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Biomedical subjects

B Baehrel

Publications and source records attributed to B Baehrel.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Value of transesophageal echography in the diagnosis of posterior ventricular septal rupture during the acute phase of myocardial infarction. Apropos of 2 cases].

The authors report two cases of posterior ventricular septal defects complicating acute myocardial infarction diagnosed by transesophageal echocardiography. Transesophageal echocardiography was well tolerated confirmed the diagnosis, and enabled accurate evaluation of the shunt in the transgastric view. The anatomical results guided the surgical approach and correlated well with the operative findings.

Acute Disease↗
PubMed1993

[Mobile thrombus of the right heart and pulmonary embolism: diagnostic and therapeutic problems. Apropos of 12 cases].

The objectives of this report were to analyse clinical presentation, echocardiographic features and diagnostic and therapeutic problems posed by an unusual form of thrombo-embolic disease: mobile right heart thrombosis. Systematic echocardiography in 170 cases of severe pulmonary embolism identified mobile right thrombi in 12 cases. The auscultatory findings were abnormal in 6 cases, 3 showing signs of tricuspid obstruction. Two-dimensional echocardiography showed an extremely mobile right atrial mass, sometimes prolapsing across the tricuspid valve, which was variously spheric, ovoid or worm-like; dilatation of the right heart chambers and echocardiographic signs of cor pulmonale were observed in all cases. The differential diagnosis with other embolic masses of the right atrium and, above all, with well-developed Chiari networks, may be difficult and requires transoesophageal echocardiography. Pulmonary angiography is contra-indicated because of the risk of embolism. Embolectomy under cardiopulmonary bypass was carried out in 8 patients, immediately after echocardiography in 6 cases. The thrombus was recovered from the right atrium in 6 cases and from the pulmonary artery in 2 cases: there was one operative death. Medical treatment was administered to 3 inoperable patients. The clinical and echocardiographic outcome was good in 2 of these but the third patient died; autopsy revealed thrombi in the right atrium and pulmonary artery. One patient died before any treatment could be given and autopsy showed the thrombus in the pulmonary artery. These results confirm the extreme instability of this type of thrombus and the risk of death due to its embolism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Postoperative hemopericardium compressing the left atrium. Apropos of 8 cases].

The authors report 8 cases of hemopericardium compressing the left atrium occurring at varying intervals after cardiac surgery. This is an unusual anatomical and classically rare site of pericardial effusion. This type of tamponnade has special clinical features, leading to a picture of subacute left ventricular failure, by interference with filling and typical echocardiographic appearances, with special features in two-dimensional mode and, in TM mode, an abnormal anterior movement of the posterior wall of the left atrium, which is studied. CT scan of the thorax, when performed, confirms this highly specific topographic situation. This type of effusion must be managed surgically as quickly as possible, with an anterior approach, either by left thoracotomy or by midline sternotomy.

Adult↗
PubMed1990

[Malignant histiocytofibroma of the heart simulating myxoma of the left atrium].

The authors report a case of malignant fibrous histiocytoma of the left atrium which was excised but rapidly recurred in a 47-year-old woman. Clinical examination, echocardiography and the absence of biochemical abnormalities were in favour of the diagnosis of left atrial myxoma. This report illustrates the clinical similarity between myxoma and sarcoma of the left atrium. Very careful anatomopathological examination of multiple sections of the tumour are necessary to distinguish it from benign tumours, especially myxomas.

Diagnosis, Differential↗
PubMed1990

[Iatrogenic arteriovenous fistula between the internal mammary artery and the innominate venous trunk. Contribution of digital arteriography in the positive and anatomic diagnosis].

The authors report the case of an arterio-venous fistula between the internal mammary artery and the trunk of the innominate vein following puncture of the internal jugular. The clinical signs of this unusual complication led the authors to list the differential diagnoses which should be considered and to draw attention to the importance of digitalized angiography in anatomical diagnosis.

Angiography, Digital Subtraction↗
PubMed1990

[Natural course of type III traumatic chronic dissection in a patient with Marfan's syndrome].

Description of a traumatic dissection of the descending thoracic aorta, occurring in a female patient with Marfan's syndrome, the chronic course of which over more than three years was complicated by retrograde extension to the ascending thoracic aorta, resulting in death by massive aortic insufficiency and pleuro-pericardial effusion. Advantages of clinical and sonocardiographic monitoring of chronic dissections.

Aortic Dissection↗
PubMed1990

[Cardiac metastasis secondary to digestive adenocarcinoma. A case report].

The authors report a case of cardiac metastasis revealing a malignant tumor of the biliopancreatic junction. This observation raises the problem of the diagnosis of revealing metastases. Immunohistochemical and ultrastructural studies may help to diagnose and identify primary tumors. This identification plays a major role predicting the prognosis and determining an optimal treatment.

Adenocarcinoma↗
PubMed1989

[Postoperative hemopericardium compressing the left atrium. Apropos of a case].

We report a case of tamponade due to an effusion of blood which had occurred two weeks after an aorto-coronary bypass and was unusually located behind the left atrium. The effusion, with severe clinical symptoms, was diagnosed by echocardiography and computerized tomography of the chest. These examinations provided an accurate anatomical diagnosis on which the approach route of the emergency operation was based.

Cardiac Tamponade↗
PubMed1988

[Aortic dissection with normal aortography and x-ray computed tomography. A diagnostic trap not to be ignored].

We are reporting the case of a 63 y.old patient whose initial clinical examination and ultrasonographic data had led to the diagnosis of acute aortic dissection. Only an emergency surgical procedure was able to confirm the diagnosis, after failure of angiography and CT-scan to do so. In the light of this example, we are presenting a reminder of the sensitivity of various paraclinical examinations, classically accepted to establish this diagnosis.

Aortic Dissection↗
PubMed1982

[Abnormal communications in acute bacterial endocarditis of the aortic valve].

Abnormal communications acquired during acute aortic valve bacterial endocarditis are rare but serious complications. Seven cases are reported; between the left ventricle and right atrium (3 cases), the left and right ventricles (2 cases), the aorta and right atrium (I case) and the aorta and left atrium (I case). The usual causal organisms is a staphylococcus (4 out of 7). The diagnosis is suspected on the development of atrio-ventricular block, a parasystolic murmur and sudden severe cardiac failure, but can only be confirmed by catheterisation and angiocardiography (impractical in our patients because of their poor condition). Echocardiography is of great diagnostic value. Surgical cure involves a double approach aortotomy and opening the other chamber involved), with extensive excision of the infected tissues, closure of the perforation, reconstruction of the aortic ring and implantation of an aortic valve prosthesis. The extent of the anatomical lesions affects the choice of the mode of reparation. There was no operative mortality in our series but two patients have persistent diastolic murmurs due to perivalvular leaks. In one case, recurrent infection led to the implantation of an apico-aortic tube with a fatal outcome.

Adult↗
PubMed1982

[Hemangioendothelioma of the right supra-clavicular region. Clinicopathologic study and management. Report of a case (author's transl)].

The authors present a case of hemangioendothelioma of the right supra-clavicular region in a 14-year-old boy. Interest of scanner in extension bilan and supraselective arteriography with tumor embolisation are stressed. Complete excision was possible and no sign of recurrence is noted 18 months later. Essential characteristics of a such tumor are reviewed.

Adolescent↗
PubMed1981

[Myxomas of the right atrium. Apropos of 3 cases. Review of the literature].

The authors report 3 cases of right atrial myxoma and review 88 other cases in the literature managed by surgery. The first personal case, in a 74 year old patient, illustrate the dramatic consequences of tumour engagement in the tricuspid orifice, in this instance cardiac arrest during catheterisation justifying emergency surgery. The second case exemplifies the diagnostic value of echocardiography: the correction of an erroneous diagnosis of pericarditis. The third case shows that some forms may be totally asymptomatic, the tumor being diagnosed on clinical examination and confirmed by echocardiography. In their review of the literature, the low overall incidence of primary cardiac tumours, of which myxoma is the most common, is emphasised. A right atrial localisation is found in only 25% cases. 88 surgical reports have been published since Bahnam's original attempt at surgical cure under cardiopulmonary bypass. Myxoma may occur at any age but it usually presents between the ages of 30 and 60. Some familial forms have been reported. The presenting symptoms are protean but usually point to an obstacle in the right heart chambers. They may be summarized as follows: 1. Isolated right ventricular failure without left heart disease may be observed in large tumours (reported in 50% of cases). 2. Simulating pericarditis (25% of cases) with a low grade pyrexia (25% of cases). 3. Paroxysmas of cardio respiratory distress of variable severity (a few cases). Clinical examination, chest x-ray and ECG are not diagnostic but do show non-specific changes which are of value in drawing attention to the heart and leading to echocardiography. This confirms the diagnosis by showing abnormal mobile echos in the right atrium prolapsing into the right ventricle in diastole. Angiography serves only to confirm these appearances. Surgery is the treatment of choice, and preferably with the shortest possible delay. It offers definitive cure at a minimal risk to the patient.

Adult↗
PubMed1980

[Double aortic arch with coarctation. Apropos of a case].

One case of double aortic arch with coarctation is reported. Anatomically, partial atresia of the anterior arch presented as a Kommerel's diverticulum; the coarctation was situated on the dominant posterior arch just proximal to the origin of the subclavian artery. This malformation had been diagnosed clinically during childhood. The operative indications were increasingly severe hypertension with associated left ventricular hypertrophy, and dramatic epistaxis from a nasal angioma which necessitated repeated arterial embolisation. The surgical treatment comprised the insertion of a prosthetic tube from the brachiocephalic trunk, proximal to the coarctation, to the descending thoracic aorta distal to the coarctation. The immediate operative result was excellent with return of normal peripheral pulses and blood pressure. The diagnostic difficulties of this malformation and its associations with other vascular malformations are emphasised. The surgical indications are discussed and the different techniques reviewed:--resection and end-to-end anastomosis,--tubular prosthesis,--associated procedures for double aortic arch. The choice of technique depends on the age of the patient, the anatomical conditions (double arch, coarctation, collateral circulation), and the quality of the aortic wall (atheroma).

Aorta, Thoracic↗
PubMed1980

[Prophylactic intra-aortic balloon pumping in the surgery of the left main coronary artery].

92 significant stenoses of the left main stem artery (LCA) underwent revascularisation procedures by aorto-coronary venous bypass grafting. Three groups of patients were identified. Group I comprised 11 stenoses of the LCA associated with lesions of at least three other coronary vessels and a subtotal stenosis of the LCA. These patients underwent systematic prophylactic intra-aortic balloon counter-pulsation (IACP) when they were taken off cardiopulmonary bypass. Group II comprised 47 patients with stenosis of the LCA and at least three coronary vessels. IACP was required in 6 cases in whom difficulty was experienced at the end of cardiopulmonary bypass, or after haemodynamic decompensation. Group II comprised 33 stenoses of the LCA which were isolated or associated with lesions of 1 or 2 vessels. The operative risk increased with the severity of the coronary lesions associated with LCA stenosis. 6 p. 100 deaths occurred in Group III, compared to 21 p. 100 in Group II (p = 0.06). the use of IACP before the onset of possible haemodynamic decompensation improved the operative prognosis of stenosis of the LCA associated with lesions of at least three coronary vessels. Mortality in Group I was 0 p. 100, compared to 21 p. 100 in Group II (p = 0.09). Prophylactic IABP also seemed to decrease the number of perioperative infarctions: Group I, 16 p. 100, Group II, 36 p. 100, but p > 0.01. analysis of global mortality (12 cases) showed that 50 p. 100 patients (6 cases) had ejection fractions of less than 0.50. In agreement with other authors, we found that systematic IABP improved the operative prognosis in stenosis of the LCA. However, we do not advocate its use in every case. A selection of high risk patients seems a reasonable objective. The severity of the coronary lesions associated with LCA stenosis is statistically a good criteria of selection. The incidence of left ventricular hypokinesis with an ejection fraction less than 0.50 in the deceased patients, is a factor in favouring the use of prophylactic IACP in left ventricular dysfunction.

Arterial Occlusive Diseases↗
PubMed1979

[Coronary endarterectomy associated with coronary artery bypass in severe coronary artery disease. 50 cases].

The surgical indications of coronary endarterectomy were defined from a study of 50 cases in which endarterectomy was associated with aorto-coronary bypass surgery. This total represented 6 p. 100 of all the aorto-coronary bypass operations performed in the same period. Coronary endarterectomy was performed "on principal" for the right coronary artery, and "of necessity" for the left anterior descending artery. The special techniques of endarterectomy on the left anterior descending artery are described. Endarterectomy does not increase the operative risk and enables revascularisation of vessels unsuitable for bypass surgery. 85 p. 100 patients are asymptomatic with an average follow up period of 2 years after endarterectomy and aorto-coronary bypass graft of the right coronary artery.

Adult↗