Biomedical subjects

R Roudaut

Publications and source records attributed to R Roudaut.

At least 73 records · Page 4Linked to original sources

PubMed1996

[Systemic embolism and thrombosis of the left atrium in a patient in sinus rhythm with cardiac amyloidosis].

The authors report the case of a female patient admitted for complete heart failure with a diagnosis of type AL amyloidosis associated with dysglobulinaemia. While in hospital, she developed femoral embolism found to be secondary to atrial thrombosis in the absence of any supraventricular arrhythmia. The frequency and mechanism of intracardiac thrombosis and embolic accidents in cardiac amyloidosis are discussed in the light of this case.

Aged↗

PubMed1996

[Aneurysms of the atrial septum].

Aneurysms of the atrial septum (ASA) frequently diagnosed since the introduction of transoesophageal echocardiography are implicated in the aetiology of cerebral and systemic embolic events. This update was undertaken to resume recent data on this pathology and its relationship with embolic events. The diagnostic criteria are described together with the morphological features (size, movements, thickness) and associated abnormalities (interatrial shunts, valvular prolapse). The authors summarise the data concerning possible complications of ASA, especially the different mechanisms invoked to explain embolism (paradoxical embolism. thrombosis in situ, supraventricular arrhythmias). Therapeutic options are discussed with respect to the clinical contexts (therapeutic abstention, platelet antiaggregant drugs, oral anticoagulants, interventional cardiology or surgery.

Adult↗

PubMed1996

[Value of echocardiography-dobutamine in the study of reserve myocardial contractility in aortic stenosis with alteration of left ventricular function. Apropos of a case].

The authors report a case of tight aortic stenosis, without coronary artery disease, presenting with heart failure, alteration of global left ventricular contractility and a low gradient. Increasing-dose dobutamine echocardiography demonstrated an improvement of myocardial contractility and an accentuation of the transvalvular gradient. The place of this examination in the therapeutic strategy and follow-up of the disease is discussed in the light of the current data of the literature.

Aged↗

PubMed1996

[Antithrombotic therapy in patients with mechanical valve prostheses].

Mechanical valvular prostheses have the advantage of longevity but carry a risk of thrombosis which is itself dependent on many haemodynamic, haemostatic and parietal factors. Antithrombotic therapy in patients with mechanical valvular prostheses is based on vitamin-K antagonists, the optimal dosage of which should reflect the type and location of the prosthesis and the underlying pathology. The patient with a mechanical valvular prosthesis treated by oral anticoagulation must be fully informed and regularly followed up. Special situations: extracardiac surgery, dental extraction, gastrointestinal endoscopy, require specific, well established management.

Administration, Oral↗

PubMed1995

Atrial septal aneurysm. Morphological characteristics in a large population: pathological associations. A French multicenter study on 259 patients investigated by transoesophageal echocardiography.

UNLABELLED: A strong association between interatrial septal aneurysm (IASA) and stroke has recently led many authors to consider IASA as a potential cardiac source of embolism. We studied the morphological characteristics and main associations of IASA in a large cooperative study based on transoesophageal echocardiographic examinations; 259 IASA were studied in 134 men and 125 women with a mean age of 59 +/- 15 years. Fifty-five percent of IASA were found to overlap the commonly described fossa ovalis region. IASA protruded into the right atrium in 90% of the cases. They appeared thin in 81% of the patients and highly mobile in 79%. Fifty-eight percent of patients had a history of systemic embolic events, while an atrial septal shunt was detected in 61% of the patients. In patients with an embolic event, only the mobility of IASA was significantly higher than in those with no embolic event. In nine cases a pulmonary embolism was associated with arterial embolism. Furthermore, we reported three cases of paradoxical embolism. However, the true demonstration of a thrombus within the IASA was quite rare. CONCLUSION: IASA is probably an important risk factor for stroke. In patients with IASA and a history of embolic events, IASA may enhance migration of a thrombus constituted in situ or transiting through it. Marked mobility of IASA may also increase the risk of peripheral embolus.

Adult↗

PubMed1995

Assessment of non-invasive new imaging techniques in the diagnosis of heart liposarcoma.

Two patients, with recurrent acute pericarditis as the first presentation of liposarcoma, were admitted to our department between August and December 1992. The pericarditis was pericardial in one case and retroperitoneal with pericardial inflammation in the other. In contrast to most reported cases, where diagnosis was made post-mortem, diagnosis and surgical decision were based on non-invasive imaging techniques, without cardiac angiography. In cases of recurrent acute pericarditis resistant to usual drugs, new imaging techniques, such as computed tomodensitometry and magnetic resonance imaging, can detect rare causes such as liposarcomas in which prognosis is critically dependent on early diagnosis.

Acute Disease↗

PubMed1995

Ramipril-induced regression of left ventricular hypertrophy in treated hypertensive individuals. HYCAR Study Group.

The objective of this trial was to assess the effects of 6-month daily treatment with two doses of ramipril on left ventricular mass and the dependence of this on blood pressure changes in hypertensive patients with left ventricular hypertrophy. After a selection phase of 4 to 6 weeks with patients under antihypertensive therapy with 20 mg furosemide daily, 115 patients with either controlled or uncontrolled hypertension and left ventricular hypertrophy were randomized in a double-blind manner to receive either placebo (n = 40), 1.25 mg (low dose, n = 38), or 5 mg (regular dose, n = 37) ramipril daily for 6 months. Treatment with furosemide was continued unchanged during this phase. The main outcome measured was left ventricular hypertrophy regression as assessed from central blind reading of echocardiograms recorded at randomization and after 6 months. No significant differences were observed for changes in casual or ambulatory blood pressure between the three groups. Left ventricular mass index was found to be significantly reduced in patients receiving 5 mg ramipril compared with those receiving placebo (-10.8 +/- 3.7 versus +4.1 +/- 4.0 g/m2, P = .008); in patients receiving 1.25 mg ramipril, the difference was close to borderline significance compared with placebo (-7.0 +/- 4.3 g/m2, P = .06). Similar results were observed for changes in left ventricular mass (-20.3 +/- 6.6 and -13.0 +/- 7.8 g in the 5- and 1.25-mg ramipril groups, respectively, versus +9.1 +/- 7.2 g in the placebo group; P = .004 and .04, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗

PubMed1995

[Valve ring abscesses: apropos of 59 cases. A multicenter study].

The authors report the results of a multicenter study which recensed 59 cases (46 men, 13 women, average age 59.8 +/- 14 years) of valve ring abscesses defined by echocardiographic criteria alone (20 cases) or by echocardiographic and/or operative criteria (39 cases). The site of abscess was aortic (53 cases), mitral (5 cases) and tricuspid (1 case). The abscess complicated a prosthetic valve in 34 cases, occurred with a non-pathological valve in 11 cases or a pathological valve in 14 cases. Taking the 39 operated patients as a reference, the diagnostic sensitivity of transthoracic echocardiography was 25% and that of transoesophageal echocardiography: 88%. Bacterial vegetations were diagnosed with a sensitivity of 55% for transthoracic and 88% for transoesophageal echocardiography. The mediocre results of transthoracic echocardiography make transoesophageal echocardiography mandatory when there is a clinical suspicion of abscess: transoesophageal echocardiography should be systematic in prosthetic valve endocarditis and widely employed in native aortic valve endocarditis. The clinical outcome of these cases was: 39 cases were operated: global mortality of 23%, and 18 cases were treated medically, surgery having been declined for various reasons: old age (2 patients), operative risk (1 patient), patient refusal (4 patients), general condition considered to be too good to justify surgery (11 cases, including 6 sterilised abscesses diagnosed some time after the acute infectious phase). The outcome of these 18 patients, who form the biggest non-operated series of valve ring abscesses to date, was studied in detail: 4 died (18% mortality), 1 was operated secondarily for progressive valve dehiscence and 13 had a favourable outcome with an average follow-up period of 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗

PubMed1995

[Value of end diastolic pulmonary venous flow in the estimation of left ventricular diastolic pressure].

The aim of this study was to analyse the possible relationship between inversion of the end diastolic wave of pulmonary venous flow (Avp) recorded by transoesophageal echocardiography in the left superior pulmonary vein and left ventricular end-diastolic pressures (LVEDP) at cardiac catheterisation. In this series of patients, there was a poor correlation between the E/A ratio of transmitral blood flow and LVEDP. On the other hand, there was a better correlation between LVEDP and the difference of duration of the end diastolic Avp wave and the A wave of mitral flow. An even better correlation was found between LVEDP with respect to the contribution of atrial systole and the difference of duration Avp-A. When the pressure due to atrial contraction exceeds 15 mmHg, the difference between the durations of pulmonary and mitral A waves increases. Therefore, when the duration of the end diastolic Avp is greater than that of the mitral A wave, a LVEDP of over 15 mmHg may be predicted with a sensitivity of 88% and a specificity of 74%.

Adult↗

PubMed1995

[Remission of left ventricular hypertrophy with ramipril independently of blood pressure changes: the HYCAR study (cardiac hypertrophy and ramipril)].

Most studies of the regression of left ventricular hypertrophy by antihypertensive treatment have methodological weaknesses and have not shown if regression of left ventricular hypertrophy can be obtained independently of blood pressure reduction. In the HYCAR study, after an inclusion phase of 4 to 6 weeks on furosemide (20 mg/day), 115 patients with left ventricular hypertrophy were randomised in a double blind manner to placebo group (N = 40), ramipril, 1.25 mg/day, (N = 38) or 5 mg/day (N = 37) for a period of 6 months. Furosemide was continued during the double blind treatment period. Echocardiography and ambulatory blood pressure monitoring were performed just before the randomisation and at 6 months. At the end of the study, there was no significant difference between the casual and ambulatory blood pressure changes. Expressed in g/m, the left ventricular mass index decreased significantly with respect to placebo in the ramipril 5 mg group (-12.2 +/- 3.9 versus +5.5 +/- 4.3 g/m2, p = 0.003) and in the 1.25 mg group (-7.5 +/- 4.6 g/m2, p = 0.04). The reduction in left ventricular mass index expressed in g/m2 was significant in the 5 mg ramipril (p = 0.008) but not in the 1.25 mg ramipril group (p = 0.06).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1995

[Myxoma of atypical manifestation and morphology].

The authors report a case of myxoma of the left atrium unusual by its clinical presentation, very calcified radiological appearance and histological findings. The topographic description, facilitated by transoesophageal echocardiography, is also emphasized.

Calcinosis↗

PubMed1994

[Guidelines of the French Society of Cardiology on the training of echocardiographers and the performing of echocardiography].

The considerable advances achieved in the field of echocardiography have made this investigation an essential diagnostic tool. Under the auspices of the French Society of Cardiology, the Working group on Echocardiography publishes its practical recommendations for optimising the training of echocardiographers (theoretical instruction and practical courses) and for performing echocardiography (understanding the clinical problem, referral to previous examinations, necessary recordings and measurements, and appropriate equipment). In the future, these recommendations should be updated to take into account continuing technical improvements and changes in methods of studying cardiac disease by echocardiography.

Cardiology↗

PubMed1993

[Cardiac involvements in scleroderma: study with echocardiography and cardiac Doppler in 38 patients].

A study of heart lesions has been conducted in 38 patients with systemic sclerosis using echocardiography, doppler and colour doppler. Abnormalities were found in 66% patients. Valvulopathies (mainly mitral regurgitation) were the most frequent lesions (45%). The presence of anti-SCL70 antibody was correlated to right cavities dilatation. Pulmonary hypertension was found in 6 patients.

Adult↗

PubMed1993

Carcinoid heart disease: two cases of left heart involvement diagnosed by transthoracic and transoesophageal echocardiography.

We report two observations of significant left heart involvement in patients with the carcinoid syndrome assessed by transthoracic and transoesophageal echocardiography. Echocardiographic lesions of this kind have only been reported twice. In the present cases, there was mitral involvement with mitral regurgitation in one case and a mitro-aortic involvement with mitral and aortic regurgitation in the other. The mechanism of left heart lesions is unclear since in both cases no right-to-left cardiac shunt was present, as attested by colour Doppler and saline contrast transoesophageal echocardiography. The location of the primary tumour was unknown in one case and ileal in the other; no pulmonary metastasis was detected. The use of transoesophageal echocardiography might make it possible to detect left-sided cardiac lesions more frequently since they were found in anatomical series, in 30% of patients with carcinoid syndrome.

Aged↗

PubMed1993

Incidence of bacteraemia or fever during transoesophageal echocardiography: a prospective study of 82 patients.

The incidence of bacteraemia during transoesophageal echocardiography (TEE) was evaluated in a prospective study of 82 consecutive patients. Three series of blood cultures were carried out for each patient: from group 1 (n = 44), prior to the examination, at the end of the examination and 15 min afterwards. For group 2 (n = 38), blood cultures were performed prior to the examination, 10 min after the start and immediately after the end. A single positive blood culture was detected in two patients. For the first patient, blood culture at the end of the examination demonstrated Corynebacteria, and for the second, Staphylococcus epidermidis was identified on cultures taken during the examination. During the first 24 h, a transient subfebrile temperature was recorded in 15% of the patients, including the patient with the Corynebacteria-positive blood culture. By mid-term (6 months) no patient had developed endocarditis. Our findings suggest that antibiotic prophylaxis during TEE is not warranted.

Adult↗

PubMed1993

Ventricular arrhythmia revealing mitochondrial myopathy in a 69-year-old woman.

We report a case of mitochondrial myopathy (MM), assessed by histological and biochemical studies. This illness was diagnosed in a 69-year-old patient with myocardiopathy revealed by ventricular arrhythmias. The originality of this case lies in the patient's age, the mode of onset and the biochemical features (i.e. normal mitochondrial enzymatic complexes but very low respiration when using glutamate as a substrate).

Aged↗

PubMed1993

[Ultrasonography in the diagnosis of bacterial endocarditis: value and limits].

This cooperative study recensed 148 patients who had infective endocarditis (IE) with anatomopathological correlations. The infection was on native valves in 89 cases and prosthetic valves in 59 cases. Transoesophageal echocardiography diagnosed vegetations on native valves with a sensitivity, specificity, positive predictive and negative predictive values of 89%, 87%, 88% and 90% respectively, whereas for transthoracic echocardiography the results were 68%, 83%, 81% and 72% respectively. With respect to prosthetic valve vegetations, transoesophageal echocardiography had a sensitivity, specificity, positive predictive and negative predictive values of 67%, 84%, 48% and 92% respectively compared with 56%, 84%, 44% and 83% respectively for transthoracic echocardiography. These results underline the difficulties in differentiating degeneration and endocarditis of bioprostheses. Transoesophageal echocardiography diagnosed aneurysm formation and valvular perforation with a sensitivity, specificity, positive and negative predictive values of 61%, 93%, 91% and 72% respectively compared with 35%, 96%, 98% and 58% respectively for transthoracic echocardiography. The false negative results of transoesophageal echocardiography were usually observed in lesions of the posterior leaflet or commissures. In this series, the 6 aortic cusp perforations were undiagnosed by both transthoracic and transoesophageal echocardiography. With respect to aortic ring abscess, the sensitivity, specificity, positive and negative predictive values of transoesophageal echocardiography were 89%, 100%, 100% and 93% respectively, compared with 27%, 100%, 100% and 62% for transthoracic echocardiography. The false negative results of transoesophageal echocardiography were observed in cases of anterior abscesses or of calcific aortic valves. These results demonstrate the superiority of transesophageal over transthoracic echocardiography in the diagnosis of infective endocarditis and its complications. However, the limitations of the method should be recognized in the situations described.

Abscess↗

PubMed1993

[Diagnostic contribution of transesophageal echocardiography in infectious endocarditis. Apropos of 101 cases].

One hundred and one consecutive patients with infectious endocarditis were examined by transthoracic (TTE) and transoesophageal echocardiography (TEE). There were 71 cases of endocarditis on native valves (N) and 30 cases of endocarditis on prosthetic valves (P). The detection of vegetations was significantly greater by TEE (93%), than by TEE (73%) on native valves but the rate of detection of endocarditis on prosthetic valves was low and identical with both methods. Out of a total of 18 abscesses, only 6 were detected by TEE compared with 15 by TEE. There were 3 false negative results by TEE: small anterior abscesses marked by the prosthesis or aortic calcifications. In addition, TEE demonstrated 3 perforations and 2 mycotic aneurysms of the mitral valve. The lesions were confirmed anatomically in 48 cases. The sensitivity of TEE was 94% and the specificity was 84.5%; the negative predictive value was 87.5%. These results show that TEE is significantly superior in the detection and morphological analysis of vegetations. It is the method of choice for the diagnosis of abscesses, especially in prosthetic valve endocarditis.

Adolescent↗