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Biomedical subjects

J C Jouven

Publications and source records attributed to J C Jouven.

At least 19 recordsLinked to original sources
PubMed1994

[Spontaneous dissection of the common trunk and principal branches of the left coronary arterial system. Apropos of a case].

The authors report the case of a 45 year old woman presenting with inaugural anterior myocardial infarction due to spontaneous dissection of the left main and principal branches of the left coronary arterial system. Two attempts of thrombolysis at a one hour interval were made within 6 hours of the onset of symptoms with signs of reperfusion but the ECG and echocardiography showed anterolateral myocardial infarction. A recurrence of chest pain on the fifth day led to emergency coronary angiography. The extent and severity of the observed lesions led to emergency surgical revascularisation with no post-operative complications. Skin biopsy showed signs of dystrophy of the elastic tissues. Angiographic control ten months after surgery showed complete regression of the lesions, especially those of the left main coronary with, however, occlusion of the second segment of the left anterior descending artery and sequellae of anterior myocardial infarction. Treatment of this type of disease is difficult as the outcome is unpredictable and has to be decided case by case.

Aortic Dissection↗
PubMed1987

[Cardiac rhabdomyoma in the adult. Echocardiographic diagnosis and successful surgical treatment].

Cardiac rhabdomyoma is a rare tumour (190 cases in the literature). Since the first operation, in 1959, the tumour has been removed in about 30 patients. Our case is the first cardiac rhabdomyoma diagnosed in live adults. The patient was a 59-year old woman without any significant history. Echocardiography showed a single tumour in the right atrium. A tentative diagnosis of myxoma was made and the patient was operated upon. At pathology, the tumour turned out to be a rhabdomyoma. After a 2.5-year follow-up period, the patient remains asymptomatic. Cardiac rhabdomyoma almost exclusively occurs in children. Only six adult cases have been published, all diagnosed at autopsy. Cardiac symptoms are either those of a valve disease or arrhythmias. Treatment is surgical for single tumours. Multiple rhabdomyomas are associated with Bourneville's disease (tuberous sclerosis) in 50 p. 100 of the cases, which entails a sombre prognosis. In our patient, the presence of a single tumour at the age of 59 without any sign of tuberous sclerosis and the fact that the tumour could be entirely removed were factors of favourable prognosis.

Echocardiography↗
PubMed1984

[Parietal rupture of the heart in the acute phase of a postero-inferior myocardial infarction. Echocardiographic diagnosis, surgical cure].

A 58 year old patient with no previous cardiac history developed a postero-inferior myocardial infarction, complicated at the 6th hour by parietal rupture leading to acute tamponade. This was diagnosed by echocardiography which showed a compressive pericardial effusion containing large thrombi. Surgery under cardiopulmonary bypass was successful and led to good quality survival, maintained for over 6 months. A recent angiocardiographic control showed the absence of coronary artery lesions. This case is exceptionally rare and demonstrates the value of echocardiography in myocardial infarction complicated by sudden cardiovascular collapse. In addition, in this case, the haemorrhagic nature of the pericardial effusion was demonstrated by the visualization of thrombi in the pericardial space. Their presence would seem to be quite specific of parietal rupture.

Angiocardiography↗
PubMed1983

[Resistant ventricular tachycardia caused by right ventricular dysplasia. A case of surgical recovery reported 6 years after intervention].

A 52 year old patient with no previous medical history had an attack of ventricular tachycardia, the configuration of which showed left sided delay. Electrical reduction was followed by multiple recurrences. There were ST-T wave changes over the right precordium on the basal ECG. The hydro-electrolytic equilibrium was normal. Coronary angiography and selective left ventricular cineangiography were also normal. Right angiocardiography showed an aneurysmal deformation of the pulmonary infundibulum. The recurrence of attacks over a two year period led to several hospital admissions, demonstrating the failure of antiarrhytmic therapy. The attacks became so frequent in the last three months that surgery was undertaken. Epicardial mapping showed delayed potentials over the pulmonary infundibulum and surgery consisted in resection of the abnormal infundibular zone. The macro- and microscopic pathological findings were of wall thinning and muscular degeneration with fibrosis and fatty infiltration. The authors discuss the relationship between right ventricular dysplasia and a localised form of Uhl's anomaly. Six years after surgery the patient has had no recurrence of the arrhythmia or shown signs of cardiac failure in the absence of any drug therapy.

Cardiomyopathies↗
PubMed1983

[Hemopericardium after coronary recanalization with streptokinase in the acute phase of myocardial infarction. Drainage and early aortocoronary bypass on the 4th day].

A case of hemopericardium after coronary recanalisation with streptokinase during the acute phase of myocardial infarction is reported, emphasising the value of routine daily echocardiography in all cases of intracoronary thrombolysis. The patient was a 48 year old man with a primary antero-lateral infarct in whom coronary angiography was performed at the 4th hour, showing total proximal obstruction of the left anterior descending artery. The streptokinase protocol of intracoronary thrombolysis was performed, resulting in recanalisation of the left anterior descending artery at the 30th minute. Improved left ventricular function and persistance of coronary patency were confirmed 14 hours after recanalisation. In the following days the patient showed signs of right ventricular failure with successive echocardiogrammes demonstrating an increasing pericardial effusion. On the 4th day, 600 ml of blood were drained surgically and aorto-coronary bypass carried out on the left anterior descending artery. This procedure maintained coronary patency and the improvement in left ventricular function. Several studies have shown that the hemorrhage of reperfusion only occurs in the zones of necrosis, and thrombolytics, especially streptokinase, may aggravate this condition.

Coronary Artery Bypass↗
PubMed1983

[Relations between the site of significant monotruncular coronary stenosis and left ventricular function. Therapeutic implications].

The indications of coronary bypass surgery in single vessel disease remain controversial. Therefore, we carried out a retrospective study of the coronary angiogrammes and left ventriculography of 93 patients with single vessel disease (greater than 70 p. 100 stenosis) involving the left anterior descending (LAD) or dominant right coronary arteries (RCA) to evaluate the quantity of myocardium at risk. Five angio-hemodynamic parameters were compared: the ejection fraction (EF), the ratio of end systolic left ventricular pressure to volume (LVESP/LVESV), the velocity of circumferential fibre shortening (VCF), end diastolic volume (EDV) and end systolic volume (ESV). Six subgroups were defined: 28 proximal LAD stenosis (16 without and 12 with myocardial infarction (MI], 37 mid LAD stenosis (20 without and 17 with MI), and 28 RCA stenosis (8 without and 20 with MI). In all, there were 44 single vessel stenoses without MI and 49 with previous necrosis. Left ventricular function was normal in the absence of MI but deteriorated progressively in cases with MI and LAD disease. In cases of proximal LAD stenosis without and with MI, the hemodynamics showed: EF (p. 100) = 67,12 +/- 2,07 leads to 43,83 +/- 4,7 (p less than 0,001); LVESP/LVESV = 3,24 +/- 0,34 leads to 1,92 +/- 0,50 (p less than 0,05); VCF (s-1) = 1,28 +/- 0,05 leads to 0,74 +/- 0,06 (p less than 0,001); in cases of mid LAD stenosis without and with MI: EF = 69,1 +/- 2,08 leads to 45,11 +/- 3,42 (p less than 0,001); LVESP/LVESV = 3,64 +/- 0,39 leads to 1,46 +/- 0,12 (p less than 0,001); VCF = 1,32 +/- 0,008 leads to 0,74 +/- 0,06 (p less than 0,001). In contrast the change in LV function was minimal in patients with necrosis and RCA stenosis: EF = 70,37 +/- 3,85 leads to 56,4 +/- 3,19 (p less than 0,05); LVESP/LVESV = 5,20 +/- 1,83 leads to 2,56 +/- 0,36 (p less than 0,05); VCF less than 1,42 +/- 0,17 leads to 1,03 +/- 0,08 (p less than 0,05).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1982

[Caval extension of renal cancer. Surgical problems].

The authors report on a case of renal neoplasm with associated thrombosis of the vena cava extending to the right auricle. The authors undertook, right away, by way of a median sternotomy and under extracorporeal circulation, the ablation of the intra-cardiac thrombus, and also the removal of the remainder of thrombus in the inferior vena cava. This having been achieved without complications, they performed excision of the right kidney as well as a cavectomy, thus effecting ablation of the tumour while preserving the venous drainage above the liver and the left renal vein. A review of the literature confirms that exeresis of this type of tumour is logical in the absence of metastasis or lymphatic invasion. They stress, above all, the importance of firstly effecting exeresis of the intra-cardiac thrombus under the facility of extracorporeal circulation. This ensures the least risk to the patient, for surgery of this kind.

Adenocarcinoma↗
PubMed1980

[Subclavian route placement of electrodes for permanent stimulation].

The subclavian vein gives a rapid, direct approach to the right heart cavities. The pacing catheter was introduced via the subclavian vein in a series of 187 patients. A no. 9 Desilets and Hoffman percutaneous catheter introducer may be used with most types of pacing catheter, including bipolar models. Complications were rare : one case of pneumothorax was observed. The subclavian vein approach simplified the operative procedure of implantation and offers a useful alternative in difficult cases of reimplantation.

Female↗
PubMed1980

[Sinus node dysfunction. Clinical outcome and results of cardiac pacing].

112 patients (average age 66 +/- 13 years) with sinus node dysfunction, selected on clinical, electrocardiographic and electrophysiological criteria, were followed up for a period of 3 to 55 months (average: 30,2 months). Permanent cardiac pacing was instituted in 59 patients (52,6 p. 100), and the remaining patients treated medically. 25 patients were lost to follow up (22,3 p. 100: 5 paced, 20 non paced). 16 patients died (14,2 p. 100): mortality was relatively early (average 11,7 months) and higher in patients with pacemakers (15/16); the causes of death were acute heart failure (8 cases), and cerebral vascular accident (3 cases). In the surviving paced patients neurological symptoms completely regressed. In this series, the life expectancy of patients with sinus node dysfunction seemed to depend mainly on the state of their myocardium, but the functional prognosis was clearly improved by cardiac pacing.

Adolescent↗
PubMed1979

[Use of dopamine in sequelae of extracorporeal circulation. Apropos of 50 patients].

Dopamine was used after open heart surgery in a group of 50 patients. The therapeutic indications were: diffuse coronary insufficiency in 27 cases, myocardial infarction in 12 cases and early septicaemic shock in 6 cases. In the other 5 cases, dopamine was prescribed for short lasting circulatory insufficiency. The dosage varied between 3-15 gammas/kg/min. The variations of different parameters were studied over 12 hours. Improvement of cardiac efficiency was an early feature (less than 3 h) and was observed for all dosages (above 3 gammas/kg/min). It was accompanied by a marked diuresis. The chromotropic effects were non-existent at these dosages. At medium-term dopamine was effective in 40 patients (80 p. 100). Dopamine is effective in over 3 out of 4 cases after cardiopulmonary bypass. Its effect is immediate, and is observed in dosages less than 10 gammas/kg/min.

Adult↗