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Biomedical subjects

J Losay

Publications and source records attributed to J Losay.

At least 73 records · Page 4Linked to original sources
PubMed1990

Hypoplastic transverse arch and coarctation in neonates. Surgical reconstruction of the aortic arch: a study of sixty-six patients.

From Jan. 1, 1983, to Jan. 1, 1988, 66 consecutive neonates with coarctation and severe hypoplasia of the transverse arch underwent coarctation repair by resection of the coarctation and reconstruction of the aortic arch. Mean age at operation was 14 +/- 8 days, ranging from 2 to 30 days; 63% of the newborn infants were less than 2 weeks of age. The coarctation was isolated in 23%, associated with a ventricular septal defect in 39%, and associated with complex anomalies in 38%, including 16 cases of transposition of the great arteries or doublet-outlet right ventricle plus ventricular septal defect, two cases of simple transposition, two of corrected transposition plus ventricular septal defect, and five cases of "hypoplastic" left ventricle. The surgical technique comprises a wide resection of the coarctation extended to the contiguous ductal tissue followed by the reconstruction of the aortic arch in bringing the descending aorta into the concavity of the aortic arch. This technique is able to relieve the obstruction of the aortic arch provided that (1) the descending aorta is widely dissected to allow mobilization and (2) the incision of the transverse arch is extended proximal to the ostium of the left carotid artery. The operation was performed through a left thoracotomy in 62 patients and through a sternotomy in four additional neonates with transposition and ventricular septal defect who underwent a one-stage repair with aortic reconstruction, closure of the defect, and arterial switch. The overall early mortality rate (less than 30 days) was 14% (9/66; 95% confidence limits = 5% to 22%), including four deaths occurring within the first month, at a concomitant or subsequent repair of the associated anomaly. There were six late deaths, all related to the associated lesions. The overall mortality rate was 23% (15/66; 95% confidence limits = 13% to 33%). The mean follow-up was 21 +/- 10 months, ranging from 6 to 66 months. Actuarial survival rates at 5 years are 72% +/- 10% for the overall group; 87% +/- 17% for simple coarctation; 88% +/- 12% for coarctation and ventricular septal defect; and 52% +/- 18% for complex coarctation. The rate of recurrent coarctation was 12.5% (95% confidence limits = 2% to 23%), leading to five reoperations with no deaths. Freedom from reoperation was 89.5% +/- 9% at 5 years. This technique of coarctation repair offers several advantages: low operative mortality, complete relief of the left ventricular obstruction, wide resection of the ductus tissue, absence of prosthetic material, and preservation of the left subclavian artery.

Aorta, Thoracic↗
PubMed1989

[Middle-term result of surgery in 78 cases of complete atrioventricular canal before one year of age].

Between 1970 and 1985, 78 children with complete atrioventricular canal were operated upon before the age of one year at the Marie-Lannelongue Surgical Centre. Forty-seven survivors were followed up for periods of 3 months to 13 years after the initial operation; 2 were lost of following. Among the 13 children who survived banding, 1 died spontaneously, 1 had Blalock-Taussig anastomosis and 11 underwent full repair with 5 deaths; out of 6 survivors, 4 are doing well without any treatment, 1 was reoperated upon twice and died during the second operation, and 1 was lost sight of; the survival rates at 5 and 10 years are 46 +/- 23 p. 100 and 29 +/- 23 p. 100 respectively. Among the 34 children who survived an initial complete repair, 2 were reoperated upon 3 months after the repair, with 1 death, 7 subsequently died of infection (6 had trisomy 21); out of 26 survivors followed up for 3 years and 3 months on average after the complete repair (2 to 13 years), 18 show an excellent result and 3 a mediocre result; the survival rates at 5 and 10 years are 45 +/- 9 p. 100 and 30 +/- 27 p. 100 respectively. Whether the patients initially had banding followed by complete repair or complete repair from the start, the probability of survival at 5 and 10 years was the same. The presence of trisomy 21 is an unfavourable prognostic factor at medium-term.(ABSTRACT TRUNCATED AT 250 WORDS)

Down Syndrome↗
PubMed1987

[Endoluminal mitral valvuloplasty in young adults and children. Apropos of 10 cases].

Between April 1 and May 15, 1986, transluminal dilatation of the mitral valve was performed at the Marie-Lannelongue Hospital, near Paris, in 10 patients aged from 12 to 48 years (mean 25,3 years) suffering from rheumatic mitral stenosis with supple valve leaflets. The procedure, carried out under local anaesthesia, included trans-septal catheterization followed by installation of one, then usually two balloons opposite the mitral orifice. The total diameter of the balloons was often greater than that of the mitral annulus. No haemorrhage, embolism or arrhythmia was observed. A significant left-to-right shunt, evaluated by radioisotope exploration with technetium pyrophosphate performed on the 8th day, was present in only one patient. The LV-LA end-diastolic gradient fell from 14.4 +/- 9.8 to 4.6 +/- 3.4 mmHg (p less than 0.01). The mean pulmonary arterial pressure was reduced less significantly from 39.9 +/- 18.4 to 27.2 +/- 11.3 mmHg (p less than 0.02). The cardiac output was only moderately increased from 2.52 +/- 0.48 to 2.88 +/- 0.66 l/min/m2. The mitral valve area, measured from the smaller axis on 2-dimensional echocardiography, more than doubled, reaching a mean value of 1.99 +/- 0.56 cm2. This figure was confirmed by the reduction, at Doppler velocimetry, of the gradient half-regression time from 267 +/- 62 to 118 +/- 46 ms (p less than 0.01). Similarly, the end-systolic gradient evaluated by Doppler, fell from 17.5 +/- 8.9 to 5.3 +/- 4.7 mmHg (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Long-term course after palliative surgery in children with a single ventricle].

Single ventricle or univentricular heart is a rare congenital malformation (1/10 000) which has a very poor prognosis. The cases of 68 children with single ventricles who had palliative surgery between January 1964 and December 1982 were studied. The average age of the patients at surgery was 4.41 +/- 5.8 years; 36% of the children were under 1 year of age. Surgery consisted in 48 systemico-pulmonary anastomoses and 20 pulmonary artery bandings. The global mortality was 22% (16% in the anastomosis group and 35% in the banding group). Age seemed to be an important factor: 25% mortality in children under the age of 1; 2.4% in children over 1 year (p less than 0.05). The 15 year survival rate was 43 +/- 23% overall; 56 +/- 28% in children with anastomoses and 20 +/- 28% at 8 years in children with banding. Although surgery did not appear to improve survival it probably did improve survival it probably did improve the quality of life; 73% of the survivors has satisfactory functional results and the efforts of everyday life were well tolerated. However, the evolution was complicated in 10% of cases by infection and neurological complications, and atrioventricular regurgitation was observed in 7 patients, requiring valve replacement in 2 cases. Our results are globally comparable with those of similar previously reported studies. The best published results of physiological correction of single ventricle (Fontan, septation) are relatively unsatisfactory with a mortality rate of about 35%. Therefore, palliative surgery still appears justified in these cases.

Aorta↗
PubMed1986

[Rheumatic mitral stenosis. The medical solution].

The first case of balloon catheter valvular dilatation for rheumatic mitral stenosis is reported in a 13 year-old child. The technique, under local anesthesia, required a transseptal access, then the introduction of one, then simultaneously 2 balloon catheters through the mitral valve. A perfect opening of the valve, without mitral insufficiency was obtained. This technique, even if difficult, seems to be adaptable to most children with rheumatic mitral stenosis.

Adolescent↗
PubMed1986

[Surgical treatment of complete atrioventricular canals, regular and irregular forms, in 75 patients].

The cases of 75 consecutive patients operated for complete atrioventricular canal between 1/1/1978 and 1/1/1985 at Marie-Lannelongue Hospital were reviewed. The age ranged from 1.5 months to 16 years. Forty-nine per cent of patients were operated in the first year of life in the period 1982-1984. Seventy-eight per cent of patients were operated before one year of age. Certain anatomical characteristics enable regular and irregular forms of the condition to be distinguished. Regular forms are characterised by the association of a defect of the inter atrio-ventricular septum, of a common atrioventricular orifice and of ventricles of equal volume without other associated malformations. Irregular forms include the parachute mitral valve, the double mitral orifice, deficient mitral valvular tissue, ventricular hypoplasia, subaortic stenosis, abnormal right ventricular muscular bands, associated cardiac malformations and pulmonary obstructive vascular disease. Surgery comprises repair of the ventricular septal defect and the ostium primum with two separate patches, respecting the anterior and posterior valves and partial or complete closure of the cleft valve. The hospital mortality rate was 33 p. cent. It was 16 p. cent in regular forms and 58 p. cent in irregular forms (p less than 0.01). The hospital mortality of patients operated before 1 year of age with the regular form of the malformation was 22 p. cent. Six children were reoperated secondarily with 2 deaths. Four pacemakers were implanted for complete atrioventricular block. The secondary mortality was 10 p. cent. Thirty-nine patients were followed up for an average of 28 months (range 3 months to 5.5 years).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Hemodynamic development of the auricular communication of the ostium secundum and sinus venosus type. Study of 1189 patients].

The haemodynamic data of 1,189 subjects with an atrial septal defect catheterised between 1953 and 1983 at the Marie Lannelongue Surgical Center and at Broussais Hospital was reviewed. Sixty per cent were under 20 years of age and 40 per cent were 21 to 75 years of age. The defect was an ostium secundum type in 89 per cent and sinus venosus in 11 per cent of patients. The commonest associated cardiac malformation was a partial anomalous pulmonary venous drainage which was present in 125 patients. Systolic and mean pulmonary arterial pressures decreased from a value slightly higher than normal between birth and 5 years of age to normal values between 5 and 20 years of age and then increased progressively to maximal values attained after 50 years of age (p less than 0.001). The proportion of patients with raised systolic and mean pulmonary arterial pressures increased with age after 20 years of age (p less than 0.001). A parallel increase in pulmonary blood flow was observed after 20 years of age, which was less marked than the increase in pressures, but nevertheless statistically significant (p less than 0.05). This increase in left to right shunt disappeared after 50 years of age. An increase in pulmonary resistances was observed after 20 years of age and persisted all through life (p less than 0.001). Two successive preoperative catheter studies were performed in 34 patients after a 6.4 +/- 4.7 years interval. In each patient, systolic pulmonary arterial pressures had increased and were significantly higher at the time of the second study (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Pulmonary valve stenosis. The medical solution].

Pulmonary valvular stenosis had been diagnosed since infancy in a 3 year-old girl. Cyanotic episodes occurring when the child cried led to the decision to remove the stenosis, whose gradient was 58 mmHg. Transluminal dilatation through the femoral vein, after premedication and local anesthesia induced a decrease of the gradient to 18 mmHg with a good angiographic result. This technique, which may be used in numerous types of pulmonary stenosis, allowed avoidance of the disadvantages of surgery under general anesthesia with median sternotomy and cardiopulmonary by-pass.

Angioplasty, Balloon↗
PubMed1985

[Two-dimensional echocardiography of coronaro-cavitary fistulas].

4 cases of congenital coronary arteriovenous fistulae in children 20 days to 10 years old were studied by 2D echocardiography. The coronary fistulae were treated surgically in all four cases after biplane aortography and selective coronary arteriography. The visualisation of the coronary arteries was performed by systematic use of several echocardiographic views: - left parasternal short axis view through the aortic root, - apical view, - longitudinal and transverse subcostal views. 3 cases of coronary fistulae between the right coronary artery and a cardiac chamber were diagnosed on the basis of significant dilatation (9 to 12 mm) of the right coronary artery, though the origin and diameter of the left coronary artery were normal. 1 case of a fistulae from a single left coronary artery was not diagnosed despite the demonstration of dilatation of the left main stem. Conversely, there were no false positive 2D echocardiographic diagnoses during the study period. The communication of the coronary fistula to the receiving cardiac chamber was demonstrated in two cases (right atrium: 1 case, left atrium: 1 case, on apical and subcostal views. It was not possible to visualise the communication of the coronary fistula with the right ventricle in the other two cases. 2D echocardiography is a non-invasive method of diagnosing coronary arteriovenous fistulae, but the development of a fistula on a single left coronary artery is a potential source of diagnostic error.

Angiography↗
PubMed1985

[Aortic subvalvular stenosis caused by accessory mitral tissue].

Three cases of subaortic stenosis due to accessory mitral tissue are presented. The diagnosis of the cause of obstruction was correctly established in each child before surgery, by 2D echocardiography and cineangiography. Resection of the accessory mitral tissue through a simple aortotomy gave excellent results. The eight previously published cases are discussed, emphasising the importance of accurate preoperative diagnosis. The cause of obstruction is difficult to determine at surgery, which may have disastrous consequences, whilst simple resection of the abnormal tissues leads to a complete and definitive cure.

Aortic Stenosis, Subvalvular↗
PubMed1985

[Malformations of the tricuspid valve associated with Fallot's tetralogy. Apropos of a series of 224 surgically treated Fallot's tetralogies].

This study was based on 7 children aged 20 months to 13 years with tetralogy of fallot (TOF) and tricuspid valve defects. Cases of endocardial cushion defects (8 cases of atrioventricular) were excluded. Three types of tricuspid valve defect were observed: 4 tricuspid valve prolapse (with one associated mitral valve prolapse); 2 accessory tricuspid valves passing through a ventricular septal defect to prolapse in diastole under the aortic valve; 1 Ebstein anomaly. The prevalence of tricuspid valve defects associated with TOF 3 p. 100 in this series. The diagnosis can: usually be made by 2D echocardiography. Tricuspid valve prolapse (usually the septal leaflet) is visualised in the apical 4 chamber view. The passage of accessory tricuspid tissue across the VSD into the left ventricular outflow tract is visible in the parasternal long axis or subcostal long axis views. Ebstein anomaly can be demonstrated in apical 4-chamber views showing the abnormally apical site of insertion of the septal leaflet of the tricuspid valve and "atrialisation" of part of the right ventricle. Tricuspid valve defects did not pose any special surgical problems during complete repair of TOF but this series did not include any cases of tricuspid hypoplasia or parachute tricuspid valve which have been reported in the literature and which do complicate surgery. Tricuspid valve and subendocardial cushion defects should be looked for systematically in patients with TOF undergoing 2D echocardiography.

Adolescent↗
PubMed1985

[Surgical closure of interventricular communications before 2 years of age. Long-term clinical and electrocardiographic course].

The long-term follow-up of the first 100 children under 2 years of age, presenting with ventricular septal defect (VSD) who underwent surgical closure between 1972 and 1976 at the Centre Chirurgical Marie-Lannelongue, was studied. Only cases with isolated VSD were taken into account except for 18 cases with ductus arteriosus related to operation and 41 cases with atrial septal defect (ASD) or persistent foramen ovale. This study included clinical and electrocardiographic investigations focused on the long-term follow-up of conduction disorders. Clinical tolerance was excellent with only one Eisenmenger's syndrome induced by a residual VSD. Three secondary cases of aortic regurgitation without present functional repercussions were observed. Conduction disorders were considered as unchanged or even improved. There were no sudden death, no secondary atrioventricular block (AVB), no trifascicular block even after one case with transitory immediate postoperative AVB.

Age Factors↗
PubMed1984

[Outcome of infants operated on for aortic coarctation before 3 months of age].

Between January 1966 and June 1982, 177 infants less than 3 months of age underwent surgical cure of coarctation of the aorta. Seventy-one percent had associated cardiac lesions not including a patent ductus arteriosus. With the cure of the coarctation either by resection anastomosis or angioplasty, 45% underwent associated surgical procedure, mainly pulmonary artery banding. Early mortality was 26% for the last 4 years of the study. Early deaths, significantly correlated with the severity of the preoperative heart failure and the importance of pulmonary hypertension, were not correlated with an associated heart disease. Of the 95 survivors operated on before December 31, 1981 and with a long follow-up, 18 died later on. Late deaths are related with associated cardiac malformations. Thirty-nine (41%) of the survivors had recurrent coarctation. This was correlated with the year of surgery and not with the surgical technique. In cases with coarctation of the aorta surgical cure should not be withheld before age 3 months, when there is heart failure, with or without associated cardiac malformations. The mortality, even in isolated coarctation (6%), the occurrence of sudden deaths after good surgical repair, the frequency of recoarctations lead to suggest that in infants under 3 months of age, careful supervision and conservative medical treatment should be considered, if the coarctation is isolated and well tolerated.

Aortic Coarctation↗
PubMed1984

[Acute hemiplegia complicating Kawasaki disease].

An infarct in the left middle cerebral artery territory in a 9 months old girl occurred in the course of Kawasaki's disease which in addition had induced a coronary aneurysm and a myocardial infarct. Embolism from the myocardial infarct was likely to have provoked the cerebral infarction. Neurological symptoms and signs are unusual in Kawasaki's disease.

Acute Disease↗
PubMed1983

Subvalvular aortic stenosis: long-term surgical results.

Seventy-six patients, with a mean age of 11.6 years, presenting with congenital subvalvar aortic stenosis were operated upon between 1965 and 1979. Seventy had moderate subvalvular stenosis. Eighty-eight percent had myotomy combined with resection of the obstruction. Five patients (6.6%) died postoperatively. Of 48 survivors followed up between 6 months to 13 years postoperatively (mean 4.2 years), 4 underwent reoperation and 2 of them died. Survival at 5 years and 10 years was 96% and survival without reoperation at 5 years and 10 years was 91%. When last seen, 90% of the patients were asymptomatic, left ventricular hypertrophy on ECG had disappeared in 63%. No patient had atrioventricular block. Two thirds of the patients had no systolic thrill and of 13 patients recatheterized (3.2 years follow-up) 9 had a peak systolic gradient below 50 mmHg. If, postoperatively 60% of the patients had aortic insufficiency versus 31% preoperatively for the whole period, this percentage fell to 33% after 1976. As subaortic stenosis is a progressive disease and late surgical results are correlated to preoperative peak systolic gradient, early surgery is recommended. Close postoperative follow-up is needed since recurrence of aortic stenosis is possible (and acquired aortic insufficiency may persist).

Adolescent↗