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Biomedical subjects

M Desnos

Publications and source records attributed to M Desnos.

At least 91 records · Page 5Linked to original sources
PubMed1995

[Hypertrophic cardiomyopathy: place and limitations of medical therapy].

The development of echocardiography and kindred studies have enabled the detection of an increasing number of asymptomatic forms of hypertrophic cardiomyopathy. Drug therapy, by far the commonest therapeutic method of managing this condition, has only been shown to be effective on the symptoms. Therefore, due to the risk of iatrogenic disease, medication is only proposed to symptomatic patients: high dose betablockers is the usual treatment; when ineffective or contra-indicated, verapamil may be prescribed at progressively increasing doses under strict medical control. These products may need to be given at high doses in order to be effective but excessive bradycardia may be a limiting factor. Amiodarone alone or in association, may be preferred in forms with arrhythmias. The comparative efficacy of the different drugs, especially in preventing sudden death, requires well designed, controlled, therapeutic trials. Their results, if positive, would question the dogma of only treating symptomatic patients.

Adrenergic beta-Antagonists↗
PubMed1995

[Hormone replacement therapy in postmenopausal women and cardiovascular risk].

Although the cardiovascular effects of hormone replacement therapy of menopause have been controversial for a long time, the benefit of this treatment currently appears to be well established, despite the methodological problems of most studies and the absence of definitive demonstration by a prospective randomized study. The mechanism of this favourable action appears to be multifactorial with, in particular, an improvement of the lipid profile. In the absence of any gynaecological contraindication, the combination of a natural oestrogen and a progestogen devoid of any androgenic effect therefore appears to be the preferable treatment in postmenopausal women, especially as its cardiological value is added to other important and clearly documented actions.

Aged↗
PubMed1995

[How to evaluate a patient with heart failure? Round table].

Evaluation of heart failure is the first step prior to introduction of an adapted therapeutic strategy. Three principal objectives must be defined: 1) identify the cause of heart failure, which may directly guide subsequent treatment (valvular heart disease, coronary artery disease, etc.); 2) evaluate the repercussions of heart failure on everyday life: evaluation of quality of life, severity of functional disorders and reduction of the everyday capacity. This evaluation is the most delicate as it is based on clinical interview: evaluation of the various NYHA stages lacks precision and reproducibility. The stress test with measurement of oxygen consumption appears to constitute an acceptable evaluation technique; 3) evaluation of the prognosis. Many studies have demonstrated precise relationships between life expectancy and a number of criteria, alteration of myocardial function, echocardiographic findings, ejection fraction, cardiac output and even an AP chest x-ray. Although statistically valid, these criteria have a limited application in individual patients. Evaluation of all these parameters is the most accurate way to predict the subsequent course of the disease which therefore allows a more accurate choice of treatment and subsequent evaluation of their efficacy.

Heart Failure↗
PubMed1995

[Restenosis: physiopathology, treatments and prevention].

Despite fifteen years of extensive research, we still do not know how to predict or prevent restenosis. Angioplasty induces lesions in the intima, media and sometimes adventitia, resulting in a cicatricial process comprising proliferation and migration of smooth muscle cells towards the intima and secretion of extracellular matrix, leading to the formation of a neointima. Since angioplasty is associated with the simultaneous development of neointimal hyperplasia and restenosis, a cause and a effect relationship has therefore been proposed between neointimal hyperplasia and restenosis. All the restenosis prevention strategies based on inhibition of smooth muscle cell proliferation, which successfully limited restenosis in animal models have failed in man, due to the hazardous extrapolations from experimental models which are very different from the atheromatous lesions observed in man, rather than to the use of animal models in general. It is reasonable to wonder whether we have not selected the wrong target: is smooth muscle cell proliferation really responsible for restenosis? Experimental results supported by histological and ultrasonographic data in man, show that the cicatricial process which induces restenosis consists of constrictive remodelling, which decreases the perimeter of the external elastic lamina and the lumen. The use of stents appears to be the primary strategy designed to limit restenosis and prevent constrictive remodelling in man, even if it stimulates neointimal hyperplasia. Progress in the understanding of the mechanisms of postangioplasty remodelling open new perspectives in the prevention of restenosis.

Angioplasty, Balloon, Coronary↗
PubMed1995

[Ambulatory treatment of chronic cardiac insufficiency].

Considerable progress has been made in the medical treatment of chronic heart failure. A large number of patients with NYHA class II and III heart disease can be improved to class I and II. Treatment is maintained on an outpatient basis in order to prevent episodes of acute failure, while avoiding the adverse effects of drugs at high doses or in combination. Diuretics are still the drug class most frequently prescribed, especially loop diuretics (furosemide) which have the advantage of being able to be used in patients with renal failure. Aldosterone antagonists have the pathophysiological value of reducing the development of myocardial fibrosis. Digitalis alkaloids have a positive inotropic effect, which is even observed in the presence of sinus rhythm and which is associated with slowing of the heart rate in tachyarrhythmias. Angiotensin converting enzyme inhibitors are among the most recently used drugs. They decrease the left ventricular post-load and prevent activation of the renin-angiotensin-aldosterone system. Phosphodiesterase inhibitors cannot be administered orally in the long-term and are therefore not suitable for outpatient treatment. However, they are very effective by intravenous injection during the acute phase of heart failure and cardiogenic shock in hospital.

Ambulatory Care↗
PubMed1995

[Giant negative T waves in idiopathic apical diverticulum of the left ventricle in adults].

Left ventricular diverticula, congenital or acquired, with normal coronary arteries are rare. Apical diverticula are exceptionally rare in the adult. The authors present the clinical, paraclinical, anatomopathological pre- and postoperative data in a case of apical diverticulum of the left ventricle presenting with giant negative T waves. The differential diagnosis of these electrocardiographic changes is discussed, in particular apical cardiomyopathy, especially as the two conditions may be associated.

Adult↗
PubMed1994

Determination of left ventricular mass with electron beam computed tomography in deformed, hypertrophic human hearts.

This study firstly determined the accuracy of left ventricular mass (LVM) determination by electron beam CT in normal and distorted human cadaver hearts, and secondly the in vivo reproducibility of these measurements, in normal subjects and patients with various cardiac diseases, over a wide range of LVM (104-631 g). In cadaver hearts, there was a close correlation between electron beam CT and autopsy LVM values: r = 0.97, SEE = 16 g. Intra-observer variability: results of LVM measurements obtained in cadaver hearts by observer 1 and in in vivo studies by observer 2 were y = 1.001 x -1.34, r = 0.99, SEB = 6 g and y = 0.99 x +3.78, r = 0.99, SEE = 19 g, respectively. Inter-observer variability: results in cadaver and in vivo studies were y = 1.05 x -5.94, r = 0.98, SEE = 14 g and y = 1.13 x -23, r = 0.99, SEE = 28 g, respectively. Thus, these results over a wide LVM range provide extensive validation of electron beam CT measurements in hearts with marked left ventricular distortion. This method should play a valuable role, within the scope of clinical research, in assessing left ventricular remodelling in various conditions in which echocardiographic data are inaccurate.

Adult↗
PubMed1994

[Physiopathology of mitral mechanics in hypertrophic cardiomyopathy. Groupe de travail "Cardiomyopathies et insuffisance cardiaque" de la Société Française de Cardiologie].

Ventricular hypertrophy, the only indisputable phenotypical marker of hypertrophic cardiomyopathy, is the basis of the physiopathology and treatment of the disease. Mitral valve abnormalities are usually considered to be secondary to the hypertrophy but the genesis of systolic anterior motion by the Venturi effect has been questioned by many clinical and experimental observations. Abnormalities of the mitral valve apparatus may in themselves (elongation of the valves, antero-internal malposition of the mitral papillary muscles and/or hyperlaxicity of antero-internal corhdae tendinae) create systolic anterior motion or subaortic obstruction in the absence of septal hypertrophy and/or increased subaortic flow velocities. Anatomo-clinical studies have confirmed this hypothesis: a high prevalence of mitral valve disease (increased valvular surface and length) has been found in hypertrophic cardiomyopathy. The recognition of these abnormalities is of value from the therapeutic (mitral valvuloplasty) diagnostic (in borderline cases) and genetic (when the primary nature of the abnormalities is confirmed) points of view.

Animals↗
PubMed1994

[Demonstration of a fifth locus implicated in familial hypertrophic cardiomyopathies].

Hypertrophic cardiomyopathy is familial in about 50% of cases and is transmitted in the autosomal dominant mode. The first morbid gene implicated in the disease was the gene coding the beta myosin heavy chain (beta MHC) on chromosome 14. However, only 30% of families have this genetic abnormality. Recently, three new loci have been identified on chromosomes 1q3, 11p13-q13 and 15q2. In order to determine whether other genes could be implicated in the disease a linkage analysis study was performed in a West Indian family. The method is based on the analysis of the distribution of the disease in the family and the microsatellite markers. The microsatellites used were those which recognised the 4 loci previously mentioned and 4 new markers situated and arranged with respect to known microsatellites. The results show that in the family studied, the disease did not concord with the markers of the beta MHC gene or with those recognising the loci on chromosomes 1q3, 11p13-q13 and 15q2. There is, therefore, a fifth gene implicated in familial HCM. The heterogeneity of the disease seems even greater than originally thought.

Adult↗
PubMed1994

[Multiple pulmonary coronary fistulae. Apropos of a case].

Coronary-pulmonary fistula is a rare congenital anomaly. It is usually detected fortuitously in adulthood during a coronary angiography carried out to assess signs of myocardial ischemia. Multiple coronary fistulae are still more rare. Coronary angiography evaluates the lesions and indicates the most appropriate treatment. The congenital lesions are frequently combined with atheromatous lesions. The case described is that of a double fistula in a 61-year old man which was revealed by angina; the stenoses and occlusions which accompanied the fistulae lead to a discussion of their atheromatous nature and the nature of the pathological link between them: is this fortuitous or are they a progressive complication? Treatment involves both exclusion of the fistulae and coronary revascularization.

Arterio-Arterial Fistula↗
PubMed1993

[Coronary angioplasty combining rotational atherectomy and balloon dilatation. Results in 67 complex stenoses].

The treatment of complex coronary stenoses by conventional angioplasty is limited by a relatively low angiographic success rate, associated with a high risk of major complications. The role of new angioplasty techniques in the treatment of these lesions has not yet been determined. The aim of this prospective study was to evaluate the systematic association of rotational atherectomy (Rotablator) with balloon angioplasty on coronary stenoses characterised by at least 2 type B criteria of the ACC/AHA classification (type B2 lesions). The procedures was begun with rotational ablation with a medium-sized burr (50 to 70% of the reference diameter of the artery) and completed systematically by balloon angioplasty (balloon/artery ratio = 1), using the lowest possible inflation pressures for successful dilatation. This technique was used in 61 patients who had 67 coronary stenoses with a primary success rate (residual stenosis < 50% and no major complications) of 93.4% (57 patients). One emergency coronary bypass procedure was necessary and another patient developed transmural infarction on the 3rd day after the procedure. There were two technical failures (3.3%). The mean inflation pressure of the balloon was 4.1 +/- 1.2 atmospheres. There were no fatalities. During atherectomy, transient conduction defects were observed in 4 patients (6.6%): severe hypotension in 2 patients (3.3%) and complete spasm in 3 stenoses (4.5%). A significant increase in cardiac enzyme levels was observed in 4 patients (6.6%). The authors conclude that rotational atherectomy with a medium-sized burr, followed by systematic low pressure balloon dilatation allows treatment of certain complex coronary stenoses with a high primary success rate and few major complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1993

[Anticoagulant treatment and pregnancy. Apropos of 47 cases].

The authors report a series of 47 patients treated with anticoagulants during pregnancy. The commonest indication was the presence of an artificial heart valve (72.3% of cases), most often mitral (58.9%). Thirty seven women were treated with heparin (group I) and ten with oral anticoagulants (OA) (group II) during the first three months. There was one peripheral venous thrombotic event and 2 post-partum deaths. Obstetric complications were equally distributed between the 2 groups, with the exception of spontaneous abortions during the first three months and fetal deaths, which were commoner with OA. Hemorrhagic complications occurred in 17% of cases at the time of delivery and during the immediate post-partum period. One case of coumarin embryopathy was seen. This series confirms that three periods are dangerous in the context of anticoagulant treatment during pregnancy: the first three months, delivery and postpartum. We recommend the use of heparin during the first three months and at the end of pregnancy, restricting OA to the period between 4 and 9 months.

4-Hydroxycoumarins↗
PubMed1993

[French familial multicenter survey of hypertrophic cardiomyopathy. Initial Doppler echocardiographic results].

A French multicentre study of hypertrophic cardiomyopathy has recruited 260 subjects belonging to 18 families. At least 3 persons from each family included had a hypertrophic cardiomyopathy. A Doppler echocardiographic examination was performed in all members of these 18 families. The diagnosis of hypertrophic cardiomyopathy was based on M mode and/or 2D observations of parietal hypertrophy: wall thickness over 13 mm. Asymmetrical forms were distinguished from symmetrical forms by a septum/posterior wall ratio of over 1.3 in M mode or 2D study. The patients had an average age of 40 +/- 18 years, 127 were men and 133 women. One hundred and sixty eight were considered to be normal, 87 had hypertrophic cardiomyopathy and 5 were border line. The maximal diastolic wall thickness on M mode recording of pathological cases was 19.2 +/- 4.8 mm compared with 9.5 +/- 1.9 mm in healthy subjects (p < 0.001). The septum/posterior wall ratio was 1.8 +/- 0.62 in pathological cases and 1.1 +/- 0.8 in normal ones (p < 0.001). Eighty five per cent of the cardiomyopathic cases were asymmetrical (74/87) and only 15% were considered to be symmetrical (13/87) on M mode study whereas 5% were concentric on 2D echocardiography. By Maron's classification, type I hypertrophy was observed in 6% of cases (4/64), type II in 30% (19/64), type III in 58% (37/64), and type IV in 6% (4/64). Signs of obstruction were looked for and systolic anterior motion of the mitral valve was observed in 52% of pathological cases (45/86) and mid-systolic aortic valve closure in 30% (25/83).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiomyopathy, Hypertrophic↗
PubMed1992

[Spasm of the left main coronary artery resistant to intracoronary vasodilators. Apropos of a case].

Coronary spasm is essentially and angiographic diagnosis. Catheter-induced spasm is frequent during coronary angiography and usually regresses after the administration of intracoronary vasodilators. The authors report a case of coronary spasm with subocclusion of the left main coronary artery: the coronary narrowing remained significant after intracoronary vasodilator therapy, suggesting an organic component. The spasm was relieved only after a prolonged intravenous infusion of isosorbide dinitrate.

Angina Pectoris, Variant↗
PubMed1991

[Retrograde dissection of the common trunk of the left coronary vessel during angioplasty of left anterior descending coronary artery. Apropos of 2 cases].

Acute dissection of the left main coronary artery during coronary angiography or angioplasty is a rare but well known complication; it is attributed to a mechanical trauma caused by the tip of the catheter guide wire. The authors present two cases of dissection at the site of coronary angioplasty with a retrograde extension to the left main stem requiring emergency coronary surgery.

Aged↗
PubMed1990

Preliminary report: follow-up after dynamic cardiomyoplasty.

Five patients were studied 5-13 months after dynamic cardiomyoplasty for refractory heart failure. In two, muscle flap stimulation caused a pronounced increase in cardiac index (mean 55%) and ejection fraction (mean 75%); no patient showed improvement in cardiac filling pressure. 2 years after surgery, one of the patients with haemodynamic improvement died from ventricular fibrillation, and histochemistry of the stimulated muscle flap revealed predominantly fatigue-resistant type I fibres, without evidence of fibrosis. In selected cases, dynamic cardiomyopathy could be of long-term benefit.

Adult↗