Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Apr 1984
[Significance of a supraventricular arrhythmia precipitated during an electrophysiological study].
The clinical history and 24 hour Holter monitoring of 749 patients without ECG appearances of ventricular preexcitation were compared with the results of electrophysiological investigations to determine whether supraventricular arrhythmias initiated during endocavitary electrophysiological investigations had any pathological significance. Endocavitary studies were undertaken to investigate symptoms of dizziness, syncope and/or conduction defects except in the group of paroxysmal junctional tachycardia (PJT) where the indication was investigation of a tachycardia (78 cases). In 544 patients (Group I) no arrhythmias were initiated. ⋯ Fixed atrial stimulation (less than 200/min) triggered AF or AFI in 14 patients. Nine had spontaneous SVT (64.3%) : AV was greater than 200/min in 2 cases (14.2%) and VA' greater than or equal 170/min in 2 of the 10 cases studied (20%). Ventricular stimulation induced SVT in 15 patients, 14 of whom had SVT (92%).(ABSTRACT TRUNCATED AT 400 WORDS)
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Arch Mal Coeur Vaiss · Mar 1984
[Prevention of gas microemboli during cardiac surgery. Numerical control of cardiac cavity purging by an ultrasonic detector].
Despite all precautions taken by cardiac surgeons to eliminate air remaining in the cardiac cavities and pulmonary veins at the end of cardiopulmonary bypass, many micro bubbles probably remain and pass into the systemic circulation with a risk of deteriorations of cerebral or myocardial function. Over the last four years we have used ultrasound to try to prevent the risk of preoperative gas microemboli: the machine is equipped with a detector (a quartz oscillator coupled to a piezoelectric transducer emitting a continuous beam of ultrasound at a frequency of 5 Mhz) which allows the following variables to be determined: the time interval from the onset of detection, the total quantity of bubbles (arbitrary units) in the examined regions, the quantity of bubbles detected over a given time interval which can be adjusted from 15 to 120 seconds. The passage of bubbles is also indicated by light and sound alarms. ⋯ Therefore, after cardiopulmonary bypass, and despite all efforts at purging the air, we showed that numbers of microbubbles were ejected into the ascending aorta for a variable period of time: only some of them were eliminated by active aspiration through a trocar placed distal to the periaortic probe. The right coronary ostium was poorly protected against microbubbles because of its anatomical situation (6 cases in this series). We therefore established a protocol for the use of this apparatus to aid the purging of the cardiac cavities and pulmonary veins before stopping cardiopulmonary bypass: the manoeuvres, guided by the ultrasound probes, are performed before the left ventricle is allowed to eject blood into the ascending aorta.(ABSTRACT TRUNCATED AT 400 WORDS)
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Arch Mal Coeur Vaiss · Jan 1984
Case Reports[1:1 atrial flutter in an elderly patient: one of the methods of discovering Wolff-Parkinson-White syndrome. Apropos of a case in an adult].
Atrial flutter with 1:1 atrioventricular conduction giving rise to a ventricular rhythm of 240/min in an 80 year old man was the first sign of the Wolff-Parkinson-White syndrome; all previous electrocardiogrammes had shown no evidence of pre-excitation. It was only on the fifth day of hospitalisation that the ECG showed a short PR interval with a delta wave. This case illustrates that: --all supraventricular arrhythmias with abnormally high ventricular rates (over 220/min in adults) should alert to the possibility of an accessory atrioventricular pathway; --rapid atrioventricular conduction may be the first sign of an accessory pathway; --the differential diagnosis lies between an accessory atrioventricular pathway and an atriohisian tract; --digitalis, which may shorten the refractory period of the accessory pathway, is contraindicated in patients with a Kent bundle.
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Arch Mal Coeur Vaiss · Jun 1981
[Early and late term results of triple valve replacements. Use of a tricuspid bioprosthesis].
Triple valve replacement (TVR) is associated with an increased operative and long-term mortality rate. The aim of this study was to reduce operative mortality by effective myocardial protection (coronary perfusion with moderate hypothermia) and to improve long-term results by the optimal choice of valve prosthesis and, in particular, by the systematic use of xenografts for tricuspid valve replacement. Twenty TVR were performed between 1970 and 1977. ⋯ Thirteen patients had cardiac catheterisation over one year after operation: right atrial and mean pulmonary artery pressures were significantly reduced (p less than 0.001 and p less than 0.01 respectively); there was a moderate increase in cardiac index( p less than 0.001). Late clinical complications were rare, only one regressive cerebral embolism was observed. Triple valve replacement, when necessary, carried a limited early postoperative risk, and satisfactory functional and haemodynamic results may be obtained in the long term.
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Arch Mal Coeur Vaiss · Jun 1981
[Echocardiography of an operated case of a myxoma of the tricuspid valve].
The case of a 6 year old child with a tricuspid valve myxoma is presented. Early diagnosis by echocardiography, confirmed by angiography, resulted in surgical cure before any symptoms appeared. This is the only reported echocardiographic study of a myxoma inserted on the tricuspid valve found in a review of the literature of 6 cases of right ventricular myxoma. ⋯ The echocardiographic signs localising the precise origin of the tumor in the tricuspid valve are developed. The differential diagnosis with right atrial myxoma prolapsing into the ventricular cavity, benign and malignant right ventricular tumours and tricuspid valve vegetations is discussed. The precision of the diagnostic information obtained by echocardiography suggests that angiography may not be essential any longer, especially when the risk of embolisation and acute obstruction are taken into consideration.