Biomedical subjects

R Roudaut

Publications and source records attributed to R Roudaut.

At least 55 records · Page 3Linked to original sources

PubMed1993

Incidence of bacteraemia or fever during transoesophageal echocardiography: a prospective study of 82 patients.

The incidence of bacteraemia during transoesophageal echocardiography (TEE) was evaluated in a prospective study of 82 consecutive patients. Three series of blood cultures were carried out for each patient: from group 1 (n = 44), prior to the examination, at the end of the examination and 15 min afterwards. For group 2 (n = 38), blood cultures were performed prior to the examination, 10 min after the start and immediately after the end. A single positive blood culture was detected in two patients. For the first patient, blood culture at the end of the examination demonstrated Corynebacteria, and for the second, Staphylococcus epidermidis was identified on cultures taken during the examination. During the first 24 h, a transient subfebrile temperature was recorded in 15% of the patients, including the patient with the Corynebacteria-positive blood culture. By mid-term (6 months) no patient had developed endocarditis. Our findings suggest that antibiotic prophylaxis during TEE is not warranted.

Adult↗

PubMed1993

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↗

PubMed1993

[Ultrasonography in the diagnosis of bacterial endocarditis: value and limits].

This cooperative study recensed 148 patients who had infective endocarditis (IE) with anatomopathological correlations. The infection was on native valves in 89 cases and prosthetic valves in 59 cases. Transoesophageal echocardiography diagnosed vegetations on native valves with a sensitivity, specificity, positive predictive and negative predictive values of 89%, 87%, 88% and 90% respectively, whereas for transthoracic echocardiography the results were 68%, 83%, 81% and 72% respectively. With respect to prosthetic valve vegetations, transoesophageal echocardiography had a sensitivity, specificity, positive predictive and negative predictive values of 67%, 84%, 48% and 92% respectively compared with 56%, 84%, 44% and 83% respectively for transthoracic echocardiography. These results underline the difficulties in differentiating degeneration and endocarditis of bioprostheses. Transoesophageal echocardiography diagnosed aneurysm formation and valvular perforation with a sensitivity, specificity, positive and negative predictive values of 61%, 93%, 91% and 72% respectively compared with 35%, 96%, 98% and 58% respectively for transthoracic echocardiography. The false negative results of transoesophageal echocardiography were usually observed in lesions of the posterior leaflet or commissures. In this series, the 6 aortic cusp perforations were undiagnosed by both transthoracic and transoesophageal echocardiography. With respect to aortic ring abscess, the sensitivity, specificity, positive and negative predictive values of transoesophageal echocardiography were 89%, 100%, 100% and 93% respectively, compared with 27%, 100%, 100% and 62% for transthoracic echocardiography. The false negative results of transoesophageal echocardiography were observed in cases of anterior abscesses or of calcific aortic valves. These results demonstrate the superiority of transesophageal over transthoracic echocardiography in the diagnosis of infective endocarditis and its complications. However, the limitations of the method should be recognized in the situations described.

Abscess↗

PubMed1993

[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↗

PubMed1993

[Saccular aneurysms of the renal artery].

The increasingly frequent use of arteriography in the investigation of hypertension and of obliterative arterial disease of the lower limbs has led to recognition of the actual incidence of renal artery aneurysms. The importance of this type of lesion is due to the fact that the natural history of renal artery aneurysms remains unknown, their relationship with hypertension is still controversial and the risk of complications, and rupture in particular, has led to the suggested possible need for their routine surgical excision. The current trend is to limit indications for surgery to certain specific cases since a number of recent series have shown that the risk of rupture of a small saccular aneurysm was very small.

Aneurysm↗

PubMed1992

Assessing prosthetic heart valve function. Value of Doppler echocardiography and patient/prosthetic valve identity and follow-up card.

Doppler echocardiography is being used increasingly in the follow-up of patients with valvular heart prostheses because it provides unique hemodynamic information about flow through prosthetic valves. A baseline checkup about 3 months after implantation is now recommended. We therefore now supply each patient with an identity and follow-up card for each particular prosthesis.

Echocardiography, Doppler↗

PubMed1992

[Non-invasive imaging in aortic dissection].

Previously with a drastic prognosis, aortic dissection has extensively benefitted from advances in medical and surgical treatment, as well as progress in methods of investigation. While aortography is classically the reference special investigation, non-invasive methods now have a place of choice both during the acute phase (transthoracic and transesophageal echocardiography) and the chronic phase or for the purpose of post-operative monitoring (CT scan, magnetic resonance imaging). In an emergency context, the most important point is to diagnose a type A dissection, involving the ascending aorta, the treatment of which is surgical. In the majority of cases the diagnosis can now be made on the basis of transthoracic and transesophageal echocardiographic findings, which also enable identification of the site of the portal of entry, extension and concomitant lesions, all important features to be taken into consideration regarding surgical tactics.

Aortic Dissection↗

PubMed1992

[Transesophageal echocardiography in infectious endocarditis].

During the past 20 years, TTE has acquired a role of choice in the positive diagnosis as well as in the prognostic evaluation of endocarditis. However, it is a non-histobacteriological technique and is also operator-dependent. If often enables the detection of high risk patients: large vegetations, severe valve damage with major leaks, threatened complications: abscess, fistula, sometimes leading to referral of the patient for emergency surgery when required by hemodynamic conditions (often without recourse to catheterisation) or when infection is uncontrolled despite proper medical treatment. Embolism is the chief cause of morbidity and mortality in IE. In this context, the size of vegetations appears to be a risk factor. TEE enables refinement, precision and completion of TTE findings. It should be requested in the following circumstances: 1) strong clinical suspicion of IE but TTE negative, 2) monitoring of severe forms due to virulent organisms, 3) whenever there is suspicion of IE affecting a valve replacement.

Echocardiography, Doppler↗

PubMed1992

[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↗

PubMed1992

Mechanical cardiac valve thrombosis. Is fibrinolysis justified?

BACKGROUND: Thrombosis is a serious complication of heart valve replacement, and management is often difficult. In recent years, thrombolytic therapy has been used as the primary technique by some investigators. METHODS AND RESULTS: Sixty-four consecutive patients presenting with 75 instances of prosthetic heart valve thrombosis (41 mitral, 33 aortic, one tricuspid) were treated with fibrinolytic agents. Obstructed prosthetic valves comprised 39 tilting disc and 36 bileaflet valves. The time interval between valve replacement and obstruction ranged from 15 days to 192 months (mean, 38 months). Fibrinolytic agents used were streptokinase (42 patients), urokinase (27 patients), or recombinant tissue-type plasminogen activator (six patients). Immediate results of fibrinolytic treatment were 1) full success after one or several consecutive fibrinolytic regimens in 55 cases (73%), 2) incomplete improvement in two cases, and 3) failure in 18 cases, leading to an emergency surgery in nine cases. Nine patients died (four strokes, four cardiac arrests, one hemorrhage). Only one severe hemorrhagic complication was observed, but 11 cases of embolism occurred during fibrinolytic treatment (14.6%) (four major cerebral embolisms with death). The immediate efficacy was better for thrombosed aortic prosthesis than with the mitral prosthesis (85% versus 63%). CONCLUSIONS: Fibrinolytic treatment appears to be an attractive nonsurgical alternative for prosthetic heart valve thrombosis, but because of the risk of cerebral embolism, its use should be reserved for tricuspid valve thrombosis or critically ill patients with mitral or aortic valve thrombosis. The use of a fibrinolytic agent in cases of small, nonobstructive paravalvular thrombosis demonstrated with transesophageal echocardiography needs further studies.

Aortic Valve↗

PubMed1992

[Effects of verapamil and nifedipine on blood pressure during rest and exertion and on left ventricular hypertrophy].

UNLABELLED: The effects of 6 months treatment with nifedipine 20 mg SR (N) or verapamil 240 mg SR (V) on rest and exercise BP and left ventricular mass (LVM) and function were evaluated in 31 essential hypertensive patients (mean age: 54, 19 males, 12 females), never treated with calcium antagonist. After a 15 days placebo run in, BP was measured at rest and during a maximal bicycle exercise test (stages: 30 watts, 3 min). 2D guided M mode echocardiography and pulsed Doppler allowed assessment of left ventricular mass (Devereux's formula) and function (fractional shortening FS, peak early (E) and late (A) velocities of LV filling). Patients were randomised to N (n = 18) or V (n = 13) and reassessed 6 months later. All echo-Doppler recordings were read blindly by 2 observers. RESULTS: rest BP was similarly reduced in both groups (V: 148 +/- 12/88 +/- 5 vs 162 +/- 10/101 +/- 7; N: 148 +/- 15/90 +/- 7 vs 170 +/- 14/101 +/- 8), as well as exercise maximal BP (V: 224 +/- 32/93 +/- 11 vs 243 +/- 21/104 +/- 11; N: 206 +/- 27/90 +/- 10 vs 231 +/- 17/97 +/- 8). The duration of exercise was significantly increased with V (15 +/- 5 min vs 12 +/- 4, p < 0.05) and insignificantly decreased with N (11 +/- 2 vs 12 +/- 3). Left ventricular mass was higher in V group at entry and was significantly more reduced with V (250 g +/- 74 vs 302 g +/- 92, p < 0.01) than with N (225 g +/- 54 vs 234 g +/- 69).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

[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↗

PubMed1992

[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↗

PubMed1992

[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↗

PubMed1991

[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↗

PubMed1991

[Left ventricular diastolic function. Doppler-echocardiography study].

During the last few years the use of the noninvasive doppler-echocardiography method to study left ventricular relaxation and filling has aroused considerable interest owing to its excellent feasibility. However, it is now known that the filling flow rate may vary according to several parameters including filling conditions, heart rate, patient's age, site of measurement and medication, so that the curves obtained must be interpreted with extreme caution. Apart from this, doppler-echocardiography is invaluable not only to distinguish between physiological and pathological left ventricular hypertrophy, but also to detect heart transplant rejection.

Echocardiography, Doppler↗

PubMed1991

Echocardiographic study of left ventricular function in type 1 diabetes mellitus: hypersensitivity of beta-adrenergic stimulation.

Systolic left ventricular function was investigated by echocardiography in 23 young, type 1 diabetics and 11 control subjects. A stimulation by isoproterenol was performed in order to study beta-adrenergic cardiac responsiveness. M-mode recordings were digitized and analyzed by computer. Systolic parameters such as left ventricular fractional shortening and mean velocity of circumferential shortening were not different, but maximal velocity of shortening was increased both at rest (P less than 0.01) and with isoproterenol (P less than 0.05) in the diabetics. An abnormal systolic anterior motion of the mitral valve was found during administration of isoproterenol in 65% of the diabetics and in only one control. These findings are suggestive of a hyperkinetic state, associated with a poor metabolic control (high value of HbA1), together with adrenergic hypersensitivity in type 1 diabetes mellitus.

Adult↗

PubMed1991

Echocardiographic assessment of myocardial performance after prolonged strenuous exercise.

To determine the effect of strenuous prolonged exercise on systolic and diastolic left ventricular function, 11 non-elite marathon runners aged 37 +/- 7 years (mean +/- SD) were studied before and during early recovery from a marathon race. Cavity dimensions, wall thickness, and fractional shortening were computed from two-dimensionally guided M-mode echocardiograms. Doppler left ventricular inflow tract recordings were analysed for peak early and late velocities and their ratio. In seven subjects, heart frequency was recorded throughout the race. These subjects ran the marathon at 87 +/- 4% of their maximal heart rate. Left ventricular diastolic dimension was slightly reduced at the end of the race (49.4 +/- 4.2 mm to 47.3 +/- 5.1 mm; P less than 0.05). Fractional shortening remained unchanged, although blood pressure (P less than 0.001) and systolic wall stress (P less than 0.01) were decreased. The left ventricular filling pattern was unchanged, and the ratio of early to late velocities remained constant. These results suggest that the fractional shortening was a result of the opposing effects of changes in preload and afterload. However, the absence of a change in the end systolic dimension, despite a marked reduction in afterload and the occurrence of septal akinesia in one subject after the race could only suggest that strenuous prolonged exercise may alter myocardial performance.

Adult↗