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Biomedical subjects

B de Geeter

Publications and source records attributed to B de Geeter.

17 recordsLinked to original sources
PubMed1998

[Fetal supraventricular tachycardia associated with anasarca: poor prognosis despite treatment. Apropos of two cases].

Two cases of foetal supraventricular tachycardia with hydrops with fatal outcomes illustrate the poor general prognosis of this condition. The absence of therapeutic consensus, of large series in the existing literature, does not prevent logical and reasonable management based on rhythmological, pharmacological and prognostic criteria. A combined approach associating antiarrhythmic therapy by the transplacental and intrafunicular approaches seems acceptable now that funicular puncture can be undertaken easily, and certain antiarrhythmic molecules suggest encouraging results. It is important to try to assess the haemodynamic tolerance by foetal Doppler echocardiography because the foetal prognosis depends on ischaemic cerebral lesions induced by anoxia, difficult to diagnose in utero: when observed, aggressive and occasionally dangerous therapies to foetus and mother may be justified in these extreme situations of foetoplacental hydrops.

Adult↗
PubMed1996

[Percutaneous valvotomy of aortic valve stenoses in children].

A retrospective cooperative study of percutaneous aortic valvuloplasty was undertaken in 12 French centres from 1985 and included 90 children over 3 months of age (average 8.5 +/- 5.2 years) treated for isolated aortic valve stenosis with peak transvalvular pressure gradients of 80.7 +/- 23 mmHg. over 50 mmHg in 92% of cases. The majority of cases were performed by a retrograde femoral arterial approach with inflation of a balloon with a diameter approximating that of the aortic annulus. There was one serious complication (lethal collapse occurring before dilatation) and 12% of local complications due to arterial trauma: the latter were temporary or accessible to simple therapeutic measures. Overall, the pressure gradient decreased by an average of 39.2 +/- 25.4 mmHg. There were 15 immediate failures (17%) and 21 partial results (23%) requiring a further procedure at varying intervals after the valvuloplasty. There were 54 primary successes (60%) with annulation of the pressure gradient and this result was sustained in 45 of the 51 cases followed up for an average of 34 +/- 21 months. Aortic regurgitation was observed or aggravated in 29 children; at the end of the study, this remained a serious problem in 15 cases (17%). The authors conclude that interventional catheterisation is an elegant. simple and relatively economical alternative to conventional surgery. It is as safe, but less immediately effective overall; aortic continence may be compromised in the long-term. In the absence of technical innovations, a parallel development of the two therapeutic procedures is to be expected.

Adolescent↗
PubMed1995

Mediastinal stabilization by an expansion prosthesis in postoperative congenital diaphragmatic hernia with severe pulmonary hypoplasia.

The authors illustrate a case of right neonatal congenital diaphragmatic hernia (CDH) of Bochdalek with major pulmonary hypoplasia and postoperative massive mediastinal displacement to the right, leading to tracheal compression and recurrent respiratory distress at every attempt to wean the infant from the ventilator. Mediastinal stabilization was obtained by placing an expansion prosthesis (of the cutaneous type) in the right hemithorax, to prevent mediastinal obstruction of the main airways. This procedure may prove to be an original and efficient solution for the critical postoperative respiratory obstruction due to severe pulmonary hypoplasia and mediastinal mass effect in the newborn with CDH. However, this may not prevent progressive scoliosis, a serious problem frequently seen in the absence of one lung.

Airway Obstruction↗
PubMed1993

[Severe hemolysis after endoluminal closure of the ductus arteriosus and recovery following implantation of a second obturator].

A few hours after closure of a large patent ductus arteriosus by the endoluminal approach in a 28 month old infant, severe hemolysis occurred due to incomplete closure; cure was obtained by the implantation of a second obturator by the femoral vein. Definitive complete occlusion of the ductus was followed by immediate disappearance of the hemolysis.

Anemia, Hemolytic↗
PubMed1988

[Digital subtraction angiography in pediatrics].

In spite of the prominent position reached by echocardiography in the anatomical and functional diagnosis of congenital heart disease, angiography remains the reference method for preoperative assessment of most cardiovascular malformations. Digitalization of angiographic images, recently applied to cardiology, is of particular interest in paediatrics: the versatility of the method, the smaller amount and dilution of the contrast medium, the diminution of catheter size and the shorter exposure to X-rays are factors that reduce the risk of this invasive investigation. The experience acquired by the exploration of 500 congenital heart disease shows that there is no technical obstacle to using this method in paediatric cardiology, especially since the images obtained clearly are of better quality. Digital angiocardiography already has superseded the conventional analogical exploration in paediatric patients.

Adolescent↗
PubMed1987

Anomalous left coronary artery from the pulmonary artery in infants. Which operation? When?

The surgical management of anomalous left coronary artery from the pulmonary artery in infants and small children remains controversial, because the ideal surgical procedure and the optimal time for operation are yet to be determined. From 1977 to 1985, 22 patients less than 4 years of age (mean age 18.2 months) underwent direct aortic reimplantation of the anomalous left coronary artery. There were five operative deaths (23%, confidence limits 13%-36%). The determinant risk factor of early mortality was the severity of preoperative left ventricular dysfunction (p = 0.05), not age at operation (p = 0.64) or preoperative clinical status (p = 0.36). There were not late deaths (mean follow-up 38 months). All survivors but one were symptom free. The reimplanted anomalous left coronary artery was patent in each reevaluated case (9/17). Left ventricular function improved significantly in all survivors. Moderate to severe preoperative mitral incompetence lessened in all patients but one, without mitral valve repair. When technically feasible, direct aortic reimplantation of the anomalous left coronary artery is an attractive procedure because it offers a high rate of patency and avoids the potential drawbacks of procedures involving autogenous venous or arterial tissue. Optimal intraoperative myocardial preservation and institution of temporary left ventricular assistance at the end of the operation may decrease the operative risk. Left ventricular function nearly always recovers after successful revascularization, and resection of left ventricular myocardium is rarely indicated, if ever. Mitral incompetence almost always lessens, and the mitral valve should not be repaired at initial operation; however, residual mitral incompetence may necessitate reoperation in a few cases. In infants with moderate left ventricular damage (usually asymptomatic with medical therapy), surgical treatment should be delayed until 18 to 24 months of age so that it can be performed with a low operative risk. Infants with severely impaired left ventricular function and persistent congestive heart failure should probably undergo operation as soon as the diagnosis has been made.

Age Factors↗
PubMed1986

[Severe hypertrophic cardiomyopathy associated with an adrenocortical adenoma].

A case of severe asymmetrical hypertrophic cardiomyopathy occurring in a 11 month-old infant presenting with adrenocortical adenoma is reported. Cardiac involvement, as shown by echocardiography, recovered after complete excision of the tumor. Despite few published cases, the etiology of the associated cardiomyopathy is discussed.

Adenoma↗
PubMed1983

Cardiac tumors in infancy. Recent aspects.

Intracardiac tumor is rare in the newborn but often responsible for severe cardiorespiratory distress and neonatal death. Diagnosis is made very late and most of them are only recognized after death. We observed 5 cases of intracardiac tumors in newborn, of various etiology and, in the last patients, diagnosis was made very early after birth and even during pregnancy. Echography and especially fetal echocardiography seems to be of great importance in managing this kind of pathology.

Echocardiography↗
PubMed1981

[Ductus arteriosus in neonatal cyanotic cardiopathies. Value of the recording of the cutaneous partial pressure of oxygen].

Adaptation to extrauterine life is always precarious in the newborn with cyanotic cardiac malformations. Limited survival is possible in cases with obstructive lesions of the right heart providing ductal closure is delayed. This was monitored in 3 cyanotic neonates with ductal dependant cardiac malformations (tricuspid atresia, transposition of the great arteries with atresia or severe stenosis of the pulmonary valve) by continuous measurement of the cutaneous pO2. The value of cutaneous pO2 monitoring has already been established. It is a reliable indicator of arterial pO2 in the neonatal period. Its major advantage, apart from the possibility of continuous monitoring, is that it is non-invasive and may be performed at the bedside. Analysis of curves recorded over several hours or days showed the cyclical nature of cutaneous pO2, probably related to slow variations in ductal diameter equilibrating effective pulmonary flow, arterial pO2 and ductal constriction. Prolonged hyperoxygenation of these desaturated children does not usually improve their condition; progressive deterioration due to the constrictive effect of oxygen on the ductus may be observed. When a clear decrease in the amplitude of oscillation is recorded ductal closure is imminent and palliative surgery should be undertaken whenever possible.

Ductus Arteriosus, Patent↗
PubMed1979

[Aortic arch interruption and cutaneous PO2].

In three neonates with cardiac failure and coarctation the cutaneous PO2 (cPO2) has been measured during the administration of a high concentration of oxygen. One sensor was fitted to the skin just below the right clavicle (preductal) and the other on one of the legs (postductal). The difference in the cPO2 provided evidence for a large right to left shunt through the duct. This finding in conjunction with the clinical syndrome of co-arctation is characteristic, in our view, of atresia of the aortic arch. The results of the test, with clinical and echocardiographic details enable more accurate decisions to be made before catheterisation and surgery.

Aortic Coarctation↗
PubMed1979

Right-to-left ductal shunt and transcutaneous PO2.

The continuous monitoring of the PO2 with double sensors, pre- and post-ductal, is very interesting during the neonatal period; the magnitude of the right-to-left ductal shunting, related to high pulmonary vascular resistance, is well evaluated by the hyperoxemia test. This noninvasive method allows a reliable observation of the pulmonary vascular response to oxygen, alkaline solutions, or tolazoline infusion.

Blood Gas Analysis↗
PubMed1976

[Severe hyperosmolarity caused by dietary error in the newborn. A disorder of particular concern in migrants].

Hyperosmolarity as a result of dietary error is a fairly common condition. It is more grave than "thirst fever", the benign reputation of which should not be taken too lightly. The consequences may be serious: death or sequelae related to vascular thrombosis or cerebral lesions. Prevention should be possible in most instances as long as obstetricians, paediatricians, midwives and nursery nurses are aware of the danger of overconcentrated milk formula. Its treatment remains fraught with hazard.

Animals↗