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ABSTRACT: We report a case of Williams and Beuren syndrome in which the obstruction of the pulmonary vascular bed, linked with peripheral stenoses of the pulmonary arteries, associated here with an interventricular communication, was aggravated due to the coexistence of in situ thrombotic disease, leading to a progressive hypoxaemia, requiring long-term anticoagulant treatment, and compromising the long-term prognosis. This case report puts into question the so-called favourable prognosis of pulmonary arterial branch stenoses in this malformation syndrome.
Archives des maladies du coeur et des vaisseaux 01/2007; 99(12):1256-8. · 0.40 Impact Factor
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Heart (British Cardiac Society) 01/2006; 91(12):1614. · 4.22 Impact Factor
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ABSTRACT: We report the case of a 68 years old patient with platypnea orthodeoxia syndrome who has been clinically suspected on cutaneous saturation position's variation. It has been confirmed by transthoracic and transesophageal echocardiography (TEE). TEE showed the size of patent foramen ovale (PFO), visualised the right to left shunt. A right heart angiography confirmed echocardiographic data and allowed successful closure by a Cardioseal percutaneous transcatheter button device implantation. Symptom's disappearance and a TEE control after 2 months confirmed the success of the procedure.
Archives des maladies du coeur et des vaisseaux 02/2003; 96(1):55-8. · 0.40 Impact Factor
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ABSTRACT: We report the case of a 50-year-old man admitted to hospital for a type A aortic dissection. After conventional surgical repair, he was asymptomatic and underwent computed tomography imaging at 15 days, 3 and 6 months. The first CT scan showed a small perigraft circulating false aneurysm which totally disappeared on the last exam. This case emphasizes the potential role of CT scan in the follow-up of patient after aortic surgery and the likely favorable outcome of some false aneurysm.
Journal de Radiologie 03/1999; 80(2):153-6. · 0.42 Impact Factor
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ABSTRACT: Acute cardiac failure should be approached clinically and paraclinically as an emergency and precipitation is not always what is required. Consequently, strict clinical and paraclinical strategy leads to decisive action to improve the prognosis. The authors describe the principles of management of acute cardiac failure. The different stages which are carried out simultaneously in clinical practice are discussed: physiopathological basis, clinical and paraclinical investigations, symptomatic and aetiological treatment. The description and indications of circulatory assistance are considered. This constitutes a major therapeutic advance of the last decade and has changed the treatment of the most severe clinical forms of acute cardiac failure.
Archives des maladies du coeur et des vaisseaux 12/1998; 91(11):1349-58. · 0.40 Impact Factor
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ABSTRACT: The aim of this study was to identify the similitudes and the differences in the epidemiology and prevention of myocardial infarction and cerebrovascular accidents by analysis of trials of primary and secondary prevention of myocardial infarction and cerebrovascular accidents. The principal risk factors common to both pathologies are hypertension, smoking and increased LDL-cholesterol. However, the statistical significance with respect to causality differs from one pathology to the other. Similarly, the impact of preventive measures is not the same: the treatment of hypertension is more important in the prevention of cerebrovascular accidents than myocardial infarction; the situation is the other way around with respect to the treatment of hypercholesterolaemia. Of the therapeutic interventions, aspirin is effective in all stages of coronary artery disease but does not prevent cerebrovascular accidents in patients without documented atherosclerosis. Thrombolysis carries a much higher benefit/risk ratio in the treatment of myocardial infarction than in that of cerebral infarction. The so-called cardioprotective drugs, such as the betablockers and angiotensin converting enzyme inhibitors, have only been used to any extent in the secondary prevention of myocardial infarction. These differences reflect the fact that cerebrovascular accident covers a range of diseases much more diverse than does myocardial infarction, and also that the brain is much more exposed to haemorrhage whereas cardiac haematoma is highly unusual. Finally, cerebral atherosclerosis is a later event than coronary atherosclerosis and this has epidemiological implications which are difficult to assess. In conclusion, the prevention of myocardial infarction and of cerebrovascular accidents may proceed theoretically by a common pathway but in practice, it is very different.
Archives des maladies du coeur et des vaisseaux 11/1998; 91 Spec No 5:59-63. · 0.40 Impact Factor
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ABSTRACT: The mechanism of structural failure of bioprosthetic valves is still not clearly understood. This study was undertaken to assess pure leaflet tear as a mode of failure in porcine and pericardial bioprostheses.
Of 246 bioprosthetic valves (109 porcine, 137 pericardial) implanted between 1975 and 1991, 101 had to be explanted and served as the study population.
The reasons for valve failure were calcific degeneration in 73, pure tear in 12, and endocarditis in 10. Six other patients had a perivalvar leak. The mean age at operation was 32 years. Freedom from degeneration at 10 years was 45 +/- 7% and from pure tear it was 92 +/- 2%. The hazard functions were strikingly different, as that for degeneration showed a progressive increase while that for pure tear peaked at six years post-implant. The mean age of the patients with pure tear was 41 years and for degeneration it was 24 years (p = 0.00001). The reasons for the difference in hazard function are discussed. The characteristic clinical features of pure tear allow clinical diagnosis in the majority of patients.
Pure tear is the result of uneven tissue loading with tearing occurring at sites of maximal stress. The four possible mechanisms in pericardial valves are (a) intense stress concentration at the top of the stent post (commissure); (b) compression stress below the top of the post; (c) abrasion stress in tissue mounted outside the frame; and (d) increased bending stresses on leaflet opening. In stent-mounted porcine valves, pure tear is related to incorrect mounting or to increased bending stresses.
The Journal of heart valve disease 02/1996; 5(1):35-9. · 0.81 Impact Factor
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ABSTRACT: The aim of this study was to determine the diagnostic efficiency of transesophageal echocardiography (TEE) in isthmic aortic ruptures and to describe the echocardiographic Doppler anomalies. TEE was performed prospectively for 18 months in 33 patients with serious polytraumas requiring intensive care. The average age was 40.75 years (range, 17 to 78 years). Single or biplanar TEE was used. In three patients with aortic transection, echocardiography showed an intimal flap thicker than that of dissections. The flaps were torn and retracted on the free edge. It was difficult to distinguish the periaortic hematoma. Doppler imaging showed turbulent flows in several places around the aorta. These flows were especially visible at the beginning of the intimal flap. They were visible on M-mode color imaging during systole and diastole. During diastole, a large color flow was observed in the middle of the aortic lumen. It was turbulent in some places and mimicked the systolic filling of the aorta. These flows create the characteristic "to and fro sign" spectrum of Doppler imaging, usually seen in peripheral false arterial aneurysms. TEE findings were confirmed in two cases by surgery and in one case by aortography. TEE seems to be an effective means of detecting isthmic rupture, with the diagnosis resting on the data obtained from echocardiography and Doppler imaging. A suspected isthmic disruption should be assessed by an emergency TEE and aortography used only for uncertain or complex cases.
Journal of the American Society of Echocardiography 9(5):657-62. · 3.71 Impact Factor
