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Biomedical subjects

S Magnier

Publications and source records attributed to S Magnier.

At least 73 records · Page 4Linked to original sources
PubMed1980

[Interruption of the aortic arch and an aorto-pulmonary fistula. Simultaneous correction of lesions in a 5 1/2 month old infant].

Aortic arch hypoplasia is rare but carries a poor prognosis. It is usually associated with a left to right shunt at ventricular level. The association of an aorto-pulmonary fistula is exceptional. A case of a 5 1/2 month old infant treated successfully by simultaneous correction is reported with a review of the physiopathological changes. Pulmonary hypertension and aortic perfusion depend on the calibre of the ductus arteriosus and its evolution. The therapeutic problems which result are the suppression or palliation of pulmonary hypertension and resaturisation of distal aortic vascularisation. Surgery is the only hope of cure, and current techniques are reviewed: two stage procedures with revascularisation of the distal aorta and pulmonary artery banding, or simultaneous correction of aortic continuity with suppression of the left to right shunt under cardiopulmonary bypass. The technical conditions are analysed: perfusion of the different aortic segments, methods of reestablishing aortic continuity. Good results are as yet rare, and are obtained after complete correction under cardiopulmonary bypass.

Aorta, Thoracic↗
PubMed1980

[Isotopic radiocardiography as a method for hemodynamic investigation in pediatric cardiology (author's transl)].

In 22 children with acquired or malformative heart diseases catheterization and radiocardiography (RCG) investigations were performed. The results obtained with this method of hemodynamic investigation, in which the dilution curve of a short-lived isotope (Indium 113) is detected externally and recorded, were compared with the catheterization data. There is a significant correlation between the pulmonary arterial and capillary pressures obtained with RCG and those measured by catheterization in non cyanotic heart diseases. In addition, morphological analysis of RCG curves may provide information concerning the anatomic diagnosis of some heart diseases.

Adolescent↗
PubMed1979

[Contraception using a progestagen-only minipill in cardiac patients].

The choice of method of contraception in cardiac patients is often peremptory, as combined oestrogen-progesterone preparations and intra uterine devices are often contraindicated. A pure progesterone mini-pill, lynoestrenol (500 microgram) has been used in our department for several years, and would appear to be a possible solution. Its daily, uninterrupted administration for 6 to 30 months in 40 cardiac patients, many considered to be high risk cases (28 cases), has confirmed its contraceptive action: totally effective, excellent reversibility and satisfactory acceptability despite definite menstrual changes. Above all, it was almost totally innocuous, an essential factor in cardiac patients. No haemodynamic, hypersensitive or thromboembolic side effects were observed in any pateint. No changes were observed in glucose or lipid metabolism, hepatic function or blood coagulation after 3 to 6 months, in 6 to 14 patients at high risk. Platelet aggregation, factors II, V, VII and X, fibrinogen and anti thrombin II were normal. Although this is a small series of patients, the use of microdosage lynoestrenol seems an acceptable method of oral contraception for cardiac patients, providing they collaborate and are closely followed up from the cardiac point of view.

Adolescent↗
PubMed1978

[Dwarfism and constrictive pericarditis. Apropos of a case of so-called Mulibrey dwarfism with hypereosinophilia].

A child of 10 was admitted to a cardiology unit with adiastole. The marked degree of dwarfism and anatomical features were characteristic of the so-called 'Mulibrey' dwarfism. Surgical intervention confirmed the constrictive pericarditis which is normally found in this condition. Unfortunately, the adiastole persisted which, taking into account the marked eosinophilia, made an associated endomyocardial fibrosis seem likely. The distinctive features of constrictive pericarditis and of the constrictive type of cardiomyopathy are recalled.

Cardiomyopathies↗
PubMed1978

[Indices of left venticular performance and evaluation myocardial quality in mitral valve insufficiency, chronic aortic valve insufficiency and stenosis].

132 patients with pure mono-valvular cardiopathies (mitral incompetence, aortic stenosis and aortic incompetence) were classified into two groups according to the values of the systolic work index/myocardial mass ratio (SWI/MLV). Normal values of the ejection function (EF) and mean velocity of circumferential fibre shortening (VCF) for each cardiopathy were so obtained. Only patients with aortic stenosis of group I (SWI/MLV greater than or equal to 0.75 gm . g-1) had normal EF. All the other patients had EF and VCF values below normal although this did not always imply impaired myocardial function. Therefore the myocardial mass should also be considered in the evaluation of myocardial function and it would seem desirable to take this parameter into account in the management of these patients.

Adult↗
PubMed1978

[Extensive aortic dissection and aneurysm of the left coronary trunk. 20-year spontaneous development].

A case is reported of dissection of the aorta in a lady of 35. The condition was complicated first by myocardial infarction and secondly by severe aortic incompetence which led, 20 years after the onset of the dissection, to the death of the patient from intractable heart failure. At post-mortem, an extensive dissection was found to involve the whole of the aorta and several of its branches, but did not involve the coronary arteries, which were normal except for the trunk of the left coronary; this was dilated. The natural history of dissections of the aorta is reviewed. The incidence, course and etiology of coronary aneurysms are also discussed.

Adult↗
PubMed1978

[Changes in the subvalvular apparatus and left ventricular function in pure mitral stenosis].

Disordered left ventricular function and changes in the sub-valvular apparatus appear to be associated in patients with isolated mitral stenosis (MS). Left ventricular cine-angiography has demonstrated two groups of patients, according to the presence (group II) or absence (group I) of changes in the sub-valvular apparatus. There was no significant difference between the two groups in terms of age, heart rate, left ventricular end diastolic pressure, surface area of the mitral valve, or ventricular ejection time. However, group II patients had a lowered ejection fraction (EF), systolic ejection volume (SEB), speed of shortening of circular fibres (VCF), and systolic work index (SWI) compared with group I cases (respectively 0.49 +/- 0.06 and 0.58 +/- 0.04 for the EF, 36 +/- 7 ml.m-2 and 41 +/- 7 ml.m-2 for the SEV, 0.85 +/- 0.12 circ.s-1 and 1.09 +/- 0.16 circ.s-1 for the VCF, 45 +/- 11 gm.m-2 and 57 +/- 11 gm.m-2 for the SWI. Nevertheless, it appears that changes in the sub-valvular apparatus indicate rather than cause dysfunction of the left ventricle, which occurs in a certain number of patients who have a normal sub-valvular apparatus.

Adult↗
PubMed1978

[Evaluation of the contractile reserve of the myocardium by post-extrasystolic potentiation in aortic insufficiency].

Calculations were made of the indices of ventricular performance during the ejectional phase in 10 patients with a normal left ventricle and in 24 patients with aortic aneurysm, both under basal conditions and in the presence of extrasystoles produced incidentally during left biplanar cineventriculography. The fact that these indices were constantly raised implies the presence of post-extrasystole potentiation associated with an increase in contractility without significant changes in load. This technique, which provides a dynamic study of the behavior of the left ventricle in aortic incompetence allows us to assess the contractile reserve, and thus to give a more accurate prediction of the potential for recovery after operation.

Aortic Aneurysm↗
PubMed1978

[Physiopathological study of coupled electric stimulation].

The charges of left ventricular function provoked by coupled electrical stimulation were studied in 17 patients with severe chronic aortic incompetence and 9 controls. These results were compared with those obtained after isolated extrasystole in 24 cases of aortic incompetence and 10 controls, and during paired electrical stimulation in 12 cases of aortic incompetence. Left ventricular function increased uniformly after post-extrasystolic potentiation whatever the mode of stimulation. The preload did not change significantly, the increased ventricular function being mainly due to increased contractility. Coupled electrical stimulation mobilised the greatest contractility reserve (ejection fraction : +32 % in controls and +37 % in aortic incompetence and averaged circumferentiel fibre shortening +55 % in controls and +47 % in aortic incompetence). The contractility reserve is inversely proportional to the initial ejection fraction except when its value is less than 35 %. The myocardial response then becomes variable so that left ventricles with probable irreversible hypocontractility may be distinguished from those whose ventricular funciton would improve after surgical correction.

Adult↗
PubMed1977

[The value of myocardial mass determination in the evaluation of left ventricular functional value in chronic mitral insufficiency. Apropos of 44 cases].

The functional value of the left ventricle in chronic mitral incompetence, determined as a function of haemodynamic and angiocardiographic indices, has now become a difficult factor to determine because of the multiplicity of indices which exist, and because of disagreement about the pathological values which are often a function of the valvular pathology in the particular case. Moreover, the importance of myocardial hypertrophy is rarely taken into account. The ratio systolic work/myocardial mass (WS/WM) which lies between no limits in the normal subject (0.81+/-0.03 gm.g-1) has allowed us to classify 44 patients with chronic mitral incompetence into three groups: groupe I (WS/V(M) greater than 0.87 gm.g-1), characterised by an increase in WS proportionally superior to that of V(M) (hyperfunctional); group II (0.87 gm.g-1 larger than or equal to WS/V(M) larger than or equal to 0.75 gm-1), characterised by a parallel increase of mass and WS (isofunctional); group III (WS/V(M) less than 0.75 gm.g-1) in which the increase in mass is proportionally greater than the variation in WS (hypofunctional). A comparison between the selectivity of this relationship and that of other indices, which contain large areas of overlap between the various groups of patients, lead us to hope for a prognostic index which will take account of the myocardial mass and of the pump action of the left ventricle.

Adolescent↗
PubMed1976

[Mitral insufficiency in obstructive myocardiopathies. Hemodynamic study and cineangiography].

A haemodynamic and 2-plane cine-angiographic study of 23 patients with obstructive cardiomyopathy has shown that the mitral valve has a limited opening capacity, an unusually anterior position in early systole and is displaced anteriorly during systole. Mitral incompetence is present in more than half of the cases, but usually remains as the only lesion. When it is severe, it is because there are additional lesion: perforation, rupture of the cordae. The behaviour of the mitral valve was fairly constant in all 15 cases of hypertrophic, hyperkinetic, cardiomyopathy, and mitral incompetence was common, and usually found in isolation. The mechanism is discussed, and the physiopathological and therapeutic implications of these facts are reviewed.

Adolescent↗
PubMed1976

[Correlation between the angiographic appearance and the left intraventricular gradient in obstructive myocardiopathy. Apropos of 42 cases].

42 patients who were given the diagnosis of obstructive cardiomyopathy (OCM) on the basis of a basal left intraventricular systolic gradient equal to or in excess of 20 mmHg were divided into two groups, according to the angiocardiographic appearances (in the right anterior oblique projection) of the left ventricular cavity during systole. In 20 cases the appearances were those of a typical obstructive cardiomyopathy. In the other 22, despite the presence of a fairly large left intraventricular gradient, the appearances on angiocardiography were closest to those described for the non-obstructive cardiomyopathies with diffuse myocardial hypertrophy. These two groups were compared in the quest for a difference between the clinical, radiological, electrocardiographic, phonomechanographic, and haemodynamic picture on the one hand, and the appearances at angiography on the other. These two groups can only be separated by the mean value of the left intraventricular systolic gradient established under basal conditions; this is greater when the angiographic picture is less characteristic. However, the value of this gradient is shown by the positive correlation between the figure for the gradient and that for the left ventricular ejection time, as determined from external phonomecanographic measurements and from the catheter on the left side. This determination confirms the existance of obstruction to the outflow and the diagnosis of obstructive cardiomyopathy, even when the angiographic appearances are not typical.

Adolescent↗
PubMed1976

[Long-term results of aortic valve replacement with a prosthesis].

A long term evaluation of prosthetic replacement of the aortic valve by various types of prosthesis has been carried out; 530 patients from various centres of cardiology were studied. The average annual mortality after the first two postoperative years was about 2.5% and half of the patients undergoing surgery were still alive after 10 years. The functional improvement is usually marked and is generally to be expected, although with an increased risk, even in patients who underwent surgery at stage IV of the NYHA classification. In this study, the prostheses which were associated with the best long term results were the Starr-Edwards 1260, the Smeloff-Cutter, and the Björk. The commonest complications after the first month were dehiscence of the prosthesis (11.8%), thromboembolic episodes (11.2%), coronary complicatons (11.1%) and cardiac failure (7.1%). The most serious is infection of the prosthesis, which is almost invariably fatal. Deterioration in the substance of the prosthesis has become very rare, but there must be reservations in this respect with the SE2400, which has still not been in use long enough. Revision operations were carried out on 7.6% of the survivors at one month, with a mortality of 18.4%. Sudden death remains a constant threat. A study of the actuarial survival graphs for operated and non-operated cases shows that surgery should be advised in all poorly tolerated valve defects, and even for an uncomplicated tight aortic stenosis. Bearing in mind the progressive lowering of operative mortality, surgical treatment is also justified in cases with marked or gross aortic incompetence which is well tolerated if flow-up studies show a progressive increase in cardiac volume.

Aortic Valve↗
PubMed1976

[Diagnosis of myxomas of the left auricle by ultrasonic echography].

The two case histories of myxoma of the left auricle reported in this paper illustrate how echography is a diagnostic method which is non-invasive, simple, and relatively accurate provided that different angles of incidence are used, and especially the "root aorta-left auricle" incidence. It is indicated especially in cases with variable mitral murmurs on auscultation, but also where there is a very large left auricle, heart failure of unknown cause, or even an apparently straightforward case of mital stenosis. Moreover, as one of these case histories demonstrates, the technique allows both short and long term postoperative follow-up to be carried out with ease and safety, so that a possible recurrence can be picked up later.

Adolescent↗
PubMed1976

[Spontaneous development of obstructive myocardiopathies].

49 cases of obstructive cardiomyopathy (37 of the sporadic type, 12 of the familial type), confirmed by phonomechanocardiographic, haemodynamic and/or angiographic investigation and followed up for more than 5 years (mean 7.5 years) without surgical intervention, form the basis of a study on the natural history of this condition. There were 19 deaths (39%), of which 7 were of the familial type (58%) and 12 of the sporadic type (32%). The actuarial survival curves, which were commenced at the time or the first clinical symptom or the date of the first hospitalisation, show that approximately one patient in two dies at or about the age of 40. In 6 cases, death occurred in patients who were greatly improved by medical treatment to the extent of remaining symptomfree up to the time of death. No factors could be found in the initial investigation (phonomechanocardiographic electrocardiographic, radiographic, haemodynamic and angiographic examination (phonomechanocardiographic, electrocardiographic, between the patients still alive and those who had died; each paramater studies had mean values which overlapped in the two groups. Only the age at which the first clinical feature appeared separated the two groups: those patients who died had their first symptom or sign of disordered function at a much younger average age (15.9 years) than the survivors (25 years). This study has confirmed the very serious nature of obstructive cardiomyopathy, especially the familial types, and those with a low age of onset. It emphasises the extreme difficulty in arriving at a prognosis in this condition.

Adolescent↗