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Biomedical subjects

E Donal

Publications and source records attributed to E Donal.

At least 19 recordsLinked to original sources
PubMed2005

Hypoxaemia associated with an enlarged aortic root: a new syndrome?

OBJECTIVE: To assess the mechanisms through which an enlarged aortic root may facilitate right to left shunting through a patent foramen ovale. PATIENTS: 19 patients with the platypnoea-orthodeoxia syndrome (POS) were compared with 30 control patients without platypnoea. INTERVENTIONS: Multiplane transoesophageal echocardiography. MAIN OUTCOME MEASURES: The aortic root diameter, atrial septal dimension behind the aortic root, and amplitude of the phasic oscillation of the septum were measured. Four groups of patients were compared: 12 platypnoeic patients with a dilated aortic root (POS-D), 7 platypnoeic patients with a normal aortic root (POS-N), 15 control patients with a dilated aortic root (CONT-D), and 15 control patients with a normal aortic root (CONT-N). RESULTS: In POS-D and CONT-D patients, the apparent atrial septal dimension was 16.3 (2.7) mm and 17.4 (5.9) mm respectively, compared with 24.4 (5.2) mm in POS-N patients and 25 (4) mm in CONT-N (p < 0.005). Furthermore, the amplitude of septal oscillation was 14.7 (2.5) mm in the POS-D group versus 5.8 (2.4) mm in CONT-N (p < 0.001) compared with 23.3 (3) mm in seven patients with an atrial septal aneurysm (p < 0.001). CONCLUSION: Patients with an enlarged aorta have an apparently smaller dimension and increased mobility of the atrial septum. These findings appear to result from compression by the aortic root and decreased septal tautness. Consequently, a "spinnaker effect" with the inferior vena caval flow may take place, opening the foramen ovale and leading to sustained right to left shunting.

Adult↗
PubMed2005

[Atrial remodeling, systemic hypertension, stroke].

Atrial remodeling has been demonstrated to be associated with rapid atrial pacing or with hemodynamic overload. It may refer to changes in electrophysiological properties and/or in structure and function. Hemodynamic overload of the atria has been found to be an important pathogenic factor of atrial fibrosis, providing a morphological substrate for atrial fibrillation. This finding could partly account for the high risk of stroke in hypertensive patients. In this respect, a strong involvement of the renin angiotensin system has been suggested by experimental, clinical and epidemiological data. Thus, prevention or even partial regression of atrial remodeling could be reasonably expected from ACE-inhibitors and angiotensin 2-blockers.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2005

[Value of systematic biological markers of inflammation for the prognosis at 12 months of patients undergoing programmed coronary angioplasty].

Value of systematic dosage of biological markers of inflammation for the prognosis at 12 months of patients undergoing programmed coronary angioplasty Systematic dosage of proteins of inflammation has been suggested for assessing the prognosis of athero-thrombotic diseases. The authors undertook a study of plasma C-reactive protein (CRP) and interleukin 6 (IL-6) for evaluating the prognosis of patients undergoing programmed coronary angioplasty. A prospective monocentric study of 117 patients (65 +/- 8 years) was divided into a control group of 28 patients undergoing coronary angiography (Group 1) and 89 patients undergoing programmed coronary angioplasty (Group 2). Serum IL-6 and CRP levels were measured before arterial puncture and at H12 and H24 after coronary catheterisation. The follow-up period was 12 months. The angioplasty did not significantly increase CRP and IL-6 concentrations compared with coronary angiography. Twenty patients (Group 2) (22%) suffered a cardiovascular event in the 12 months' follow-up. These patients had significantly higher CRP levels at H0, H12 and H24 after coronary angioplasty than those who had uncomplicated outcomes. This was not observed for IL-6 concentrations because of the wide dispersion of the results obtained. Increased CRP concentrations between H0 and H24 was also a good predictive factor independently of high basal CRP levels potentially due to other causes than atheroma. Coronary angioplasty is associated with increased CRP at H0, H12 and H24. These values are correlated with the risk of future events at 6 and 12 months. This information is easily obtained and should help management of these patients.

Aged↗
PubMed2005

[Viral cardiomyopathy].

In too many cases, the cause of dilated cardiomyopathy (DCM) remains undetermined. Coronary or valvular heart diseases, connective tissue disorders, toxic causes and signs of infection are systematically investigated. With the exceptions of coronary and sometimes valvular heart disease, the treatment of cardiac failure remains symptomatic treating the consequences but not the cause of DCM, which is therefore diagnosed as "idiopathic". This artericle reports the clinical history of 4 patients followed up for apparently "idiopathic" DCM in whom the presence of chronic Parvovirus B-19 infection was demonstrated. Based on these 4 cases, the hypothesis of an infectious cause of DCM and the role of myocardial biopsy, given the progress in molecular biology, are reconsidered. Parvovirus B-19 infection has recently been recognised not only as a cause of myocarditis but also of chronic viral cardiomyopathy, as in adeno and enteroviral infection. The authors conclude that the progress in molecular biology, the recognition of a viral aetiology and the efficacy of immuno-modulator therapy such as beta-interferon, may lead to a new management strategy of patients with DCM in cardiological referral centres.

Adult↗
PubMed2002

[Candida endocarditis: retrospective study in 12 patients].

PURPOSE: Candida endocarditis are rare, with a poor prognosis. Actually, the principal problem concerns the growing incidence of nosocomial fungal infections. The objective of the present investigation is to assess a disease which risks becoming more pronounced in the future. METHODS: We have collected observations of Candida sp. endocarditis between 1985 to 1997 from three French university hospitals. RESULTS: Twelve of the observations fit the Duke criteria of acute endocarditis. Patients were eight men and four women, with a mean age of 46 years. An immunodepression was found in seven cases, and four patients were active drug addicts. Six had an underlying heart disease at risk to acute endocarditis. Candidemia risk factors were found in nine cases, with an average of 2.7 risk factors per patient. The fungal agents detected were Candida albicans (eight cases), C. tropicalis (one case), C. parapsilosis (two cases), and C. glabrata (one case). These vegetations were on aortic (seven cases), mitral (three cases), tricuspid valves (two cases) or in other areas (three cases), with multiple localizations (two cases). In three observations, vegetations were associated with myocardium abscesses. Eight patients had embolic complications, two had a cardiac insufficiency leading to death. The treatment was medical in all of the cases and combined with a surgical treatment in ten cases. The surgery was performed, on an average, 17 days after diagnosis, allowing seven surviving patients. Among them, five received a secondary prophylaxis and no recurrence was recorded. CONCLUSIONS: Prognosis remains severe because of the voluminous, friable and necrotic vegetations, which favor embolic migrations and which are not easily accessible to antifungals, which penetrate poorly into these vegetations. Therapy is based on a medical treatment combined with a valve replacement which needs to be done early on, and is followed by a relapse prevention which can occur several years after the initial episode.

Adult↗
PubMed2002

[Doppler parameters in the followup of and evaluation of patients with heart failure].

Cardiac failure plays an increasing role in the daily practice of cardiologists and internists. Cardiac failure is purely diastolic in nearly 40% of cases. Whether purely diastolic or mixed, cardiac failure requires appropriate management in the long term. A step by step approach is often necessary and echocardiography with Doppler analysis of blood flow is certainly one of the most pertinent methods of following up these patients. In addition, new technologies now provide access to quantifiable regional left ventricular systolic and diastolic function: Doppler tissue and strain rate imaging will certainly be an additional help for the adaptation of strategies of management of cardiac failure in the near future.

Cardiac Output, Low↗
PubMed2001

[Systemic markers of inflammation after coronary angioplasty].

UNLABELLED: THE RISK OF RESTENOSIS: Coronary angioplasty is an effective treatment of stable and instable coronary disease and its principle limitation, despite technical progress, remains restenosis. In instable angina, the physiopathologic and prognostic role of inflammation proteins is well documented. THE ROLE OF THE C-REACTIVE PROTEIN (CRP): Is a validated risk factor for patients presenting with heart failure, whether instable or stable angina and in the general population. This risk factor is distinct from tobacco abuse, hypercholesterolemia or diabetes. In all the series studied to date, the frequency of restenosis following coronary angioplasty increases when CRP values are high prior to surgery and continue to rise up to the 48th or 72nd hour. PERSPECTIVES: New therapeutic measures widen the possibilities of mechanical strategies (angioplasty with or without stent) and treatment of inflammatory mechanisms in the atheromatous plaques (statines, brachytherapy or "covered" stents).

Angioplasty, Balloon, Coronary↗
PubMed2001

Normal coronary angiogram and dobutamine-induced left ventricular obstruction during stress echocardiography: a higher hemodynamic responsiveness to dobutamine.

UNLABELLED: This study assessed the clinical or echographic factors predisposing to dynamic left ventricular obstruction (LVO) during dobutamine echocardiography (DE) in patients with angina-like chest pain but without coronary artery disease (CAD). DE is an effective technique for the noninvasive diagnosis of underlying CAD. During DE, an LVO is not unusual in ischemic patients. METHODS: DE (5-40 microg/kg/min) was performed in 52 consecutive patients with angina-like chest pain and normal coronary angiogram. Mean (standard deviation) age was 61 +/- 10 years (27 men, 25 women). Dobutamine-induced LVO was defined as a new intracavitary flow acceleration of at least 3 msec in the left ventricle. RESULTS: Dynamic LVO was observed during DE in 20 (38%) of the 52 patients and was not related to clinical or baseline echocardiographic parameters. The chronotropic response and the systolic blood pressure during DE were higher in the group with LVO (P < 0.03 and P < 0.05, respectively). Appearance of chest pain during the test was also more frequent when LVO occurred (P < 0.02). CONCLUSION: Dynamic LVO is common during DE in a population of patients with angina-like chest pain without epicardial CAD and is associated with a higher hemodynamic responsiveness to dobutamine.

Adrenergic beta-Agonists↗
PubMed2001

Dobutamine stress echocardiography response of asymptomatic patients with diabetes.

AIMS: This study investigated the role of dobutamine stress echocardiography for the silent diagnosis of myocardial ischemia in a diabetic population. Results from the stress test were compared between diabetic and nondiabetic groups. METHODS: Forty-nine diabetics and 63 consecutive nondiabetics underwent dobutamine stress echocardiography between April and December 1999, to check for new regional wall-motion abnormalities. A single operator, using the same echograph with tissue harmonic imaging in each case, performed all the examinations, using the same techniques. RESULTS: Significant coronary artery disease was detected in 9% of asymptomatic diabetics. Dynamic left ventricular obstruction was observed in 59% of the diabetic population and only 22% in the nondiabetic population. One patient suffered an adverse event (fast atrial fibrillation) during the stress test. Cardiac frequency at the beginning and end of the stress test differed significantly between the two populations. CONCLUSION: Dobutamine stress echocardiography allows for detection of silent myocardial ischemia. In the diabetic population, we describe, for the first time under dobutamine infusion, a great number of dynamic left ventricular obstructions.

Cardiotonic Agents↗
PubMed2001

Echocardiographic features of Candida species endocarditis: 12 cases and a review of published reports.

OBJECTIVE: To describe the specific echocardiographic features of Candida species endocarditis. DESIGN: Retrospective review of the case records of patients with confirmed candida endocarditis. SETTING: Cases referred to three French university centres over an eight year period were studied. DESIGN: 12 patients with confirmed Candida species endocarditis infection were identified. The transthoracic (n = 12) and transoesophageal (n = 12) echocardiographic appearances were compared with the surgical findings (n = 10). RESULTS: Large dense heterogeneous vegetations were found in 11/12 cases. A hyperechogenic heterogeneous myocardial texture, observed in seven of the 12 patients, was associated with extensive myocardial damage at surgery. While it was possible to diagnose candidal cardiac infection in all patients by transthoracic echocardiography, transoesophageal echocardiography was useful for optimal assessment of the valvar and paravalvar structures. CONCLUSIONS: In the setting of endocarditis, the detection of myocardial involvement, which is characterised by a heterogeneous myocardial texture, is an argument in favour of Candida species endocarditis and may warrant early surgical intervention.

Adult↗
PubMed2001

[First case of myocardial metastasis of an epidermoid tumor. Value of Doppler tissue imaging].

The authors report the first case of a poorly differentiated epidermoid oesophageal cancer with myocardial metastasis. The diagnosis of malignant invasion of the myocardium was made by transthoracic echocardiography with electrocardiographic changes of subepicardial ischaemia. The authors review the literature of metastasic cardiac disease after the study of this particular case and underline the value of Doppler tissue imaging for myocardial characterisation.

Carcinoma, Squamous Cell↗
PubMed2001

[Cardiogenic shock due to myocardial infarction: surgical revascularization with centrifugal left ventricular assistance. Report of 2 cases treated successfully].

Cardiogenic shock in the acute phase of myocardial infarction still carries a high mortality. In young patients who cannot be revascularised by angioplasty, when medical therapy is failing, some workers recommend an energetic approach, even cardiac transplantation, often with the bridge of mechanical cardiac assistance. This is not possible everywhere, thus preventing possible myocardial salvage and resulting in fairly high mortality. The authors report two cases in which endoluminal revascularisation was not possible and so complete surgical revascularisation with left ventricular assistance was chosen. The two patients survived and one was successfully transplanted electively. This management may be proposed in young patients with multiple occlusions of large coronary arteries in post-infarction cardiogenic shock when medical management is failing despite intra-aortic balloon pumping.

Adult↗
PubMed2001

[Heart rupture by closed chest trauma].

Cardiac rupture is certainly unrecognised in the context of closed chest trauma. There have been few reports in the literature despite the fact that autopsy series show that it is the second cause of death after serious thoracic injury. The authors report three cases of traumatic rupture of the heart. The clinical presentation, apart from cardiogenic shock, differs according to whether there is an associated rupture of the pericardium. When the pericardium is intact, the diagnosis is suggested by the signs of tamponade: With earlier treatment of trauma by medical teams, this lesion should be diagnosed as soon as possible. Echocardiography has many indications in closed chest trauma. Early surgical intervention is the only treatment of these lesions.

Adult↗
PubMed2000

[Ultrasonic myocardial characterization. Application of an original method of acoustic quantification to analysis of healthy and hypertrophic interventricular septal myocardium].

Echocardiography does not provide objective tissue characterisation of sonified tissues. A recent advance has been the introduction of the radiofrequency signal. At present, its exploitation remains a research tool. The required material for quantification is still insufficiently robust and discriminative. The indices derived from histograms of grey scales are calculated by the majority of workers for regions of interest manually positioned in the image. This statistical method allows analysis of the average grey level but not of the architecture of the tissue examined. Tissue characterisation is, therefore, only a potential feature of echocardiography. The authors' approach consists in developing software applied to digital signal provided by the echograph and not directly by the transducer, as in the research based on the use of radiofrequency signals. This software allows characterisation of the texture by two statistical methods applied to signal processing: the histograms of the grey scales, the matrix of co-occurrence (assessing the make-up of the different grey scales in the region of interest). This tool of tissue characterisation is presented here in the studies of the interventricular septum in the parasternal long axis view. Two populations, one with healthy myocardium and the other with myocardial hypertrophy, have been studied. These two populations are differentiated in a significant manner by their respective values of parameters of myocardial texture characterisation in early diastole. Despite a number of methodological problems, this study confirms the hopes that it will be possible in the near future to obtain a quantitative "histological" definition of tissues by echocardiography.

Echocardiography↗
PubMed2000

[Tissue characterization by study of myocardial response to ultrasound. Review of the literature and perspectives].

Echocardiography is a routine daily cardiological investigation. Recent technological developments suggest that it may become possible to quantify myocardial texture and thereby achieve histological and functional definitions of cardiac diseases. Two approaches are under evaluation: "videodensitometry" uses tools of statistical quantification from the echocardiographic image; more recently, analysis of the radiofrequency signal has been proposed. This is based on direct exploitation of a continuous signal at the transducer head of wide dynamic range containing all the information received by the piezo-electric crystals. These two approaches have given encouraging preliminary results in the recognition of different myocardial hypertrophic reactions, in diabetic cardiac disease and in the identification of myocardial viability. Despite the many remaining problems, the perspectives are promising and a new field of echocardiography should see the light of day.

Echocardiography↗
PubMed2000

[Valvular tumor: diagnostic trap. Report of a case of marastic endocarditis].

Marastic endocarditis is a rare clinical condition described in cases of cancer or other severe inflammatory diseases. The authors report the case of a young patient in good general condition, admitted after a cerebro-vascular accident. Investigations showed an isolated mitral valvular mass on transoesophageal echocardiography which, after unsuccessful medical therapy, was operated. It was, in fact, a case of marastic endocarditis, and a pulmonary tumour was discovered one month after surgery. The bronchopulmonary adenocarcinoma had remained infraclinical beforehand. The advances in echocardiographic imaging will probably lead to an increase in such cases of early diagnosed thrombotic non-bacterial endocarditis (ETNB. This case suggests that it is justified to carry out an aetiological investigation of thrombotic non-bacterial endocarditis in all cases of isolated mitral valve masses.

Adenocarcinoma↗