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B Desveaux

Publications and source records attributed to B Desveaux.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Partial abnormal pulmonary venous return. An underestimated and unknown association in Turner-Ullrich syndrome. Presentation of an original case].

The authors report the case of a 59-year-old woman with a complex cardiac lesion consisting of degenerative major mitral insufficiency masking partial abnormal pulmonary venous return. These cardiac abnormalities fell within a context of genetic disease since the patient had Turner's syndrome, confirmed at the age of 58 by a 45 x 0 karyotype. They detail the originality of the clinical manifestations of partial abnormal pulmonary venous return and review the literature concerning cardiac malformations in Turner's syndrome.

Angiography↗
PubMed1990

[Livedo reticularis, cerebrovascular disorders and mitral disease: a new cause of Sneddon's syndrome?].

Sneddon's syndrome consists of livedo reticularis and cerebral vascular accidents with no evidence of systemic disease responsible for the livedo. The syndrome has been assimilated to a subgroup of systemic lupus erythematosus (SLE) with presence of antibodies directed against phospholipids. Recently, a significant increase in the frequency of cardiac valve diseases has been demonstrated in some SLE patients with livedo reticularis, cerebral vascular accidents and antiphospholipid antibodies. We report the case of a 26-year old woman who had been presenting for 6 years with idiopathic livedo reticularis. Her history was remarkable for the occurrence of 2 cerebral ischaemic accidents at the ages of 23 and 26 years, generalized convulsive seizures at 22 years, and hypertension of pregnancy with 2 miscarriages. Biopsy of the livedo showed normal histological patterns, but electron microscopy detected an obliterating endothelial proliferation and endothelial cells with numerous Weibel-Palade bodies. Laboratory signs of SLE, as well as antiphospholipid antibodies were absent. At the age of 26 years, cardiac abnormalities were heard at auscultation for the first time, and echocardiography showed that they were due to a fairly loose mitral stenosis. According to Burton's criteria our patient had all the typical features of Sneddon's syndrome. The finding of mitral stenosis--an emboligenic cardiopathy that is potentially responsible for cerebral vascular accidents--raises the problem of its relationship with Sneddon's syndrome. The association does not seem to be fortuitous, since our case is very similar to the cases of SLE or antiphospholipid antibody syndrome associated with cardiac valve lesions. However, this case is particular in that 6 years after the onset of the disease there was still no sign of SLE and of antiphospholipid antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[An often ignored complication of left heart catheterization: embolism of cholesterol crystals. Report of 9 cases].

Cholesterol embolism (CE) is caused by the migration of cholesterol crystals from severe atheromatous lesions. Until recently, this was considered to be a classical but rare complication of atheroma. With the upsurge in techniques of left heart catheterization there has been a regain of interest in this subject. Nine cases of cholesterol embolism occurring after left heart catheterisation are reported, 3 after coronary angioplasty, and 3 cases after associated thrombolytic therapy. Three patients developed cutaneous syndromes (livedo reticularis, the "purple toe syndrome") with a favorable outcome in a few weeks. Two patients developed segmental necrosis of the small bowel requiring surgical resection of the affected area. Finally, in 4 cases, the patients died 12 hours to 3 months after catheterization: 2 patients had polyvisceral involvement; one patient developed cardiogenic shock; one patient had intestinal necrosis involving 2/3 of the ileum and the right colon. The cases illustrate the variability of the presentation of CE and its potential gravity. At present, the only effective measures are prophylactic; curative treatment remains particularly disappointing.

Aged↗
PubMed1990

[Partial interruption of the inferior vena cava using a percutaneous endovenous filter].

Partial interruption of the inferior vena cava (IVCI) by a percutaneous endovenous filter (Günther filter n = 65, LEM filter n = 36) was undertaken in 100 patients with an average of 72 +/- 11 years for recent deep vein thrombosis. The indications were: contraindications to anticoagulant therapy (36.5%); recurrent pulmonary embolism (12%); threatening venous thrombosis with a previous embolic episode (12%); caval thrombosis (15.7%); prophylactic, with no previous pulmonary embolism (23.8%). The filters were evaluated at short and mid term. There were no technical problems. The mortality rate was 17.5%, one death being probably due to recurrent pulmonary embolism. No other recurrences of pulmonary embolism were observed, indicating an efficacy of 99 per cent. The early patency rate was 96.5%, there being no difference between the two filters used, independent of the initial site of venous thrombosis, of distal migration of the filter and associated medical treatment (anticoagulation). Distal migration was observed in 76% of IVCI by the Günther filter and 48.5% by the LEM filter (p less than 0.001); tilting was observed in 7.4% of Günther and 3% of LEM filters. Five LEM filters were incompletely opened. The IVC was transfixed by 3 Günther filters. One Günther filter had fractured spokes. There were 12 recurrences of lower limb deep vein thrombosis and 16 post-deep vein thrombosis complications were recorded. These percutaneous endovenous filters are similar to the Kimray Greenfield filter with respect to efficacy and permeability although the follow-up was relatively short. The advantages of these percutaneous filters are the facility, innocuity and rapidity of their insertion with, however, a higher incidence of distal migration.

Adult↗
PubMed1989

[Thrombosis in unstable angina. Is there a role for thrombolytic agents?].

Intracoronary thrombosis is more and more considered as a major etiological factor of unstable angina (UA). The physiopathological diagram from ulceration of the plaque to unstable then stable thrombosis is based on many arguments: pathological (Falk-Fuster), biological, angioscopic (Forrester) and finally angiographic; numerous studies have demonstrated the frequency of non-obstructive coronary thrombi in UA. Their frequency is directly related to the delay in control, in relation with the last painful episode, indicating the spontaneous lysis of the clot. This role suggests the beneficial effect of a thrombolytic treatment. Several non-randomized studies (Vetrovek, Mandelkorn, Gotoh, Vermeer) demonstrate reduction of the clots after thrombolysis. But considering spontaneous lysis, only randomized studies published to date (Gold, Topol and Nicklas) report encouraging results. More extended studies are necessary to specify the beneficial effect and the exact haemorrhagic risk of this treatment and the probable place of additional tests like transluminal coronary angioplasty (TCA) and aortocoronary by-pass.

Angina Pectoris↗
PubMed1989

[Angiography of right ventricular volume after surgical repair of tetralogy of Fallot].

Right ventricular volume and ejection fraction were measured in children who had undergone surgical repair for tetralogy of Fallot with excellent results. Fourteen children who had been operated upon at the age of 3 +/- 2.6 years had cardiac catheterization and cineangiography of the right ventricle at the age of 4.6 +/- 2.7 years. Right ventricular volumes were determined from single-plane cineangiography in right anterior oblique projection (Ferlinz method). Eleven children with a normal right ventricle served as controls. Dual projection cineangiography of the pulmonary artery enabled the pulmonary insufficiency to be divided into 4 grades. Echocardiography with colour-coded doppler velocimetry was also performed, showing the absence of residual shunt and of tricuspid, mitral and aortic valve abnormalities. The extension of pulmonary regurgitation flow to the right ventricle was analysed and divided into 4 grades. Pulmonary insufficiency was present in all patients; it was graded 1 or 2 by the two methods in 8 cases (group A) and 3 or 4 by one or the other of the two methods in 6 cases (group B). In 7 patients of group A the operation had included the insertion of a small patch to widen the pulmonary channels (infundibulum alone in 3 cases, transvalvular in 4 cases); in 5 patients of group B a large infundibulo-pulmonary transvalvular patch had been installed. The right ventricular systolic pressure was always below 50 mmHg (mean: 40.9 +/- 6.7 mmHg) and the systolic gradient between right ventricle and pulmonary artery never exceeded 30 mmHg (mean: 14.9 +/- 6.2 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1989

[Tissue plasminogen activator (alteplase) in acute massive pulmonary embolism. A pilot study].

Twenty six patients with acute (less than 5 days) pulmonary embolism (PE) confirmed by bilateral pulmonary angiography with a Miller index greater than 15 were given tissue plasminogen activator (Alteplase) (rt-PA) intravenously (n = 20) or directly into the pulmonary artery (n = 6). The dosage was 100 mg/7 hours (bolus 10 mg + 40 mg/2 hours + 50 mg/5 hours). Heparin (5000 IV as a bolus and 1000 IV/hour) was associated in all cases. The Miller index decreased from 24 +/- 1 (n = 26) before treatment to 12 +/- 1 (n = 25) (p less than 0.001) after 100 mg of Alteplase, and from 25 +/- 0.4 (n = 14) to 22 +/- 0.5 (n = 14) (p less than 0.001) after 50 mg. The mean pulmonary arterial pressures fell from 30 +/- 2 mmHg to 21 +/- 2 mmHg after 50 mg (n = 26) (p less than 0.001) and to 14 +/- 1 (n = 25) (p less than 0.001) after 100 mg of Alteplase. A decrease in mean pulmonary artery pressures (-22%, p less than 0.001) and total pulmonary resistances (-29%, p less than 0.001) was obtained after one hour of thrombolysis in 12 monitored patients. There were no fatalities. Severe haemorrhage occurred in 6 cases. Therefore, Alteplase induced a rapid dissolution of recent intrapulmonary thrombi without inacceptable haemorrhagic complications. Its action could be particularly beneficial in patients with right ventricular failure due to life threatening pulmonary embolism.

Acute Disease↗
PubMed1988

[Control of the patency of coronary-internal mammary artery bypasses by non-selective angiography].

98 successive coronary bypasses using the internal mammary artery were controlled systematically, at an early stage, about the 17th postoperative day, by non selective brachial angiography using a retrograde injection. This control method, simple, quick, reliable and non-aggressive, enables to visualize the internal mammary artery and the bypassed coronary vessel, over its entire length. There were no failure in the control, nor any local or general complication during this examination. The overall patency of such bypasses, evaluated with this method, is 98 p. cent in our series, with however, 12 p. cent of angiographic aspects of a poorly functional bypass. These aspects are related to a slow flow in the by-pass (spindly internal mammary artery, anastomotic stenosis or thin distal bed of the bypassed coronary artery), or to a competitive flow (non significant coronary stenosis). The perfusion of the bypassed coronary, which is not so well studied in the literature, is important to analyze and difficult to evaluate with our technique because of the static views that are used. A similar non-selective angiographic method using a dynamic recording (radio-cinema with dual incidence) is currently being evaluated.

Adult↗
PubMed1987

[False positive of the exercise test and right auricular hypertrophy].

Seldom mentioned as a possible etiology of false positive stress tests (ST), the right atrial hypertrophy (RAH) may cause electrocardiographic aspects evocative of myocardial ischemia in the lower areas. The retrospective study concerns STs in 4 patients, staying in a cardiac rehabilitation center, following (D14) surgery for isolated type II IAC, Fallot's trilogy (n = 1), or dual valvular disease (tricuspid insufficiency and mitral stenosis, n = 1), and presenting all on basal ECG a RAH (group I). These STs are compared to that of a reference group operated (D14) from a IAC type II (isolated n = 3, associated to RVPA n = 1), but without signs of RAH on the rest ECG (group II). All other possible causes of electrically positive STs were eliminated from this study. In patients with RAH, the stress test is positive in the lower area (ST = -1.27 +/- 0.25 mm). In four other patients without HAD, the STest is negative in 3 cases and uncertain in one. These results do not seem to be linked to pre-operative hemodynamic data, nor to sonocardiographic data. Atrial repolarization alone seems to be the cause of these ECG alterations during stress, as demonstrated, in one patient, by sudden variations of the ST segment during a change from an atrial rhythm (AR) (with retrograde atrial depolarization) to a sinus rhythm (SR). These observations suggest the role of atrial repolarization in the origin of false positive stress tests in patients with RAH.

Adult↗
PubMed1987

[Partial interruption of the inferior vena cava using the 2612 filter. Apropos of 35 patients].

Partial interruption of inferior vena cava (I.C.V.) forms an integral part of treatment of thromboembolic disease. The most frequently used filter worldwide is currently that of Greenfield, but although its effectiveness and permeability are remarkable it can be the subject of transfixions, sliding movements and migrations. A new model of the authors' own conception is presented which eliminates these faults. The "2612" filter is based on the same concepts, but has added to it 6 lateral flanges soldered to the base of the arms, these applying pressure to the I.V.C. and ensuring its perfect positioning, and 12 hooks (6 turned downwards and 6 upwards) ensuring perfect stability. Results of a multicentre trial in 35 patients, after insertion of the "2612" filter and follow up assessment after 3 months (28 cases) by cavography and in some patients by a scan, showed permeability of 93% and total efficacy. No side effects were reported. This filter appears to represent true progress in the means of interrupting I.V.C., and further studies are contemplated.

Female↗
PubMed1986

[Arteriovenous fistula disclosing a renal cancer. Apropos of a case].

The authors report the case of a 49 year old woman who presented with congestive cardiac failure and hypertension. Clinical examination revealed a high output state and an abdominal mass with a continuous murmur which angiography showed to be a very vascular right renal tumour with a large and early venous return. Catheter studies confirmed the increased cardiac output (cardiac index 5.37 l/mn/m2), an increase in right heart and mean pulmonary capillary pressures (28 mmHg), decreased peripheral arterial resistances and a left-to-right shunt effect at the level of the suprarenal inferior vena cava (+ 3.8 volumes of oxygen per 100 ml). After radical right nephrectomy, the cardiac failure and hypertension regressed and the haemodynamic parameters returned to normal.

Arteriovenous Fistula↗
PubMed1985

[Complex ventricular arrhythmia in apparently healthy young subjects].

The aim of this study of 20 young subjects (28 +/- 10.6 years) with no apparent cardiac disease on clinical examination and chest X-ray was to determine the origin of complex ventricular arrhythmias: monomorphic or polymorphic ventricular extrasystoles, isolated or in valves (average 18 158 +/- 12 388 per 24 hours) and/or ventricular tachycardia (5 cases, sustained in 3). These arrhythmias were aggravated (N = 6), disappeared (N = 8) or remained unchanged (N = 5) during exercise. The inter-critical ECG showed ST changes in 5 cases. The extrasystoles had a left bundle branch block configuration in 14 cases and a right bundle branch block configuration in 9 cases. Nine patients were Grade 2 (45%) and 11 patients Grade 4B of Lown's classification. Complementary investigations (echocardiography), radionuclide investigations, right and left heart catheterisation, selective right and left ventriculography and coronary angiography) showed a high incidence of arrhythmogenic right ventricular dysplasia (N - 14) associated with left ventricular abnormalities in 13 cases: hypofixation of Thallium (N = 14) associated with left ventricular abnormalities in 13 cases: hypofixation of Thallium (N = 11), abnormal global left ventricular function (N = 13) with decreased ejection fractions in half the cases, left ventricular dilatation in a third of cases (average and diastolic volume: 109.8 ml/m2), mean velocity of circumferential fibre shortening decreased in 86% of cases (average 0.88 cir/sec), angiographic abnormalities of segmental left ventricular wall motion in 36% of cases; 2 clinically silent cases of mitral valve prolapse were associated with these left ventricular changes; these cases represent forms of arrhythmogenic cardiac disease localised to the right ventricle or involving both ventricles which should be searched for routinely in young patients with apparently normal hearts but with idiopathic and severe ventricular arrhythmias. The diagnosis can only be established by angiography. In other cases, isolated left ventricular abnormalities are detected: two cases of hypertrophic non obstructive cardiomyopathy including one apical form, a condition which may be suspected from analysis of the surface ECG and careful 2D echocardiographic study; phonomechanography may be normal; one idiopathic left ventricular aneurysm which was only diagnosed at ventriculography; one dilated cardiomyopathy affecting the left ventricle. In our series, none of the patients had coronary artery disease and two patients even had no abnormality of any of these investigations.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1985

[Paroxysmal mitral insufficiency caused by ischemic dysfunction of the papillary muscles. Hemodynamic and angiographic study of 18 cases. Pathogenic hypotheses].

18 of 39 cases of ischaemic papillary muscle dysfunction reported elsewhere underwent cardiac catheterisation and angiography. Fifteen patients had previous myocardial infarction. The average age of the patients was less than in the overall series (69 vs 73 years) but the incidence of infarction and the degree of cardiac disease were greater. The absence of catheter data in the other patients is explained by their older age (76.4 years) and the longer period of recruitment. Their results and outcome of medical or surgical treatment are reported. The pathogenesis of the syndrome is reconsidered in the perspective of paroxysmal forms. A protocol for investigation is suggested to guide the therapeutic options. Right heart catheterisation at rest (n = 16), on exercise (n = 12), under vasodilator therapy (n = 6) and during angiography (n = 2) does not show a specific profile. These investigations only provide haemodynamic data related to therapy but they are essential for the interpretation of ventriculography. Ventriculography (n = 8) demonstrated 4 cases of mitral regurgitation (2 major and 2 minor), a reduced EF (0.47 +/- 0.17), asynergy of 36.1 p. 100 of segments analysed, predominantly in the inferior and lateral zones. Coronary angiography showed triple vessel disease in 6 cases, double vessel disease in 1 case and 1 stenosis of the left main coronary artery. Stenosis was commonest on the left circumflex (87.5 p. 100) and right coronary arteries (87.5 p. 100) but also frequently involved the left anterior descending artery (75 p. 100). Of the 12 patients treated medically, 8 died (66.6 p. 100) and the survivors remain symptomatic (33.3 p. 100), half with and half without attacks. After surgery (n = 8) comprising coronary bypass surgery (n = 6) or mitral valve replacement (n = 2), patients were asymptomatic. 1 patient died of cancer. These paroxysmal forms of mitral regurgitation may be explained by the association of aggravating, reversible ischaemic or haemodynamic factors to organic mitral lesions. Mitral valve replacement is justified when dysfunction becomes permanent and coronary bypass surgery is advocated whenever possible. The indications for surgery can only be taken into account after complete haemodynamic and angiographic investigation. A protocol for the interpretation of these investigations is suggested.

Aged↗