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Biomedical subjects

R Grolleau

Publications and source records attributed to R Grolleau.

At least 19 recordsLinked to original sources
PubMed1992

[Evaluation of the size of thrombolysed myocardial infarction by serum myosin determination].

The prognosis of myocardial infarction is very dependent on the size of the infarct. The measurement of the infarct size after thrombolysis remains difficult despite the large number of methods available, all of which have drawbacks. This parameter is however essential to assess prognosis and the efficacy of thrombolytic therapy. Serum beta heavy chain myosin determination is a recently introduced method of evaluating infarct size; there are relatively few published studies, especially concerning post-thrombolytic patients. A prospective study was undertaken in 40 patients (37 men and 3 women: average age 55.6 years) with a primary myocardial infarction treated by thrombolysis. Myosin levels (peak and area under curve of 5 samples in 10 days) were compared with other methods of assessing infarct size: electrocardiogram (number of leads with Q waves, ST segment analysis), cardiac enzymes (peak and release integrals of CK abd LDH), contrast ventriculography (segmental asynergy score, ejection fraction), coronary angiography and resting MIBI myocardial scintigraphy. The peak and integral of myosin release correlated well with the other methods (p < 0.01): a correlation was particularly apparent between the integral of myosin release and MIBI scintigraphy scores (r = 0.77, p < 0.001). Complex myosin release kinetics were observed significantly more often in patients with large infarcts (p < 0.01) or in those with occlusion of the artery responsible for infarction at coronary angiography on the 6th day (p = 0.001). In conclusion, with 5 blood samples over a 10 day period, it is possible to estimate the infarct size after thrombolysis in everyday cardiological practice: this method could help identify high risk subjects (complex kinetics of myosin release and high peak myosin levels) and also could be used to assess efficacy of thrombolytic therapy in large scale trials.

Adult↗
PubMed1992

[Electrocardiography of atrioventricular block].

A functional physiological block protects the ventricles from the risks of excessively rapid atrial rhythms. Pathological AVB is classified in three degrees according to whether the ventricular excitation is delayed, intermittent or absent. The site of AVB can be accurately determined by endocavitary electrophysiological studies but can also be estimated from the surface electrocardiographic recordings. fundamental research has questioned the sle responsibility of conduction defects in Wenckebach and paroxysmal blocks: they suggest the presence of abnormalities of excitability in pathological zones.

Bradycardia↗
PubMed1991

[Coronary revascularization by long endarterectomy and reconstruction].

Endarterectomy and reconstruction of the coronary arteries is a technique for patients with diffuse coronary disease and in whom coronary bypass grafting is contraindicated. In a serie of 418 patients undergoing coronary bypass between May 1988 and April 1990, 55 had endarterectomy and reconstruction of a coronary artery. The mean age was 62.2 years (44-80 years). Twenty-five patients had class III (NYHA) angina and 30 had class IV angina. On the coronary angiogram, 10 patients had double-vessel disease and 45 had triple vessel disease. Endarterectomy and reconstruction were performed on one coronary artery in 53 patients and on two coronary arteries in 2 patients. At mean of 2.6 grafts per patient were performed. Four patients died during the perioperative period. Ten had a perioperative myocardial infarction. No other complications were noted. No residual postoperative angina was present. Five patients had a follow-up angiogram during the first postoperative month. All grafts were patent and correctly revascularised the endarterectomised artery and branches. These satisfactory preliminary results suggest that endarterectomy and reconstruction of the coronary arteries is a reliable and reproducible technique for coronary grafting. It is indicated in patients with diffuse atheromatous coronary disease who were previously not considered for surgery.

Adult↗
PubMed1990

Assay of serum cardiac myosin heavy chain fragments in patients with acute myocardial infarction: determination of infarct size and long-term follow-up.

To evaluate the correlation between myosin heavy chain release and the necrosis mass, serum levels of myosin heavy chain fragments were determined serially in 55 patients with acute myocardial infarction. Eight of these patients were successfully treated with thrombolytic agents: the others were not treated. The same myosin titration was applied to the sera of 25 dogs with an experimental myocardial infarction. Six of the dogs were successfully treated with thrombolytic agents. The time courses of the myosin concentrations are typical and monophasic for all patients with a noncomplex myocardial infarction. The values for the kinetic parameters of myosin release are comparable to those previously reported. We have now determined that cumulative myosin release significantly correlates with cumulative creatine kinase (CK), CK-MB, and lactate dehydrogenase release, as well as with thallium-201 distribution, as determined for different patient groups. Thrombolytic treatment does not seem to qualitatively upset myosin kinetics. The results obtained in dogs with or without thrombolysis conclusively indicate that myosin release is a quantitative index of the necrosis mass. From a practical point of view, a few serial determinations of serum levels of myosin heavy chains are enough to estimate the necrosed mass in patients with acute myocardial infarction. More generally, serum myosin titration could be useful in detecting any cardiac disturbance involving myocardial injury resulting in membrane leakage of cardiac cells.

Adult↗
PubMed1990

[Myocardial infarction and anti-ethinylestradiol antibody. Apropos of a case in an 18-year-old woman].

An 18-year-old woman presented with a large anterior myocardial infarction. Her cardiovascular risk factors were cigarette smoking in moderation and oral contraception with a synthetic oestroprogestative pill prescribed a few months previously. Coronary angiography showed occlusion of the left anterior descending artery but no other lesions. Biological investigations excluded an abnormality of coagulation. Antibodies to synthetic steroids (ethinylestradiol and progesterone) and circulating immune complexes were found in the serum. The role of antiethinylestradiol antibodies in the mechanism of myocardial infarction is discussed. These antibodies are present in 30 per cent of women taking oral contraceptives and their titres are significantly higher in 90 per cent of women who develop vascular thrombosis unrelated to atherosclerosis. The mechanism of the thrombogenic action of the antibodies and circulating immune complexes is also considered.

Adolescent↗
PubMed1990

[Myocardial morphological changes related to sodium intake in normotensive and hypertensive patients never treated before].

Several factors have been implicated in the pathogenesis of myocardial hypertrophy, and the role of sodium has recently been suggested. In the present study, we assessed the influence of dietary sodium on the degree of left ventricular hypertrophy (LVH) and LV structure in 30 normotensive (NT) subjects aged 34 +/- 11 years (mean +/- SD) and 50 patients (39 +/- 10 years) with mild essential hypertension EH (canal blood pressure 154 +/- 16/96 +/- 11 mmHg), who had never received antihypertensive drugs. Posterior wall thickness (PWT) and left ventricular mass (LVM) were measured by M-mode echocardiography and urinary sodium excretion (UNa, mmol/24h) was taken as an index of sodium intake. In NT and EH, LVM was directly correlated with UNa (r = 0.48 and 0.49; p less than 0.006 and 0.002, respectively). A stepwise multiple regression analysis confirmed that UNa was a determinant of LVM independently of sex, age, and body weight in the two groups. In NT the correlation with UNaV was the result of an increase of the end-diastolic diameter without change in PWT whilst in EH it was the consequence of an increase in wall thickness (R = 0.49, p less than 0.0001) without a modification of LV diameter. These results suggest that salt intake may be an important determinant of cardiac structural adaptation in both NT and EH subjects; however, only EH have a salt sensitive LV wall hypertrophy.

Adult↗
PubMed1979

[Automatic activity of the pre-excitation pathways].

The possibility of preexcitation pathways exhibiting automatic activity was demonstrated in 3 cases: in two cases electrophysiological studies supported this diagnosis which was confirmed in the third case by histological examination of the preexcitation pathway. During sinus node dysfunction, spontaneous or induced (by rapid right atrial pacing or by a reciprocating tachycardia), the substitute rhythm arose from the Kent Bundle either transiently or for a longer period: rhythms arising from the Kent Bundle can only be diagnosed after eliminating the possibility of an atrioventricular junctional rhythm conducted to the ventricles by Mahaïm fibres.

Adult↗
PubMed1979

[1st degree and 2nd degree blocks (Wenckebach type) during right ventricular stimulation in the course of Prinzmetal's angina].

Right axial deviation and delay between stimulation and ventricular response was observed during pacing of the apex of the right ventricle in Prinzmetal angina. The degree of deformation of the ventricular complex and the length of this delay appear to be related to the severity of the anginan, the length of the preceding diastolic period and the amplitude of stimulation. This observation demonstrates the presence of conduction defects at the heart of ischaemic myocardium and may explain the failure of prophylactic pacing in Prinzmetal angina complicated by paroxysmal atrioventricular block.

Aged↗
PubMed1979

[Improvement and normalisation of the QRS complex by stimulation of the bundle of His in complete left branch block].

The asynchronism of ventricular activation resulting from a major degree of left bundle branch block (QRS greater than or equal to 0.12 s) may be suppressed by stimulation of the distal portion of the His Bundle, whether the block be intermittent (3 cases) or permanent (17 cases). The selective stimulation of the His Bundle normalises ventricular depolarisation whilst non-selective stimulation narrows the QRS complex by the fusion of the activation wave fronts from the His Bundle and the interventricular septum. The reestablishment of synchronous ventricular conduction by His Bundle stimulation is generally interpreted as a sign of longitudinal dissociation in the proximal portion of the His Bundle. This results does not, however, exclude the possibility of a very localised lesion at the origin of the left bundle, responsible for a conduction delay, and suppressed by stimulation carried out close to the zone of block (summation effect, electrotonic influence).

Adult↗
PubMed1979

[Spontaneous blocks by intra-atrial conduction disorders of reciprocating atrioventricular rates using a Kent's bundle].

Paroxysmal tachycardia in Type A Wolff-Parkinson-White syndrome was due to a reciprocating rhythm involving a left lateral Kent Bundle in the retrograde direction. Spontaneous interruption of the reentry resulted not from block in the normal or accessory atrioventricular pathways but from an intraatrial conduction defect: delay in conduction between the left and right atria on intraatrial reentry terminated the tachycardia.

Adult↗
PubMed1979

[Physiopathology of coronary stenosis].

The blood and oxygen needs of the heart are considerable. At rest, the left ventricle uses twenty times as much oxygen as skeletal muscle and on effort its consumption is five times greater again. The level of extraction of oxygen from coronary blood by the myocardium is very high at rest and thus can only increase by limited amounts on effort. Coronary venous blood is the most desaturated in the body. Furthermore, the anaerobic capacity of the heart is limited. As a result, the increased oxygen needs of the heart on effort can be dealt with only an increase in coronary flow. There is in fact a balance between myocardial oxygen supply and needs.

Arterial Occlusive Diseases↗
PubMed1977

[Negative retrograde P wave in D1, sign of left postero-lateral Kent bundle].

A negative P wave in D1 with a mean atrial vector which is horizontal or descending in the frontal plane, occurring during paroxysmal tachycardial due to reciprocal rhythm or after ventricular stimulation suggests atrial depolarisation which starts in the left auricle at some distance from the A-V node and near the pulmonary veins. In the absence of an external anterograde ventricular pre-excitation, such P waves may indicate the presence of a hidden bundle of Kent posterolaterally on the left, allowing retrograde conduction during the tachycardia by a reciprocal rhythm.

Electrocardiography↗
PubMed1977

[Corrected transposition of the great vessels and preexcitation syndrome (apropos of 2 cases)].

Two cases with treated transposition of the great vessels and incompetence of the left atrioventricular valve showed a type B preexcitation syndrome. In one case, this consisted of a typical W.P.W. syndrome in which the second PR interval was not shortened, but rather consisted of a delta wave and a widened QRS complex. Post mortem examination showed an abnormal connection between the bundle of His and the ventricular septum, and a low insertion of the inverted tricuspid valve. The published cases of W.P.W. syndrome in cases with treated transposition are reviewed, and the mechanism of preexciation discussed in the light of the anatomical peculiarities of the malformation and of the abnormalities which are a feature of Ebstein's syndrome.

Child↗