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Biomedical subjects

M M Massin

Publications and source records attributed to M M Massin.

32 records · Page 2Linked to original sources
PubMed1999

Cardiac autonomic dysfunction in diabetic children.

OBJECTIVE: Adults with type 1 diabetes may have abnormal alterations in heart rate variability (HRV) due to cardiac autonomic neuropathy. This prospective study was performed to determine whether HRV can be used to detect subclinical autonomic neuropathy in diabetic children. RESEARCH DESIGN AND METHODS: We examined five time domain and three frequency domain HRV indices determined from 24-h Holter recordings in 73 diabetic children and adolescents aged 3-18 years (mean 12.1 years) with a mean duration of diabetes of 55 months. The measures were compared with normal ranges. Z scores were established for each parameter and were compared with classic risk factors of other diabetic complications. RESULTS: Most HRV indices were significantly depressed in children aged > or = 11 years, and the levels of HRV abnormalities were significantly correlated with long-term metabolic control (mean GHb for 4 years) in that age-group. In younger patients, HRV indices were within the normal range and were not correlated with the level of metabolic control. Illness duration and microalbuminuria but not short-term metabolic control (most recent GHb) were also independently predictive of HRV abnormalities. CONCLUSIONS: These results suggest that early puberty is a critical period for the development of diabetic cardiac autonomic dysfunction. Therefore, all type 1 diabetic patients should be screened for this complication by HRV analysis beginning at the first stage of puberty regardless of illness duration, microalbuminuria, and level of metabolic control.

Adolescent↗
PubMed1999

[Medico-surgical management of childhood cardiopathy: results of the Liège experience].

OBJECTIVE: Evaluation of the results obtained in the management of congenital heart diseases in Liège. MATERIAL AND METHODS: We evaluated the results, the mortality and the morbidity of diagnostic and interventional cardiac catheterization, and of the cardiac surgery in the 123 cardiac children who were referred to us during the three first years of operation of our medico-surgical team. RESULTS: 89 children underwent a catheterization, including 12 therapeutic interventions, whereas 68 were operated. In the two domains, the results are completely comparable with those of the established centers. CONCLUSIONS: The widening of the activity of paediatric cardiology and the creation of an activity of pediatric cardiac surgery in Liège appeared important to us for the quality of management of the cardiac children. This goal could be reached only if our results were comparable with those of the literature. The bet seems to be held. The ultimate objective is to contribute by an adequate policy of management to the quality of life and the health of the cardiac children.

Adolescent↗
PubMed1999

Midterm results of the neonatal arterial switch operation. A review.

Complete transposition of the great arteries is a relatively common anomaly, which comprises 5 to 7% of all instances of cardiac malformations. Given the decreasing mortality rates associated with a neonatal arterial switch operation and the unacceptable morbidity associated with atrial baffle operations, it is reasonable to accept this operation as the procedure of choice for the treatment of the complete transposition of the great arteries. It represents a major improvement since it does not introduce any additional intracardiac anomaly, restores the left ventricle to its natural systemic function, and maintains the sinus node function. Long-term survival exceeds 90%. Midterm general health status is encouraging. To date, there have been limited long-term follow-up studies after a neonatal arterial switch operation, although the intermediate data are promising. It will be necessary to determine whether the theorized benefits of the anatomic repair are realized, since experience is limited to the last 15 years. Translocation of the coronary arteries remains one of the most difficult aspects of the operation and late mortality appears to coincide with coronary artery events with sudden death secondary to acute myocardial infarction being reported in 1-2% of hospital survivors. Supravalvar pulmonary stenosis, neoaortic root dilation and valvar regurgitation, bronchopulmonary collateral arteries, coronary insufficiency, and myocardial perfusion abnormalities are other specific areas which require close observation and further investigation.

Cause of Death↗
PubMed1999

Reversible hypertrophic cardiomyopathy in congenital hyperinsulinism.

A neonate with congenital focal hyperinsulinism developed hypertrophic cardiomyopathy that progressed until partial pancreatectomy was performed. Surgery was followed by complete resolution of the condition. Hyperinsulinism may be a cause of treatable cardiomyopathy.

Cardiomyopathy, Hypertrophic↗
PubMed1999

[Aorto-pulmonary collaterals in an infant with 22q11 monosomy].

The authors present the case of a young girl in whom the diagnosis of pulmonary atresia with ventricular septal defect and multiple aorto-pulmonary collateral vessels was established in the context of microdeletion of chromosome 22. Surgical treatment was excluded following the discovery by angiography of the absence of central pulmonary arteries, a multifocal pulmonary collateral circulation and the appearance of multiple peripheral pulmonary artery stenoses on various aorto-pulmonary collateral vessels during the first months of life. This case illustrates the hypothesis recently developed in the literature according to which the chromosomal abnormality is responsible not only for an anomaly of conotrunkal septation, but also early disorders of branching of the pulmonary vascular bed and disturbances of the connection of peripheral pulmonary segments to central arteries, which are responsible for severe pulmonary vascular abnormalities making biventricular repair of this heart disease in children with 22q11 microdeletion almost always impossible.

Abnormalities, Multiple↗
PubMed1998

Growth of pulmonary artery after arterial switch operation for simple transposition of the great arteries.

UNLABELLED: This retrospective study attempts to assess the size and growth pattern of the pulmonary artery about 1 year after neonatal arterial switch operation for simple transposition of the great arteries. Sixty-seven patients underwent cardiac catheterization, including catheterization of the right and left pulmonary arteries, and right ventricular angiography an average of 13.9 months after arterial switch operation. In 34 of these patients pre-operative right ventricular angiocardiograms were available. The diameter of the main pulmonary artery and that of its proximal right and left branches were measured. The values were compared to those of normal children matched for body surface area, taken from the literature and, for the branch values, related to the degree of branch stenosis and to the corresponding values, measured on pre-operative angiocardiograms. The cross-section of the main pulmonary artery after arterial switch operation with Lecompte manoeuvre becomes oval. The branches of the pulmonary artery are sometimes underdeveloped and this finding is related to branch stenosis. The ratio of the branch gradients is inversely proportional to the growth ratio of both branches while the pre- and postoperative Nakata indices are identical. CONCLUSION: The Lecompte manoeuvre induces a flattening of the main pulmonary artery with concomitant reduction of its cross-sectional area. There is also frequently trivial or rarely moderate branch pulmonary stenosis which is accompanied by growth retardation of the concerned branch.

Angiocardiography↗
PubMed1998

Heart rate behavior in children with atrial septal defect.

The aim of this study was to assess heart rate variability, a noninvasive parameter for studying the neurohumoral control of heart rate, in children with atrial septal defect. We examined five time-domain and three frequency-domain indices of heart rate variability determined from 24-hour Holter recordings in 20 children, aged 3-14 years, with secundum atrial septal defect who were about to undergo operation. The measures were compared to normal ranges and to the hemodynamic data of the preoperative cardiac catheterization. Most indices of heart rate variability were moderately depressed in children with atrial septal defect. Our data revealed negative correlations between indices and the mean right atrial pressure and the enddiastolic right ventricular pressure, respectively. The study demonstrates the importance of the right ventricular filling pressures for the autonomic control of the heart in children with atrial septal defect.

Adolescent↗
PubMed1997

Angiographic study of aorta, coronary arteries, and left ventricular performance after neonatal arterial switch operation for simple transposition of the great arteries.

This retrospective study attempts to assess the growth pattern of the aorta and the coronary arteries and the left ventricular function approximately 1 year after neonatal arterial switch operation for simple transposition of the great arteries. Seventy-one patients underwent cardiac catheterization and cineangiocardiography an average of 13.5 months after the operation. The diameters of aortic annulus, aorta at different sites, and coronary arteries were compared with normal ranges taken from the literature. Left ventricular systolic performance was also evaluated. Observations included the following: Neoaortic annulus and root were larger than normal, trivial or mild neoaortic regurgitation was frequently observed, and the development of aortic anastomosis was normal. One patient had unexpected coronary occlusion, one had a coronary artery fistula, and two had a hypoplastic left anterior descending coronary artery. Except in one child who underwent an internal mammary bypass graft immediately after anatomic correction, the global left ventricular performance was normal. Six patients had regional wall motion abnormalities. Our midterm results are encouraging, but potential late complications remain concerns that must continue to be evaluated in long-term follow-up studies.

Aorta↗
PubMedDate not supplied

Patterns of physical activity defined by continuous heart rate monitoring among children from Liège.

Health benefits of a physically active lifestyle are well documented. We therefore investigated the physical activity patterns of 200 children from Liège. They were monitored continuously using a 24-hour Holter monitoring system during normal weekdays and the percentage of heart rate reserve (%HRR) was used to measure the amounts of physical activity at different intensities. Preschool children attained 184.3+/-54.2, 40.7+/-16.1, 15.8+/-6.9 and 6.0+/-7.2 minutes/day (mean+/-SD) between 20% to 40%, 40% to 50%, 50% to 60%, and greater than 60% of HRR, respectively. At the same %HRR intensities, schoolchildren attained 165.6+/-74.6, 32.1+/-12.1, 15.8+/-6.7 and 7.0+/-5.9 minutes/day, and teenagers attained 159.2+/-68.3, 32.1+/-23.5, 13.1+/-6.0 and 6.1+/-6.3 minutes/day. Age was a significant predictor of the intercept and slope of the time spent in physical activity and %HRR relationship. In Liège the average youth accumulates +/-30 to 40 minutes/day of moderate-intensity physical activity and +/-20 minutes/day of high-intensity physical activity. Those children meet the classical revised guidelines for physical activity but do not compare favourably with children from elsewhere. On the other hand, they get more than 2 1/2 to 3 hours/day of low-intensity physical activity. Our findings suggest that children from Liège are not engaged in sedentary behaviour but do not experience the ideal amount and type of physical activity classically believed to benefit the cardiopulmonary system. Public health strategies should be adapted to our findings.

Adolescent↗
PubMedDate not supplied

Spectrum and frequency of illness presenting to a pediatric emergency department.

BACKGROUND: Knowledge of the spectrum and relative frequencies of pediatric emergencies is an important factor in developing appropriate training curricula for pediatric residents. MATERIAL AND METHODS: To provide these data, we indexed the 11,483 consecutive patients seen in our pediatric emergency department (PED) during the year 2003. RESULTS: Age ranged from 1 week to 27 years, with a mean age of 3.9+/-4.3 years. 52.7% of the visits were by children younger than 3 years, 9.5% by adolescents, and 0,1% by young adults with chronic conditions. 55.1% of the patients arrived on day shift, 32.5% on evening shift and 12.4% on night shift. 61.8% of the patients were seen during the evening/nighttime or on the weekends. 25.2%, 22.1% and 28.6% of the patients seen on night, day and evening shifts respectively were hospitalized. The most common chief complaints were fever (22.1%), upper respiratory tract infection (13.2%) and diarrhea (10%). The most common final diagnoses were upper respiratory tract infection (26.7%), viral syndrome (13.1%) and gastroenteritis (10.7%). The majority of chief complaints and final diagnoses were related to infection (63.9%). CONCLUSION: These data may contribute to curriculum development in training of PED physicians. We especially recommend an emphasis on management of fever and infections to optimize the quality of care delivered in the pediatric emergency department.

Adolescent↗
PubMedDate not supplied

Gas exchange and heart rate kinetics during binary sequence exercise in cystic fibrosis.

MATERIAL AND METHODS: Gas exchange and heart rate (HR) kinetics were investigated in 20 patients with cystic fibrosis (CF) by using a pseudorandom binary sequence (PRBS)-technique. Electrocardiogram was continuously recorded, and VO2, VCO2 and ventilation/min (VE) responses to a multifrequent input signal were measured by means of breath-by-breath analysis. Lag time and peak value in the time-domain, and amplitude ratios in the frequency-domain were calculated to characterize the crosscorrelation functions between input and responses, and compared to normal ranges. RESULTS: Time and frequency domain parameters are abnormal for VO2, VCO2 and VE responses in moderately and severely ill patients, and for the HR response only in severely ill patients. Correlations are shown between those parameters, the severity of the illness evaluated by the Shwachman score and the level of impairment of the pulmonary function. CONCLUSION: The PRBS-technique is a useful tool to investigate the gas exchange and HR kinetics in CF patients, that offers many advantages: (1) no explicit mathematical models are assumed, (2) it is a walking test that may be used even in very young or severely ill patients, and (3) it challenges the ability to adapt to non-steady state exercise and is therefore representative for daily activities.

Adolescent↗