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Biomedical subjects

P M Jaumin

Publications and source records attributed to P M Jaumin.

8 recordsLinked to original sources
PubMed1979

Cardiac valve replacement in congestive heart failure due to infective endocarditis.

From January 1961 to July 1974, 138 patients underwent cardiac valve replacement because of complications of infective endocarditis. The overall operative mortality was higher in patients with Class IV cardiac functional disability (17%) than in patients with Class III (7%) or II (8%). The mortality for patients who had undergone aortic valve replacement with Class IV disability was higher (22%) than that for patients with Class III (0) or II (6%). When compared with patients without infective endocarditis who had undergone cardiac valve replacement, the operative mortality per valve replacement was approximately the same when the degree of cardiac disability was the same at the time of surgery for both groups of patients. Patients with aortic regurgitant murmurs caused by infective endocarditis should be observed closely for the onset of heart failure, especially during the first month of disease. In patients with aortic or mitral incompetence, if heart failure develops or progresses during the first month, we believe that prompt cardiac valve replacement should be considered, because even heart failure that may initially appear mild often progresses to severe heart failure during this period.

Aortic Valve Insufficiency↗
PubMed1978

Significance of pulmonary input impedance in right ventricular performance.

Right ventricular adaptation to changes in pulmonary input impedance was studied in open-chest dogs. When identical increases in pulmonary vascular resistance are imposed by two different manoeuvres (lung inflation and clamping of the left pulmonary artery), external power and pressure-time integral of the right ventricle at similar filling pressure are always greater during clamping than during inflation. Further studies demonstrate that, at equal increases in pulmonary input impedance modulus at 0 Hz, the clamping produces a greater change in the sum of the first three harmonics of impedance than the inflation (respectively +77% and -10% vs control modulus; -82% and +8% vs control phase). These impedance changes could explain the different behaviour of the right ventricle either by better matching of the ventricular internal impedance or by functional modification of the outflow tract.

Animals↗
PubMed1978

Valve replacement in patients with active infective endocarditis.

Eleven of 138 patients with infective endocarditis (IE) who underwent cardiac valve replacement for IE during a 12 1/2-year period had active IE. Eight of the 11 (all with aortic IE) had positive blood cultures within 48 hours preoperatively; six of the eight had positive Gram stains and cultures of the excised cardiac tissue. All 11 patients had Class IV cardiac functional disability (New York Heart Association classification) at the time of surgery. Staphylococci (three patients with Staphylococcus aureus and one with S. epidermidis) were the most frequent isolates. Three patients died; two of these three deaths occurred in patients who had a sudden onset preoperatively of severe aortic regurgitation and heart failure. In one patient (S. epidermidis infection) prosthetic valve endocarditis developed. Cardiac valve replacement may be performed successfully in patients with active IE even when blood cultures are positive in the immediate perioperative period. The hemodynamic status of patients with IE should be the determining factor in the timing of cardiac valve replacement, rather than the activity of the infection or the length of preoperative antimicrobial therapy. A radical surgical procedure may be necessary in patients with myocardial or aortic abscesses in whom conventional aortic valve replacement is not possible.

Adolescent↗
PubMed1975

Prosthetic valve endocarditis.

From January 1963 until January 1974, 45 patients had prosthetic valve endocarditis. Symptoms of prosthetic valve endocarditis developed within 2 months after operation (early onset) in 16 patients (36%) and more than 2 months after operation (late onset) in 29 patients (64%). Overall mortality among the 45 patients was 56% (88% among those with early onset and 40% among those with late onset). Medical therapy alone was curative in 60% of the surviving patients. Combined medical and surgical therapy was curative in 40% of the survivors. The most frequent isolates in the early-onset group were Staphylococcus aureus (44%) and Gram-negative bacilli (38%); associated mortality was 86% and 83%, respectively. The most frequent isolates in the late-onset group were viridans streptococci (41%) and Gram-negative bacilli (31%); the mortality was 25% and 22% respectively. Suggestions are offered for operative antimicrobial prophylaxis and for medical and surgical treatment of prosthetic valve endocarditis. Prompt surgical replacement of an infected prosthesis is necessary when medical therapy fails.

Bacteria↗
PubMed1975

Cardiac function early after repair of tetralogy of Fallot.

Hemodynamics of 12 patients with tetralogy of Fallot were monitored during the first 72 hours after surgical repair. Total immediate repair in 5 patients was followed after 24 hours by a greater decrease in cardiac index than that observed in the group of 4 patients with previous palliative shunt (minus 25 plus or minus 6 vs. minus 1 plus or minus 7 per cent, p smaller than 0.025). This difference disappeared after 48 hours, and the short-term follow-up periods of these two groups were equally smooth. Six patients with pulmonary stenosis requiring the placement of an outflow patch had higher right ventricular filling pressures (after 24 hours 13.8 vs. 10.8 mm. Hg, p smaller than 0.025; 2 to 4 weeks later 9.6 vs. 5.5 mm. Hg, p smaller than 0.05), suggestive of a persistent right ventricular depression. This ventricular depression must be attributed to the induced pulmonary insufficiency and to the presence of akinetic areas. Both these factors should therefore be carefully minimized during the surgical procedure.

Adolescent↗
PubMed1974

Circulatory effects of deep inspirations, blocked expirations and positive pressure inflations at equal transpulmonary pressures in conscious dogs.

1. Circulatory effects of deep inspirations, blocked expirations and constant endotracheal positive pressure inflations were studied in six conscious dogs under comparable geometries of the pulmonary vascular bed, i.e. at equal transpulmonary pressures (around 10.2 cm H(2)O) and similar lung volumes.2. In order to characterize these effects, we measured beat-by-beat left and right ventricular ejections, pulmonary arterial, left atrial and aortic mean transmural pressures, and concomitant intrathoracic and tracheal pressures. Changes in pulmonary-left heart blood volume were also computed.3. During inspiration when intrathoracic pressure became more negative, there was a slight increase in right ventricular output (+15%; P < 0.1) and always a net decrease in left ventricular output (-25%; P < 0.01) despite a significant increase in mean transmural left atrial pressure (+3 cm H(2)O, i.e. +40%; P < 0.005). It is concluded that the more negative intrathoracic pressure increases the left ventricular outflow impedance and that an inspiratory increase in pulmonary vascular capacity cannot explain the observed reduction in left ventricular output since this reduction occurs together with an increase in left ventricular filling pressure.4. During blocked expiration when intrathoracic pressure was positive, decreases in right ventricular output (-17%; P < 0.05) and in pulmonary-left heart blood volume (-12 ml.; P < 0.05) were observed while right ventricular outflow impedance increased. After an initial augmentation in left ventricular output (despite a concomitant progressive decrease in mean transmural left atrial pressure), left ventricular output also decreased (-17%; P < 0.05). Such circulatory changes were similar but less marked than those observed under constant positive pressure inflations. These observations suggest that the decrease in venous return (and consequently in right ventricular output) following the increase in intrathoracic pressure is the leading factor which overshadows the augmentation in left ventricular output associated with the simultaneous decrease in left ventricular outflow impedance.5. Similar experiments performed on two additional dogs in acute conditions showed the same circulatory effects before and after pharmacological blockade. These observations therefore confirm that mechanical factors play a leading part during these respiratory manoeuvres.

Animals↗