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Biomedical subjects

T Mesana

Publications and source records attributed to T Mesana.

At least 55 records · Page 3Linked to original sources
PubMed1993

Diagnosis of prosthetic heart valve thrombosis. The respective values of transthoracic and transoesophageal Doppler echocardiography.

Early diagnosis of acute prosthetic thrombosis remains a challenge. In 20 patients with 23 thrombosed cardiac valves, we evaluated the respective value of transthoracic (TTE) and transoesophageal (TEE) Doppler echocardiography. According to the presence or absence of prosthetic obstruction by continuous-wave Doppler, prostheses were separated into two groups. Group 1 included nine thrombosed prostheses (8 mitral, 1 aortic) with severe obstruction. All patients presented with severe symptoms of heart failure. Transthoracic Doppler echocardiography allowed immediate diagnosis of prosthetic thrombosis, even in critically ill patients, showing (1) eccentric transprosthetic colour flow jets in all eight mitral prostheses, (2) severe obstruction on Doppler examination (mean gradient = 18 to 36 mmHg in eight mitral prostheses, and 69 mmHg in one aortic valve), and (3) direct echocardiographic evidence of thrombosis (i.e. thrombus or abnormal disc or leaflet motion) in four patients. All nine patients were immediately treated by surgery (n = 8) or fibrinolysis (n = 1) on the basis of TTE results only. TEE allowed better visualization of thrombus and restricted leaflet or disc motion, but had little influence on patient management. Group 2 included 14 thrombosed prostheses (10 mitral, 4 aortic) with mild or absent obstruction. In three patients with massive mitral prosthetic thrombosis, an associated minimal thrombosis of a prosthetic aortic valve was found at surgery, but was detected neither by TTE, nor by TEE. The 11 remaining patients with isolated partial mitral (n = 10) or aortic (n = 1) thrombosis. Clinical presentation was fever, cerebral embolism, or mild dyspnoea, but no heart failure. TTE was normal in all.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1992

[Plasma glycosylated residues demonstrated by proton NMR spectroscopy. Value in the detection of heart graft rejection].

In conjunction with biopsy and Doppler studies, we analysed by high resolution proton NMR spectroscopy the blood plasma of 22 heart transplant recipients. There was a significant variation in the glycosylated residues of proteins with the development of acute cardiac rejection. A more extensive study is underway to assess the sensitivity and specificity of this approach for the early diagnosis of acute cardiac rejection.

Acetylglucosamine↗
PubMed1992

[Right intra-atrial extension of hydatid cyst mimicking cardiac thrombosis. Apropos of a case].

The authors describe an unusual case of hydatid cyst inserted in the inferior vena cava and extending into the right atrium. The transoesoesophageal echocardiographic appearances were similar to those of a thrombus: the tumour was very mobile, echogenic, polylobular with a cord-like pedicle in the inferior vena cava. The pathological examination revealed a ruptured hydatid cyst. The mass and its insertion were not visible on CT scan or cavography. Transoesophageal echocardiography would therefore seem to be a very useful diagnostic method for tumours arising in the inferior vena cava and extending into the right atrium.

Cardiomyopathies↗
PubMed1991

[Surgical treatment of right-sided infective endocarditis].

Between 1980 and 1989, 8 patients (5 men, 3 women; mean age 30 years) were operated upon in our department of right-sided infective endocarditis. Six patients were heroin addicts and among these 3 were HIV positive and 2 had confirmed AIDS. The most frequently encountered microorganisms (6 cases) were staphylococci. It was decided to operate because of persistent infection and haemodynamic deterioration. The infection involved the pulmonary valve in only 1 of the 8 patients. Surgery was performed during the acute phase in 5 patients and was conservative in 6 patients, consisting of excision of the vegetations or valvulectomy combined or not with valvuloplasty. A high mortality rate (3/8 cases) was observed only among patients operated upon in the acute phase. This may be due to the underlying immunodeficiency and poor haemodynamic state of these patients. Among survivors, the long-term results were excellent, with no recurrent endocarditis and no death, and with only one subsequent operation, 4 years after the first one, for residual tricuspic valve regurgitation. This study shows that patients with right-sided infective endocarditis should be operated upon outside the acute phase of the disease and as soon as complications appear, and that surgery should preferably be conservative.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Periprosthetic false aneurysm after Bentall's operation: diagnosis with magnetic resonance imaging].

Periprosthetic false aneurysm due to dehiscence of a suture line represents a serious postoperative complications after Bentall's procedure, because of its asymptomatic presentation and spontaneous course towards progressive increase in size with high risk of sudden rupture. This type of complication justifies systematic radiologic follow-up. Magnetic Resonance Imaging, as proved by our two cases, is a reliable technique in the diagnosis of this complication requiring reoperation.

Adult↗
PubMed1990

[Approaching the posterior wall of the aortic arch. Temporary division of the innominate artery].

Two cases of wound affecting the posterior wall of the aortic arch are reported. One wound occurred during mediastinoscopy, the other was caused by a bullet. During surgery under extracorporeal circulation, the approach and repair of the wounds was greatly facilitated by temporary division of the innominate artery: the ascending and horizontal portions of the aorta could be tilted to the left, giving a very satisfactory access to the posterior wall of the arch. The innominate artery was easily repaired, without neurological complications. The authors insist on the convenience of this technique to approach not only the aortic arch but also various mediastinal organs, such as the tracheal bifurcation, the right branch of the pulmonary artery and the roof of the left atrium.

Adult↗
PubMed1990

[Neurological disorders disclosing auricular myxoma: 3 cases].

We report 2 cases (n. 1 and 2) of cerebral infarction caused by a left atrial myxoma, and 1 case (n. 3). of dementia associated with a large left atrial myxoma. Cerebral emboli and neurological symptoms which can occur prior to cardiac obstructive and/or systemic signs require echocardiography. The cardiac post-operative condition was dramatically improved in cases revealed by an hemiplegia.

Aged↗
PubMed1989

[Atypical heart transplantation. Technical considerations. Apropos of a case].

A heterotopic heart transplantation was performed on a patient placed on circulatory assistance with a Biomedicus pump for ten days using a heart taken from a donor with situs inversus. In relation to this case, the authors describe the technical procedures allowing transplantation of a heart obtained from a donor with situs inversus into a heterotopic position and an orthotopic position or a normal heart in a recipient with situs inversus. Lastly, in the case of complex cardiac malformations with preservation of the lungs, they present the procedures allowing heart transplantation in cases of situs incertus, anomalies of venous return and transposition of the great vessels.

Adult↗
PubMed1989

[Clinical history and anatomic findings following the longest survival after cardiac transplantation].

The authors report the case history of the first patient in the world to have survived 18 and a half years with a heart transplant. This survival was marked by several episodes of rejection during the early years and various other incidents. The pathology encountered was primarily iatrogenic: diffuse osteoporosis sometimes limited the patient's activity. Two skin cancers and a lung cancer were diagnosed and treated. The patient died from progressive respiratory failure with pulmonary hypertension and signs of right ventricular failure. Pathological examination revealed a subnormal myocardium with a certain amount of overloading of the coronary arteries, confirmed the lung cancer and pulmonary hypertension and, most importantly, revealed the presence of nodular regenerative hepatic cirrhosis responsible for ascites during the last few months of life and a renal adenocarcinoma. These last two lesions are observed in immunosuppressed patients. The authors pay tribute to this patient who led an active and devoted life in the service of others.

Carcinoma, Bronchogenic↗
PubMed1988

[18 and one-half years' survival after cardiac graft. Clinical course and anatomical findings].

Operated upon in November, 1968, the last survivor of heart transplant recipients in those times has died on May 11, 1987, having survived 18 years and 6 months. The active life of this patient, however, was marred by episodes of graft rejection during the first post-operative years and by various incidents. It was mainly the complications of the immunosuppressive treatment that hampered his activities (osteoporosis) and provoked his death. Post-mortem examination confirmed that the heart was in good condition, found an active bronchial epithelioma and revealed iatrogenic lesions, namely adenomas, adenocarcinoma of the kidney and "regenerative" nodular hyperplasia of the liver with portal hypertension. Such lesions are observed in patients under long-term treatment with immunosuppressants. A "sleep apnoea" syndrome might have accounted for the formation of pulmonary hypertension lesions. The authors wish to pay their respects to this man who devoted himself to the service of other men.

Endomyocardial Fibrosis↗
PubMedDate not supplied

Severe lower limbs lymphedema following breast carcinoma treatment revealing radiation-induced constrictive pericarditis--a case report.

In patients treated for breast carcinoma, unilateral lymphedema of the upper limb is usual. However, to the authors' knowledge, lower limb lymphedema has never been reported as a complication of breast carcinoma therapy. They report here the first case of a radiation-induced constrictive pericarditis revealed by severe lower limbs lymphedema. A 60-year-old woman was treated for left breast carcinoma with quadrantectomy, axillary lymphadenectomy, and combined radio chemotherapy (60 grays). Three and a half years later she suffered from a diffuse and increasing lower limbs lymphedema, which became huge and disabling. Radiation-induced constrictive pericarditis was evidenced by right cardiac cavities catheterization. A dramatic improvement was rapidly obtained after pericardectomy. Histopathologic analysis of the pericardium did not reveal neoplastic cells. Radiation-induced constrictive pericarditis is usually responsible for lower limbs edema, but lymphedema is exceptional. This case highlights the need to search for a constrictive pericarditis also in the case of lower limbs lymphedema, particularly in a patient treated with mediastinal radiotherapy or combined radio chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

First significant animal survival with a Wankel-type left ventricular assist device.

The authors' laboratory is developing a device for heterotopic left ventricular assistance. It consists of a titanium Wankel-type rotary pump, driven by an hermetically sealed electric motor. In our animal experiments, the motor-pump unit was implanted in the thoracic wall. The pump was connected to the left heart chambers by left atrial cannulation, and to the descending aorta. The motor was connected to the power and control unit by an electric wire through the skin. In this report, the authors describe the first significant animal survival with this system. Laboratory results were encouraging for hemolysis. The pump failed at 13 days due to a deposit of fibrin and blood cells in the gear housing. This problem was not surprising since similar events have been encountered with centrifugal devices. However, further design improvements should allow longer animal survival and clinical application.

Animals↗