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P Louis

Publications and source records attributed to P Louis.

At least 109 records · Page 6Linked to original sources
PubMed1989

[Paraclinical tests in the diagnosis of right ventricle infarction].

Right ventricular infarction is often associated with an inferior myocardial infarction. ECG demonstrates a ST segment elevation in the leads V3R and V4R when taken early. Two dimensional and M mode echocardiography are useful in the differential diagnosis of cardiac tamponade. However they can demonstrate right ventricular functional derangements. Hemodynamic abnormalities are variables: adiastole, features of tricuspid regurgitation.

Electrocardiography↗
PubMed1989

[Right-left auricular shunt caused by patent foramen ovale at a multi-purpose intensive care unit. Apropos of 3 cases].

Three cases of symptomatic right-to-left interatrial shunt through a patent foramen ovale were detected in the course of a case of paradoxical embolism related to a massive pulmonary embolism, a case of refractory hypoxemia after cardiopulmonary bypass and a case of refractory hypoxemia in a patient with tricuspid endocarditis. According to anatomic studies, the incidence of patent foramen ovale is 25-30% in healthy people. In that case any pathological event generating an increase in the right atrial pressure higher than the left atrial pressure may induce a right-to-left shunt with systemic arterial desaturation and possible paradoxical embolization. The reported cases emphasize the advantage of ultrasonic examinations (contrast sonocardiography, pulsated or coloured Doppler) to show the right-to-left atrial shunt. The demonstration of this acquired shunt requires appropriate measures in order to reverse the atrial gradient. Sometimes a specific therapy is required such as caval filter insertion in case of pulmonary embolization or surgical closure of foramen ovale in some patients.

Adult↗
PubMed1988

Congenital diverticulum of the right atrium situated on the floor of the coronary sinus.

A diverticulum of the right atrium was found on the floor of the coronary sinus in a neonate. The diverticulum was distinguished from a pericardial cyst by contrast echocardiography, and its relations with coronary sinus and coronary venous return were identified by coronary angiography. Because the diverticulum compressed the left ventricular inferior wall and prevented its growth, it was excised. Thebesian veins were discovered at operation and prevented complete correction of the defect.

Coronary Angiography↗
PubMed1988

[Tolerance and prognostic value of Thallium 201 myocardial tomoscintigraphy with dipyridamole in the aged subject].

The authors present a retrospective study of 46 consecutive patients aged from 70 to 79 years (mean 73.3 +/- 2.5 years) with suspected coronary artery disease who, being unfit for exercise tests, were explored by myocardial scintigraphy with thallium 201 after coronary dilatation with intravenous dipyridamole. The examination was well tolerated by 30 patients. Such classical side-effects as chest pain, malaise, dizziness, headache, flushing, vomiting and transient arrhythmia or repolarization disorders were recorded, but they were not more frequent than in younger subjects. However, the occurrence of severe hypotensive malaise relieved by theophylline in two cases and of angina in about one third of patients with myocardial ischaemia means that the procedure must be performed under close supervision. A fall in blood pressure (-11 mmHg on average) and a rise in heart rate (+8 beats/min on average) were usual. Post-scintigraphy follow-up of patients over a mean period of 11.1 +/- 6.2 months showed that a reversible defect of thallium 201 uptake, due to redistribution, is a highly selective indicator of patients who are particularly exposed to a cardiac accident in the short--or mid-term. Only one out of 26 patients without reversible ischaemia (4 p. 100) subsequently presented with a major coronary event (unstable angina). In contrast, in the group of 20 patients with reversible ischaemia three required early myocardial revascularization; furthermore, five serious accidents (29 p. 100) occurred among the 17 patients who were left under medical treatment, including two sudden deaths, two cases of unstable angina and one case of myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

[Transesophageal stimulation in the treatment of atrial flutter and tachysystole. Factor influencing immediate results].

The effectiveness and safety of transoesophageal atrial pacing in the treatment of atrial flutter and tachycardia have been well demonstrated. The purpose of this study was to determine the factors that could influence the results of this method at the end of the procedure. Seventy-seven transoesophageal atrial pacings were performed in 62 unselected consecutive patients with either flutter or atrial tachycardia. The following parameters could be evaluated in 55 patients: date of onset of the arrhythmia, echocardiographic diameter of the left atrium, maximum amplitude of oesophageal atrial potentials, voltage and frequency of stimuli in the last stage of pacing. Our results can be summarized as follows: In both flutter and atrial tachycardia taken globally, conversion to sinus rhythm was obtained in 37 p. 100 of the cases, and conversion to atrial fibrillation in 46.7 p. 100 of the cases. The failure rate was 19.4 p. 100; all failures were due to lack of atrial capture during pacing. The main factor or transoesophageal atrial capture is voltage. Patients must be able to tolerate the voltage needed for capture. In the case of flutter, when capture was achieved a normal-sized left atrium and a high maximum amplitude of oesophageal atrial potentials were factors indicating that conversion to sinus rhythm could be expected. This, however, did not apply to atrial tachycardia. -- Whatever the type of tachyarrhythmia, the more recent its onset the easier its reduction.

Adolescent↗
PubMed1988

[Attempt at in vitro decalcification of aortic valves using various types of lasers].

The effects of three types of laser were studied in vitro on calcified aortic valves removed in the course of valve replacement. These were: 1) argon laser; 2) Nd-YAG laser with a long (1 ms) impulse, and 3) Nd-YAG laser with a short (10 ns) impulse. With the first two types of laser, lesions of carbonization and fragments detached from the areas treated were observed. With the 10 ns ND-YAG laser, a mean energy of 100 mj per shot excavated the calcified valves by drilling holes that were 0.5 to 1.5 mm in diameter and had clear-cut non carbonized borders. No residue was found during the procedure: the substance was simply vaporized. The splitting of several calcareous nodules on a valve made it more pliable. If it were possible to transfer this high peak energy onto a flexible optic fibre, the aortic valves could be decalcified by interventional catheterization.

Calcinosis↗
PubMed1987

[Outcome of 195 patients with Wolff-Parkinson-White syndrome].

Between 1974 and 1984, 207 patients with Wolff-Parkinson-White syndrome (WPW) were admitted to our hospital department; 195 of them were followed up for periods ranging from 1 to 12 years (6 years in children, 3 years and 9 months in adults on average); 160 had undergone electrophysiological exploration. Fifty-seven patients were less than 16 years old: 7 died, including 6 with associated congenital heart disease; an asymptomatic 12-year old girl died suddenly while taking part in a sporting event. The signs of WPW disappeared in 5 out of 10 children under 1 year of age. One hundred and thirty-eight patients were older than 15: 15 of them died, but only 3 deaths were related to WPW: one was consecutive to surgery for WPW and one to fulguration; the third patient died of WPW tachyarrhythmia; the refractory period of his Kent's bundle was short, but his compliance with treatment was irregular. We found no correlation between changes in functional symptoms and Kent's bundle refractory period values; paradoxically, the frequency of attacks and resistance to treatment was higher in cases with long refractory period. On the whole, this series confirms that WPW usually is a benign disease. However, the risk of sudden death, of which it offers an example, indicates that all patients with WPW should be evaluated with at least an exercise test and, depending on its results or on the socio-professional context, an electrophysiological exploration.

Adolescent↗
PubMed1987

[Prognostic value of ventricular tachycardia induced by stimulation in patients without documented tachycardia].

In order to determine the cause of syncopes or disorders of conduction, 584 programmed stimulations using 2 ventricular extrastimuli delivered during an imposed rhythm were performed, between 1981 and 1985, in patients without ventricular tachycardia (VT) proven by Holter recordings. Eighty-seven non-sustained VT (NSVT) (15%), 8 ventricular fibrillations (VF) (1%), 16 ventricular flutters (VF1) (3%) and 23 sustained VT (SVT) (4%) were induced. To appraise the significance of these responses the patients were followed up for a mean period of 2 +/- 1 years. Among the NSVT patients the first 47 were followed up until 1984 and the others, less numerous, until 1985. Patients who responded to stimulation with NSVT had (4.4%) or did not have an underlying cardiopathy; their mean left ventricular ejection fraction (LVEF) was 53.5 +/- 17% (n = 10); 17% died of heart disease, but the disease was related to VT in only one case; 36% of these patients had cardiac symptoms, but only one presented with episodes of NSVT. Patients who responded with VF had a normal (50%) or abnormal heart; their mean LVEF was 52 +/- 19%; one died of heart failure, the others were asymptomatic. All but one of the patients who responded with VF1 had an underlying cardiopathy and a mean LVEF of 38 +/- 19%; 3 died, 2 of heart failure and 1 of sudden death; 13 were asymptomatic. All patients who responded with SVT had an underlying cardiopathy and a mean LVEF of 37 +/- 13%; 7 (30%) died, including 2 sudden deaths; 2 had episodes of VT and 12 were asymptomatic. In summary, an underlying cardiopathy was present in one-half of the patients who responded with NSVT or VF and in all patients who responded with VF1 or SVT. The risk of VT was low (5%) in patients who responded with NSVT, VF or VF1 and was higher (17%) in those who responded with SVT.

Adolescent↗
PubMed1987

[Tricuspid endocarditis with right-left auricular shunt through a patent foramen ovale].

The authors report the case of a tricuspid endocarditis secondary to Streptococcus bovis with important regurgitation and severe hypoxemia secondary to a right-left atrial shunt through a patent foramen ovale, requiring a surgical treatment which included the replacement of the tricuspid valve and closure of the dehiscence in the inter-atrial septum. The presence of a patent foramen ovale in the course of a tricuspid endocarditis has been exceptionally reported. This diagnosis deserves to be evoked in case of an unexplained hypoxic condition or a systemic embolism complicating a tricuspid endocarditis. The report emphasizes the advantage of ultrasonic examinations (contrast sonocardiography, pulsated Doppler) in order to demonstrate this right-left atrial shunt in addition to the data collected about the tricuspid valve.

Adult↗
PubMed1986

[Coronarography in the study of myxoma. Apropos of a case diagnosed by this technic].

In a 59 years old woman presenting a rudimentary picture of myocardial infarction, ventriculograms confirm a limited necrosis and coronarography shows an abnormal vascular image, evoking an intracardiac tumor, while the arteries are free of atherosclerosis or thrombosis on angiography. Although auscultation and echography are normal, the diagnosis of myxoma will be confirmed by angiocardiography, then by surgery and pathology. The advantage of selective coronary angiography in myxomas is considered with 24 cases from the literature having undergone this examination, including 20 cases, among which ours, which present an aspect of "tumoral vascularisation". The particularities of coronarography (aneurysms, embolic obstruction, origin and aspect of hypervascularisation) are analyzed. This technique appears very useful, not only to detect a complication of the tumor or an associated coronaritis, but also to help in the diagnosis of myxomas in cases where angiocardiography or mostly echocardiography are deficient.

Coronary Angiography↗
PubMed1986

[Congenital paravertebral arteriovenous fistulae in children and adolescents].

These arteriovenous fistulae (AVF) situated in the paravertebral area present as a murmur which explains their cardiological orientation. They are characterised by the presence of one or more afferent paravertebral arteries giving rise to collateral vessels irrigating the bone marrow. The aim of this study of 13 cases was to study the diagnostic and therapeutic problems, and the evolution of this particular localisation of AVF. Two groups of paravertebral AVF were individualised: - Cervical AVF in which the vertebral artery was always involved (7 cases). Four were simple (only one fistula) and three were complex, having several afferent arteries. Two presented as a rapidly growing vascular tumour. Two caused an asymptomatic angiographic vertebral steal syndrome. Two simple forms were obturated by a detachable balloon and one by surgical excision. Two complex forms were treated by embolisation and surgery. Total closure of the AVF was obtained in all cases without complications. - Dorso-lumbar AVF (6 cases). The afferent vessels are the intercostal (D6 to D8) or lumbar (L2 to L4) arteries. Anatomically, these are extra-medullary fistulae with an extra or intra-vertebral venous drainage. Enlargement in an adjacent conjugating foramen forms a tumour which may narrow the spinal canal (1 case diagnosed by CAT) or erode the vertebral body, so compromising the spinal support. Spontaneous closure of the AVF was observed in 1 case. Three cases were treated surgically with good results; two patients are waiting for embolisation. A review of the literature provides complementary information on the long-term evolution of these AVF and confirms the need for systematic therapy as demonstrated in our study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Unruptured aneurysms of the sinus of Valsalva disclosed by syncopal disorders of cardiac excitability. Apropos of 2 cases].

Aneurysms of the sinus of Valsalva are rarely diagnosed before rupture into the cardiac cavities which usually leads to the appearance of a continuous murmur and cardiac failure. In the two cases described, the presenting symptom of the aneurysm was syncope due to cardiac hyperexcitability: ventricular tachycardia in the first and paroxysmal tachyarrhythmia in the second case. The presenting symptoms of unruptured aneurysms of the sinus of Valsalva were analysed. In general, they are: uncontinuous cardiac murmurs: either diastolic murmurs of aortic regurgitation, systolic murmurs of mitral or tricuspid regurgitation, or, as in our first case, of obstruction to right ventricular ejection; arrhythmias: the commonest are conduction defects, which can be syncopal; hyperexcitability (especially ventricular) seems to be very care. Echocardiography is a valuable tool for the diagnosis of sinus of Valsalva aneurysms. The appearances of unruptured aneurysms in our two patients are described. The presence of syncopal cardiac hyperexcitability, possibly associated with one of the preceding auscultatory abnormalities is an indication for echocardiography which may lead to the diagnosis of this condition.

Aged↗
PubMed1986

[Pseudotumoral mitral endocarditis. Diagnostic and therapeutic problems apropos of a case report with review of the literature].

The authors report an observation of infectious endocarditis of the mitral valve with voluminous pseudo-tumoral growth. The developmental, symptomatic and etiological characteristics of this form of endocarditis were specified through a review of the literature. Echocardiography provides the best means of early detection of these large vegetations but it is not always easy to distinguish them from other left intra-auricular tumors, more especially as several cases of infectious myxoma have been described. Spontaneous development of mitral endocarditis is very harmful, as are infected left intra-auricular tumors, and surgical treatment of these disorders seems essential as soon as the infectious process has been arrested.

Adolescent↗