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Biomedical subjects

R Grolleau

Publications and source records attributed to R Grolleau.

At least 73 records · Page 4Linked to original sources
PubMed1987

[Intestinal malformations and congenital heart diseases].

A series of 21 patients with both congenital heart disease and intestinal malformation seen over a 12-year period is reported. The intestinal malformations were: anorectal malformations (11 cases), duodenal atresia (5), omphalocele (4) and common mesentery (1). Congenital heart diseases consisted of: atrial septal defect (ASD) (10 cases), ventricular septal defect (VSD) (2), tetralogy of Fallot (2) and miscellaneous cardiopathies. In patients with anorectal malformations ASD and VSD predominated (6/11 cases) and multiple malformations syndromes were present in 8 cases, including trisomy 13, Vater syndrome, skeletal (4), neurological (3) and renal abnormalities (3); 3 children died. Duodenal atresia was always associated with left-to-right shunt: VSD (3), ductus arteriosus (2), complete atrioventricular canal (1) and trisomy 21 (2); one child died. Omphalocele coexisted with VSD (2), tetralogy of Fallot (1), dual outlet right ventricle (1), trisomy 21 (1) and multiple malformations syndromes (3); 2 children died. The patient with common mesentery had left-to-right shunt. Comparison of this series with data from the literature showed that children with congenital heart disease have a much higher incidence of intestinal malformations than those with normal heart and that they frequently present with multiple malformations (chromosome aberrations or multiple organ lesions). This multiple malformation complex is particularly common in anorectal malformations where the incidence of congenital heart diseases is 9 to 14%, with predominance of VSD and tetralogy of Fallot. In patients with duodenal atresia trisomy 21 is extremely frequent, and the incidence of cardiopathies is 18%; in the absence of trisomy 21 the cardiopathy is complex.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1987

[Results of combined valvular and coronary surgery].

Between 1975 and 1984, 50 patients underwent cardiac valve replacement combined with coronary revascularization. All had heart failure (class II 28, class III 18, class IV 4), and only 39 complained of angina, including 12 who had previously experienced myocardial infarction; 32 aortic valves, 17 mitral valves and 1 mitral + 1 aortic valve were replaced, these operations being combined with 1 to 4 bypasses (mean: 1.3) per patient. The overall peri-operative mortality rate (i.e. before the 30th post-operative day) was 12 p. 100 (aortic valve 6.2 p. 100, mitral valve 23.5 p. 100), with a regular decrease since 1978. The overall incidence of peri-operative infarction was 6 p. 100 (2.4 p. 100 after 1978). After the peri-operative period 15 patients died, 8 of them of cardiac disease (6 of heart failure, 1 of myocardial infarction, 1 of embolic accident). All survivors were improved, with only 3 cases of heart failure and 1 case of residual angina during a mean follow-up period of 36.1 months (range: 6-120 months). In combined valvular and coronary surgery the mortality rate and the incidence of peri-operative infarction have gradually decreased as years went by, and they are now similar to those of valvular surgery alone. This decrease is due to the progress achieved in cardiac surgery, notably to optimal myocardial protection and maximal revascularization. This progress, together with technical improvements in anaesthesia and intensive care, has rendered combined surgery feasible with an acceptable operative risk and with such satisfactory long-term results that patients over 70 years of age can now be offered this type of treatment.

Aged↗
PubMed1985

[Transesophageal stimulation in the treatment of atrial flutter and tachysystole].

Transoesophageal left atrial pacing was used to reduce 102 episodes of ectopic atrial rhythms (79 common flutters and 23 ectopic tachycardias) in 83 patients (64 men, 19 women) aged 33 to 85 years (average 61 years). Overdrive pacing, at a faster rate than that of the spontaneous rhythm, was delivered via a bipolar pacing catheter introduced nasally and positioned behind the atrium under fluoroscopic and/or electrocardiographic control. Long pulse durations (up to 20 ms) were used to capture the atria with intensities of less than 20 mA for better tolerance. The overall results were: a) conversion to sinus rhythm in 60.8 p. 100 of cases (47 p. 100 directly and 13.8 p. 100 after transient atrial fibrillation), b) atrial fibrillation lasting over 24 hours in 7.8 p. 100 of cases, c) failure (31.4 p. 100) due to non-capture or intolerance (20.6 p. 100) or recurrence of the arrhythmia after transient atrial fibrillation (10.8 p. 100). Atrial flutter is more accessible to pacing than tachycardia (restoration of sinus rhythm in 63.3 p. 100 and 52.2 p. 100, respectively). Arrhythmias in the postoperative period of cardiac surgery, and isolated and recent arrhythmias were more easily converted. Prior antiarrhythmic therapy did not seem to improve results. Fifty per cent of failures of oesophageal pacing were converted to sinus rhythm by endocavitary pacing. These results show that atrial flutter or tachycardia may be successfully treated by oesophageal pacing in over 50 p. 100 of cases without having to use other forms of electrotherapy (endocavitary pacing or cardioversion).

Adult↗
PubMed1984

[Treatment by endocavitary fulguration of recurrent ventricular tachycardia caused by right ventricular dysplasia].

A 27 year old man had recurrent ventricular tachycardia since the age of 16. Different antiarrhythmic drugs were used successively without success (mexiletine, amiodarone, acebutolol, propafenone, sotalol). The diagnosis of VT due to arrhythmogenic right ventricular dysplasia was suggested by the morphology of the tachycardia (left-sided delay), surface ECG appearances (right bundle branch block and potential after the QRS in right precordial leads) and the presence of delayed potentials on right ventricular endocavitary recordings. However, there were no obvious RV changes on echo or angiographic examination. The arrhythmogenic zone was localised in the postero-basal zone of the RV using three electrophysiological criteria: the recording of delayed systolic potential in sinus rhythm which overlapped into diastole during tachycardia, mapping of ventricular depolarisation during VT and results of RV "pacemapping" reproducing the appearances of the spontaneous tachycardia. VT was reproducible on stress testing (non-sustained VT at the beginning of the recovery phase) and on endocavitary stimulation. One 250 joule electric discharge between the endocavitary electrodes and a large dorsal surface electrode prevented any further attacks without antiarrhythmic therapy (follow-up: one year). Control electrophysiological investigation after 4 months showed another potentially arrhythmogenic zone which is quiescent at present.

Adult↗
PubMed1984

[Coronarography].

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Coronary Angiography↗
PubMed1984

[Angiography].

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Angiocardiography↗
PubMed1983

[Reciprocating tachycardia and anterograde conduction by a nodoventricular pathway].

Two patients were investigated for paroxysmal regular tachycardia with left bundle branch block centrifugation. A right-sided nodo-ventricular accessory pathway was demonstrated in both cases at electrophysiological investigation with His bundle recording and atrial and ventricular programd pacing techniques. However, the function of this pathway was different in the two cases. In the first case, there were no signs of an accessory pathway on the surface ECG in sinus rhythm but it could be unmasked by simple right atrial pacing at the same rhythm (widening of the QRS and shortening of HV from 40 to 25 ms). The tachycardias could be only initiated by ventricular extrastimulus. They showed major pre-excitation with left sided delay and a 1/1 atrio-ventricular response. There was no His potential before the ventriculogramme which retained the same configuration throughout the attack. The investigations also suggested the presence of a dual nodal pathway with the accessory pathway connected to the slow pathway. In the second case, the presence of an accessory pathway could be suspected from the appearance of the QRS complex in sinus rhythms. Tachycardia was initiated by an atrial extrastimulus with initially a first complex showing slightly more marked pre-excitation and a distinct His potential before the QRS but with a shorter HV interval than in sinus rhythm. Then the reciprocating tachycardia had appearances of major pre-excitation, left-sided delay and a 1/1 atrio-ventricular response. However, in contrast to the first case, all ventricular complexes were preceded by a His potential and the degree of pre-excitation was variable with a HV interval ranging from 0 to 15 ms. These two cases merit attention because of: --their points in common: nodal duality and an accessory pathway which was not atrio-ventricular (decremental conduction) but nodo-right ventricular, conducting well in the anterograde direction but more or less masked in sinus rhythm; the presence of the accessory pathway was clearly visible during reciprocating tachycardia; --the differences: in the first case the nodo-ventricular pathway formed part of the circuit of the reciprocating tachycardia which was antidromic: descending limb, the slow nodal pathway and then the accessory nodo-ventricular pathway; ascending limb, the His bundle and then the rapid nodal pathway. In the second case, the reciprocating tachycardia was entirely intranodal, the accessory pathway not being involved in the circuit but connected to it in parallel with the normal Hisian pathway.

Adult↗
PubMed1983

[Infectious endocarditis in the neonatal period].

A case of bacterial endocarditis in a newborn without any congenital heart disease is reported. The clinical diagnosis was suspected on evolutive heart failure by mitral dysfunction with sepsis. T.M. mode echocardiography could detect only the valvular defects. Correlations between anatomic and echocardiographic findings allowed to discuss the limits of the method. Neonatal bacterial endocarditis is a rare event. Its diagnosis is difficult and its prognosis very poor. This affection must be prevented.

Endocarditis, Bacterial↗