these 13 boys and six girls was 3 years (range: 3 months to 10 years). Symptoms always pointed to a chest disease whether pericarditis occurred first (n = 13) or it complicated evolution of a known infectious process (n = 6). Tamponnade was present in seven infants upon admission and required urgent pericardiocentesis or drainage. An extrapericardial infectious site was found in 11 cases: six pulmonary infections, three osteomyelitis, one cellulitis and one sinusitis. An organism was isolated in 17 cases, 14 times in the pericardial fluid, eight times on blood culture. The identified bacteria were: Staphylococcus aureus (n = 6), Haemophilus influenzae (n = 4), Streptococcus A (n = 3), Streptococcus pneumoniae (n = 3), Meningococcus (n = 1). Treatment consisted of intra-venous antibiotics associated 15 times to surgical drainage of the pericardium. One infant had no pericardiocentesis and no drainage because he presented late with constrictive pericarditis and needed pericardectomy. All infants healed but four developed contrictive pericarditis and required pericardectomy; none of these four patients had early drainage (two had no drainage at all). Pericardectomy, carried out between 2 and 6 months after the beginning of pericarditis with adiastolic signs and pericardial thickening, permitted healing in all cases and disappearance of all cardiac symptoms. CONCLUSIONS: Early diagnosis and treatment of purulent pericarditis, especially early pericardial drainage, are the best ways of avoiding constriction.

Child↗
PubMed1996

The multi-track angiography catheter: a new tool for complex catheterisation in congenital heart disease.

OBJECTIVE: To develop a simple and versatile catheter system for complex cardiac catheterisation because angiography and pressure measurements during diagnostic and interventional cardiac catheterisation are often unsatisfactory. METHODS: The Multi-Track Angio catheter system is a single lumen side-hole catheter with a short distal extension containing a lumen for a standard guidewire. The catheter is introduced over a previously placed guidewire running through this distal extension. It can then be manipulated within the heart by sliding along the guidewire. The tip of the catheter is always stabilised by the guidewire. This stability enhances angiography and pressure recordings. RESULTS: The Multi-Track Angio catheter system was used in 84 patients (age 1 day-20 years). Thirty one procedures were diagnostic and 53 interventional. The decision to use the Multi-Track Angio catheter was based on three criteria: firstly, unsatisfactory angiography obtained with conventional equipment; secondly, difficult catheter course requiring use of a guidewire; and thirdly, requirement for angiography and pressure recordings during interventional procedures. No complications were encountered. High quality angiography could be performed in all cases without catheter recoil. CONCLUSIONS: The Multi-Track Angio catheter system allows for high quality angiography and pressure recordings during diagnostic and interventional cardiac catheterisation. The advantage of the system is that both angiography and pressure recordings can be performed repeatedly from stable catheter positions using a previously placed guidewire. This reduces the need for guidewire manipulations or catheter exchanges and decreases procedure time and the risk of complications.

Adolescent↗
PubMed1996

Long-term fate of the coronary arteries after the arterial switch operation in newborns with transposition of the great arteries.

OBJECTIVE: Concern continues to be expressed about the long-term impact of coronary artery translocation after the arterial switch operation for transposition of the great arteries. This study was conducted to determine the prevalence of obstructions of the translocated coronary arteries by the use of selective coronary artery angiography. METHODS AND RESULTS: 64 children (mean age 7.6 (SD) 1.5 years) who had survived an arterial switch operation underwent evaluation. They had been operated on by one surgeon and they were followed up by a single hospital. Selective coronary artery angiography was possible in 58 patients. Five patients showed occlusion or stenosis of a coronary artery: one occlusion and two stenoses of the left coronary trunk, two occlusions of the circumflex artery. The prevalence of late coronary artery complications was 7.8 (SD) 6.6% (95% CI 1.2 to -14.4%). The three patients with occlusion of one coronary artery had perioperative ischaemic complications, with associated electrocardiogram evidence of ischaemia and left ventricular dysfunction with mitral valve insufficiency. Both patients with stenosis of the left main coronary artery trunk did not have any evidence of an anomaly before catheterisation. CONCLUSIONS: The prevalence of the late coronary artery complications after an arterial switch operation was low in this series. This accords with the view that the arterial switch operation remains the preferred treatment for such patients. Screening for late coronary artery patency should be done by using selective coronary artery angiography, because even patients who remain symptom free can have coronary artery anomalies.

Coronary Angiography↗
PubMed1996

Pulmonary balloon valvuloplasty in the palliation of complex cyanotic congenital heart disease.

OBJECTIVE: To assess the value of pulmonary balloon valvuloplasty in the interim palliation of complex congenital heart disease and pulmonary stenosis in children, who often require numerous palliative operations before definitive surgical repair. METHODS: Evaluation of pulmonary balloon valvuloplasty procedures performed over a five year period in 18 patients (age 8 days--29 years; mean 5.5 years) with complex cyanotic congenital heart disease. RESULTS: After pulmonary balloon valvuloplasty oxygen saturation increased from a mean (SD) of 69 (7.5)% to 83 (7.0)% (P < 0.001). Mean pulmonary artery pressure increased from a mean (SD) of 11.3 (3.8) mm Hg to 15.7 (3.9) mm Hg (P < 0.001). Transient complete atrioventricular block occurred in one patient. No other complications were encountered. In 5 patients (28%) there was an inadequate improvement in cyanosis compared with pre-procedure values (72 (4.7)% v 66 (8.1)%). Reasons for failure were increasing infundibular stenosis in three and inadequate mixing in one child. In 13 patients (72%) pulmonary balloon valvuloplasty gave adequate interim palliation over a mean follow up of 1.1 (1.3) years. Oxygen saturation was 81 (5.6)% at last follow up compared with 70 (7.3)% before pulmonary balloon valvuloplasty (P < 0.001). CONCLUSION: Pulmonary balloon valvuloplasty is a safe and effective technique in the palliation of patients with complex cyanotic congenital heart disease associated with pulmonary valve stenosis.

Adolescent↗
PubMed1996

[Percutaneous valvotomy of aortic valve stenoses in children].

A retrospective cooperative study of percutaneous aortic valvuloplasty was undertaken in 12 French centres from 1985 and included 90 children over 3 months of age (average 8.5 +/- 5.2 years) treated for isolated aortic valve stenosis with peak transvalvular pressure gradients of 80.7 +/- 23 mmHg. over 50 mmHg in 92% of cases. The majority of cases were performed by a retrograde femoral arterial approach with inflation of a balloon with a diameter approximating that of the aortic annulus. There was one serious complication (lethal collapse occurring before dilatation) and 12% of local complications due to arterial trauma: the latter were temporary or accessible to simple therapeutic measures. Overall, the pressure gradient decreased by an average of 39.2 +/- 25.4 mmHg. There were 15 immediate failures (17%) and 21 partial results (23%) requiring a further procedure at varying intervals after the valvuloplasty. There were 54 primary successes (60%) with annulation of the pressure gradient and this result was sustained in 45 of the 51 cases followed up for an average of 34 +/- 21 months. Aortic regurgitation was observed or aggravated in 29 children; at the end of the study, this remained a serious problem in 15 cases (17%). The authors conclude that interventional catheterisation is an elegant. simple and relatively economical alternative to conventional surgery. It is as safe, but less immediately effective overall; aortic continence may be compromised in the long-term. In the absence of technical innovations, a parallel development of the two therapeutic procedures is to be expected.

Adolescent↗
PubMed1996

[Cardiac MIBG imaging: a new marker for myocardial function in children?].

MIBG cardiac imaging is a non-invasive procedure of studying neuronal recapture of noradrenaline. In adult cardiomyopathy, abnormal results are observed earlier than the increase in circulating catecholamines and constitute a reliable prognostic indicator of the disease. The authors assessed this technique in children with severe cardiac dysfunction in whom the evaluation of ventricular pump function was of primordial importance for the therapeutic decision. Twenty-eight patients aged 3 months to 20 years (average 6.4 +/- 5.8 years) were included in the study. Twenty had hypokinetic dilated cardiomyopathies: with respect to the normal values in adults MIGBG uptake was reduced in all cases. This alteration was correlated with the severity of myocardial dysfunction assessed by echocardiography but is was without doubt the expression of another type of physiopathological process. No relationship was observed with the aetiology of the cardiomyopathy. Eight children had a single ventricle treated by cavopulmonary bypass in 7 cases and by pulmonary artery banding in the other case: MIBG imaging did not allow assessment of myocardial function in these patients probably because the cavopulmonary bypass denervated the heart and thereby changed MIBG uptake independently of the cardiac function. These preliminary results are encouraging and should lead to the adoption of MIBG imaging as one of the key investigations in the functional evaluation of childhood cardiomyopathy and perhaps as an important parameter in the decision of transplantation in this indication.

3-Iodobenzylguanidine↗
PubMed1996

[Treatment and prognosis of tachyarrhythmia after atrial surgical repair of transposition of great vessels].

The Mustard and Senning procedures may be complicated by atrial tachyarrhythmias. In order to determine their prognosis, the authors undertook a review of the 288 patients operated and followed up in their department. Thirty-six (12.5%) had documented atrial tachycardias. In 13 cases, Holter monitoring showed bursts of atrial tachycardia. In the other 23 cases, the tachycardia was sustained and often caused severe symptoms (syncope). Reduction of the sustained forms was obtained by rapid atrial pacing, cardioversion or amiodarone therapy. After restoration of sinus rhythm, several therapeutic protocols were used, often in the same patient: abstention, leading to 5 recurrences in 6 cases; treatment with betablockers in 12 patients with well tolerated or exercise-induced atrial tachycardia with 11 successes; amiodarone, with 4 relapses out of 5 when the dosage was less than 200 mg/m2/day and 13 successes out of 18 when the dosage was 200-250 mg/m2/day. During a follow-up of 1 to 19 years, 6 severe complications (neurological sequellae, cardiac failure), and 6 deaths, were observed. All these patients were poorly controlled and continued to be have tachyarrhythmias. The authors conclude that tachyarrhythmias are neither rare nor always symptomatic, so justifying their systematic investigation. They should be reduced by oral amiodarone or rapid atrial pacing depending on the clinical urgency, never by intravenous antiarrhythmics which can be dangerous. The poor prognosis associated with tachyarrhythmias makes their control essential either with betablockers or good doses of amiodarone, eventually covered by permanent cardiac pacing.

Adolescent↗
PubMed1995

Mitral dilatation with the Multi-Track system: an alternative approach.

We developed a simple and versatile new technique (Multi-Track) for percutaneous mitral valvotomy using two two separate balloon catheters positioned on a single guidewire. The first catheter, with only a distal guidewire lumen and a proximal balloon, is introduced over the guidewire into the vein and then advanced into the mitral valve orifice. Subsequently, a normal balloon catheter running on the same guidewire is inserted and lined up with the first catheter so the two are positioned side by side. The balloons are then inflated simultaneously. The technique was applied in 12 patients between 10 and 44 years of age (mean, 27.1) and weighing 24-80 kg (mean, 50.3). Valve area increased from 0.66 cm2 (range, 0.3-0.9 cm2) to 1.97 cm2 (range, 1.3-3.1 cm2) and mean left atrial pressure dropped from 31 mmHg (range, 18-52 mmHg) to 12 mmHg (range, 5-22 mmHg). Mitral dilatation with the Multi-Track system gives results comparable to those with previously described techniques and uses simpler and less costly catheters.

Adolescent↗
PubMed1995

Balloon valvotomy for critical stenosis or atresia of pulmonary valve in newborns.

OBJECTIVES: Percutaneous balloon valvotomy was studied retrospectively in newborns with critical pulmonary valve stenosis or atresia to assess its potential role as an alternative therapy to operation. BACKGROUND: Severe right ventricular outflow tract obstructions are life-threatening conditions requiring prostaglandin infusion immediately after birth and then relief of the valvular obstruction. To avoid surgical hazards at this age, it would be useful to extend to newborns the balloon valvotomy so effective in older patients. METHODS: Ninety-seven newborns (82 with critical pulmonary valve stenosis, 15 with atresia) underwent balloon valvotomy, provided that they had a well developed right ventricle, including an infundibulum close to the pulmonary artery. In patients with atresia, the outflow tract membrane had to be perforated with a wire needle or a radiofrequency probe. RESULTS: Balloon valvotomy could be performed in 81 patients and was effective in 77. It caused 3 fatal and 16 nonfatal complications. Ten patients with persistent poor right ventricular compliance despite an effective valvotomy required a surgical shunt. Among the 81 patients in whom the procedure could be performed, right ventricular surgery was avoided in 5 (55%) of the 9 patients with atresia (95% confidence interval [CI] 28% to 80%) and 55 (76%) of the 72 patients with stenosis (95% CI 66% to 86%) at the end of the follow-up period (9.7 years). CONCLUSIONS: Balloon pulmonary valvotomy is not always feasible in newborns, but it is relatively safe and effective and should be considered a valid alternative to operation.

Catheterization↗
PubMed1995

[Percutaneous occlusion of patent ductus arteriosus by the Rashkind double-umbrella device].

BACKGROUND: The transcatheter option consisting of implanting and releasing an occlusive device designed as a double-umbrella is an interesting alternative to surgery aimed to close persistently patent ductus arteriosus. POPULATION AND METHODS: Closure of a duct with the Rashkind device had been planned in 113 children. The procedure was abandoned in 12 with inadequately sized ducts (too large or too small). This study therefore included 101 attempts in patients aged 2.3 months to 18.5 years (m +/- 1 SD = 45.9 +/- 43.2 months) whose weights ranged from 3.3 to 87 kg (m +/- 1 SD = 15.7 +/- 11.7 kg). The narrowest dimension of the duct on the aortograms ranged from 1.2 to 6.2 mm (m +/- 1 SD = 2.9 +/- 0.9 mm). RESULTS: The procedure failed in seven patients because of a too large and/or tubular vessel, causing removal of the device prior to release in five patients, or surgical extraction after it had embolized into a pulmonary artery branch in two patients. An early acute hemolysis requiring again the surgical removal of an instable device in a tubular duct was seen in one case. Two patients had femoral artery occlusion successfully treated with thrombolytic agents. Complete occlusion was immediately proven in 32 (35%) of the 92 successful and stable implantations. These figures raised to 64% (59 cases) prior to discharge. At final follow-up (0.3-59 months, m +/- 1 SD = 13.8 +/- 14.4 months), another 16 total occlusions were observed and one patient was successfully managed by a second implantation. The final occlusion rate was 83% (76 cases). Of the 16 residual shunts, five were surgically suppressed and the remaining were minimal. CONCLUSION: Transcatheter occlusion of the patent ductus arteriosus is safe in children weighing more than 5 kg, having ducts with a narrowing ranging from 1 to 6 mm. It is efficient in five out of six cases and has less disadvantages than surgery.

Adolescent↗
PubMed1995

[Gene localisation in 12q12 in Holt-Oram atrio-digital syndrome].

The Holt-Oram syndrome, first described in 1960, consists of non-cyanotic congenital heart disease, usually an atrial septal defect, arrhythmias and malformations of the upper limbs affecting the radial segment. The transmission of the syndrome is autosomal dominant with almost complete penetrance. The authors report the localisation of a genetic abnormality of the Holt-Oram syndrome on the long arm of chromosome 12 (12q21-q3) by analysis of linkage in 9 multiplex families (Zmax = 8.19 at locus D12S354). Multipoint analysis showed a genetic interval of 7 centimorgans containing a gene of the Holt-Oram syndrome between loci D12S84 and D12S79 (multipoint lod score, 10 g base 10 = 8.96). In situ hybridization of artificial yeast chromosomes containing the surrounding markers showed that a gene of the Holt-Oram syndrome is located in 12q23-q24. The genetic heterogeneity was demonstrated in 3 families of the Holt-Oram syndrome with polydactyly or without cardiac disease (homog-test: chi 2 = 13.28; p = 0.0001). The localisation of a gene of the Holt-Oram syndrome is, to the authors' knowledge, the first chromosomal localisation of a cardiac malformation with septal defects in man. The identification of this gene should open wide perspectives for genetic research of cardiac morphogenesis and clarify the molecular mechanisms which govern cardiac septation during embryogenesis.

Chromosome Mapping↗
PubMed1995

[Pulmonary atresia with ventricular septal defect: therapeutic strategy in newborn infants].

Pulmonary atresias with ventricular septal defect, a right ventricular infundibulum and pulmonary artery separated by an imperforated membrane and a complete pulmonary tree with two branches in continuity are called "favourable" forms of this malformation. The authors studied 29 neonates, less than 1 month old, in whom the malformation was both ductus- and prostaglandin-dependent, prostaglandin infusion being essential for pulmonary flow and impossible to stop because of the resulting severe hypoxia. The choice of treatment depended on the anatomical form defined by angiocardiography. In the 19 regular forms with regular pulmonary arteries with little hypoplasia, percutaneous perforation-dilatation was successful in 3 out of 5 attempts with one secondary death and 2 good results leading to complete repair; anastomosis was performed in 9 cases with 3 deaths, 1 partial result and 5 good results which were followed by complete repair in 3 cases; primary complete repair attempted in 7 cases led to 1 death and 6 successes completed in 3 cases by reoperation for left pulmonary artery stenosis. In the 10 less favourable anatomical forms with stenosis or severe hypoplasia or the pulmonary branches, only palliative procedures were proposed: 2 perforations-dilatations which only gave partial results, 7 anastomoses with 1 death and 4 partial results; and 1 ventriculo-pulmonary connection without closure of the ventricular septal defect (good result). In view of the good results obtained over the 6 years of the study, the authors advise primary complete correction for the anatomically favourable forms of the malformation when weaning from prostaglandin infusion is impossible.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1995

[Percutaneous dilatation of recurrent coarctation of the aorta in the 1st year of life].

It is not rare for surgery of coarctation of the aorta to be complicated by recurrence of the lesion at medium-term, especially when it is performed very early in life. Advances in interventional catheterisation now offer an alternative to surgical reoperation. This study is a retrospective analysis of balloon angioplasty in 20 patients in whom isthmic stenosis had been operated before the age of one month in 19 cases, in whom recurrent coarctation was identified 3.2 +/- 2.1 months later. The percutaneous angioplasty was performed by a femoral arterial approach at an average age of 5.4 +/- 2.3 months. The femoral pulses returned together with a fall in the transisthmic systolic pressure gradient from 58.3 +/- 23.4 mmHg to 18.3 +/- 12.5 mmHg, and the isthmic lumen increased by +117 +/- 52%. Judged by the residual pressure gradient, the results were good, the best results being observed in the shortest and most severe stenoses. After a maximum follow-up of 5 years (average: 20.1 +/- 16.6 months), the angioplasty was successful in 14 cases (70%), 4 cases had a mild residual gradient (20%) and 2 were failures (10%). None of the patients required reoperation. There were no fatalities or early aneurysmal complications in the dilated zone monitored by echocardiography and magnetic resonance imaging. The only complication was femoral artery obstruction (6 cases) which was successfully thrombolysed in 5 cases but which recurred at long-term in 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Coarctation↗
PubMed1995

[Therapeutic strategy in newborn infants with multivisceral failure caused by interruption or hypoplasia of the aortic arch].

Left heart obstructive lesions, in particular interrupted aortic arch or severe forms of coarctation with hypoplasia of the aortic arch, are the main cause of cardiac failure in the neonate and are often at the root of multiple organ failure which worsens the prognosis. Based on a retrospective study of 35 neonates admitted between July 1984 and June 1994, the authors attempted to identify the prognostic factors for admission to the intensive care unit and the optimal timing for operation of these patients. All neonates with a ductus-dependent aortic obstructive lesion and severe multiple (at least four) organ failure, were included in the study. There was a high mortality (54%) including firstly 7 patients who died in the three days following admission to the intensive care unit (20%); this was so-called "medical" mortality for which there was no identifiable poor prognostic factor. On the other hand, the surgical mortality (12 out of 28 cases, 43%) was significantly different in neonates operated before recovery from multiple organ failure (72%) and those operated after recovery from multiple organ failure (17%). Based on these results, the authors propose a therapeutic strategy based on prolonged preoperative intensive care until the initial multiple organ failure is reversed rather than early surgery.

Aorta, Thoracic↗
PubMed1994

Bacterial pericarditis in infancy and childhood.

The authors report on a cooperative study of 43 cases of bacterial pericarditis observed in children. This disorder was suspected in patients with septicemia who developed symptoms and signs of pericarditis (precordial pain, muffled heart sounds, pericardial friction rub, cardiomegaly). Early diagnosis of this condition is now facilitated by echocardiography. A combination of medical and surgical treatments (appropriate antibiotic therapy after culture and sensitivity tests and early pericardial drainage) led to complete recovery in almost all of the cases (42 of 43). After long-term follow-up, no cases of constrictive pericarditis were observed.

Adolescent↗
PubMed1994

[Palliative treatment of tetralogy of Fallot by percutaneous dilatation of the right ventricular outflow tract. 40 cases].

This study was undertaken to assess the value of percutaneous dilatation of the right ventricular outflow tract as a substitute for surgical systemic pulmonary anastomosis in varieties of tetralogy of Fallot with severe irregularity or major pulmonary arterial hypoplasia unsuitable for complete repair of first intention. Fifteen neonates aged 3 to 23 days with severe desaturation (SaO2 = 73 +/- 11%) and twenty five children aged 1.2 to 174 months with anoxic crises or severe desaturation (SaO2 = 67 +/- 15%) fulfilled these criteria. They underwent right heart catheterisation completed by an attempted pulmonary dilatation. This manoeuvre failed in 6 cases, all neonates, because it was not possible to cross the annulus or maintain the balloon in position, or because of infundibular perforation. There were complications in 5 cases, all neonates: 2 tamponades with 1 death, one dissecting aneurysms of the annulus, 1 gastroenteritis and 1 caval thrombosis. Of the 34 patients dilated, 8 were poor results, mainly in the older age group (7 cases) and 26 were successful as judged by a significant improvement in arterial saturation. However, 7 patients rapidly deteriorated due to anoxic crises (6 infants and children) or fatal secondary tamponade (1 neonate). Therefore, there remained 19 stable successful procedures, 49% of attempts, representing 56% of successful attempts and 73% of primary successes. In neonates, these proportions were respectively: 47%, 78% and 87%, and in the older children: 48%, 48% and 63%.(ABSTRACT TRUNCATED AT 250 WORDS)

Balloon Occlusion↗