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Biomedical subjects

C de Place

Publications and source records attributed to C de Place.

26 records · Page 2Linked to original sources
PubMed1985

[Left ventricle-right atrium communications acquired in bacterial endocarditis].

Three cases of acquired LV-RA communication during bacterial endocarditis are reported. The causal organisms were Staphylococcus aureus and Streptococcus. The endocarditis complicated aortic valve disease in 2 patients and a congenital aneurysm of the membranous interventricular septum in the third case. Perforation of the septal abscess was preceded by 1st and 2nd degree AVB in all cases associated with bursts of intrahisian tachycardia in 1 case. The clinical presentation was that of an acute VSD; LV-RA communication was diagnosed by the radiological demonstration of systolic expansion of the RA, by 2D echocardiography using constant and Doppler techniques which gave the exact diagnosis in 1 case, by oximetry showing a large left-to-right shunt situated in the RA, and finally by selective left ventriculography. Surgery is essential and urgent and comprises repair of the fistula by two patches, one atrial shown on via a right atrial approach and the other ventricular via aortotomy associated with correction of the valvular lesions. Third degree AVB is observed in all cases, due to the anatomical location of the His bundle and requires permanent pacing. Good results were observed in 2 cases with follow-up periods of 14 and 48 months respectively.

Acute Disease↗
PubMed1985

[Severe hypoxemia due to a right-to-left shunt at the atrial level caused by an infarction of the right ventricle].

The authors report the case of a biventricular inferior myocardial infarction complicated in the acute phase by massive tricuspid regurgitation and a right-to-left interatrial shunt through a patent foramen ovale; this resulted in severe hypoxaemia. The diagnosis was made by contrast 2D echocardiography which showed ventriculo-atrial regurgitation and the passage of microbubbles from the right to the left atrium leading to opacification of the left ventricule: right heart catheterisation with oxymetry and selective right ventriculography confirmed the diagnosis. The hypoxaemia became less severe as the haemodynamic conditions improved. This is one possible mechanism of severe hypoxaemia in the acute phase of myocardial infarction and should be excluded routinely in this situation as it can have important prognostic and therapeutid implications.

Blood Gas Analysis↗
PubMed1984

[Hemodynamics and M mode echocardiography of the consequences of ventriculo-atrial conduction in the human].

A haemodynamic and M mode echocardiographic study of 57 patients hospitalised for chronic, symptomatic 2nd or 2rd degree AV block was carried out after 3 periods of pacing, each lasting 2 hours : 1) sequential AV pacing ( SAV ) with a 200 ms delay, considered as the mode of reference; 2) sequential ventriculo-atrial pacing ( SVA ) with the same sequential delay, recreating equivalent conditions of 1/1 ventriculo-atrial conduction (VAC); 3) ventricular pacing (V) recreating complete AV dissociation ( CAVD ). The pacing rate was the same for each patient (89 +/- 9/min). In comparison with SAV , SVA caused much worse haemodynamic changes than V : large increases in mean atrial pressures (+161% and +64% in RAP and PCP respectively); "canon" atrial A waves which were poorly tolerated (mean amplitude 14 mmHg and 18 mmHg on the RA and PCP waves respectively); in some cases, a large fall in blood pressure was observed due to the failure of systemic resistances to increase and compensate for the constant decrease in pump function (mean reduction of 23% of cardiac index; 29% of LV work index). These changes are much more pronounced in diseased than in healthy hearts, especially in the presence of mitral or tricuspid regurgitation. Echocardiography showed the main cause of these haemodynamic changes to be a reduction in ventricular filling with significant reductions in LV systolic and diastolic dimensions, changes in the mitral valve echos (reduction in the opening and closing velocities, delayed closure), probably related to a decrease in transvalvular blood flow, and decreased regional contractility of the interventricular septum. These observations justify an increase in the indications of modes of pacing maintaining permanent atrio-ventricular sequence (VVI pacing at slow rates; AAI pacing, DVI or DDD pacing in cases of abnormal AV conduction with VAC, especially in cases of sick sinus syndrome with permanent bradycardia). These modes of pacing are particularly beneficial when the electrical abnormality is associated with a decompensated cardiac lesion, or with decreased ventricular compliance or mitral regurgitation.

Adolescent↗
PubMed1983

[M-mode echocardiographic study of right ventricular involvement in the acute phase of inferoposterior myocardial infarction].

The aim of this study was to assess the value of a non-invasive technique, echocardiography, in diagnosing RV extension during the acute phase of myocardial infarction. Forty patients with an acute infero-posterior infarct were divided into two groups according to the presence (Group A) or absence (Group B) of RV akinesia on angiography. M mode echocardiography was carried out from two positions: left parasternal, for the study of quantitative parameters: RV and LV diameters, wall thickness and excursion, VCF and fractional shortening, mitral and tricuspid valve morphology, aortic and left atrial dimensions; subxostal: for the study of one parametere: RV inferior wall motion assessed as normal or akinetic. A comparative statistical study including a group of 35 controls was carried out. The results showed at comparable values in both groups, that patients in Group A had lower global LV function, hypokinesia of the LV posterior wall with minor changes in the mitral valve echo and LA dimension; akinesia of the RV inferior wall, a direct and specific sign of RV infarction, was observed in 50 p. 100 of cases; in comparison with the other two groups, despite large individual variations, there was a significant increase in RV diameter (p less than 0,001) and RV/LV diameter (p less than 0,001), and in the amplitude of systolic motion of the RV anterior wall (p less than 0,05 and p less than 0,01). Other qualitative signs were inconstant: paradoxical septal motion (7/20), pericardial separation (3/20), tricuspid B point (5/20). Dilatation of the RV was inconstant (50 p. 100 of cases) but its association with paradoxical septal motion was indicative of significant tricuspid incompetence. Akinesia of the RV inferior wall seemed to be of prognostic value: RVEDP and the extent of angiographic RV akinesia were greater in its presence (p less than 0,05). There was a slight correlation between RV dimensions (RV diameter and RV/LV diameters) and the extent of angiographic RV akinesia (R = 0,50, p less than 0,05) and with cardiac index (R = 0,60, p less than 0,05). This study shows that M mode echo provides positive direct signs of RV infarction in about 50 p. 100 of cases. The sensitivity of the technique is therefore relatively low. However, it does distinguish the more severe forms of biventricular infarction, especially when complicated by tricuspid incompetence.

Adult↗