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Biomedical subjects

G Drobinski

Publications and source records attributed to G Drobinski.

At least 109 records · Page 6Linked to original sources
PubMed1986

[Coronary stenosis after radiotherapy. Clinical study of 5 cases and review of the literature].

Coronary artery stenosis is one of the possible complications of radiotherapy to the mediastinum. Although less frequent than pericardial disease, anatomopathological studies have shown it not to be uncommon. Five cases with different clinical presentations are reported and the 30 previously described cases are reviewed. Radiotherapy was performed for Hodgkin's disease in 70% of cases and for carcinoma of the breast in 10% of cases. The average delay before onset of the symptoms was 4 years but in some cases delays of up to 10 years were observed. The most common presentation was an inaugural myocardial infarction (50 to 60% of cases). In other cases, angina of effort or typical spastic angina was observed. The coronary lesions were mainly proximal single artery stenosis affecting especially the left anterior descending artery. The typical histological appearances of the stenosis were intimal and sometimes adventicial fibrosis, occasionally associated with medial hyaline sclerosis. However, atherosclerotic lesions were also commonly present. This observation raises the question of the role of irradiation in the development of precocious atherosclerosis by coronary endothelial damage. This hypothesis is supported by the results of experimental studies and by the fact that several autopsy reports showed that the atheroma only developed in the irradiated zone. In addition, although the most demonstrative cases are those of young patients of 30 to 35 years of age, the responsibility of radiotherapy in the development or coronary pathology of older patients cannot be excluded, especially when none of the classical coronary risk factors are present.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Echocardiographic study of left ventricular contraction by a scoring method in chronic coronary insufficiency].

The echocardiographic evaluation of left ventricular function in chronic coronary insufficiency is based on the two-dimensional ultrasound examination. Several methods of analysis can be used: volumetric analysis or comparison of the diastolic and systolic contours after separation of the images, but they are relatively difficult to perform and are associated with a certain degree of error. We present the results of a method of analysis based on scoring of the real time image without reprogramming. The left ventricle is divided into nine parts according to Heger's model and the segmental kinetics of each segment are scored according to the following system; 0: parietal aneurysm; 1: dyskinesia; 2: akinesia; 3: hypokinesia; 4: normal. The maximal score is therefore 36. This method was applied prospectively in 30 consecutive patients with chronic coronary insufficiency requiring coronary angiography. The results were compared to those of ventriculography in 30 degrees RAO and 45 degrees LAO cranio-caudal views, which were analysed quantitatively. A correct echocardiographic analysis was obtained in 29 patients. There was good concordance with the ventriculography in 20 cases. In two cases, the contractile abnormality was detected on the echocardiogram, but it was located in an adjacent area on the angiography. In five cases, a localised abnormality of one segment was only detected on angiography. The comparison of the score with the angiographic ejection fraction revealed a good concordance and a very high degree of sensitivity for the method in the identification of cases with an ejection fraction of less than 30 p. cent. This scoring method avoids a number of errors of the other volumetric methods or the methods which compare the contours and it provides clinically significant results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Sarcoma of the heart. Apropos of 2 cases].

Sarcoma of the heart is a very rare condition. We present here two cases with very different clinical expression. The first patient, a 15-year old girl, presented with extremely severe ventricular arrhythmia, whereas the second patient, a 63-year old woman, mainly had signs of congestive cardiac failure. A diagnosis of cardiac tumour was made in the first case on the basis of ultrasonographic results which clearly showed the tumour developed from the walls of the left ventricle. In the second case, the tumour involved the right ventricular wall, the deformation of which was undetected by ultrasounds and only suspected at angiography. Both patients died rapidly, and the diagnosis of sarcoma was confirmed at post-mortem examination.

Adolescent↗
PubMed1985

[Evaluation of 100 attempted percutaneous coronary angioplasties in the treatment of coronary insufficiency].

Between November 1983 and June 1985, 100 coronary angioplasties were performed in the department of cardiology of the Pitié-Salpêtrière hospital, in 96 patients and 101 vessels. 71 attempts were successful (70%). There were no deaths. 8 bypass grafts were performed because of a symptomatic occlusive dissection in 3 cases, arterial trauma proximal to the stenosis in 2 cases and coronary artery thrombosis following a failed attempt at dilatation in 3 cases. There were 3 infarcts. The success rate improved from 56 per cent in the first 25 patients to 77 per cent in the last 25 patients. The success rate was maximal in patients with stenosis of the IVA, where it was as high as 90 per cent in the last 50 patients. In this last series, the success rate was identical in cases of stable and unstable angina. The rate of re-stenosis was low: 12 per cent in patients with a follow-up of at least 6 months.

Adult↗
PubMed1985

[Regression of post-infarction parietal dyskinesia after percutaneous coronary angioplasty].

Normalisation of abnormal segmental wall motion is rarely observed after myocardial revascularisation by aorto-coronary bypass when the territory revascularised is the site of post-transmural infarction dyskinesia. In particular, normalisation of segmental wall motion is extremely rare when dynamic tests designed to detect potential for improvement (trinitrin test and post-extrasystolic potentiation) are negative. We present the case of a 41 year old man who had anterior and septal wall dyskinesia 2.5 months after antero-septal infarction which was not improved by trinitrin. Dilatation of the left anterior descending artery by percutaneous coronary angioplasty was undertaken because of recurrent effort angina. Control angiography at 6 months showed almost complete normalisation of left ventricular contraction. This myocardial recovery is paradoxical because the trinitrin test did not show potential for improvement. The case illustrates the possibility of normalisation of segmental abnormalities of left ventricular contraction after revascularisation of the dyskinetic zone by percutaneous coronary angioplasty.

Adult↗
PubMed1985

[Coronary disease. Medical or surgical treatment?].

Aortocoronary bypass procedures have been proven to be effective in relieving angina pectoris. Whether the procedure actually prolongs life, on the other hand, still remains a matter of controversy. Many prospective and randomized studies have been undertaken in Europe and in the United States on this subject. The results of 6 of these studies are reported and discussed: the Seattle Heart Watch, the Veterans Administration Study, the Cooperative American Study on Unstable Angina, the Cooperative European Study on Coronary Artery Surgery, results of findings from Duke University, and the randomized Coronary Artery Surgery Study. Analysis of results of these prospective studies is of value in establishing a therapeutic approach to coronary artery disease.

Angina, Unstable↗
PubMed1985

[Angiocardiographic diagnosis in right ventricular dysplasias].

Right ventricular dysplasia (RVD) is characterised by fatty and fibrous infiltration of the right ventricular wall and usually presents clinically with ventricular arrhythmias. The aim of this study was to determine the morphological changes of RVD and establish diagnostic criteria applicable in cases with atypical clinical signs or electrocardiographic changes. The angiocardiographic data of 10 cases of RVD was reviewed. 8 cases were complicated by right ventricular arrhythmias. The other 2 cases were not arrhythmogenic but had highly suggestive ECG changes; there were no other causes of right ventricular disease. Selective right ventriculography was performed with the catheter positioned in the inflow tract distal to the moderator band. In the 8 cases without tricuspid regurgitation there was one constant finding: the presence of parietal fissuration with massive impregnation of the ventricle distal to the moderator band. Two signs were commonly observed; the stagnation of contrast in the inferior regions of the right ventricle during left ventricular opacification (6/8 cases); irregular opacification of the pulmonary infundibulum (5/8 cases); an infundibulor aneurysm was observed in 1 case. Biometrical data was normal in all 8 cases compared with a control group of 10 normal subjects: the right ventricular disease was segmental and not diffuse. It was associated with a moderate alteration of left ventricular function and with segmental abnormalities of wall motion in 2 cases. None of these signs were observed in the right ventriculographies of 7 cases of typical dilated cardiom-opathies. These 4 signs were not found in 2 cases with tricuspid regurgitation where changes were essentially limited to a dilatation of the right ventricular inflow tract.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Effects of injectable nitroglycerin on atheromatous coronary stenoses].

The beneficial effects of glyceryl trinitrate (GTN) are the result of several mechanisms which reduce venous return, cardiac work and intraparietal tension, and redistribute blood flow to the subendocardial layer and ischaemic zones. A direct action on atheromatous coronary stenosis is disputed. The coronary angiogram of 45 patients with organic stenosis and no clinical or electrocardiographic signs of coronary spasm were studied under basal conditions and after intravenous injection of 1.5 mg of GTN. Eighty stenotic segments and the corresponding 80 prestenotic segments were traced for comparison after enlargement on a Vanguard retroprojector and calibrated with reference to the coronary angiographic catheter. Aortic pressure fell 2 minutes after the injection in all patients to return to initial values at the end of the investigation. The diameter of the stenosed segment increased in 17 cases, remained unchanged in 54 cases and decreased in 9 cases. When expressed as a percentage of stenosis, the narrowing increased in 25 cases, decreased in 16 cases and remained the same in 39 cases. In the cases aggravated by GTN the diameter of the stenosis decreased or remained the same, whilst the diameter of the prestenotic decreased; in the cases improved by GTN, the diameters of both stenotic and prestenotic segments increased and prestenotic segments showed only slight variations. There was no difference in the diameter of the prestenotic segments between the 3 groups, but the diameter of the stenotic segments was larger in the group aggravated by GTN in comparison with the other two groups. Different haemodynamic factors and neurotumoral and local metabolic autoregulatory mechanisms may be activated by GTN.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗
PubMed1985

[Emergency treatment of chronic ventricular tachycardia after myocardial infarction by endocavitary fulguration].

Endocavitary catheter ablation consists of delivering an impulse of 160 to 240 joules via a catheter used for electrophysiological investigation resulting in an electrical discharge which, in addition to its thermal effects may alter the arrhythmogenic substrate mechanically. This method was used in 2 patients with resistant and recurrent VT after myocardial infarction complicated by ventricular aneurysm. Two sessions of catheter ablation were necessary in both patients, but in the second one a single shock was successful in critically ill patients with VT. The first patient has been followed up for 20 months and the second for 13 months. Under prophylactic antiarrhythmic therapy, neither patient has had recurrence of the ventricular arrhythmias which had previously led to their hospitalisation. Catheter ablation is therefore presented as a technique which may be performed in the electro-physiological laboratory and repeated in cases of incomplete efficacy. This method may be used successfully in the treatment of chronic VT after myocardial infarction complicated by ventricular aneurysm.

Aged↗
PubMed1985

[Familial forms of interauricular communication of the ostium secundum type].

The occurrence of several cases of ASD in the same family is rare. Familial forms of ASD are characterised by the high incidence of associated cardiac lesions in affected patients or in the family, by the frequency of atrioventricular block with prolongation of the PR interval and by the presence of a large defect in the interatrial septum. The condition is thought to be transmitted in an autosomal dominant manner. The authors report the case of a family in which 7 cases of ASD were found, 6 of which were repaired surgically. There were no associated cardiac or extracardiac malformations; AV conduction was normal in 4 of the 6 operated cases--the defects were all large. The study of the genealogical tree with examination of most members of the family suggests autosomal dominant transmission of the condition.

Adolescent↗
PubMed1985

[Prospective study of the prevalence of coronary involvement in isolated aortic stenosis].

From 1980 to 1982, 148 consecutive patients with isolated aortic stenosis (AS) were studied prospectively with coronary angiography. Significant coronary artery disease was discovered in 27 patients (18.4 percent of cases), with involvement of the left main coronary artery 4 times (15 percent of cases), three-vessel involvement 10 times (37 percent of cases), two-vessel involvement 8 times (30 percent of cases), and single-vessel involvement 9 times (33 percent of cases). Clinical information such as age, sex, the existence of angina (present in 81 out of 148 patients, or 54.7 percent of cases), or electrocardiographic findings could not accurately predict coronary artery involvement except for the previous history of a myocardial infarction. Five patients with coronary artery lesions had no manifestations of angina, comprising 18.5 percent of patients with coronary artery disease, 3.4 percent of the entire group of 148 patients with AS, and 7 percent of patients without angina. This study's originality resides in the fact that it is a prospective study which demonstrates that coronary artery lesions associated with AS can often be severe and can not be predicted without coronary angiography. No other examination can reliably identify the association of these two conditions, making coronary angiography a routine part of the preoperative evaluation of AS if these lesions are to be discovered.

Adult↗
PubMed1984

[Interatrial septal aneurysm. Echocardiographic diagnosis].

Interatrial septal aneurysm is a rare abnormality and can now be diagnosed by echocardiography. We report the case of a 52 year old woman in whom this condition was diagnosed after an embolic cerebrovascular accident. M mode recordings showed a linear echo in the left atrial cavity in early and mid systole. The aneurysm was directly visualised by 2D echo as a hemispherical bulge in the mid portion of the interatrial septum, which was mobile and had a to-and-fro motion between the two atria in relation to the different phases of the cardiac cycle. The diagnosis was confirmed by angiography, and at surgery. A feature of this case was the close correlation between echocardiographic, angiographic and operative findings. The pathogenesis of this type of aneurysm remains conjectural as does its role in the production of cerebral embolism, the evidence for which was circumstantial in the absence of other demonstrable causes and in the light of previously reported cases.

Angiography↗
PubMed1984

[Differential diagnosis between constrictive pericarditis and cardiac amyloidosis by computerized M-mode echocardiography].

A diastole is a non specific haemodynamic syndrome which may result from constrictive pericarditis or from a restrictive cardiomyopathy. The aim of this study was to differentiate these two types of condition by analysis of computerised M mode recordings of the left ventricle. Three groups of patients were studied: 5 cases of confirmed cardiac amyloidosis (Am); 5 cases of constrictive pericarditis confirmed surgically (CP) and 10 normal subjects (NL). The study was based on analysis of parameters of ventricular filling and of diastolic thinning of the LV free wall. A significant difference was observed between AM and CP but not between PC and NL. Amyloidosis was characterised by a reduction in the maximum velocity of endocavitary diameter lengthening (AM 0,84 +/- 0,56 cir/sec; PC 3,95 +/- 0,77, p less than 0,01), prolongation of the rapid filling phase (AM 0,42 +/- 0,17 sec; PC 0,16 +/- 0,06 sec, p less than 0,02) and a decrease in maximum velocity of free wall thinning (AM 0,45 +/- 0,23 th/syst/sec; PC 4,79 +/- 2,1, p less than 0,01). The diastolic thickness of the free wall was greater in the amyloidosis group (AM 1,73 +/- 0,61 cm; PC 1,05 +/- 0,21, p less than 0,05) and correlated with the reduction of maximum velocity of free wall thinning. Parameters of global diastolic filling did not distinguish the two conditions. The M mode recordings were therefore digitalised to provide graphs of chamber filling and wall thinning and their derivatives.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Hemodynamic effects of ARL 115 in left ventricular insufficiency].

ARL 115 has vasodilator and positive inotropic properties which justify its use in heart failure. The effects of this drug were studied in 8 patients with advanced myocardial failure (7 cases of primary cardiomyopathy and 1 case of ischaemic cardiomyopathy) undergoing diagnostic cardiac catheterization, 15 minutes after angiocardiography. The cardiac output pressures were measured and the M mode electrocardiogram was recorded under basal conditions and following an infusion of 1 mg/kg of ARL 115 over 10 minutes. An improvement was observed in 7 cases, with an increase in the cardiac output and a decrease in the left ventricular diastolic pressure (p less than 0.05). There was no significant modification in the heart rate and there were no side effects. In one case, an abrupt fall in the diastolic pressure led to a decrease in the cardiac output. The arterial and venous vasodilator properties were demonstrated in every case, but a positive inotropic action (increase in the dp/dtmax and modification of the end-diastolic pressure: dimension ratio) was demonstrated in only two cases. The absence of positive inotropic action in the 6 other cases could be due to the advanced myocardial deterioration in these patients or to a delay in the positive inotropic effect in relation to the vasodilator effect.

Adult↗