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Biomedical subjects

L A Mercier

Publications and source records attributed to L A Mercier.

29 records · Page 2Linked to original sources
PubMed1980

Atrial myxomas: a review of clinical experience in 40 patients.

We have reviewed the Mayo Clinic experience in the diagnosis and management of 40 cases of atrial myxoma seen over a 20-year period, 1957 to 1977. The diagnosis of atrial myxoma was seldom made clinically on the basis of history, physical examination, chest roentgenogram, or electrocardiogrammthere was no reduction in the time interval from onset of symptoms to operation between patients seen in the period 1957-1967 and those seen in 1968-1977. Although myxomas are rare, they should be considered in the differential diagnosis of patients with suspected mitral valve disease and congestive heart failure or constitutional disturbances who are in sinus rhythm. The greater number of patients diagnosed preoperatively in the second 10-year period, 1968-1977, reflects the introduction of echocardiography as a noninvasive diagnostic procedure. Echocardiography should be performed on all young patients with embolic disease and on those in whom the diagnosis of myxoma needs to be ruled out before exploratory or definitive surgery is undertaken so that unnecessary and potentially serious complications can be avoided. Surgical excision of the myxoma can be performed with low mortality (1 death occurred in 37 cases or 2.7%), and it provides excellent and sustained symptomatic relief. The recurrence rate is low (5.4%), but long-term follow-up and serial echocardiography are advisable.

Adolescent↗
PubMed1979

Assessment of left ventricular function in secundum atrial septal defect by computer analysis of the M-mode echocardiogram.

Left ventricular function in 53 patients with secundum atrial septal defect was assessed by computer-assisted analysis of the left ventricular echocardiogram and by cardiac catheterization. The patients were divided into two groups, those younger and those older than 60 years, to investigate the effect of aging on left ventricular function. Cavity size was significantly smaller than normal (p less than 0.01) and septal motion was abnormal in 86%, but values for cardiac index, left ventricular end-diastolic pressure, velocity of circumferential fiber shortening, left ventricular filling rate, and duration of rapid filling were normal in both groups. Regional dynamics assessed in terms of peak rates of systolic thickening and diastolic thinning of the septum and posterior wall were also normal in both groups. We concluded that, although left ventricular minor dimensions are small, and septal motion is reversed in the majority of patients with atrial septal defect, left ventricular function is normal, and it does not appear to deteriorate with increased age, pulmonary hypertension, or the presence of right ventricular failure. The abnormal septal motion appears to be compensated for by enhanced septal and posterior wall percentage thickening.

Adolescent↗
PubMedDate not supplied

Aneurysm of the membranous ventricular septum and accessory valvular tissue causing obstruction of the pulmonary outflow tract in corrected transposition.

Aneurysm of the membranous portion of the ventricular septum and accessory valvular tissue are two infrequent congenital lesions. This case illustrates a rare association of aneurysm of the membranous septum and accessory valvular tissue originating from the mitral valve, causing right-sided ventricular outflow tract obstruction in a patient with corrected transposition. Multiplane transesophageal echocardiography allowed for determination of the dual nature of the obstruction.

Adult↗
PubMedDate not supplied

Results of percutaneous mitral commissurotomy in patients with a left atrial appendage thrombus detected by transesophageal echocardiography.

To evaluate whether the presence of a left atrial appendage (LAA) thrombus increases the embolic risk of percutaneous mitral commissurotomy (PMC), we reviewed 240 transesophageal echocardiographic studies performed before intended PMC for mitral stenosis. We found 14 patients (5.8%) with left atrial clots, 12 located in the LAA (none detected by transthoracic echocardiography [TTE]) and two in the body of the left atrium. In the two patients who had a left atrial body thrombus, TTE did not unequivocally show the thrombus. Seven patients with an LAA thrombus underwent PMC by the double-balloon technique. The hemodynamic and echocardiographic results were comparable to those of the larger series. No embolic complications were noted either during the procedure, in the 48 hours of observation after the procedure, or at a mean follow-up of 12 months. We conclude that PMC by the double-balloon technique can be performed safely in patients with an LAA thrombus who have been given anticoagulants. Transesophageal echocardiography is still indicated before PMC because TTE is suboptimal for detection of left atrial clots.

Adult↗
PubMedDate not supplied

Angiosarcomas of the interatrial septum mimicking atrial myxomas.

Angiosarcoma of the heart is a rare tumor. This tumor is most frequently located in the right atrium and pericardium. Localization of a tumor in the interatrial septum usually suggests atrial myxoma. We report two cases of angiosarcoma originating from the interatrial septum, one extending into the right atrium and the other into the left atrium, mimicking atrial myxomas. Transesophageal echocardiography allowed the diagnosis and comprehensive assessment of compromised structures.

Aged↗
PubMedDate not supplied

Canadian consensus recommendations for the measurement and reporting of diastolic dysfunction by echocardiography: from the Investigators of Consensus on Diastolic Dysfunction by Echocardiography.

Abnormalities of diastolic filling are increasingly recognized as a cause of symptoms and predictors of outcome in patients with most forms of heart disease. Noninvasive assessment of diastolic filling is possible in almost all patients, but accurate evaluation must relate echocardiographic Doppler measurements to the complex physiologic and hemodynamic factors responsible for normal and abnormal filling. This evaluation has been facilitated by recent correlation of Doppler measurement of mitral and pulmonary venous inflow with hemodynamic studies. These studies have confirmed that when a careful, integrated approach is taken, Doppler flow patterns can document a progressive pattern of abnormality in many conditions. Impaired left ventricular (LV) relaxation is seen early and is recognized by a decrease in early transmitral LV filling and an increased proportion of filling during atrial contraction. As abnormalities progress, increasing LV chamber stiffness and elevated left atrial pressure lead to a "pseudonormal" filling pattern that previously has caused considerable confusion. This can be unmasked by careful evaluation of pulmonary venous inflow and the use of the Valsalva maneuver. When marked diastolic abnormalities are present, LV filling has restrictive features characterized by rapid early filling, a very stiff left ventricle with high filling pressures, and a poor prognosis. Routine measurement of indexes of diastolic filling have been hampered by uncertainty as to what should be measured, what techniques should be used, definition of normal values, and a clear method of reporting findings. This report represents the efforts of a Canadian consensus group to define a national standard for the performance and reporting of echocardiographic Doppler studies of diastolic filling.

Aged↗