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Biomedical subjects

J P Binet

Publications and source records attributed to J P Binet.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Endoluminal mitral valvuloplasty in young adults and children. Apropos of 10 cases].

Between April 1 and May 15, 1986, transluminal dilatation of the mitral valve was performed at the Marie-Lannelongue Hospital, near Paris, in 10 patients aged from 12 to 48 years (mean 25,3 years) suffering from rheumatic mitral stenosis with supple valve leaflets. The procedure, carried out under local anaesthesia, included trans-septal catheterization followed by installation of one, then usually two balloons opposite the mitral orifice. The total diameter of the balloons was often greater than that of the mitral annulus. No haemorrhage, embolism or arrhythmia was observed. A significant left-to-right shunt, evaluated by radioisotope exploration with technetium pyrophosphate performed on the 8th day, was present in only one patient. The LV-LA end-diastolic gradient fell from 14.4 +/- 9.8 to 4.6 +/- 3.4 mmHg (p less than 0.01). The mean pulmonary arterial pressure was reduced less significantly from 39.9 +/- 18.4 to 27.2 +/- 11.3 mmHg (p less than 0.02). The cardiac output was only moderately increased from 2.52 +/- 0.48 to 2.88 +/- 0.66 l/min/m2. The mitral valve area, measured from the smaller axis on 2-dimensional echocardiography, more than doubled, reaching a mean value of 1.99 +/- 0.56 cm2. This figure was confirmed by the reduction, at Doppler velocimetry, of the gradient half-regression time from 267 +/- 62 to 118 +/- 46 ms (p less than 0.01). Similarly, the end-systolic gradient evaluated by Doppler, fell from 17.5 +/- 8.9 to 5.3 +/- 4.7 mmHg (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Long-term course after palliative surgery in children with a single ventricle].

Single ventricle or univentricular heart is a rare congenital malformation (1/10 000) which has a very poor prognosis. The cases of 68 children with single ventricles who had palliative surgery between January 1964 and December 1982 were studied. The average age of the patients at surgery was 4.41 +/- 5.8 years; 36% of the children were under 1 year of age. Surgery consisted in 48 systemico-pulmonary anastomoses and 20 pulmonary artery bandings. The global mortality was 22% (16% in the anastomosis group and 35% in the banding group). Age seemed to be an important factor: 25% mortality in children under the age of 1; 2.4% in children over 1 year (p less than 0.05). The 15 year survival rate was 43 +/- 23% overall; 56 +/- 28% in children with anastomoses and 20 +/- 28% at 8 years in children with banding. Although surgery did not appear to improve survival it probably did improve survival it probably did improve the quality of life; 73% of the survivors has satisfactory functional results and the efforts of everyday life were well tolerated. However, the evolution was complicated in 10% of cases by infection and neurological complications, and atrioventricular regurgitation was observed in 7 patients, requiring valve replacement in 2 cases. Our results are globally comparable with those of similar previously reported studies. The best published results of physiological correction of single ventricle (Fontan, septation) are relatively unsatisfactory with a mortality rate of about 35%. Therefore, palliative surgery still appears justified in these cases.

Aorta↗
PubMed1986

[Surgical anatomy of the interventricular communications of the septal trabecula].

Muscular ventricular septal defects (VSD) are a special anatomical and surgical entity. They are observed in 85% of cases of multiple VSD. This study was based on the operative findings in 70 patients and 20 pathological specimens of muscular VSD. A surgical topographic classification is proposed, superior, intermediate and inferior, with a specific surgical approach for each of the three types. The superiorly situated muscular VSDs are approached through the right ventricle, the intermediate ones through the right atrium and the inferior through the right atrium or left ventricle. Section of the moderator band greatly facilitates the exposure of the intermediate and inferior segments of the septum through the tricuspid valve. Left ventriculotomies should be reserved for inferiorly situated muscular VSD with right ventricles of small volume.

Heart Septal Defects, Ventricular↗
PubMed1986

[Diagnosis of cellular respiratory arrest by NADH laser fluorimetry. Applications in heart surgery and in experimental pharmacology].

The continuous measurement of intratissular NADH concentration allows early detection of cellular respiration arrest during clinical situations, i.e. allows a non-destructive, in situ, continuous measurement of ATP formation. This detection enables the physician or surgeon to intervene during a phase of cellular respiration arrest, before structural cellular alterations occur, thereby preventing potential tissular necrosis. The method has now been validated in experimental cardiac surgery for the monitoring of myocardial preservation techniques during cardiopulmonary by-pass, and in cardiac pharmacology, for analysis of drugs' effects on myocardial energetic metabolism. Its industrial development is currently under way. Preliminary investigation strongly suggests the vast potential of this diagnostic method in both clinical and experimental fields.

Adenosine Triphosphate↗
PubMed1986

[Surgical treatment of complete atrioventricular canals, regular and irregular forms, in 75 patients].

The cases of 75 consecutive patients operated for complete atrioventricular canal between 1/1/1978 and 1/1/1985 at Marie-Lannelongue Hospital were reviewed. The age ranged from 1.5 months to 16 years. Forty-nine per cent of patients were operated in the first year of life in the period 1982-1984. Seventy-eight per cent of patients were operated before one year of age. Certain anatomical characteristics enable regular and irregular forms of the condition to be distinguished. Regular forms are characterised by the association of a defect of the inter atrio-ventricular septum, of a common atrioventricular orifice and of ventricles of equal volume without other associated malformations. Irregular forms include the parachute mitral valve, the double mitral orifice, deficient mitral valvular tissue, ventricular hypoplasia, subaortic stenosis, abnormal right ventricular muscular bands, associated cardiac malformations and pulmonary obstructive vascular disease. Surgery comprises repair of the ventricular septal defect and the ostium primum with two separate patches, respecting the anterior and posterior valves and partial or complete closure of the cleft valve. The hospital mortality rate was 33 p. cent. It was 16 p. cent in regular forms and 58 p. cent in irregular forms (p less than 0.01). The hospital mortality of patients operated before 1 year of age with the regular form of the malformation was 22 p. cent. Six children were reoperated secondarily with 2 deaths. Four pacemakers were implanted for complete atrioventricular block. The secondary mortality was 10 p. cent. Thirty-nine patients were followed up for an average of 28 months (range 3 months to 5.5 years).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Thymoma epithelial cells secrete thymic hormone but do not express class II antigens of the major histocompatibility complex.

17 thymomas were studied by indirect immunofluorescence for the presence of thymic hormones and antigens of the major histocompatibility complex (MHC). The thymoma epithelial cells (specifically identified by their keratin content) contained thymic hormones (thymulin and thymosin alpha 1), a finding corroborated by the observation of elevated thymulin serum levels. In contrast with normal or hyperplastic thymuses, thymoma epithelial cells did not express HLA-DR and HLA-DC antigens as assessed by immunofluorescence as well as immunoblot analyses. Conversely, MHC class I antigens (HLA-ABC) were normally expressed. Thus, we conclude that thymoma epithelial cells are endocrinologically active but are defective for the expression of some MHC products (class II molecules) known to play an essential role in intrathymic T cell differentiation.

Adult↗
PubMed1985

[Adult pulmonary valvular stenosis, major stenosing right ventricular hypertrophy and tricuspid insufficiency. Apropos of 2 cases].

2 cases of severe pulmonary valvular stenosis in two young adults aged 21 and 29 years respectively are presented. Despite the degree of stenosis (4 mm jet), the right ventricular pressures did not exceed systemic pressures because of severe tricuspid regurgitation. This dominated the clinical and anatomical findings, causing aneurysmal dilatation of the right atrium and displacement of the tricuspid valve to the left. The diagnosis of Ebstein's anomaly was raised in one case but excluded by echocardiography and angiocardiography. In spite of the severity of the symptoms and peripheral clinical signs, surgery of the right ventricular outflow tract, tricuspid valvuloplasty and resection of part of the right atrium led to a complete and rapid cure, confirmed by catheterisation one month after operation.

Adult↗
PubMed1985

[Anatomopathology, physiopathology and treatment of the emphysematous disease of infants (apropos of an experience with 133 surgically treated cases)].

Infantile and childhood lobar pulmonary emphysema (LPE) has finally become a rather straightforward problem after 28 years experience and the important statistics published. Contrary to adult emphysema, and leaving aside the particular aspects of causal lesions, the pediatric form is usually a unilateral lobar or infralobar disorder, and therefore lends itself to surgical treatment.

Adolescent↗
PubMed1985

[Two-dimensional echocardiography of coronaro-cavitary fistulas].

4 cases of congenital coronary arteriovenous fistulae in children 20 days to 10 years old were studied by 2D echocardiography. The coronary fistulae were treated surgically in all four cases after biplane aortography and selective coronary arteriography. The visualisation of the coronary arteries was performed by systematic use of several echocardiographic views: - left parasternal short axis view through the aortic root, - apical view, - longitudinal and transverse subcostal views. 3 cases of coronary fistulae between the right coronary artery and a cardiac chamber were diagnosed on the basis of significant dilatation (9 to 12 mm) of the right coronary artery, though the origin and diameter of the left coronary artery were normal. 1 case of a fistulae from a single left coronary artery was not diagnosed despite the demonstration of dilatation of the left main stem. Conversely, there were no false positive 2D echocardiographic diagnoses during the study period. The communication of the coronary fistula to the receiving cardiac chamber was demonstrated in two cases (right atrium: 1 case, left atrium: 1 case, on apical and subcostal views. It was not possible to visualise the communication of the coronary fistula with the right ventricle in the other two cases. 2D echocardiography is a non-invasive method of diagnosing coronary arteriovenous fistulae, but the development of a fistula on a single left coronary artery is a potential source of diagnostic error.

Angiography↗
PubMed1985

[Aortic subvalvular stenosis caused by accessory mitral tissue].

Three cases of subaortic stenosis due to accessory mitral tissue are presented. The diagnosis of the cause of obstruction was correctly established in each child before surgery, by 2D echocardiography and cineangiography. Resection of the accessory mitral tissue through a simple aortotomy gave excellent results. The eight previously published cases are discussed, emphasising the importance of accurate preoperative diagnosis. The cause of obstruction is difficult to determine at surgery, which may have disastrous consequences, whilst simple resection of the abnormal tissues leads to a complete and definitive cure.

Aortic Stenosis, Subvalvular↗
PubMed1985

[Malformations of the tricuspid valve associated with Fallot's tetralogy. Apropos of a series of 224 surgically treated Fallot's tetralogies].

This study was based on 7 children aged 20 months to 13 years with tetralogy of fallot (TOF) and tricuspid valve defects. Cases of endocardial cushion defects (8 cases of atrioventricular) were excluded. Three types of tricuspid valve defect were observed: 4 tricuspid valve prolapse (with one associated mitral valve prolapse); 2 accessory tricuspid valves passing through a ventricular septal defect to prolapse in diastole under the aortic valve; 1 Ebstein anomaly. The prevalence of tricuspid valve defects associated with TOF 3 p. 100 in this series. The diagnosis can: usually be made by 2D echocardiography. Tricuspid valve prolapse (usually the septal leaflet) is visualised in the apical 4 chamber view. The passage of accessory tricuspid tissue across the VSD into the left ventricular outflow tract is visible in the parasternal long axis or subcostal long axis views. Ebstein anomaly can be demonstrated in apical 4-chamber views showing the abnormally apical site of insertion of the septal leaflet of the tricuspid valve and "atrialisation" of part of the right ventricle. Tricuspid valve defects did not pose any special surgical problems during complete repair of TOF but this series did not include any cases of tricuspid hypoplasia or parachute tricuspid valve which have been reported in the literature and which do complicate surgery. Tricuspid valve and subendocardial cushion defects should be looked for systematically in patients with TOF undergoing 2D echocardiography.

Adolescent↗
PubMed1985

[The variability in the duration of human atrial action potentials increases with age].

35 human atrial samples, presenting electrophysiological characteristics within "normal" limits, were studied in vitro. 19 were sampled from adult patients and 16 were sampled from very young patients. Maximum diastolic potential did not significantly differ between adult and young, either in mean value or in variability. Action potential duration increased with age, particularly during the earliest years of life. The variability of action potential duration, which is considered as an arrhythmogenic factor, is greater in the adult.

Action Potentials↗