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Biomedical subjects

R Kieny

Publications and source records attributed to R Kieny.

At least 73 records · Page 4Linked to original sources
PubMed1977

[Right juxtaposition of the atria. Apropos of one case without associated trunco-conal abnormalities].

A child of 7 had coarctation of the aorta and an atrial septal defect. In the course of surgery to close the septal defect, she was found to have a right-sided juxtaposition of the appendages. This is a very rare abnormality, with no symptoms of its own, but usually associated with severe cardiac malformations especially of the truncus and conus. This case report is most unusual because of the right-sided disposition of the appendages and the absence of any serious associated cardiac lesion.

Aortic Coarctation↗
PubMed1977

[Massive pulmonary embolism Apropos of 26 embolectomies with definitive survival, 10 of them by Trendelenburg's operation].

The authors report 26 pulmonary embolectomies carried out successfully, 10 of them having been Trendelenberg procedures and 16 having been carried out under extracorporeal circulation. The latter method gives better results, and appears to be the procedure of choice. The haemodynamics before operation were always abnormal, and there were 4 cardiac arrests, 11 cases of severe shock, and 6 cases with less severe hypotension. In the other cases, cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. It was possible to carry out arteriography in 14 cases, and this showed extensive pulmonary vascular obstruction in between 70 and 90%. In 4 cases this procedure was followed by an exacerbation, and extremely urgent treatment became neccessary. This examination is important for diagnosis and for assessment of the prognosis. It seems clear to the authors that surgery has a certain place, alongside medical fibrinolysis of a severe prognosis. It seems clear to the authors that surgery has a certain place, alongside medical fibrinolysis of a severe pulmonary embolus. The essential indications for surgery are moribund patients, those in whom fibrinolysis is contraindicated or unsuccessful, and those with massive obstruction of the pulmonary arterial tree.

Adult↗
PubMed1977

[Massive mitral insufficiency due to spontaneous and isolated rupture of a posterior papillary muscle. Echocardiographic study, treatment by assisted circulation and prosthetic valve replacement].

The authors report a case of a patient of 72 years of age in whom the sudden onset of severe left ventricular failure led to the discovery of massive mitral incompetence. The diagnosis of rupture of the posterior papillary muscle of the mitral valve, which was suggested on clinical and echocardiographic grounds, was confirmed at operation. This was carried out after 72 hours of assisted circulation by counter-pressure, and consisted of a replacement by a prosthetic valve. The authors emphasise, in the light of this case, the importance of echocardiography by ultrasound in the early diagnosis of this type of acute mitral incompetence, clarify the signs, and emphasise the part played by assisted circulation with an intra-aortic balloon in the treatment of this condition.

Aged↗
PubMed1976

[Phreno-celiac disease and merycism in adults].

In this paper are described two new examples of a peculiar semiological association of which the authors have already reported a case, and in which occured simultaneously a phreno-coeliac disease and merycism since childhood. Strong epigastric pains accompained the merycism. In these two cases, the compression of the coeliac trunk by the median arcuate ligament of the diaphragm was important; in one case existed besides a compressive stenosis of the superior mesenteric artery. After the surgical liberation of the coeliac artery and the peri-coeliac neurectomy in one case, all symptoms relieved. This good result persists after twelve months. Because of the rarity of the phreno-coeliac disease and of this type of merycism, the authors think that this association is not accidental, but the result of a new nosological association.

Adult↗
PubMed1976

[Emergency surgical treatment of septal perforations in the acute phase of myocardial infarct. Apropos of 2 cases operated on successfully in the 48th hour and 5th day after development after the necrosis].

The authors report two personal cases of septal perforation during the acute phase of myocardial infarction which under medical treatment would have been rapidly fatal, and which were treated successfully by surgery on the second and fifth days respectively after the infarction, i.e. very early. After briefly recalling the main diagnostic and etiological factors of this serious complication, and the spontaneous prognosis which is usually catastrophic, they emphasise that in presence of poorly controlled heart failure and cardiogenic shock, uncontrollable by intensive medical treatment, only early surgical repair during the first few hours or days of the course of the coronary accident will permit one in certain cases to avoid a fatal issue as proved by their two cases and a review of recent publications. They emphasis the place of circulatory assistance by intraaortic balloon in the preparation of patients for operation and the methods of mycardial revascularisatin during the operation.

Aged↗
PubMed1976

[Leiomyosarcoma of the left side of the heart with a mitral symptomatology. Echocardiographic study].

A patient presented with the clinical findings of mitral stenosis, and angiocardiography revealed an intracardiac tumour. It was found at surgery to be a leiomyosarcoma, occupying almost the whole of the left auricle, and infiltrating the inter-atrial septum, the atrio-ventricular ring at the posterior commissure, and the posterior surface of the left ventricle. A mass with three lobes and a pedicle attaching it to the posterior wall and the ring of the mitral valve was found within the cavity of the left ventricle. The findings on echocardiography corresponded with the anatomical findings; but after surgery, ultrasonic investigation was found to be unreliable at detecting the unresected portion of the tumour, which was situated in the right postero-inferior region of the auricle of the left atrium.

Echocardiography↗
PubMed1976

[Post infarction septal perforation. Is the early operation benefical?].

A case is reported of a ruptured septum in a man of 74 which was operated on after 48 hours; the authors recall the development of ideas on the surgical treatment, and also the advantages which may be expected from counterpressure from an intra-aortic balloon. If this is not available, it seems to them that the operation must be carried out even more swiftly, within the first few hours, if damage to the myocardium and the consequences of prolonged shock, are to be avoided.

Aged↗