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Biomedical subjects

M Ben-Ismail

Publications and source records attributed to M Ben-Ismail.

At least 19 recordsLinked to original sources
PubMed1981

[Late thromboses on tricuspid valve prostheses. Apropos of 6 cases].

Six out of 24 patients with tricuspid valve prostheses, operated between 1968 and 1978, followed-up from 1 to 10 years (average 4,2 years) developed thrombosis. This complication occurred between 15 and 59 months after operation (average 37 months). All patients were female with ages ranging from 18 to 44 years (average 38 years). Starr-Edwards prostheses were used in all cases. Five of these patients were on anticoagulants therapy, which was well within therapeutic limits in 3 patients. In contrast to thrombosis of mitral or aortic valve prostheses, the presenting symptoms were slowly progressive and discreet in 4 patients; in 1 case, the thrombosis was diagnosed on routine follow-up examination. The slow clinical presentation allows time for useful complementary investigations, catheterisation and angiocardiography being the most reliable methods of confirming this difficult diagnosis: these investigations were carried out in 2 patients, and in both cases, very high right atrial pressure with diastolic gradients between the right atrium and right ventricle of over 10 mm Hg were recorded. Cineangiography showed tricuspid regurgitation in both cases with reflux in the vena cavae and very dilated right atria, stagnation of contrast and poor right ventricular filling. Five patients were reoperated with two postoperative deaths. Particular anatomical appearances were observed at operation or autopsy with fibrin and platelet deposits at different levels of the prosthesis (sewing ring and/or struts) interfering and even blocking the function of the ball or disc. Organized thrombus on the cage was only observed in one patient. In this case, the struts on the prosthesis were set in the right ventricular cavity. Thrombosis of tricuspid valve prostheses is generally a slowly progressive complication and may be diagnosed in time by regular follow-up, so that reoperation may be considered without unnecessary delay.

Adolescent↗
PubMed1981

[Long-term results of tricuspid prostheses].

The results of a series of 38 patients with a tricuspid valve prostheses (:76% Starr-Edwards ball valves) associated with correction of one or two left heart valvular lesions are presented. 24 patients underwent clinical and haemodynamic assessment on average 4,2 years after surgery. The conclusions were that signs of systemic venous hypertension were mainly related to residual right ventricular failure despite normal valve function and secondarily to the poor hemodynamic profile of these prostheses and their paradoxical motion. Using these results: 18% early mortality; 24% late mortality; 24% late thrombosis amongst survivors and 52% residual right ventricular failure; and 47,5% of excellent results. The clinical and haemodynamic profiles of the patients were analysed to determine the surgical indications. Apart from the correction of associated left heart valve lesions, it seems that the prognosis in tricuspid valve repair depends on the duration of tricuspid regurgitation and the severity of right ventricular myocardial disease. In elderly patients with chronic tricuspid regurgitation and severe right ventricular failure, long-term analysis showed 87,5% poor results, whilst in younger patients with a shorter history of tricuspid regurgitation and less severe right ventricular failure, there was 77,7% excellent long-term results. Semi circular annuloplasty is widely indicated in mild or severe functional tricuspid regurgitation. Tricuspid valve replacement, a much more serious operation, remains essential in chronic organic lesions and in some cases of massive functional tricuspid regurgitation. A regards the choice of prosthesis, the authors suggest the Hancock bioprosthesis as a logical choice in cases of severe right ventricular failure as they are less prone to thrombosis than mechanical prostheses and have good haemodynamic profiles. The evolution of the right ventricular failure even after correction of tricuspid regurgitation underlines the importance of preventative therapy by early correction of left heart lesions.

Adolescent↗
PubMed1980

[Late thromboses of prosthetic heart valves. Apropos of 15 cases].

15 patients developed late thrombosis of their prosthetic heart valves: --9 mitral, 4 tricuspid and 2 aortic valve prostheses. --12 thromboses occurred on Starr-Edwards ball prostheses (7M, 3T and 2 Ao), 2 on Starr-Edwards disc prostheses (1M, 1T) and one on a Björk-Shiley valve. 14 patients were on anticoagulant drugs but treatment was only effective in 5 patients; only 1 patient was not anticoagulated. Thrombosis of mitral and aortic valves presented with signs of pulmonary oedema and/or systemic (especially cerebral) embolism and tricuspid valve thromboses presented with signs of right heart failure or were discovered on routine examination. Paraclinical investigations, when performed, showed valve movement to be an unreliable sign but phonocardiography was useful. Differing pathological appearances were observed, either peroperatively (7 cases) or at autopsy (8 cases). Late thrombosis is a rare but dangerous complication which should be avoided by effective anticoagulation and diagnosed at an early stage.

Adult↗
PubMed1980

[Detachment of valve prostheses. Apropos of 24 cases].

A series of 24 cases of paraprosthetic valvular regurgitation, 10 mitral and 14 aortic, in 19 out of a group of 634 operated patients with a total of 822 prosthetic heart valves is reported. The presenting features are dominated by auscultatory changes, though inconstant episodes of heart failure, and, in aortic prostheses, the high incidence of infective endocarditis. Paraclinical investigations are of variable value; cineradiography in aortic valves and phonocardiography in mitral valves are useful; catheterisation with ventriculography or aortic angiography according to the case under study are the investigations of choice, especially in mitral regurgitation where it is essential. Typical clinical settings for these problems are valve ring dilatation calcification, and previous or active infective endocarditis. The indications for urgent surgery depend on the clinical signs, the presence of heart failure, haemolysis, active endocarditis and deterioration despite medical treatment. The series compares the data in mitral paraprosthetic regurgitation, difficult to diagnose but with a reasonably good prognosis, and aortic paraprosthetic regurgitation, easier to diagnose but associated with a poor prognosis due to the high incidence of associated endocarditis.

Adolescent↗
PubMed1979

[Heart valve prosthesis and pregnancy].

Sixteen pregnancies were followed up in 13 patients with prosthetic heart valves: 8 pregnancies went to term under oral anticoagulation, 4 under heparin and 4 without anticoagulation. 9 healthy normal children were delivered; there were 2 still births and 5 abortions. On the maternal side 3 haemorrhages and thromboembolic episodes which involved 2 patients on heparin, one of whom died, were observed. The following points are apparent from our observations and a review of the existing medical literature: --the risk of thromboembolism is not increased. The marked clotting tendency of maternal blood post-partum contraindicates the withdrawal of anticoagulants during this critical period; --haemorrhagic complications are common with anticoagulants; --foetal loss is greatly increased; --the teratogenecity of vitamin-K antagonists is certain, but the risk is small. The problems of anticoagulation are discussed; theoretically heparin should be given during the 1st trimestre and from the 38th week to the second post-partum week. The patients should be closely supervised by both obstetrician and cardiologist and hospitalisation is advised for the last month of pregnancy. Normal vaginal delivery is usually possible.

Abnormalities, Drug-Induced↗
PubMed1979

[Heart valve prostheses in children with reference to 95 cases].

Over a 10 year period, 95 children aged 15 years and less underwent replacement of one or several of their heart valves, usually by a Starr-Edwards ball prosthesis. The predominant pathology was rheumatic heart disease and the most commonly affected valve was the mitral. Severe symptomatology, heart failure, cardiomegaly and high wedged-capillary and pulmonary arterial pressures were practically constant findings. Operative mortality was low (3.2%) and the long-term mortality was 10 patients. With an average follow-up of 40 months, results were excellent in the great majority of patients, with complete regression of symptoms, cardiomegaly and high capillary and pulmonary arterial pressures. Anticoagulant therapy was not systematic and only half the series were so treated. Thromboembolic complications were rare, 5.5% patients, but only affected those without anticoagulant therapy. The problems of evolving rheumatic disease and, above all, of tricuspid incompetence, the persistence of which after surgery on the mitral valve seems to be a sign of advanced myocardial damage, are discussed.

Adolescent↗
PubMed1978

[Total anomalous pulmonary venous return: apropos of an unusual case].

A case is reported in which the entire pulmonary venous return was abnormal, being retro-cardiac. Unusual features were the age at which the abnormality was discovered (14 years), and the anatomical type of abnormality of pulmonary venous return. The return effectively emptied into a posterior cavity which was "a diverticulum of the right atrium" which had a wide communication with the "normal" right atrium, which in turn communicated with the left atrium by a highly placed Ostium Secundum. The muscular septum which separated the highly placed auricle of the left atrium and the "diverticulum" was removed, and vertical partitioning allowed a right and left atrial cavity to be reconstituted. The post-operative progress was uneventful.

Heart Defects, Congenital↗
PubMed1978

[Mitral commissurotomy in children. Apropos of 100 cases].

We report 100 cases of mitral commissurotomy in children, 15-years-old or less, suffering from rheumatic mitral stenosis. Mitral stenosis in children is characterised by the severity of functional impairment and the considerable radiological, electocardiological and haemodynamic changes, with pulmonary arterial hypertension which is always present and often well marked. The early results of mitral commissurotomy are very satisfactory with clinical improvement and a low mortality. But, in the long term, we have seen progressive deterioration in the clinical state of these patients resulting from re-stenosis or from the progression of another valve lesion. Three problems have been discussed. First, the progression of the rheumatic process which seems to account to a large extent for the late failures of mitral commissurotomy in children. Secondly, the problem of tricuspid insufficiency, which is often associated with mitral stenosis in childhood and which usually disappears during the post-operative period. Finally, the problem of pre-capillary pulmonary arterial hypertension which always showed a tendency towards regression.

Adolescent↗
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↗
PubMed1977

[Risk factors in mitral valve replacements].

The authors report 137 isolated mitral valve replacements carried out between 1966 and 1975, with an operative mortality of 13.1%. Certain risk factors are demonstrable:--from the clinical point of view: previous cardiac surgery, 3 or more attacks of cardiac failure, a prolonged preoperatives course, atrial fibrillation, and cardiomegaly on the X ray. The combination of these risk factors is very serious as when three or more risk factors are operative at the same time, the mortality is 40%. Reduced ventricular function preoperatively was an essential factor governing operative mortality; improved results follow earlier indications for surgery.

Adolescent↗
PubMed1977

[Outcome of corrected and uncorrected tricuspid insufficiency after repair with prostheses in mitral and mitro-aortic valve diseases. Apropos of 159 cases].

This is a study of 159 patients with tricuspid incompetence (TI) associated with a mitral or mitro-aortic valve defect. The mean age of the patients at operation was 25.5 years. The TI was left untreated in 84, corrected by semi-circular annuloplasty in 39, and corrected by a prothesis in 28, by a Carpentier ring in 6, and by Kay's plasty in 2. The 33 early deaths (21%) are regrettable. The long-term outlook was studied with a mean follow-up period of 26 months. The overall mortality rises, if these are included, to 42 (26%). By comparing the preoperative findings in those with good and poor results, we have been able to identify a certain number of risk factors: a preoperative course of greater than or equal to 6 years, a number of attacks of cardiac failure greater than or equal to 3, a cardiothoracic ratio greater than or equal to 0.70, a mean right atrial pressure greater than 12, a mean pulmonary arterial pressure of greater than or equal to 50. Severe TI is also a poor prognostic factor. If the three groups of patients are compared, bearing in mind the fact that their preoperative state was very similar, and that the TI was either left untreated or repaired by annuloplasty or prosthesis, it appears that such a correction improves neither the surgical mortality nor the long-term prognosis. It therefore seems to us that a functional TI can be treated expectantly since its resolution depends more on the unified treatment of the whole underlying disorder and on the state of the myocardium than on any localised correction of the TI.

Adolescent↗
PubMed1977

[Long-term outcome of valve prostheses. Apropos of 299 operated patients].

The authors report a series of 299 operated cases betwen 1966 and August 1975. The operative mortality was 16%, usually a result of low output states and arrhytmias. Long-term survival was 74% at 3 years and 64% at 6 years, being better in those with only one valve replacement. The late results were very good taken as a whole. The few poor results were associated especially with a degenerating myocardium. The mitral group were favoured with a better 5 year survival rate and by clinically, and above all haemodynamically severe tricuspid incompetence. Thromboembolic complications, which are a major hazard, were favoured by irregular and inadequate anticoagulant therapy. In patients under 20 it would seem possible to stop after 6 months' effective treatment. Children have had generally better results than adults, probably because of the better state of their myocardium.

Adolescent↗