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Biomedical subjects

S Magnier

Publications and source records attributed to S Magnier.

At least 55 records · Page 3Linked to original sources
PubMed1988

[Aortic subvalvular obstructions. Anatomical forms and surgical treatment of 82 consecutive cases].

The authors report their experience of surgery for subvalvular aortic obstruction in 82 patients aged from 4 to 44 years (mean 15 years). Nearly one-half of the patients presented with symptoms; the others were operated upon for various reasons: gradient exceeding 60 mmHg, development or aggravation of aortic regurgitation, positive exercise test, electrocardiographic or echocardiographic signs of left ventricular repercussions. Nineteen children had previously undergone surgery for another malformation, but the subvalvular aortic obstruction had either been missed during this first operation or had developed subsequently. The diaphragmatic pattern was the most frequent (62 cases); the fibromuscular pattern was less common (9 cases) and the tunnel pattern (6 cases) was regularly associated in this series with hypoplasia of the aortic ring. Obstruction due to faulty insertion of the mitral valve was encountered on 3 occasions. The operative technique for each anatomical pattern is described. Tunnel obstructions did not require primary aortoventriculoplasty without prosthetic valve replacement of apicoaortic conduits. In addition to treatment of associated lesions (including 4 cases of ventricular septal defect), 9 aortic commissurotomies, 6 aortic valvuloplasties and 4 aortic valve replacements were performed. The transaortic gradient was dramatically improved. The aortic regurgitation murmur subsided with or, usually, without valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Tetralogy of Fallot in adults. Apropos of 43 cases with 38 total corrections].

The records of 43 patients older than 18 years presenting with tetralogy of Fallot were retrospectively examined to determine the semiological characteristics of the disease in adults. One or more palliative operations had previously been performed in 27 patients. Full correction was carried out in 38 patients with results described below. Tetralogy of Fallot has the following characteristics in adults as compared with children: clinically, heart failure, attacks of angina, haemoptysis and sequelae of previous complications are more frequent; at electrocardiography, right atrial hypertrophy, right bundle disorders of conduction and ventricular extrasystoles are also more frequent; radiology shows that cardiomegaly is no longer exceptional; haemodynamic studies demonstrate an increase in right atrial and right ventricular end-diastolic pressures. These characteristics indicate a deterioration of haemodynamic adjustment to the disease with age. The operative morbidity mostly consisted of haemorrhages (55% of the patients), more frequent in subjects with permeable anastomoses (p less than 0.01), and heart failure (50% of the patients) the frequency of which increased with the subject's age, the duration of the operation and the use of an infundibulo-pulmonary prosthesis (p less than 0.05). The operative mortality (18%) depended on the extent of the pulmonary stenosis and on the presence of a previous anastomosis (p = 0.04). An analysis of the causes of death reported in the literature showed that in adults the presence of an anastomosis constitutes a separate risk factor in complete repair. The excellent long-term results of corrective surgery concerning cardiac function and survival suggest that except for those rare cases where the operative risk is very high all adults with tetralogy of Fallot should undergo complete repair.

Adult↗
PubMed1987

[Endocarditis of the pulmonary valve complicating interventricular communication. Echocardiographic detection].

A 29-year old woman known to have Roger's disease was hospitalized for streptococcal endocarditis with pulmonary embolism and cerebral vascular accident. Echocardiography demonstrated vegetations on the pulmonary valve, and this was confirmed at surgery. Pulmonary valve endocarditis is a rare lesion sometimes occurring as a complication of congenital malformations with ventricular septal defect. Its prognosis is governed not so much by bacterial resistance or haemodynamic repercussions as by the risk of septic pulmonary embolism or systemic embolism. Prophylaxis is essential to avoid this dangerous complication.

Adult↗
PubMed1985

[Large aneurysm of the left heart, an unusual cause of cardiomegaly in children].

Idiopathic left ventricular aneurysms are rare in childhood as are the congenital epigastric muscular diverticula which form part of a complex congenital malformation. The aneurysms are usually symptomatic and present either with cardiac failure or another complication. The authors report a very rare case in which the aneurysm effectively realised a double chamber left ventricle. The aneurysm was larger than the true ventricle, muscular, lined by normal endocardium and covered by coronary vessels. Surgical ablation was indicated for cardiac failure. Two similar cases have been previously reported.

Cardiomegaly↗
PubMed1985

[Collateral pulmonary circulation in Fallot's tetralogy].

An angiographic study of 231 patients with tetralogy of Fallot (TOF) in both neonatal and adult age groups (0 to 49 years) was in this condition. Cases of pulmonary atresia with ventricular septal defect were excluded. Two types of collateral pulmonary circulation were observed: the most common form is the result of distal intrapulmonary anastomosis between systemic parietal, mammary and bronchial vessels with the pulmonary arteries. This type of collateral circulation represents an evolutive stage of TOF and is directly related to age and to the degree of hypoxia; the other, oa rare and probably congenital form (1.7 p. 100 of cases) observed even in young children, consisting of proximal anastomoses between systemic vessels arising from the aorta (1 to 3 vessels) and the pulmonary arterial tree. The rare forms of TOF with single pulmonary arteries acquired after palliative or congenital anastomoses (1.4 p. 100) have both types of collateral circulation. Preoperative diagnosis of the collateral pulmonary circulation requires opacification of the aorta especially of the descending thoracic segment and its branches, completed in cases of an absent pulmonary artery by wedged pulmonary venous opacification. The haemodynamic effects of this collateral circulation on the pulmonary bed to a variable degree of histological change. This may partially explain some of the poor surgical results of repair of TOF and, in view of recent progress in cardiopulmonary bypass techniques in children, incite to earlier surgical correction of this condition.

Adolescent↗
PubMed1985

[Date of surgery in congenital cardiopathies].

The appropriate time for surgical intervention in congenital cardiopathies is chosen as a function of several imperatives; psychological and family reasons militate in favour of an early intervention. In particular, in cardiopathies accompanied by pulmonary arterial hypertension (serious VSD, arterial transpositions with VSD, etc.) there is a risk of irreversible obstructive pulmonary arterial disease in the first months of life in some cases. This risk, added to those of cardiac insufficiency, prompts early intervention. The progressive risks of cyanotic cardiopathies: risks of intravascular thrombosis and of cerebral abscess have contributed to these cardiopathies being operated upon earlier than was done some years ago. The decision to be taken remains difficult for complex cardiopathies. Coarctations of the aorta are usually operated upon before the age of 4 years in order to avoid the risk of permanently fixed arterial hypertension and premature vascular degeneration. The operative indications in aortic stenoses are now guided not only by clinical data but also by an assessment of the haemodynamic tolerance by ultrasonography and exertion tests.

Adolescent↗
PubMed1984

[Idiopathic dilatation of the right atrium in 2 infants disclosed by arrhythmia].

Idiopathic right atrial dilatation is a rare and probably congenital malformation. Two new cases are reported, in an 18 months old infant and a six week old baby, both presenting with supraventricular tachyarrhythmias. Clinical examination was normal. Chest X-ray showed bulging of the right heart border and electrocardiography revealed partial right bundle branch block. The diagnosis was made by echocardiography which showed aneurysmal dilatation of the right atrium. There were no signs of valvular heart disease or of an intracardiac shunt; the septal tricuspid leaflet was in its normal position. M-mode recordings showed no signs of Ebstein's anomaly. The diagnosis was confirmed by cardiac catheterisation in the first case; this investigation seemed to be pointless in the second case. Both children experienced many episodes of supraventricular tachyarrhythmias. The first developed tricuspid regurgitation but the second remains asymptomatic.

Echocardiography↗
PubMed1983

[Congenital aneurysm of Valsalva's sinus rupturing into the left ventricle. Apropos of a case in a 3-year-old child].

The authors present the case of a 3 year old child with cardiac failure of recent onset, arterial hyperpulsatility and a systolo-diastolic murmur. Aortic angiographic showed an aneurysm of the sinus of Valsalva and valvular aortic regurgitation. At surgery the aneurysm was found to have ruptured into the left ventricle. The fistula was closed. The postoperative course has been satisfactory with a 20 month follow-up period, despite some residual aortic regurgitation. This is the first published pediatric case of a congenital sinus of Valsalva aneurysm rupturing into the left ventricle. The case is discussed and compared with 6 other cases in the literature concerning adults.

Aortic Rupture↗
PubMed1982

[Infectious endocarditis of a healthy heart in an infant].

The case of a 22 months old child with no previous medical history hospitalised for an acute infection with pyrexia, arthritis, meningitis and leukocytosis with polynucleosis is reported. All bacteriological investigations were sterile; the search for soluble antigen and serological tests were negative. Antibiotic therapy (Ampicillin and Thiamphenicol) cured the meningitis and arthritis. On the 10th day of treatment the temperature rose, a systolic murmur was detected and echocardiography showed the presence of a large vegetation on the anterior mitral leaflet. Three weeks later (on Ampicillin and Amikacine), asymptomatic abolition of the femoral pulses and disappearance of the vegetation on echocardiography were observed. Angiography confirmed obstruction at the bifurcation of the aorta. Surgical removal of the embolism resulted in revascularisation of the femoral artery and was followed by apyrexia. This infant probably developed endocarditis on a healthy heart. It was complicated by systemic embolism and mitral regurgitation which at present is well tolerated.

Aortography↗
PubMed1981

[Tetralogy of Fallot and aortic insufficiency].

Seven out of 348 cases of Fallot's tetralogy (2 %) referred over an eight year period were complicated by aortic incompetence (AI). The incidence of AI was much lower than in VSD (7.6 %), probably because of the prevailing haemodynamics: in high VSD, the left-to-right shunt may damage the aortic cusps whilst in Fallot's tetralogy the output of both ventricles is ejected directly into the aorta with no alteration of aortic valve function. In this series, infective endocarditis was the predominant cause of AI (3 cases); surgery had to be undertaken in the infectious phase in 2 cases. AI was coincidental in two other cases (rheumatic valvular disease and calcified bicuspid valve). In the remaining two cases, the role of increased aortic flow in late distension of the aortic valve ring is discussed. AI should be corrected in the same operative time as the Fallot's tetralogy. Late onset AI occurring after repair of Fallot's tetralogy should also be corrected; in this situation, it is often difficult to diagnose the origin of the diastolic murmur. Without surgery the prognosis is poor as the diastolic regurgitation occurs in a ventricle whose function is often already compromised.

Adolescent↗
PubMed1981

[Functional respiratory disorders in children with left-to-right shunt].

The respiratory function of 19 children aged from 2 months to 9 years old with a cardiac lesion giving a left-to-right shunt was studied and analysed with respect to the hemodynamic disturbance. Respiratory function tests (RFTs) included measurement of functional residual capacity (FRC), the partial pressure in oxygen (Pa 02) on arterialised blood taken from the ear lobe, dynamic pulmonary compliance (CI dyn.) and total pulmonary resistance (RI). FRC and RI were not significantly modified. On the other hand, CI. dyn. was low (-31.2 +/- 22.9%, p less than 0,001) as were the CI. dyn. CFR ratio (-25.5 +/- 20.9%, p less than 0.001) and the Pa 02 (-7.6 +/- 12.7% p less than 0.02). There was a significant correlation between the reduction of CI. dyn. and mean pulmonary arterial pressure (PAP) and the increase in the pulmonary blood flow. In addition, a significant correlation was also found between the reduction in Pa 02 and the PAP and increase in pulmonary blood flow. These results show that cardiac lesions with left-to-right shunts give rise to diffuse changes in respiratory function and are discussed in the light of the abnormalities in pulmonary development previously described in pulmonary biopsy of patients with left-to-right shunts. The value of RFTs in the surveillance of patients with left-to-right shunts is underlined.

Airway Resistance↗