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A Choussat

Publications and source records attributed to A Choussat.

At least 19 recordsLinked to original sources
PubMed2003

[The best of pediatric cardiology in 2002].

This past year has been remarkable for considerable advance in the field of interventional cardiology for congenital heart disease. Ostium secundum atrial defect is by now cured by percutaneous closure with excellent results. Closure of patent foramen ovale (PFO) in patients with paradoxical embolism is still controversial. Nevertheless, some studies demonstrate the efficiency of this procedure, reducing the incidence of ischemic events. In cases of platypnoea-orthodeoxia syndrome occurring in patients having undergone pneumonectomy or presenting dilatation of ascending aorta, closure of PFO with an occluder gives spectacular results with disappearance of dyspnea and cyanosis. Other more complex procedures such as closure of membranous ventricular septal defect, replacement of an pulmonary or aortic valve are still to be assessed. As the last point let us underline the progress of foetal cardiology, the studies of sudden death in children an adolescents, and the care of adults with congenital heart disease.

Adolescent↗
PubMed2003

[Ectopic junctional tachycardia of the neonate].

Congenital ectopic junctional tachycardia (EJT) is a rare arrhythmia presenting in the first 6 months of life. It is often resistant to antiarrhythmic drugs and its poor prognosis (35% mortality) explains its often complex management. The authors report two cases which illustrate its unpredictability with a potential to degenerate to serious ventricular arrhythmias. The possibility of progression to atrioventricular block, increased by antiarrhythmic therapy, may lead to implantation of a cardiac pacemaker. The poor outcome of the two babies underlines the severity of these arrhythmias.

Adrenergic beta-Antagonists↗
PubMed2002

[The best of 2001. Pediatric cardiology].

During this last year, paediatric cardiology has gone through significant changes, although no capital evolution is to be pointed out. Foetal cardiology, initiated some years ago has been remarkably developed. The rate of cardiac anomalies detected is increasing, which leads to very difficult discussions regarding therapeutic abortion and even increasing legal responsibility as evidenced by "arrêt Perruche". Interventional cardiology is more and more resorted to and a reliable, safe and efficient procedure which improved atrial septal defect (ASD) occlusion devices. Data on occlusion of ASD and patent foramen ovale confirm the reliability of these methods. In the field of imaging. Nuclear Magnetic Resonance angiography which gadolinium can, in some cases, replace fluoroscopy with clearer pictures. Reinforced interest is given to Primary Pulmonary Hypertension (PPH) due to genetic studies and new therapies. The rate of familial PPH is about 6%. It is an autosomic dominant disorder located on chromosome 2q31-32. New treatment use various prostacyclines administrated by different ways: subcutaneously, orally or by inhalation. It is too early to assess their impact on the prognosis. Finally, we may note the paradoxical importance of congenital heart disease in adult as an outcome of interventional cardiology and follow-up of operated children becoming adults. As the beginning of the 21st century, the definition of paediatric cardiology has considerably evolved.

Adult↗
PubMed2002

[Value of fetal echocardiography in screening for congenital heart diseases. Report of 1,049 consecutive examinations].

Specialised antenatal echocardiographic screening has allowed 1049 consecutive examinations in 992 patients resident in the Aquitaine region over a period of nine years. The most frequently encountered indications are expertise (suspicion of cardiopathy during initial screening) and family history. Expertise allows a higher detection rate (46.5%) compared to the other indications. We have screened 150 cardiopathies in utero and among them 143 were able to followed up after delivery. We have noticed a much greater severity of the anomalies compared to those encountered in paediatric cardiology. An associated chromosomal anomaly was noticed in 9% of cases and more frequently for atrio-ventricular communication and conotruncal cardiopathies. The rate of abortion was 35%, and the mortality for the surviving pregnancies was elevated (35%). Pharmacological treatment was instituted in 95% of cases of sustained supraventricular tachycardia with 81% successful. Diagnosis errors concerned benign cardiopathies above all and did not change the management of the pregnancy. The sensitivity of fetal echocardiography was 93.1% and its specificity 99.1%. This study shows the viability of fetal cardiac echography for the detection of the majority of congenital cardiopathies in a population at risk and in the management of fetal cardiac rhythm disorders. Nevertheless it remains a specialised examination for which the performance depends much on the initial screening performed by gynaecologists. Although the mortality rate of the screened children is elevated, indicating the frequent parental choice of abortion and the complexities of the cardiopathies, antenatal diagnosis has allowed optimisation of the neonatal management for certain curable cardiopathies.

Abortion, Induced↗
PubMed2002

[Placement of an implantable defibrillator via the endocavitary route in a patient presenting with a univentricular heart and a Glenn anastomosis].

We report the observation of a female 45 year old patient presenting with a post-surgery complex congenital cardiopathy, associated with serious ventricular rhythm disorders necessitating the placement of an implantable defibrillator. The palliative surgery performed (cavo-pulmonary Glenn anastomosis) does not allow the usual access to the right ventricle via the superior vena cava. The different possibilities for defibrillator implantation are discussed. These include associating a surgical approach to introduce the bipolar probe with subcutaneous tunnelling to connect the probe to the box.

Arrhythmias, Cardiac↗
PubMed2002

[Ebstein's anomaly].

Since Ebstein's first description in 1866 and the first surgical attempts at treatment in the 1950's, the natural history of this condition remains obscure. The anatomical description contrasts with the clinical and prognostic variability of this malformation. The form observed in the foetal or prenatal periods has a very different prognosis to that observed in adults. The risk factors are not the same even though the anatomical entity is comparable. The difficulty in managing these patients is due to the problems of diagnosis and determination of these prognostic factors. Advances in echocardiography, the key investigation which facilitates diagnosis, and in surgical and ablation techniques, have improved our understanding of this condition and its prognosis.

Adult↗
PubMed2002

[Outcome of operated Fallot's tetralogy].

Fifty years after the beginning of cardiac surgery, a large percentage of operated congenital heart disease patients attain adulthood. The tetralogy of Fallot is one of the malformations in which the natural outcome was unfortunately nearly fatal in the long-term. Open heart surgery has radically transformed the prognosis of this, the most common of all cyanotic congenital cardiac malformations. Nowadays, most operated patients lead normal professional and family lives. Lonf-term survival after correction is between 90-95% after 30-35 years. Although surgical repair is satisfactory, the operated heart is not anatomically normal. The patients have a variable degree of devalvulation of the pulmonary outflow tract, a scar on the right ventricle, a patch repairing the ventricular septal defect and scars on the atrium (cannulation for cardiopulmonary bypass). These sequellae expose the patients to a number of complications, notably arrhythmic and sometimes haemodynamic, affecting the right ventricle. The late mortality rate varies from 5 to 13% in the literature. The main causes of death are sudden death and reoperation. Sudden death is the most severe long-term complication but it is uncommon, affecting less than 5% of the population. It is mainly due to ventricular arrhythmias. Certain predisposing factors should be identified during long-term follow-up, among them the presence of haemodynamic abnormalities: systolic overload (residual pulmonary stenosis) or diastolic overload of the right ventricle (pulmonary regurgitation), infundibular aneurysm, right ventricular dysfunction. It would appear to be important to prevent pulmonary regurgitation by preserving the pulmonary valve even if it means persistence of a mild transvalvular pressure gradient. When pulmonary regurgitation is inevitable, follow-up is essential to evaluate the timing of valvulation of the pulmonary orifice. Despite these different complications which must be understood for proper follow-up of these patients, the long-term outcome of operated tetralogy of Fallot remains very good.

Adult↗
PubMed2001

[Myocardial infarction in a child with an anomalous left coronary artery arising from the right coronary sinus. Value of echocardiography].

An anomalous left coronary artery arising from the right sinus of Valsalva with a trajectory between the aorta and the main pulmonary artery is a rare isolated congenital anomaly carrying a high risk of sudden death and of acute myocardial ischaemia, especially in children and young adults in a context of exercise. It is usually a post-mortem finding. The authors report the rare case of a 12 year old child who suffered acute myocardial infarction on exercise due to this condition. The diagnosis was made in the acute phase by echocardiography. Surgical correction was performed as this is the only means of prevention of sudden death of an ischaemic recurrence. Effort syndromes in children or young adults should lead to a request for echocardiographic examination to exclude the diagnosis in a non-invasive manner as well as those of hypertrophic cardiomyopathy or congenital aortic stenosis.

Child↗
PubMed2000

The short- and mid-term results of bidirectional cavopulmonary shunt with additional source of pulmonary blood flow as definitive palliation for the functional single ventricular heart.

OBJECTIVE: The purpose of this study was to demonstrate the early and late outcomes of bidirectional cavopulmonary shunt (BCPS) as a definitive procedure for the functional single ventricular heart. METHOD: From September 1991 to December 1997, 34 patients underwent a BCPS procedure without a routine conversion to Fontan circulation. The additional source of pulmonary blood flow was left in all patients. Conversion was performed only when it was required for excessive cyanosis. RESULTS: The hospital mortality rate was 8.8% (3/34, 95% confidence limit; 1.9-23%) and the 5-year survival rate was 75% for a mean follow-up period of 33+/-22 months. Seven patients underwent a conversion procedure for remnant or recurrent cyanosis and deterioration of exercise tolerance. Four of these patients died after conversion to Fontan circulation. Twenty-five long-term survivors with BCPSs maintained an arterial oxygen saturation of 84+/-6.1%, and 52% of them had a normal exercise tolerance or mild limitation. No patients developed severe late complications other than recurrent cyanosis. CONCLUSION: Due to the high mortality after conversion to Fontan circulation in patients whose conditions had deteriorated, we could not demonstrate the clear superiority of long-term BCPS over the construction of Fontan circulation for management of the functional single ventricular heart. If deteriorated conditions were successfully managed in the late period, the outcome of long-term BCPS would have been better.

Adolescent↗
PubMed1999

Immunohistological and ultrastructural analysis of the intimal thickening in coarctation of human aorta.

OBJECTIVES: The histological nature and characteristics of aortic coarctation are not clearly defined, the aim of this study is to analyse intimal thickening in aortic coarctation. METHODS: In order to characterize the components of intimal thickening in coarctation, narrowed segments of aorta obtained after surgery from ten children were examined immunocytochemically and by electron microscopy. RESULTS: Histological analysis of aortic coarctation demonstrated a widened subendothelial region with separation of endothelial cells from the internal elastic lamina. Masson's trichrome staining showed a marked increase in extracellular matrix and cell numbers in the intimal thickening compared with normal aorta. Cellular component analysis demonstrated invagination of the intima by smooth muscle actin-positive cells, with a fragmentation of the internal elastic lamina. No proliferating smooth muscle and inflammatory cells were identified in the intima. In order to characterize the smooth muscle cell phenotypes, various smooth muscle cell markers were sought using specific monoclonal antibodies: alpha-smooth muscle actin, smooth muscle-myosin heavy chain, heavy caldesmon, desmin. In moderate coarcted aorta, at least two distinct smooth muscle phenotypes were identified. In the juxtamedial part of the intima smooth muscle, cells were differentiated and expressed all smooth muscle markers; in the subendothelial part of the intimal thickening, the majority of smooth muscle cells expressed only alpha-smooth muscle actin and appeared dedifferentiated. In regions of marked stenosis, a strong expression of smooth muscle-myosin heavy chain, and heavy caldesmon in the intimal thickening pointed to the presence of redifferentiated smooth muscle cells, not still expressing desmin. Electron microscopic examination also revealed a variety of smooth muscle cell phenotypes in the intimal thickening. In the superficial layer, smooth muscle cells appeared to be in the synthetic state, while in the deeper part, both synthetic and contractile components were identified. CONCLUSIONS: These observations indicated that human coarctation was characterized by intimal recruitment of non-proliferating smooth muscle cells with dedifferentiated phenotype. However, the presence of smooth muscle cells with an intermediate phenotype in the narrowest part of the coarctation suggest that the redifferentiation process could participate in the pathogenesis of aortic coarctation.

Actins↗
PubMed1999

[Cardiac myxoma in patients over 75 years of age. Report of 19 cases].

Left atrial myxoma is considered to be exceptionally rare in the elderly. The authors observed and reported on 19 cases occurring in patients over 75 years of age out of a series of 100 myxomas diagnosed between 1962 and 1997, in 12 women and 7 men (mean age: 80 years, range 75 to 89 years). In 3 cases, the myxomas were chance findings at echocardiography but the 16 symptomatic patients (85%) had left ventricular failure (47%), positional symptoms (25%), pyrexia and poor general health (17%) or systemic embolism (17%). The location of the myxoma was the left atrium in all cases, with mitral valve obstruction in 13 of the 19 cases. Eighteen tumours were attached to the interatrial septum and one to the atrial surface of the anterior mitral leaflet. Calcifications were observed in 5 patients. Surgical ablation of the tumour was performed in 15 of the 19 patients. The post-operative course was usually uncomplicated: one patient died of a cerebral haemorrhage. Four patients did not undergo surgery because of patient refusal in 3 cases and major associated morbidity in the other case. These cases were included in the study because the tumours had all the characteristics of myxomas. Though the discovery of a myxoma remains a classical surgical emergency, the presence of quiescent, non-obstructive, well circumscribed and calcified myxomas with a low risk of obstruction and of embolism in elderly high risk patients may be exceptions to this traditional dogma.

Age Factors↗
PubMed1999

[Surgical evaluation of transthoracic tridimensional echocardiography in the anatomic study of atrial septal defect].

The closure of atrial septal defects by interventional catheterisation requires an accurate assessment of their morphology and anatomical relationships. This study evaluated transthoracic three-dimensional echocardiography for the selection of atrial septal defects accessible to an occlusive prosthesis. The transthoracic three-dimensional echocardiographic measurements of 17 patients (4 to 55 years) with ostium secundum atrial septal defects were compared with those of the surgeon in a prospective study. The maximal diameters of the defect, the height of the interatrial septum, the distances to the superior vena cava (postero-superior border) and inferior vena cava (postero-inferior border), to the coronary sinus and the tricuspid valve were measured as a reconstruction of the interatrial septum seen from the right atrium. The aortic border was measured from a three-dimensional view from the left atrium. Thirteen of the 17 investigations (76%) were exploitable. The diameters of the defect varied during the cardiac cycle (p = 0.0002). Ther correlations between the surgical and echocardiographic measurements varied from 0.82 for the maximal diameter to 0.6 for the postero-inferior limits. Three-dimensional echocardiography is capable of detecting all the contra-indications of an occlusive prosthesis: 2 inadequate postero-inferior and 1 inadequate aortic borders, 9 maximal diameters which were too large, 3 insufficiently high atrial septa, 1 double atrial septal defect. The coronary sinus was only visualised in 1 case. Transthoracic three-dimensional echocardiography is a non-invasive technique capable of improving the selection of atrial septal defects for interventional closure. The transoesophageal approach should be reserved for candidates selected by the transthoracic investigation for the detection of small structures (coronary sinus) and when the transthoracic window is poor.

Adolescent↗
PubMed1999

[Congenital left ventricular aneurysms and diverticula. Two case reports].

The authors report the cases of two young adults (25 and 27 years) presenting with congenital left ventricular aneurysm or diverticulum with healthy coronary arteries. This saccular evagination of the ventricular wall is rare. The authors describe a classification distinguishing muscular (contractile) diverticula, composed of the three cardiac tunics, fibrous diverticula and finally aneurysms with a dyskinetic wall. Although the limits of this classification are sometimes poorly defined, it presents a prognostic value, because it appears logical to propose nonsurgical management in the context of muscular diverticula and it seems legitimate to operate on fibrous diverticula and aneurysms due to the risks of rupture, extension, thrombosis or arrhythmia.

Adult↗
PubMed1998

[Study of the cardiorespiratory response and chronotropic function after correction of tetralogy of Fallot. Important role of residual pulmonary regurgitation].

Effort tolerance is reduced after correction of Tetralogy of Fallot. This prospective study investigated the cardiorespiratory response and the chronotropic function (mean follow-up 11.1 years) of 70 patients (43 boys and 27 girls) with an average age of 14.9 +/- 7.2 years (group 1) compared with 65 normal, sedentary subjects paired red for age and gender (group 2). All underwent exercise testing (Bruce protocol) with measurement of respiratory gases. Quantification of pulmonary regurgitation was performed by Doppler echocardiography. The chronotropic response to exercise was assessed by calculating the mean of slopes established by chronotropic metabolic relationship of Wilkoff. The cardiorespiratory response to exercise was abnormal in group 1: the duration of exercise (11.3 vs 13.6 min; p = 0.005), peak VO2 (35.5 vs 46 ml/min/kg; p < 0.001) and anareobic threshold (8.3 vs 9.2 min; p = 0.001) were decreased. Maximal heart rate (172 vs 190bpm; p < 0.001) and the mean of the metabolic-chronotropic slopes (0.68 vs 0.83; p < 0.001) were decreased in the patient group, showing abnormal chronotropic response to exercise. The latter seemed to be related to the severity of pulmonary regurgitation. The duration of exercise (10.6 vs 11.5 min; p = 0.001), peak VO2 (33 vs 37 ml/min/kg; p < 0.001), maximal heart rate (161 vs 177 bpm; p = 0.002) and the mean of the slopes of the metabolic-chronotropic relationship (0.59 vs 0.72; p < 0.001) were decreased in patients with moderate to severe pulmonary regurgitation. This study shows that significant pulmonary regurgitation is responsible for a poor cardiorespiratory response to exercise and for an abnormal chronotropic response which seems to be multifactorial but probably related to an adaptation favouring left ventricular filling during exercise.

Adolescent↗
PubMed1997

Physical training improves exercise capacity in patients with mitral stenosis after balloon valvuloplasty.

BACKGROUND: Haemodynamic measurements taken at rest and during exercise showed that percutaneous transvenous mitral commissurotomy results in both acute and long-term improvement. However, the time lag before there is an increase in exercise and in peak oxygen uptake appears to be delayed and irregular. PATIENTS AND METHODS: To assess the potential of physical training to restore better physical capacity after percutaneous transvenous mitral commissurotomy, 26 patients with mitral stenosis were studied after the procedure. The group was split into two. Thirteen underwent a 3-month rehabilitation programme, and the other 13, who did not, acted as controls. RESULTS: The mitral valve orifice area increased similarly, from 1.12 +/- 0.17 to 1.88 +/- 0.28 cm2 in the training group and from 1.04 +/- 0.16 to 1.88 +/- 0.19 cm2 in the control group. Cardiopulmonary parameters were similar before percutaneous transvenous mitral commissurotomy (peak VO2: 19.9 +/- 2.4 vs 18.9 +/- 4.5 ml. min-1.kg-1; peak workload: 94.6 +/- 29.3 vs 96.1 +/- 25 watts; VO2 at anaerobic threshold: 17 +/- 3.4 vs 16.1 +/- 5.2 ml.min-1.kg-1; all P = ns). Three months later the results were higher in the training group 1 (peak VO2: 26.6 +/- 4.7 vs 21.6 +/- 3.8 ml.min-1.kg-1, P = 0.03; peak workload: 125.4 +/- 26.6 vs 108.5 +/- 23 watts, P = 0.03; VO2 at anaerobic threshold: 19.6 +/- 5.8 vs 15.8 +/- 2.9 ml.min-1.kg-1; P = 0.02). CONCLUSION: These results indicate that patients should take up exercise after successful percutaneous transvenous mitral commissurotomy for better functional improvement.

Adult↗
PubMed1997

Cardiorespiratory response to exercise after venous switch operation for transposition of the great arteries.

STUDY OBJECTIVES: This study reports on the cardiorespiratory response to graded exercise in patients after venous switch operation for transposition of the great arteries. DESIGN: Several small studies have documented a diminished exercise tolerance after Mustard repair for transposition of the great arteries, little information exists, however, about long-term cardiorespiratory exercise performance in patients who have had the Senning procedure. PATIENTS: This prospective study reports on the serial long-term (mean, 11 +/- 2.8 years) cardiopulmonary exercise performance of 43 patients (age, 12 +/- 3.1 years) who underwent a Senning procedure, with no significant postoperative abnormalities. Forty-three matched healthy children were also studied as a control group. MEASUREMENTS AND RESULTS: All underwent exercise testing (Bruce protocol) with metabolic gas exchange to determine parameters at 3 min, anaerobic threshold, similar heart rate (150 beats/min), and peak exercise. Time of exercise was 10.5 +/- 1.9 min in patients and 13.4 +/- 2 min in control subjects (p = 0.0001). Overall, patients reached 73% of peak oxygen uptake achieved by control subjects (32.6 +/- 5.6 vs 44.7 +/- 6 mL/kg/min). Chronotropic response (188 +/- 15.7 vs 166.5 +/- 19.6 beats/min [p = 0.0001]) and oxygen pulse (7.4 +/- 2.9 vs 10.7 +/- 4.2 mL/beat [p = 0.0002]) were lower in patients at peak exercise. Patients had a greater respiratory response to exercise: both respiratory rate and ventilatory equivalent for carbon dioxide were significantly higher at all stages of exercise. Exercise capacity assessed by peak oxygen uptake was correlated with time elapsed since surgical repair (r = 0.48; p = 0.001). CONCLUSIONS: It is concluded that even in asymptomatic patients, exercise endurance and respiratory response are generally altered as much as 11 +/- 2.8 years after venous switch operation, although early surgical repair is predictive of a better long-term functional result.

Child↗