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Biomedical subjects

J Valty

Publications and source records attributed to J Valty.

At least 73 records · Page 4Linked to original sources
PubMed1977

[Critical study of echocardiography in mitral cardiopathies].

The importance of the echocardiogram in a study of mitral disorders has been analysed by examining 107 echocardiograms set against a clinical examination, an investigation of haemodynamic function (57), left-sided angiography (42), and/or examination at the time of operation (40). This study confirms the great diagnostic value of the echocardiographic findings in mitral stenosis (56 patients): the amplitude DE, the slope EF, the percentage of mid-diastolic closure, the echo from the valves, and the dimension of the left atria (P less than 0.001). This association remains valid if there is mitral incomptence as well as stenosis, or if there is also an aortic lesion, provided all the parameters are used. The degree of stenosis of the mitral orifice cannot be determined with sufficient certainty to allow surgical exploration to be undertaken solely on echocardiographic results, however the patients are selected (sinus rhythm, absence of calcification, mobile valve...). The echocardiographic diagnosis of the 17 cases of mitral incompetence was incomplete (except for rupture of the chords); the volume of the regurgitation is poorly appreciated.

Cardiac Output↗
PubMed1977

[Changes in the aortic prosthesis surgical risk].

Between May 1963 and December 1976, 889 patients underwent single valve aortic replacement by prosthesis. Hospital (30 day) mortality fell, with an exponential decrease (r = 0.94, p less than 0.01) to 4 per cent in 1976. Early risk factors are studied, taking into account the changes affecting them respectively over the time period considered. The average age of the patients increased but did not significantly affect operative mortality. Cardio-thoracic ratio, sex and the duration of extracorporeal circulation had little or no prognostic value. Only classification in class IV of the N.Y.H.A. and the type of valvular disease (severe incompetence) were of clearly pejorative significance. Most deaths occurred early in a context of signs of poor cardiac output, severe disturbances of ventricular rhythym, visceral (digestive) syndromes and/or thrombotic complications. They were characterised at autopsy by sub-endocardial haemorrhagic lesions. The prevalence of these lesions and that of early deaths appeared to decrease with techniques for myocardial protection during the operation.

Adult↗
PubMed1976

[Long-term results of aortic valve replacement with a prosthesis].

A long term evaluation of prosthetic replacement of the aortic valve by various types of prosthesis has been carried out; 530 patients from various centres of cardiology were studied. The average annual mortality after the first two postoperative years was about 2.5% and half of the patients undergoing surgery were still alive after 10 years. The functional improvement is usually marked and is generally to be expected, although with an increased risk, even in patients who underwent surgery at stage IV of the NYHA classification. In this study, the prostheses which were associated with the best long term results were the Starr-Edwards 1260, the Smeloff-Cutter, and the Björk. The commonest complications after the first month were dehiscence of the prosthesis (11.8%), thromboembolic episodes (11.2%), coronary complicatons (11.1%) and cardiac failure (7.1%). The most serious is infection of the prosthesis, which is almost invariably fatal. Deterioration in the substance of the prosthesis has become very rare, but there must be reservations in this respect with the SE2400, which has still not been in use long enough. Revision operations were carried out on 7.6% of the survivors at one month, with a mortality of 18.4%. Sudden death remains a constant threat. A study of the actuarial survival graphs for operated and non-operated cases shows that surgery should be advised in all poorly tolerated valve defects, and even for an uncomplicated tight aortic stenosis. Bearing in mind the progressive lowering of operative mortality, surgical treatment is also justified in cases with marked or gross aortic incompetence which is well tolerated if flow-up studies show a progressive increase in cardiac volume.

Aortic Valve↗
PubMed1976

[Valve replacement by ball prosthesis. Study of risk factors].

245 patients had consecutive operations for replacement of a valve by a ball-valve prosthesis in the aortic position (114) in the mitral position (91), or in more than one position (40) between 1970 and March 1973. The operative mortality was 14.3% (9.5% if emergency operations are excluded). A statistical study of the risk factors has shown the relatively minor influence of the patients' preoperative status (age, NYHA functional classification, cardiomegaly, mean pulmonary arterial pressure, mean capillary pressure) and of the conditions during surgery (duration of extacorporeal circulation, size of the prosthesis). The majority of the early deaths (19 deaths out of 35) occur as part of a syndrome of low cardiac output (9) and/or of a severe disorder of ventricular rhythm (11). 9 of the 14 post-mortem examinations on such patients showed a haemorrhagic subendocardial lesion and/or, in 4, an intracardiac thrombosis on the prosthesis. The coronary arteries were normal (14), or slightly atheromatous (1). The histological picture is one of a haemorrhagic interstitial infiltration mainly in the subendocardial layers. The late failures (secondary deaths and poor results) are essentially related with poor preoperative status (age, functional classification, cardiothoracic ratio) or with complications which would be treatable given proper and regular follow-up supervision of the patients (porsthesis which pulls away or fails to function, thromboembolic accident, coronary complication).

Female↗
PubMed1975

[Study of interventricular septal defects with equal aortic and pulmonary artery pressures. Classification by clinical and computer methods of 70 cases].

Application of various methods of classification to a group of 70 cases of ventricular septal defect with high pulmonary artery hypertension allowed a comparative study between the various methods aiming at distinguishing the forms with low from high pulmonary artery resistance. The reference clinical classification provides supplementary informations derived from the natural or post-operative course and eventually from the microscopic examination. The first automatic classification relies on the study of a single criterion: the pulmonary arteriolar resistance and the systemic resistance ratio. A second classification is based on the attribution of points to some clinical or haemodynamic signs resulting in a score orienting the classification of every individual. Multifactorial analysis methods deal with all the available informations for the overall group, and suppose the use of a computer. The informatic methods make it possible to study the classifying value of every sign. Correlations were established between these various techniques and the medical classification.

Adolescent↗