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Biomedical subjects

J Langlois

Publications and source records attributed to J Langlois.

At least 127 records · Page 7Linked to original sources
PubMed1980

[One stage repair of VSD in infants (author's transl)].

Concerning their experience between February 1973 and May 1979 about 258 infants less than 12 Kg operated up for large VSD, the authors studies the 27 deaths. Their is not statistical difference between patients under 6 Kg of weight (128 cases, 15 deaths) and patients over 6 Kg of weight (130 cases, 11 deaths). The procedure is performed under hypothermia and circulatory arrest under 5 Kg and moderate hypothermia with cardioplegic myocardial protection in other cases. The causes of deaths have been: --either post-op. complications (post-operative bleeding, catheter complication, mediastinitis), --or pre-operative error (Swiss cheese VSD, single ventricle). The indications for pulmonary artery banding remain multiples VSD, and VSD associated with other visceral malformations.

Body Weight↗
PubMed1979

[Pulmonary stenosis with intact ventricular septum. Surgical experience in 200 cases, excluding the neonatal period].

Experience over 10 years, studying two groups of patients (group I: 79 cases aged between 2 months and 2 years, group II: 151 cases aged over 2 years) has shown that the operative prognosis of severe forms is now the same as in simple forms. Interest is now focused on the long term function of the right ventricle with regard to the surgical procedure. The main discussion in management is between isolated pulmonary commissurotomy, whatever the anatomical form, and operations such as we perform which associate ventricular resection with or without an infundibular patch in severe cases. The possible causes of late ventricular dysfunction are discussed, especially the muscular resection, the operative myocardial protection and the preoperative myocardial sclerosis. The good results observed in this series as opposed to the doubt as to the cause and variability of late ventricular dysfunction do not justify a change in our management at present.

Adolescent↗
PubMed1979

[Complete correction of Fallot's tetralogy with a Waterston shunt].

The influence of a Waterston shunt on the mortality in complete correction of Fallot's tetralogy varies from series to series. Some authors believe that it has no influence and others, on the contrary, believe it plays an important role to the point of recognising a particular premonitory syndrome of pulmonary hypertension and a low output state. This divergence of opinion in patients with comparable lesions is surprising, and cannot always be explained by poor surgical indications (irreversible pulmonary hypertension) or by problems of surgical technique. In our experience the conditions of cardiopulmonary bypass are of prime importance and we believe that the common factor in surgical failure is poor myocardial protection. This point of view is suggested by our present results in the correction of moderate and severe forms of Fallot's tetralogy under cardioplegia and seems to be reinforced by the results of extensive repair in forms with a Waterston shunt, said to be high risk procedures, that is to say with considerable asymmetry of the pulmonary vascularisation by stenosis of the right main pulmonary artery.

Adolescent↗
PubMed1979

[Surgical treatment of double outlet left ventricle].

Three young patients with double outlet left ventricle were operated on at the Centre chirurgica Marie-Lannelongue. There was one secondary death. The follow up period of the two survivors is 24 months and 8 months respectively. The diagnosis of this rare congenital abnormality is difficult because of the multiplicity of the anatomical changes and the diversity of the final clinical entity. This is reflected in the attempts at classification. These difficulties are increased by the high incidence of incomplete forms of the condition which gives rise, especially in vivo, to problems of terminology. Echocardiography provides valuable information in the diagnosis of these forms by showing the abnormal relationship between the interventricular septum and the origin of the great vessels. A complete work up is essential before any decision can be made on management. Particular importance is placed on the topographical and morphological features of the atria and ventricles, the connections of the aorta and pulmonary arteries, and the state of the pulmonary tract. Modern surgical techniques have made correction possible in most forms of the disease, but involves complex procedures which leaves doubts on their long term outcome.

Aorta↗
PubMed1979

[Ascending aortic aneurysm with mucoid infiltration of the media and aortic leaflets. Pathogenic hypotheses- surgical consequences].

The theoretical and practical problems posed by aneurysms of the ascending aorta with mucoid infiltration of the Media and the aortic leaflets are discussed with reference to two suggestive cases. These histological changes are not specific for Marfan's syndrome, the relation with which is very inconstant. Incomplete replacement of the affected tissues risks a recurrence which is especially serious when the sinus of Valsalva is involved. Therefore, total replacement of the ascending aorta with aortic valve replacement and reimplantation of the coronary arteries is generally indicated. Histology of the excised tissues should be performed routinely with specific stains for mucopolysaccharides. Close follow-up of operated patients with this condition is recommended, especially those with only partial replacements.

Adult↗
PubMed1978

[Angina pectoris and muscular bridges on the anterior interventricular artery. Apropos of 3 operated cases].

A relationship between ischaemia of the myocardium and a muscular bridge over the anterios descending artery has now been demonstrated. The authors report three cases in which the severity of the clinical features was sufficient to justify surgical division of the muscular bridge without touching the underlying artery. Progress remained satisfactory after a follow-up period of 1.5 to 3 years. The opportunity is taken to discuss the role of the muscle bridge in causing pathology in the coronary arterial system.

Adult↗
PubMed1978

[Aberrant left pulmonary artery. Apropos of 5 operated cases].

The authors report 5 cases of aberrant left pulmonary artery undergoing surgery with 3 successful results and 2 failures; 4 of the 5 operations were carried out through a sternal split with either extra-corporeal circulation or circulatory arrest and profound hypothermia. The authors have reviewed the cases reported in the literature which amount to 78, 51 of which have been operated on surgically, the condition having been corrected in only 34 of them. They have studied particularly the incidence of associated tracheo-bronchial lesions which are themselves the reason for the seriousness of the condition, as well as the longterm results and the possible incidence of thrombosis in the anastomosis. By contrast with the views of Sade, the authors are optimistic about the results which have been obtained in the survivors.

Abnormalities, Multiple↗
PubMed1977

[Post-partum myocardiopathy. Apropos of 25 cases].

The authors have studied 25 cases of PPC which were selected according to very strict criteria. These cases represent 1 case of PPC for every 2 687 confinements, and 37.8% of all cardiomyopathies in females of child-bearing age. The females with PPC belonged to the more deprived socio-economic population. Multiparity and twin pregnancies are predisposing factors. The clinical picture is usually one of biventricular of left heart failure. Four cases of embolism are included (16%, which is a high figure for Africa). The special investigations are important. Mechanographic studies show a very significant lengthening of the pre-ejection phase (especially QB1), and a reduced ejection phase; haemodynamic studies show in particular increased pressures on the right side in 4 cases out of 6. (3 of which had an arterio-capillary gradient). Angiocardiography, carried out in 4 cases, showed abnormalities especially of the left ventricle (especially dilation and hypokenesia). The outcome may be favourable, especially after 3 to 6 months have elapsed. However, complications may arise in the long-term (10, 14 and 37 months). There were two deaths (8%). Histologically, the lesions were mainly of a congestive type, with some areas of fibrosis, and rarely areas of inflammation (myocarditis). From the aetiological standpoint, it might be thought that during the posptpartum period, various abnormal conditions prevail or would be discovered (13 in our series); but it is also true that some cases of true PPC, with marked stasis and a tendency to thrombosis, as well as severe involvement of the myocardium (as witnessed especially by the mechanographic findings), to progress after 3 months either to resolution, death, or complications; the histological findings in the two fatal cases were of myocarditis.

Adult↗
PubMed1977

[Unexpected findings during surgery for interventricular communication and for banding of the pulmonary artery in the infant and child].

While the authors recognise the difficulty of obtaining a complete picture of the lesion in certain types of ventricular shunt with pulmonary hypertension, they emphasise the importance of a precise diagnosis, which may modify the medical treatment and the decision to operate. Conditions may nevertheless be found by surprise at operation, and lead to a modification of the planned action.

Child, Preschool↗