Biomedical subjects

L Iserin

Publications and source records attributed to L Iserin.

42 records · Page 3Linked to original sources

PubMed1995

[Percutaneous dilatation of recurrent coarctation of the aorta in the 1st year of life].

It is not rare for surgery of coarctation of the aorta to be complicated by recurrence of the lesion at medium-term, especially when it is performed very early in life. Advances in interventional catheterisation now offer an alternative to surgical reoperation. This study is a retrospective analysis of balloon angioplasty in 20 patients in whom isthmic stenosis had been operated before the age of one month in 19 cases, in whom recurrent coarctation was identified 3.2 +/- 2.1 months later. The percutaneous angioplasty was performed by a femoral arterial approach at an average age of 5.4 +/- 2.3 months. The femoral pulses returned together with a fall in the transisthmic systolic pressure gradient from 58.3 +/- 23.4 mmHg to 18.3 +/- 12.5 mmHg, and the isthmic lumen increased by +117 +/- 52%. Judged by the residual pressure gradient, the results were good, the best results being observed in the shortest and most severe stenoses. After a maximum follow-up of 5 years (average: 20.1 +/- 16.6 months), the angioplasty was successful in 14 cases (70%), 4 cases had a mild residual gradient (20%) and 2 were failures (10%). None of the patients required reoperation. There were no fatalities or early aneurysmal complications in the dilated zone monitored by echocardiography and magnetic resonance imaging. The only complication was femoral artery obstruction (6 cases) which was successfully thrombolysed in 5 cases but which recurred at long-term in 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Coarctation↗

PubMed1994

[Palliative treatment of tetralogy of Fallot by percutaneous dilatation of the right ventricular outflow tract. 40 cases].

This study was undertaken to assess the value of percutaneous dilatation of the right ventricular outflow tract as a substitute for surgical systemic pulmonary anastomosis in varieties of tetralogy of Fallot with severe irregularity or major pulmonary arterial hypoplasia unsuitable for complete repair of first intention. Fifteen neonates aged 3 to 23 days with severe desaturation (SaO2 = 73 +/- 11%) and twenty five children aged 1.2 to 174 months with anoxic crises or severe desaturation (SaO2 = 67 +/- 15%) fulfilled these criteria. They underwent right heart catheterisation completed by an attempted pulmonary dilatation. This manoeuvre failed in 6 cases, all neonates, because it was not possible to cross the annulus or maintain the balloon in position, or because of infundibular perforation. There were complications in 5 cases, all neonates: 2 tamponades with 1 death, one dissecting aneurysms of the annulus, 1 gastroenteritis and 1 caval thrombosis. Of the 34 patients dilated, 8 were poor results, mainly in the older age group (7 cases) and 26 were successful as judged by a significant improvement in arterial saturation. However, 7 patients rapidly deteriorated due to anoxic crises (6 infants and children) or fatal secondary tamponade (1 neonate). Therefore, there remained 19 stable successful procedures, 49% of attempts, representing 56% of successful attempts and 73% of primary successes. In neonates, these proportions were respectively: 47%, 78% and 87%, and in the older children: 48%, 48% and 63%.(ABSTRACT TRUNCATED AT 250 WORDS)

Balloon Occlusion↗

PubMed1994

[Outcome of Wolff-Parkinson-White syndrome in children. Transesophageal study of anterograde permeability of the accessory pathway and of atrial vulnerability].

Twenty-nine children with the Wolff-Parkinson-White syndrome (WPW) were evaluated by transoesophageal electrophysiological studies to determine the quality of anterograde-conduction in the accessory pathway and the atrial vulnerability. The study group included 15 neonates, 1 to 30 days old, and 14 children from 5 to 15 years of age; Anterograde conduction through the bundle of Kent was tested by incremental transoesophageal atrial pacing and by the determination of the shortest conducted cycle with preexcited RR waves; bursts of atrial pacing were then used to try to trigger an atrial arrhythmia. In the group of the 15 neonates, 11 had accessory pathways capable of conduction to the ventricules at frequencies > 300/min (stimulation cycle < or = 2.00 ms) but no atrial arrhythmias could be induced. The older children had slower conduction in the accessory pathways with the shortest conducted cycle length > 200 ms in 11/14 cases; on the other hand, atrial fibrillation was easily induced in 4 children, all over 12 years of age. The risk of syncope by rapid conduction of an atrial arrhythmia through the accessory pathway is negligeable in young children, including those on digoxin. This study suggests that this low risk is explained more by the absence of atrial vulnerability than by the electrophysiological properties of the accessory pathways.

Arrhythmias, Cardiac↗

PubMed1993

[Perforation-dilatation of pulmonary atresia with intact interventricular septum in neonates and infants].

Sixteen children (14 neonates less than 1 week old and 2 infants aged 3 and 6 months) had a "favorable" type of pulmonary atresia with an intact interventricular septum in which the hypoplasia of the right ventricle was mild and the cavity tripartite with a well developed infundibulum arriving in contact with a good-sized pulmonary artery from which it was separated by a totally or almost totally imperforate dome. They underwent a procedure associating an infusion of prostaglandin. E1 and an attempted pulmonary valve disobliteration by interventional catheterisation: needle puncture followed by balloon dilatation. There were 4 failed procedures (impossible puncture or dilatation), only one of which in the last 10 cases. The outcome of the 12 primary successes was related to the rapidity of recovery of right ventricular diastolic function: 7 patients were cured within a few days or weeks with prostaglandin therapy: 5 children required surgical anastomosis with a longer recovery period--3 cures but 2 deaths. Overall, there were two myocardial effractions without serious complications and 1 enterocolitis which was long-lasting but eventually cured. Two mild residual stenoses were redilated. In conclusion, the puncture-dilatation technique may be used instead of surgical valvectomy in favorable forms of pulmonary atresia with intact septum in the neonate. With experience, it was possible to remove the obstruction in 9 out of 10 cases with a minimum of complications. It is the compulsory first stage to complete cure, the probability and rapidity of which depend on recovery of right ventricular compliance.

Angiocardiography↗

PubMed1993

[Cavopulmonary shunts in the treatment of univentricular heart diseases in children. An experience of 60 cases].

Sixty children with a complex cardiac malformation consisting of a single functional ventricle and a protected pulmonary circulation, previously palliated by one or several Blalock anastomoses (40 cases) underwent a cavopulmonary shunt procedure. All but one had an excellent hemodynamic status: ventricular end diastolic pressure < 15 mmHg, mean pulmonary pressure < 20 mmHg, pulmonary vascular resistance < 3 units and a Mayo Clinic index (a combination of these parameters and pulmonary and systemic blood flow) < 4. The shunt was complete from the outset in the 27 most favorable cases which did not require any other surgical procedure. There were 2 immediate failures which necessitated reducing the reconstruction to a partial shunt; 9 cases were complicated by thrombosis of the intercaval connection (2 case, 1 death), by neurological complications (2 cases, 1 death), by chronic serous effusions (5 cases): of the 21 survivors followed up for a maximum of 54 months (average 28 +/- 9 months), 18 were well and 2 handicapped by venous stasis. The shunt was partial in 33 cases, especially in 17 cases because it was necessary to operate the pulmonary branches, the subaortic area, or an atrioventricular valve; there was no immediate mortality but 5 complications which were related to an associated procedure in 3 cases. There were no complications in 28 cases: of the 30 children followed up an average of 24 months, there were 3 secondary degradations (2 deaths and 1 cardiac transplantation), 10 shunts completed 2 to 32 months later with no deaths and 8 excellent results, and 17 children waiting for more favorable conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Left ventricular flow propagation during early filling is related to wall relaxation: a color M-mode Doppler analysis.

OBJECTIVES: This study was designed to evaluate the relation between the velocity of flow propagation and left ventricular relaxation by using color M-mode Doppler echocardiography to analyze flow propagation in the left ventricle. BACKGROUND: Noninvasive attempts to identify alterations in left ventricular relaxation have been hampered because both the relaxation rate and left atrial filling pressure are the determinants of peak early velocity and filling rate. METHODS: Color M-mode velocity data were transferred to a microcomputer and compared with conventional pulsed Doppler data to assess the ability of color M-mode echocardiography to analyze velocity field properties. The velocity of flow propagation was measured as the slope of the flow wave front during early filling in normal subjects (n = 29) and in patients with disease that alters relaxation (dilated cardiomyopathy [n = 31], ischemic cardiomyopathy [n = 8], hypertrophic cardiomyopathy [n = 5], systemic hypertension [n = 22] and aortic valve disease [n = 25]). In nine patients with end-stage dilated cardiomyopathy, echocardiographic and left heart catheterization data were obtained at baseline and during intracoronary dobutamine infusion. RESULTS: Color M-mode and pulsed Doppler echocardiographic data were highly correlated (n = 217, r = 0.94, p less than 0.0001, velocity range 0.2 to 1.5 m/s). The velocity of flow propagation was lower in patients than in normal subjects (0.46 +/- 0.15 vs. 0.84 +/- 0.11 m/s, p less than 0.0001). The decrease was significant in all disease forms with or without left ventricular dilation. The velocity of flow propagation was related to peak early velocity in normal subjects (p less than 0.001) but not in patients. It varied inversely with the isovolumetric relaxation time constant during dobutamine infusion and the two variables were highly correlated (p less than 0.0001). CONCLUSIONS: The velocity of flow propagation during early filling seems to be highly dependent on the left ventricular relaxation rate and could be an important tool in studying diastolic function.

Blood Flow Velocity↗