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Biomedical subjects

P Maurice

Publications and source records attributed to P Maurice.

At least 55 records · Page 3Linked to original sources
PubMed1983

[Recurrent ejection of aortic valve prostheses. Apropos of 22 case reports].

Twenty two cases of recurrent perivalvular leaks in aortic valve prostheses were reviewed in a multicentre cooperative study. From 1963 to 1978, 22 patients, mean age 39 years, underwent aortic valve replacement; 18 patients had aortic regurgitation, 6 due to infective endocarditis, and 4 patients had calcific aortic stenosis. Eight Starr-Edwards, 6 Smeloff-Cutter, 2 Braunwald-Cutter, 3 Björk, 1 Lillehei-Kaster and 2 bioprostheses were inserted. All 22 patients had to be reoperated for perivalvular leaks due to active or previous infective endocarditis in 7 cases. The prostheses implanted (3 reinsertions, 19 valve replacements) were 10 Starr-Edwards, 4 Smeloff-Cutter, 5 Björk, 1 Lillehei-Kaster, 1 Magovern and 1 bioprosthesis. All 22 patients had further perivalvular leaks, 6 caused by infective endocarditis, and 15 patients underwent a third operation. The prostheses implanted this time (2 reinsertions, 13 valve replacements) were 4 Starr-Edwards, 3 Smeloff-Cutter, 7 Björk and 1 bioprosthesis. Four patients had a third perivalvular leak, and 2 patients a fourth perivalvular leak. The first and second episodes of perivalvular leak were detected early in over half the cases. They were associated with cardiac failure, angina and hemolysis in 20 to 45% of cases. The average period between the first and second operations, and the 2nd and 3rd operations were 15 months and 9 months respectively. Overall, 11 patients died (50%), 4 due to cardiac failure and 3 of sudden death; 3 patients have been lost to follow-up (14%), and there are 8 survivors (36%) with a mean follow-up period of 5 years. However, the mortality rate when the cause of perivalvular leak was infective, was 82%, and only 18% when the cause was mechanical. The factors which favour recurrent perivalvular leaks are infection (30% of cases) and technical difficulties related to the poor quality of the aortic ring (calcification, dystrophy or dilatation). The prevention of this complication depends on careful peroperative technique, the use of certain surgical bypass techniques, a constant battle against infection, and regular examination of operated patients.

Adult↗
PubMed1983

[Severe postoperative heart blocks appearing late. 16 cases].

Sixteen patients, aged 4 to 42 years, operated for congenital heart disease, presented, months or years after surgery, complete atrioventricular (11 cases) or sinoatrial block (5 cases). Six patients had transient complete atrioventricular block in the immediate postoperative period, the maximum duration of which was less than 30 days. The late postoperative period was defined as at least 6 months after surgery. The period between surgery and the implantation of a pacemaker varied from 9 months to 19 years, average 6,3 years. Analysis of long term electrocardiographic studies distinguished three types of progression: --group I: alternation of sinus rhythm and conduction defect until definitive block, sometimes presenting with syncope; --group II: sudden, severe conduction defect after a long period of sinus rhythm; --group III: progressive lengthening of the PR interval. Seven patients developed syncope; 4 had dizziness, 2 were short of breath; only 3 were asymptomatic. All underwent permanent pacing. The incidence of late conduction defects appears to be 1 to 2% of operated patients. The causes include progressive fibrosis, slow sclerosis extending over conduction pathways which are congenitally fragile. Most late blocks are of an advanced degree. Some may be responsible for unexplained sudden death. It is therefore desirable to avoid this complication by the judicious and considered implantation of a cardiac pacemaker. Some authors mention the following factors in deciding on the indications for pacing: --complete, transient atrioventricular block during the operation or the immediate postoperative period; --ECG appearances of right bundle branch block and left anterior hemiblock, or trifascicular block; --His bundle studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

[Conduction disorders and aneurysms of the sinus of Valsalva].

A series of 15 sinus of Valsalva aneurysms (SVA) admitted between 1961 and 1981 was reviewed to analyse associated conduction defects. It comprised 11 men and 4 women; the mean age was 31 years (range 16 to 53). The diagnosis of SVA was made at the time of rupture (4 cases), during investigation of associated cardiac disease (8 cases), at surgery (1 case) and during advanced conduction disorders (2 cases). All patients underwent catheterisation and angiography. Endocavitary electrophysiological studies were performed in 3 patients. Eight out of 15 patients had conduction defects which comprised: incomplete right bundle branch block (2 cases), atrioventricular block (AVB) (6 cases). Endocavitary investigation of 3 of the 6 AVB showed conduction defects at several levels: sino atrial, suprahisien, intrahisian and infrahisian blocks (1 case); transient complete AVB with 1 degree and 2 degree intrahisian block (1 case); complete AVB, six years after correction of SVA, due to infrahisian block (1 case). Thirteen of the 15 patients underwent surgery; none of the 9 cases of SVA without conduction defects before surgery developed conduction defects. Four of the 6 cases of AVB required permanent pacing; there was 1 postoperative death. One patient was not operated. These conduction defects were caused by the close relationship of the SVA to the intracardiac conduction pathways. The right anterior was the most commonly affected sinus. The investigation of AV conduction should be systematic in cases of SVA, and, conversely, the finding of AVB in young patients should alert the physician to the possibility of a SVA.

Adolescent↗
PubMed1983

[Dissection of the ascending aorta after aortic valve replacement].

Three patients who underwent aortic valve replacement had dissection of the ascending aorta 7 months, 2 years and 15 years after surgery. This is a rare complication of aortic valve replacement (11 reported cases). Its incidence estimated from the literature would appear to be less than 1% of all aortic valve replacements. It occurs in both cases of stenosis and regurgitation (4 aortic regurgitations, 2 aortic stenosis, 5 mixed aortic valve disease) and is seen in ball and cage (7 cases), tilting disc (3 cases) and bioprosthesis (1 case). Six of these patients had hypertension. The role of the initial surgery for valve replacement in secondary aortic dissection is discussed. Aortic clamping and cannulation can cause immediate dissection but may also damage the aortic wall, leading to the risk of secondary dissection. An aneurysm of the ascending aorta was observed in 5 Cases at surgery; in 3 cases, the aorta was dilated without true aneurysm; in 3 other cases the aorta was considered to be macroscopically normal. The integrity aorta is sometimes difficult to confirm and a macroscopically normal of the aorta may have fragile aortic walls, especially in cases of aortic regurgitation due to valvular dysplasia and forms frustres of Marfan's syndrome, and are associated with a risk of secondary dissection. The appearances of the aorta at aortic valve replacement influence the choice of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Anatomic study of the right ventricular inferior wall. Search for the optimal site for implanting epicardial pacing electrodes].

The inferior wall of the right ventricle was studied to determine the optimal site of implantation of epicardial pacing electrodes. The hearts of 10 patients without cardiac disease, aged 57 to 84 years, who died in Broussais hospital, were studied. The hearts were washed, weighed (300 to 550 g) and placed in a formol solution to which was added half its volume of Larsen's solution. They were then examined and cut in sections about 0,8 cm thick, perpendicular to the long axis of the heart. Each section was drawn and the thickness of the inferior right ventricular wall measured. The inferior wall of the right ventricle is shaped like a right angled triangle limited medially by the inferior interventricular groove, posteriorly by the atrioventricular groove (containing the right coronary artery), and laterally by the right free border. The surface area of the triangle varies between 14 and 34 cm2, a fatty border is always observed, and, in 5 out of 10 cases, vessels (arteries and veins) run in a randomised fashion across its surface. The inferior wall is very irregular on section, appearing craggy and cavernous with sudden variations of 1 to 10 mm in thickness due to the many 2nd and 3rd order trabeculations. In the muscular zone near the interventricular septum, the thickness varies from 2 to 10 mm, but only 10 out of 70 measurements were less than 4 mm. In the middle and central zones, only 34 out of 182 measurements were less than 4 mm thick. On the other hand, at the apex and right border of the heart, the values fell to 7 mm and parts of the anterior right ventricular wall was as thin as 0,5 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

[Supraventricular tachycardias induced by swallowing].

The authors report the case of a 34 year old woman admitted to hospital for attacks of atrial tachycardia inducing very poorly tolerated junctional tachycardia at 260 beats/min. The attacks were always induced by swallowing and could be reproduced at will. Electrophysiological studies could only be undertaken after the administration of large doses of amiodarone. An exclusively retrograde rapidly conducting paranodal accessory pathway was demonstrated with triggering of runs of reentrant tachycardia. No underlying gastro-oesophageal or cardiac disease apart from thromboembolism was found. Swallowing-induced supraventricular tachycardia is rare and possible mechanisms are discussed. The arrhythmia may be triggered by direct mechanical stimulation, by changes in vagosympathetic tone, or by an association of the two phenomena. Previously published reports describe similar clinical situations resulting from a variety of different mechanisms.

Adult↗
PubMed1982

Intra-SA-nodal pacemaker shift: indirect evaluation in the open chest dog.

Thirteen open chest dogs with normal sinus node function were studied by premature stimulations with a constant relative prematurity--50% of the preceding sinus cycle length. These premature beats were induced in the lower part of the crista terminalis of the right atrium and to the roof of the left atrium. Significant linear correlations were found between the return cycle (A2A3) and the spontaneous cycle (A1A1) lengths, with a slope of +0.75 in the right atrium, +1.36 in the left atrium. The evaluation of sinus node function is disturbed by pacemaker shifts, both spontaneous and induced. Sinus node organisation may be assessed by stimulating standardised sites, by measuring intra-atrial conduction time, and by comparing A2A3 with A1A1 at constant relative prematurity during significant variations in A1A1 obtained with changes in vago-sympathetic tone.

Animals↗
PubMed1982

[Non-invasive study of aortic insufficiency by Doppler echocardiography].

The possibilities of diagnosis and quantification of aortic regurgitation by pulsed Doppler analysis of blood flow in the aortic arch were examined in 60 patients aged between 9 and 67 years old. Aortic flow curves were recorded from the suprasternal area with the sample volume positioned at the junction of the horizontal part of the aortic arch and the descending aorta. Normal flow curves are characterised by an anterograde systolic wave with a brief proto-diastolic reflux. In aortic regurgitation holodiastolic reflux is observed. An index of regurgitation may be calculated from the ratio of the amplitude of end diastolic reflux measured on the R wave of th ECG and the maximal amplitude of anterograde systolic flow. This ratio eliminates the factor related to the incident angle between the ultrasound beam and the direction of blood flow. The values of this ratio were compared to the semi quantitative assessment of aortic regurgitation from ascending aortic angiography. The only false negatives were observed in patients with negligible regurgitation (grade I). One false positive result was obtained in a patient in whom it was difficult to obtain the recording and in whom the value of the ratio was very low (0,02). Global specificity was 91 p. 100 and sensitivity was 82 p. 100. The sensitivity for average or severe regurgitation was 100 p. 100. The correlation coefficient between the Doppler index or regurgitation and the semi quantitative angiographic estimation was 0,69. In patients with pure aortic regurgitation the correlation reached 0,85 (p less than 0,001). The differences between the different groups then became highly significant.

Adolescent↗
PubMed1982

[Doppler echocardiographic diagnosis and evaluation of tricuspid regurgitation].

The reliability of pulsed Doppler echocardiography in the diagnosis and quantification of tricuspid regurgitation was assessed by analysis of blood flow in the inferior vena cava in 28 patients. The inferior vena caval flow was sampled in the retrohepatic portion of the vessel from the subxiphoid region. Recordings from 10 normal patients were used to define criteria of normality. This was characterised by two anterograde components (one systolic and one diastolic); atrial contraction gave rise to an end diastolic retrograde component. In tricuspid incompetence, retrograde systolic blood flow was recorded. A Doppler index was calculated from the ratio of the maximal amplitude of systolic reflux to the maximal amplitude of anterograde diastolic flow. In the absence of tricuspid regurgitation, this index approximated 0. The average of this ratio over 10 consecutive beats was compared with the semi quantitative assessment of tricuspid regurgitation from selective right ventricular angiography. There were no false positive results, specificity was, therefore, 100 p. 100. Six minimal regurgitations were not detected: sensitivity was therefore 74 p. 100. All moderate and severe regurgitations were detected, and the sensitivity for these cases was 100 p. 100. There was a close correlation (R = 0,89, p less than 0,01) between the Doppler index and the degree of regurgitation assessed by selective right ventricular angiography.

Adolescent↗