Biomedical subjects

R Roudaut

Publications and source records attributed to R Roudaut.

At least 37 records · Page 2Linked to original sources

PubMed1990

Is echocardiography an adequate method to evaluate left ventricular hypertrophy regression?

M mode echocardiography is certainly an adequate method to evaluate left ventricular hypertrophy (LVH) regression in hypertensive patients, provided that some important conditions are fulfilled. Left ventricular mass assessment can be made only with non-distorted ventricles, as usually encountered in non-complicated hypertensive patients. The main problem is to limit all sources of variability for serial measurements and all sources of subjectivity in their interpretation. So, we propose some guidelines that should be useful when designing and completing such studies. Two-dimensional echocardiography offers the potential advantage of allowing assessment of left ventricular mass even when the left ventricle is far from its usual shape. However, a standardization of methods and studies of its reproducibility are still required before this method could be recommended in studies of LVH regression.

Antihypertensive Agents↗

PubMed1990

[Doppler echocardiographic evaluation of right heart pressure in children with ventricular septal defect].

Thirty seven children with ventricular septal defects (VSD) alone or associated with other malformations were examined by Doppler echocardiography to evaluate systolic right ventricular pressure (SRVP) non-invasively. All patients underwent cardiac catheterisation within 48 hours of the Doppler estimation. The maximum interventricular pressure gradient could be assessed in 32 patients (86%) from the recording of the maximum velocity of the VSD jet using the simplified Bernoulli formula. The SRVP was calculated by subtracting the maximum interventricular pressure gradient from the systolic blood pressure measured by sphygmomanometry. The SRVP estimated by continuous wave Doppler ranged from 24 to 108 mmHg (mean: 60 mmHg) compared with 20 to 109 mmHg (mean: 64 mmHg) at catheterisation. Two types of correlation were sought: 1) between the maximum interventricular pressure gradient measured by Doppler echo and the peak-to-peak LV-RV pressure gradient (r = 0.95; SD = 6 mmHg; Y = 1.03 x X + 1.3); 2) and between the SRVP measured by Doppler and by catheterisation (r = 0.94; SD = 6 mmHg; Y = 1.06 x X + 7.7). These results show that the maximum velocity of the interventricular jet and thereby the SRVP may be accurately measured by Doppler echocardiography in the majority of patients with VSD.

Adolescent↗

PubMed1990

[Study of infectious endocarditis using Doppler echocardiography].

Infective endocarditis is still a common and serious disease. Echocardiography is an essential complementary investigation in this condition. Its value in the diagnosis of valvular vegetations has become more accurate since the introduction of two-dimensional and transesophageal echocardiography. Transesophageal echocardiography is currently the most reliable non-invasive technique for demonstrating small vegetations of less than 5 mm diameter. The diagnosis and surveillance of complications (valvular destruction, ring abscess) are also privileged indications of transthoracic and transesophageal echocardiography coupled with intracardiac Doppler blood flow studies. The finding of these lesions may sometimes lead to early surgical management.

Echocardiography, Doppler↗

PubMed1990

[Complementarity of transthoracic and transesophageal Doppler echocardiography in the diagnosis of thrombosis of a mitral prosthesis. Apropos of 3 cases].

The diagnosis of partial thrombosis of mitral disc valve prostheses is particularly difficult because the clinical presentation is often atypical and the motion of the two hemi-discs is hard to analyse by transthoracic echocardiography. The authors report three cases of partial thrombosis of mitral double-disc valve prostheses. It was not possible to analyse the motion of the two hemi-disc correctly in any of the three patients. The mitral transprosthetic flow recorded by continuous wave Doppler was abnormal with respect to the reference postoperative recording. In addition, in one case, an abnormal echo was observed floating in the left ventricular inflow tract and was suggestive of a thrombus. Transesophageal echo showed abnormal motion of one of the hemi-discs. In two patients this consisted in immobility of the hemi-disc in the semi-closed position; in the other patient, limited excursion of the hemi-disc was recorded. Abnormal retrograde flow in the left atrium was observed in 2 cases and abnormal echoes on the atrial surface of the valve were recorded in one case. After fibrinolysis the transthoracic and transesophageal Doppler echocardiographic parameters returned to normal. These three cases underline the complementarity of transthoracic and transesophageal echocardiography in the diagnosis of dysfunction of mitral disc valve prostheses.

Adult↗

PubMed1990

[Echodoppler evaluation of the normally functioning Saint-Jude's aortic valve prosthesis].

The aims of this study were: to define Doppler echocardiographic criteria of normality of aortic St Jude Medical (SJM) valve prostheses with respect to their size and to verify the validity of the continuity equation in the determination of prosthetic valve functional surface area. Forty patients with apparently normally functioning SJM prostheses without other cardiac disease were investigated at least one month after surgery. The group consisted in 1 n. 19, 6 n. 21, 9 n. 23, 12 n. 25 and 12 n. 27 SJM prostheses. The following parameters were measured: the maximum transprosthetic velocity, maximum and mean transprosthetic pressure gradients, permeability index and the Doppler surface area calculated by the continuity equation using the method proposed by Skjaerpe. The global results were as follows: maximum velocity = 2.5 +/- 0.4 m/s (1.8-3.7 m/s); maximum gradient = 26.9 +/- 9.8 mmHg (14-53 mmHg); mean gradient = 13.7 +/- 5.6 mmHg (7-30 mmHg); permeability index = 0.41 +/- 0.09 (0.23-0.57); Doppler surface area = 1.89 +/- 0.66 cm2 (0.73-3.23 cm2). When the prostheses were considered according to their sizes a weak negative correlation was observed between the mean pressure gradients and the size of the prostheses: r = -0.43, p less than 0.05 and a positive correlation between Doppler surface area and the theoretical prosthetic surface area: r = 0.71, p less than 0.005; SD = 0.45 cm2. No significant differences were observed between the pressure gradients and velocities of each size of prosthesis except when sizes 21 + 23 were compared with the large sizes (n. 25 + 27).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

[Left atrial extension of bronchial cancer diagnosed by echocardiography. Report of 2 cases].

The authors report 2 cases of left atrial extension of bronchial carcinoma detected by echocardiography. There have only been ten previous reports of echocardiography. There have only been ten previous reports of echocardiography detection of this complication as echocardiography is not requested systematically in patients with bronchial carcinoma. Left atrial metastasis is not uncommon at autopsy and the diagnostic value of echocardiography is excellent : the tumour appears as a hyperdense mass invading the roof of the left atrium through the pulmonary veins. Echocardiographic detection of left atrial extension of bronchial carcinoma is important because it implies a poor prognosis and because it may lead to a different therapeutic approach.

Carcinoma, Bronchogenic↗

PubMed1990

[Value and limitations of transthoracic Doppler echocardiography in the diagnosis of thromboses of mechanical valve prosthesis. Report of 19 cases].

The diagnosis of thrombosis of a valvular prosthesis is difficult especially in cases of partial thrombosis. The authors report 19 cases of partial thrombosis of mainly (16 cases) mechanical valve prostheses confirmed by radioscopy and treated either by reoperation or fibrinolysis. Mitral Valve Prostheses: 14 cases (6 Björk, 7 SJM, 1 Carbomedics). All but one case showed significant prolongation of the pressure half time compared with the postoperative reference value. In one case, however, the functional parameters of the prosthesis were normal; the diagnosis was made from the finding of a mobile thrombus on the ventricular surface of the prosthesis. Aortic Valve Prostheses: 5 cases (3 Björk, 1 SJM, 1 Duromedics). Continuous wave Doppler showed significant increases in the velocity of transprosthetic blood flow with respect to the postoperative reference values. Accurate analysis of the mobile elements of the prostheses was usually impossible. These results show that transthoracic Doppler echocardiography remains an excellent method of study and surveillance of mechanical valve prostheses but the limitations of the technique should be familiar to all operators.

Aged↗

PubMed1990

[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↗

PubMed1990

[Value of Doppler color echocardiography in the diagnosis of diastolic mitral insufficiency in severe aortic insufficiency. Report of 2 cases].

The authors report the value of Doppler color flow mapping in the diagnosis of late diastolic mitral regurgitation in two patients with severe post-endocarditis aortic regurgitation requiring rapid surgical intervention. Doppler color flow mapping played an essential part in the management of these cases by helping in the diagnosis of late diastolic mitral regurgitation which is known to carry a very poor prognosis in this context.

Aortic Valve↗

PubMed1990

[Incidence and severity of cardiac involvement in Streptococcus bovis septicemia. Report of 10 cases].

Endocarditis due to the streptococcus Bovis is an affection which is more and more often recognized and whose link with the colic tumor pathology has been well established those last few years and confirmed in this study with a frequency of 60 p. cent. However, few studies have stated the gravity of the heart affection in streptococcus Bovis septicaemias. In this series of 10 streptococcus Bovis septicaemias, the valvular affection is frequent and serious. The vegetations are found in 9 cases out of 10. The aortic affection is slightly more frequent (8 times out of 10), against 7 times out of 10 for the mitral affection (double mitroaortic affection, 6 times). A valve replacement due to sub-acute or chronic cardiac failure was necessary in 6 cases out of 9, that is 66 p. cent. The mortality was nil.

Aged↗

PubMed1990

[Value and limitations of the measurement of the jet diameter in aortic insufficiency using Doppler color. Report of 68 patients].

The aim of this study is to specify the feasibility and value of the diameter measurement of the jet of aortic insufficiency (AI) in colour Doppler. 68 consecutive patients had a supra-sigmoid angiography and a colour echo-Doppler. An aortic insufficiency was revealed 58 times by the angiography and Doppler. In all the cases except four, it has been possible to measure the jet diameter at the origin in para-sternal incidence in colour TM by confronting the images in great and small axis section. The Doppler results have been compared to the angiographic score in 4 grades according to Sellers classification. The jet diameter at the origin in colour TM is significantly different in groups I, II, III-IV. In the group III-IV, it is always higher or equal to 13 mm. The failures of quantification of the AI jet in colour Doppler are linked with the very eccentric nature of the jet or to the poor quality of the echo-Doppler imaging. On the whole, the jet diameter measurement proves to be a very useful element in the assessment of the gravity of an AI, particularly when it is a central and circular jet.

Adult↗

PubMed1990

[Treatment of post-reno-contusive arterial hypertension by upper polar nephrectomy. Results after 10 years].

The authors report the observation of arterial hypertension occurring six years after renal trauma, secondary to the upper polar infarction of the left kidney accompanied by a hypersecretion of bilateral renin and whose cure was obtained by partial nephrectomy. According to a literature review, it seems that post-reno-contusive arterial hypertension is not rare and can be due to various lesions whose common denominator is renal ischaemia. At present, no clinical or paraclinical element enables the prediction with certainty of the reversibility of the hypertension after the surgical intervention. However, the earlier the intervention, the better the chances of recovery, thus showing the importance of the systematic screening of renal lesions after lumbo-abdominal trauma.

Child↗

PubMed1989

[Echocardiography in anorexia nervosa].

The echocardiographic parameters of 10 patients with anorexia nervosa were studied at the time of admission and compared with those of 10 matched controls. There was a decrease of ventricular volumes and of the calculated left ventricular mass, but the haemodynamic values at rest showed a normal "pump function". The left ventricular mass correlated with the body mass, which indicates that the heart of anorectic patients is also involved by malnutrition. Two patients had asymptomatic mitral valve prolapse. These results are in agreement with the few published studies which report deep cardiac alterations with decrease of heart cavities volumes and reduction of wall thickness and myocardial mass. This results in altered exercise performance, despite a satisfactory haemodynamic status at rest. The high frequency of mitral valve prolapse due to disproportion between ventricle and valve must be noted.

Adolescent↗

PubMed1989

Left ventricular mass changes with nicardipine therapy in essential hypertension.

Eighteen hypertensive patients (13 males, 5 females; age 48 +/- 13; diastolic blood pressure greater than 95 mmHg), either previously untreated or who had been off treatment for more than 3 months, underwent M-mode echocardiography before (DO) and after (D90) 3 months of nicardipine therapy (60-90 mg/day). All echocardiograms were read blind, and left ventricular mass (LVM) was calculated (Devereaux's formula). Blood pressure was significantly reduced after 3 months from 167 +/- 15/102 +/- 8 mmHg on DO to 152 +/- 16/92 +/- mmHg on D90 (p less than 0.001). The reduction in LVM was not significant: 266 +/- 95 g on DO, 247 +/- 78 g on D90. There was a trend to a higher (although nonsignificant) LVM reduction in patients with left ventricular hypertrophy at entry (-11%, n = 11) than in patients without left ventricular hypertrophy (-2%), n = 7).

Adult↗

PubMed1989

Left ventricular mass in normotensive subjects. Importance of blood pressure response to activity.

Recent works have shown the importance of blood pressure (BP) response to exercise or to daily activity as determinants of hypertensive cardiac hypertrophy. We have tested the relationship between BP and left ventricular (LV) mass in 23 normotensive young adults (mean age 25 +/- 5) with normotensive parents. Blood pressure was measured at rest, at the end of maximal exercise test, and during 24-hour ambulatory monitoring during daily routine. Left ventricular mass was assessed with M-mode echocardiography. We found a closer relationship between LV mass with BP when measuring during activity (average day time BP and end exercise BP) than with rest BP (rest BP and average nighttime BP). Multiple regression analysis indicates an independent association of LV mass with both average day time and end exercise systolic blood pressure. Thus, we conclude that these two ways of assessing "activity" BP may be more complementary than opposing. Ambulatory BP monitoring appreciates the reactions to daily stresses and the exercise test measures the response to physical activity.

Adult↗

PubMed1989

Relationship between left ventricular mass and noninvasive monitoring of blood pressure.

We studied the relationship between left ventricular mass index (LVMI) and blood pressure (BP) monitored during 24 hours in 35 normotensive and 58 hypertensive patients with no treatment for more than three months. We found a close correlation between LVMI and the average daytime systolic BP (r = 0.68). Other parameters derived from BP monitoring were also correlated with LVMI: daytime diastolic BP (0.54), nighttime systolic and diastolic BP (0.61 and 0.54), pulse pressure (0.58), the average of the five highest systolic and diastolic BP (0.57 both), and the percentage of systolic BP above 140 mm Hg (r = 0.64). However, in a stepwise multiple regression analysis only daytime systolic BP was independently correlated to LVMI. The standard deviation of systolic BP was not significantly correlated to LVMI. The same positive correlation between daytime systolic BP and LVMI was found in normotensive and hypertensive patients, males and females, and patients with and without left ventricular hypertrophy. So, at least regarding the prediction of the degree of left ventricular hypertrophy, the average systolic BP during daytime seems to be the only valuable parameter to look at in ambulatory BP monitorings of untreated hypertensive patients.

Adult↗

PubMed1989

[Association of sacciform aneurysm of the renal artery and hypertension. Cause or coincidence? Apropos of a case].

Aneurysms of the renal artery are seldom encountered. They present as different aetiopathological types. We report the case of a female patient who had both severe arterial hypertension and an apparently dysplastic aneurysm of the right prepyelic artery. Resection of the aneurysm failed to have the effect we expected on arterial hypertension. The relationship between arterial hypertension and aneurysm of the renal artery is discussed.

Adult↗

PubMed1989

[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↗