[Embolic infarction in the anterior cerebral artery in a patient with aneurysm of the interatrial septum].
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Aged↗
Biomedical subjects
P Durandet
Publications and source records attributed to P Durandet.
Ventricular arrhythmia revealing mitochondrial myopathy in a 69-year-old woman.
We report a case of mitochondrial myopathy (MM), assessed by histological and biochemical studies. This illness was diagnosed in a 69-year-old patient with myocardiopathy revealed by ventricular arrhythmias. The originality of this case lies in the patient's age, the mode of onset and the biochemical features (i.e. normal mitochondrial enzymatic complexes but very low respiration when using glutamate as a substrate).
Aged↗
'White coat' hypertension. No harm for the heart.
The superiority of ambulatory blood pressure monitoring over casual blood pressure measurement for the prediction of target-organ damage is now well established, although the significance of "white coat" hypertension is still controversial. Is an office blood pressure measurement that is higher than the mean ambulatory value an added risk? Because left ventricular hypertrophy is a potent risk factor, the effect of hypertension on left ventricular mass merits attention. Left ventricular mass indexed for height was measured by M-mode echocardiography in 204 essential hypertensive patients (140 males, 64 females; mean age [SD], 50 [11] years). Blood pressure over 24 hours was monitored routinely with a noninvasive auscultatory device. Office blood pressure after 10 minutes of the subject in the supine position was measured by the same physician under the same conditions. The white coat effect was defined as the difference between the office and average daytime values of systolic and diastolic blood pressures. Patients were divided into four quartiles according to their office and daytime blood pressures. Two-way analysis of variance was used to assess the influence of the white coat effect at a given level of daytime blood pressure on left ventricular mass. Left ventricular mass increased significantly (P < .001) with daytime systolic blood pressure but was independent of white coat effect for both the whole population and the 143 untreated patients. We conclude that the white coat effect has no influence on left ventricular mass, favoring the view that white coat hypertension is a benign condition.
Adolescent↗
[Diagnostic contribution of transesophageal echocardiography in infectious endocarditis. Apropos of 101 cases].
One hundred and one consecutive patients with infectious endocarditis were examined by transthoracic (TTE) and transoesophageal echocardiography (TEE). There were 71 cases of endocarditis on native valves (N) and 30 cases of endocarditis on prosthetic valves (P). The detection of vegetations was significantly greater by TEE (93%), than by TEE (73%) on native valves but the rate of detection of endocarditis on prosthetic valves was low and identical with both methods. Out of a total of 18 abscesses, only 6 were detected by TEE compared with 15 by TEE. There were 3 false negative results by TEE: small anterior abscesses marked by the prosthesis or aortic calcifications. In addition, TEE demonstrated 3 perforations and 2 mycotic aneurysms of the mitral valve. The lesions were confirmed anatomically in 48 cases. The sensitivity of TEE was 94% and the specificity was 84.5%; the negative predictive value was 87.5%. These results show that TEE is significantly superior in the detection and morphological analysis of vegetations. It is the method of choice for the diagnosis of abscesses, especially in prosthetic valve endocarditis.
Adolescent↗
[Relative value of attenuation and negativation of systolic pulmonary venous flow in severe mitral insufficiency. Transesophageal echocardiographic study].
The aim of this study was to analyse the velocity profile of the systolic fraction of the pulmonary venous flow (PVF) in mitral regurgitation (MR). Three velocity profiles were identified in left superior pulmonary vein. Inversion of the systolic fraction of the PVF was specific for angiographic grade 4 MR (specificity 97%, sensitivity 100%). On the other hand, a decrease in this wave is much less specific for mild MR and depends on severe factors such as left atrial pressure, size and ejection fraction and the lack of atrial systole (as in atrial fibrillation or atrioventricular block). Therefore, inversion of PVF has a good positive predictive value for severe MR, but the interpretation of attenuation of this wave should take into consideration not only the MR but also left atrial pressure and compliance.
Blood Flow Velocity↗
[Diagnosis of abnormal intra-atrial echoes. Contribution of transesophageal echocardiography].
The aim of this study was to evaluate the results of transesophageal echocardiography in the diagnosis of abnormal intraatrial echoes detected by transthoracic echocardiography. Patients with active endocarditis, mitral stenosis, and valve prostheses were excluded. The 47 patients (28 women and 19 men) were classified into 4 groups according to the results of transesophageal echocardiography. Group I: normal (7 cases), "phantom echos"; Group II: anatomical variants (9 cases), Chiari apparatus, muscular spur; Group III: pseudo-tumours (7 cases); retro-atrial haematoma, mitral valve prolapse, interatrial septal aneurysm; Group IV: cardiac masses (24 cases). This group comprises: typical myxomas (10 cases), typical thrombi (2 cases), localised atypical masses, relatively immobile and non-prolapsing: 5 myxomas, 1 metastasis, 2 thrombi. The results of this study suggest that transesophageal echocardiography is very useful in diagnosing suspected abnormal intraatrial echos observed on conventional transthoracic examination. However, the nature of the mass may remain obscure.
Adult↗
[Cardiac compression by a large thymic cyst. Apropos of a case, review of the literature].
Thymic cysts are rare and almost always asymptomatic. The authors report the case of a 45 year old woman with a thymic cyst diagnosed after recurrent right sided heart failure resulting in signs suggestive of adiastole, regressing after "pleural" (mainly cystic) aspiration and diuretic therapy without any morphological or functional changes on Doppler echocardiography. This report concerns a rare tumour, with an exceptional volume (2 litres) extending down the cardiac borders and causing cardiac compression. It illustrates the diagnostic difficulty of a pathology with an unusual clinical presentation, despite complementary investigations including CT scan and MRI, very sensitive in this type of problem. A complete cure was obtained by total surgical ablation.
Adult↗
[Coronary disease and peripheral arterial disease: contribution of echo-Doppler in the study of the arteries of the neck and lower limbs before the age of 60. Apropos of 76 cases].
Echo-duplex exploration of heart and inferior limbs arteries is performed in 76 patients less than 60 years old, with angiographically established coronary heart disease. Peripheral vascular lesions are found in 15 cases (20%), they are more frequent in patients with tritrunkular coronary disease (35%) than in those with one (16%) or two-vessel lesions (10%). Mean encephalic circulatory resistance index is higher in patients with tritrunkular lesions (p less than 0.03). Vascular echo-duplex should be performed in case of coronary disease in order to avoid catheterism complications and to purpose combined surgical procedure (coronary bypass and carotid endarterectomy).
Adult↗
[Transesophageal echocardiography: a new view of the heart].
Transoesophageal echocardiography is a simple technique which is now the object of a growing and well-deserved interest, due to the wealth of information it provides. This examination does not supersede the conventional transthoracic echocardiography, but it completes it by supplying more accurate data, especially in difficult clinical cases, such as mitral valve pathology, cardiac valve prostheses, intracardiac thrombosis, aortic dissection and septal abnormalities.
Echocardiography↗
[Morphological and functional characteristics of the heart in untreated hypertension].
UNLABELLED: To better define the different forms of hypertensive heart disease, we performed 2D guided M mode echo recording of the left ventricle (LV) and Doppler assessment of LV filling in 118 newly recognised (less than 1 year) and untreated hypertensive patients (mean age +/- SD: 49 +/- 10 years, 80 males, 38 females). All recordings were read "blindly". 86 patients underwent also 24 hours BP monitoring during daily routine. MAIN RESULTS: 1) The relative wall thickness (h/r) shows a normal distribution: mean = 0.39; SD = 0.08; 1st quartile = 0.33; 3rd = 0.43; 2) The septal/posterior wall ratio (ST/PWT) shows also a normal distribution: mean = 1.14; SD = 0.24; 1st quartile = 1; 3rd = 1.3; 3) Among patients with LVH (Devereux's criteria, n = 65) the 6 patients with h/r less than or equal to 0.33 are significantly different from the 18 patients with h/r greater than or equal to 0.43 for age (44 +/- 8 vs 51 +/- 10; p less than 0.03), casual (146 +/- 7 vs 166 +/- 13 mmHg; p less than 0.05) and ambulatory SBP (135 +/- 19 vs 146 +/- 16 mmHg; p less than 0.05), peak systolic stress (280 +/- 15 vs 187 +/- 31 Dynes/cm2; p less than 0.001) and E/A ratio (1.17 +/- 0.01 vs 0.94 +/- 0.27; p less than 0.05) but not for ponderal excess. 4) Patients with asymmetric LVH(ST/PWT greater than 1.3 in 22; greater than 1.5 in 10) are significantly different from patients with symmetric LVH for age (54 +/- 10 vs 47 +/- 10; p less than 0.03), diastolic diameter (51 +/- 5 vs 53 +/- 5 mm; p less than 0.02), ST (13.2 +/- 2.9 vs 10 +/- 1.9 mm; p less than 0.001) and PWT (8.9 +/- 1.5 vs 9.7 +/- 1.5 mm; p less than 0.02) but not for BP fractional shortening and LV filling. CONCLUSION: eccentric LVH may be found in young hypertensive patients with normal systolic function and LV filling despite high parietal stress; asymmetric LVH is more frequent in older patients in which LVH seems to develop rather on the septum than on free wall, independently of BP and without consequences on LV function.
Adult↗
[Effect of sotalol on left ventricular mass and function in the hypertensive patient].
The effects of 6 months treatment with Sotalol on the blood pressure, left ventricular mass and function, were studied in patients with essential hypertension and left ventricular hypertrophy. Thirty-three patients (18 men and 15 women aged 53 +/- 11 years) were included initially and 26 were reviewed after 6 months of treatment. The left ventricular mass and function were evaluated by Doppler echocardiography and all recordings were interpreted "blind" at the end of the study by two operators. Treatment led to a significant reduction of the blood pressure (152 +/- 12/94 +/- 11 versus 166 +/- 18/100 +/- 9 mmHg) and of the heart rate (60 +/- 10 versus 76 +/- 12 beats per minute). The left ventricular mass index decreased by 8% (p less than 0.001) due to reduction in wall thickness. Resting left ventricular systolic function was unchanged. Left ventricular filling patterns improved with an increase in the E/A ratio which was reduced at the beginning of the trial.
Adult↗
[Acute aortic dissecting: contribution of transesophageal echography. Apropos of 10 cases].
The diagnostic value of combined transthoracic (TTE) and transesophageal echocardiography (TEE) was evaluated in 10 consecutive patients with acute dissecting aneurysm of the aorta and compared to aortography (10 cases) and computed tomography (7 cases). TEE seems to be highly superior to TTE because the intimal flap in always seen (versus 4 of the 10 TTEs) and the descending aorta and the entry site are better visualized. TEE is superior to X-ray computed tomography because it shows the direction of the flow in the false lumen (an advantage of a color Doppler), the entry site and aortic regurgitation. In spite of false-positives (1/10), TEE seems to be at least as good as aortography, the most reliable, but highly invasive, technique available. Thus, transesophageal echocardiography, performed at the patient's bedside, appears to be a promising non-invasive tool for diagnosing suspected dissecting aneurysms of the aorta.
Acute Disease↗
[Two-dimensional echocardiography in the diagnosis of intracardiac metastases].
The authors describe the echocardiographic features of 19 cases of intracardiac metastatic tumours diagnosed over a 5-year period. The cardiac appearances were very varied: pericardial effusion alone or associated with an intrapericardial tumour (9 cases), myocardial infiltration (9 cases), immobile or mobile intracavitary tumour sometimes simulating a myxoma (15 cases). In 18 out of the 19 cases, the tumour mass was hyperechogenic which made it easy to diagnose. However, in one case of right atrial tumour, the mass was hypoechogenic and the diagnosis could only be made by contrast echocardiography. This study illustrates the important role that two-dimensional echocardiography plays in the non-invasive diagnosis of intracardiac metastatic tumours but physicians should be aware of the potential pitfalls and limitations of the technique.
Aged↗
[Prognostic value of arterial pressure during exertion in hypertensive subjects].
UNLABELLED: We reviewed the course of 240 patients with uncomplicated essential hypertension whose condition has been initially evaluated between january 1976 and february 1979 with both exercise (bicycle) and casual BP. Their outcome was evaluated in the first months of 1988. Thirty-eight patients were lost to follow up. The remaining 202 patients (67 p. 100 males, mean age at entry 43 +/- 13 years, mean casual BP at entry 161 +/- 25/98 +/- 15) had a mean follow-up of 9.5 +/- 2 years. Events retained for the analysis were myocardial infarction (n = 12), angina pectoris with positive coronarography (n = 8), stroke (n = 8), cardiac failure (n = 2) and sudden death (n = 3). We performed a stepwise discriminant analysis first with only casual and end exercise systolic and diastolic BP, then after introducing age, overweight (Lorentz's formula), duration of hypertension, Sokoloff index and cholesterolemia. RESULTS: the analysis with only BP shown that end exercise BP was the best predictor of outcome with 64 p. 100 of the subjects correctly classified (CC). After introducing the other risk factors, the significantly discriminant variables were 1) overweight (65 p. 100 CC) 2) age, 3) end exercise systolic BP, 4) cholesterolemia. These 4 variables adequately classified 70 p. 100 of the subjects. Another analysis was performed in patients with maximal exercise test and gave the following results: 1) overweight, 2) cholesterolemia, 3) end exercise systolic BP with 77 p. 100 patients CC. In women, the pronostic value of exercise BP seems less important than in men.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Beta blocking drugs in chronic obstructive bronchopneumopathies].
UNLABELLED: The respiratory tolerance can limit the use of beta-blocker medication (beta-) currently indicated in numerous clinical situations, both cardiovascular and also neurological and ophthalmological. Blockade of beta adrenergic receptors is without risk in subjects free of bronchial pathology, but may destabilize underlying airflow obstruction; either presenting as or sustaining bronchospasm in an asthmatic, and increasing bronchial obstruction, in patients suffering from chronic airflow obstruction (BPCO). Now BPCO, and in particular asthma, are easily associated with diseases for which beta- are indicated. In addition the notion of cardioselectivity is relative and dose dependent. IN PRACTICE: beta- are contraindicated in chronic airflow obstruction with bronchial hyper-reactivity; in other cases, beta- should be used carefully choosing the most cardioselective products at the lowest effective dose. Whatever the route of administration (in particular eye drops), the beta- are reliable to produce the same harmful effects. There should be strict follow up of treatment and a watch kept for signs of a worsening or a provocation of respiratory problems; conversely the occurrence of such symptomatology in a patient with bronchial pathology should call into question the place of beta-. Finally beta- should be avoided in allergic subjects and (a fortiori) in specific immunotherapy where there is a possibility of anaphylactic shock.
Adrenergic beta-Antagonists↗
[Circulating lupus coagulation inhibitor in two sisters, one with disseminated lupus erythematosus and the other with immunologic thrombocytopenic purpura].
Familial cases of lupus anticoagulant were rarely described. We report the observation of two sisters with lupus anticoagulant, one with thrombocytopenic purpura and the other with systemic lupus erythematosus.
Adult↗