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Biomedical subjects

N Danchin

Publications and source records attributed to N Danchin.

At least 235 records · Page 13Linked to original sources
PubMed1990

Methylergometrine-induced coronary artery spasm causing total occlusion of all three coronary arteries.

In a 58-year-old man with rheumatic mitral valve disease and nocturnal chest pain of recent onset, intravenous injection of 0.4 mg methylergometrine during coronary angiography resulted in the total occlusion of all three angiographically normal coronary arteries, with electromechanical dissociation. Intravenous isosorbide dinitrate failed to relieve coronary spasm which had to be treated by intracoronary administration of nitrates and nifedipine.

Coronary Angiography↗
PubMed1990

[Changes in right ventricular ejection fraction in right coronary angioplasty].

In order to analyse the response of the right ventricule (RV) to transient myocardial ischaemia, the RV ejection fraction was measured using a new rapid response thermodilution catheter in 15 patients (14 men and 1 woman: average age 58 +/- 7 years) referred for percutaneous transluminal coronary angioplasty of a dominant right coronary artery. Only patients with single vessel disease with a proximal stenosis of the right coronary without a visible collateral circulation who had no previous history of myocardial infarction were included. Right heart catheterisation was performed with a rapid-response thermodilution catheter which enabled measurement of heart rate, cardiac index, RV end-diastolic and end-systolic volumes and RV ejection fraction. Angioplasty was carried out with the usual steerable balloon catheters. During balloon inflation, there was a slight increase in RV end-diastolic volume (from 78 +/- 11 ml/m2 to 85 +/- 13 ml/m2 at 60 seconds; p less than 0.01) and a large increase in RV end-systolic volume (from 29 +/- 8 ml/m2 to 35 +/- 8 ml/m2 at 30 seconds and 43 +/- 11 ml/m2 at 60 seconds, p less than 0.001) leading to a significant decrease in RV ejection fraction (from 62 +/- 8% to 56 +/- 6% at 30 seconds and 51 +/- 7% at 60 seconds; p less than 0.001). All parameters returned to basal values two minutes after the dilatation. Acute occlusion of the proximal segment of the right coronary artery is therefore associated with a marked change in right ventricular function which rapidly returns to normal after the coronary circulation is restored.

Aged↗
PubMed1990

[Prognostic value of two-dimensional echocardiography before aneurysmectomy in anterior aneurysm of the left ventricle].

The prognostic value of echocardiographic apical 4 chamber recordings was assessed retrospectively in 18 patients who underwent left ventricular aneurysmectomy following anterior wall myocardial infarction. After an average follow-up period of 2 years, 7 patients had died or remained in functional Classes III or IV (Group 1) and 11 patients had satisfactory clinical outcomes (Group 2). There were no significant clinical or coronary angiographic differences between the two groups. The left ventricular surface area, transverse diameter and fractional shortening of the surface were also comparable in the two groups. The surface area of the aneurysm was greater in patients in Group 1 (37.4 +/- 11.8 cm2 vs 21.1 +/- 15.8 cm2, p less than 0.05). However, the more discriminating parameters were those related to the non-aneurysmal contractile zones (NACZ). Patients in Group 1 had a smaller relative surface area of the NACZ than those in group 2; 6 of the 7 patients in Group 1 had NACZ of less than 40 per cent of the left ventricle compared with none of the patients in Group 2 (p less than 0.001). In addition, the function of the NACZ was significantly worse in Group 1: surface fractional shortening: 9.6 +/- 10.2% vs 32.6 +/- 8.3% (p less than 0.001); ejection fraction: 20.7 +/- 9.1% vs 41.6 +/- 6.1% (p less than 0.001). All patients in Group 1 and none in Group 2 had ejection fractions of the NACZ of less than 30 per cent. Therefore, the apical 4 chamber view provides valuable prognostic information in patients who are candidates for surgical resection of left ventricular anterior wall aneurysms.

Adult↗
PubMed1990

[Relations of the duration of pre-existing angina pectoris, collateral circulation and left ventricular function after isolated coronary occlusion with or without myocardial infarction].

The aim of this retrospective study was to determine the relationship between the duration of preceding angina pectoris, collateral circulation and left ventricular function after isolated coronary occlusion with or without myocardial infarction. Coronary angiography of 138 consecutive patients showed isolated and complete occlusions of the left anterior descending (58 patients) or right coronary artery (80 patients). One hundred and four patients had myocardial infarction with (Group A, n = 21) or without (Group B, n = 83) preceding angina pectoris and 34 had angina without myocardial infarction (Group C). The left ventricular ejection fraction was measured by ventriculography in the 30 degrees right anterior oblique projection. The collateral circulation was assessed by coronary angiography and evaluated as follows: no flow or flow limited to collateral branches (subgroup 1) and partial or complete filling of the epicardial arterial segment (subgroup 2). In the global population the left ventricular ejection fraction was higher and the duration of preceding angina pectoris was longer in the subgroups with a well developed collateral circulation. There was no difference in ejection fraction between Groups A and B (presence of myocardial infarction), on the other hand, within each of the groups, a good collateral circulation (subgroup 2) was associated with a significantly higher ejection fraction. Group C (without infarction) patients had better ejection fractions than Groups A or B, especially when the collateral circulation was poorly developed. Within Group C, the quality of the collateral circulation did not seem to affect the ejection fraction. The left ventricular ejection fraction is lower in patients with isolated coronary occlusion and myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1990

[Abnormal tricuspid flow in carcinoid heart disease. A case report].

A case of the carcinoid syndrome with right heart involvement is reported. Echocardiography showed diffuse right ventricular disease with a pathological tricuspid valve. Doppler recordings of forward tricuspid blood flow showed changes suggesting abnormal right ventricular filling, the mechanisms of which are discussed.

Carcinoid Heart Disease↗
PubMed1990

[Retrocardiac pheochromocytoma associated with a double carotid site. Diagnostic and therapeutic discussion].

A case of cardiac paraganglioma is reported in a 30 year old man operated two years previously for bilateral carotid body paraganglioma. Due to the persistence of high catecholamine levels in the superior vena cava, a cardiac localization, suspected on echocardiography, was confirmed by coronary angiography. MRI identified the exact site of the tumour in contact with the posterior surface of the left atrium and the great vessels of the base of the heart. Complete resection was performed via sternotomy. The adhesions to the great vessels and atrium and the retrocardiac site of the tumour required continuation of the operation under CPB with transection of the superior vena cava, aorta and pulmonary artery in order to achieve complete resection despite the hypervascular nature of the tumour. Postoperative collapse of peripheral resistance requiring 48 hours of adrenaline infusion demonstrated the immediate efficacy of the surgical operation. After a follow-up of four months, the blood pressure and catecholamine levels remained normal. The authors emphasise: the value of MRI for the topographic diagnosis of thoracic lesions, the association of a double carotid body paraganglioma and a mediastinal tumour, especially cardiac, which has already been reported in the literature and the availability of CPB in order to perform complete resection of these tumours with complete security in view of their intimate relations with cardiac cavities and the vessels of the base of the heart.

Adrenal Gland Neoplasms↗
PubMed1990

[Painless obstruction of the left coronary trunk. Apropos of a case].

The originality of this observation of the complete occlusion of the left coronary artery lies in its painless character on the angina level. The affection was revealed by the clinical manifestations of the left ventricular failure in severe ischaemic myocardiopathy. The diagnosis of the ischaemia was made during the physical exercise test coupled with thallium scintigraphy. It therefore seems to be a form of silent ischaemia in major coronary lesions, for which the only conceivable therapeutic option is surgery, considering the particularly pessimistic spontaneous prognosis.

Coronary Disease↗
PubMed1989

[Survival in primary dilated cardiomyopathy as a function of tobacco smoking. A retrospective study].

In order to determine the influence of tobacco smoking on the course and long-term prognosis of idiopathic dilated cardiomyopathy, we conducted a retrospective study of 111 patients (95 men and 16 women, mean age 45.5 +/- 8.1 years) who had undergone cardiac catheterization between January 1970 and December 1979 and had been followed up for 6 to 16 years. The criteria of inclusion was diffuse hypokinesia of the left ventricle with an ejection fraction of 50 per cent or less, normal coronary arteriography and cardiomyopathy of unknown origin. The overall mortality rates at 1, 5 and 10 years were 10, 50 and 66 per cent respectively, and the main predictive factor was the left ventricular ejection fraction. Forty-six per cent of these patients were smokers, 19 per cent were non-smokers and 35 per cent had undetermined smoking habits. A univariate analysis showed a favourable predictive effect of smoking on survival (P less than 0.01), and this was confirmed by the statistical hypothesis of maximum bias for patients with undetermined smoking habits. On multivariate analysis, this predictive effect was superseded by the left ventricular ejection fraction, but after stratification of the sample according to the mean value of ejection fraction (30 per cent), the predictive value of smoking reappeared clearly in the group with a less than 30 per cent ejection fraction (P less than 0.003).

Adult↗
PubMed1989

Mitral valve prolapse as a risk factor for infective endocarditis.

The frequency of mitral valve prolapse was assessed in 48 patients with mitral valve endocarditis and in 96 controls matched for age and sex, attending a routine family screening clinic or having surgery of the limbs. The frequency of mitral valve prolapse in cases with endocarditis (9 of 48 patients) was more than three times that in controls (6 of 96) (odds ratio 3.5; 95% confidence interval [CI] 1.1-10.5). When patients with rheumatic heart disease, an established risk factor for infective endocarditis, were excluded from the study group, patients were nearly six times more likely to have infective endocarditis than were controls (odds radio 5.7; 95% CI 1.8-18.4). However, a higher risk of infective endocarditis was seen only in the subjects with mitral valve prolapse and a previously known systolic murmur (odds ratio 14.5; 95% CI 1.7-125). The results indicate that mitral valve prolapse constitutes a true risk factor for infective endocarditis only when associated with the presence of a precordial systolic murmur.

Adult↗
PubMed1989

Significance of spontaneous obstruction of high degree coronary artery stenoses between diagnostic angiography and later percutaneous transluminal coronary angioplasty.

Among 265 patients with severe coronary artery stenoses amenable to percutaneous transluminal coronary angioplasty, 13 (5%) developed new total coronary occlusion of the vessel to be dilated during the period between diagnostic coronary angiography and repeat coronary angiography at the time of the operation. Time from diagnostic to "therapeutic" angiography (76 +/- 74 vs 31 +/- 31 days, p less than 0.0001), degree of coronary stenosis on diagnostic angiography (85 +/- 7 vs 80 +/- 8%, p less than 0.05) and impaired coronary flow distal to the narrowing (Thrombolysis in Myocardial Infarction grade 2: 38 vs 10%, p less than 0.01) were the only variables related to the occurrence of spontaneous coronary occlusion. The clinical course of the patients who developed new total coronary occlusion was remarkably favorable. Twelve of the 13 patients had unchanged or improved anginal symptoms. The electrocardiogram at rest remained unchanged in 11 patients and there was no transmural myocardial infarction. Eight patients had 2 ventriculograms and the mean ejection fraction remained unchanged (only 2 patients had greater than 5% decrease in ejection fraction between the 2 examinations). Spontaneous occlusion of high degree coronary artery stenoses is not unusual and is usually well tolerated, presumably due to the development of collateral circulation.

Angiography↗
PubMed1989

Return to work after percutaneous transluminal coronary angioplasty: a continuing problem.

Earlier studies have shown that return to work following PTCA is frequent; however PTCA is now performed in patients with more extensive coronary artery disease. The present study was designed to compare the vocational outcome of patients who underwent PTCA in 1980-1982 with that of patients who underwent the procedure in 1985. From 1980 to 1982, 53 of 73 consecutive patients who were employed before PTCA returned to work (73%). Return to work was related to primary success of the procedure (85% vs 40%, P less than 0.01) age (46.1 +/- 7.9 vs 49.3 +/- 6.6 years, P less than 0.05) and clinical status at follow-up (72% feeling well or very well vs 30%, P less than 0.01). In 1985, although the primary success rate had increased to 89%, the overall rate of return to work in the 91 patients employed before PTCA was 64%. The decrease was particularly striking for patients with primary success of the procedure (64% vs 85%, P less than 0.01). The patients in the 1985 group had greater incidences of previous myocardial infarction (40% vs 11%, P less than 0.01) and multivessel coronary disease (43% vs 8%, P less than 0.01); however, these factors were not related to subsequent return to work. In contrast, the age of the patients, which was an important determinant of work resumption, was significantly higher in the 1985 patients (49.9 +/- 7.3 vs 46.4 +/- 9.1 years, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Cardiac pheochromocytoma. Failure of classic non-invasive diagnostic methods].

We report an exceptional case of cardiac pheochromocytoma which raised problems of localization. A 30-year old man who for several years had been hypertensive was admitted for attacks of paroxysmal hypertension. Very high levels of urinary catecholamines suggested a diagnosis of pheochromocytoma, but no tumour was found at computerized tomography (CT) and metaiodobenzylguanidine (MIBG) scintigraphy. However, regional venous samplings detected two para-carotid phaeochromocytomas which were surgically removed. Thereafter, the symptoms persisted and investigations were resumed. As new regional venous samplings persisted and investigations were resumed. As new regional venous samplings showed high levels of catecholamines in the right atrium, a mediastinal and, chiefly, cardiac phaeochromocytomas was suspected. No tumour was visible at CT or ultrasonography and another MIBG scintigraphy proved negative. Coronary angiography showed a very large tumour behind the left atrium, well supplied by the circumflex artery and by a branch of the right coronary artery. The patient was operated upon and is now totally asymptomatic after a 9-month follow-up. This case emphasizes the value of invasive methods (i.e. regional venous sampling and coronary angiography) in the localization of this ectopic tumour. In most cases, however, phaeochromocytomas can be localized by MIBG scintigraphy.

3-Iodobenzylguanidine↗
PubMed1989

[Tamponade disclosed by functional right-left shunt reversible after surgical drainage].

The authors report a case of tamponade revealed by the discovery, during emergency radioisotope scanning of the lung, of an acquired right-to-left shunt which was reversed by surgical drainage. The patient was a 60-year old woman treated by anticoagulants for suspected pulmonary embolism who had sudden worsening of her symptoms on the 7th day of the disease.

Cardiac Tamponade↗
PubMed1989

[Difficulties in the echocardiographic diagnosis of false aneurysm of the left ventricle. Apropos of 2 cases].

The echocardiographic diagnostic criteria of left ventricular pseudo-aneurysm are well established: the demonstration of a narrow-necked communication between the left ventricular cavity and the aneurysm and endocardial discontinuity at the site of myocardial rupture. The authors report two cases in which these criteria were fulfilled, leading to an echocardiographic diagnosis of pseudo-aneurysm which was erroneous as the operative findings were those of true left ventricular aneurysms.

Diagnosis, Differential↗
PubMed1988

Dilated cardiomyopathy: long-term follow-up and predictors of survival.

To determine long-term survival and the prognostic factors of dilated cardiomyopathy, we retrospectively studied a consecutive series of 111 patients (95 men, 16 women, mean age: 45.5 +/- 8.1 years) undergoing cardiac catheterization and diagnostic coronary angiography from January 1970 to December 1979. The inclusion criteria were: normal coronary angiography, diffuse hypokinesia of the left ventricle and left ventricular ejection fraction less than 50%. Base-line clinical data were collected from the hospital records and follow-up data were obtained from the general practitioners and cardiologists. A questionnaire was sent to all living patients. The length of follow-up ranged from 6 to 16 years. Six patients (5%) were lost to follow-up. At the time of catheterization, a majority of the patients had dyspnea and were in New York Heart Association (NYHA) classes II (41%) and III (31%). Clinical history revealed an excessive alcohol consumption in 56% of the patients. During follow-up, 66 patients (63%) died (heart failure: 37%; sudden death: 19%; non-cardiac death: 15%; unknown cause: 27%). Actuarial survival was 90, 50, and 33% at 1, 5, and 10 years, respectively. Univariate analysis revealed that 10-year mortality was related to: left ventricular ejection fraction less than 30%; left ventricular end-diastolic pressure greater than 10 mm Hg; cardiothoracic ratio greater than 54%; episodes of heart failure; left ventricular end-diastolic volume greater than 200 ml/m2, dyspnea of NYHA class III or IV; absence of smoking; absence of moderate systemic hypertension; electrocardiographic evidence of left ventricular hypertrophy and mean systemic arterial pressure greater than 95 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗