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Biomedical subjects

G Grollier

Publications and source records attributed to G Grollier.

At least 145 records · Page 8Linked to original sources
PubMed1988

Short-term clinical and haemodynamic assessment of balloon aortic valvuloplasty in 30 elderly patients. Discrepancy between immediate and eighth-day haemodynamic values.

Recently, percutaneous aortic valvuloplasty has been considered as a possible palliative procedure in elderly patients with critical valvular stenosis in whom valve replacement is deferred or contra-indicated because of high operative risk. However, the demonstration of the efficacy of such a procedure is based on immediate post dilatation haemodynamic data and clinical improvement. The purpose of this study was to evaluate the haemodynamic consequences of this procedure on the eighth day after a post procedure haemodynamic control. Thirty consecutive patients (mean age 75 +/- 8.4 years) with long-standing aortic stenosis were treated at the time of cardiac catheterization with balloon dilatation. Of these 30 patients, 24 (mean age 76 +/- 8) underwent haemodynamic evaluation eight days after the procedure. Prevalvuloplasty examination revealed a mean aortic valve gradient (MAVG) of 82 +/- 19.9 mmHg, a mean thermodilution calculated cardiac output (CO) of 3.6 +/- 0.9 l min-1 and a mean aortic valve area (VA) of 0.37 +/- 0.14 cm2. Immediate postvalvuloplasty control showed a fall in MAVG to 44.5 +/- 16.7 mmHg (P less than or equal to 0.001), a decrease in CO to 3.3 +/- 1.4 l min-1 (NS) and an increase in VA to 0.60 +/- 0.35 cm2 (P less than or equal to 0.01). Eighth-day haemodynamic control revealed an increase in MAVG to 71 +/- 18.8 mmHg (P less than or equal to 0.001), an increase in CO to 4.1 +/- 1.3 l min-1 (P less than or equal to 0.001) and a decrease in VA down to 0.47 +/- 0.10 cm2 (P less than or equal to 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Post-radiotherapeutic left main coronary ostial stenosis: clinical and histological study.

Pericardial abnormalities remain the most common manifestation of radiation-induced cardiac disease, but coronary artery lesions are not rare. In this report we describe a left coronary ostial stenosis which appeared five years after mediastinal irradiation for breast carcinoma in a 50-year-old woman. The patient underwent coronary angiography. A pressure drop was observed as the left catheter tip engaged the left coronary ostium; so, only nonselective coronary opacifications were performed showing an isolated, marked narrowing of the left coronary ostia. During surgery, a circumferential aortotomy allowed the examination of the left coronary ostium which appeared severely stenosed. The coronary tree was otherwise normal. A termino-terminal saphenous vein graft was anastomosed on the left stem and its proximal part was implanted on the ascending aorta. The coronary ostium and the proximal part of the left main stem were excised and the macroscopic examination of the proximal part of the left coronary artery confirmed the diagnosis of severe ostial stenosis. Microscopic examination of the coronary ostium showed a severe intimal thickening without any evident lesion of the media. This intimal thickening consisted of fibrous tissue without extracellular lipid deposit. Microscopic examination of the aorta near the coronary ostium also demonstrated an intimal thickening without any lesion of the media. Coronary ostial stenosis appears to be a rare lesion; its incidence has varied between 0.13 and 2.7% in angiographic studies and there is co-existing disease in multiple coronary vessels in the majority of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1988

Percutaneous balloon dilatation of calcific aortic valve stenosis: anatomical and haemodynamic evaluation.

Two groups of elderly patients with calcified aortic stenosis were treated by balloon dilatation. In group 1, the valve was dilated just before surgical replacement of the valve. The valvar and annular changes occurring during dilatation were examined visually. In 20 of the 26 patients in this group there was no change. In the six remaining patients mobilisation of friable calcific deposits (1 case), slight tearing of the commissure (4 cases), or tearing of the aortic ring (1 case) were seen. Dilatation did not appear to alter valvar rigidity. In 14 patients (group 2) the haemodynamic gradient across the aortic valve was measured before and immediately after dilatation and one week after the procedure. Dilatation produced an immediate significant decrease of the aortic mean gradient and a significant increase of the aortic valve area. Eight days later the mean gradient had increased and the aortic valve area had decreased. Nevertheless there was a significant difference between the initial gradient and the gradient eight days after dilatation. The initial aortic valve area was also significantly larger than the area eight days after dilatation. The aortic valve gradient rose significantly in the eight days after dilatation and at follow up the gradients were those of severe aortic stenosis.

Aged↗
PubMed1987

[Acute and subacute ruptures of the free wall of the heart in acute myocardial infarction].

Nowadays, acute rupture of the cardiac free wall is, after cardiac failure, the second most frequent cause of hospital deaths consecutive to acute myocardial infarction. This mechanical complication of myocardial infarction is usually beyond surgical treatment in patients with sudden cardiac arrest at the time of rupture. However in about 30% of the cases the rupture may be subacute and amenable to surgical treatment provided the condition is rapidly diagnosed. Diagnostic criteria are clinical (abrupt fall in blood pressure, often preceded by recurrent thoracic pain, associated with venous hypertension in the absence of left ventricular failure), haemodynamic or angiographic but mainly echocardiographic (pericardial effusion with or without intrapericardial mass suggesting a blood clot). Attention should be paid to certain subgroups at risk, notably women under 70 and patients with prolonged or recurrent anginal pain.

Echocardiography↗
PubMed1987

Angioplasty of chronic totally occluded coronary arteries: usefulness of retrograde opacification of the distal part of the occluded vessel via the contralateral coronary artery.

Eighteen patients with chronic totally occluded coronary arteries underwent percutaneous coronary angioplasty. Eleven of these patients had a proximal occlusion of the left anterior descending artery and seven had occlusion of either the proximal or middle right coronary artery. All patients had severe angina pectoris with clearly positive results of stress treadmill testing. Preservation of a viable myocardium despite an occluded artery was, in each instance, the result of excellent collateral flow arising from the contralateral coronary artery. The guide wire and the dilatation balloon were properly positioned by opacifying the distal segment of the occluded artery by injection of contrast into the contralateral artery in 15 of 18 patients. Almost simultaneous injection, first into the contralateral vessel and then into the occluded artery, allowed evaluation of the true length of the occlusion. Contralateral opacification disappeared immediately after adequate recanalization and reappeared during inflation of the balloon. These examples show that in patients with chronic coronary occlusion, opacification of the distal segment by injection of contrast into the contralateral vessel seems to be helpful and without risk to the patient.

Aged↗
PubMed1987

Anterograde percutaneous transseptal valvuloplasty in a case of severe calcific aortic stenosis.

The retrograde catheterization and percutaneous dilatation of calcific stenotic aortic valves is not always possible in elderly patients. We report the case of a 76-year old woman admitted with severe aortic stenosis in whom it was impossible to reach the left ventricle retrogradely. This led us to attempt percutaneous aortic valvuloplasty using a transseptal anterograde approach. The Mullins transseptal sheath catheter was advanced into the left ventricle and a 7 F catheter containing a long guide wire (400 cm) passed through the sheath. The flexible end of the guide wire was advanced through the aortic valve anterogradely and an angled wireloop retriever used to catch the flexible end of the guide wire and to draw it out of the body through the left femoral artery. A 7 F balloon catheter was introduced percutaneously over the long guide wire and allowed dilatation of the interatrial septum and femoral vein. A 8 F Schneider-Grüntzig catheter (80 mm) length, 19 mm diameter when inflated) was inserted anterogradely through the aortic valve over the guide wire without difficulty and the balloon catheter was inflated to a pressure of 6 atmospheres with a 30 seconds inflation-deflation cycle. Before the procedure the mean aortic valvular gradient was 114 mmHg and the aortic valve area was 0.30 cm2. After the procedure the mean aortic gradient had fallen to 60 mm Hg and the valve area had risen to 0.90 cm2. These results are comparable to those expected using the more usual retrograde balloon dilatation of the aortic valve.

Aged↗
PubMed1987

Sipple's syndrome associated with a large prolactinoma.

A 26-year-old male presented with the symptoms and signs of acute congestive heart failure and hypertension. The left ventricle was shown to be thickened and displayed reversible hypokinesia. Further investigations revealed the underlying pathology of a phaeochromocytoma, bilateral medullary thyroid carcinoma (MTC), parathyroid adenoma and macro-prolactinoma. There was a family history of MTC. The echocardiographic features of catecholamine-induced cardiomyopathy were important in this diagnosis. Our research revealed no previous report of Sipple's syndrome associated with a macroprolactinoma. This case, along with the other 13 reports of mixed (type I and II) multiple endocrine neoplasia (MEN), are not within the classical subsets of MEN.

Adenoma↗
PubMed1987

Percutaneous mitral valvotomy in rheumatic mitral stenosis: a new approach.

Three patients with rheumatic mitral stenosis were treated with percutaneous mitral valvotomy. A Brockenbrough catheter was advanced transseptally into the left atrium and then into the left ventricle over a long guide wire. An angle wire loop retriever was advanced through a 10 Fr straight catheter via the femoral artery into the left ventricle. The retriever was used to catch the flexible end of the long guide wire. This end of the long guide wire was then drawn out of the right femoral artery by the retriever through the straight catheter. The straight catheter was left in the descending aorta; the Brockenbrough catheter was removed and a 7 Fr balloon catheter was introduced percutaneously over the long guide wire through the femoral vein. This balloon catheter was used for interatrial septal dilatation and right femoral venous dilatation. In two patients this catheter was replaced over the long guide wire with a 9 Fr Schneider-Medintag Grüntzig catheter (3 X 12 mm diameter when inflated) and in the other by a Mansfield (18 mm diameter when inflated). The procedure was well tolerated in these three patients and there were no complications. Haemodynamic function improved, there was appreciable decrease in dyspnoea, and exercise tolerance was increased. This procedure has several advantages: the balloon is more easily positioned through the mitral valve; the stability of the balloon during inflation is improved by traction at both ends of the long guide wire; and there is the option of rapidly exchanging one balloon for a larger one over the long guide wire. This technique seems to be less arrhythmogenic and results in less blood loss because manual compression of the femoral vessels after the procedure is easier.

Adult↗
PubMed1987

[Cardiac involvement in 2 cases of malignant non-Hodgkin's lymphoma. Course of cardiac involvement under chemotherapy].

In a recently published post-mortem series the incidence of cardiac lesions in malignant lymphoma was estimated at about 8.7%. These lesions rarely produce specific cardiac symptoms; they usually are late manifestations of a disease with multiple secondary lesions or are discovered at autopsy. In most patients the lesions are not limited to the heart but represent the extension to that organ of a malignant lymphoma. We observed two cases of cardiac lesions secondary to malignant non-Hodgkin lymphoma and we were able to evaluate their response to chemotherapy. In the first patient the cardiac symptoms revealed the lymphoma; in the second patient the cardiac involvement was discovered 4 years after the lymphoma was diagnosed. In both cases the cardiac lesions were detected by two-dimensional echocardiography. They presented as polypoid masses filling the right atrium and associated with periaortic thickening in the first case, and as a large heterogeneous mass including a tricuspid valve leaflet and extending to the free wall of the right ventricle in the second case. Pericardial effusion was present in the two patients. These echocardiographic findings were confirmed computerized tomography and catheterization. In the first case, followed up for one year, the echocardiographic images reverted to normality after chemotherapy. The second patient, unfortunately, did not respond to chemotherapy and deteriorated rapidly.

Aged↗
PubMed1987

[Isolated ostial stenosis: a peculiar anatomic form of coronary insufficiency in women].

We report 5 cases of isolated ostial stenosis of the left main coronary vessel. Isolated ostial stenosis occurs preferentially in young or middle aged women for whom coronary insufficiency is usually not a serious threat. Patients with this type of lesion have characteristically severe angina of relatively recent onset. The condition may be difficult to diagnose at angiography, but a fall in pressure when the tip of the catheter enters the coronary lumen beyond the stenosis, a lack of reflux of the contrast medium into the sinus of Valsalva during intracoronary injection and its persistence in the coronary vessel should alert the investigator. A pathological study of 3 cases revealed typical atheromatous lesions in 2 patients (with extension of an aortic plaque to the left coronary ostium in one, and atheroma localized on the ostium in the other) and a purely fibrous lesions in a patient who had undergone thoracic radiotherapy 5 years previously. Although relatively rare, stenosis must be diagnosed in view of its sombre spontaneous prognosis (one patient died 3 days after coronary arteriography), of the risk of underestimating its frequency, and of the hazards of selective coronary catheterization in such patients (one of our patients died 15 minutes after coronary exploration).

Adult↗
PubMed1987

[Transient Q wave in adrenergic myocarditis. Contribution of echocardiography apropos of a case].

The authors report the occurrence of a transient Q wave in a case of adrenergic myocarditis consecutive to a hypersecretory phaeochromocytoma. There was no biochemical evidence of anatomical infarction. During a hyperadrenergic clinical attack, electrocardiography displayed a pattern of incipient anteroseptal infarction with a Q wave of necrosis, while echocardiography recorded a very low and paradoxical septal contraction together with marked abnormalities of mitral valve kinetics. Under medical treatment the Q wave totally regressed within a few hours, without rise in enzyme levels. The echocardiographic abnormalities gradually disappeared over a few days. After surgical excision of the phaeochromocytoma, both electrocardiography and echocardiography were perfectly normal. In such cases the Q wave is most probably due to a direct impact of catecholamines of the myocardium, with deep but reversible alterations of cellular metabolism. The echocardiographic abnormalities reflect an acute disorder of ventricular filling responsible for delay in mitral valve opening and disappearance of the E wave. The paradoxical septal kinetics are more difficult to explain; they seem to be related to adrenergic hyperactivity.

Adrenal Gland Neoplasms↗
PubMed1987

[Pharmacokinetics and pharmacodynamic effects of digoxin in dilated cardiomyopathies. Influence of nicardipine].

Numerous studies have been devoted to the effect of slow calcium channel inhibitors on plasma digoxin concentrations. The principal drugs tested, verapamil and nifedipine, were found to increase significantly plasma digoxin levels mainly by reducing digoxin total clearance. Very few studies on the nicardipine-digoxin interaction have been reported. The dual purpose of the present study was to evaluate the influence of orally administered nicardipine on plasma digoxin concentrations over 24 hours and to measure possible variations in the pharmacodynamic effects of digoxin in 9 patients with chronic congestive heart failure. The pharmacodynamic assessment involved simple and cross-sectional echocardiography, systolic time interval measurements and cardiac catheterization. In these patients under chronic digoxin treatment, oral nicardipine had little effect on plasma digoxin concentrations which increased but not significantly; no sign of digitalis toxicity was observed. Nicardipine improved left ventricular function and myocardial contractility by reducing after-load, the nicardipine-induced peripheral vasodilatation tending to counteract the digoxin-induced vasoconstriction.

Aged↗
PubMed1986

[Heart involvement in carcinoid syndrome].

In about 50% of the cases, the carcinoid syndrome is complicated with cardiac lesions. These predominate in the right heart and consist of tricuspid and/or pulmonary valve disease, and endocarditis of the right atrium or ventricle. Two-dimensional echocardiography provides and early and accurate diagnosis of these lesions, so that surgical correction, if possible, can be performed before right cardiac failure with its high mortality rate develops.

Carcinoid Heart Disease↗
PubMed1986

[Radiation-induced cardiopathies].

Pericardial lesions are the most frequent complications of thoracic radiotherapy; they occur in 2% to 30% of the cases depending on the publications. Acute pericarditis, which is the most common form, develops early or late and usually has a favourable course. Chronic pericarditis is divided into chronic pericardial effusion, the incidence of which is underestimated as it produces few or no symptoms, and chronic constrictive pericarditis, itself divided into 2 subgroups of different prognosis depending on the presence (pure fibrous pericarditis) or absence (constrictive sero-fibrous pericarditis) of underlying myocardial lesions. The incidence of myocardial lesions ("myocarditis") varies from 4% to 13% in the literature. They have a minor clinical form characterized by arrhythmias or disorders of conduction and a major form as restrictive or congestive cardiomyopathy with or without cardiac failure. Lesions of the coronary vessels are probably underestimated in view of the results of recent necropsies. Radiation-induced vascular lesions and hyperlipidaemia seem to act synergetically in the genesis of atherosclerosis. Cardiac valve lesions are even less frequent, but here again their incidence seems to be underestimated by conventional diagnostic methods. Echocardiography, radionuclide angiography and exercise tests appear to be useful for the long-term monitoring of patients who had their chest irradiated.

Acute Disease↗