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Biomedical subjects

A Barrillon

Publications and source records attributed to A Barrillon.

At least 55 records · Page 3Linked to original sources
PubMed1977

[Electrocardiogram in the "typical angina of effort with normal arteriography" syndrome].

This study related to 163 cases of chest pain with the typical clinical features of angina of effort (AE) selected from a continuous series of patients who had carotid arteriography (CA) for anginal pain. These 163 cases were divided into two groups: a study group (SG) consisting of 44 patients with a normal CA, and a control group (CG) which, when patients with ECG evidence of transmural necrosis had been excluded, consisted of 119 cases of coronary artery stenosis, almost all amounting to more than 75 percent. Among those with typical AE (without ECG evidence of transmural necrosis), the proportion of normal CA was 27 percent. It was reduced to 17 percent when those patients with ECG evidence of transmural necrosis were added to the CG. The clinical features of the pain were noted for the SG and the CG, as well as the incidence of "risk factors". By contrast, the SG contained significantly more young subjects and females than the CG (P less than 0.001). The proportion with normal ECGs at reat was the same in the two groups (32 percent). The proportion of non-ischaemic abnormalities of repolarisation was 32 percent in the SG and 18 percent in the CG. Ischaemic abnormalities of repolarisation were present in 23 percent of cases in the SG, and in 49 percent in the CG (p less than 0.01). The exercise test on a bicycle ergometer was carried out for 16 cases in the SG was positive in 7 (44 percent: one male, six females). Of the 33 tests in the CG, a positive response was obtained in 20 (60 percent: 18 males, 2 females) (NS). 37 percent of patients in the SG showed an abnormality of volume or of left ventricular kinetics on arteriography (5 cases) and/or elevation of the end-diastolic pressure before and after arteriography (9 cases). These findings are not significantly different from those in the CG. 9 patients in the SG were studied for myocardial metabolism under pacing: 2 were found to have abnormalities in lactate production.

Adult↗
PubMed1976

[Severe hyperkalemia in cardiac patients].

Hyperkalaemia with severe myocardial consequence may complicate the treatment of heart failure. In five patients who developed kalaemia ranging from 6.5. to 8.6. mEq/l, the ECG showed altered auriculogram and/or widened QRS, the latter change being associated with ST segment elevation and very large T wave in one case. Such hyperkalaemia cannot be termed iatrogenic, although it is promoted by diuretic-induced hyponatraemia and dehydration. The essential part is played by an aggravation of the haemodynamic status, responsible for acute renal insufficiency with oligoanuria, and by the attendant metabolic acidosis. The correction of this metabolic acidosis promotes diuresis, causing potassium depletion and the rapid regression of electrocardiographic abnormalities. Parenteral alkalinization with sodium bicarbonate, associated with furosemid to prevent sodium overload, instituted in emergency, is the only way to prevent asystole or ventricular fibrillation when kalaemia exceeds 8 mEq/l.

Acidosis↗
PubMed1976

The surgical treatment of constrictive fibrous endocarditis.

Constrictive fibrous endocarditis is a pathological entity described by Loëffler in 1936. Its etiology is unknown. The clinical course is characterized by an evolution towards cardiac insufficiency leading rapidly to a fatal outcome. Moderen paraclinical investigations are necessary to assess the diagnostic. Caridac catheterization brings the proof of adiastole and angiogardiography reveals the shape of amputation of the ventricle with auriculoventricular regurgitation. The operative procedure consists of resection of the ventricular fibrosis including the valves and auriculo-ventricular valve replacement by a prosthetic valve. The disease affects both Caucasians and Negros. Our experience includes 5 cases. The indications for operation and their results are discussed.

Adult↗
PubMed1976

[Value of caudo-cranial and left anterior obleque projections in the angiographic study of the left coronary artery].

The use of new apparatus which offers an unlimited choice of projections in the frontal and sagittal planes is a great step forward in the radiological investigation of the coronary arterial tree. The results obtained with the left anterior oblique caudo-cranial projection have been reported. In a series of 100 consecutive coronary arteriographies, this method showed up lesions which were passed over or unnoticed, or showed up the magnitude of stenoses which had been underestimated in the standard projections, in 24 cases. From among these, it was possible to show up 6 stenoses which were at or above the 75% level; 4 of these were on the diagonal artery, 1 on the anterior desceinding artery, and one on the left coronary trunk. In 16 other patients it confirmed the degree of stenosis, which had been uncertain when assessed by the usual technique. All in all, it gave useful information in 40% of cases. This new projection is especially useful for investigation the proximal parts of the branches of the trunk of the left coronary artery.

Coronary Angiography↗
PubMed1976

[Anatomic study of early failures of aortocoronary venous bypass].

A post-mortem study of 10 patients who died soon after an aorto-coronary by-pass procedure (16 grafts) showed that 5 grafts were blocked by recent thrombus (31%) in 5 patients, 3 of whom had infarcts as a result. It seems that the two main causative factors of early thrombosis were: -the wider calibre of the saphenous graft; the ratio of the circumference of the graft to the circumference of the coronary artery at the site of anastomosis is greater when there is a graft thrombosis (5.6/1 +/- 2.2) than when the graft is permeable (2.3/1 +/- 1.1) (p less than 0.01); -stenosing atherosclerosis of the artieal tree beyond the anastamosis. Changes in the endothelium of the vein, especially those caused by suturing, could equally well play a part in thrombus formation. Certain other factors, such as an insufficiently large graft ostium into the aorta, and poor outflow in the distal arterial bed, or an insufficiently large territory of supply belonging to the artery which has been bypassed, may also influence the degree of myocardial revascularisation brought about by the operation. A by-pass procedure requires a vein graft with a reasonably small diameter which matches, if at all possible, that of the coronary artery, and a good flow in the distal arterial bed, which must be confirmed at operation.

Adult↗
PubMed1975

Premonitory sign of heart block in acute posterior myocardial infarction.

The appearance of the ARS complex in leads V3R and V4R was analysed in a series of 94 patients with acute posterior myocardial infarction. The cases of posterior myocardial infarction with direct signs of injury (ST segment elevation with a rise of 0.5 mm or more of point F and/or QS pattern) in leads V3R and/or V4R were complicated three times as often by atrioventricular block as those in which such signs were absent (66% and 22%, respectively; P smaller than 0.001). When one of these signs was present in leads V3R and/or V4R, the disorder of conduction was "severe" (complete atrioventricular block or sinotrial block with pauses) in half the cases and "unstable" (bradycardia below 50 beats/min; ventricular pause with or without syncope; widening of QRS complex; ventricular hyperexcitability) in one-third, justifying the introduction of a stimulating catheter. Such disorders were found, respectively, only 1 in 7 (14%), and less than 1 in 10 (8%) when these signs were absent (P smaller than 0.001). The association of ST segment elevation and QS pattern was rarer (15 cases) than the isolated finding of either sign. It was found in the most severe disorders of atrioventricular conduction. The changes observed in leads V3R and/or V4R before the appearance of atrioventricular block enable one to predict which patients with posterior myocardial infarction are the most likely to develop atrioventricular block. These electrocardiographic features seem to indicate septal involvement.

Adult↗
PubMed1975

[Epicardial cartography and surgical treatment by simple ventriculotomy of certain resistant re-entry ventricular tachycardias].

Intraventricular reentry has been prooved by pre-operative electrophysiological studies in two patients without coronary artery disease and resistant ventricular tachycardia. A simple ventriculotomy oriented by epicardial mapping during tachycardia was successfull with a background of 9 and 14 months respectively. In addition, delayed epicardial potentials put into evidence an intraventricular reentry in human myocardium. This new method holds promises for the treatment of some resistant ventricular tachycardia.

Adult↗
PubMed1975

[Coronary thrombosis and long term anticoagulant treatment. Results of 173 autopsies after myocardial infarction].

Report of an anatomical-clinical study concerning 173 patients with an average follow-up period of 5 and 1/2 years after the onset of myocardial infarction. They were subdivided into four comparable groups differing only in the quality of the long-term antivitamin K treatment which was administered. A survey of the coronary artery and myocardial lesions was performed for every heart. Acute occlusive coronary artery thromboses were four times less frequent in the correctly treated group then in the other three groups (p less than 0.001). There was no significant difference between the insufficiently treated groups and the untreated group. Recurrent myocardial infarctions were accompanied in 90 per cent of cases by acute occlusive coronary artery thromboses and were four times less frequent when treatment was efficient (p less than 0.001). These results confirm the part played by coronary artery thrombosis in the aggravation of coronary atherosclerosis and justify the attempts at long-term prophylaxis. The provide the proof that antivitamin K administration, at efficient dosage, maintained for a long time, has a significant influence on the cause of death in these patients, by decreasing the number of coronary artery thrombosis. Long-term anticoagulant treatment, in spite of its haemorrhagic complications and limits, should not be given up until a new efficient treatment is available.

Aged↗
PubMed1975

[Silent mitral insufficiency caused by partial dislocation of a Starr-Edwards valve. Apropos of 2 cases with 1 being successfully re-operated].

Silent mitral incompetence due to partial dislocation of the Starr-Edwards valve, leading to an apparently unexplained cardiac failure, has been observed in two patients, one two months and the other 35 months postoperatively. There was a fatal outcome in the first patient, no operation being carried out. Cardiac catheterisation with arteriography of the left anterior descending artery established the diagnosis, and led to a successful reoperation in the second case. It is therefore essential to carry out a haemodynamic and angiocardiographic investigation of any case who, after an initial trouble-free interval post-operatively, develops a deterioration of function which cannot be explained.

Adult↗
PubMed1975

Comparison of angiographic aspects and anatomical lesions of coronary arteries.

The coronary angiograms of 32 patients were compared with the anatomical lesions found during the postmortem examinations which were done early after the X-ray examination. The angiographic and anatomical data coincided in 81.6 per cent of all the coronary artery segments studied. The best coincidence was observed for the right coronary artery and the less accurate for the left coronary trunk (nevertheless, with 77 per cent good correlations). On the whole, the observer tends to underestimate the severity of the stenoses involving the large trunks (left coronary trunk and anterior descending artery) and to overestimate the involvement of the distal segments, especially if their size is small. Habitually, the errors noted are insufficient to modify the therapeutic attitude. Rarely, on the anterior descending artery, they have led to the performance of an uneccessary aorta-to-coronary by-pass (1 case) or to an unjustified conservative attitude (2 cases). Equally, over-estimation of a distal bed to a left circumflex artery was responsible for an abusive contra-indication (1 case). Thus, if on the whole coronary angiography is a fiable examination, it is necessary to resort to new incidences to improve its results.

Coronary Disease↗