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Biomedical subjects

F Latour

Publications and source records attributed to F Latour.

36 records · Page 2Linked to original sources

[Surgical treatment of congenital aortic valve constriction with associated obstructive cardiomyopathy. Perioperative left intraventricular gradient treated with beta blockers. Apropos of a case].

The authors report a case of congenital valvular aortic stenosis associated with echocardiographic and angiographic appearances of hypertrophic obstructive cardiomyopathy. After valvular replacement and partial myotomy a high intraventricular pressure gradient (125 mmHg) with low intra aortic pressure was recorded. High dose intravenous propranolol (25 mg in 2 hours) reduced this gradient to 50 mmHg allowing cardiopulmonary bypass to be discontinued. This clinical combination is associated with a risk of aggravation of the intra-ventricular obstructive phenomenon when the obstacle to left ventricular ejection is relieved: surgical myotomy was performed in similar, previously published cases. High doses betablocker therapy can be performed in similar, previously published cases. High dose betablocker therapy can be useful in this association and it may also be instituted when right intraventricular pressure gradient increase after relief of pulmonary valvular stenosis.

Adolescent↗

[Auriculo-ventricular block in the Kearns-Sayre syndrome. Apropos of a case].

A 21 year old patient was operated for bilateral ptosis and external ophthalmoplegia at 13 years of age. At this time there were no signs of retinitis pigmentosa or atrioventricular block, features of the Kearns and Sayre Syndrome (1958) which were detected five years later. His bundle recording showed an intrahisian block (1 degree proximal and a complete distal block) with a trifascicular block, the latter persisting alone during a brief return to sinus rhythm. This is one of the rare cases of the Kearns and Sayre Syndrome with documented His bundle recordings and the only reported case with intrahisian block. The patient also suffered from bilateral neural deafness. The patient's condition remains stable after implantation of an isotopic cardiac pacemaker and he now leads a normal life. A review of 52 previously published cases shows that this rare condition appears to be caused by a mitochondrial abnormality, which, for an unknown reason, affects only the neuromuscular and cardiac conduction systems. The prognosis is poor when swallowing and respiration are affected, but this does not occur in all cases. As cardiac conduction abnormalities are the other life-threatening complication, cardiac pacing has greatly improved the prognosis of these patients.

Adult↗

Crohn's disease of the mouth and ovary.

A patient is presented who has granulomatous involvement of the gingiva, ileum, cecum, appendix, and ovary consistent with Crohn's disease. A discussion of the uncommon oral and ovarian lesions is presented.

Adult↗

[Paroxysmal sinoatrial tachycardia. Apropos of 44 cases].

44 cases of paroxysmal sinoatrial tachycardia (PAT) due to reentry within the sinus node or between the sinus node and the atrium are reported; these tachycardias are usually quite well tolerated clinically as the rhythm is rarely faster than 140/min and they are often degraded by functional AV block. They can be triggered and terminated by one (or two) atrial stimuli, and reduced by carotid sinus massage but relapse in the short term. They often alternate with a disturbance of atrial excitability in patients who also have binodal disease. Their diagnosis implies endocavitary investigation showing sinusal anterograde atrial activation and atrial and ventricular stimulation to differentiate them from other types of paroxysmal tachycardia, especially those due to reentry involving concealed right sided Kent bundles. Studies of sinus node function by atrial extrastimulus techniques in 38 patients usually showed an isolated and prolonged Zone I followed, without a transitional plateau, by a Zone IV of sinus echos during which the tachycardia could be triggered. This type of tachycardia, without doubt as common as junctional tachycardia, may respond to treatment with Quinidine, Amiodarone, Verapamil, or beta-blockers, associated with permanent pacing in cases of binodal block.

Adult↗

[Retrograde ventriculo-auricular heart conduction in 126 patients with or without supra-ventricular paroxysmal tachydardia, with or without ventricular preexcitation].

Ventriculo-atrial (VA) conduction was studied by ventricular stimulation at increasing rate and atrial mapping in 126 patients either without ventricular preexcitation (WPW) and supraventricular tachycardia (SVT) (Group I: 60 cases) or with the WPW syndrome with or without SVT (Group II: 30 cases) or with SVT without WPW (Group III: 53 cases) or with short PR intervals (Group IV: 3 cases). In Group I, 22 patients had VA block, 10 had concealed accessory pathways and 28 had nodal VA conduction. In Group II, 2 patients had VA block, 6 had nodal VA conduction and 22 had preferential retrograde conduction through the Kent bundle. In Group III, 9 patients had concealed Kent bundles and 24 had nodal retrograde conduction. In Group IV, the results were varied. The characteristics of retrograde VA conduction are therefore often different from those of anterograde conduction. 52 attacks of SVT were recorded; in the 18 cases of Group II, 5 septal, 3 right lateral, 8 left lateral Kent bundles and 2 intranodal reentries were demonstrated. In the 33 cases of SVT without overt WPW (Group III) a concealed accessory pathway was demonstrated in 9 cases. In all, approximately a half (25 out of 52) of all SVT were due to reentry involving an accessory pathway which was concealed in about one third of cases (9 out of 25) and more often situated on the left border than on the right or in the septum.

Adolescent↗

[Treatment of severe chronic cardiac insufficiency with dihydralazine. Short-and median-term results].

17 patients with severe chronic heart failure (class III and IV) were prescribed hydralazine, an arterial vasodilatator, orally at doses of 150 mg to 400 mg/day. Considerable clinical improvement was observed in most patients. After 24 to 48 hours the cardiac index rose 79 p. 100, the systolic index by 67 p. 100 and left ventricular work by 73 p. 100, whilst systemic and pulmonary resistances fell by 51 p. 100 and 34 p. 100 respectively. There was no significant change in systemic blood pressure or in heart rate. These results were confirmed at 4 months. Mean pulmonary capillary pressure varied little at the start of treatment but decreased by 52 p. 100 at medium term (4 and 12 months) in this series. No cases of systemic lupus erythematosis were observed. The main, but not the only, indication of therapy with dihydralazine is low output heart failure with little elevation in the pulmonary capillary pressure, especially in primary cardiomyopathy and valvular regurgitation. At present, treatment should be based on the results of cardiac catheterisation and the dosage adjusted according to the rate of hepatic acetylation.

Administration, Oral↗

[Chronic idiopathic binodal block. Occurrence, course and pathogenesis].

The incidence of binodal, sinoatrial (SA) and atrioventricular (AV), block was determined in a series of 362 patients, 90 of whom had chronic sinoatrial block (group I), 162 suprahisian, infrahisian or diffuse AV block (group II), 38 with paroxysmal supraventricular tachycardia (group III), and 70 with slow atrial fibrillation, 54 of whom were studied in sinus rhythm (group IV). Electrophysiological investigation revealed: overt or latent AV block in 71% of group I, 48% of group III, and 100% of group IV; overt or latent SA block in 40 to 61% of group II, 87% of group III and 78% of group IV; paroxysmal atrial fibrillation in 61% of group I, 25% of group II and 50% of group IV; intra-atrial block in 26% of group I, 20% of group II, 16% of group III and 31% group IV. An ECG syndrome associating binodal block and disturbances or atrial conduction and excitability is suggested. The pathogenesis and anatomical basis are discussed, the prime lesion of which may be fibrosis of the atrial tissues which may ultimately result in partial or total atrial standstill.

Adult↗

[Adult familial idiopathic binodal block].

Four brothers with a maximum age difference of 20 years, the eldest of whom has been re-examined after a 10 year interval, have sinoatrial block, a supra-hisian atrioventricular block and paroxysmal atrial arrhythmias which have led to partial atrial standstill in the eldest: left anterior hemiblock is also present in the two youngest brothers. The condition is very well tolerated. This family is compared to the other 12 reported cases of familial idiopathic binodal block in the adult, an autosomal dominant condition with variable penetration. The diagnosis is reserved and justifies endocavitary investigation of the sinus node function and atrioventricular conduction in the four brothers and the most exposed members of their family. The mechanism of the condition is unknown. It seems to arise from variable degrees of nonspecific of the nodal and atrial tissues.

Adult↗