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Biomedical subjects

J Normand

Publications and source records attributed to J Normand.

At least 55 records · Page 3Linked to original sources
PubMed1988

The anatomical aspects of adult aortic stenosis.

Since the recent introduction of percutaneous balloon valvuloplasty, there has been a renewed interest in anatomical studies. This study was based on a retrospective analysis of 100 autopsy reports and 269 surgical reports from adult patients with AS. Valvular calcification, which was always found over the age of 50 years, plays an important part in the origin of aortic stenosis (AS). Congenital or acquired aortic valvular lesions are a common pre-condition for calcified AS. Three anatomical types were found: (i) calcified bicuspid valves with anterior and posterior cusps (more frequent than a left and a right cusp) were found in 41% of autopsy reports and 40% of surgical reports. The resultant rigidity due to calcification makes the valve stenotic; (ii) post rheumatic calcified AS with strong fusion of the commissures and calcified cusps was found in 30% of autopsy reports and 8% of surgery reports; and (iii) degenerative calcific aortic stenosis was the most frequent form found over 70 years of age. The sinuses of Valsalva were filled with calcium deposits. The three commissures were apparently free, but cusp fusion was found on the ventricular aspect of the valve (29% of autopsy cases and 52% of surgical reports). Percutaneous balloon valvuloplasty is more efficient in this anatomical type.

Aged↗
PubMed1987

[Current results of the treatment of transposition of the great vessels. Apropos of a series of 168 cases including 138 physiologic corrections].

This study takes stock of the current results of physiological correction (Mustard's or Senning's operation) in simple transposition of the great vessels, at a time when anatomical corrections, or detranspositions, are developing. Between January 1, 1974 and December 31, 1984, 168 neonates with simple transposition of the great vessels were operated upon and followed up for a mean period of 3.67 years (up to 11 years and 10 months). Thirty of them died before correction (12.7% mortality rate with palliative surgery) and 15 immediately after corrective surgery (11.2%). Among the 111 children who survived corrective surgery, the results were satisfactory in 62.7%, fair in 17.8% and poor in 10.2%; the late mortality rate was 9.3%. Post-correction morbidity mainly consisted of mechanical complications suspected in one-third of the patients (with 3 consecutive deaths) and heart rhythm disorders (50% of patients in this series had abnormal Holter recordings), with predominance of atrial rhythm disorders (regression of sinus rhythm was 3.82% per annum). This, after correction the survival curve underwent an actuarial regression of 1.31% per annum. This primary and secondary morbidity and mortality justifies a switch to anatomical corrections the results of which remain to be fully evaluated.

Arrhythmias, Cardiac↗
PubMed1986

[Prognosis of surgically corrected chronic aortic insufficiency].

It is difficult to determine the surgical indications of asymptomatic chronic aortic regurgitation (AR). This study was undertaken in 205 patients with pure AR, operated between 1970 and 1982: 136 patients were symptomatic (Classes III and IV of the NYHA, +/- cardiac failure +/- angina, mean age: 49.5 years). Sixty nine asymptomatic patients (Classes I and II of the NYHA without cardiac failure or angina, mean age: 42 years). The prognostic value of 58 variables was studied in these two groups. The mortality during the first postoperative month was 14% in the symptomatic patients and the 5 year survival rate was 68.7%; this was significantly lower in patients with ECG changes of systolic left greater than or equal to ventricular overload, with radiological cardiomegaly (cardiotolerance index 0.60) with calcific aortic valve disease, with raised arterio-venous difference and/or low cardiac output, and with a low ejection fraction. In the asymptomatic group, the hospital mortality was zero and the 5 year survival rate 86.8%. This was significantly decreased in patients with an increased PR interval and a low cardiac index. It is possible that the small number of patients did not demonstrate the predictive value of left ventricular function in asymptomatic patients (a hypothesis suggested by the causes of secondary mortality which were the same in both groups of patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Primary coronary fistulas. Angiographic study of 21 cases].

A retrospective study of 21 cases of congenital primary coronary fistulae and a review of the literature underline the exceptional features of 2 of our cases and recall the main features of coronary fistulae. Coronary angiography (18 cases) or aortography (3 cases) confirmed the diagnosis in our 21 cases. Six of them involved the right coronary artery, 12 the left one, and 3 the two coronary arteries. Seven of them involved the right heart (2 right atrium, 5 right ventricle), 11 the main pulmonary artery, 2 the left heart (the left ventricle in both cases), and the last case was a coronaro-bronchial fistula. Our series comprised 11 men and 10 women; the mean age was 33 (range: 4 days to 67 years of age). The main presenting features were: murmur (7 cases), angina (7 cases), angina (7 cases), Stage II or III dyspnoea (5 cases). Clinical examination showed a systolic-diastolic murmur in 12 cases and a systolic murmur in one case. The chest X ray showed signs of left to-right shunt in 6 cases. The right heart catheterisation of 16 of the 19 left-to-right shunts confirmed the shunt in 9 cases. The 7 cases of coronaro-right cardiac fistulae drained directly (4 cases), by aneurysmal dilatation with diaphragm (3 cases); the 2 cases of coronaro-left-ventricular fistulae drained via microfistulae; the 11 cases of proximal coronaro-pulmonary fistulae drained mostly by an angiomatous plexus (9 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Bacterial endocarditis presenting as acute vertebral osteomyelitis: 14 cases.

Association between bacterial endocarditis (BE) and vertebral osteomyelitis (VO) has infrequently been noted. In a retrospective analysis of BE (280 cases) and VO (150 cases) 14 cases were found to have this association. There were 12 males and 2 females, ages ranging from 39 to 72 years, mean age 56.6. Blood cultures were positive for Streptococcus viridans (6 cases). Str. faecalis (4 cases), staphylococcus (2 cases), Gram negative bacteria (1 case). Organism was not isolated in one case. Fever and severe back pain antedate the diagnosis of VO 3.5 and 2.5 months. X rays films of the spine and bone scans (4 cases) revealed lumbar (6 cases) or cervical (4 cases), or dorsal (3 cases) or combined cervical and dorsal (1 case) locations. History of murmur (4 cases) and development of mitral (8 cases) or aortic (4 cases) or combined mitral and aortic (2 cases) insufficiencies were consistent with concomitant BE. Echocardiogram revealed vegetations in 6 out of 9 cases. Patients received antibiotic therapy for 3.5 months. Ten patients were cured with antibiotics only, 4 required valve replacement. One died. Thus age, sex, history of heart disease, valvular involvement, duration of symptoms prior to admission and bacteriological pictures are the same in BE with VO as in BE without VO. Survival rates are also the same if early recognition of BE and VO with prompt and prolonged antibiotic therapy may prevent severe haemodynamic or vertebral problems.

Acute Disease↗
PubMed1984

[Course of the results observed in the 1st 100 coronary angioplasties performed in 96 patients. Experience in Lyons].

TCA is an original method of myocardial revascularisation which, when successful, enables coronary bypass surgery to be avoided. However, a certain number of failures and complications are inherent to the development of a new therapeutic technique. The object of this study is to analyse the evolution of our results with this technique to determine which factors changed as our experience increased. The methodology used was that initially described by A. Gruntzig. TCA was carried out 72 times on the left anterior descending, 20 times on the right coronary and 8 on the left circumflex coronary artery (72 single vessel, 28 multivessel disease). The primary success rate was 75% (72% for the first 50 and 78% for the second 50 procedures). Coronary bypass surgery was required within the first 24 hours of TCA in 7% of cases. Myocardial infarction (Q wave changes) was observed in 5% of cases. One patient died on the third day (occlusion of an aorto-coronary venous graft). In retrospect, taking into account the experience gained and the development of the material now available, a certain number of failures and complications could probably have been avoided. However, a certain number of complications seems to be unavoidable. TCA remains an inviting but not infallible alternative in the treatment of coronary artery disease and should be included in the medico-surgical management of this condition.

Adult↗
PubMed1984

[Association of an interauricular communication of the sinus venosus type with obstructive myocardiopathy. Surgical treatment].

The authors report the case of a 46 year old man in congestive cardiac failure for 4 years due to the association of a sinus venosus atrial septal defect and hypertrophic obstructive cardiomyopathy. Surgery was attempted because of the poor response to medical therapy. The operation consisted in a trans aortic left ventricular myotomy with mitral valve replacement, enlargement of the atrial septum by a patch and correction of the sinus venosus also by a patch. The result was excellent, with regression of the clinical signs of cardiac failure, maintained after 6 months' follow-up. This is certainly a very rare pathological association of which we were unable to find any previous reported case in the literature. Two cases of ostium secundum atrial septal defect with hypertrophic obstructive cardiomyopathy have been operated on previously, one successfully and the other one without success. A rational surgical approach is suggested, based on the analysis of the physiopathological consequences of this rare association.

Cardiomyopathy, Hypertrophic↗
PubMed1984

[Value of prostaglandin E1 in cardiac malformations in the newborn infant].

Prostaglandin E1 (PGE1) was administered to increase ductus patency in 26 neonates who present a cyanotic heart disease with right ventricular obstruction (1st group, 13 cases) or congestive heart failure with left ventricular outflow obstruction (2nd group, 13 cases). Clinical improvement occurred in all but the oldest infant in the first group. The efficacy of PGE1 is inconstant in the second group, but medical status was very poor before treatment. We could usually reduce the dose of PGE1 but in no case we could stop the drug before surgery. Surgery could be delayed several hours or days to get an hemodynamic and biologic satisfactory condition and even a few weeks until the infants and their pulmonary arteries had grown (1st group). Side effects are common but relatively minor.

Ductus Arteriosus↗
PubMed1982

[Use of valved tubes in the treatment of ventriculo-pulmonary discontinuity. Long-term results].

Forty five patients, 2 months to 42 years of age, had valved tubes implanted for ventriculo-pulmonary discontinuity. The underlying malformations were: certain forms of Fallot's tetralogy (16 cases), transposition of the great arteries with ventricular septal defect and pulmonary stenosis (8 cases), truncus arteriosus (9 cases), double outlet right ventricle (6 cases), other malformations (4 cases). Hospital mortality (at 30 days) was 31% (14 cases). This was mainly due to technical difficulties related to the large number of palliative procedures and to irreversible pulmonary hypertension, present in 43% of cases with fatal outcomes. Thirty one patients were followed up for 6 months to 7 years (mean 3 +/- 1,6 years). There were 3 late deaths, one during reoperation for a residual shunt. All survivors underwent clinical assessment with hemodynamic control in 17 cases (15 routine control catheterisations). To date it has only been necessary to change one valved tube: a good result was obtained.

Adolescent↗
PubMed1982

[Hydatid cyst of the heart diagnosed with bidimensional echography. Apropos of a case].

A hydatid cyst of the left ventricular posterior wall was diagnosed by 2D echocardiography in a 36 year old North African patient presenting with exertional dyspnoea and atypical chest pain. Clinical examination was negative but the surface ECG showed inverted T-waves in the infero-lateral leads. Postero-anterior and lateral chest X rays were initially interpreted as normal but 2D echocardiography immediately revealed a cystic cardiac tumour which very probably was hydatid, given the patient's origin. Thorough investigation showed no other localisations and hydatid serology was also negative. Left ventricular and selective coronary angiography were performed to determine the vascular relationships of the cyst: ablation was carried out under cardiopulmonary bypass and pathological examination confirmed the diagnosis of hydatid disease.

Adult↗
PubMed1981

[Cardiopathies in trisomy 21. Therapeutic indications].

Approximately 50% of patients with Trisomy 21 have congenital heart lesions and they account for 2.7% of the admissions to the Pediatric Cardiac Unit of the Cardiac Hospital of Lyons. In a series of 91 cases observed over a 10 year period (1070-1980) undergoing hemodynamic and angiographic investigation, 9 out of 10 cases - as previously reported - had the following abnormalities: endocardial cushion defect, 42.7% (39% of which were complete atrioventricular canals), ventricular septal defect, 33%, and Fallot's tetralogy, 12%. These lesions were characterised by the high incidence and precocity of pulmonary hypertension (69 out of 72 cases with a left-to-right shunt . A comparison of the hemodynamic data of children with Trisomy 21 with ventricular septal defects, and children without Trisomy 21 of the same age with ventricular septal defect showed the pulmonary arterial resistances to be significantly higher in the group with Trisomy 21, suggesting that Trisomy 21 plays a role in the pathogenesis of severe early pulmonary hypertension. The operative risk is much higher in these patients, especially with openheart surgery (4 operative deaths out of 12 cases of closure of VSD). The surgical indications are difficult to define because of the context of malformation and mental retardation, the high incidence of pulmonary hypertension and the high opertive risk requiring a large and detailed dialogue with the family.

Child↗
PubMed1981

[Remote results of corrective surgery for aortic coarctation in newborn infants and infants].

A review of 122 cases of symptomatic coarctation of the aorta in neonates and infants confirmed the need for early corrective surgery in the majority of cases, in relation to the usual coexistence of associated cardiovascular malformations. The operative risk in the newborn up to one month of age was very high (42 %) but fell very sharply thereafter (5%). Restenosis was the principal late complication (36 %), persistent hypertension being rare in this age group. The risk of restenosis (not a significant vital risk during secondary surgery) should not weigh in the balance against life saving surgery where clinical deterioration is observed despite medical therapy or due to associated malformations.

Age Factors↗
PubMed1980

[Anomalous origin of the left coronary artery from the pulmonary artery. Treatment by left subclavian-left main coronary artery anastomosis].

The technique of left subclavian-main left coronary artery is described as the treatment of anomalous origin of the left coronary artery from the pulmonary artery, without the aid of cardiopulmonary bypass, which, however, remains on standby. Through a left postero-lateral thoracotomy, the left main coronary artery is detached from the main pulmonary artery with a cuff of pulmonary wall after lateral clamping of the pulmonary artery. Tapes are encercling the pulmonary artery and the descending thoracic aorta, making them ready for an eventual connection to the standby bypass, in case the coronary clamping is not well tolerated. The anastomosis between the left subclavian artery dissected free and the prepared left main coronary artery is then possible and easy even in a small infant. This technique has been used in three infants aged three to thirty months without any mortality nor particular morbidity.

Child, Preschool↗