[Is hemolysis a sign of endocarditis in obstructive cardiomyopathy?].
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Aged↗
Biomedical subjects
G Habib
Publications and source records attributed to G Habib.
[Coronary disease of transplanted heart. Physiopathology, prevention].
Coronary artery disease in cardiac transplant recipients is the main cause of mortality after the first postoperative year. This atheroma has unique anatomical features with widespread infiltration of the intima by inflammatory cells. The different physiopathological hypotheses are analysed. Immunological processes are probably responsible, suggesting chronic rejection. The cytomegalovirus could be an inductive mechanism. The classical vascular risk factors probably play a role but their action is not as clear as that of immunological and viral factors. Hyperlipidaemia is a causative mechanism and the predisposing role of steroid therapy is also recognised. From the practical point of view, correction of the classical risk factors is the only available therapeutic possibility at present.
Animals↗
[Diastolic function of the left ventricle in aortic valve stenosis. Doppler echocardiography].
Doppler echocardiographic parameters of LV diastolic function (isovolumic relaxation time, E wave velocity, ratio of E/A wave velocities, mitral valve pressure half time) were compared to catheter data in 35 patients (average age 67 years) with pure or dominant aortic stenosis (mean gradient: 65 +/- 30 mmHg). The isovolumic relaxation time was prolonged in most patients (m = 103 +/- 23 ms) and seemed uninfluenced by any haemodynamic parameter. There was a positive correlation between pressure half time and ejection fraction (r = 0.41, p = 0.02) and a negative correlation with pulmonary capillary pressure (r = -0.61, p < 0.01). The E and E/A ratio were negatively correlated with the ejection fraction (r = -0.41 and -0.52) and positively correlated with pulmonary capillary pressure (r = 0.46 and 0.62). The Doppler parameters were independant of the patients' age, severity of stenosis and degree of left ventricular hypertrophy. Patients with normal pulmonary capillary pressure (< 15 mmHg, N = 19) had abnormal diastolic filling with low E wave velocities (71 +/- 28 cm/s) and E/A ratios (0.9 +/- 0.6) and prolonged half pressure times (96 +/- 37 ms). Conversely, patients with high pulmonary capillary pressures (> 15 mmHg, N = 16) had normal or high E wave velocities (107 +/- 31 cm/s) and E/A ratios (1.5 +/- 0.6) and normal or shortened isovolumic relaxation times (62 +/- 22 ms).(ABSTRACT TRUNCATED AT 250 WORDS)
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[Right intra-atrial extension of hydatid cyst mimicking cardiac thrombosis. Apropos of a case].
The authors describe an unusual case of hydatid cyst inserted in the inferior vena cava and extending into the right atrium. The transoesoesophageal echocardiographic appearances were similar to those of a thrombus: the tumour was very mobile, echogenic, polylobular with a cord-like pedicle in the inferior vena cava. The pathological examination revealed a ruptured hydatid cyst. The mass and its insertion were not visible on CT scan or cavography. Transoesophageal echocardiography would therefore seem to be a very useful diagnostic method for tumours arising in the inferior vena cava and extending into the right atrium.
Cardiomyopathies↗
[Pyogenic cervical osteomyelitis following pneumonia].
A 65-year-old man was admitted because of severe cervical pain radiating to both shoulders and bouts of fever, which followed pneumonia. Bone scan showed increased focal uptake in C6-7, while computerized tomography showed destruction of the 7th intervertebral disk, with bone sequesters and soft tissue swelling. Fine needle aspiration drew purulent material with gram-positive bacteria on direct staining. Culture grew Staphylococcus aureus, coagulase positive. Treatment with IV cloxacillin for 3 weeks, followed by oral treatment for another 3, resulted in complete remission.
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[Development of echocardiographic and Doppler parameters after orthotopic cardiac transplantation, except during rejection periods].
The aim of this study was to evaluate spontaneous changes of Doppler and echocardiographic parameters of cardiac transplants in the absence of rejection. Based on 258 recordings representing the follow up of 30 patients after orthotopic cardiac transplantation in the absence of histological signs of rejection on biopsy within 24 hours, we tried to define: the evolution of these parameters from the first postoperative week to after the 30th month (average 12 months); the Doppler echocardiographic values of "normal" transplants: the values observed one year after surgery were compared with a control group age-matched to the donors.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Changes in personality and hypertension. The "athymhormic" syndrome].
In 3 hypertensive patients, aged 57 to 66, profound behavioral and personality changes occurred rather abruptly, characterized by total loss of spontaneous activity and initiative, apathetic behavior, passivity, lack of drive and motivation, loss of interest for any of previous occupations and hobbies, and total flatness of affect. Neurological examination was normal or only showed mild extra-pyramidal signs. Neuropsychological evaluation was only remarkable for mild intellectual impairment suggestive of frontal lobe dysfunction. None of the 3 patients fulfilled criteria for dementia or severe depression. This neurobehavioral syndrome has been coined "athymhormic syndrome" (Habib & Poncet, 1988), a term emphasizing the specific defect in drive ("horme") and affect ("thumos"). Electrical and clinical heart examination was unremarkable. Blood pressure was always found within normal limits during hospitalization, including 24-hour monitoring in one case. However, all patients were known as hypertensive in the past, with repeated bouts of high blood pressure (up to 270 mmHg systolic in one case). X-ray CT-scan was usually normal or showed non-specific white matter changes (so-called "leukoaraiosis"). In all 3 cases, a brain MRI scan showed multiple small infarcts mainly involving deep subcortical structures (caudate nuclei and/or adjacent periventricular white matter) of both hemispheres, consistent with the definition of lacunes.(ABSTRACT TRUNCATED AT 250 WORDS)
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[Study of early myocardial infarction by nuclear magnetic resonance imaging with gadolinium Dota injection].
Ten patients with acute myocardial infarction were studied by magnetic resonance imaging (MRI) with injection of a paramagnetic contrast agent: Gadolinium-DOTA (Gd-DOTA). The time interval between the onset of symptoms and MRI was 8 to 12 days. The site of infarction was determined in all cases by Thallium 201 scintigraphy (hypofixation) and selective ventriculography (segmental wall anomalies): anterior (6 cases), inferior (4 cases). MRI was performed with a 0.5 Tesla CGR Magniscan by the multiple spin technique. A series of tomographic sections was recorded immediately after intravenous injection of 0.4 mmol/Kg of Gd-DOTA. Recent myocardial infarction with parenchymal oedema gives an enhanced transmural signal: only 3 patients had a sufficiently contrasted image on the 1st spin echo. After Gd-DOTA, 7 patients had significantly increased contrast on this echo and in all excellent contrast between infarcted and healthy myocardium was obtained in 9 of the 10 patients. There was excellent correlation concerning the site of infarction between Thallium scintigraphy and left ventriculography. The intensity of signal and T2 relaxation time of different myocardial segments was studied by the regions of interest technique: the ratio of signal intensity of infarcted/healthy myocardium was 1.3 before and 1.7 after Gd-DOTA on first spin echo images. The mean T2 was 54.1 +/- 9 ms in healthy and 82 +/- 28 ms in infarcted myocardium. After Gd-DOTA, both values decreased and tended to equalize.(ABSTRACT TRUNCATED AT 250 WORDS)
Diastole↗
[Comparative study of effects of diltiazem, nifedipine and their combination on exercise stable angina].
Diltiazem and Nifedipine could be synergic. The aim of this study was to investigate the benefits of their association. Eighteen patients, 15 men and 3 women, average age 61 +/- 6 years, with stable angina on effort, were studied. Eight patients had single vessel disease and 10 patients had multivessel disease. The patients underwent a randomised double-blind trial with 4 successive treatment periods each lasting one week: placebo; 360 mg/day of Diltiazem; 60 mg/day of Nifedipine; 180 mg/day of Diltiazem with 30 mg/day of Nifedipine. The benefits were evaluated clinically, by exercise stress testing and with drug plasma concentrations at the end of each sequence. The results at the end of the 3 treatment periods were significantly better than with placebo. Diltiazem was significantly better than Nifedipine with respect to the development of angina during exercise testing (1 patient compared with 7 patients) and to maximum load (118.3 +/- 33.3 watts compared with 105.9 +/- 35.4 watts) (p less than 0.05). The association of the two drugs did not give better results than Diltiazem alone. Compared with placebo, the total duration of exercise testing and the duration of 1 mm ST depression were significantly longer during the 3 treatment sequences but there were no significant differences between each of them. Secondary effects were significantly more common with Nifedipine (7 patients) and with the drug association (9 patients) than with Diltiazem alone (3 patients) or placebo (1 patient). Plasma concentrations of Diltiazem were 328 +/- 35 ng/l with the 360 mg/day dosage and 137 +/- 52 ng/l with the 180 mg/day dosage.(ABSTRACT TRUNCATED AT 250 WORDS)
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[Heart and heart-lung transplantation. 3 years' experience in Timone CHU (Marseilles 1985-1988)].
Since December 1985, we have performed 38 transplantations: cardiac (CT) n: 31, cardiopulmonary (CPT) n: 1, or bipulmonary (BPT) n: 6. There were 31 male and 7 female patients, aged 7 to 62, mean 46. In the cardiac group, the cardiomyopathy was primitive in 13, ischemic in 16, valvular in 2. Five patients had undergone one or more previous operations. Three patients had a biventricular assist device (1,6 and 7 days before transplant) for acute cardiac failure. The indication of CPT or BPT was pulmonary artery hypertension (1), silicosis (1), cystic fibrosis (4). There were 4 post-operative deaths in the CT group (12.9%); failure of graft, low cardiac output, pulmonary artery hypertension by multiple pulmonary thrombosis, and 2 deaths in the CPT and BPT groups (28%). The mean post-operative hospital stay was one month. All patients with CT were treated by an initial maintenance bitherapy protocol (cyclosporine, steroids) and observed by myocardial biopsies and echocardiograms. In 40 per cent of the patients, Azathioprine was subsequently added. The patients had 2.1 rejection episode/patient/year, either spontaneously reversed of treated medically. There were two late deaths (2 and 7 months) by refractory rejection. 78 per cent of the patients were alive one year after transplant. All survivors have recovered a normal life, some of them with full-time work.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Contribution of Doppler echocardiography to the evaluation and monitoring of normal and pathologic mitral valve prostheses].
Doppler echocardiographic examinations were performed in 146 patients with normal and 42 patients with pathological (31 regurgitations and 11 obstructions) mitral valve prostheses confirmed by catheterisation and/or surgery. The maximum and mean transprosthetic gradients and pressure half times (PHT) were calculated from continuous wave Doppler recordings and regurgitant signals were searched for by continuous and pulsed wave Doppler. In the group of normal mitral valve prostheses, the mean gradients and PHT were very variable even within the subgroups of the same type and size of prosthesis. The best haemodynamic profile was observed with the St Jude prosthesis (mean gradient = 5 +/- 2 mmHg, PHT = 90 +/- 22 ms, p less than 0.05 vs other prostheses). Minimal mitral regurgitation was detected in 12 per cent of bioprostheses and 20 per cent of mechanical prostheses. No correlations were found between the mean pressure gradient or PHT and the size of the prostheses. Regular Doppler echocardiographic follow-up over 2.4 years was obtained in 25 patients and showed a remarkable stability of the Doppler parameters in 17 patients whereas prosthetic valve dysfunction was diagnosed in the other 8 cases. In the group of pathological mitral valve prostheses, regurgitation (N = 31) was associated with a high early diastolic pressure gradient (20.2 +/- 8 mmHg) and a normal or shortened PHT (84 +/- 28 ms). Obstructed prostheses (N = 11) had high mean pressure gradients (17 +/- 5 mmHg) and increased PHT (195 +/- 53 ms). All cases of obstruction were correctly identified by the Doppler but 4 prosthetic valve regurgitations were missed or underestimated (4 mechanical prostheses).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Contribution of Doppler echocardiography in the evaluation of normal and pathologic aortic valve prosthesis].
Doppler echocardiography was performed in 112 patients with normal aortic valve prostheses and 13 patients with dysfunction (3 obstructions, 10 regurgitations) confirmed at catheterisation and/or surgery. The maximum and mean transprosthetic pressure gradients were measured in all patients by continuous wave Doppler. The prosthetic valve surface area was calculated by applying the continuity equation in the last 67 patients and compared with the effective surface area deduced from hemodynamic studies in the literature: --There was a great variability in the values of mean pressure gradient and prosthetic valve area within each group and with each size of prosthesis in patients with normal valves. No significant difference was observed between the gradients of different prostheses. However, for a given size, the St Jude Medical prosthesis had larger calculated surface areas than the other prostheses. The Doppler valve surface area did not differ significantly from the area measured invasively for the different categories of prostheses, and it increased with the size of the prosthesis. Mild aortic regurgitation was observed in 16 per cent of bioprostheses and 30 per cent of mechanical prostheses. The three cases of obstruction were characterised by a high mean pressure gradient (59 +/- 16 mmHg, p less than 0.01 vs normal prostheses) and a reduced Doppler surface area (0.7 +/- 0.2 cm2, p less than 0.005 vs normal prostheses) and were correctly diagnosed by Doppler echocardiography. Eight of the ten prosthetic regurgitations were correctly quantified by Doppler. Cardiac Doppler coupled with echocardiography is a very valuable method of non-invasive assessment of aortic valve prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Immediate delayed coronary angioplasty after intravenous thrombolysis in myocardial infarction. Prospective study].
A prospective randomized study was undertaken in 50 patients treated with intravenous thrombolysis (streptokinase, tissue plasminogen activator, association of the two thrombolytics) for acute myocardial infarction to determine the best time to perform percutaneous transluminal coronary angioplasty (PTCA). Coronary angiography was carried out 24 to 72 hours after thrombolysis. This investigation allowed identification of the patients in whom PTCA was technically feasible. These patients were then divided into two groups: Group A: early PTCA (24-72 hours) and Group B: delayed PTCA (8-10 days). During the hospital period, the patients were prescribed heparin therapy and aspirin. Recurrent ischemia (RI) was investigated and treated by PTCA. The criteria of success of strategies A and B were a primary success of PTCA and no RI during the hospital period. Coronary angiography was performed in 108 successive patients of whom 50 were included for the comparative trial, 25 in Group A and 25 in Group B. In group A, PTCA was successful in 24 cases and there were 2 incidents of RI (6 hours and 12 days). In Group B, 4 episodes of RI were observed in the 24 hours following coronary angiography: after 10 days, 15 of the 20 patients with uncomplicated courses underwent PTCA; 1 patient refused consent, 2 regressions of stenosis and 3 asymptomatic reocclusions were observed. A primary success of PTCA was obtained in 13 of the 15 patients. There was no statistically significant difference between the results of the strategies adopted in Groups A and B. A therapeutic success was obtained in 22 of the 25 patients in Group A, and 19 of the 25 patients in Group B.(ABSTRACT TRUNCATED AT 250 WORDS)
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[Complete atrioventricular block induced by carbamazepine].
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Adult↗
[Neurological disorders disclosing auricular myxoma: 3 cases].
We report 2 cases (n. 1 and 2) of cerebral infarction caused by a left atrial myxoma, and 1 case (n. 3). of dementia associated with a large left atrial myxoma. Cerebral emboli and neurological symptoms which can occur prior to cardiac obstructive and/or systemic signs require echocardiography. The cardiac post-operative condition was dramatically improved in cases revealed by an hemiplegia.
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[Double mitral valve orifice. Apropos of a case discovered by echocardiography].
The authors report a case of isolated double orifice mitral valve in a 20-year old pregnant woman. This exceptional and seldom isolated anomaly is usually discovered at autopsy or surgery. In this particular case it was diagnosed by pulsed doppler ultrasound combined with echocardiography. Data from the literature are reviewed on that occasion, and the echocardiographic images of the malformation are described. Despite its rarity, double orifice mitral valve deserves to be known and its presence should be looked for by echocardiography, notably in patients with complete or partial atrioventricular canal.
Adult↗
[Detection of acute rejection by Doppler echocardiography in orthotopic cardiac transplantation. Prospective comparative study with endomyocardial biopsy].
In a prospective study of 23 patients who had undergone orthotopic heart transplantation we tried to assess the value of doppler-echocardiography in the detection of acute graft rejection. For this purpose, 220 echocardiographic records were compared with the results of endomyocardial biopsies performed at an interval of less than 12 hours. The parameters investigated by TM and two-dimensional echocardiography were: morphological parameters (including septal echodensity), left ventricular mass and systolic function parameters. Diastolic parameters (isovolumetric relaxation time [IVR], transmitral gradient half-decrease time [T 1/2] and proto-end-diastolic mitral velocity ratio [E/A] were measured by TM echocardiography and pulsed doppler velocimetry. The best doppler-echocardiographic criteria for graft rejection were a more than 15 ms reduction of IVR, a more than 15 p. 100 increase of myocardial mass, and a more than 30 p. 100 increase of teh E/A ratio, the corresponding sensitivities for histological rejection being 82, 76 and 74 p. 100 respectively. In contrast, T 1/2 and systolic function studies seemed to be disappointing. Finally, the increase of septal echodensity enabled rejection to be diagnosed with an excellent (92 p. 100) specificity but an insufficient sensitivity. Thus, none of the parameters measured were sensitive enough, taken separetely, to replace endomyocardial biopsy. However, the combined use of the most sensitive of them should make it possible to reduce the frequency of systematic biopsies.
Acute Disease↗
[Carcinoid cardiopathy: value of ultrasonography and MRI. Apropos of a case related to bronchial tumor. Review of the literature].
A case of carcinoid cardiopathy (C.C.) of the right heart, related to liver metastases secondary to a bronchial tumor, is reported. Non-invasive investigative methods have enabled an easy diagnosis of C.C.: liver metastases by scan and abdominal sonogram, restrictive myocardiopathy with typical tricuspid lesions by echocardiography and MRI, magnitude of the tricuspid regurgitation by cardiac Doppler. These extremely performing methods must allow an early diagnosis at a stage when the patient may be still operable, since C.C. is the most frequent cause of death in patients with carcinoid tumors.
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