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Biomedical subjects

C Almange

Publications and source records attributed to C Almange.

At least 55 records · Page 3Linked to original sources
PubMed1988

[Aortic valve replacement in persons over 75. 128 operated patients].

Aortic valve replacements are performed in ever older subjects. In the surgical cardiovascular clinic of Rennes, 128 patients aged 75 or over (up to 85 years) and presenting with solitary or predominant (126 cases) aortic stenosis underwent aortic valve replacement between 1976 and 1985 inclusive. Pre-operative evaluation consisted, on principle, of non-invasive explorations. Myocardial protection was ensured by hypothermic cardioplegia. We used a mechanical (Björk-Shiley) prosthesis in the 19 patients operated upon before 1980, and a bioprosthesis (Carpentier-Edwards porcine, supra-annular type since 1983), in the 109 patients operated upon since 1980. The operative mortality rate was 8.6% (11 deaths). The survival curve was similar to that of a control population of the same age-group (survivors 75% at 4 years, operative mortality included). The quality of survival was remarkable since 96% of survivors were in NYHA stages I or II, the poor results being due to early or late cerebral vascular accidents. Advances in surgery (notably myocardial protection), anaesthesia and intensive care make it possible reasonably to operate upon very old patients, provided they have remained in good general and cerebral vascular condition. Non-surgical alternatives, such as percutaneous valvuloplasty, now used in elderly patients can only be reliable if results of similar quality and durability can be expected from them.

Aged↗
PubMed1987

Thrombolysis of acute total occlusion of the left main coronary artery and long-term survival.

A young woman was admitted with acute anterior myocardial infarction. Emergency coronary angiography showed a total occlusion of the LMCA. Selective infusion of streptokinase recanalized the left main coronary artery (LMCA), the circumflex artery, and the first diagonal, but not the entire left anterior descending artery (LAD). The right coronary artery was dominant and normal. The left-sided congestive heart failure was severe; treatment improved the heart failure and the patient was discharged on Day 25. She was readmitted for control 28 months later: she was only moderately disabled and coronary angiography showed the same occlusion of the LAD; result on ejection fraction (right anterior oblique view 30 degrees) was not significant, but circumflex artery recanalization probably preserved lateral wall contraction. The presence of a normal dominant right coronary artery seems to be a very important factor in contributing to initial survival.

Adult↗
PubMed1986

[Evaluation of aortocoronary bypass using exercise myocardial thallium 201 scintigraphy].

The surveillance of aortocoronary bypass grafts is a difficult problem. Clinical examination and exercise testing are unable to give a complete evaluation of the operative results and cardiac catheterisation with radiological opacification of the grafts are not without risk and cannot be repeated periodically. Therefore, radioisotopic methods have been proposed as a means of assessing aortocoronary bypass grafts. The aim of this study was to evaluate postoperative myocardial perfusion by Thallium 201 scintigraphy. The authors compared pre and postoperative scintigraphies in 37 patients undergoing aortocoronary bypass surgery (36 men and 1 woman, average age: 53.9 years). Preoperative coronary angiography showed 9 cases of single vessel disease, 11 cases of double vessel diseases and 17 cases of triple vessel disease. Seventy one bypass grafts were performed (average 1.92 grafts/patient): 37 on the LAD, 15 on the circumflex, 10 on the diagonal and 9 on the right coronary. All patients were submitted to the same protocol before surgery and during the third postoperative month; Clinical examination, ECG, exercise stress testing and Thallium 201 myocardial scintigraphy. The results confirm the improvement in myocardial perfusion after coronary bypass surgery. The percentage of pathological scintigraphic segments fell from 42 per cent before surgery to 27 per cent after surgery (p less than 0.01). The total Thallium perfusion index improved significantly after surgery from 9.3 +/- 2 to 7.7 +/- 1.9 (p less than 0.01). Thallium 201 scintigraphy was superior to clinical examination and exercise testing in the assessment of graft patency, identifying 2 postoperative infarctions inapparent on clinical examination, excluding postoperative non-anginal chest pain and evaluating myocardial perfusion in patients who had sub maximal postoperative exercise stress tests. The relatively non traumatic character of Thallium 201 scintigraphy makes it the best non-invasive method of assessing aortocoronary bypass graft patency.

Adult↗
PubMed1985

[Idiopathic ventricular arrhythmia in children. Apropos of 24 cases].

The severity and prognosis of idiopathic ventricular arrhythmias in childhood were studied in 24 patients (12 boys, 12 girls) with an average age of 8 years at the time of diagnosis of the arrhythmia. Investigations included clinical assessment and analysis of basal ECG (morphology of the arrhythmias) and dynamic recordings (Holter and exercise stress testing). The clinical course was followed for an average of 3.8 years. The patients were classified in two groups: monomorphic arrhythmias (Group I) and polymorphic arrhythmias (Group II). Group I was divided into 4 subgroups: isolated ventricular extrasystoles (IA), 11 patients; ventricular extrasystoles with bursts of ventricular tachycardia (IB), 6 patients; sustained ventricular tachycardia without intercritical extrasystoles (IC), 1 patient; accelerated idioventricular rhythm (ID), 2 patients. Subgroups IA, IB and ID were characterised by the absence of symptoms, the disappearance of the arrhythmia on exercise, the decreased efficacy of antiarrhythmic drugs and an excellent prognosis. Therapeutic abstention was the rule in these patients. Patients in Group IC were characterised by the variability of their symptoms, the absence of exercise induced arrhythmias, the need for treatment in most cases and a good long-term prognosis. Group II was divided into 2 subgroups: adrenergic polymorphic ventricular tachycardia (IIA), 2 patients, and non-adrenergic polymorphic ventricular tachycardia (IIB), 2 patients. Patients in Subgroup IIA were characterised by syncope on exercise or emotion, the need for betablocker therapy which considerably improved the patients symptoms but which did not usually prevent sudden death.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Accelerated idioventricular rhythm. 2 new cases in children].

Two new cases of idiopathic accelerated idioventricular rhythm are reported in children aged 12 and 16. This is a very rare arrhythmia in childhood with only 12 previously published cases in the medical literature. The prognosis seems to be excellent in all cases which underlines the importance of distinguishing this rhythm from other ventricular arrhythmias observed in childhood.

Adolescent↗
PubMed1984

[Fetal bradycardia caused by an anomaly of auriculo-ventricular conduction. Apropos of a case with prenatal diagnosis. Review of the literature].

In discussing a case of isolated A-V block, the authors note that this condition occurs frequently in association with other cardiac and non-cardiac foetal malformations. Diagnosis of this type of disorder has been greatly facilitated by the development of ultrasonography. Obstetric management depends on the degree of malformation. Neonatal monitoring is mandatory, as is the presence of a paediatric ressuscitation team at delivery.

Adult↗
PubMed1984

[Severe tracheo-bronchial compression caused by a circumflex aorta. Apropos of 3 cases treated by aortic uncrossing].

The cases of three children with an encircling right aortic arch and left sided descending aorta illustrate the fact that this rare abnormality may cause severe compression of the tracheo-bronchial axis. A ventricular septal defect was associated to the abnormal vascular arch in all three cases. The compressive structure was the aorta and these children could only be extubated after surgical uncrossing . Before diagnosing tracheomalacia in a child operated for an abnormal vascular arch, residual compression must be excluded by tracheo-bronchial fibroscopy.

Aorta, Thoracic↗
PubMed1982

[Comparison of data from exercise tests and continuous electrocardiographic recording in patients with ventricular extrasystole. Apropos of 131 cases].

A series of 131 patients aged from 4 to 70 years old with significant ventricular arrhythmias corresponding to at least Grade 2 of Lown's classification underwent exercise stress testing and continuous 24 hour electrocardiography. There were two objectives: to compare exercise electrocardiography and Holter monitoring in the detection and assessment of the seriousness of the arrhythmia, and to assess the arrhythmia's modifications on exercise. The patients were divided into 4 types: "chronic coronary insufficiency", "mitral valve prolapse", "other cardiac disease" and "idiopathic" arrhythmias. The maximum grade of arrhythmia corresponded to salvos of ventricular extrasystoles in 44 cases (33,5 p. 100), doublets in 44 cases (33,5 p. 100), polymorphic extrasystoles in 10 cases (7,6 p. 100) and monomorphic extrasystoles in 33 cases (25,2 p. 100). A significant arrhythmia was found in 90,8 p. 100 of cases by Holter and in 82,4 p. 100 of cases on exercise stress testing. The maximum grade of arrhythmia was also better appreciated on Holter monitoring (84,7 p. 100) compared to exercise stress testing (46,5 p. 100). The difference being more clear cut for repetitive forms. The superiority of Holter monitoring for assessing the grade of arrhythmia was obvious in the "idiopathic", "other cardiac disease" and "coronary" groups (79,4 p. 100 compared to 41,2 p. 100) but was not significant in the mitral valve prolapse group (73,9 p. 100 compared to 65,2 p. 100). Aggravation of the arrhythmia on exercise defined as a large increase, even transient of the number of extrasystoles (7 cases) or changing to a higher grade (59 cases) was significantly less common (p less than 0,01) in the idiopathic group (30 p. 100) than in the other groups (64,1 p. 100 in the coronary, 65,2 p. 100 in the mitral valve prolapse group). Aggravation of the arrhythmia in the coronary group was not observed more often in positive than in negative exercise electrocardiography. Complete regression of extrasystoles in the last two minutes was observed in 50 cases and significantly more often in idiopathic arrhythmias (p less than 0,01). There was no correlation between the behavior of the arrhythmia on exercise and the presence of salvos of extrasystoles, previous syncope or electrical cardioversion. Important individual differences were observed in all groups of patients. These observations suggest that the statistical superiority of Holter monitoring is debatable and imply that it is often necessary to request both investigations for the exact diagnosis of the arrhythmia and for the eventual therapeutic management of the patient and his mode of life.

Adolescent↗
PubMed1980

[Myxoma of the mitral valve in a child. Apropos of an operated case].

The case of an 8 year old child with a symtomless murmur of mitral incompetence is reported. Echocardiography showed the presence of an intracardiac tumour, a mass of dense echos between the two mitral leaflets being recorded; multiscan examination suggested insertion on the anterior mitral leaflet. The tumour and its pedicle were resected, causing some loss of valvular tissue, which required repair with a strip of pericardium. This would appear to be the first reported case of mitral valve myxoma in children. Left atrial myxoma, the commonest cardiac tumour, is rarely observed before 15 years of age; insertion on the mitral valve itself is rare at any age. The site of insertion is determined by quite separate echocardiographic criteria compared to left atrial myxoma. This is important as surgery may sacrifice the mitral valve, and mitral valve replacement may be needed; valvuloplasty should be attempted in this age group, despite the risk of tumour recurrence, which is porbably greater with this unusual location.

Child↗
PubMed1978

[Thoracopagus. Possibilities of surgical separation].

A new case of thoracopagus twins is reported. Radiological, hemodynamical and surgical explorations showed a communication between the two hearts, situated at the atrial level and associated with digestive and cardiovascular malformations. These abnormalities were definned by the anatomical study realized after vascular injection:hypoplastic pulmonary artery (associated with a persistent atrio-ventricular canal in one case, with a tricuspid atresia in the other case), a large fused liver, common pancreas and ileum. A bibliographic study allows the authors to define surgical separation possibilities. The prognosis depends essentially on cardiovascular abnormalities associating abnormal connections between the twins' hearts with malformations often too severe for surgical repair.

Humans↗