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Biomedical subjects

R Nottin

Publications and source records attributed to R Nottin.

At least 37 records · Page 2Linked to original sources
PubMed1989

Combined ascending aorta rupture and left main bronchus disruption from blunt chest trauma.

After blunt chest trauma, early diagnosis of associated bronchial, vascular, and esophageal injuries must be attempted, as those lesions may be produced by the same mechanism. We report a case of successful management of associated bronchial transection and injury of the ascending aorta. Aortic repair required cardiopulmonary bypass and the use of prosthetic materials, although gross contamination of the mediastinum from the bronchial disruption is a theoretical contraindication to such a procedure. A separate approach to the vascular and airway injuries allowed successful management of both lesions.

Adult↗
PubMed1989

Electrical activity of human atrial fibres at frequencies corresponding to atrial flutter.

Little information is available about rate dependent changes in electrical activity of human myocardial cells. We therefore studied, in vitro, the electrical activity of adult human atrial fibres driven at frequencies near that of atrial flutter by means of the standard microelectrode technique. Thirty two atrial samples exhibiting "normal" responses with fast upstroke were selected. At very high frequencies, the action potential (AP) upstroke arose from the repolarisation phase of the preceding AP in spite of marked frequency induced shortening of the plateau. As the stimulation rate was progressively increased, the take off potential (TOP) was less and less negative and the maximal rate of depolarisation (Vmax) decreased. Moreover, in most preparations, a clear alternation between two types of action potentials occurred. Calcium channel inhibitors cobalt (5 mM) or diltiazem (5 x 10(-6) M) shortened AP duration, increased Vmax and markedly reduced alternation. Sodium channel inhibitors, tetrodotoxin (7.5 10(-6) M) or lignocaine (10(-5) M) shortened AP duration and induced a transient increase in Vmax. Ouabain (10(-6) M) prolonged AP duration, decreased Vmax, enhanced alternation and finally suppressed the 1:1 capture of the atrial tissue. Our results show that, at high driving rates corresponding to the frequencies of atrial flutter, slight variations in action potential duration induced by drugs are associated with marked concomitant variations in Vmax and probably with consequent modifications of the conduction velocity.

Action Potentials↗
PubMed1989

[Desinsertions of aortic valve prostheses treated by subcoronary implantation of the valve].

Thirteen patients requiring emergency surgery for desinsertion of their aortic valve prostheses were treated by subcoronary aortic valve grafting, using a procedure based on Danielson's method. The particularity characterizing this technique consists in obtaining direct revascularization of the left coronary artery via a coronary sinus approach, thereby reducing the complexity of the surgical operation. All the patients presented valvular ring lesions, associated with aortic root degeneration accountable for failure of conventional artificial aortic valve replacements; in 8 patients, this had been their third aortic prosthetic surgery. The mean survival period for eight patients was 44 months. Considering the highly critical aspect of such lesions, this technique apparently constitutes a working solution, barring all chances for relapse.

Adult↗
PubMed1988

[Congenital tracheal stenosis due to complete circular rings. Tracheoplasty using autologous pericardium].

The case of a 9-month old infant with congenital tracheal stenosis due to complete tracheal rings, associated with an aberrant left pulmonary artery is reported. Surgery was carried out under extracorporeal circulation to ensure adequate oxygen supply. Extubation, thus made possible, enabled the lesion to located accurately by bronchoscopy. Tracheoplasty by means of an autologus pericardial patch was performed. The quality of the repair was checked by a second bronchoscopy. The long-term result is satisfactory.

Cartilage↗
PubMed1988

[Surgery for incomplete atrioventricular canal. Mid-term follow-up apropos of 128 patients].

Among 128 consecutive patients operated upon between 1972 and 1984 at the Marie-Lannelongue Surgical Centre for incomplete persistent atrioventricular canal, 102 could be followed up for periods ranging from 18 months to 11 years. Of the 23 patients lost sight of, 19 were foreigners. One patient died during the first postoperative month and two died during the following five months; there was no death thereafter. One patient developed complete atrioventricular block immediately after surgery. At the end of the follow-up period, three patients had been reoperated upon for disinsertion of the patch on the ostium primum associated in one case with massive mitral regurgitation; two complete atrioventricular blocks requiring permanent pacing had occurred some time after surgery; five patients had presented with late atrial dysrhythmia, and only six patients had signs of heart failure primarily due to residual mitral regurgitation. At radiography, the cardiothoracic ratio was reduced in 74 p. 100 of the cases from 0.60 +/- 0.08 to 0.53 +/- 0.05 (p less than 0.001), and the earlier the operation had been performed, the greater the reduction in cardiothoracic ratio (p less than 0.05). A mitral regurgitation murmur was observed in 72 p. 100 of patients immediately after surgery and in 82 p. 100 of patients at the end of the follow-up period. The murmur was usually weak (79 p. 100) with a tendency to remain stable (44 p. 100) or to increase in intensity (43 p. 100, but reoperation was necessary in only one case.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Diagnosis of cellular respiratory arrest by NADH laser fluorimetry. Applications in heart surgery and in experimental pharmacology].

The continuous measurement of intratissular NADH concentration allows early detection of cellular respiration arrest during clinical situations, i.e. allows a non-destructive, in situ, continuous measurement of ATP formation. This detection enables the physician or surgeon to intervene during a phase of cellular respiration arrest, before structural cellular alterations occur, thereby preventing potential tissular necrosis. The method has now been validated in experimental cardiac surgery for the monitoring of myocardial preservation techniques during cardiopulmonary by-pass, and in cardiac pharmacology, for analysis of drugs' effects on myocardial energetic metabolism. Its industrial development is currently under way. Preliminary investigation strongly suggests the vast potential of this diagnostic method in both clinical and experimental fields.

Adenosine Triphosphate↗
PubMed1985

[Reoperation on valve bioprostheses. Apropos of 64 cases].

Sixty-four patients with one or more bioprostheses were reoperated between 1970 and 1982. Reoperation was performed for degenerative lesions in cases (48%), for aseptic periprosthetic leaks in 18 cases (28%), for infectious lesions in 13 cases (21%) and for thrombosis in 2 cases (3%). Degenerative and infectious lesions were commoner in aortic bioprostheses whilst periprosthetic leaks were commoner in mitral bioprostheses. The average interval between operations was 38 months. This was shorter in patients reoperated for mechanical problems (6 months) than those with infections (28 months) or degenerative (5 years) complications. At reoperation 14 prostheses were reinserted and 50 were replaced. The global hospital mortality was 21% (14 deaths). The mortality was related to the surgical indication: mechanical lesions (11%), degenerative lesions (16%), infectious endocarditis (38%), thrombosis (100%). The mortality rate also varied with time (36% during the period 1970-1978 and 18% during the period 1979-1982). This improvement was related to two factors: the use of cardioplegic solutions for myocardial protection and earlier recognition of surgical indications before the onset of irreversible haemodynamic complications. When choosing a valvular prosthesis, the mortality of reoperation for degenerative changes is the only disadvantage of the bioprosthesis which is silent, rarely complicated by thromboembolism and which does not require anticoagulant therapy for life. The mortality has decreased with time and will continue to fall if the indications for reoperation are based on stethacoustic, electrical, radiological and echocardiographic criteria of valvular dysfunction and not on the presence of overt cardiac failure as is still often the case.

Adolescent↗
PubMed1984

[Mitral insufficiency complicating idiopathic subvalvular aneurysm of the left ventricle. Apropos of 5 surgical cases].

The surgical team of Pr Ch. Dubost operated 5 cases of idiopathic subvalvular left ventricular aneurysm with associated mitral incompetence over a 6 year period (from 1976 to 1981). These 5 cases closely resemble Abraham's et al's classical description of "annular subvalvular left ventricular aneurysms". They occur in black Africans, often young adults (mean age of our five cases 31,8 years) in the absence of coronary artery disease. The common feature is the peculiar anatomical localisation of the aneurysm on the posterior or lateral wall of the left ventricle, which explains the common finding of mitral regurgitation. They are often calcified and thrombosed, the thrombosis tending to extend into the left heart chambers. This was the case in 3 of the reported cases. Mitral regurgitation was controlled in one case by closure of a fistula into the left atrium with a very good result, and in 2 cases by simple section-suture of the neck of the aneurysm with good results and a small residual mitral leak. In a fourth case (Case n degree 1) the mitral valve was normal, regurgitation being the result of an extensive thrombosis. The valve was replaced but, in the light of the following cases, it is possible that the valve might have been unnecessarily sacrificed. Despite their sometime vast size and the association with mitral regurgitation, these subvalvular idiopathic left ventricular aneurysms are reasonable surgical indications for the following three reasons: the neck is often narrow, enabling closure under satisfactory surgical conditions; the structure of the valve is normal which, in the majority of cases, means that it can be respected at surgery; the absence of coronary artery disease.

Adult↗
PubMed1984

[Abnormal aortic arches in infants and children (experience with 322 cases)].

It is very rare that the knowledge of the human embryology helps the medical diagnosis and guides the surgical treatment when it is necessary. With the oesophagogramm it is possible to obtain the exact topography of the abnormal vascular ring and to perform live saving operation. Our experience of 322 cases is the most important published up to now.

Aorta, Thoracic↗
PubMed1984

[Calcified aortic stenosis and coronary disease. Apropos of 115 surgically-treated cases].

The authors studied 115 surgical cases of calcific aortic stenosis (AS) with coronary angiography. Between 1970 and 1981, 56 of these patients also had one or more aortocoronary bypass grafts (ACBG) (Group I). The other 59 cases, recruited from 1978 to 1981, comprise the control group who underwent isolated aortic valve replacement either with a normal coronary angiogram (Group II: 50 cases) or with such extensive coronary artery disease that ACBG was impossible (Group III: 9 cases). 93% of patients in Group I had preoperative angina compared to 80% in Group II and 78% in Group III. The incidence of previous myocardial infarction was 19%, 4% and 44% respectively. The number of main coronary arterial lesions per patient was 2 in Group I and 1.8 in Group III. In Group I, aortic valve replacement (AVR) was associated with a single aorto-coronary bypass in 70% of cases, a double bypass in 27% and a triple bypass in 3% of cases. The revascularisation ratio was 1.3 bypass per patient. The number of "complete" revascularisations rose from 56% (1970-1976) to 73% from 1977 to 1981. Overall hospital mortality per group (less than 1 month) was 16%, 4% and 0% respectively. The mortality rate in Group I fell from 31% (1970-1976) to 10% from 1977 to 1981. The perioperative rate of myocardial infarction in each group was 9%, 0% and 11% respectively. This figure fell considerably in Group I from 12.5% (1970-1976) to 7.5% from 1977 to 1981.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

[Cardiac hydatidosis].

Cardiac localizations in hydatid disease are uncommon and often latent. A mass at the apex of the heart was discovered in a 42-year-old patient who presented with abnormal EKG repolarization. This mass was anechoic. Coronography demonstrated an avascular lesion with displaced coronary arteries. A hydatid cyst was suspected. No other visceral localizations of hydatid disease were detected. The patient refused surgery and was seen two years later with acute pericarditis and rapidly developing cardiac tamponade. A very large amount of pericardial fluid and a single hydatid cyst were discovered upon surgery. The cyst was aspirated and sterilized and the protruding cyst wall was resected. A severe postpericardotomy syndrome and positivation of hydatid disease serological tests occurred during the postoperative course. The patient was then given flubendazole. Prompt recovery occurred and the patient is still doing well under therapy two years later. In hydatid disease, an isolated cardiac localization is uncommon and often latent and may be revealed by complications. Prompt diagnosis should be made by echocardiography.

Adult↗
PubMed1983

[Hypoxemia after heart surgery by a right-left shunt via a permeable unrecognized foramen ovale].

Hypoxemia is a relatively common complication in the immediate postoperative period after cardiac surgery under cardio-pulmonary bypass, usually due to pulmonary disease. When this does not improve with oxygen therapy and in the absence of pulmonary disease, it may be due to a right-to-left shunt. We report a case with a right-to-left intracardiac shunt due to persistence of a patent foramen ovale, which became functional again under the new hemodynamic conditions after surgery under cardiopulmonary bypass and assisted ventilation. The diagnosis and physiopathological mechanism were studied by cardiac catheterisation and angiography. Contrast echocardiography should be able to detect these acquired shunts relatively easily. The diagnosis requires appropriate therapy: discontinuation of ineffective assisted ventilation as this may aggravate the situation by increasing pulmonary resistance, and anticoagulant therapy to prevent potentially disastrous paradoxical thromboembolism.

Aortic Valve Insufficiency↗