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Biomedical subjects

J M Lablanche

Publications and source records attributed to J M Lablanche.

At least 199 records · Page 11Linked to original sources
PubMed1980

[Non-obstructive hypertrophic myocardiopathy. Apropos of 5 cases].

Out of a total of 1 470 cardiac catheterisations performed in one year, 5 were motivated by the chance finding of giant negative T waves, greater than 10 mm and maximal in leads V3, V4. The patients were all males with an average age of 50 +/- 3,2 years. Four were asymptomatic and the other had scleroderma. The changes partially regressed on exercise electrocardiography. M mode echocardiography showed normal septal (8,8 +/- 0,25 mm) and posterior wall (8,38 +/- 0,21 mm) thickness and a normal septum/posterior wall ratio (1,02 +/- 0,01). Coronary angiography was normal in all cases. Left ventricular and diastolic pressure was raised after ventriculography (21 +/- 1,34 mm Hg). There was no intraventricular pressure gradient. Left ventriculography in the 30 degrees right anterior oblique plane showed an end diastolic appearance similar to that of the ace of spades and the apex was obliterated in systole. End diastolic volumes (68 +/- 4,7 ml/m2) and ejection fractions (68,6 +/- 5,21) were normal. The wall thickness measured from the angiography was 10,4 +/- 0,81 mm at the mid zone of the anterior wall and 17,2 +/- 0,85 at the apex with a septum / posterior wall ratio of 1,67 +/- 0,08. In three cases, atrial pacing with coronary arterial and venous lactate sampling revealed abnormalities in myocardial metabolism. The final diagnosis was of non obstructive apical hypertrophic cardiomyopathy. The site of hypertrophy explains the electrical changes. The prognosis of this cardiomyopathy is still unknown, one regression and two aggravations of the electrical changes have been observed. continuous 24 hour ECG showed an episode of ventricular tachycardia in 1 patient, which would imply a reserved prognosis.

Angiography↗
PubMed1980

Use of provocative testing in angina pectoris.

The detection of coronary artery spasm, which can play an important role in spontaneous angina pectoris, may be particularly important with respect to therapeutic considerations. Since the documentation of spontaneous spasm is a rare occurrence, provocation of spasm under controlled conditions can facilitate the diagnosis. In our laboratory, the provocation test is carried out according to a standard protocol with the use of a bolus injection of 0.4 mg methergine ( a close congener of ergonovine). The 321 patients studied since 1976 were distributed into five groups: none of 99 patients with atypical chest pain had spasm; only one of 42 patients with typical angina pectoris of effort had spasm; spasm was induced in 48 of 104 patients with spontaneous angina pectoris, 41 of whom had Prinzmetal's variant angina with 39 of the latter demonstrating spasm; seven of 52 patients with angina both at rest and of effort displayed spasm; and two of 24 patients with myocardial infarction and normal coronary arteries were found to have methergine-induced spasm. The risk of serious complications (such as arrhythmias) is very low provided that an induced spasm is immediately relieved by intracoronary injection of nitroglycerin. Measurement of coronary sinus blood flow indicates that the mechanism is primarily that of an increase in vascular resistance due to spasm and not an increase in myocardial oxygen demands. Thus, the provocation test is useful and indicated for patients with isolated spontaneous angina pectoris, especially those with Prinzmental's variant angina, patients with angina both at rest and of effort and in patients with myocardial infarcation and normal or nearly-normal coronary arteries.

Angina Pectoris↗
PubMed1979

[Detection of coronary artery spasm by the methylergometrin test. Technic. Results. Indications].

Methylergometrine (Methergin) was given intravenously (0.4 mg) to 118 patients undergoing coronary arteriography. The electrocardiogramme and intraaortic pressure was continuously monitored whilst coronary arteriography was performed, 1,3, and 5 minutes after the injection of the ergot alkaloid. The test was positive if: 1) coronary spasm was observed; 2) if ST segment elevation was recorded with or without pain. Positive tests were obtained in 13 out of 14 patients with Prinzmetal angina. The test was negative in the other patients. However in 3 patients with Prinzmetal angina, the test produced typical coronary spasm without electrocardiographic changes. In Prinzmetal angina the sensitivity of this test was 93 p. 100 with a high specificity: 96-100 p. 100 depending on whether or not electrocardiographical changes associated with spasm are considered. Taking into account current therapeutic methods of treating Prinzmetal angina the indications of this test of coronary spasm are: 1) patients presenting with resting angina whatever the state of their coronary arteries; 2) patients with documented Prinzmetal angina with "angiographically normal" coronary arteries.

Angina Pectoris, Variant↗
PubMed1979

[Acquired pulmonary atresia complicating tetralogy of Fallot].

Pf 51 cases of Fallot's tetralogy who underwent preoperative angiography before a palliative anastomosis and then a second angiography before complete correction, 10 had developed pulmonary atresia (infundibular in 8 cases, valvular in 2 cases). The type of anastomosis (Blalock-Taussig of Waterston), and the interval between the two operations do not seem to be determinant factors. The initial severity of the stenosis seems to favour the development of atresia but this is not invariable. The authors discuss the aggravating role of the anastomosis and the consequences of this type of complication.

Adolescent↗
PubMed1979

[Coronary lesions due to aortic valve disease. I -- Occurrence and clinical prognosis].

A multicentre retrospective study of 467 cases of operated aortic valve disease was undertaken to define the indications of coronary arteriography in the pre-operative work-up. Significant coronary artery disease was present in 15% of all cases or, more precisely, in 17% of cases with angina and in 8% when investigation was only routine. Coronary artery disease was more frequent in males, in patients with clinical or electrical evidence of previous myocardial infarction, in patients with ST-T wave changes, and when angina was severe (more than one attack per day). None of these factors was specific. It is therefore difficult to limit coronary arteriography to these patients or there would be a risk of missing significant lesions in a small number of cases. It is important to give the surgeon all the necessary information before aortic valve replacement and so coronary arteriography should be widely practiced in this context. However exceptions may be made for young patients and also those in congestive cardiac failure in whom coronary arteriography represents an unnecessary risk before surgery.

Aortic Valve Insufficiency↗
PubMed1978

Left ventricular compliance in acute transmural myocardial infarction in man.

130 patients with recent transmural myocardial infarction were studied in order to evaluate changes in left ventricular compliance. Left heart catheterization and cineangiographic left ventriculography were performed. The modulus of chamber stiffness (K) was determined from the slope of the linear relation between volume stiffness (dP/dv) and pressure; the modulus of muscle stiffness was evaluated by the Laird index (asymptotic slope of logP vs log V). Patients were divided in 3 groups: Group A included 5 patients studied before and after myocardial infarction who experienced an increase in the modulus of chamber and muscle stiffness after infarction. Group B included 10 patients who were studied at the onset of infarct and 15 days later: this group demonstrated changes in LV compliance with, most often a rightwardshift of P-V curve in anterior infarct and inversely a leftward shift in posterior infarction. The 115 patients of Group B are roughly equally distributed in the areas of normal, increased or decreased compliance. Any correlation was found between the extent of asynergy and changes in modulus of chamber stiffness. However, ejection fraction or VCF were higher in patients with a reduction of compliance than in patients with an increase of compliance.

Cardiac Catheterization↗
PubMed1978

[Echocardiography in Ebstein's anomaly. Apropos of 12 cases].

The authors report 12 cases of Ebstein's disease, and have studied the echocardiographic findings in these cases. The results have been compared with those of a control series of 12 patients with an atrial septal defect and a large shunt effect. There are only two conditions which are important in the diagnosis of Ebstein's disease: the finding of the tricuspid valve beyond the midclavicular line, and a delay in the closure of the tricuspid valve greater than or equal to 0.06 seconds when compared with the mitral valve. Using these two criteria, the diagnosis could be made by echocardiography in 10 cases out of 12.

Adolescent↗
PubMed1977

[Contribution of echocardiography to the diagnosis of infradiaphragmatic total anomalous pulmonary venous return].

The authors report the case of a neonate with an abnormal pulmonary venous return which was totally infradiaphragmatic. Multiscan and monoscan echocardiography made the diagnosis, demonstrating an echo-free zone behind the left atrium extended backwards behind the mitral ring and the left ventricle. The child underwent successful surgery, and a follow-up echocardiogram showed that this abnormal space was lessened, responding with the collecting trunk.

Echocardiography↗
PubMedDate not supplied

Coronary hemodynamics following intravenous or intracoronary injection of diltiazem in man.

We measured coronary sinus blood flow by continuous thermodilution technique and aortic pressure after administration of diltiazem to 23 patients with coronary artery disease. In one group of patients (n = 12) the drug was infused at a rate of 0.15 mg/kg during 2 min followed by an infusion of 0.05 mg/kg during 8 min. Heart rate was unchanged except at 5 min when it decreased slightly. Aortic pressure was significantly (p less than 0.01) decreased, while coronary sinus flow increased slightly and transiently. A second group of patients (n = 5) received an intracoronary injection of 0.15 mg/kg of diltiazem into the left coronary artery. In a third group of patients (n = 7) 0.05 mg/kg of diltiazem was injected into the left coronary artery. In both these two groups the drug induced a marked increase of coronary sinus flow and a decrease of aortic pressure, while myocardial oxygen consumption was unchanged. This effect was dose related, since the rise in coronary flow was 47% with an injection of 0.15 mg/kg but only 23% with a dose of 0.05 mg-kg. These changes were short-lasting with values returning to normal within 10 min after the injection. We conclude that diltiazem is a potent dilator of coronary arteries.

Adult↗
PubMedDate not supplied

Coronary angioscopic findings in the infarct-related vessel within 1 month of acute myocardial infarction: natural history and the effect of thrombolysis.

BACKGROUND: Limited angioscopic information is available on the natural history of infarct-related plaque after myocardial infarction (MI), in particular the effect of thrombolysis. METHODS AND RESULTS: We studied with angioscopy the morphological characteristics of the infarct-related lesion in 56 patients between 24 hours and 4 weeks after MI. Forty of these patients were initially treated with a thrombolytic agent. Most lesions were complex (complex + ulcerated shape = 54%). The predominant color of the plaque was yellow in 79% of cases; only 6% were uniformly white. Angioscopically visible thrombus was found in 77% of cases. Despite angioscopic evidence of instability, only 7% of the patients had post-MI angina. During the 1-month time window since the occurrence of MI, there was no significant difference in the angioscopic appearance of the plaque except for a slight increase in uniformly white plaques (P=.07). The use of a thrombolytic agent at the onset of MI was associated with a reduction in thrombus size and less protruding thrombi (P=.02) but not with a decreased frequency of plaque containing thrombi. Furthermore, a trend for more frequently ulcerated plaques (45% versus 16%, P=.06) was associated with the use of a thrombolytic agent. CONCLUSIONS: These results suggest that healing of the infarct-related lesion requires more than 1 month and that an "unstable" yellow plaque with adherent thrombus is common during that period. This finding may partly explain the unique behavior of recent infarct-related lesions, which are more prone to occlude than other lesions.

Angioscopy↗