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N Danchin

Publications and source records attributed to N Danchin.

At least 271 records · Page 15Linked to original sources
PubMed1986

[Aneurysm of the sinistro-anterior sinus of Valsalva causing coronary insufficiency. Apropos of a case].

The aneurysm of the sinistro-anterior sinus of Valsalva (ASASV) can very rarely be disclosed by symptoms of coronary insufficiency. The authors report the case of a 73 old man suffering from unstable angina pectoris, in whom the diagnosis of ASASV was evoked by two-dimensional echocardiography and confirmed by aortography. Coronary angiography revealed an external compression of IVA by the ASASV and allowed to exclude the presence of associated autonomous coronaropathy. The interest of this observation lies in the fact that the preoperative diagnosis was made after the two-dimensional echocardiography allowing the evaluation of the importance and volume of the ASASV. Aortography and coronary angiography are indispensable procedures in the presence of chest pain suspect of coronary insufficiency. These investigations will guide the surgical treatment which should always associate a closure of the aneurysmal neck, an aortic valvular replacement and a bypass of the compressed coronary artery.

Aged↗
PubMed1985

[Apical hypertrophic cardiomyopathy: an element in the continuum of hypertrophic cardiomyopathies].

Fourteen cases of apical hypertrophic cardiomyopathy (i.e. hypertrophy localized to the distal half of the left ventricular wall) are reported. There were 12 men and 2 women aged from 21 to 84 years. Only one of the patients presented, at first consultation, with severe functional symptoms, namely stage IV dyspnoea. ECG tracings were always abnormal, but the classical giant T waves were found in only 7 patients. In the 9 patients who had cardiac catheterization the left ventricular end-diastolic pressure was raised, and angiography showed an "ace of spades" diastolic image of the left ventricle with systolic obliteration of its tip. The distribution of parietal hypertrophy was best studied by two-dimensional echocardiography: the left ventricular apex was affected alone in 7 patients and concomitantly with the adjacent segments of the left or right ventricle in the other 7 patients. A family study showed that 3 patients had a descendant with obstructive cardiomyopathy. At a 4.6 years' follow-up the course of the disease was usually favourable. Apical hypertrophic cardiomyopathy is not a particular entity but one of different possible forms of hypertrophic cardiomyopathy. It seems to be benign in most cases.

Adult↗
PubMed1985

Assessment of right ventricular outflow tract in children by two-dimensional echocardiography using a new subcostal view. Angiocardiographic and morphologic correlative study.

Evaluation of the right ventricular (RV) outflow tract in congenital heart disease is extremely important for surgical management. Therefore, the value of 2-dimensional echocardiography (2-D echo) to assess the RV outflow tract was studied using a new approach: the subcostal elongated right oblique view. Twenty normal children and 49 children with congenital heart disease, aged 1 day to 11 years, were studied. Significant pulmonary infundibular obstruction was present in 22 patients with conotruncal malformations. To obtain the subcostal elongated right oblique view from the short-axis view at the aortic valve level, the transducer was slightly rotated clockwise with an anterior angulation of about 30 degrees so that the ascending aorta was seen in its long axis, providing an image similar to that obtained by a right ventriculogram in the elongated right anterior oblique view. The deviation of infundibular septum was appreciated by measurement of the angle alpha, defined by the long axis of the infundibular septum and the plane of aortic cusps. This view could be obtained in 64 patients (92%). In correlation with angiographic or anatomic data, the subcostal elongated right oblique view permitted recognition of several types of RV outflow tract: type I--normally formed RV outflow tract; type II--disorganized RV outflow tract with obstruction (alpha less than 90 degrees); type III and IV--disorganized RV outflow tract with obstruction (alpha greater than 90 degrees). This view could visualize the crista supraventricularis in type I, but also the anatomic components of RV outflow tract that may contribute to obstruction in the other types: infundibular septum, septoparietal trabeculations and trabecula septomarginalis.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1985

Prophylactic effect of intravenous tiapamil on methylergometrine-induced coronary artery spasm in patients with variant angina: randomized double-blind trial.

Tiapamil is a new calcium entry blocker. The ability of its intravenous form to prevent methylergometrine-induced coronary artery spasm was studied in 11 consecutive patients with angiographically documented vasospastic angina. The study was designed as a double-blind crossover trial of tiapamil vs placebo. Each patient received, in a randomized order, either tiapamil, as a 1.5 mg/kg intravenous bolus followed by a 50 micrograms/kg/min infusion lasting 3 hours, or a matched placebo. Immediately after the infusion, methylergometrine tests were performed with up to 0.4 mg of methylergometrine or until a positive ECG was recorded. Compared to the values obtained after placebo infusion, tiapamil significantly lowered systolic and diastolic blood pressure (respective pre- and posttiapamil values: 119.9 +/- 17.7 vs 142.1 +/- 25.5 mm Hg, p less than 0.01; and 72.0 +/- 9.1 vs 82.4 +/- 9.3 mm Hg, p less than 0.02); the drug exerted no significant effect on heart rate (63.9 +/- 13.3 vs 67.6 +/- 16.5 bpm, NS), PR interval (0.180 +/- 0.020 vs 0.177 +/- 0.017 sec NS), or QTc interval (404.4 +/- 16.5 vs 396.0 +/- 26.6 msec, NS). After placebo, 10 patients had positive methylergometrine tests following single doses ranging from 0.1 to 0.4 mg. The remaining patient developed ventricular bigeminy, which resolved immediately after administration of isosorbide dinitrate; his test was therefore considered negative in the evaluation of the results. In contrast, after tiapamil, eight patients had negative tests for doses of up to 0.4 mg methylergometrine, and three had positive tests for the same methylergometrine doses as after the placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Biventricular thrombosis in nephrotic syndrome with hypercoagulability and hypereosinophilia].

A case of double right and left intraventricular thrombosis diagnosed by 2D echocardiography is reported in a 20 year old man with nephrotic syndrome with eosinophilia and hypercoagulability, admitted as an emergency for a staphylococcal septicaemia in shock and anuria. Anticoagulation with heparin did not prevent two episodes of pulmonary embolism. Complete dissolution of the thrombi was obtained by peripheral administration of fibrinolytic therapy (urokinase and plasminogen). The authors discuss the differential diagnosis of echocardiographic appearances of biventricular masses and possible causes of these thrombi are suggested.

Adult↗
PubMed1985

[Spasm in a single coronary artery].

A 52 year old man presented with effort and resting angina with positive exercise stress testing and myocardial scintigraphy. The initial coronary angiogram showed a single coronary vessel arising from the right coronary ostium dividing into a right coronary artery with a normal trajectory lined with a few non stenotic atheromatous plaques and a left coronary artery which passed between the aorta and pulmonary artery to reach the left atrioventricular groove. At first, it was suggested that the angina was due to compression of the left coronary vessel by the great arteries during effort, but this mechanism could not explain attacks of resting angina and the failure of betablocker therapy. An ergometrine test performed during repeat coronary angiography induced almost complete occlusion of the right coronary vessel and Prinzmetal diaphragmatic ischaemia. The anginal attacks were completely suppressed by Calcium antagonist drugs. The association of coronary spasm and a single coronary artery is rare; only one case has been previously reported. We do not believe that there was a relationship between the two phenomena in our case: the spasm occurred at a distance from the aberrant course of the vessel. The authors emphasise the diagnostic problems and the potential danger of this association.

Coronary Vasospasm↗
PubMed1985

[Mitral valve prolapse. Results of electrophysiological studies].

Classically, the frequency of latent left-sided Kent bundles and ventricular tachycardia (VT) is increased in mitral valve prolapse (MVP). To verify this hypothesis, 23 patients with clinical and echocardiographic (M mode and 2D) signs of MVP underwent electrophysiological studies for dizziness or syncope (12 cases) or palpitations (11 cases). In addition to the standard electrophysiological studies, analysis of sinoatrial and atrioventricular conduction, they underwent programmed ventricular pacing (St V2): coupled and then paired St V2 in sinus rhythm and during ventricular pacing (100-150/min) under basal conditions (15 patients), after injection of 2 mg Atropine (6 patients), and 10 micrograms of Isoproterenol (4 patients). These manoeuvres showed that symptoms of dizziness were due to increased vagal tone in 6 cases (associated with paroxysmal nodal tachycardia--PNT--in 3 cases), to sinoatrial block in 2 cases (associated with atrial tachycardia in 1 case), to suprahisian conduction defects in 3 cases (associated with atrial tachycardia in 1 case) and to VT in 1 case. Palpitations were due to VT in 1 case, atrial tachycardia in 1 case and PNT in 9 cases. Our analysis showed a high incidence of PNT (10 cases) with normal inter critical ECG. These arrhythmias were due to intranodal reentry in 7 cases (70%), to a latent left-sided Kent bundle in 2 cases and to a paraseptal Kent bundle in 1 case. These PNT were characterised by induction during exercise (6 cases) and by their association with flutter-type reentry (5 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Sudden death in mitral valve prolapse. Apropos of 2 cases].

Two cases of sudden death are reported in patients with mitral valve prolapse with mitral insufficiency. Both had significant impairment of left ventricular function. Irreversible ventricular fibrillation occurred in one patient one-half hour preceding a catheterization, whereas the other patient died during sleep. Review of the literature revealed 42 cases of sudden death in patients with prolapse. Occasionally left ventricular dysfunction or medication overdosage can explain or favor development of the terminal arrhythmia, but usually no precipitating factor other than prolapse can be identified. It appears impossible to identify actual subgroups at risk, although sudden death does occur more frequently in patients with a large amount of prolapse of both valves, previous syncopal episodes, and ECG abnormalities at rest. Complex ventricular arrhythmias are also reported, but their predictive importance is difficult to evaluate. Sudden death is a rare complication of mitral prolapse, fact which should conservatively influence indications for further supplementary testing and treatment in these patients.

Adult↗
PubMed1985

[Apical hypertrophic myocardiopathy. Apropos of 10 cases].

Apical hypertrophic cardiomyopathy is a recently defined subgroup of primary hypertrophic cardiomyopathy. Ten new cases are studied. The electrical features (anomalies of repolarisation) were constant and giant negative T waves were observed in 3 out of 10 cases. Two-dimensional ultrasonography confirmed the diagnosis in every case; the optimal views consisted of 4 cavity scans obtained by the apical approach. When angiography was performed (7 cases out of 10), it confirmed the ultrasonographic findings and was able to eliminate any coronary artery lesions. The patients had a mean age of 48.3 years with a marked male predominance (sex ratio of 0.8) and all of the patients are alive with a mean follow-up of 3.4 years. The functional handicap was moderate (class III: 1 case, class II: 5 cases and class I: 4 cases) and did not progress during the period of follow-up. The family surveys performed revealed that apical hypertrophy can be integrated into the spectrum of segmental hypertrophic cardiomyopathy. In two cases, this survey revealed the coexistence in the same family of segmental hypertrophy with different topography. The long term prognosis of this disease is unknown and the authors consider that the risk of ventricular arrhythmia justifies routine rhythmological evaluation in order to guide subsequent treatment.

Adult↗
PubMed1984

Effects of propranolol and of verapamil on heart rate and blood pressure in hyperthyroidism.

Cardiac manifestations of hyperthyroidism have been attributed to enhanced sympathoadrenal activity, but thyroid hormones also have a direct positive chronotropic effect on sinoatrial cells, in which there are slow calcium channels. We evaluated the effects of verapamil on heart rate, PR and QT intervals, and blood pressure in eight patients with hyperthyroidism and compared them to those effects of propranolol. Three doses of propranolol (0.05, 0.1, and 0.2 mg/kg) and verapamil (0.1, 0.2, and 0.4 mg/kg) were injected intravenously after a 72-hr withdrawal period in a double-blind, crossover fashion. Propranolol increased the RR interval from 581 +/- 51 to 734 +/- 65 msec, whereas verapamil did not have any negative chronotropic effect despite prolonging the PR interval. Systolic blood pressure decreased from 134 +/- 5 to 119 +/- 8 mm Hg after verapamil and was not affected by propranolol. Diastolic blood pressure was depressed equally by both drugs. We conclude that verapamil is not a good alternative drug to propranolol in hyperthyroidism. Our data cannot confirm the possibility of an interaction between thyroid hormones and slow calcium channels in patients with hyperthyroidism.

Adult↗
PubMed1984

Two-dimensional echocardiographic recognition of aortic valve ring abscess.

2D-echocardiography was performed in 42 consecutive patients with suspected aortic endocarditis who subsequently underwent surgery. On surgery, 12 patients had perivalvular aortic abscesses: in the posterior part of the ring (7) with extension to the aorto-mitral fibrous trigone or pseudo-aneurysm of the aortic wall; in the anterior part of the ring (3), with extension toward the interventricular septum; or with near complete aorto-left ventricular disruption (2). Perivalvular abscess was seen on 2D-echo in 8 patients: echo-free cavity located in the aortic ring, beyond the sigmoid valvulae and sometimes containing necrotic material. In 4 patients, the abscess was not diagnosed on 2D-echo; 2 had small, localized abscesses but the remaining 2 had large abscesses developed around previously implanted mechanical prostheses, which considerably impeded echographic examination. One additional patient with acute aortic regurgitation and fever had an image of posterior abscess, but on surgery, the posterior wall of the aorta appeared inflammatory and oedematous without perivalvular abscess. Accurate topographic diagnosis was made in 6 of the 8 patients, while in 2 the abscess was located more to the left than considered on 2D-echo. Generally, 2D-echo tended to underestimate the importance and extension of the lesions. It is concluded that 2D-echo is helpful to diagnose perivalvular aortic infection.

Abscess↗
PubMed1984

Transient acute ischaemic episodes during or immediately after percutaneous transluminal coronary angioplasty.

Transient ischaemic episodes, defined as chest pain with ST segment elevation resolving in less than 15 min, have been encountered in 18 out of 130 patients during or in the 12h following percutaneous transluminal angioplasty (PTCA). During PTCA, ischaemic episodes occurred in 11 patients (8.5%) along with complete coronary artery occlusion (3 cases), high degree stenosis (6 cases) or no visible angiographic change (2 cases). After PTCA, 7 additional patients (5.3%) had transient ischaemic episodes; 4, within 15 min of the last balloon inflation, corresponding to a high-grade stenosis distal to the site of angioplasty and resolving after intra coronary nitrates; 3 from 45 min to 7h after PTCA, resolving spontaneously or with sublingual nitrates in a few minutes. Several pathophysiological mechanisms may be responsible: catheter induced coronary spasm, coronary artery thrombosis, migration of atheromatous debris from the plaque, bubble emboli, or fall of coronary blood flow. The clinical course is usually benign but repeat angiography and emergency bypass surgery may be necessary if the episodes of ischaemia are recurring or prolonged.

Adult↗
PubMed1984

Verapamil: a cause of sudden death in a patient with hypertrophic cardiomyopathy.

Sudden death was recorded by continuous ambulatory electrocardiographic (Holter) monitoring in a 62 year old man with hypertrophic cardiomyopathy and atrial fibrillation, who had been treated for four days with verapamil 360 mg orally. Analysis of the tape showed a third degree atrioventricular block followed by complete asystole. The sudden death could be related to treatment with verapamil.

Atrial Fibrillation↗
PubMed1984

[Results of coronary transluminal angioplasty following Prinzmetal's angina or fixed stenosis with associated spasm].

Transluminal coronary angioplasty (TCA) was carried out in 130 patients (109 men and 21 women) with an average age of 51 years (range 20 to 76 years) between April 1980 and December 1982. The most commonly affected artery was the LAD (100). All patients were on heparin, coronary vasodilators and calcium antagonists before the procedure, and on calcium antagonists and platelet antiaggregant drugs after TCA. The material and methods used were those described by Gruntzig. In this population, we identified a group of patients, Group I, with fixed stenosis and associated coronary spasm--either Prinzmetal angina (13 cases, 6 of which had both ST-T elevation and other ECG changes) or spontaneous spasm with a variable degree of stenosis (2 cases). The stenosis remained greater than or equal to 70% in all cases after intracoronary injection of nitrate derivatives. There were no differences between this group and that of fixed stenosis (Group II) with respect to age and type of diseased vessel (although the right coronary artery was more commonly involved in cases of spasm). The overall primary success rate was 72.8% (14/15--93%--in Group I, and 85/121--70.2%--in Group II: no statistically significant difference). The angiographic relapse rate at 6 months was significantly higher in Group I (8/12: 67%) than in Group II (15/63: 23.8%) p less than 0.02. When "redilatation" with stable success is taken into consideration the difference is not significant (33% and 22.2% respectively). The relapses may be dissociated in Group I (2 cases with recurrent spastic angina and normal angiography).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Socio-professional rehabilitation after transluminal coronary angioplasty].

Between April 1980 and October 1982, 109 patients underwent attempted transluminal coronary angioplasty (TCA) with a primary success rate of 71,6% (78 patients). Two patients died of complications of TCA and another one died suddenly 3 months after TCA. The socio-professional rehabilitation of the 106 survivors was studied by questionnaire to which 98 subjects (81 men, 17 women; average age 50,2 +/- 9,2 years) replied. Seventy seven patients were working before their coronary disease and 73 (62 men, 11 women; average age 46,4 +/- 9,1 years) replied to the questionnaire (95%). This constituted the study group, the socio-professional outcome or which was compared to that of 37 active patients who underwent single aorto-coronary bypass surgery during the same period. After TCA, 53 patients (73% returned to work, 48 as full time workers, after an average convalescent period of 4 months. Professional rehabilitation depended mainly on the initial result of TCA: 85% after primary success; 40% after failure (p less than 0,001); in the latter case, the rate of return to work improved if the patients had surgery (58%) rather than medical therapy (125%). Similarly, the average age of re-employed patients was lower (46,1 +/- 7,9 years, compared to 49,3 +/- 6,8 years, p less than 0,05). Finally, the patients returning to work usually claimed to be in good or very good health (72% compared to 30% p less than 001). After single aorto-coronary bypass, only 14 patients (38%) returned to work, 8 full-time, after an average 7 months' convalescence. The duration off work before surgery was related to the incidence of re-employment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Cost of a coronary transluminal angioplasty compared with a single coronary bypass. Economic effects].

The authors discuss the financial incidence of transluminal coronary angioplasty (TCA) compared to isolated coronary bypass surgery (CBS). The study was limited to 1982 (76 cases of TCA) and compares two groups: successful TCA (17 consecutive cases: group I); isolated CBS (18 cases: group II). The following parameters were studied in each group: average length of hospital study, credits received from the Department of Social Security, hospital expenditure. Hospital expenditure was classified under 6 headings: personnel, material, investigations, drugs, hospital costs and administration costs. The results expressed as the mean per patient were: in group I: hospital stay, 10 days; Social Security reimbursement, 10 813 FF; hospital expenditure, 10 586 FF. In group II: hospital stay, 18 days (including 4 days in the ICU); Social Security reimbursement 46 656 FF; hospital expenditure, 28 955 FF. The hospital costs of personnel were relatively small (especially for TCA). The economies realised by reutilising catheters designed for single usage were significant: the use of guide wires, catheters and balloon catheters falls from 1.64, 1.9 and 0.1 per patient to 0.47, 0.53 and 0.05 respectively, a saving of 5 068 FF per TCA and 385 168 FF per year. Compared to costs in the United States (4 773 and 14 952 dollars) TCA and CBS is much cheaper in France.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1984

[Retrospective study of the role of systematic coronarography in patients with heart valve diseases].

The aim of this study was to assess retrospectively the valve of routine coronary angiography in the investigation of patients with valvular heart disease. Between 1978 and 1981, 598 patients over 40 years old underwent left heart catheterisation with routine coronary angiography. In the group with a medical history of angina or infarction (N = 149), there were 49 cases (33%) of severe coronary artery disease (greater than or equal to 70%) and 17 cases of moderate coronary artery disease (11%); of the 49 patients with severe lesions, 2 died after catheterisation, 8 were considered to have too high an operative risk because of their coronary disease and 19 were operated. Valve replacement was associated with a procedure for myocardial revascularisation in 15 cases. In the group without angina (N = 449), severe coronary lesions were much less common (3.6%) and only 5.1% had moderate coronary disease. Severe coronary lesions were found more frequently in certain sub-groups: Stage IV dyspnoea (9%), patients over 65 years of age (11.5%), and coronary calcification (24%). Of the 39 patients without angina and over 50% narrowing on coronary angiography, 17 underwent isolated valve surgery, and 9 underwent combined valvular and coronary surgery (2% of catheterised patients without angina; 3.5% of patients operated without angina. These results show that routine coronary angiography is fully justified in patients with valvular heart disease and a history of angina as vital information is obtained in a high proportion of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗