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N Curien

Publications and source records attributed to N Curien.

7 recordsLinked to original sources
PubMed1983

Myocardial map derived from two-dimensional echocardiography: reproducible and standardized description of infarction topographies.

The aim of this study was to improve the reproducibility and the standardization of the topographical assessment of myocardial infarctions in routine two-dimensional echocardiography. A myocardial map of the left ventricle was derived from a necropsy study of normal human hearts; interventricular grooves and papillary muscles were used as anatomical landmarks defining 16 segments with similar planimetered surfaces. A reporting sheet was prepared, with diagrams of standardized echo sections and with a map showing the position of the corresponding outlines. The echocardiographic method consisted in identifying on each section the regions without systolic thickening, and displaying the results on the map, until a coherent picture of the abnormal areas was obtained. Interobserver reproducibility was studied in 50 consecutive patients with prior myocardial infarction; segments were classified as fully abnormal, partly abnormal, non-visualized, and normal. Among the 800 segments there were 1% severe and 12% moderate discrepancies; discrepancies were significantly lower for segments with confrontation in two different sections intersecting on the map. A classification of infarction topographies was obtained in 100 consecutive patients; it was compared with the data of two reanalysable pathologic series from the literature; a similar presentation of the results showed similar typical patterns of myocardial involvement, for which a nomenclature was proposed. A myocardial map may be used to provide a simple and reproducible description of infarction topographies; the results obtained lead us to recommend an echocardiographic standardization of ventricular segmentation and of nomenclature of infarction topographies, similar to that of pathological studies.

Echocardiography↗
PubMed1982

[Surgery of truncus arteriosus in the first 2 years of life. Analysis of a consecutive series of 22 patients].

At the Laennec Hospital in Paris, between 1976 and 1980 twenty-two children with Truncus Arteriosus Communis (TAC) underwent primary total repair during the first twenty-four months of life, according to the technique described by McGoon in 1968. All infants operated before the age of three months (group A: 7 patients) were in severe cardiac insufficiency with respiratory distress. Eleven patients (group B) were electively operated between four and nine months of age. Only four patients (group C) underwent surgical treatment after twelve months and before twenty-four months of age. The hospital mortality was very high in group A, because of the severity of the preoperative conditions. In three patients who underwent total repair at eight and eighteen months of age respectively, irreversible pulmonary hypertension (stage IV according to Edwards classification) was the cause of death. In our experience, severe postoperative myocardial ischemia was often associated with complete atrio-ventricular block (BAV): the possible causes are discussed. Furthermore, all patients, to a variable extent, had some manifestations of left ventricular (LV) insufficiency, which was always reversible after medical treatment. For several days, almost systematically, mechanical ventilation is necessary after a total repair of TAC. The result in the nine surviving patients is excellent: they had a strictly normal life, without any therapy. In conclusion, we believe that elective surgery for TAC can be performed more safely between six and nine months of age: if medical treatment cannot control heart failure, surgery must be performed urgently in order to avoid severe ventilatory disturbances. After twelve months of age, total repair is performed only if a pulmonary biopsy confirms the possibility of regression of the pulmonary vascular lesions.

Age Factors↗
PubMed1981

Influence of positive end-expiratory pressure on left ventricular performance.

Although left ventricular dysfunction is common during ventilatory support with positive end-expiratory pressure (PEEP), the mechanism of this disorder remains unclear. In 10 patients with the adult respiratory-distress syndrome we studied the effects of a stepwise increase in PEEP from 0.to 30 cm H2O on left ventricular output, intracardiac transmural pressures, and two-dimensional echocardiographic measurements of left ventricular cross-sectional area at end-systole and at end-diastole. Increasing PEEP was associated with progressive declines in cardiac output, mean blood pressure, and left ventricular dimensions and with equalization of right and left ventricular filling pressures. The radius of septal curvature decreased at both end-diastole and end-systole, implying a leftward shift of the interventricular septum. At the highest PEEP, blood-volume expansion did not restore cardiac output, although left ventricular transmural filling pressures had returned to base-line values. We conclude that decreased cardiac output during PEEP is mediated by a leftward displacement of the interventricular septum, which restricts left ventricular filling.

Blood Pressure↗
PubMed1978

[Indices of left venticular performance and evaluation myocardial quality in mitral valve insufficiency, chronic aortic valve insufficiency and stenosis].

132 patients with pure mono-valvular cardiopathies (mitral incompetence, aortic stenosis and aortic incompetence) were classified into two groups according to the values of the systolic work index/myocardial mass ratio (SWI/MLV). Normal values of the ejection function (EF) and mean velocity of circumferential fibre shortening (VCF) for each cardiopathy were so obtained. Only patients with aortic stenosis of group I (SWI/MLV greater than or equal to 0.75 gm . g-1) had normal EF. All the other patients had EF and VCF values below normal although this did not always imply impaired myocardial function. Therefore the myocardial mass should also be considered in the evaluation of myocardial function and it would seem desirable to take this parameter into account in the management of these patients.

Adult↗