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Biomedical subjects

P Vouhe

Publications and source records attributed to P Vouhe.

At least 19 recordsLinked to original sources
PubMed2001

[Cardiogenic shock in an infant due to rupture of an aneurysm of the sinus of Valsalva into the left ventricle].

The authors report the case of a 15 month-old infant admitted to the intensive care unit for cardiogenic shock due to rupture of an aneurysm of the right anterior sinus of Valsalva into the left ventricle, associated with massive aortic regurgitation. The patient underwent a Ross procedure with resection of the aneurysm. This is a very rare condition because rupture of the aneurysm into the left ventricle has not been previously reported in a young girl to the best of the authors' knowledge. Moreover, a Ross procedure has not been previously described in this indication. The case illustrates the diagnostic difficulty associated with this pathology and underlines the necessity of thinking of this diagnosis in infants with appearances of dilated cardiomyopathy and aortic regurgitation.

Aortic Aneurysm↗
PubMed1992

Role of CMV pneumonia in the development of obliterative bronchiolitis in heart-lung and double-lung transplant recipients.

Obliterative bronchiolitis (OB) is the main cause of late mortality after lung transplantation. Cytomegalovirus infection has been associated with late graft failure. The aim of this study was to determine whether the development of OB was related to CMV pretransplant serological status and to CMV infections. The study group comprised 36 lung transplant recipients (27 HLT and 9 DLT) who survived more than 4 months, of whom 47% developed OB (defined by the persistence of an unexplained obstructive disease: FEV1/VC < 0.7). OB occurred more frequently: (1) in seronegative recipients with seropositive donors (8/9) than in seropositive recipients (7/19) or seronegative well-matched recipients (2/8); and (2) in patients who experienced CMV pneumonia (11/16) and CMV recurrence (11/16). Since matching seronegative recipients is the best way to prevent CMV infection, we believe that seronegative grafts must be reserved for seronegative recipients.

Adolescent↗
PubMed1990

[Results of the surgical treatment of tetralogy of Fallot before 6 months of age. A consecutive series of 62 cases with 49 complete repairs].

From January 1980 to July 1988, 62 infants aged under 6 months with an uncomplicated Tetralogy of Fallot (single ventricular septal defect, normal coronary arteries, no localised pulmonary artery branch stenosis) underwent 64 surgical procedures. The indications for surgery were increasing cyanosis and/or anoxic spells. Fourteen systemic-pulmonary shunts (21.5%), 49 complete repairs (75.4%) and one enlargement of the right ventricular outflow tract and of the main pulmonary artery without closure of the ventricular septal defect, were performed. The results of palliative shunts are preoccupying: cumulative mortality of 36 per cent; high rate of early reoperation for complete repair: 14 per cent. Complete repair was associated with an operative mortality of 14 per cent. Only one child had to be reoperated. There was no late death after complete repair compared with 2 late deaths after shunt. Ultimate results of complete repairs are good. Some risk factors were statistically significantly associated with complete repair: age (2.5 months or less), weight (4,500 g or less), measurements of the pulmonary arteries estimated by the diameter of the right pulmonary artery (5 mm or less). Conversely there was no death in the subgroup of 31 infants aged more than 2.5 months without major pulmonary hypoplasia (diameter of the right pulmonary artery over 3.5 mm). One-stage complete repair give the best short and medium-term surgical results in treatment of uncomplicated Tetralogy of Fallot in infants, irrespective of age and weight providing they have no diminutive pulmonary arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1990

[Mitral valve replacement in atrioventricular septal defect].

This study reports the cases of 14 patients aged 5 months to 13 years (average: 3.5 years) at the time of the initial repair of an atrioventricular septal defect (AVSD). The AVSD was partial in 5 and complete in the other 9 cases. After failure of the initial mitral valvuloplasty, the patients underwent mitral valve replacement with a prosthesis at the age of 1 to 29 years, after an interval of 0 days to 15 years. A second valvuloplasty had been attempted in 3 cases beforehand. The aim of this paper was to analyse the causes of failure of mitral valvuloplasty and to determine the conditions of mitral valve replacement and the specific complications of this type of surgery. Failure of mitral valvuloplasty was related to complex valvular malformations (5 cases), technically inadequate valvuloplasty procedures (4 cases), deterioration of an initially satisfactory valvuloplasty (5 cases). Four bioprostheses were implanted (repeat valvular replacement was necessary in 3 patients). Early mortality was 28% (4 patients). The postoperative complications specific to this condition were: immediate atrioventricular block (8 cases) but only 1 persistant complete atrioventricular block; traumatic fistula between the left ventricle and right atrium (4 cases); moderate stenosis of the left ventricular outflow tract (4 cases). There was one late death (due to isolated cardiac arrhythmia).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Coronary artery bypass using bovine internal mammary artery].

Among 760 patients who underwent coronary artery bypass graft (CABG) 8 received one or two bovine internal mammary artery grafts. The surgical procedures were 4, 3 and 3 CABG respectively in 1, 3 and 4 cases with greater saphenous veins in 4 cases, internal mammary artery in 4 cases and bovine internal mammary artery in 11 cases. The 3 mm bioflow grafts were used to revascularize the left coronary artery in 6 cases (to the left anterior descending, circumflex artery) and the right coronary artery in 5 cases. The indications for the use of bovine mammary artery grafts were lack of suitable autologous vessels because of bilateral saphenous vein stripping in 4 cases, bilateral varicose veins in 3 cases and inadequate length of vein in 1 case. Post-operative angiographic studies of these bovine mammary grafts with a maximum follow-up of 11 months showed 5 occluded grafts, 2 grafts with proximal stenosis, one graft which remained patent until the patient died and 3 grafts still under evaluation. Bovine internal mammary artery grafts provide a solution for the acute stage of coronary disease, but do not achieve total and durable revascularization. Their use must remain exceptional.

Aged↗
PubMed1990

[Heart tumors in newborn infants and infants. Apropos of 5 cases].

Between February 1985 and March 1987, 5 children underwent resection of primary cardiac neoplasms, 3 of them in the first days of life and 2 before the age of 6 months. Routine echocardiographic follow-up of pregnancies allowed detection of cardiac tumors in 2 foetuses 30 and 36 weeks old. In 3 children the diagnosis was suspected by the discovery of cardiac murmur or congestive heart failure. The first case was an hemangioma, originating from outside of the left ventricular wall, which could be resected without cardiopulmonary bypass (CPBP). The other case was a pseudomyxoma, spreading extensively inside the right atrium. The third case was a rhabdomyoma arising from the pulmonary infundibulum with clinical manifestations of tuberous sclerosis. The last two patients had intraseptal lesions, just above the aortic valve; complete resection was therefore impossible, particularly in one patient with multiple tumors. There was one death related to congestive heart failure. The remaining four survivors were followed up for an average of 18.4 months (+/- 12.9) and all were in functional class I. Echocardiographic follow-up showed evidence of a residual subaortic lesion in one asymptomatic patient.

Age Factors↗
PubMed1990

[Tumors of the heart in newborn infants and infants. Apropos of 5 cases].

Between February 1985 and March 1987, 5 children underwent resection of primary cardiac neoplasms, 3 of them in the first days of life and 2 before the age of 6 months. Routine echocardiographic follow-up of pregnancies allowed detection of cardiac tumors in 2 foetuses 30 and 36 weeks old. In 3 children the diagnosis was suspected by the discovery of cardiac murmur or congestive heart failure. The first case was a hemangioma, originating from outside the left ventricular wall, and was resected without cardiopulmonary bypass (CPBP). The other case was a pseudomyxoma, spreading extensively in to the right atrium. The third case was a rhabdomyoma arising from the pulmonary infundibulum with clinical manifestations of tuberous sclerosis. The last two patients had intraseptal lesions, just above the aortic valve; complete resection was therefore impossible, particularly in one patient with multiple tumors. There was one death related to congestive heart failure. The remaining four survivors were followed up for an average of 18.4 months (+/- 12.9) and all were in functional class I. Echocardiographic follow-up showed evidence of a residual subaortic lesion in one asymptomatic patient.

Female↗
PubMed1989

[Lung transplantation].

Lung transplantation has been made possible by the advent of cyclosporin, and it can be divided into three categories: single lung, double lung and heart-lung transplantations. Heart-lung transplantation is the only one that can be performed in case of primary pulmonary arterial hypertension, but the respective indications of these three types of transplantation in patients with respiratory failure have not yet been clearly determined. Heart-lung transplantation is also the one that gives the best results in terms of survival and respiratory function. In the post-operative period, graft rejection and bacterial, viral, fungal or parasitic infections are responsible for a 35 per cent death rate. Later in life, transplant recipients are prone to respiratory impairment caused by obliterating bronchiolitis, itself due to insufficiently treated chronic rejection. The development of lung transplantation is considerably limited by the scarcity of donors with procurable lungs and by the frequency of heart procurement at the expense of the heart-lung block.

Cyclosporins↗
PubMed1988

Anomalous left coronary artery arising from the pulmonary artery in infancy: is early operation better?

From January 1975 to January 1987, 21 consecutive infants aged less than six months (mean (SD) 2.6 (1.2] were admitted with anomalous origin of the left coronary artery from the pulmonary artery. In the first 12 patients, who were seen up to 1982, operation was performed after the age of one year (mean (SD) 29 (29) months) (group 1). The next nine infants, seen from 1983 to 1987, had their operations within a few weeks of the onset of symptoms (mean (SD) age 4.8 (1.4) months) (group 2). In group 2 the left coronary artery was relocated into the aorta, whereas in group 1 there was additional resection of the left ventricular wall or mitral valvoplasty or both. At presentation there were no differences in age, clinical condition, heart enlargement, and echocardiographic left ventricular dysfunction between groups 1 and 2. Seven of the 12 patients in group 1 died, five while they were awaiting operation (three died suddenly at home) and two at operation. The five survivors are doing well 6.4 (3.1) years after operation with normal left ventricular function which improved slowly over several months after operation. Two of the nine patients in group 2 died; both deaths occurred at or soon after operation. The seven survivors are doing well 1.8 (0.9) years after operation. In three, left ventricular function recovered within three weeks; and there was even partial or total regression of the Q waves in the supposedly necrotic areas. In the remaining four the pattern of improvement in left ventricular function resembled that in group 1. Operation should be undertaken early in infants with anomalous left coronary artery arising from the pulmonary artery because the procedure is relatively safe, prevents a high natural mortality, and offers a better chance of a faster recovery of left ventricular function.

Age Factors↗
PubMed1988

[Lung transplantation].

Three different ways of pulmonary transplants are feasible: heart and lungs together, one single lung or both lungs. While concerning the primitive or secondary pulmonary arterial hypertension, only the cardio-pulmonary transplant is possible, concerning the respiratory deficiency; the respective indications of each of these transplants are not yet clearly defined. During the postoperative period, rejection and bacteriological, viral, fungal or parasitical infections are responsible for a mortality of about 30%. In the long term, the transplant patients are in danger of respiratory insufficiency by obliterating bronchiolitis due to untreated chronic rejection. The development of these transplants is considerably limited by the rarity of donors whose lungs are usable and by the frequency of isolated heart removals to the prejudice of the cardiopulmonary bloc transplants.

Forecasting↗
PubMed1988

[Heart and heart-lung transplantation in the child. Indications, methods and results].

Over a 20 month period, 19 children aged 13 days to 15 years (10 under 3 years), received a heart transplantation (isolated: 16 cases, heart-lungs: 3 cases). There were 5 early deaths and 2 during the 3rd postoperative month (total: 44%). Postoperative period is currently over for 8 of the 9 survivors, who lead a normal life, with rather simple constraints: oral cyclosporin-azathioprine immunosuppressive therapy, monthly evaluation in the out-patient department. The method is relatively simple when it concerns heart transplantation. It is quite heavier and complex when it concerns heart-lung transplantation. On the whole, subject to a rigorous selection of the transplant (whose later dysfunction was the major cause of failure, with bacterial or viral infections), these methods find reasonable indications in a number of heart and/or lung malformations or dysfunctions inaccessible to conventional treatments or which used up their resources, making short-term death likely.

Adolescent↗
PubMed1988

[Practical aspects in the surveillance of heart and heart-lung grafts in children].

The short and middle term survivors of the 19 transplanted children (heart and heart-lungs) of our program are treated with an association of cyclosporine and azathioprine. The detection of rejection is the main worry and relies on endomyocardial biopsy, but this investigation may be dangerous and lowers the available veins of smaller children. Thus, we use it only for the situations of clinical suspicion (18 times in 20 months in 8 children, which proved rejection 6 times in 3 patients). Renal function supervision is careful and comprises systematic renal biopsy; tubulo-interstitial lesions were constant: minimal 3 times, moderate 3 times. This prompts to prescribe the lowest possible cyclosporine dosages which ensure an effective residual blood level (100-300 ng/ml). In case of heart-lung transplantation (3 cases), pulmonary rejection is difficult to prove, opportunistic infections more frequent and severe, and the tracheal suture is responsible for complications (stenosis in 2 cases). By and large, the constraints of supervision are reasonable and allow an almost normal life.

Child↗
PubMed1987

[Heart-lung transplantation].

The combined transplantation of heart and lungs, first done successfully by the Stanford Team (USA) in 1982, at present seems to be superseding lung transplantation alone, and has broadened the indications of heart transplantation to include terminal heart failure with fixed pulmonary arterial hypertension. After reviewing the causes for failure in lung transplants, the authors stress the superiority of heart-lung transplants compared to isolated lung transplantations: healing of the tracheal anastomosis, ease of detection of rejects by endomyocardial biopsy and the lack of inhomogeneity of the ventilation/perfusion ratios. This operation still poses problems of surgical technique as the mediastinal nerves need to be preserved and the risk of haemorrhage linked to the mediastinal dissection or to the eventual pulmonary separation under cardiopulmonary bypass is important. Donor subjects for cardiopulmonary transplantation are rare as they ought to have a thoracic cage of matching size to the recipient and to be free of pulmonary infection and trauma. The post-operative complications are essentially those of immediate haemorrhage, graft rejection, pulmonary oedema and infection. The late complications are coronary atherosclerosis and bronchiolitis obliterans. The indications of such a transplant are currently reserved for primary or secondary pulmonary hypertension and to respiratory failure with a normal thoracic cage and ventilatory mechanics.

Heart Transplantation↗
PubMed1985

[Cardiac manifestations of chronic atrophic polychondritis].

The authors present a case of chronic atrophic polychondritis with cardiovascular complications, consisting of aortic incompetence due to dilatation of the aortic ring associated with an aneurysm of the ascending aorta and a first degree atrio-ventricular block occurring six months after the onset of the disease. The progression towards heart failure resulted in the replacement of the ascending aorta and of the aortic valve. The authors discuss the cardiovascular complications of this disease.

Aorta↗