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Biomedical subjects

R Gourgon

Publications and source records attributed to R Gourgon.

At least 91 records · Page 5Linked to original sources
PubMed1988

[Cardiac involvement in Behçet's disease. 12 cases].

Fifteen cardiac manifestations observed in 12 of a series of 196 patients with Behçet's disease are reported. In this retrospective study conducted in an internal medicine department, 5 cases of pericarditis and 4 cases of myocardial infarction were encountered. The other cardiac manifestations were observed only once. They included ventricular aneurysm, endomyocardial fibrosis of the right heart, aortic insufficiency, mitral valve insufficiency, mitral valve prolapse, and right heart failure consecutive to pulmonary arterial hypertension. There was no relationship between the severity of cardiac lesions and that of the extracardiac manifestations of the disease. Comparison of these data with those found in the literature showed that pericarditis is the most frequent pathology, but it usually regresses rapidly. Lesions of the coronary arteries, with or without myocardial infarction, consist of stenosis, occlusion or pseudoaneurysm requiring surgical treatment. Myocardial lesions (with the possibility of pseudoaneurysm) and endomyocardial right heart fibrosis are exceptional but fairly characteristic of Behçet's disease which they should suggest. Hughes-Stovin's syndrome may be complicated by pulmonary arterial hypertension, although death is generally caused by massive haemoptysis.

Adult↗
PubMed1988

[Neuroendocrine changes in chronic cardiac insufficiency].

Throughout the course of chronic congestive heart failure cardiac and peripheral compensatory mechanisms are at play, most of them under the influence of the neuroendocrine system. The reserves of heart rate and contractility are regulated essentially by the noradrenergic system (NAS), but this mechanism is partial and transient owing to the gradual decrease in the density and sensitivity of myocardial beta-adrenergic receptors induced by overstimulation. Adaptation of the heart to exercise may be reduced. This escape phenomenon is also observed with almost all cardiotonic drugs which interfere with cyclic adenosine monophosphate (cAMP), in contrast with the paradoxically favourable effects of beta-blockers in small doses or of drugs that are both agonists and antagonists of beta-adrenergic receptors. The mechanisms which contribute to the induction of left ventricular hypertrophy are imperfectly known. The noradrenergic system and the renin-angiotensin-aldosterone system (RAAS) are probably not the only ones involved. The setting in action of Frank-Sterling heterometric regulation, at first during exercise then permanently, requires an increase in filling pressure obtained by venous constriction (predominantly controlled by the NAS) and, mostly, by an increase in circulating blood volume. NAS and RAAS intervene in the kidneys to produce water-and-salt retention.(ABSTRACT TRUNCATED AT 250 WORDS)

Arginine Vasopressin↗
PubMed1988

[Measurement of oxygen consumption during exertion in patients with cardiac failure].

Measurement of O2 (VO2) consumption makes it possible to refine non-invasive assessment of congestive heart failure (CHF). The peak of VO2 during exercise is determined by the maximum values of cardiac output and of the arteriovenous O2 difference. It thus provides semi-quantitative hemodynamic information. In addition, reproducibility of the VO2 peak is quite satisfactory in these patients; it allows them to be classified according to their VO2 peak and permits more objective assessment of therapeutic management. Finally, the anaerobic threshold, when it can be determined, provides the same type of information during sub-maximum exercise.

Dyspnea↗
PubMed1988

[Physical properties of the aorta and left ventricular geometry evaluated by Doppler echocardiography in normal subjects].

UNLABELLED: In 45 normotensive subjects (21-84 years) we simultaneously measured: 1) arterial pressure (AP) according to guidelines of the World-health-organization; 2) left ventricular (LV) wall thickness (WT) and antero-posterior radius (r), aortic diameter (AD) by M-mode echo with 2D echo control; 3) isthmus--diaphragm pulse wave delay (PWD) by measurement of time, between the foot of aortic velocity curves, respectively in the isthmus and near the diaphragm; 4) sternal length (L). We derived WT/r ratio, pulse wave velocity (PWV) as the ratio L/PWD, the product AD X PWD and the PWD/AD. RESULTS: AP, WT/r, PWD, PWV, AD, AD X CFD, PWD/AD are significantly correlated with age (respective r = 0.30, p = 0.05; r = 0.61, p less than 0.001; r = -0.67, p less than 0.001; r = 0.73, p less than 0.001; r = 0.61, p less than 0.001; r = -0.49, p less than 0.001; r = 0.52, p less than 0.001. WT/r is significantly correlated with PWD (r = -0.52, p less than 0.001); PWV (r = 0.50, p less than 0.001); AD (r = 0.44, p less than 0.03); AD X PWD (r = -0.38, p = 0.01) and PWD/AD (r = 0.35, p less than 0.02) but not systolic AP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Left ventricular hypertrophy. Advantages and disadvantages].

The increase in left ventricular myocardial mass is a mechanism of adjustment of the ventricular pump to a normal process, such as growth or sports, or a pathological process (mechanical overload or cardiomyopathy). The associated geometrical changes tend to normalize systolic performance and/or strain--one of the main determinants of myocardial metabolic requirements. When left ventricular hypertrophy is inadequate quantitatively, geometrically and functionally, and when contractility and preload reserves are exhausted, the systolic performance of the ventricular pump becomes narrowly dependent upon the increased systolic strain. some types of "pathological" hypertrophy may ultimately result in alteration of myocardial intrinsic properties during contraction, relaxation and/or extension, and this in turn may induce or aggravate ventricular failure. The causes of left ventricular hypertrophy are imperfectly known, the views most commonly held being metabolic imbalance of the myocardium due to increased demands, and reduction of coronary reserve and exchange capacities.

Cardiomegaly↗
PubMed1987

[Coronary angioplasty 1987].

Percutaneous transluminal coronary angioplasty (PTCA) is currently a common technique in the treatment of coronary artery disease, since the first dilatation was performed with success by A. Gruentzig (1977). If clinical indication is reserved to symptomatic angina pectoris, angiographic indications have been enlarged on account of progress in techniques and technology. Immediate success is good, about 90% with a low rate of mortality (1%), sometimes despite an emergency surgical revascularization. Restenosis is frequent, about 30% a few months after PTCA, with necessity of a new PTCA in almost half the cases. Long-term follow-up is satisfactory, about two third patients are asymptomatic. Immediate efficacy of this simple technique, and good results on a long-term follow-up, are explications of the increase in the number of PTCA during the last ten years.

Angioplasty, Balloon↗
PubMed1987

[Aortic valvuloplasties: treatment of calcified aortic stenosis in elderly subjects].

Since September 1985, transluminal balloon catheter aortic valvuloplasty has been developed in France (Cribier and al.) and all around the world. Indications are still limited, in almost all catheterization laboratories, to elderly patients, with Monckeberg's disease, and with a very high operative risk. Immediately after aortic valvuloplasty, there is a moderate but a significant increase in valve area, without serious complications. Subjective improvement is often spectacular during few months after the valvuloplasty. In long-term evolution, there is sometimes a symptomatic restenosis which require a new valvuloplasty. So, if percutaneous valvuloplasty is efficacy in aortic stenosis in the elderly, long-term evaluation of this new technique is necessary.

Aged↗
PubMed1987

[Left ventricular insufficiency: definitions and mechanisms].

Left ventricular failure is defined as an inability to maintain, under resting conditions, a cardiac output sufficient for the oxygen requirement. It is accompanied by a rise in trans-mural ventricular filling pressure and/or a reduction in systolic volume. It may be linked to an alteration in the systolic performance and/or an alteration in the characteristics of the left ventricle. The compensatory mechanisms are represented by the noradrenergic stimulation; a rise in the muscular mass of the left ventricle and the associated changes in its geometry the heterometric regulation of Frank Starling. Some peripheral adaptive mechanisms such as salt and water retention, arteriolar vaso-constriction and a rise in the peripheral extraction of oxygen contribute to compensating for the lower systemic cardiac output.

Cardiomegaly↗
PubMed1987

[Total pericardectomy. Exceptional treatment for recurrent idiopathic cortico-dependent pericarditis].

The authors report a case of definitive treatment of idiopathic relapsing pericarditis by total pericardectomy in the absence of signs of constrictive pericarditis after a 15 month period marked by multiple invalidating recurrences and the development of dependence on corticosteroid therapy. The indications of total pericardectomy must be discussed in these exceptional cases of failure of medical therapy in idiopathic relapsing pericarditis.

Humans↗
PubMed1987

[Evaluation of bidimensional echography in the etiological orientation of pericardial disease. Apropos of 39 anatomo-echographic comparisons].

Echocardiography provides a firm diagnosis of pericardial effusion and evaluates its repercussions on the cardiac cavities. The images obtained with two-dimensional echocardiography are of such quality that the anatomical lesions can be analyzed, but the predictive value of this examination for the aetiological diagnosis has not yet been established. To investigate this point we have compared the images recorded in 39 episodes of pericardial disease with the corresponding anatomical data provided by surgery (n = 38)) or necropsy (n = 1) less than 48 hours after the ultrasonic examination. In one case, the purely solid nature of the pericardial content, suspected on the presence of an echo-filled cavity with adherent membranes, was confirmed at surgery. Conversely, the totally or partly liquid nature of the effusion was ascertained whenever the two pericardial membranes were separated by an echo-free cavity in at least one portion of the region examined, and there was no false-positive result (n = 38). The images obtained could be compared with the anatomical lesions in 28 out of 38 cases of partly or totally liquid pericarditis. The pericardial cavity was entirely echo-free in 12 of these cases, and this was confirmed by the anatomical examination, except in one case where epicardial nodules were found at surgery. Abnormal intrapericardial images were detected in the other 16 echocardiographic examinations, viz.: round masses in 2 cases, linear echoes in 2 cases and mattress-like deposits in 12 cases. In 9 of these 16 cases corresponding intrapericardial formations were discovered at surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Value of early vasodilator treatment with prazosin in chronic cardiac insufficiency].

The purpose of the present study was to find out whether the beneficial effect of prazosin in congestive heart failure persists after 2 and 6 months of treatment and whether the clinical and haemodynamic data obtained correlate with the response to treatment. Twenty-four patients of mean age 50.0 +/- 3.00 years presenting with congestive heart failure stage II (3 cases), stage III (18 cases) or stage IV (3 cases) in the NYHA functional classification were treated. All abstained from taking digitalis at least one week before treatment and were given prazosin 14.5 +/- 0.77 mg/day together with spironolactone 25 to 100 mg/day. The results of treatment were assessed by its effects on echocardiography, systolic time intervals, ejection fraction and cardiac index measured by the radioisotope method, and maximal duration of a 60-watt exercise on an ergometric bicycle. Treatment was discontinued before the 6th month in 9 out of 10 non-responders. The remaining 14 patients responded to treatment and their condition improved. Mean blood pressure rose in 6 months from 95.4 +/- 3.92 to 104 +/- 3.06 mmHg (p less than 0.05). The cardiothoracic ratio was reduced at 2 months (-0.05 +/- 0.01, p less than 0.01) and at 6 months (-0.08 +/- 0.02, p less than 0.01). Systolic time intervals were not significantly altered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Drug treatment of left ventricular insufficiency. Current aspects].

The medical treatment of left ventricular failure classically relies upon the use of diuretics with or without digitalis. The recent arrival of vasodilators allows for both an improvement in the quality of life as well as a prolongation of survival for people in heart failure. The "new" positive inotropic agents which can be used orally in the longterm have not yet given the results which were anticipated. The prognosis of left ventricular failure remains poor, underlining the importance of preventive treatment and in the last resort the possibility of cardiac transplantation.

Cardiotonic Agents↗
PubMed1987

[Esophageal motility in cases of chest pain with normal coronarography].

The aim of this study was to assess the incidence of oesophageal abnormalities and to determine their nature in patients with retrosternal chest pain and normal coronary angiography with a negative coronary spasm provocation test. Oesophageal manometry was carried out in all cases with or without a spasm provocation (usually alkalosis) test. Forty consecutive patients were studied: 19 men (47.7 +/- 10.0 years) and 21 women (54.7 +/- 7.5 years). A history of gastro-intestinal disorder was obtained in 57 p. 100 of cases (hiatal hernia and/or gastro-oesophageal reflux, biliary lithiasis and/or cholecystectomy, gastritis). Seventeen patients had broad based powerful oesophageal contractions which are an established cause of pain; they were recorded under basal conditions in 5 cases and after a provocation test in 12 cases. Two patients had a megaoesophagus without giant waves. Thirteen patients had manometric signs of reflux (malposition and hypotonia of the lower oesophageal sphincter) of whom 7 had giant waves on provocation. In addition, three patients experienced pain during gastro-oesophageal reflux (1 case) or hypotonia of the lower oesophageal sphincter (2 cases). In all, a very probable oesophageal origin of the chest pain was demonstrated in 22 patients (55 p. 100 of cases).

Angina Pectoris↗
PubMed1987

[Non-obstructive hypertrophic cardiomyopathy and systolic compression of 3 coronary arteries. Long-term improvement with verapamil].

Systolic compression of the three main coronary vessels was observed during the investigation of a 23 year old African with hypertrophic cardiomyopathy. The patient was admitted in 1982 for evaluation of retrosternal chest pain and one syncopal attack during exercise. The ECG showed left ventricular hypertrophy with important ST-T wave changes which became more severe on exercise. Diffuse myocardial hypertrophy without obstruction was confirmed by echocardiography and cardiac catheterisation. Coronary angiography showed systolic compression of the three main coronary arteries. There was no coronary vasodilatory response to rapid atrial pacing; increased left ventricular end diastolic pressure confirmed the poor tolerance of exercise. The therapeutic failure of betablockers suggested a possible coronary spasm. Long-term (4 years) clinical improvement was obtained with calcium antagonists (Verapamil 360 mg/day) without significant regression of the hypertrophy. Coronary vasodilation under Verapamil led to improved tolerance of rapid atrial pacing. Control angiography showed only mild systolic compression of the three main coronary vessels. The improvement of this functional coronary insufficiency with Verapamil was attributed to its negative inotropic effects associated with improved myocardial relaxation and ventricular filling.

Adult↗
PubMed1986

[Left ventricular hypertrophy. Advantages and drawbacks].

The increase of the muscular mass of the left ventricle represents, for the ventricular pump, a mechanism of adaptation to a normal process (growth, sport, etc.) or a pathological process (mechanical overload or cardiomyopathy). The geometrical variations which are associated, tend to normalize the performances and/or the systolic constraints, determining elements of the metabolic needs of the myocardium. If left ventricular hypertrophy is not quantitatively, geometrically and functionally adequate and if the contractility and precharge reserves become exhausted, the systolic performance of the ventricular pump is altered and becomes extremely dependent upon the systolic constraints which are then increased. It may be difficult to take into consideration an insufficiency of the contractility of the ventricular muscle in front of clinical signs of cardiac insufficiency which is conditioned by abnormalities in the filling of the ventricular pump. In addition, some "pathological" hyperthophies may secondarily induce an alteration of the intrinsic properties of the muscle (during its contraction, relaxation an/or extension), susceptible to induce or aggravate a ventricular insufficiency. The causes remain uncertain, since a metabolic imbalance of the myocardium by increase of the needs as well as a decrease of the coronary reserve and the exchange capabilities are commonly accepted. What are the mediators of these mechanisms of quantitative, geometric adaptation and also--at least in some animals--structural adaptation (isoenzymes of myosin)? Why do they seem, at times, strangely absent or quickly out-of-date, or sometimes excessive, with all the drawbacks specific to hypertrophy? The answer to these questions would perhaps represent a new therapeutic approach to left ventricular insufficiency.

Adaptation, Physiological↗