Biomedical subjects
Publications and source records attributed to M Dallocchio.
To-day, two dimensional echocardiography represents a fundamental technique for diagnosis in cardiovascular emergency in the adult. The appropriate place for that type of examination is in different pathologies such as acute myocardial infarction, cardiac tamponade, dissecting aortic aneurysm, pulmonary embolism, dysfunction of prosthetic cardiac valves.
The case of a young man hospitalised for bilateral lower limb deep vein thrombosis is reported. None of the usual causes were found after systematic wide-ranging investigation. The only abnormality on admission was a spontaneous increase in the cephalin-kaolin time to 65 seconds compared to a control time of 40 seconds. Measurements of the clotting factors showed a moderate and isolated deficiency in factor XII (30 p. 100), also present in a brother (50 p. 100) and a sister (42.5 p. 100). Fibrinolytic therapy was administered : an initial course of Streptokinase was followed by extension of a left femoral vein thrombosis and pulmonary embolism. Two courses of Urokinase were given with an eight day interval without significantly improving the venous circulation. This case is an example of thrombogenic disease due to a deficiency of a clotting factor resulting in non-activation of physiological fibrinolysis.
This case of an intracardiac myxoma observed in a 15 year old girl had several points of interest: the mode of presentation: the clinical signs were exclusively systemic and articular; the mode of diagnosis: 2D echocardiography demonstrated an immobile, dense mass about the size of a walnut implanted on the ventricular surface of the posterior mitral leaflet along the whole of its base and seemingly adherent to the ventricular wall; the intraventricular location of the tumour (exceptionally rare) and its mitral valve origin. The site of the tumour imposed mitral valve replacement but we were able to discuss the surgical approach using the results of echocardiography before surgery and a bioprosthesis was inserted to protect the maternal future of the patient.
The authors report another case of successful endocavitary electrocautery in a young woman with Wolff-Parkinson-White syndrome. The pre-excitation was controlled by the administration of two 250 joule electrical shocks applied to the atrial origin of the right anterior bundle. The clinical and laboratory tolerance were satisfactory. Although these results are encouraging, other studies are required in order to define the indications and protocols of electrocautery of accessory pathways.
This study was carried out on 12 hospitalized hypertensive patients to assess the antihypertensive efficiency and the duration of action of a once daily dose of atenolol. 100 mg of atenolol was given at 8 am every day for 5 days. Before and during the therapeutic period. 24-h blood pressure recordings were obtained with a continuous, automatic, non-invasive method working on the principle of oscillometry (Dinamap 845.950). Atenolol induced a significant reduction in mean blood pressure from 119 +/- 3.6 to 102.3 +/- 4.7 (P less than 0.001). This effect was significant from the very first day of treatment and was maintained over the duration of the study in ten patients. The decrease in blood pressure induced by atenolol lasted 24 h. Clinical tolerance of atenolol was excellent. In particular no case of excessive bradycardia was noted.
The new anti-arrhythmic agent flecainide was compared in a single-blind cross-over study to arabogalactane quinidine sulfate in the treatment of stable chronic extrasystole, using a fixed twice-daily dose protocol. Results were assessed by the Holter method. 12 patients (7 men and 5 women) with an average age of 56.5 were selected on the basis of stable and essentially ventricular extrasystole (VES) in 11 cases, and essentially atrial extrasystole (AES) in the remaining case. All patients however had some VES and 6 had some AES, and 5 patients had bursts of VES. The protocol provided for four sequences lasting one week each: one fixed, for selection, and the other three random, flecainide (375 mg), quinidine (660 mg), or placebo (2 doses). Data on each were recorded for Holter analysis. Statistical comparison of results was performed by studying variances on an equilibrated block. Comparison between the selection and placebo sequences showed the stability of the arrhythmia whatever its type. Against ectopic complexes as a whole, only flecainide had significant activity (p less than 0.01). Against AES, both compounds were active (p less than 0.05), quinidine more than flecainide (-73%/63%: a non-significant difference). Only flecainide was active against VES (-88.5%). Quinidine did not significantly reduce VES (-56%).(ABSTRACT TRUNCATED AT 250 WORDS)
Although rare, cardiac amyloidosis is the commonest cause of infiltrative myocardiopathy. The diagnosis may be suspected clinically in patients with mainly right ventricular failure of sudden onset. The aim of this study was to assess the diagnostic value of M-Mode and 2D echocardiography in this condition. Seven cases of cardiac amyloidosis were studied. Biventricular hypertrophy, usually more severe on the left side with reduction in size of the left ventricular chamber, was observed in all cases. Parameters of systolic and diastolic function were abnormal. A significant pericardial effusion was demonstrated in 3 patients. 2D echocardiography also allows evaluation of the myocardial structure: in 3 cases the whole of the left ventricular myocardium seemed granular, sparkling and abnormally echogenic. In patients with cardiac failure these appearances are very suggestive of amyloidosis, especially when the ECG shows low voltage complexes and pathological Q waves. In 3 other patients, this abnormal echogenic myocardial appearance was observed only in the interventricular septum, which is much less suggestive of cardiac amyloidosis. In conclusion, in patients with cardiac failure with cardiomegaly and a low voltage ECG, echocardiographic findings of hypertrophic cardiomyopathy (only rarely with dilatation) and hypokinetic wall motion are suggestive of cardiac amyloidosis, especially when the myocardium has a granular, sparkling appearance.
The aim of this study was to assess whether, as previously reported series have suggested, aortic valve replacement is too late when echocardiography shows a left ventricular end systolic diameter (LVS) greater than or equal to 55 mm, a left ventricular fractional shortening (FS) less than or equal to 25%, and a ratio of left ventricular radius to wall thickness (R/H) greater than or equal to 4. Sixty-seven patients with pure chronic aortic regurgitation were operated in the period between 1979 and June 1981. All had at least one good quality preoperative M mode recording. Using the above mentioned parameters, the patients were divided into two groups: Group I (n = 41) "good surgical candidates" with LVS less than or equal to 55 mm, FS greater than 25%, and/or R/H less than 4; and Group II (n = 26) "high risk candidates" with LVS greater than 55 mm, FS less than or equal to 25% and/or R/H greater than or equal to 4. The clinical improvement was spectacular in both groups after surgery (mean follow-up 28 +/- 8 months). There were no operative deaths but 5 patients out of each group died secondarily. An echocardiogram was recorded in the immediate post-operative period in 55 cases; there was a significant reduction in LV diameters in both groups but the values in Group II remained higher. A control echocardiogram was recorded 17,5 +/- 8,9 months later 46 cases. The LV diameters had returned to normal in Group I but remained at the upper limit of normal in Group II. We conclude that patients with echocardiographic indices of " high risk " usually have a favourable postoperative course. However, although the echocardiographic parameters to improve, they do not return completely to normal.
Modifications of attention in cardiovascular field with the aim of a perceptive activity focused on a vegetative feature may include in man: a specific arousal component linked to significant visual information (blood pressure); an unspecific attention component (P300), obvious in modifications of averaged visual response in the same time to a background unsignificant stimulation.
Ultrasound provides anatomical (wall thickness, diameter) and functional (thickening of the wall, ventricular ejection, ventricular filling) information about the left ventricle. The reliability and reproducibility of these measurements have been improved by the development of mono and bidimensional techniques, so that, today, ultrasound is the method of choice for the investigation and surveillance of left ventricular function, provided it is of good quality. Apart from the indirect information about left ventricular function drawn from mitral or aortic traces, the echocardiogram has proven to be a reproducible method for estimation of the thickness of the ventricular wall, the ventricular diameters and the left ventricular muscle mass. Whatever the geometry of the left ventricle, the ventricular volume is assessed most accurately by bidimensional ultrasound.
To assess the prevalence of asymmetric septal hypertrophy (ASH) in hypertensive patients, 613 echocardiographic examinations performed over a period of one year were reviewed. Asymmetric septal hypertrophy (defined by an echocardiographic interventricular septum to left ventricular free wall thickness ratio of greater than or equal to 1.3 and by the presence of suggestive two-dimensional echocardiographic abnormalities) was found in 28 patients (5%). Clinical characteristics of asymmetric septal hypertrophy were assessed in 101 patients who underwent a complete evaluation. Patients with asymmetric septal hypertrophy (n = 9) were compared with patients with echocardiographic symmetrical left ventricle hypertrophy (n = 38) and without left ventricular hypertrophy (n = 54). Our results indicate that neither the severity of hypertension, nor the renin-angiotensin system nor sympathetic nerve activity appear to be the primary determinants in the development of asymmetric septal hypertrophy.
UNLABELLED: Recent improvements in surgical technics have dramatically changed the outcome of patients with aortic dissection (AD). The aim of this work is to evaluate the reliability of two dimensional echocardiography (2DE) in the diagnosis of AD. The 2DE was recorded in all patients with a systematic approach in order to visualize the entire aorta (Ao). 58 cases were studied in a three years period. At the beginning of this study we validate 2DE by comparison with angiography (angio) in 14 of our first patients: the 2 angio criteria (dilatation, abnormal intraluminal image) have been found on 2DE in 12 pts (92%), with intraluminal image) have been found on 2DE in 12 pts (92%), with no significant difference between internal diameter of Ao on angio and 2DE. In our experience with 58 pts a positive diagnosis was possible in 90% of AD type I and only 18% of AD type III. IN CONCLUSION: 2DE is a practical and valuable method for the assessment of type I and II AD. Two 2DE criteria must be present at the same anatomical level (dilatation, abnormal intraluminal echo). In these conditions we have been able to avoid aortography in 26 of our last patients with type I and II.
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We studied the effects of left ventricular hypertrophy (LVH) induced by one clip-two kidney Goldblatt hypertension on coronary circulation of conscious rats. Twenty four weeks after clipping, coronary blood flow per unit mass after pharmacological dilation by carbochrome (6 mg/kg) (coronary flow reserve-CFR) was measured using radioactive microspheres. Coronary flow reserve remained normal either during development or LVH in untreated rats or after reversal of LVH in rats treated with captopril or nephrectomy. An appropriate relationship between pressure and mass, which varied in parallel, layed a significant role in maintaining a normal CFR. This, if confirmed in man, our results would suggest that antihypertensive drugs that alter this relationship by decreasing pressure but not LV mass may adversely affect CFR.
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The mechanism of arrhythmias in mitral valve prolapse (MVP) is still unclear. The aim of this study was to determine if there were electrophysiological features common to patients with MVP. Eighteen patients with MVP documented on echo and angiocardiography underwent electrophysiological investigation. The series comprised 5 patients with ventricular arrhythmias and 5 with supraventricular arrhythmias, two of whom had ECG appearances of the Wolff-Parkinson-White, syndrome, and one a short PR interval. The RR interval, PR interval, intraatrial conduction (PA), atrio-hisian conduction (AH), intraventricular conduction (HV) the effective refractory periods of the atrium, AV node and ventricle, and the corrected sinus node recovery time were measured in the MVP group and in 20 presumed normal control subjects. There was a significant increase in the PR interval (p less than 0,05) at the expense of nodal conduction (AH) in the MVP group. In addition the Wenckebach point was significantly lower in this group. The other electrophysiological parameters in spontaneous rhythm and the atrial, AV nodal and ventricular refractory periods were the same in both groups. Sinus node function was comparable in both groups. In two patients without paiviously documented tachycardia, junctional tachycardia was initiated by provocative stimulation. However, no ventricular arrhythmias could be induced by pacing. A large number of preexcitation syndromes was observed in the MVP group (4/18), including one case of a latent Kent bundle, in patients with paroxysmal supraventricular tachycardias. On the other hand, the value of electrophysiological investigation seems to be limited for clarifying the mechanisms of the ventricular arrhythmias, probably because of their endomyocardial origin. Nevertheless, hemodynamic investigation showed abnormalities of left ventricular contraction in 4 of the 5 patients with ventricular arrhythmias.
Echocardiography is a practical and reliable method of detecting endocardial vegetations. The aim of this study was to assess the course of echocardiographic vegetations in bacterial endocarditis under anti infectious therapy and to assess the prognostic significance of the vegetations. Twenty four patients with echocardiographic signs of vegetations were included in a standardised protocol: M mode and 2D examination at the beginning and at the end of medical treatment and when possible after bacteriological cure (average period of follow-up 16 +/- 6 weeks). Special attention was paid to the volume (assessed I to III) and acoustic density of the vegetations. Fifteen patients underwent surgery (62.5%). The size of the vegetations did not differ significantly from that observed in the other patients. The size of the vegetations remained constant during medical therapy and after bacteriological cure in 2/3 of cases. The vegetations grew during medical therapy (even when the patients were apyrexic) in 29% of cases, and even after a 40 day course of anti infectious therapy in 2 cases. The size of the vegetations decreases in 3 cases during treatment (2 cases of embolisation) and in 2 cases after bacteriological cure (without embolisation). No correlations could be drawn between the acoustic density of the vegetations and the outcome. In conclusion, the presence of a large vegetation in bacterial endocarditis does not in itself mean a poor prognosis. However, these large vegetations are often associated with severe mutilating lesions (62.5% in our series). The size of the vegetations remained unchanged during and after medical treatment in two thirds of cases.
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