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Biomedical subjects

G Hanania

Publications and source records attributed to G Hanania.

At least 19 recordsLinked to original sources
PubMed1994

Pregnancy and prosthetic heart valves: a French cooperative retrospective study of 155 cases.

A French cooperative retrospective study analysed 155 pregnancies in 103 women with prosthetic heart valves: 95 mechanical prosthesis (MP) and 60 bioprostheses (BP). Among them 13 MP and 10 BP were bivalvular and four were mixed implants. In all, 182 (108 MP and 74 BP) prostheses were exposed to the risk of pregnancy. Among the 108 MP-bearing patients, 16 thromboembolic accidents (TEA) were recorded: 10 thromboses in 13 mitral, two aortic and one pulmonary MP. TEA were four times more frequent under oral anticoagulant therapy. Among the 74 BP, seven suffered premature valve failure. Ninety-nine infants were born to 50 MP-bearing women (53%) and 48 BP-bearing patients (80%) (P < 0.001). Twenty miscarriages were reported; they occurred more often under anticoagulant treatment (17%) than without it (4%) P < 0.02). Coumarin-induced embryopathies were rare (only one definitively identified). Because pregnancy with an MP under anticoagulant therapy is dangerous for the mother and may effect the fetus, the therapeutic indications for women of child-bearing age must be taken into consideration. In a women already with an MP at the time of conception, the duration of heparin therapy should be limited to the following two periods: from the 6th to the 12th week (coumarin-induced embryopathies) and during the last 2 weeks of gestation (haemorrhages during delivery and the neonatal period).

Adult↗
PubMed1994

[Complex cardiac lesion diagnosed more than 20 years after the causal injury].

Penetrating wounds of the heart, when not immediately fatal, may give rise to complex lesions associating valvular regurgitations and fistulous connections. The authors report the case of a patient with mitral and aortic regurgitation associated with an aorto-left atrial fistula of traumatic origin and causing invalidating cardiac failure. The interest of this particular case lies in the duration of the interval between the causal trauma and the appearance of symptoms (over 20 years). Complete surgical repair of the lesions provided a good functional result. The authors discuss the different types of lesions which may be caused by wounds of the heart and their modes of presentation.

Aortic Valve Insufficiency↗
PubMed1994

[Pregnancy in patients with heart valve prosthesis. A French retrospective cooperative study (155 cases)].

A French cooperative study of 155 pregnancies in 103 women with valvular prosthesis (95 mechanical, 60 bioprostheses including 27 bivalvular prostheses) is reported. Therefore, a total of 182 prostheses (108 mechanical and 74 bioprostheses) were exposed to the risk of pregnancy. The maternal outcome in the group of 108 mechanical prostheses was complicated by 16 thromboembolic events (TE) including 10 prosthetic valve thromboses which required emergency valve replacement in 4 cases, 6 systemic TE in 13 mitral, 2 aortic and 1 pulmonary mechanical prostheses. The TE were four times more frequent in patients on heparin than in those on oral anticoagulants. There were 4 deaths, 3 among the 10 prosthetic valve thromboses (one reoperation, two sudden deaths). Seven of the 74 bioprostheses were reoperated for degeneration on average 5.9 years after the initial operation but there were no deaths or TE. The outcome of pregnancy was 99 children (63%), 49 of which were born to mothers with mechanical prostheses (53%) and 50 to mothers with bioprostheses (80%) (p < 0.001). Seven of the children were born prematurely, all mothers being on anticoagulant therapy. The birth weight was over 400 grams heavier (3 kg versus 2.6 kg) in the bioprosthesis group (p < 0.05). The 20 spontaneous abortions (13%) were more common in patients on anticoagulants (17%) than in those without (2%) (p < 0.02). Congenital defects due to oral anticoagulants were rare (one certain case). There was one case of phocomelia, an abnormality which has never been described in this context. The 36 remaining pregnancies were still deaths (N = 5), abortion due to maternal death (N = 4), maternal complications (N = 8), therapeutic (N = 9) or voluntary abortions (N = 10) (28 mechanical and 8 bioprostheses).(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗
PubMed1994

[Pregnancy in patients with heart valve prosthesis. Retrospective study apropos of 40 pregnancies].

In order to be able to offer pregnant artificial heart valve patients a practical management approach enabling reduction of maternal and fetal risks, the authors evaluated 40 pregnancies in 24 women. Thirty one valves had been inserted prior to these pregnancies: 24 mechanical valves and 7 biological valves. Different types of anticoagulation regimens were used in 32 pregnancies, while 8 took place without the use of anticoagulants (biological valves in sinus rhythm). From a clinical standpoint, almost all these pregnancies brought to term took place without cardiac decompensation. They resulted in the birth of 26 live infants, including one premature. One child was born at term with a phocomelia-type malformation and two were stillborn. There were five therapeutic abortions and six spontaneous abortions. There were four cases of thromboses of the artificial valve, three of which occurred in patients on heparin (dose of 5,000 IU/12 h). Three massive thromboses required emergency valve replacement surgery. There were also three embolic accidents, including one which regressed totally in a few hours. Two hemorrhagic complications occurred with subcutaneous heparin during the post-partum period. In practice, we feel that: when a young woman wishing to become pregnant requires valve replacement, a biological device is preferable; oral anticoagulants are contra-indicated during the first three months of pregnancy; the dose of 5,000 IU/12 h of heparin is insufficient to prevent thrombo-embolic accidents; when a mechanical valve is already implanted, the sequential treatment protocol of subcutaneous heparin--oral anticoagulant--subcutaneous heparin, with an initial dose of heparin of 5,000 IU/12 h then adjusted on the basis of APTT, is the best choice.

Adult↗
PubMed1993

[Prosthetic valve endocarditis: current problems].

Prosthetic valve endocarditis is a rare complication of valve replacement surgery but carries a grim prognosis. The physiopathology of this condition allows identification of two clinically distinct forms based on their bacteriological profiles and outcome: early endocarditis, diagnosed in the first year following valve replacement is observed in 0.7 to 3% of cases: staphylococci are the predominant organism as contamination usually occurs at operation. The prognosis is poor due to the high incidence of complications and the mortality rate is about 60 to 70%; late endocarditis: diagnosed after the second year, it is observed in 0.5 to 1% of cases per year. Contamination is due to bacteraemia and the commonest organisms are the streptococci. The mortality rate is over 20%. The diagnosis is particularly difficult in chronic forms and those with negative blood cultures. Cardiac imaging in prosthetic valve endocarditis is mainly dependent on Doppler echocardiography especially using the transoesophageal approach which allows evaluation of lesion such as abscesses, vegetations and perivalvular leaks, and enables planning of treatment. Management is medico-surgical. Apart from symptomatic treatment of complications, antibiotic therapy using synergistic drugs at bactericidal dosages intravenously is essential as soon as bacteriological specimens have been sent for culture. Surgery is essential in early forms but may be avoided in uncomplicated late forms. The timing of surgery (the objectives of which are to excise the infected material, to repair destructive lesions and to implant a new valve) is a decisive factor in reducing the morbidity and mortality of this condition. Prophylactic measures have a particularly important role to play: they are based on pre- per- and postoperative guide lines.

Echocardiography, Transesophageal↗
PubMed1992

[Mycotic aneurysm of the carotid artery secondary to acute bacterial endocarditis].

Mycotic aneurysms of the extracranial carotid arteries are rare. A new case of mycotic aneurysm of the bifurcation of the carotid artery secondary to acute bacterial endocarditis affecting the aortic valve is reported. Simultaneous treatment of the two lesions was instituted. The twenty six cases of mycotic aneurysm of the extracranial carotid arteries previously described in the literature are reviewed by the authors.

Aneurysm, Infected↗
PubMed1992

[Cardiology in general hospitals. A cooperative survey on medical teams, technical means and activity].

A national enquiry carried out in 1990 in the departments of cardiology of general and private non-profit making hospitals established the status of these departments and the evolution of their personnel and equipment since their creation. The enquiry involved two thirds of the cardiology departments of the general hospitals (119/180) and showed that most (66%) were established between 1974 and 1988. Implanted in fairly important cities with catchment areas of 100,000 to 400,000 people, they have an average of 32 beds (range 11 to 100) and 7.25 coronary care beds (range 4 to 19); 347 doctors work full (211) or part time (136) in these departments. These two types of work are allowed in the majority of these units (64/119). Specialist certified cardiologists practice in 62 departments (56%). The usual technical equipment is available in 80% of the units (Doppler echocardiography, exercise stress testing, Holter monitoring, right heart catheterisation). Permanent pacing is performed in 65% of these hospitals, more so in the provinces than in the Paris region. Coronary angiography is only available in 21%, radioisotopic investigations in 15% and coronary angioplasty in 12% of these centres. A prospective study performed in 1990 concerning 110 hospitals recruited 1,030 myocardial infarctions, which enabled the total number of infarcts hospitalised in the coronary care units of the general hospitals to be estimated at about 21,000 (60% of French myocardial infarctions).

Angioplasty↗
PubMed1992

[Early postoperative thrombolysis of Saint-Jude aortic valve prosthesis].

The authors report a case of thrombolytic therapy with streptokinase in the early postoperative period after aortic valve replacement with a Saint Jude medical prosthesis. After good initial progress, the patient had to be reoperated on the 12th postoperative day for sternal disunion. Reoperation was followed rapidly by progressive thrombosis of the aortic prosthesis demonstrated by repeated Doppler echocardiographic examination. The impossibility of eliminating mediastinitis led to medical thrombolysis. The outcome was favourable after a regressive cerebral embolic event. This case illustrates the value of Doppler echocardiographic examination in the postoperative period. Thrombolysis may constitute an alternative to reoperation when the operative risk is high. The risk of thrombolysis may not be as great as some believe.

Echocardiography, Doppler↗
PubMed1991

[Dystrophic aortic insufficiency: influence of dilatation of the ascending aorta on secondary outcome].

This cooperative study recensed 89 cases of patients operated for aortic regurgitation in whom the dystrophic process was confirmed on anatomical (thin, translucent valves without symphysis, multilation or sclerosis) and histological criteria (mucinous infiltration). They included 81 men (91%) and the average age was 52 +/- 14 years. The valvular degeneration was part of a generalised dystrophy of elastic tissue in 8 patients (6 "formes frustes" of Marfan's syndrome, 2 Lobstein's syndrome). The patients were divided into 2 groups according to the diameter of the ascending aorta measured by echocardiography and/or aortography. In Group 1 (n = 40), the aorta was not dilated (diameter less than 40 mm) whereas in Group 2 (n = 49), the diameter of the ascending aorta was dilated (40-55 mm) but not aneurysmal (loss of parallelism of the aortic walls). The two groups were comparable before surgery with respect to age, sex, functional class, degree of left ventricular dilatation, left ventricular ejection fraction and presence of associated coronary disease). There were no differences in the operative parameters but aortic parietal biopsy (n = 35) revealed clear signs of cystic medianecrosis more often in Group 2 than in Group 1 (14/25 versus 1/10, p less than 0.05). No operative procedure was performed on the ascending aorta during aortic valve replacement. One operative death occurred in each group. After an average follow-up of 4 years, there was a higher mortality in Group 2: the actuarial 7 year survival rate being 74% in Group 1 and 54% in Group 2. This was explained by a higher incidence of ascending aortic complications. Only 1 patient in Group 1 developed an aneurysm of the ascending aorta requiring reoperation compared to 14 patients in Group 2, 8 of whom were reoperated (p less than 0.01). These results suggest that non-aneurysmal dilatation of the ascending aorta in patients with dystrophic aortic regurgitation is a poor prognostic factor because of the high incidence of secondary aortic parietal complications (aneurysm, dissection).

Actuarial Analysis↗
PubMed1990

[Delays in hospital admissions of myocardial infarction].

Analysis of the delays in hospital admission to the coronary care unit of 100 patients with recent myocardial infarctions showed an average delay time of 9 hr 50 with early hospital admission within 4 hours in 38% of cases. The number of early hospital admissions increased to: 51% when the infarct was preceded by unstable angina (35 cases, p less than 0.05); 65% when the patient himself diagnosed a coronary thrombosis (34 cases, p less than 0.001); 72% when the intermediary was a specialised emergency medical service called directly by the patient (11 cases, p less than 0.01). These results confirm the necessity of improving public education and of increasing direct access to emergency cardiovascular ambulance services.

Adult↗
PubMed1989

[Infective endocarditis of a valve prosthesis. Multicenter study (179 cases)].

Over a 5-year period (1982-1986) 176 cases of infective endocarditis on prosthesis (IEP) were recorded in 40 cardiology departments. 65 p. 100 of the patients were male, and the mean age of the population was 51 years. Mechanical prostheses were involved in 57 p. 100 of the cases and bioprosthesis in 43 p. 100. There was a high proportion of initial indications for bacterial endocarditis (18 p. 100) and for reoperation on prosthesis (10 p. 100). IEP developed early in 40 cases and late in 139 cases; 19 (48 p. 100) of the early IEPs were staphylococcal, while 31 p. 100 of late IEPs were streptococcal (p less than 0.01). 143 patients were reoperated upon within less than 1 month in 41 p. 100 of the cases, with a pre-operative antibiotic therapy of less than 10 days in 39 p. 100. Reoperation was performed in stage IV or as an emergency in 45 p. 100 of the cases. Abscesses were three times more frequent with aortic prostheses than with mitral prostheses (58 p. 100 vs 20 p. 100, p less than 0.001). Vegetations were more frequent on mechanical prostheses than on bioprostheses (43 p. 100 vs 31 p. 100, NS). The operative mortality rate was 25 p. 100; the mortality rate of unoperated patients was even higher (31 p. 100). The survival rate in operated IEP was 51 p. 100 at 30 months, as against 46 p. 100 at 12 months in unoperated IEP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Echocardiographic-Doppler study of a case of subacute and incomplete parietal rupture after myocardial infarction].

The authors report the case of a 55 year old man who suffered a silent, laterobasal myocardial infarction which was complicated by a subacute pseudo-false aneurysm of the lateral wall of the left ventricle. They underline: The importance of two-dimensional echocardiography in the diagnosis of a neo-para left ventricular cavity showing systolic expansion and communicating with the left ventricle by a narrow neck indicating rupture of the free ventricular wall; The value of two-dimensional color coded Doppler which enables the operator to distinguish the active nature of the neo-left ventricular cavity before surgery and its inactivity after surgery. The surgical indication for emergency resection of the pseudo aneurysm was based on these preoperative non-invasive observations. This case confirms the value of cardiac two-dimensional echo-Doppler studies in the investigation of ischaemic heart disease.

Aged↗
PubMed1986

[Surgery of acquired heart valve diseases in France: developments in a 10-year period. A multicentric study].

A multicenter study compares the surgery of acquired valvular diseases in France in 1974 and 1984. This study concerns etiology, surgical procedures and postoperative results within 3 months after operation. 2718 observations issued from 20 medical and surgical centers are divided in 2 groups: the first includes 856 patients who underwent surgical operation in 1974, the other group with 1862 patients was operated on in 1984. Significant differences may be observed. The mean age is higher in 1984 (55 vs. 47 years); the rheumatismal etiology decreases from 50.2% in 1974 to 35.1% in 1984; the degenerative and dystrophic causes increase from 13.8% in 1974 to 32.9% in 1984; while the monovalvular mitral lesion is more frequent (42%) than the aortic one (32.7%) in 1974, the proportion is reversed in 1984 where 47% aortic and 34.5% mitral lesions are found; the number of surgical treatments of mitral stenoses in 1984 is half of those in 1974, but the number of surgically treated aortic stenoses and mitral regurgitations is double of those in 1974; the preoperative examination includes left-side heart catheterization in 81.1% and coronary angiography in 64% of surgically treated patients en 1984, the respective percentages en 1974 being 57.8% and 16.1%. In 1974, 27.6% of patients are in a preoperative functional stage I or II, in contrast to 42.8% in 1984. Mitral commissurotomy represents 29.3% of mitral surgery in 1974 (25.6% of them with closed operation), the respective percentage in 1984 being only 10.5% (2.5% of them with closed heart operation).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Aneurysms of sinus of Valsalva: two-dimensional echocardiographic diagnosis and recognition of rupture into the right heart cavities.

The aim of this study was to evaluate the role of echocardiography in the diagnosis of sinus of Valsalva aneurysms projecting toward the right heart cavities. Three patients who had a ruptured aneurysm of a sinus of Valsalva diagnosed by echocardiography and confirmed by catheterization underwent cardiac surgery. In two patients, the aneurysm originated from the right coronary sinus and had perforated into either the inflow or outflow tract of the right ventricle. In the third patient, the aneurysm, which originated from the noncoronary sinus, ruptured into the atrium. A fourth patient was also investigated and had an unruptured aneurysm of the right coronary sinus projecting into the right ventricular outflow tract. M-mode, two-dimensional and contrast echocardiographic studies were performed before cardiac catheterization in all patients and after surgery in three patients. M-mode echocardiography was useful only when the aneurysm had an anterior projection, whether or not the aneurysm was ruptured. Conversely, two-dimensional echocardiography was always able to identify the aneurysmal sac which appeared as an abnormal circular thin-walled structure protruding into the right heart cavities. By using multiple views, it was possible to investigate the whole abnormal structure and locate the sinus from which the aneurysm originated. The use of the echo contrast technique allowed more precise definition of the aneurysmal sac and diagnosis of a left to right shunt by demonstrating a negative contrast image in the right cavities. On the other hand, no negative contrast image was recorded in the patient with an unruptured aneurysm or in the two instances of a successful surgically reconstructed aorta.

Adult↗
PubMed1982

[Nodoventricular Mahaim fibres. 2 cases confirmed by electrophysiological study].

Two adolescents with no obvious cardiac were investigated for paroxysmal tachycardia at a rate of about 200/mn with wide QRS complexes showing left bundle branch block, reduced by vagal manoeuvres. Atrial pacing showed shortening of the HV interval associated with widening of the QRS complex to appearances identical to those of the tachycardia, suggesting right ventricular preexcitation masked in sinus rhythm. The progressive prolongation of the atrio-ventricular conduction time with increasing prematurity of the extrastimulus and atrioventricular block after intravenous injection of ATP were more in favour of right nodo-ventricular Mahaim fibres (NV) than a Kent bundle. These properties of the NV pathway and the recording of a "gap" phenomenon during the measurement of the refractory period of the accessory pathway are explained by the proximal part of the AV node not being short-circuited. Paroxysmal tachycardia was easily induced by atrial and ventricular stimulation; the tachycardia QRS complexes always showed appearances of left bundle branch block with a His potential at the onset of the ventricular complex. The NV pathway therefore always depolarised in the anterograde direction in tachycardia; the retrograde pathway is discussed: His, latent Kent bundle or purely intranodal reentry.

Adolescent↗