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Biomedical subjects

M C Malergue

Publications and source records attributed to M C Malergue.

At least 37 records · Page 2Linked to original sources
PubMed1985

Clinical and echocardiographic observations in pulmonary valve endocarditis.

Clinical and echocardiographic data from 12 patients with pulmonary valve endocarditis are described. Seven patients had isolated pulmonary endocarditis and in 5 patients other valves were infected (aortic, tricuspid, mitral or all 3). Two patients were heroin addicts and 4 had underlying heart disease (congenital heart disease in 3 and aortic regurgitation in 1 patient). The organisms involved were alpha streptococci in 3 patients (all with underlying heart disease), Staphylococcus aureus in 4, Streptococcus D bovis in 1 patient and Candida guillermondii in 1. M-mode and 2-dimensional echocardiography was performed in 10 patients and revealed vegetations in 8. Pulsed Doppler echocardiography was performed in 6 patients and revealed pulmonary regurgitation in all 6. Seven patients had pulmonary emboli. Four patients underwent surgery. Four patients died, including 1 after cardiac surgery. Five patients, including the patient infected with Candida guillermondii, recovered with antibiotic treatment.

Adolescent↗
PubMed1985

Atrial septal aneurysm--a potential cause of systemic embolism. An echocardiographic study.

Atrial septal aneurysm is an uncommon condition. Between 1981 and 1984 10 cases of atrial septal aneurysm were diagnosed by real time cross sectional echocardiography performed in 4840 patients. The aneurysm was associated either with mitral valve prolapse (three patients) or with atrial septal defect (three patients) or occurred in isolation (four patients, two of whom had had a previous embolic event leading to the diagnosis of atrial septal aneurysm by cross sectional echocardiography). During cross sectional echocardiography the aneurysm appeared as a localised bulging of the interatrial septum, which was best seen in the subcostal four chamber view and in the parasternal short axis view at the level of the aortic root. The aneurysm either protruded into only the right atrium (five patients) or moved backwards and forwards between the right and the left atria during the cardiac cycle (five patients). This motion pattern might be related to changes in the interatrial pressure gradient. The two patients who had had a systemic embolism were given anticoagulant treatment, but none underwent surgery. It is concluded that the true prevalence of atrial septal aneurysm might have been underestimated before the routine use of cross sectional echocardiography, that cross sectional echocardiography enables definitive diagnosis of this condition by a non-invasive technique, and that an atrial septal aneurysm should be suspected and looked for by cross sectional echocardiography after an unexplained systemic embolism.

Adolescent↗
PubMed1984

[Aorto-septal angulation: a new cause of disorder in left ventricular ejection? (a 2-dimensional echocardiographic study apropos of 66 cases)].

Aorto-septal angulation is defined as an acute angled connection between the anterior aortic wall and the interventricular septum. It is quite a common 2D-echo finding. Does it correspond to a simple anatomical curiosity or is it associated with certain well defined diseases? Could it be a cause of obstruction to left ventricular ejection? To try to answer these questions, 66 consecutive cases of aorto-septal angulation were analysed; the echocardiographic and clinical data were correlated. The dynamic features of angulation were studied during the cardiac cycle and the investigations were completed by a phonomecanogramme with pharmacodynamic stress tests. All patients had cardiovascular pathology: aorto-septal angulation was not observed in normal subjects. The dynamic 2D-echo study distinguished two types of angulation with respect to the cardiac cycle: predominantly diastolic angulation tending to correct itself in systole (16 patients: Group CI); the majority of these patients had severe compensated aortic regurgitation; fixed angulation with no significant change between diastole and systole (50 patients: Group C2). This group consisted of patients with ventricular deformation due to coronary artery disease and patients with hypertension associated in some cases with other pathologies. Phonomecanography with pharmacodynamic stress testing in Group C2 revealed the possibility of dynamic obstruction to left ventricular ejection (6 cases) and the apparition of an ejectional systolic murmur (2 cases). Aorto-septal angulation seems to be closely related to hypertension (57% of patients) irrespective of age. Therefore, it should not be classified exclusively as a change observed in the "aging heart" but it may be the direct consequence of an adaptation to systolic strain of the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

[Right intraventricular tumors. Apropos of a case].

The authors report a case of right ventricular tumour in a 16 year old girl who presented with dyspnoea on effort, chest pain on exertion and loss of consciousness. The diagnosis was made on the basis of abnormal right intraventricular echoes on two dimensional echocardiography and was confirmed by angiography. The patient was operated with success. Histology revealed a mesenchymoma, a benign tumour, but whose infiltrating nature calls for a reserved prognosis. The echocardiogram can be used for regular post-operative surveillance. The young patient is well after 18 months' follow-up.

Adolescent↗
PubMed1983

[Visualization by bidimensional echocardiography of the trunk of the left coronary artery. Affirmation of its integrity before coronary angiography].

The aim of this study was to visualise and analyse the status of the main left coronary artery by 2D echocardiography before coronary angiography. Fifty two patients were studied. The recordings were performed from the left parasternal position on video cassettes and played back frame by frame for each patient, to analyse the left main coronary artery and its bifurcation. The patients had known stenosis of this vessel; there were echocardiographic abnormalities in all 10 cases; the stenosis was visualised directly in 5 patients and the vessel was considered to be abnormal in the other 5 patients. Forty two patients underwent 2D echo before coronary angiography. The echo of the left main coronary artery was considered to be abnormal in 8 patients: these results were compared with those of coronary angiography. In 33 cases there were no echocardiographic abnormalities and there were no angiographic lesions. The false positive results were due to the inability to record the bifurcation (proximal stenosis of the LAD interpreted as stenosis of the left main coronary) or to the direction of the left main coronary which is curved and thus cannot be analysed in the plane of the transducer. False negative results corresponded to slight stenosis (less than 50 p. 100). The bifurcation can be visualised in 60 p. 100 of patients with normal left main coronary arteries. It is only in these cases that the absence of significant lesions can be confirmed before coronary angiography.

Constriction, Pathologic↗
PubMed1983

[Treatment with intracoronary streptokinase in the acute phase of myocardial infarct. Preliminary results apropos of 20 cases].

Twenty patients with primary myocardial infarction (mean age 55 years +/- 6) were treated with intracoronary streptokinase in the acute phase. The mean interval between the onset of chest pain and treatment was 4 hours 30 minutes (extremes, 30 minutes and 6 hours). The total quantity of streptokinase required to obtain coronary revascularisation varied from patient to patient and with the technique used, but it was less than 350,000 units in all cases. The immediate results were favourable in 80 p. 100 of cases with respect to the coronary obstruction, in 50 p. 100 of cases with respect to relief of pain and in 35 p. 100 of cases with respect to ST elevation. It is not possible to confirm the efficacy of this therapy in left ventricular function from the results of this preliminary study. The authors observed, however, that the best results as assessed by 2D echocardiography, left ventricular angiography, and Thallium 201 myocardial scintigraphy were obtained in patients treated early (before the 3rd hour). They emphasise the need to check the level of antistreptokinase antibodies before starting treatment to assess the optimal total dosage for each individual patient, in order to obtain a local effect without disturbing the overall coagulation mechanism.

Adult↗
PubMed1981

Localization of the origin of systolic clicks using echo-pulsed Doppler technique.

Echo-pulsed doppler (EPD) studies were performed in 2 surgically controlled patients with systolic clicks. The recorded blood samples documented the click to be originated in the right atrium, at the site of the prolapsed anterior tricuspid leaflet in 1 case of heroin-induced tricuspid acute endocarditis. In the second patient suffering from aortic valve disease, an ejection click was recorded, and could be demonstrated by using EPD, to originate from the aortic leaflet at its time of maximal excursion. EPD apears to be a safe, noninvasive method to solve the problem of the origin of systolic clicks.

Adult↗
PubMed1980

[Pulsed echo-Doppler diagnosis and evaluation of tricuspid valve, and interventricular and interatrial communication insufficiencies. Flowmeter study of shunts].

A group of 44 patients with a total of 48 cardiac lesions ( 22 tricuspid incompetence - TI - , 12 ventricular septal defect - VSD - and 14 atrial septal defect - ASD - , and two control groups of 20 normals and 23 patients with other cardiac disease , were studied by pulsed Doppler echocardiography ( PDE ) . The flow patterns recorded in the normal right heart were identical to those recorded previously during catheterisation . TI was diagnosed by the presence of an abnormal negative systolic wave usually associated with widening of the time interval histogram with a specificity of 82 % and a sensitivity of 86 % . An acceptable semi-quantative assessment of the severity of regurgitation was obtained in 83 % by comparing the amplitude of the negative systolic wave with that of the positive diastolic wave . Shunts were diagnosed by detecting septal or tricuspid turbulence with a sensitivity of 83 % and a specificity of 90 % . A satisfactory assessment of the size of the shunt was obtained in 90 % of diagnosed cases by assessing the pulmonary and infundibular flow patterns . A systolic wave starting with isometric contractions , followed by positive early and late diastolic waves and some intermediary negative oscillations of variable amplitude were recorded along the right side of the interventricular septum in 75 % of VSDs . In 78 % cases of ASD a large late systolic - early diastolic wave overriding the second heart sound , followed by positive mid and late diastolic waves of variable size , according to the heart rate , were recorded in the right atrium . In conclusion , PDE recording of blood flow patterns and turbulence in the right heart is a useful non-invasive method of diagnosis and assessment of these three cardiac lesions . It provides a valuable contribution towards the physiopathological study of shunt patterns in atrial and ventricular septal defects .

Adult↗
PubMed1980

[Ventricular arrhythmias and mitral valve prolapse. A study of 35 cases].

35 patients with mitral valve prolapse (MVP) underwent investigation by Holter monitoring with computerised analysis. Ventricular arrhythmias were observed in 70% patients with MVP. There does not seem to be a close correlation between the severity of the arrhythmia and the degree of prolapse. The mechanisms of the ventricular arrhythmia are variable: two patients had the necessary criteria for ventricular reentry, at least six had parasystolic foci, protected or not from the sinus rhythm. The most severe ventricular arrhythmias are characterised by their variable morphology (but usually showing right bundle branch block), a clear diurnal rhythm, the inducing role of exercise or emotion and a greater diurnal variation of the sinus rhythm suggesting increased sympathetic tone. The results of beta blockade are better in the patients with the most marked diurnal rhythms.

Arrhythmias, Cardiac↗
PubMed1979

[Echocardiographic findings in the papyraceous right ventricle syndrome].

The echocardiographic findings in a young man with a "paper-thin right ventricle" or Uhl's anomaly are reported. The usual signs of right ventricular diastolic overload with slight delay in tricuspid valve closure were observed. The discordance between the normal clinical examination and the pathological appearances on echocardiography led to cardiac catheterisation which established the diagnosis.

Adolescent↗
PubMed1979

[Echocardiographic diagnosis of 4 cases of tricuspid valve endocarditis].

Four tricuspid endocarditis cases are reported. Echocardiography found, four times, large vegetations on the tricuspid leaflets leading to the diagnosis. The degree of tricuspid insuffisancy was appreciated by the RV/LV ratio. Successive echos have permitted to survey the evolution and specially to establish a clear decrease of abnormal tricuspid echoes succeeding to pulmonary embolisms. In the four cases, surgery confirmed the diagnosis.

Adolescent↗
PubMed1979

[Value of echocardiography in cardiovascular emergencies (not including congenital cardiopathies)].

The principal echocardiographic features of the main cardiovascular emergencies are discussed. After setting out a method of detailed analysis for echocardiography, the changes found in the main causes of severe chest pain, systemic embolisation and sudden heart failure are described. Special emphasis is laid on the signs of aortic root dissection, pericarditis and tamponade, ruptured valve, the mechanical complications of acute myocardial infarction and, in particular, on the assessment of residual myocardial function. Finally, the authors maintain that echocardiography should be a systematic complementary investigation for patients in the coronary care unit.

Aortic Dissection↗
PubMed1979

[Traumatic rupture of the aortic valve. Echocardiographic aspects. Apropos of a case].

The appearance of a diastolic murmur in a pyrexial patient 15 days after trauma was suggestive of infectious endocarditis. This diagnosis was excluded, especially by echocardiography, and the aortic incompetence was attributed to the trauma. The value of echocardiography and the features of other reported cases are discussed with referrence to this case.

Accidents, Traffic↗
PubMed1977

[Left atrial myxoma: a surgical emergency. Apropos of 2 cases].

This study reports on two more cases of left atrial myxoma. They were two women with embolic manifestation for several years and in whom the diagnosis was not clinically considered. It was made by echocardiography. Emergency surgery was applied in both cases one of whom without hemodynamic study. The presence of a recent brain embolism did not seem to us to be a contraindication to this surgery. In both cases the tumoral pedicle was implanted on the posterior wall of the left atrium, an unusual location.

Arrhythmias, Cardiac↗