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R Roudaut

Publications and source records attributed to R Roudaut.

At least 145 records · Page 8Linked to original sources
PubMed1987

[Aneurysms of the atrial septum. From diagnosis to treatment. Apropos of 33 consecutive cases].

Although rare, aneurysms of the atrial septum are the object of a renewed interest, for they are found with an ever increasing frequency due to technical advances in echocardiography and they have been blamed for a number of disorders, including arrhythmias and embolic accidents. We report here a series of 33 consecutive cases of atrial septal aneurysm discovered by two-dimensional echocardiography over a 5-year period. There were 21 children and 12 adults. In children, the aneurysm was usually associated with a congenital heart disease (17/21 cases). Spontaneous closure was observed in 3 cases where that disease was an isolated septal defect. In adults the aneurysm was usually isolated, but it was complicated by repeated transient ischaemic accidents in 3 patients. No arrhythmia ascribable to the aneurysm was observed.

Adolescent↗
PubMed1987

[Echocardiographic diagnosis of a free and obstructive thrombus of the left atrium: a surgical emergency. Review of the literature apropos of a case].

Thrombosis of the left atrium is frequent and often causes systemic embolism in patients with mitral valve regurgitation and major atrial dilatation. In contrast, free floating thrombi unconnected to the atrial wall are extremely rare and characterized by their great mobility and the risk they create of haemodynamic disturbances due to mitral valve obstruction. We report here one case of such a thrombus and compare our findings with those reported in the literature concerning 7 other cases diagnosed by echocardiography. The echocardiographic diagnosis of free floating thrombus is easier than that of adherent thrombus. The free floating thrombus may result from the release of an initially pedunculate thrombus, or it may form in the atrial cavity independent of the atrial wall. Its origin can only be determined at pathological examination. Emergency surgery is mandatory when faced with this situation at high risk of haemodynamic disturbances and embolism.

Aged↗
PubMed1987

[Echocardiographic diagnosis of aortic dissection. Limits, pitfalls and difficulties].

In patients with suspected dissection of the aorta two-dimensional echocardiography has become a fundamental complementary examination which can easily be used in emergencies. In the light of our experience and of published data, a floating dissected intima is the pathognomonic sign. However, false-negative results have been recorded in about 30% of the cases, as against 10% with angiography, computerized tomography and nuclear magnetic resonance imaging. In spite of this drawback, two-dimensional echocardiography still is a good screening examination, since dissection can almost certainly be excluded when the aorta is of normal caliber. False-positive results also constitute a diagnostic pitfall which must be well known and carefully avoided. The mechanisms of these various problems and the way they can be solved are discussed.

Aortic Dissection↗
PubMed1987

[Malignant lymphoma of the heart. Contribution of modern technics of medical imaging].

Although rarely encountered, tumours of the heart are now more easily and frequently diagnosed owing to the availability of non-invasive imaging methods, notably echocardiography. With echocardiography the cardiac extension of the tumour is perfectly visualized, but its connections with the mediastinum are less readily accessible. The case presented here of a female patients with a malignant lymphoma involving the heart (right ventricle and atrium, pericardium) and the mediastinum illustrates the complementary nature of echocardiography, computerized tomography and magnetic resonance imaging.

Aged↗
PubMed1987

[Echocardiographic diagnosis of aortic dissection: contribution of pulsed Doppler. Apropos of 29 cases].

Echocardiography is universally recognized as a first-line examination easy to perform at all times in patients with thoracic pain suggestive of aortic dissection. But like all diagnostic methods, it has its limitations and pitfalls. The present study, based on 29 consecutive cases, demonstrates the value of pulsed Doppler echocardiography in the diagnosis and monitoring of aortic dissection. When the echocardiographic images are typical of the disease, the Doppler technique helps evaluate the lesions (aortic insufficiency, number of patent channels), but it is mainly in cases with doubtful echocardiographic findings that the Doppler technique provides elements that clinch the diagnosis, notably by showing the presence ot two patent channels with different blood flows. In addition, we would like to draw attention to a new and useful sign: flapping ot the dissected intima when the Doppler window is over it; we observed this sign in 24 of our 29 patients.

Adult↗
PubMed1987

[Primary pulmonary arterial hypertension].

Primary pulmonary hypertension (PPH) currently remains an entity of which the precise mechanism, most likely vasospastic, is not completely explained. The diagnosis of PPH remains an exclusion diagnosis; it will be considered only after ruling out a secondary pulmonary hypertension. Non-invasive techniques such as sonography, cardiac Doppler should permit an earlier diagnosis and an easier monitoring of these patients whose prognosis remains poor in spite of the sporadic efficacy of a treatment with vasodilators. Heart-Lung transplant could be a future prospect; however, if the first reports seem encouraging, the follow-up is currently insufficient to appreciate the possible long-term advantage.

Diagnosis, Differential↗
PubMed1987

[Current aspects of Ebstein's disease].

Ebstein's disease is a rare affection which is more and more frequently discovered since the advent of sonocardiography. As a matter of fact, except in the loud but less frequent neonatal forms, Ebstein's disease appears, most of the time, in the first three decades of life under various, misleading forms. The diagnosis is, today, greatly facilitated by bi-dimensional sonocardiography. This technic enables in fact to precisely define, in typical forms, the different abnormalities of the entire tricuspid valve complex; however, there are also atypical forms which should not be ignored. The prognosis of Ebstein's disease is dominated by rhythm disorders, which should be systematically looked for, and will benefit from modern treatments, and cardiac insufficiency. In this field, recent surgical techniques have also greatly improved so that surgery should be considered as soon as the symptoms become worse (Class III of NYHA).

Ebstein Anomaly↗
PubMed1986

[TM and bidimensional echocardiography of subvalvular aortic stenoses].

28 children (age: 7.5 +/- 4.6 years) and five adults with a subvalvular aortic stenosis were evaluated by TM and bidimensional echography. Long axis parasternal and apical two cavities-aorta views seem the most reliable to determine the anatomical varieties (type I in diaphragm: 25 cases; type II fibromuscular: 5 cases; tunnel: 1 case; isolated mitral abnormalities: 2 cases). 24 patients were catheterized. Among the various echocardiographic parameters that were measured, the ratio parietal thickness/left ventricular diameter in telesystole appears best correlated to the hemodynamic gradient (r = 0.65).

Adolescent↗
PubMed1986

Short- and long-term treatment of mild to moderate hypertension with verapamil.

Forty-three patients with mild to moderate hypertension (supine diastolic blood pressure 95 to 115 mm Hg) were entered into a short-term (3 months) study. All received verapamil, 120 mg 3 times a day. After 1 month of treatment on verapamil alone, supine diastolic blood pressure was normalized (less than 95 mm Hg) in 29 patients (67%). These patients continued with verapamil at the same dosage. In 14 nonresponders (supine diastolic blood pressure greater than 95 mm Hg) a combination of althiazide (15 mg/day) and spironolactone (25 mg/day) was added. This resulted in diastolic blood pressure normalization in 9 additional patients. Verapamil induced a slight but moderate decrease in heart rate after 1 month, but no further decrease was observed thereafter. During the trial, 21% of patients reported adverse effects, mostly transient and mild. No patient had to discontinue treatment because of them. Twenty-six patients on verapamil alone were followed for 1 year. Systolic and diastolic blood pressure was adequately controlled in all patients except 1. In 13 the dosage was decreased to 120 mg 2 times a day. There were no significant differences in blood pressure between this group and patients given 120 mg 3 times a day. It is concluded that verapamil is an effective and safe antihypertensive agent in mildly to moderately hypertensive patients. Because a dosage of 120 mg 2 times a day was as effective as 120 mg 3 times a day, the former should be recommended, as it may improve patient compliance.

Blood Pressure↗
PubMed1986

[Left ventricular hypertrophy of the hypertensive patient: relation to exertional and ambulatory blood pressure].

UNLABELLED: In a prospective study the relation of left ventricular hypertrophy and exercise versus ambulatory blood pressure was analysed in 31 patients with essential hypertension (10 females, 21 males, mean age 44 +/- 14). Hypertension is borderline and has never been treated in 8 patients, mild to moderate in 24 patients who had discontinued therapy at least 8 days prior to the study. M mode echocardiogram, bicycle exercise testing and ambulatory blood pressure monitoring (spacelabs 5200) were performed within a 7 days period. Left ventricular wass (LVM) was calculated from M. mode echo data according to Devereux's formula and used to determine a LVM index (LVM/Body surface area). Correlations between LVM index and rest (R) SBP, end exercise (EE) SBP, the average of approximatively 60 SBP recordings from 7H to 22H (A-SBP) and the average of the 5 highest (5H) SBP recordings in the day are reported: (Formula: see text). There is no significative correlation with diastolic blood pressure. CONCLUSION: 24H A-SBP and EE-SBP appears to correlate better with severity of LVH than does the R-SBP. The selection of the 5 highest SBP in a day do not improve the correlation compared with R-SBP.

Adolescent↗
PubMed1986

[Tricuspid endocarditis. Value of echocardiography. Developmental data. Apropos of 11 cases].

Clinical and echocardiographic data of 11 patients with tricuspid valve endocarditis (TE) were analysed to determine diagnostic criteria and to study the outcome of this condition. The study population comprised 6 men and 5 women (average age 38.4 +/- 18 years). TE was the only lesion in 9 cases; there was 1 case of associated pulmonary and aortic valve endocarditis, and in the other patient mitral and aortic valve endocarditis was also present. Five patients were heroin addicts. In 5 cases, the causative organism was Staphylococcus aureus. The clinical presentation was usually atypical with a systolic murmur rarely characteristic in 9 patients and signs of right ventricular failure in only 3 patients. On the other hand, 8 patients had one or more episodes of acute pneumonia or typical pulmonary embolism. The diagnosis was established by echocardiography which demonstrated the valvular vegetations. The outcome was favourable in 10 patients, only one of whom required surgical intervention. Two dimensional echocardiography provided valuable information about the evolution of the valvular vegetations, frequently showing regression after medical therapy.

Adult↗
PubMed1986

[Secondary tumors of the right heart. Echocardiographic aspects. Apropos of 6 cases in the adult].

Secondary cardiac tumours are rare but but are now more frequently diagnosed by echocardiography. We report 6 cases of intracardiac metastases affecting the right heart which were diagnosed by 2D echocardiography. In 3 cases, a very mobile, oval-shaped tumour was visualised within the right atrium prolapsing into the tricuspid orifice in diastole like a myxoma but associated in 2 cases with signs of invasion of the inferior vena cava. Two other non-mobile tumours were observed causing massive invasion of the right atrium and the last case was of an infiltrating tumour of the right ventricle resulting in pulmonary infundibular obstruction. In the light of our experience and a review of the literature, it is difficult to distinguish secondary tumours of the right atrium from myxomas especially when the tumours are mobile and when it is impossible to visualise a pedicle inserted on the interatrial septum or tumoral invasion of the inferior vena cava. At the ventricular level, the diagnostic signs differ according to whether there is tumoral invasion of the cavity or infiltration of the muscular wall. These cases illustrate the value of 2D echocardiography in the diagnosis of intracardiac metastases, sometimes even in the absence of clinical signs.

Aged↗
PubMed1986

[Thromboses of the right atrium: echocardiographic aspects, practical management. Apropos of 8 cases].

Right atrial (RA) thrombosis is rare. The aim of this study was to determine their clinical and echocardiographic features and therapeutic implications. In the last 7 years, 16 RA masses were detected by 2D echocardiography. The diagnosis of thrombosis was made in 8 cases based on anatomo-pathological examination (6 cases) or their disappearance with medical treatment (2 cases). The clinical presentations were: pulmonary embolism (4 cases), anterior myocardial infarction (2 cases), Ebstein's anomaly (1 case), thrombosis of a Leveen catheter (1 case). Only 1 patient had atrial fibrillation. Two echocardiographic appearances were observed: 1) a long, very mobile thrombus floating between the RA and right ventricle (4 cases), 2) a relatively immobile mass (4 cases). The 4 patients with relatively immobile thrombi survived: 2 underwent surgery and 2 were treated medically. All cases of floating thrombi had pulmonary embolism: 2 patients underwent surgery but the postoperative course was complicated; 2 patients died suddenly before surgery. These cases show that 2D echo is the diagnostic method of choice for detection of RA thrombosis. The floating RA thrombus is a therapeutic emergency and has a poor prognosis.

Adult↗
PubMed1986

[Major tricuspid insufficiency and absence of systolic valvular coaptation. Echocardiographic study. Apropos of 6 cases].

In a retrospective series of 960 cases of tricuspid regurgitation studied by two-dimensional echocardiography 6 patients presented a systolic defect of valvular coaptation. The origin of this defect varied: one case was due to carcinoid, two to rheumatic cardiopathy, two to papyraceous right ventricle and one to sclerodermia associated with pulmonary arterial hypertension. The mechanism of the lacking coaptation varies according to the etiology: valvular retraction in carcinoid cardiopathy, right-ventricle dilatation, dilatation of the tricuspid ring and altered kinetics of the right ventricle in the other cases. Changed contractility of the right ventricle is the only element allowing to distinguish tricuspid regurgitation with and without a coaptation defect. Clinically this abnormality always points to an advanced stage of severe tricuspid regurgitation.

Aged↗
PubMed1986

[Fibrinolytic treatment of 28 thromboses of valve prostheses. A biological study].

We carried out a series of laboratory investigation in 28 patients with prosthetic valve thrombosis (17 mitral and 11 aortic). The diagnosis was confirmed by TM and bidimensional echocardiograms and by cineradiography. The treatment consisted of UK (4,500 IU/kg/hour for 12 hours) and/or SK (initial loading dose of 500,000 IU, then 150,000 IU/hour for 10 hours). We measured fibrinogen, degradation products of fibrinogen-fibrin, plasminogen and antiplasmin. Two dimensional electrophoresis against anti-fibrinogen, anti-fragment-D and anti-fragment-E were employed for some samples. After thrombolytic therapy (SK: 18; UK: 7; SK-UK: 2; UK-SK: 1) complete clot removal was obtained in 21 cases (successful: group S), partial removal in 4 cases (improvement: group A) and failure in 3 cases (failure: group E). 3 patients died. Biochemical effects can be seen in group S and in group A. There were no changes in group E.

Adult↗