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Biomedical subjects

A Guiomard

Publications and source records attributed to A Guiomard.

At least 19 recordsLinked to original sources
PubMed2000

[Diagnosis of cardiac tumor by percutaneous thromboaspiration. A case report].

Percutaneous endovascular thromboaspiration is a valuable tool as illustrated by the case of a patient suffering from a large intracardiac tumour. Histological and immuno-histochemical analysis of the tumour fragments provided the diagnosis of a cardiac angiosarcoma. The patient was a 44 year old man admitted for a large sero-sanguinous pericardial effusion which recurred after drainage. The case was complicated by a haemorrhagic cerebrovascular accident unrelated to a secondary deposit. Initially suspected after transthoracic echocardiography, the diagnosis of a tumour invading the right atrium was confirmed by transoesophageal echocardiography and cardiac CT scan. Surgery was declined and as the diagnosis of lymphoma could not be excluded, the patient underwent biopsy by an original method of percutaneous thromboaspiration. This minimally invasive, low cost technique would appear to be a valuable alternative to other endovascular biopsy techniques (saber, biotome) and to surgical biopsy, and could be proposed as the technique of first intent in an a priori non-operable intra-cardiac tumour or when lymphoma is suspected.

Adult↗
PubMed1998

[Reversible left intraventricular obstruction after treatment of pheochromocytoma and hyperthyroidism].

The authors report an original case of the association of three pathologies: pheochromocytoma, hyperthyroidism and cardiomyopathy with left ventricular outflow tract obstruction. This type of cardiac disease has occasionally been described in cases of pheochromocytoma and are usually induced by the endocrine disturbance because they regress with treatment of the pheochromocytoma. The associated hyperthyroidism observed in this case is very rare and may have increased the left ventricular pressure gradient. Medical treatment before surgery of the pheochromocytoma was unusual in that a triple therapy was used including betablockers, classically contra-indicated in pheochromocytoma alone. In this case, it provided excellent control of the blood pressure and decreased the left ventricular obstruction during the perioperative period.

Adrenal Gland Neoplasms↗
PubMed1996

[Arterial hypertension in black Africans. Clinical and echographic study in 50 patients].

OBJECTIVES: Clinical and electrocardiographic and echocardiographic data were collected in 50 black Africans with hypertension to study modifications in left ventricular geometry. METHODS: Thirty men and 20 women with hypertension (mean age 40.9 +/- 10.2 years) who had recently immigrated from Africa were included in the study. Parameters recorded were: systolic and diastolic pressures, body mass index (BMI = weight/height2); ECG; echocardiography (36 patients): end diastolic septal and posterior wall thickness, left ventricle diameter, left ventricle mass (LVM) and relative wall thickness. RESULTS: Systolic and diastolic pressures and BMI were 169 +/- 24 mmHg, 105 +/- 14 mmHg and 26.7 +/- 3.9 kg/m2). LVM was 129 +/- 41 g/m2 (Normal < 134 g/m2) in men and 113 +/- 35 g/m2 (Normal = 110 g/m2) in women. Concentric remodeling was found in 8 patients (LVM = normal, relative wall thickness > or = 0.45), concentric left ventricle hypertrophy in 10 (LVM > normal, relative wall thickness > or = 0.45), excentric left ventricular hypertrophy in 6 (LVM > normal, relative wall thickness < 0.45), asymmetric septal hypertrophy in 4 and normal echocardiogram in 8. There was a negative correlation between age and end diastolic left ventricle diameter (r = -0.34, p < 0.05) and age and end systolic ventricle diameter (r = -0.74, p < 0.05). There was a positive correlation between body surface and septal thickness (r = 0.34, p < 0.05), posterior wall thickness (r = 0.56, relative wall p < 0.001), and relative wall thickness (r = 0.45, p = 0.05). CONCLUSION: This population of young subjects with hypertension showed a high prevalence of modifications in left ventricular geometry with predominant concentric modeling with (8/36) and without (10/36) left ventricle hypertrophy.

Adult↗
PubMed1996

[Left ventricular hypertrophy in patients with hypertension. A comparative study between black Africans and white Europeans].

OBJECTIVE: The objective of this study was to compare clinical and ultrasonographic findings in 20 consecutive hypertensive Black Africans, with those of 20 hypertensive White Europeans matched for age in order to study modifications of left ventricular (VG) geometry. METHOD: 20 consecutive Black men (B), recently emigrated from Africa and applying for asylum, referred for HT, were assessed by measuring systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP), body mass index (BMI), echocardiography with measurement of the end-diastolic thickness of the septum, posterior wall (Epp), LV diameter (DTD), calculation of the LV mass index (LVMI) according to the Penn convention and the thickness/radius ratio (t/r). These subjects were matched for age with 20 consecutive European White men (W) sent to the echocardiography laboratory for assessment of HT, in whom the same parameters were measured. RESULTS: The mean age was 41.6 +/- 9.2 (B) vs 42.1 +/- 8.8 years (W) (NS). The BMI was 26.3 +/- 3.2 (B) vs 27.3 +/- 3.4 (W) (NS). SBP was 175 +/- 24 (B) vs 156 +/- 15 mmHg (W) (p < 0.01). DBP was 108 +/- 13 (B) vs 94 +/- 9 mmHg (W) (p < 0.01). PP was 67 +/- 20 (B) vs 63 +/- 10 mmHg (W) (NS). LVMI was 131 +/- 43 (B) vs 91 +/- 19 g/m2 (W) (p = 0.001). The t/r ratio was 0.48 +/- 0.08 (B) vs 0.38 +/- 0.07 (W) (p < 0.001). DTD was 47.1 +/- 3.9 (B) vs 48.6 +/- 4.4 mm (W) (NS). Epp was 11.2 +/- 1.9 (B) vs 9.1 +/- 1.4 mm (W) (p < 0.001). A poor correlation was observed between SBP and LVMI (r = 0.23, p = 0.17), and between SBP and t/r (r = 0.21, p = 0.21). CONCLUSION: Compared to a age-matched population of European hypertensive patients with similar morphology, our homogeneous group of recently emigrated patients was characterized by a greater severity of HT and the presence of concentric left ventricular hypertrophy. The marked difference in socio-economic status and access to care of these two populations must be stressed.

Adult↗
PubMed1993

[Effects of aging on left ventricle-arterial coupling in man].

Twenty-five normotensive men without any cardiac or arterial pathology, aged 22 to 68 years, 12 less than 45 year old, 13 over 45 years, underwent cardiac catheterisation and angiography. The following parameters were calculated: 1) a global index of arterial function (Ea) and its determining factors (Ea = LVESP/SV where LEVSP = left ventricular end systolic pressure and SV = left ventricular stroke volume); Ea = (HR x SVR) + Ea' where HR = heart rate, SVR = total systemic vascular resistance and Ea' = (LVESP - MAP/SV) (MAP = mean arterial pressure); 2) an index of global left ventricular pump function: ELV (ELV = LVESP/LVESV, where LVEDV = left ventricular end systolic volume; 3) an index of LV-arterial coupling: the Ea/ELV ratio. With aging, both Ea (by increase in SVR) and Ea' and ELV increased significantly. Ea/ELV (inverse of the ejection fraction-1) increased with age but ELV less than Ea. Ea/ELV was significantly higher in patients over 45 years of age but the correlation between ejection fraction and age was not statistically significant (p = 0.10). These results suggest that with aging, the improvement in LV pump function approximately corresponds to the degradation in arterial transport function: the left ventricular-arterial coupling as assessed by the Ea/ELV ratio (and therefore the ejection fraction) is maintained in the majority of cases.

Adult↗
PubMed1993

[Effects of sublingual nifedipine on the velocity of pulse wave evaluated by Doppler echocardiography of the thoracic aorta].

Sublingual nifedipine has a rapid and powerful hypotensive effect. Its action on arterial distensibility can be assessed by measurement of pulse wave velocity (PWV) by Doppler echocardiography (DE). Ten patients were used to evaluate intra-observer reproducibility (Group 1). Fifteen hypertension patients (Group 2), not taking a calcium antagonist, 64 +/- 13 years-old, were studied by DE before and 15 minutes after 10 mg of SL nifedipine. The following were measured: systolic and diastolic blood pressures (SBP and DBP), heart rate (HR), echocardiographic shortening fraction (SF) and PWV, with sternal length (SL) taken as being identical to the length of the abdominal aorta between the isthmus and the coeliac region, and by measuring delta t: time interval for propagation of the pulsed Doppler velocimetric wave between the isthmic aorta and the coeliac aorta located by echocardiography: PWV = SL/delta t. Evidence was found in the nifedipine group (n = 15) of a fall in SBP (159.5 +/- 27.8 cf. 140.9 +/- 21 mmHg; p = 0.002); in DBP (88.6 +/- 13 cf. 79.6 +/- 8.3 mmHg; p = 0.005) and an increase in HR (72.3 +/- 10.7 cf. 76.8 +/- 12.9 bpm; p = 0.04). PWV decreased after nifedipine (10.5 +/- 3.9 cf. 7.15 +/- 12.9 bpm; p = 0.002). There was a linear correlation between the percentage reduction in PWV and left ventricular HR: y = 194x - 53; r = 0.56; p = 0.029.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Sublingual↗
PubMed1992

[Ischemic cardiomyopathy: remodeling, hypertrophy, subendocardial risk. Can processes be controlled?].

Ischaemic cardiomyopathy reflects the myocardial dysfunction caused by coronary disease. It results from the association of 1. segmental infarction(s) responsible for ventricular "remodelling", i.e. expansion of the necrotic area(s) and hypertrophy-dilatation of the rest of the ventricle, eventually concurring to heart failure; 2. areas which are viable but with a function that is reversibly compromised by severe acute or chronic ischaemia (myocardial sideration or hibernation) affecting mainly the subendocardium. The spontaneous course of cardiomyopathy towards the worst can be arrested by 1. revascularisation of the myocardium at risk by coronary reperfusion performed either as an emergency in case of infarct in the process of formation, or after detection of the viable myocardial areas by isotopic methods; 2. prevention or limitation of ventricular remodelling by coronary reperfusion and improvement of the ventricular load by administration of angiotensin-converting enzyme inhibitors and nitroglycerin. The Survival and Ventricular Enlargement study (SAVE) has been the first to demonstrate the relationship between limitation of ventricular remodelling and improvement of the secondary prognosis of infarction obtained by angiotensin-converting enzyme inhibitors.

Animals↗
PubMed1992

[Functional coupling of the left ventriculo-arterial system and aging in man].

In a haemodynamic and angiographic study at rest conducted in 25 men aged from 22 to 68 years who had no more than another risk factor for arterial disease and showed no evidence of cardiac or arterial disease several parameters were measured or calculated. Firstly, a global index of arterial system function (Ea) and its various factors: Ea = ESP/SV [ESP: left ventricular end-systolic pressure; SV: systolic volume]; Ea = (HR x TSR)+Ea' [HR: heart rate/min; TSR: total systemic resistance] where Ea' = (ESP - AoP/SV) [AoP: mean aortic pressure]. Secondly, the parameters concerning the left ventricle were the mass (m) and the m/EDV ratio [EDV: end-diastolic volume] and indices of the left ventricular systolic and diastolic functions, such as ELV = ESP/ESV [ESV: end-systolic volume], kp: the volumic distensibility module of the left ventricular chamber; relations EF - o ES [EF: ejection fraction; o ES: end-systolic constraint], and kp - m/EDV as indice of left ventricular muscle distensibility. In parallel with the subjects' age, Ea increased by joint augmentation of TSR and Ea' while m, m/EDV, ELV and kp also significantly increased. The inotropic quality of the left ventricular muscle and its intrinsic distensibility were found to be decreased in a few subjects aged over 45. Ea/ELV (reverse of ejection fraction -1) tended to increase (ELV relatively less than Ea), but this increase was not significant (P = 0.10). These results show that in the ageing man the improvement observed in the ejection fraction of the left ventricular pump corresponds roughly to the degradation of the arterial system transfer function, and the arterial system-left ventricle coupling, evaluated by the Ea/ELV ratio, is maintained (better in fact than in arterial hypertension and heart failure). This improvement is achieved by increases of m and, chiefly, m/EDV which compensate for both the increase of Ea and the relative decline of left ventricular muscle contractile quality. There is a disorder of the left ventricular pump diastolic function which is due to geometric changes in the chamber and to changes in the intrinsic distensibility of the left ventricular muscle.

Adult↗
PubMed1988

[An unusual complication of percutaneous aortic valvuloplasty: rupture of an aberrant mitral chorda].

The case of a 77-year old woman who died of refractory pulmonary oedema 36 hours after percutaneous valvuloplasty for tight calcified aortic valve stenosis is reported. Post-mortem examination showed satisfactory opening of the aortic orifice but also rupture of an aberrant chorda which crossed the outflow tract below the aortic sigmoid valves, between the mitral valve and the interventricular septum. This case suggests that before all aortic valvuloplasties the absence of aberrant chorda or suspicious subaortic acceleration should be confirmed by Doppler echocardiography; moreover, during the procedure the balloon should not be inserted too deeply into the left ventricle.

Aged↗
PubMed1983

[Coronary insufficiency in hypercholesterolemic xanthomatosis. Angiographic aspects].

Coronary arteriography for severe coronary artery disease was carried out in 21 patients with hypercholesterolaemic xanthomatosis (group I) and in 42 patients with serum lipids (group II). Both groups were matched with regard to age, sex and cardiovascular risk factors (hypertension, smoking habits, diabetes). The films were examined by an observer unaware of the patients' clinical features; the severity of the lesions observed was assessed by means of a coronary score system. Group I patients had significantly more severe coronary artery lesions and a significantly higher incidence (52% versus 7%; p less than 0.001) of left main coronary artery stenosis carrying a high risk of sudden death. The percentages of affected vessels amenable to surgery and abnormalities in left ventricular function were similar in both groups. It therefore seems reasonable to envisage early coronary angiography followed, if necessary, by aorto-coronary bypass in patients with hypercholesterolaemic xanthomatosis who experience anginal attacks, show ECG abnormalities on exercise and have persistent pain after myocardial infarction.

Adult↗
PubMed1983

Coronary angiography in diabetic and non-diabetic patients with severe ischaemic heart disease.

In this retrospective study, the coronary angiograms of 36 diabetic and 36 non-diabetic patients, with severe ischaemic heart disease, were compared. Patient groups were closely matched for age, sex, cardiovascular risk factors, duration and functional disability of angina. Coronary angiograms were assessed by an independent observer without knowledge of the clinical status of the patients, and graded using a coronary score system. Left ventricular function was analyzed using computerized angiographic data. The same percentage of diabetic and non-diabetic patients had three-vessel disease. The mean coronary score per patient was similar in the two groups. Diabetic and non-diabetic patients had a statistically similar percentage of diseased vessels considered suitable for coronary bypass surgery. Left ventricular function was similar in the two groups. Thus diabetic patients with symptomatic coronary artery disease should be considered for angiographic evaluation using the same criteria as non-diabetics.

Coronary Angiography↗