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Biomedical subjects

B Gallet

Publications and source records attributed to B Gallet.

At least 19 recordsLinked to original sources
PubMed2001

Severe intermittent intraprosthetic regurgitation after mitral valve replacement with subvalvular preservation.

Preservation of the subvalvular apparatus during mitral valve replacement preserves left ventricular function and improves long-term survival. Complications of subvalvular preservation include left ventricular outflow tract obstruction and prosthesis impingement. We report a case of severe intermittent intraprosthetic mitral regurgitation detected by transesophageal echocardiography after mitral valve replacement by a bileaflet mechanical prosthesis with subvalvular preservation. Intravalvular prosthetic valve regurgitation was caused by remnants of the subvalvular apparatus, which were shown at reoperation to interfere with prosthetic leaflet motion and which were excised. Postoperative transesophageal echocardiography showed neither abnormal mitral regurgitation nor residual mass. The use of intraoperative transesophageal echocardiography could enable the detection of this rare complication.

Aged↗
PubMed2001

[Dynamic left ventricular obstruction associated with a pheochromocytoma reversible after tumor ablation].

The association of dynamic left ventricular outflow tract obstruction and pheochromocytoma is rare with only about fifteen previously reported cases in the literature. The association may be the result of chronic increased catecholamine secretion which induces intra-ventricular obstruction in a hypertrophied ventricle due to hypertension. The authors report a new case in which the intraventricular gradient on Doppler echocardiography was particularly high at 120 mmHg. The gradient totally regressed after removal of the pheochromocytoma. The finding of a systolic murmur in a patient with pheochromocytoma should lead to the prescription of Doppler echocardiography and diagnosis of left ventricular tract obstruction must lead to the association of betablocker and alphablocker therapy before surgery. The removal of the pheochromocytoma is usually followed by the complete regression of left intraventricular obstruction, as in this case.

Adrenal Gland Neoplasms↗
PubMed2000

[Cardiac side effects of anti-HIV agents].

Both nature and prognosis of cardiac complications occurring in patients infected by the Human Immunodeficiency Virus-1 (HIV-1) have changed considerably since the introduction of highly acive and anti-retroviral triple therapy ("HART"). Opportunist cardiac infections have thus been displaced and side effects of drugs now occupy the primary aetiological role. Torsades de pointe may be exceptionally triggered by anti-infectious agents such as pentacarinat or trimethoprime-sulfamethoxazole, as are those induced by the association of ketoconazole and terfenadine or cisapride, the dangers of which are well known and the prevention more effective, especially with the association with HIV antiproteases which inhibit the cytochrome P450. The diagnosis of iatrogenic myocardial dysfunction is more difficult, except when it occurs acutely as with phosphonoformate (Foscarnet), or interleukine-2. Progressive cardiomyopathy caused by -interferon and dideoxynucleosides (zidovudine, didanosine and zalcitabine), reversible on withdrawal of the drug responsible in half the cases, should be distinguished from those due to the HIV itself (therapeutic relay) or to another associated cause (alcohol, coronary artery disease). The coronary complications of diseases treated by antiproteases usually occur in smokers whose cholesterol and triglyceride levels are rapidly increased with HAART. In a series of 9 patients (amongst 700 treated with the antiproteases), after the acute phase of myocardial infarction during which the interventional approach is often preferred, the medium-term prognosis is relatively good, on condition that the patients correct the hyperlipidaemia and give up smoking.

Anti-HIV Agents↗
PubMed1998

[Transesophageal echocardiography before electric cardioversion for supraventricular arrhythmia].

OBJECTIVES: The aim of this prospective study was to assess the risks of electrical shock cardio-version in the treatment of supraventricular rhythm disorders when administered under effective-dose but short duration anticoagulation in patients with no intracavitary thrombus detectable by transesophageal echocardiography. PATIENTS AND METHODS: One hundred nineteen patients, mean age 66 years, with permanent arrhythmia due to atrial fibrillation (n = 102), atrial flutter (n = 16) or atrial tachycardia (n = 1) and taking no long-term anticoagulant therapy were treated by electrical shock cardioversion. The patients were given heparin at an effective dose 72 hours prior to cardioversion. A transthoracic and a transesophageal echocardiography were performed less than 24 hours prior to cardioversion. RESULTS: Twenty-one thrombi were evidenced in 16 patients (14.6%) including 18 in the left auricle, 1 in the left atrium and 2 in the right atrium. A spontaneous contrast was visualized in 38 patients (32%). Cardioversion was performed in 103 patients without thrombus and later in 9 of the 16 patients with thrombus after absorption under anticoagulant therapy as evidenced on the control transesophageal echocardiography. A sinus rhythm was obtained in 82% of the cases. All patients were given anti-vitamin K anticoagulants for one month. There were no clinical manifestation of ischemic vascular events during cardioversion nor during the one-month follow-up. CONCLUSION: Early use of electrical shock cardioversion in patients with supraventricular rhythm disorders can be proposed without long-term anticoagulation therapy if the absence of thrombi is demonstrated by transesophageal echocardiography and short-term heparin is given followed by oral anticoagulants for at least 4 weeks. A large-scale randomized prospective study comparing the conventional strategy with the protocol used in this study would be required to definitively validate this approach and determine its possible advantages.

Adult↗
PubMed1997

[Calculation of the regurgitation fraction in mitral insufficiency by Doppler echocardiography using a study of the zone of flow convergence].

The aim of this study was to propose a new method for calculating the regurgitation fraction of mitral insufficiency by the proximal isovelocity surface area (PISA) method and to compare it with the value of the catheter regurgitation fraction. Thirty-five patients (21 men and 14 women) aged 59 +/- 13 years with isolated mitral insufficiency were studied. Analysis of the proximal isovelocity surface area enabled calculation of an instantaneous maximum regurgitant flow, surface of the regurgitant orifice and the regurgitant volume. The regurgitant fraction was calculated by dividing the regurgitant volume by the sum of the regurgitant volume and aortic stroke volume measured by Doppler echocardiography. These parameters were compared with the corresponding catheter data and the angiographic grade of mitral insufficiency. The echocardiographic and catheter studies were performed within 1.7 +/- 1.2 days. There was a statistically significant correlation between the instantaneous maximum regurgitant flow calculated by the PISA method and the catheter regurgitant flow (r = 0.88; p = 0.0001); between the regurgitant volume calculated by the PISA method and the catheter regurgitant volume (r = 0.85; p = 0.0001) and the regurgitation fraction calculated by the PISA method and the catheter regurgitant fraction (r = 0.82; p = 0.0001). A regurgitant fraction by the PISA method of > 45% corresponded to severe mitral regurgitation (> or = angiographic grade 3 and/or a catheter regurgitant fraction > or = 50%) with a sensitivity of 88% and a specificity of 100%. The PISA method should form part or routine quantification of mitral insufficiency.

Adult↗
PubMed1994

[Study of hypertrophic cardiomyopathies with Doppler echocardiography].

The aim of this review is to demonstrate the usefulness of Doppler echocardiography in the study of hypertrophic cardiomyopathy. Two-dimensional imaging enables confirmation of hypertrophy and identification of its type (usually asymmetrical), site and extent. Intraventricular obstruction can be confirmed by echocardiography (mesosystolic aortic closure, systolic anterior mitral movement with prolonged septal contact) and Doppler (intraventricular obstruction flow). This obstruction may be obvious (present under baseline conditions), latent (appearing during provocative tests) or absent. The maximum velocity of obstruction flow can be used to calculate intraventricular gradient by application of Bernouilli's equation. This intraventricular obstruction flow must be distinguished from apical obliteration flow (with which it may be associated) and from left mid-ventricular stenosis flow (which may cause diastolic obstruction associated with the systolic obstruction). Mitral insufficiency is usually a consequence of intraventricular obstruction (loss of systolic coaptation of the mitral leaflets secondary to systolic anterior mitral movement). Ejection parameters are increased because of a fall in left ventricular afterload (hyperdynamic state). Left ventricular diastolic function is most often abnormal (relaxation anomaly). Doppler echocardiography can also be used to seek associated abnormalities, in the evaluation of family members and to monitor progress (treated or not treated). Doppler echocardiography thus enables complete anatomical and functional study of hypertrophic cardiomyopathy. Invasive hemodynamic investigations are justified only if a diagnostic problem persists, if surgical treatment is considered or if coronary arteriography is thought necessary.

Cardiomyopathy, Hypertrophic↗
PubMed1992

[Left ventricular dilatation after primary transmural anterior myocardial infarction. Influence of the percentage of akinesia on echocardiography].

The aim of this study was to determine whether the percentage of akinesia on echocardiography during the acute phase of transmural anterior myocardial infarction could predict secondary left ventricular dilatation. The study group comprised 24 patients (18 men and 6 women) with an average age of 59 years. The patients underwent two echocardiographic examinations, the first during the acute (< 72 hours) phase and the second, 6 months later. Ventricular volumes were calculated by the ellipse monoplane method in the apical 4 chamber view. The percentage of akinesia was defined as the ratio between the length of the akinetic segment and the left ventricular end diastolic perimeter in the apical 4 chamber view. An increase in end diastolic volume (83 +/- 25 vs 62 +/- 18 ml/m2; p < 0.01) and in end systolic volume (51 +/- 27 vs 34 +/- 11 ml/m2; p < 0.01) was observed 6 months after infarction without a significant change in ejection fractions (42 +/- 17% vs 44 +/- 10%). The percentage of akinesia in the acute phase was > 30% in 15 patients (Group I) and < 30% in 9 patients (Group II). The increase in ventricular volumes at 6 months after infarction was significant in Group I (p < 0.02) but not in Group II. At 6 months after infarction, the end systolic volumes were greater (60 +/- 27 vs 37 +/- 22 ml/m2, p < 0.5) and the ejection fractions were lower (35 +/- 13% vs 53 +/- 18%, p < 0.01) in Group I than in Group II.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Myocardial bridge of the left anterior descending coronary artery and myocardial infarction: does coronary spasm play a part?].

The association of a myocardial bridge of the left anterior descending (LAD) coronary artery and myocardial infarction is rare. The mechanisms by which the myocardial bridge could predispose to myocardial infarction are tachycardia (reducing the duration of diastolic coronary filling), thrombosis at the site of the myocardial bridge, and coronary spasm which, however, has never been demonstrated in the context of infarction. The aim of this study was to detect coronary spasm by provocative ergometrine testing in 4 patients, all male, aged 21 to 49 years, average 39 years old, who had anterior myocardial infarction associated with myocardial bridging of the LAD artery without atheromatous coronary stenosis. The ergometrine tests were performed during (2 cases) or after coronary angiography (2 cases). The systolic narrowing due to the myocardial bridge ranged from 25 to 95% (average 70%). The ergometrine test was strongly positive in 1 patient and negative in the other 3. Repermeabilisation of a thrombus was suggested in these 3 patients by the recording of an accelerated idioventricular rythm in the acute phase of infarction (2 cases) or by the demonstration of abnormal platelet aggregation (1 case). This is the first report of coronary spasm in a patient with myocardial bridging associated with infarction. However, it is not possible to determine the respective roles of spasm and myocardial bridging in the genesis of the infarct. We suggest systemic provocative ergometrine testing in this situation to orientate the most appropriate treatment.

Adrenergic beta-Antagonists↗
PubMed1990

[Expansion and remodelling of the left ventricle after myocardial infarction].

The remodelling of the left ventricle after myocardial infarction results from the expansion of the infarcted zone in the acute phase and the dilation of the healthy zone of the left ventricle which complicates the initial expansion. It brings about an increase in the left ventricular volume which is a major pejorative prognosis factor after myocardial infarction. The expansion, defined by the dilation and parietal stricture of the infarcted zone, complicates about 30 p. cent of the infarctions and appears in the first hours of the infarction. It is favoured by the transmural nature of the infarction, by its extent and its previous topography, and by arterial hypertension. It is accompanied by a higher mortality rate, increases the risk of parietal rupture, exposes to post-infarction aneurysm and to intraventricular thrombi, and initializes the ventricular remodelling, factor of secondary cardiac failure. The dilation of the healthy zone of the left ventricle is observed mainly in case of initial expansion. Its importance increases with the size of the infarction. It corresponds to the volume overload secondary to the increase in the telediastolic parietal constraint of the left ventricle. The remodelling of the left ventricle after infarction is limited by captopril, and possibly by the restoration of the blood flow in the artery responsible for the infarction. Captopril, administered in the first weeks following the infarction, limits the dilation of the left ventricle in man as well as in animals. This beneficial effect is due to a decrease in the post-load of the left ventricle. Captopril improves the survival after infarction in animals, but its effect on the post-infarction mortality in man is still under study.

Animals↗
PubMed1989

Massive systemic amyloidosis associated with light-chain deposition disease.

A 72-year-old woman presented with rapidly progressive renal failure and multiple myeloma. The patient died 6 months later of severe hepatic insufficiency. The light-microscopic, immunological and ultrastructural findings showed widespread kappa-light-chain deposits including the kidneys, liver, spleen, heart, lungs, tongue, ovary, pancreas and bone marrow associated with massive AL amyloid deposits in the same organs and in the thyroid gland. The concurrent presence of two different deposits is very unusual and the possible mechanisms for such an association are discussed.

Aged↗
PubMed1989

[Evaluation of pulmonary arterial hypertension by Doppler echocardiography in chronic respiratory insufficiency].

The usefulness of doppler-echocardiography for the assessment of pulmonary arterial hypertension in patients with chronic respiratory failure was evaluated in 24 consecutive patients with chronic obstructive lung disease. Seventeen of these 24 patients (71 p. 100) who had tricuspid valve regurgitation analysable by the continuous wave doppler technique were selected as study group; they included 15 men and 2 women aged from 33 to 78 years (mean 63 years). The highest maximum velocity value (method A) or the maximum velocity value averaged on several cycles (method B) of the tricuspid regurgitation jet was used to calculate the right ventriculo-atrial pressure gradient, using Bernouilli's equation. Right atrial pressure was determined by three methods: haemodynamic measurement, clinical evaluation or attribution of an arbitrary 10 mmHg value. The pulsed doppler study of the pulmonary ejection flow included measurement of the acceleration time and calculation of the acceleration time/ejection time ratio. The usual echocardiographic parameters were measured. Catheterization was performed 2.5 days on average after the doppler study. Correlations between doppler examination and catheterization to evaluate the right ventricular systolic pressure were significant (p less than 0.001) and better with method B than with method A. Depending on the method employed to evaluate the right atrial pressure, the correlation coefficients obtained with method B were: 0.93 (haemodynamic measurement), 0.91 (clinical evaluation) and 0.88 (arbitrary value of 10 mmHg). The right ventricular systolic pressure evaluated by doppler ultrasound using method B and by clinical evaluation of the right atrial pressure was 47 +/- 12 mmHg (22 to 70 mmHg), as against 51 +/- 13 mmHg (28 to 74 mmHg) measured by catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Myocardial infarction during or after exertion related to sports. Clinical and coronary angiographic analysis of 10 cases].

The purpose of this study was to analyse characteristic of myocardial infractions that occur during, or immediately after sport-related exertion in subjects who are neither athletes nor professional sportsmen and who undergo coronary angiography. Ten cases where myocardial infraction developed during (n = 3) or immediately after (n = 7) a game were studied retrospectively. All patients were men aged from 21 to 61 years (mean 48.8 years); 8 of them were smokers and 5 had hypercholesterolaemia. The sports practised were tennis (3), cycling (2), football (2), skiing (2) and weight-lifting (1). The infarction was inferior or basal in 5 cases, lateral in 1 case and anterior or anteroseptal in 4 cases. Coronary lesions involved one vessel in 6 and two vessels in 2 patients aged from 47 to 61 years. They were absent in 2 patients aged 24 and 26 respectively, with methylergonovine-induced spasm in one case. The outcome over a 2.9 years follow-up period was favorable, except for one death 6 months after the infarction (patient aged 24, normal coronary arteries, spasm). The outstanding features in this study are: (1) the occurrence of infraction during the recovery period and the noxious role played by smoking; (2) the contrast between the presence of atherosclerotic coronary lesions in middle age subjects and their absence in younger subjects (infarction due to spasm or thrombosis?), and (3) the possible usefulness of an exercise test in sport players of more than 40 years of age.

Adult↗
PubMed1988

[Acquired systemo-pulmonary fistula after pleurectomy responsible for a continuous thoracic murmur].

Systemo-pulmonary fistulae are rare. The case of a 27 year-old man, hospitalized for exploration of a continuous thoracic murmur, is reported. A right pleurectomy had been performed 2 years previously because of a recurrent spontaneous pneumothorax, and no murmur was present at that time. Angiography showed a systemo-pulmonary fistula with the right internal mammary artery and branches of the right axillary artery as afferent vessels, and the right pulmonary arteries and veins as efferent vessels. Blood gases measurements demonstrated a left-right shunt. The acquired nature of the fistula was suspected because of the history of right pleurectomy and the acquired nature of the murmur. There was no indication for surgery because of the complexity of the fistula and the absence of symptoms.

Adult↗