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Biomedical subjects

J Losay

Publications and source records attributed to J Losay.

At least 91 records · Page 5Linked to original sources
PubMed1982

[Two-dimensional echocardiography in subvalvular aortic stenosis. Apropos of 20 cases].

Twenty cases of discrete subvalvular aortic stenosis in children aged from 8 months to 23 years were examined by 2-dimensional echocardiography and cineangiography. Fifteen of these patients subsequently underwent open heart surgery to relieve the obstruction. In 18 cases the obstacle was a fixed stenosis (13 type I, 3 type II and 2 type III) and in two cases, the obstacle was provoked by accessory tissues of the anterior mitral leaflet. The echocardiographic incidences used were the left parasternal long axis, the apical LAO-equivalent, and longitudinal and transverse subcostal views. In type I, fixed subvalvular stenosis, one fine abnormal echo was visualised in the left ventricular outflow tract throughout the cardiac cycle immediately below the aortic valve, best seen on apical views. Twelve of the 13 stenoses of this type were demonstrated by 2D echocardiography. In type II stenosis an abnormal thickened echo was visualised in the left ventricular outflow tract at a distance from the aortic cups. The adherence of this abnormal echo to the anterior mitral leaflet was best demonstrated by apical views. All three cases of this type were demonstrated by echocardiography. Type III stenosis was characterised by widespread narrowing of the subaortic region with irregular borders. Obstruction due to accessory tissues of the anterior mitral leaflet were well demonstrated in left parasternal long axis and apical views. They showed an even rounded mass of echos attached to the anterior aspect of the anterior leaflet prolapsing into the left ventricular outflow tract. Both cases in this series were diagnosed by 2D echocardiography. Therefore, 2D echocardiography with apical and subcostal views is a valuable method for diagnosing subvalvular aortic stenosis and for determining its anatomical type.

Adolescent↗
PubMed1981

[Heart with criss-cross ventricles associated with an obstruction of the ejection pathway of the left ventricle and a mitral anomaly].

A case of criss-cross heart with situs inversus associated with subvalvular aortic stenosis and mitral regurgitation in a 9 year old boy is reported. Surgical correction of the valvular abnormalities gave an excellent clinical and haemodynamic result. A review of the literature shows that this abnormality of rotation of the ventricles coexists with a concordant atrioventricular connection in 70 % cases; the ventriculoarterial connection is only discordant in 12 % cases. The right ventricle is always situated above the left ventricle. The most common associated lesions are usually accessible to surgery; ventricular septal defect (98 % cases); stenosis or atresia of the pulmonary artery (70% cases). However, right ventricular hypoplasia is also common (65 % cases). Six patients underwent surgical correction of the associated lesions with 4 successes and 2 deaths. Surgery is possible in these complex cardiac malformations with good results providing a precise preoperative anatomical diagnosis is made.

Aortic Stenosis, Subvalvular↗
PubMed1981

[Diagnosis and localization of ventricular septal defects by two-dimensional echocardiography. 50 cases].

A series of 50 children aged between 1 month and 15 years old, with ventricular septal defects (VSD) were investigated by two-dimensional sector scanning and cineangiography. Fifty other children of the same age group with congenital heart disease without VSD were also investigated by two-dimensional echocardiography and angiography. No VSDs were diagnosed by echocardiography in children with angiographically intact inter ventricular septa. In the group with VSD, two-dimensional echo localised with precision: --36 membranous VSDs (36/36) --5 infundibular VSDs (5/6) --2 isolated muscular VSDs (2/2) --I atrioventricular canal type VAD (I/I) --3 multiple VSDs (3/5). The subcostal view was the most useful for visualising the VSD in 49 out of 50 cases. The parasternal views only showed the VSD in 23 cases, and the apical views only in II cases. The dimensions of the left heart chambers and the movement of the interatrial septum gave an indication of the volume of the left-to-right shunt. Dilatation of the left heart chambers and bowing of the interatrial septum into the right atrium in systole were observed in all cases where QP/QS greater than 2, except when there was an associated atrial septal defect. Two-dimensional echo also detected associated lesions: pulmonary stenosis (9/9), prolapse of an aortic valve cusp (4/5), atrial septal defect (2/2), stradling of the tricuspid valve (I/2). Two-dimensional echocardiographic short axis subcostal views are reliable in the detection and localisation of VSD. Nevertheless, trabecular and apical VSDs are particularly difficult to visualise and the use of pulsed Doppler coupled with two-dimensional echocardiography should enhance the sensitivity in diagnosing this type of VSD.

Adolescent↗
PubMed1980

Tetralogy of Fallot with type C complete atrioventricular canal: surgical repair in three cases.

The successful repair of three consecutive cases of tetralogy of Fallot associated with complete atrioventricular canal type C is reported. The correct preoperative diagnosis was established by right and left ventriculography. Operative repair in the first two patients involved division of both hemivalves above the crest of the ventricular septal defect and closure of the septal defects with a single large Dacron patch. In the third patient, the septal defects were closed with two separate patches. The undivided hemivalves were attached to the patches by interrupted sutures placed more to the right side of the midline, so that tricuspid tissue was used to reconstitute the mitral valve. Right ventricular outflow tract obstruction was relieved by infundibulectomy, pulmonary valvulotomy, and placement of a Darcon patch on the infundibulum in Cases 1 and 3. A valved tube was used in Case 2. Six months postoperatively, the condition of the patient is satisfactory. The first patient is receiving digitalis; the second, digitalis and diuretics; and the third patient is well without treatment.

Blood Vessel Prosthesis↗
PubMed1979

[Digestive complications of surgery for aortic coarctation].

The complications of surgery for coarctation have been studied by examining the case notes of 284 survivors. 37 (12%) of them had intestinal complications and 15 other complications. The predisposing factors are the treatment of the abdominal complications are analysed.

Abdomen↗
PubMed1978

Ductus arteriosus sling: report of a newly recognised anomaly and its surgical correction.

Surgical exploration of a 7-week-old infant with a diagnosis of 'pulmonary artery sling' (left pulmonary artery arising from the right) revealed the true nature of the abnormality to be persistence of the ductus arteriosus which connected the right pulmonary artery to the aortic isthmus. This malformation has not been described previously. It has the same symptomatology as 'pulmonary artery sling' and it may be treated by surgical ligation and division. We suggest the term 'ductus arteriosus sling' to describe this rare congenital anomaly.

Aorta, Thoracic↗
PubMed1978

[Cor triatriatum associated with a ventricular septal defect in infancy. 2 cases treated surgically].

Although rare, the diagnosis of cor triatriatum in its classical form is usually made pre-operatively. The association with a large ventricular septal defect, as in the two cases reported here, masks the clinical and haemodynamic signs. In one case it was the echocardiogram and cineangiography which led to pre-operative diagnosis. The surgical correction of the two lesions was done successfully in one stage. In our second case, lack of recognition of the cor triatriatum led to the death of the patient in a low output state, following closure of the ventricular septal defect.

Cineangiography↗
PubMed1978

[A new anatomo-clinical entity? The left superior vena cava obstructing the interior of the left atrium in association with a left-right shunt. Apropos of 2 cases].

The association of a left-right shunt with obstruction to the pulmonary venous return must not be ignored. Failure to recognise this may be fatal post-operatively. We have described here what we believe to be a new cause of supra-mitral obstruction: an abnormal left superior vena cava. The echocardiogram was essential in the diagnosis, and allowed us to establish, after surgical correction, that all abnormalities of the left auricle had disappeared.

Echocardiography↗
PubMed1978

Repair of atrial septal defect primum. Results, course, and prognosis.

Repair of atrial septal defect primum (ASD primum) continues to be a challenge to the surgeon. The most common problems involve reconstructing the mitral valve and avoiding rhythm disturbances after the operation. In this report we describe our results in 92 patients with ASD primum who were operated upon between 1955 and 1975.

Adolescent↗
PubMed1975

[Protein-losing enteropathy during chronic liquid pericarditis].

Severe hypo-albuminemia associated with a decrease in P.B.I., gamma-globulins and plasmatic ceruloplasmin occurred in a 2 1/2 year old girl with chronic pericarditis since the age of 8 months. This was related to a protein-losing enteropathy which was confirmed by histological examination. Venous hypertension, secondary to the chronic pericarditis may explain the enteropathy.

Abnormalities, Multiple↗
PubMedDate not supplied

Transcatheter closure of patent foramen ovale in patients with platypnea-orthodeoxia: results of a multicentric French registry.

BACKGROUND: Dyspnea and the decrease in arterial saturation in the upright position in elderly subjects is described as platypnea-orthodeoxia syndrome (POS). POS is secondary to the occurrence of an atrial right-to-left shunt through a patent foramen ovale (PFO). METHODS: This French multicentric study reports on 78 patients (mean age 67 +/- 11.3 years) with POS who had transcatheter closure of the PFO; frequently associated diseases were pneumonectomy (n = 36) and an ascending aortic aneurysm (n = 11). In all patients, the diagnosis was confirmed by transthoracic or/and transesophageal echocardiography. Five different closure devices were used: Amplatz (n = 45), Cardioseal (n = 13), Sideris (n = 11), Das Angel Wings (n = 8) and Starflex (n = 1). Closure was successful in 76 patients (97%). RESULTS: Oxygen saturation increased immediately after occlusion from 84.6 +/- 10.7% to 95.1 +/- 6.4% (p < 0.001) and dyspnea improved from grade 2.7 +/- 0.7 to grade 1 +/- 1 (p < 0.001). A small residual shunt was immediately observed in 5 patients (3 with the Cardioseal device, 1 with the Sideris and 1 with the Amplatz) leading to the implantation of a second device in one case (Cardioseal). Two early deaths occurred unrelated to the procedure (one due to sepsis probably related to pneumonectomy, another due to respiratory insufficiency). Other complications were: a small shunt between the aorta and the left atrium, two atrial fibrillations and a left-sided thrombus which disappeared with anticoagulant therapy. At a mean follow-up of 15 +/- 12 months, there were 7 late deaths related to the underlying disease. CONCLUSION: Percutaneous occlusion of the foramen ovale is safe and gives excellent results thanks to continuing improvement in available devices. This technique enables some patients in an unstable condition to avoid a surgical closure.

Aged↗
PubMedDate not supplied

[Aortic valve stenosis. Prenatal diagnosis. A case].

Closed aortic valvotomy through the left ventricular apex could be performed in a 3-day old child thanks to an echocardiographic diagnosis in utero, at 32 weeks, of aortic stenosis, confirmed immediately after birth. The functional and echocardiographic results 5 months after the operation are excellent. This case shows that the prenatal diagnosis of cardiac malformation is feasible and facilitates an early treatment in the post-natal period.

Aortic Valve Stenosis↗
PubMedDate not supplied

[Non-surgical treatment of pulmonary valve stenosis].

Percutaneous pulmonary valve valvuloplasty was attempted 17 times in 16 infants and children aged 15 days to 18 years. Valvuloplasty was performed during cardiac catheterization without general anesthesia. Balloon catheter was positioned across the pulmonary valve using a guide wire previously introduced in the right or left pulmonary artery. All patients experienced a decrease in the right ventricular peak systolic pressure from 111.5 +/- 35.9 to 69 +/- 28.9 mmHg (p less than 0.001), a decrease in the ratio of right ventricular pressure to systemic systolic pressure from 1.08 +/- 0.34 to 0.65 +/- 0.28 (p less than 0.001) and a decrease in right ventricular to pulmonary artery gradient from 88.52 +/- 37.2 to 54.82 +/- 29.4 mmHg (p less than 0.001). A child with a history of postoperative seizures had convulsions after the procedure and died 72 hours later. Four other patients are considered as a failure of the technique, 4 had clear hemodynamic improvement but right ventricular pressure remained above 50 mmHg, and 8 had satisfactory relief of their stenosis with a right ventricular pressure below or equal to 50 mmHg and a right ventricular to pulmonary artery gradient below 30 mmHg. These good results were confirmed in 2 patients, one year after the dilatation. Percutaneous balloon valvuloplasty is probably now the best treatment for pulmonary valvular stenosis. Short-term and results at distance from the procedure are good, and morbidity and cost are less than those for a surgical cure.

Adolescent↗