Biomedical subjects

M Ghannem

Publications and source records attributed to M Ghannem.

8 recordsLinked to original sources

PubMed1997

[Repolarization anomalies in postoperative ECG after aorto-coronary bypass].

The authors studied 164 patients admitted in 1994 to their rehabilitation centre less than 5 weeks after a coronary artery bypass graft. They performed an ECG on admission and noted the presence and localization of repolarization abnormalities such as a flat or negative T wave as well as the presence of QRS abnormalities, such as conduction disorders or sequelae of necrosis. The abnormalities were compared with the presence and severity of the pericardial reaction on ultrasonography and in the revascularized territories. Two-thirds of patients presented repolarization abnormalities in the anteroseptoapical (ASA) territory, regardless of the intensity of the pericardial reaction. 88% of patients with no QRS abnormalities (75 patients), had an ASA repolarization abnormality. 80% of patients presenting sequelae of isolated inferior necrosis had normal ASA repolarization. The intensity of the pericardial reaction does not determine the presence of postoperative repolarization abnormalities, but rather "myocardial" abnormalities and especially sequelae of inferior necrosis which "normalize" ASA repolarization in 80% of cases, which raises a doubt about the mechanism of these repolarization abnormalities.

Arrhythmias, Cardiac↗

PubMed1997

[Isolated congenital diverticulum of the left ventricle disclosed by ventricular tachycardia in a 72-year-old woman].

A 72-year-old woman presented with poorly tolerated ventricular tachycardia reduced by intravenous amiodarone. The possibility of an ischaemic aetiology led us to perform coronary angiography. The coronary arteries were pathological. Left ventricular angiography revealed limited anterior hypokinesia and a large contractile apical pouch appended to the left ventricle by a long narrow neck. Despite the appearance suggestive of congenital left ventricular diverticulum (contractility, narrow neck) and because of the coexistence of ischaemic heart disease, we preferred to confirm the muscular nature of the diverticulum by myocardial thallium scintigraphy, which showed reversible decreased uptake in the anterior zone related to coronary artery disease, and confirmed the muscular nature of the diverticulum which showed normal thallium uptake. MRI clearly visualized the ventricular ectasia attached by a narrow neck to the rest the left ventricle. This long narrow neck indicated that this muscular diverticulum constituted a congenital diverticulum. The contribution of ultrasonography was limited by a poorly defined point during the examination. This congenital diverticulum, discover during adulthood, and previously asymptomatic, is a rare lesion, in the light of a review of the literature.

Aged↗

PubMed1996

AREVA: multicenter randomized comparison of low-dose versus standard-dose anticoagulation in patients with mechanical prosthetic heart valves.

BACKGROUND: Moderate anticoagulation may be proposed to reduce the risk of hemorrhage for certain patients with a mechanical prosthesis, but the consequences for risk of thromboembolism are debated. METHODS AND RESULTS: The purpose of the AREVA trial was to compare moderate oral anticoagulation (international normalized ratio [INR] of 2.0 to 3.0) with the usual regimen (INR of 3.0 to 4.5) after a single-valve replacement with a mechanical prosthesis, either Omnicarbon or St Jude. Patients included were between 18 and 75 years old, in sinus rhythm, and with a left atrial diameter < or = 50 mm on the time-motion echocardiogram. Patients were randomized for INR after surgery. From 1991 to 1994, 433 patients underwent valve replacement (aortic, 414; mitral, 19) with 353 St Jude and 80 Omnicarbon prostheses; 380 patients were randomized for INR: 188 for INR 2.0 to 3.0 and 192 for INR 3.0 to 4.5. Mean follow-up was 2.2 years (1 to 4 years). Analysis of 18001 INR samples showed that the mean of the median of INR was 2.74 +/- 0.35 in the 2.0 to 3.0 group and 3.21 +/- 0.33 in the 3.0 to 4.5 group (P < .0001). Thromboembolic events, as assessed from clinical data and CT brain scans, occurred in 10 patients in the 2.0 to 3.0 INR group and 9 patients in the 3.0 to 4.5 INR group (P = .78). Hemorrhagic events occurred in 34 patients in the 2.0 to 3.0 INR group and 56 patients in the 3.0 to 4.5 INR group (P < .01), with 13 and 19 major hemorrhagic events, respectively (P = .29). CONCLUSIONS: In selected patients with mechanical prostheses, moderate anticoagulation prevents thromboembolic events as effectively as conventional anticoagulation and reduces the incidence of hemorrhagic events.

Administration, Oral↗

PubMed1996

[Restenosis on coronary endoprosthesis: treatment by implantation of a new endoprosthesis. Apropos of a case].

A 60-year-old man was admitted to hospital with threatened anterior myocardial infarction due to double tight stenosis in the 1st and 2nd segments of the left anterior descending artery. This double stenosis was successfully treated, without any complications, by two Palmatz-Schatz 15.4 mm (PS 154 A) coronary stents. He was readmitted to hospital six months later for another episode of threatened anterior infarction, due to restenosis involving the 2 coronary stents. Balloon angioplasty of this restenosis was attempted, but the poor result led us to insert 2 contiguous articulated Palmatz-Schatz 154 mm stents (PS 154 A) inside the previous two stents. The result was excellent with no complications apart from distal dissection induced by the guide, requiring insertion of an AVE Stent, 8 mm long and 3 mm in diameter. An exercising myocardial scintigraphy performed one month after the procedure was normal. The patient is still asymptomatic with a follow-up of 6 months. The feasibility and low risk of complication of balloon angioplasty in the case of restenosis, after insertion of an intracoronary stent have been demonstrated by several studies. To our knowledge, no case of restenosis of an intracoronary stent, treated by insertion of a new stent, have been reported. We report a case of restenosis on two Palmatz-Schatz stents successfully treated by insertion of two contiguous PS 154 A stents.

Angioplasty, Balloon, Coronary↗

PubMed1995

[Malignant non-Hodgkin lymphoma of cardiac localization. Apropos of a case].

Malignant non-Hodgkin's lymphomas are rare in the absence of human immunodeficiency virus infection and it is exceptional for a cardiac site to be the prominent feature. In our case, the malignant lymphoma was revealed by pericardial effusion in a context of alteration of the general state. Echocardiography revealed a heterogeneous mass in the right atrium and an abundant circumferential pericardial effusion. Thoracic computed tomography allowed local staging and magnetic resonance imaging (MRI) allowed a better definition, than CT scan, of the extension of the tumour into the various cardiac structures. The histological diagnosis was established on biopsy of a mediastinal lymph node. The patient died 7 months after the diagnosis, despite chemotherapy. The authors emphasize the contribution of echocardiography in the diagnosis of cardiac tumours, computed tomography in local staging, and MRI in the analysis of the various cardiac structures.

Heart Neoplasms↗

PubMed1995

[Systemic cholesterol embolism].

The authors report two cases of cholesterol embolism and review the literature on this subject. Cholesterol crystal emboli are very serious complication of atheroma, generally situated in the aorta and usually in patients in their sixties. The frequency of cholesterol embolism is 20% in autopsy studies in this population. The embolic process accounts for the polymorphic clinical feature. Clinical signs are always delayed in relation to triggering factors. The symptoms can sometimes simulate a systemic disease. Cutaneous signs are present in 40 to 75% of cases. Acute renal failure is present in 30% of cases. Other signs may also be observed: alteration of the general state, fever, neurological disorders, pain of the lower limbs, myalgia, gastrointestinal haemorrhage or perforation, ischaemic colitis, pancreatitis, mesenteric or coronary angina. A triggering factor is revealed in 80% of cases: aortic surgery, retrograde aortic catheterization, fibrinolysis or oral anticoagulant treatment. The prognosis is poor due to the clinical context, the patient's age and the absence of any specific treatment. The short-term mortality is 60 to 80% according to various series. The best treatment is prevention: carefully assess the indication for an endovascular procedure in an atheromatous patient; if necessary, perform transoesophageal ultrasonography to evaluate the risk; whenever possible change the incision in vascular investigations or operative procedures in high-risk patients.

Aged↗

PubMed1994

[Complex cardiac lesion diagnosed more than 20 years after the causal injury].

Penetrating wounds of the heart, when not immediately fatal, may give rise to complex lesions associating valvular regurgitations and fistulous connections. The authors report the case of a patient with mitral and aortic regurgitation associated with an aorto-left atrial fistula of traumatic origin and causing invalidating cardiac failure. The interest of this particular case lies in the duration of the interval between the causal trauma and the appearance of symptoms (over 20 years). Complete surgical repair of the lesions provided a good functional result. The authors discuss the different types of lesions which may be caused by wounds of the heart and their modes of presentation.

Aortic Valve Insufficiency↗

PubMed1993

[Anaphylactic reaction with coronary spasm following coronarography].

The authors report a case of anaphylactic shock following the injection of iodinated contrast medium for coronary angiography and complicated by two spasms affecting segments II and III of the right coronary. Vasospasm was relieved by the injection of linsidomine, revealing an angiographically healthy segment III. Such complications associated with various substances, notably iodinated contrast media, are rare. They should nevertheless always be borne in mind when evaluating anaphylactic type reactions. Vasoactive mediators (histamine, serotonin, arachidonic acid metabolites) released by the allergic reaction appear to play a major role. Treatment based upon pathogenesis can be proposed.

Anaphylaxis↗