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Biomedical subjects

Y Bouvrain

Publications and source records attributed to Y Bouvrain.

At least 19 recordsLinked to original sources
PubMed1979

[Effects of the parenteral administration of trinitroglycerin on myocardial function, coronary flow and myocardial oxygen consumption in the coronary artery disease patient (author's transl)].

An angiographic study, combined with the determination of coronary flow (thermodilution) and of coronary arteriovenous difference was performed in 10 patients with coronary artery disease under basal conditions and following an infusion of trinitroglycerine. The following changes were noted under the influence of trinitroglycerine: significant fall in left ventricular telediastolic pressure (40%), telediastolic volume (18%), telediastolic strain (53%), mean aortic pressure (11%) and mean systolic strain (21%). Significant increase in ejection fraction (8%), mean shortening (Vcf: 22%) and thickening (Vep: 22%) rates. Significant fall in coronary flow (11%) without any change in coronary arteriovenous difference. Decrease in myocardial oxygen consumption parallel to the reduction in mean systolic strain. These results indicate that the essential mechanism of haemodynamic and metabolic action of trinitroglycerine is located at the level of "load", in particular "preload".

Adult↗
PubMed1979

Multilevel block in the atrioventricular node during atrial tachycardia and flutter alternating with Wenckebach phenomenon.

The electrocardiograms of 100 patients with rapid and regular PP intervals during atrial arrhythmias (because of atrial tachycardia or flutter, or pacing) were examined for periods of irregular atrioventricular conduction. This irregular conduction corresponds to an alternating Wenckebach phenomenon, of a type that can be determined from simple rules. The different types of conduction encountered in different patients and the changes seen in the same patient suggest that the atrioventricular node functions physiologically with 3 levels of sequential block. The different prevalence of the 2 types of alternating Wenckebach block may reflect functional differences at the level of the atrioventricular node.

Atrial Flutter↗
PubMed1979

[Multicenter epidemiological survey of primary myocardiopathies. Apropos of 380 cases].

A retrospective study of adult congestive cardiomyopathy was carried out; the admission criteria being heart failure with cardiomegaly after the exclusion of known causes of heart failure. Coronary artery disease was excluded by forming two sub groups, one with proven normal coronary arteries at angiography or autopsy and the other with only assumedly normal coronary arteries. The results concern the study of the incidence of this disease which has been regularly seen over the last 10 years in departments with a large number of referrals of cardiomyopathy. --Professional factors are analysed to see if there is a higher incidence amongst the working classes. --Other factors are analysed by comparison with three control groups: normal, coronary and valvular disease, and diabetes which may be a predisposing factor, but not the serum cholesterol which is decreased in these patients. There is a significant association with smoking and alcoholism and the main biological sign of the latter condition, macrocytosis. This is also found in both coronary sub groups. The isolation of this alcohol factor in the genesis of congestive cardiomyopathy implies the possibility of reversing or stabilising the myocardial damage after its withdrawal, so changing the severe diagnosis associated with this disease.

Adolescent↗
PubMed1979

[Acute myocarditis simulating myocardial infarct with regressive heart failure].

Two patients were hospitalised with severe heart failure and hypotension thought initially to be due to acute anterior myocardial infarction because of very suggestive electrocardiographic appearances. Heart failure rapidly regressed in both cases. The young age of these two patients, the pyrexia, rapid and total regression of the ECG appearances, the absence of atheromatous lesions at coronary angiography and clinical cure with a follow-up of 10 years in one of the cases, were factors in favour of the diagnosis of acute myocarditis.

Adult↗
PubMed1979

Correlation between angiographic and ECG signs location in unstable angina.

The authors examine if the modifications of the ventricular repolarisation in patients with unstable angina have a value in localizing the site of the coronary stenoses. The relationship between ECG changes and angiographic abnormalities, as yet unrecognized, is studied in 200 patients. The subendocardial signs have little value in predicting the place of the narrowings, they often involve the lateral leads and join with diffused coronary lesions. Subepicardial ECG changes, however, have a good value for prediction: the involvement of inferior leads implies a right coronary stenosis, and that of septal leads a left anterior descending stenosis. The importance of a systematic recording of these ECG changes in unstable angina before performing coronary angiography is discussed. They should be able to specify the ischemic area of the myocardium and then help clinicians to decide when coronarography (and bypass surgery) is indicated.

Angina Pectoris↗
PubMed1978

[2 or 3 level blocks in the Tawara node during atrial tachycardia].

In atrial flutter (or paroxysmal atrial tachycardia), the ventricular response is dependant on the passage through 3 superposed zones of conduction in the Tawara node, the zone of decremential conduction being the central zone N. When the ventricular response is between half and a quarter of the atrial rate there are two possible explanations: type B alternate Wenckebach period (mobitz I block in the central zone N, 2/1 block at the nodo-ventricular junction) or type A alternate Wenckebach period (Mobitz I block in the central zone N and 2/1 block at the atrio-nodal junction). These two responses may alternate in the same patient depending on the drug therapy or vagal activity due to a phenomenon similar to the "GAP" phenomenon. Inexactitudes in the working out of the arithmetic formulae may easily be explained by a certain degree of concealed conduction of blocked activation in one zone or more rarely by hisian extrasystoles. Type A alternate Wenckebach periods are always easier to construct than type B. Perfect 3/1 atrial flutter can only be explained by a type B alternate Wenckebach period with a 3/2 period with a 3/2 period in the N zone and a 2/1 block in the NH zone. When the ventricular rhythm is permanently very slow or when the RR intervals are greater than four times the atrial cycle, 3 zones of block are usually at issue (the third being located in the inferior part of the node or superior part of the bundle of His). Examples of 5/1, 6/1 flutter are thereby analysed. Rapid atrial pacing after termination of the atrial arrhythmia allows a better analysis of its mechanism and the successive reproduction of conduction defects in each zone of block.

Atrioventricular Node↗
PubMed1978

[An unusual type of mid-ventricular obstruction. A discussion of the findings].

The authors report a case of left-sided mid-ventricular obstruction which was completely different from the usual type of obstructive cardiomyopathy, and had asymetrical hypertrophy of the septum demonstrable both by angiocardiography and macroscopically. Complete clinical and haemodynamic recovery followed left ventricular myectomy with replacement of the mitral valve (one year's follow-up).

Angiocardiography↗
PubMed1977

[Coronary thrombosis on oral contraception (author's transl)].

A case of myocardial infarction observed in a 27 years old female taking an oestrogen-progestogen combination for contraception, who died suddenly two months after the resection of a left ventricular aneurysm, provided unprecedented anatomical documents. Their histological examination allowed to state the thrombotic mechanism of the coronary occlusion and brought arguments in favour of an alteration of the coronary arterial wall in the form of thickening of the intima, likely to have been the starting point of this thrombosis.

Adult↗
PubMed1977

[Rupture of the papillary muscles of the mitrale valve during myocardial infarction].

Between 1967 and 1976, 13 cases of papillary muscle rupture during the acute phase of myocardial infraction were collected. Six patients have been treated surgically during the past three years. Three could undergo surgery by virtue of the use of an intra-aortic counterpulsion balloon. There were no operative deaths. One patient died ten days after surgery as a result of a neurological complication; while a second died 4 months after a successful operation of an undetermined cause. For very satisfactory results were obtained with a follow-up of 7, 16, 18 and 18 months.

Acute Disease↗
PubMed1977

Clinical and hemodynamic results of intraortic balloon counterpulsation and surgery for cardiogenic shock.

Forty-two patients with cardiogenic shock (CS) secondary to myocardial infarction were treated with intra-aortic balloon pumping (I.A.B.P.). In 14 patients C.S. was associated with ventricular septal defect (V.S.D.) and in four with mitral regurgitation (M.R.) secondary to rupture of the posterior papillary muscle. All patients were resistant to conventional medical therapy. Shock was reversed in 20 of the 24 patients in C.S. without mechanical complications. After 24 to 48 hours of I.A.B.P., cardiax index (C.I.) increased from 1.38 to 2.00 L./min./M2, systolic arterial pressure (S.A.P.) from 83 to 96 mm. Hg, urinary output (U.O.) from 10 to 56 ml. per hour, and pulmonary wedge pressure (P.W.P.) decreased from 22 to 16 mm. Hg. Three patients treated with I.A.B.P. alone survived more than 1 year; of the 13 patients who were balloon dependent, four have undergone emergency surgical procedures and two were long-term survivors. In all patients with mechanical complications, I.A.B.P. resulted in significant clinical and hemodynamic improvement. P.W.P. decreased from 19 to 15 mm. Hg, and U.O. increased from 13 to 38 ml. per hour while S.A.P. remained unchanged. In patients with V.S.D. the pulmonary/systemic flow ratio (P/S) declined from 3.5 to 2.8; in patients with M.R., "V" wave amplitude decreased by 8 mm. Hg. Emergency surgery was performed in 10 patients with V.S.D. and in three patients with M.R. and there were eight long-term survivors (13 to 27 months). It is concluded that I.A.B.P. is an effective means of supporting the circulation in C.S. Of the 42 patients with C.S. treated by combining I.A.B.P. and emergency surgery, 13(31%) were long-term survivors (20 +/- 6 months).

Adult↗
PubMed1977

[Biventricular massive infarction with rupture of a mitral papillary muscle and a tricuspid papillary muscle].

The authors report the case of a man of 62 who was admitted with a clinical and electrocardiographic picture of a posterior infarction which was very soon complicated by collapse and anuria. The findings on catheterisation of the right side of the heart were as expected. The cardiac index was very low, and the major abnormality was a type of adiastole with equal pressures in the right ventricle and the auricle of the right atrium. Despite an attempt to assist the circulation by an intra-aortic ballon, the patient died within a few hours. The postmortem examination confirmed the presence of a massive infarction of the left ventricle, but also of the right ventricle, together with rupture of the posterior papillary muscle of the mitral valve, and ischaemic rupture of one papillary muscle of the tricuspid valve.

Electrocardiography↗
PubMed1977

[Arrhythmias and chronobiology].

The cyclical changes in biological events have seldom been studied by cardiologists. No complete systematic method of study has ever been applied to them. It is, however, certain that the circadian rhythms play a very important role in cardiac patients. This can be seen to be so in the arrhythmias. In a preliminary report, the authors give several examples of this concept; they have obtained their material by using a computerised magnetic tape recording of the electrocardiogram during a 24 hour period.

Adult↗
PubMed1976

[Pregnancy in women with atrioventricular block. 13 cases].

Thirteen women aged between 18 and 37 years and suffering from atrio-ventricular block had 36 pregnancies. Foetal prognosis was excellent and the pregnancy quite unaffected by the block in 9 cases. In 4 women, Stokes-Adams attacks occurred. In one case from some time ago therapeutic abortion was necessary. Temporary pacing at the time of delivery was used in one case and a permanent pacemaker in one patient. The problems posed by the insertion of a pacemaker in a woman of childbearing age are discussed.

Abortion, Therapeutic↗
PubMed1976

[Diagnostic value of closed thorax pericardial biopsy. 20 cases].

Twenty patients with sub-acute and chronic pericarditis under went closed thorax pericardial biopsy. In three cases the examination brought to light a diagnosis of tuberculosis and in one of a tumoural origin. In 16 cases in which the aetiology was that of a non-specific pericarditis, the value of this examination, integrated into the context, is discussed.

Adult↗
PubMed1976

[Temporary mechanical cardiocirculatory assistance in an adolescent suffering from subacute cardiac failure].

A case is reported of subacute carciac failure during the course of a non-obstructive cardiomypathy in an adolescent. When the exacerbation of cardiac failure, which was accompanied by severe arrhythmias, failed to respond to medical treatment, the combination of a veno-arterial bypass and membrane oxygenator with diastolic counter-pressure from an intra-aortic balloon was tried with success. A reasonable remission was obtained by this means, but the young patient died 8 months later from cardiac failure which proved resistant to treatment.

Acute Disease↗