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Biomedical subjects

F Abid

Publications and source records attributed to F Abid.

At least 37 records · Page 2Linked to original sources
PubMed1990

Closed mitral valvotomy in pregnancy--a study of seven cases.

Between 1977 and 1987, seven pregnant women (mean age 28 years) had closed mitral valvotomy through a left lateral thoracotomy during their first (3 cases), second (2 cases) or third (2 cases) trimester. Surgery was necessary either because of acute heart failure with pulmonary edema not responding to medical treatment (4 cases) or to prevent the complications of severe mitral stenosis affecting either the mother or the fetus in three patients with desired pregnancies. There were neither maternal nor fetal deaths. The only complication was bleeding from a low insertion of the placenta identified in the early postoperative period in one patient that required a caesarean section, which produced a normal baby. Six pregnancies continued until term with uneventful delivery and produced normal children. We conclude that closed mitral valvotomy is a simple and a low risk procedure in pregnant women. It prevents complications of severe mitral stenosis occurring in either the mother or the fetus during pregnancy and delivery.

Adult↗
PubMed1989

Valve replacement in children under 15 years with rheumatic heart disease.

From 1967 through 1984, single- or double-valve replacement for rheumatic heart disease (RHD) was undertaken in 184 children (aged 4 to 15 years) in Tunis. At the time of operation most patients were in an advanced state of cardiac disability, but most of them were still in sinus rhythm. A total of 222 valves were inserted. The most commonly used replacement valve was the Starr-Edwards caged-ball prosthesis, with 12 hospital deaths (6.5%). There were no hospital deaths among 19 children who had a (glutaraldehyde-treated porcine) xenograft replacement valve; however, a much higher rate of valve failure occurred later, owing to valve calcification (14 of 19 replacements, 11 requiring reoperation). There were 24 episodes of clinical thrombo-embolism in 21 children after insertion of a prosthetic valve, but only one in a child with a xenograft valve. Two thirds of the patients with prosthetic valves were on anticoagulants, but fewer than half of them had effective levels because of low compliance. For the group with prosthetic valves, the 10-year survival rate was 70%.

Actuarial Analysis↗
PubMed1987

Prosthetic valve endocarditis. A survey.

Fifty eight patients (aged 8-59 years, mean 27) treated for prosthetic valve endocarditis from January 1966 to January 1985 were studied retrospectively by review of case notes. There were 12 cases of early and 46 cases of late prosthetic valve endocarditis. These developed in 28 patients with an isolated aortic valve, in 26 with an isolated mitral valve, and in four with both aortic and mitral prosthetic valves. Streptococci were the most commonly isolated microorganisms, followed by staphylococci, Gram negative bacteria, and fungi. A surgical (34 cases) or a necropsy specimen (10 cases) from 44 cases was examined. Eighty two per cent of the patients had congestive heart failure. Twenty four of the 58 patients were medically treated and 17 died (70% mortality). Combined medical and surgical treatment was used in 34 patients; the main indication for surgery was congestive heart failure. Fourteen patients on combined treatment died (40% mortality). Persistent sepsis and prosthetic valve dehiscence were the most common early and late operative complications. The most important influences on outcome were congestive heart failure, the type of micro-organism, the severity and extent of anatomical lesions, the time of onset of prosthetic valve endocarditis, and the type of treatment. This survey indicates that only patients without congestive heart failure or embolic complications and with sensitive micro-organism should be treated medically. In view of the poor prognosis patients with prosthetic valve endocarditis associated with congestive heart failure, persistent sepsis, and repeat arterial emboli should be treated by early surgical intervention.

Adolescent↗
PubMed1986

Cardiac valve prostheses, anticoagulation, and pregnancy.

The course of 76 pregnancies is reported in 51 women who became pregnant after replacement of one or more heart valves. Age at conception ranged from 17 to 39 years (mean 25). There have been 71 deliveries and five women are still pregnant at the time of writing. In the 71 pregnancies, oral anticoagulants were given during 53, heparin during five, and no anticoagulants during 13. Fetal complications consisted of 12 spontaneous abortions (eight in pregnancies in which oral anticoagulants were given, three in which heparin was given, and one in which no anticoagulants were given), of 12 premature deliveries with seven stillbirths (three on oral anticoagulants and four without anticoagulants), and there were three neonatal deaths (in all all three instances oral anticoagulants had been given during pregnancy). The maternal complications were as follows. Two women with mitral valve prostheses on heparin had thromboembolic episodes. Four women on oral anticoagulants died and 11 developed haemorrhage or systemic embolism. Two of the deaths were caused by bacterial endocarditis, one was the result of obstruction of a mitral valve prosthesis, and one was due to haemorrhage. One patient developed pulmonary oedema during delivery which rapidly resolved. Seven patients had uterine bleeding after delivery (three of them were on heparin and one was on an antiplatelet agent).

Abortion, Spontaneous↗
PubMed1986

[Infectious endocarditis surgically-treated in the active phase. Apropos of 46 cases].

The clinical and microbiological characteristics, the surgical indications and procedures, the evolution and the principal prognostic factors were reviewed in 46 cases of infectious endocarditis operated in the active phase. Using this date, the authors try to determine the optimal time for surgery during the acute active phase of infectious endocarditis. The study population comprised 28 men and 18 women aged 7 to 64 years (average age: 30). The patients were selected on strict criteria: positive blood cultures during the 48 hours prior to surgery (29 cases), positive valve or valve prosthesis culture (15 cases), the presence of an active cardiac abscess at surgery (7 cases), the presence of a large number of bacteria on histological examination of the valve (17 cases). The patients were divided into two groups: those with endocarditis of native valves (27 cases) and those with endocarditis on prosthetic valves (19 cases). The preoperative clinical features included all the classical signs of IE but congestive cardiac failure was particularly prevalent (62% of cases). Microbiologically, most cases of native valve endocarditis (67%) were due to sensitive organisms (streptococci) whilst the more virulent organisms (staphylococci, gram-negative bacteria and fungi) were observed in prosthetic valve endocarditis (64% of cases). The commonest surgical indication was haemodynamic deterioration (30 cases). The indications were mixed in 15 cases but only one case was operated for uncontrolled infection alone in this series. The surgical procedure was technically complex in 6 cases. Operative mortality was high (18 cases, 39%). The main cause of death was low cardiac output (13 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1985

[Thromboembolic accidents in patients with mechanical prostheses and heterografts].

759 patients with a prosthetic valve replacement (335 mitral prostheses, 184 aortic prostheses and 240 double or triple valve replacements) were regularly followed-up for a total duration of 3 715 patient years. The mean age of these patients was 30 years. 681 (90%) of these patients were treated by long term anticoagulants, which were effective in only 320 patients. 78 patients did not receive anticoagulant treatment. 97 patients presented a total of 129 thrombo-embolic episodes (TEE), i.e. a frequency of 12.7 p. cent or 3.4 embolisms per 100 patients-year. The rate of TEE was influenced by the site of the prosthesis and by the presence or absence of complete arrhythmia due to atrial fibrillation, but it was not influenced by the quality of the anticoagulant treatment. In the patients with a heterograft, the rate of TEE varied according to the site of the prosthesis. In the aortic position, the rate of TEE in our series of prostheses was essentially similar to that reported in series of heterografts by Davila, Oyer and lonescu. This rate is generally higher for the mechanical prostheses in the mitral position and in the case of double valve replacement. The aim of this study was to deduce the current operative indications in relation to the choice of the type of valve replacement.

Adolescent↗
PubMed1983

[Mitral valve prosthesis without anticoagulant treatment. Apropos of 46 cases].

Out of a total of 90 patients with valvular prosthesis not treated with anti-coagulants, 46 only had a prosthesis in the mitral position. These patients were treated in Professor Ben Ismail's department for an average of 58 months (extreme limits 26 and 116 months). The average age of these patients at the time of the operation was 13.6 years. It is important to note that these patients greatly improved as attested to by the evolution of the functional symptoms, cardiac volume, capillary and pulmonary arterial pressure. 7 patients had a thromboembolism (15.5 per cent or 3 embolisms per 100 patient-years). Three cases were minor or rapidly regressed and out of four major cases, one died. This complication is much more frequent in patients treated with anti-coagulants as is the risk of haemorrhage which is sometimes serious or even mortal. In view of these results, it seems legitimate, in these young patients, especially when they are in sino-astrial rhythm, have a good clinical history and are haemodynamic to forego anti-coagulant treatment which may be dangerous in these undisciplined patients under irregular and unusual treatment.

Adolescent↗
PubMed1983

[Thromboembolic and hemorrhagic complications in valve prosthesis patients].

567 patients with valve prostheses who received anticoagulant therapy were followed up by Professor Ben-Ismail's department at the Ernest-Conseil Hospital, over a period of 2 to 160 months (mean: 53 months). 220 of them had a mitral prosthesis, 183 had an aortic prosthesis and 161 had a double (153) or triple (8) valvular replacement. 66 patients (11.6%) presented a total of 85 thrombo-embolic episodes, i.e. a global incidence of 4.6 emboli per 100 patient-years. Amongst the thrombo-embolic incidents, there were 26 cases of valvular thrombosis, 47 cases of cerebral vascular accident and 11 cases of peripheral vascular emboli. The course was fatal in 18 cases. These accidents mostly occurred in the cases with mitral or polyvalvular replacements. More than one half of these patients were pursuing a regular and effective treatment. 55 patients presented a total of 60 serious haemorrhagic accidents, of which 10 died. This study reveals that the incidence of thrombo-embolic accidents is much higher in patients with mitral or tricuspid valve replacements and when the anticoagulant treatment is irregular or capricious. However, an apparently well managed anticoagulant treatment does not prevent the development of thrombo-embolic accidents and carries a significant risk of haemorrhage.

Adult↗
PubMed1981

[Late thromboses on tricuspid valve prostheses. Apropos of 6 cases].

Six out of 24 patients with tricuspid valve prostheses, operated between 1968 and 1978, followed-up from 1 to 10 years (average 4,2 years) developed thrombosis. This complication occurred between 15 and 59 months after operation (average 37 months). All patients were female with ages ranging from 18 to 44 years (average 38 years). Starr-Edwards prostheses were used in all cases. Five of these patients were on anticoagulants therapy, which was well within therapeutic limits in 3 patients. In contrast to thrombosis of mitral or aortic valve prostheses, the presenting symptoms were slowly progressive and discreet in 4 patients; in 1 case, the thrombosis was diagnosed on routine follow-up examination. The slow clinical presentation allows time for useful complementary investigations, catheterisation and angiocardiography being the most reliable methods of confirming this difficult diagnosis: these investigations were carried out in 2 patients, and in both cases, very high right atrial pressure with diastolic gradients between the right atrium and right ventricle of over 10 mm Hg were recorded. Cineangiography showed tricuspid regurgitation in both cases with reflux in the vena cavae and very dilated right atria, stagnation of contrast and poor right ventricular filling. Five patients were reoperated with two postoperative deaths. Particular anatomical appearances were observed at operation or autopsy with fibrin and platelet deposits at different levels of the prosthesis (sewing ring and/or struts) interfering and even blocking the function of the ball or disc. Organized thrombus on the cage was only observed in one patient. In this case, the struts on the prosthesis were set in the right ventricular cavity. Thrombosis of tricuspid valve prostheses is generally a slowly progressive complication and may be diagnosed in time by regular follow-up, so that reoperation may be considered without unnecessary delay.

Adolescent↗
PubMed1980

[Late thromboses of prosthetic heart valves. Apropos of 15 cases].

15 patients developed late thrombosis of their prosthetic heart valves: --9 mitral, 4 tricuspid and 2 aortic valve prostheses. --12 thromboses occurred on Starr-Edwards ball prostheses (7M, 3T and 2 Ao), 2 on Starr-Edwards disc prostheses (1M, 1T) and one on a Björk-Shiley valve. 14 patients were on anticoagulant drugs but treatment was only effective in 5 patients; only 1 patient was not anticoagulated. Thrombosis of mitral and aortic valves presented with signs of pulmonary oedema and/or systemic (especially cerebral) embolism and tricuspid valve thromboses presented with signs of right heart failure or were discovered on routine examination. Paraclinical investigations, when performed, showed valve movement to be an unreliable sign but phonocardiography was useful. Differing pathological appearances were observed, either peroperatively (7 cases) or at autopsy (8 cases). Late thrombosis is a rare but dangerous complication which should be avoided by effective anticoagulation and diagnosed at an early stage.

Adult↗
PubMed1978

Moebius syndrome, peripheral neuropathy and hypogonadotrophic hypogonadism.

The association of congenital ophthalmoplegia and facial paresis (Moebius syndrome) with a variety of other developmental somatic defects has been widely recognised. Its co-existence with hypogonadism of hypothalamic/pituitary origin and subclinical peripheral neuropathy has been reported and in this paper we describe the second case of the Moebius syndrome in association with hypogonadotrophic hypogonadism and a progressive peripheral neuropathy of mixed axonal and demyelinating type.

Adolescent↗
PubMedDate not supplied

[Rheumatic spondylodiscitis in spondylarthropathies].

The involvement of enthesis like disc space is the typical lesion of spondylarthropathies. Out of 240 patients with spondylarthropathies, 10 (7 M, 3 W; mean age: 37 years) have spondylodiscitis, affecting a total of 13 disc spaces: 1 cervical, 2 thoracic, 10 lumbar. The mean duration of spondylarthropathy at the time of diagnosis of spondylodiscitis is 10 years. Spondylodiscitis has a variable clinical presentation: painful (6 cases), asymptomatic (4 cases). Its coexistence with typical radiographic signs of spondylarthropathy added to the exclusion of bacterial origin, permit to link it to spondylarthropathy. Its evolution is generally favourable.

Adult↗
PubMedDate not supplied

Aortic valve replacement in children under 16 years of age with congenital or rheumatic valvular disease. A study of 64 cases.

Sixty-four children have had a single aortic valve replacement under 16 years of age, 50 for rheumatic disease (47) or bacterial endocarditis (3) (group I) and 14 for a congenital aortic valve lesion (group II), 38 were disk prostheses and 26 were ball prostheses. Associated procedures had to be performed 31 times, with widening of a small aortic annulus by a patch in 7 patients. The early mortality was 12.5%. Of 56 survivors, 55 were followed postoperatively for a mean period of 7 years (group I: 44, group II: 11). Forty of the 55 patients were anticoagulated (correctly maintained in only 24 patients), 15 were not anticoagulated. A high rate of late complications was observed. Thrombo-embolic accidents in 5 patients with inefficient anticoagulant treatment, 2 haemorrhagic episodes, 7 prosthetic leaks; specific problems related to this group of young patients were: recurrence of rheumatic fever with increasing severity of mitral valve disease requiring mitral valve replacement in 5 patients and outgrowth of the prosthesis, which affected 7 patients; this complication is the result of either fibrous deposit around the valve annulus or such a small annulus that the surgeon could only implant a small prosthesis. Ten patients required 11 reoperations for various reasons. The main reason for reoperation was mitral valve replacement for worsening of mitral valve disease caused by recurrence of rheumatic fever. A high late mortality 10/55 (18%) was noted. The main cause of death was a perivalvular leak (5); 1 late death was caused by a stenotic number 17 Björk-Shiley valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗