[Bacterial vegetation on a permanent endocavitary stimulation probe. Apropos of a case].
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Aged↗
Biomedical subjects
S Legeais
Publications and source records attributed to S Legeais.
Quantification of left-sided valvular stenoses by color Doppler imaging of jets.
A new methodology for assessment of severity of stenosis employing color Doppler imaging and relying upon spatial and temporal studies of aortic and mitral stenotic jets is described. The spatial study consisted of the detection of the jet origin with respect to upstream and downstream trajectories in the long-axis view, with further identification of each of the three levels from characteristics single-gated Doppler flow recordings, when desired. For the temporal study, color images were gated in midsystole for aortic, and in early diastole for mitral, stenosis. The final step consisted of imaging the jet cross-sectional area in the short-axis view with planimetry. Measurements were compared with those obtained by the Gorlin formula. The procedure was feasible in 43 of 48 studied cases and the correlation between hemodynamic and color Doppler data was satisfactory for both valvular lesions. The best agreement between both methods was for severe stenoses, where the standard error of estimate was the lowest. For large areas the variance in measurements was wider and the correlation coefficient decreased, but this did not cause errors in recognition. This new method provides a convenient and rapid visualization of stenotic jets and is particularly recommended for assessment of severe stenoses, where accuracy was highest for all clinical conditions.
Aortic Valve Stenosis↗
[Changes in mitral and tricuspid blood flow as a function of aging. Value of a combined study with Doppler echocardiography].
The many factors, especially physiological, which influence mitral diastolic flow and the difficulties in interpretation motivated this study of age related changes of blood flow through the two atrioventricular orifices, taking tricuspid flow as the reference for evaluation of any change in mitral flow. Doppler echocardiographic studies were performed in 45 normal subjects who were divided into 3 groups according to age. The amplitude, duration and velocity time integrals (VTI) of the E and A waves were studied at the level of the valve rings and at the tips of the leaflets. Ventricular isovolumic relaxation periods were measured. The following age-related changes were observed at both atrioventricular valve orifices: increased amplitude and VTI of the A waves; decreased amplitude and VTI of the E waves, leading to a decrease or inversion of the ratios of the E/A wave amplitudes and VTI. No significant differences in the duration of the E and A waves were detected. An increase in the left ventricular isovolumic relaxation period was observed. Differences were also recorded according to the site of the Doppler sample volume: increased amplitude, duration and VTI of the E and A waves when the flow was recorded at the tips of the valve leaflets. This underlines the value of using the E wave VTI/total VTI ratio which was unaffected by the sample volume position. An age-related decrease in this ratio was demonstrated at both atrioventricular valve orifices.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[A new quantitative method for quantifying left heart jets by Doppler color imaging].
Quantification of valvular lesions by Color Doppler is based on jet measurements. The aim of this new method is to reduce some of the errors in these measurements: uncertainty in delimiting the colored areas of the jets; spontaneous beat-to-beat variations of the jets entailing interpretative difficulties. The first step was to determine the correlations between the colored areas and previously established single-gated Doppler criteria, retaining spectral criteria to define the borders of the jets, so overcoming some of the limitations of color Doppler. The association of these methods resulted in better discrimination between grades and a better correlation in 45 angiographically controlled mitral and aortic regurgitations than with color Doppler alone. In stenotic lesions, spectral criteria from single-gated associated exploration enabled localisation of the level for planimetry of the section of the jet at its origin visualised by color Doppler. Satisfactory correlations were obtained with the Gorlin surface area in a group of 43 patients with mitral and aortic stenosis. A coefficient of variation of 13 to 14 per cent was found with planimetry of the regurgitant jet in the upstream cardiac chamber. Uni-dimensional measurement decreased this variation to 6 to 11 per cent in the same patients. The largest decrease in variability (6 to 8 per cent) was observed in stenotic and regurgitant lesions with planimetry of the section of jet at its origin performed in held mid-expiration and so this would appear to be the best method. The guide lines and technological improvement associated with the physiopathological information provided by color Doppler should refine the quantification of valvular heart lesions.
Adult↗
[Early peak activity of creatine kinase in non-thrombolysed myocardial infarction: prognostic factor?].
The time elapsed between the onset of pain and serum creatine kinase (CK) peak activity is an indirect marker of reperfusion in the thrombolytic treatment of myocardial infarction, and some authors regard this time as a prognostic factor in infarctions not treated with thrombolysis. CK activity was measured in 90 consecutive patients (mean age 66.9 +/- 13.7 years) with acute myocardial infarction (anginal pain + ECG signs + CK greater than 160 3U/l, including 40 p. 100 of CK MB). Measurements began at the time of admission to the intensive care unit and were repeated 6-hourly until CK levels returned to normal. Mean time of CK peak activity was 19.30 +/- 7.15 h after the initial pain (8 to 55 hours prior to admission). This time was not influenced by age, sex, presence or absence of risk factors and history of coronary disease, nor by the anterior or transmural location of the infarct. In contrast, an early arrival at the intensive care unit was associated with an early CK peak: patients who reached the unit within 6 hours or less had a peak at 18.15 +/- 6 h, whereas those who arrived after 6 h had a peak at 22.30 +/- 9.30 h (p less than 0.01). In addition, cases of infarction without Q wave and with an initially elevated ST segment had an earlier peak than the others (16.30 +/- 5.30 h vs 19 +/- 6.45 h in transmural infarctions and vs 24.30 +/- 7.30 h in infarctions with initially depressed ST; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Color and pulsed Doppler studies of atrial flow dynamics in normals and adult patients with uncomplicated atrial septal defects.
Left and right atrial flow dynamics were compared by means of color and pulsed Doppler in order to study whether color Doppler could reliably provide differentiation between normals [15] and patients without atrial shunt at catheterization [12], vs patients with confirmed atrial septal defect [12]. The procedure consisted of sequential analysis of colored images throughout the cardiac cycle using an apical approach. In addition pulsed Doppler indices were calculated from both annular traces, relating diastolic early (E) and late (A) filling waves at each annulus (E/A); E and A waves were also summed (E + A), and the sum was related between both annuli (Tricuspid/Mitral ratio). Sequential analysis had a 100% sensitivity and specificity for the diagnosis of atrial septal defect, showing an asymmetrical pattern with predominant images in the right atrium, from the 2nd half of systole till End-diastole, vs the symmetrical 'Horseshoe' pattern found over both atria for control subjects. It avoided diagnostic errors due to overriding septal images in systole in 44% of controls. There also was a significant increase of the Tricuspid/Mitral ratios, (for duration and velocity time integral of waves) in patients with atrial septal defect. The correlation coefficient between ratios and values of the Pulmonary/Systemic flow ratio invasively calculated for 10 patients was respectively 0.6 and 0.7 (p less than 0.01). Sequential analysis of colored images appears highly reliable for the diagnosis of atrial septal defect; anomalies of ratios, although of moderate value for predicting shunt magnitude, substantiate the inequality of atrial fillings.
Adolescent↗