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1.
Int J Cardiol ; 130(2): 285-7, 2008 Nov 12.
Article in English | MEDLINE | ID: mdl-17689718

ABSTRACT

Among 1146 patients undergoing percutaneous mitral valvuloplasty for symptomatic mitral stenosis, 8 (4 men and women) were at high risk for surgery on the basis of the New York Heart Association functional class IV (n=8), severe pulmonary hypertension (n=5). All these patients aged 30+/-23.6 years had signs of right heart failure, high echocardiographic score (9.6+/-3.6) and low mitral valve area (0.50+/-0.19 cm(2)). The procedure resulted in an increase in mitral valve area (1.55+/-0.17 cm(2)) with a concomitant reduction in pulmonary artery systolic pressure (58.7+/-9.9 mm Hg) and decrease in tricuspid regurgitation. At follow-up (mean 14+/-3 months), one patient with renal failure... presented with a mitral restenosis is scheduled for mitral valve replacement, two patients with severe tricuspid regurgitation required tricuspid annuloplasty. In conclusion, percutaneous mitral valvuloplasty is feasible and safe in patients at high surgical risk and can be considered as an acceptable alternative to surgery.


Subject(s)
Cardiac Output, Low/surgery , Cardiac Surgical Procedures/methods , Mitral Valve Stenosis/surgery , Adolescent , Adult , Aged , Angioplasty, Balloon/adverse effects , Angioplasty, Balloon/methods , Cardiac Output, Low/physiopathology , Cardiac Surgical Procedures/adverse effects , Female , Follow-Up Studies , Humans , Male , Mitral Valve Stenosis/physiopathology , Retrospective Studies , Risk Factors
3.
Ann Cardiol Angeiol (Paris) ; 55(3): 153-6, 2006 Jun.
Article in French | MEDLINE | ID: mdl-16792032

ABSTRACT

INTRODUCTION: Lutembacher syndrome refers to the rare combination of congenital atrial septal defect and acquired mitral stenosis. This condition is usually treated surgically by mitral valve operation with concomitant closure of the atrial septal defect. MATERIALS AND METHODS: Between 1993 and 2003, 4 patients with congenital Lutembacher syndrome had percutaneous mitral commissurotomy without closure of the atrial septal defect at our institution. The 4 patients were very symptomatic with right-sided heart failure signs and NYHA functional class III-IV. RESULTS: The procedure was carried out successfully for the four patients. Mitral valve area increased from 0.87 to 1.97 cm2 at mean; left atrial pressure decreased from 28.2 to 12.7 mmHg and the mean valve mitral gradient was reduced from 15.5 to 3.9 mmHg. Functional and clinical improvement was observed in all the cases. During a mean follow up of 55 +/- 29 months, our 4 patients remain pauci symptomatic under medical treatment. CONCLUSION: The percutaneous treatment of the Lutembacher syndrome is currently a possible alternative to the surgery among patients having an anatomy favourable to the procedure.


Subject(s)
Catheterization/methods , Lutembacher Syndrome/therapy , Mitral Valve Stenosis/therapy , Adult , Atrial Function, Left/physiology , Blood Pressure/physiology , Cardiac Output, Low/therapy , Cardiac Volume/physiology , Cardiotonic Agents/therapeutic use , Catheterization/instrumentation , Digitalis Glycosides/therapeutic use , Female , Follow-Up Studies , Humans , Middle Aged , Mitral Valve/pathology , Pulmonary Wedge Pressure/physiology
4.
Tunis Med ; 77(10): 520-4, 1999 Oct.
Article in French | MEDLINE | ID: mdl-10670285

ABSTRACT

As opposed to partial anomalous of pulmonary venous connection, it is frequent and benigns, the total anomalous of pulmonary venous connection is extremely rare and more serious. The anomalous is severe because all pulmonary venous connection, instead of left heart it go to the right heart. The age of diagnosis is closely tied up anatomics characteristics, so various clinical cases are present. The TAPVC of new born is a surgical emergency, especially where it's block up and release++ cardiorespiratory distress syndrome secondary to OAP. For great children, the total anomlous of pulmonary venous connection can be assumed to a case of atrial septal defect. This study intend to clear up this clinical and anatomical polymorphism and to report an exceptional-form of this congenital anomaly which is mixed total anomalous of pulmonary venous connection.


Subject(s)
Coronary Vessel Anomalies , Pulmonary Veins/abnormalities , Adolescent , Coronary Vessel Anomalies/diagnostic imaging , Echocardiography , Female , Heart Septal Defects, Ventricular/diagnostic imaging , Humans , Hypertrophy, Right Ventricular/diagnostic imaging , Pulmonary Veins/diagnostic imaging , Radiography
5.
Arch Mal Coeur Vaiss ; 91(10): 1249-54, 1998 Oct.
Article in French | MEDLINE | ID: mdl-9833089

ABSTRACT

Percutaneous pulmonary valvulotomy is the treatment of choice for isolated congenital pulmonary valvular stenosis in childhood. However, experience of this procedure in the adult is much more limited. Between January 1984 and December 1994, 34 patients with severe or moderate pulmonary valvular stenosis underwent percutaneous transluminal valvuloplasty. The age of the patients ranged from 20 to 47 years (mean 22 +/- 4 years). Cardiac catheterisation was performed using the femoral vein in 27 cases and the internal jugular vein in 7 cases. Success was obtained in 28 patients (81% of cases). Pulmonary artery-right ventricular pressure gradient decreased from 113 +/- 35 to 32 +/- 13 mmHg (p < 0.001) after valvuloplasty with one or two balloon catheters. The tolerance of transluminal valvuloplasty was generally good. The poor results were explained by cases of dysplasic valves or of infundibular reactions. There was one death which occurred 24 hours after the procedure. Clinical and echocardiographic follow-up was obtained in 20 patients, 3 to 36 months after valvuloplasty (average: 23 +/- 13 months). No cases of restenosis were observed. Percutaneous transluminal pulmonary valvuloplasty in the adult is feasible and gives good results which are maintained at medium-term; it has become the treatment of choice of valvular pulmonary stenosis and gives good results which are maintained at medium-term, thereby avoiding surgical valvulotomy.


Subject(s)
Angioplasty, Balloon/methods , Pulmonary Valve Stenosis/congenital , Adult , Age Factors , Catheterization , Female , Humans , Male , Middle Aged , Pulmonary Valve Stenosis/diagnosis , Pulmonary Valve Stenosis/surgery , Treatment Outcome
7.
Arch Mal Coeur Vaiss ; 91(12): 1509-12, 1998 Dec.
Article in French | MEDLINE | ID: mdl-9891835

ABSTRACT

Cardiac involvement is rare in Behçet's disease. The authors report the case of a young patient with Behçet's disease and multiple cardiac complications. The remarkable feature of this case was the presence of a coronary artery (first diagonal) aneurysm associated with multiple venous thromboses. Anticoagulant therapy was changed for a platelet aggregant. Surgery was not indicated because of the fragility of the vessels.


Subject(s)
Behcet Syndrome/complications , Coronary Aneurysm/complications , Adult , Behcet Syndrome/drug therapy , Coronary Aneurysm/drug therapy , Humans , Male , Platelet Aggregation Inhibitors/therapeutic use , Venous Thrombosis/complications , Venous Thrombosis/drug therapy
8.
Arch Mal Coeur Vaiss ; 90(10): 1371-6, 1997 Oct.
Article in French | MEDLINE | ID: mdl-9539837

ABSTRACT

One hundred and eighty-four patients underwent complete lipid analysis (total cholesterol, HDL and LDL cholesterol, triglycerides, apolipoproteins A1 and B, lipoprotein (a)) and coronary angiography, in order to evaluate the discriminant value of the lipoprotein (a). Subjects with non-significant coronary stenoses (< 50% of the lumen) were used as a control group (n = 84). The others were considered to be pathological. The total cholesterol, HDL cholesterol and triglycerides were measured by an enzymatic colorimetric method. The LDL cholesterol was calculated by Friedewald's formula. The apolipoprotein A1 and B were measured by immunoturbidimetry and the lipoprotein (a) by an Elisa. The results showed a relationship between the different lipid levels, especially between high lipoprotein (a), and the severity of the coronary disease. A quantitative and qualitative study showed no significant influence of the other risk factors on the mean lipoprotein (a) level. Gender and age had no influence. Therefore, the higher the lipoprotein (a) level, the greater was the coronary risk, independently of the other associated risk factors.


Subject(s)
Coronary Disease , Lipoprotein(a)/blood , Adult , Aged , Apolipoprotein A-I/blood , Apolipoproteins B/blood , Biomarkers/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Coronary Disease/blood , Coronary Disease/epidemiology , Female , Humans , Male , Middle Aged , Morocco/epidemiology , Predictive Value of Tests , Prevalence , Risk Factors , Triglycerides/blood
9.
Arch Mal Coeur Vaiss ; 89(11): 1425-9, 1996 Nov.
Article in French | MEDLINE | ID: mdl-9092402

ABSTRACT

The authors report the case of a young patient with a tumour of the right atrium and right ventricular outflow tract without visceral complications but with multiple muscular and skin localisations. The diagnosis of tuberculosis was made on biopsy of a suppurating skin lesion. The diagnosis of tuberculosis was made on biopsy of a suppurating skin lesion. Anti-tuberculosis treatment resulted in regression of these tumours, especially the cardiac lesions, confirmed by transoesophageal echocardiography.


Subject(s)
Heart Neoplasms/etiology , Tuberculosis, Cardiovascular/complications , Adult , Antitubercular Agents/therapeutic use , Diagnosis, Differential , Echocardiography, Transesophageal , Follow-Up Studies , Heart Atria/diagnostic imaging , Heart Neoplasms/diagnosis , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/drug therapy , Heart Ventricles/diagnostic imaging , Humans , Male , Radionuclide Imaging , Treatment Outcome , Tuberculosis, Cardiovascular/diagnosis , Tuberculosis, Cardiovascular/drug therapy
10.
Arch Mal Coeur Vaiss ; 84(3): 355-9, 1991 Mar.
Article in French | MEDLINE | ID: mdl-2048921

ABSTRACT

Ten cases of right-sided infective endocarditis (IE) were recorded in a retrospective study over a 5 year period (1984-88). In 8 cases, IE complicated known congenital heart disease. One patient was followed up for rhumatic valvular disease and in the remaining case, IE seemed to have occurred on a normal valve. The inclusion criteria were based on the clinical signs: prolonged pyrexia, the finding of a new murmur or a change on cardiac auscultation, and eventually, the occurrence of a complication (7 cases). The commonest complications were right ventricular failure and pulmonary embolism. A portal of entry was found in 5 cases: dental infection in 3 cases, osteomyelitis in 1 case and an abscess on the right leg in 1 case. Blood cultures were positive in 5 cases and grew a staphylococcus aureus on each occasion. Two-dimensional echocardiography showed vegetations in 9 cases. The short-term outcome was satisfactory. There were no fatalities and 5 patients underwent surgery.


Subject(s)
Endocarditis, Bacterial/etiology , Adolescent , Child , Echocardiography, Doppler , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/therapy , Female , Follow-Up Studies , Heart Defects, Congenital/complications , Heart Murmurs/etiology , Humans , Male , Middle Aged , Retrospective Studies , Staphylococcal Infections/complications , Staphylococcus aureus
11.
Arch Mal Coeur Vaiss ; 83(10): 1597-600, 1990 Sep.
Article in French | MEDLINE | ID: mdl-2122837

ABSTRACT

A 39-year old patient presented with small, sudden hemoptyses and a diagnosis of pulmonary tuberculosis was made on radiographic pleural and parenchymatous lesions but without bacteriological confirmation. Two years later, the patient was admitted to hospital following severe hemoptysis. Echocardiography revealed the presence of a tumour in the right ventricular outflow tract. At surgery, nodules were also resected from the superior vena cava. Histological examination of the surgical specimens suggested that the tumour was an angiosarcoma. Six months later, the patient returned complaining of a painful swelling in the left iliac fossa. Immuno-histochemical analysis of the cardiac and abdominal tumours finally concluded that it was in fact a malignant non-Hodgkinian lymphoma.


Subject(s)
Heart Neoplasms/pathology , Lymphoma, Non-Hodgkin/pathology , Abdominal Neoplasms/pathology , Adult , Diagnosis, Differential , Echocardiography , Heart Neoplasms/diagnosis , Heart Ventricles , Hemangiosarcoma/pathology , Humans , Male , Neoplasms, Multiple Primary , Vena Cava, Superior
12.
Arch Mal Coeur Vaiss ; 83(9): 1455-8, 1990 Aug.
Article in French | MEDLINE | ID: mdl-2122866

ABSTRACT

The authors report a case of isolated left ventricular capillary haemangioma, diagnosed after chest X-ray during a routine medical check-up showed a deformation of the left heart border. Echocardiography showed a solid well circumscribed tumour. Its vascular origin was confirmed at coronary angiography. Myocardial biopsy performed after left thoracotomy confirmed the histological diagnosis. The authors review the medical literature of this condition in the light of this rare finding.


Subject(s)
Heart Neoplasms/diagnosis , Hemangioma/diagnosis , Adult , Heart Ventricles , Humans , Male
13.
Arch Mal Coeur Vaiss ; 81(6): 793-6, 1988 Jun.
Article in French | MEDLINE | ID: mdl-3144951

ABSTRACT

We report the case of a 14-year old boy who was stabbed with a knife and sustained a chest wound responsible for clinical tamponade. Surgery was performed as an extreme emergency, so that lesions could not be assessed preoperatively. During the operation, beside the pericardial blood collection a wound of the pulmonary infundibulum was discovered and sutured (closed heart surgery). One year later the patient was readmitted for global heart failure. Auscultation of the heart revealed a continuous left latero-sternal murmur. Two-dimensional echocardiography showed discontinuity between the right anterior sinus of Valsalva and the right ventricular outflow tract. Contrast echocardiography displayed a negative jet image in the right ventricular outflow tract. At that level, pulsed doppler ultrasound recorded continuous turbulence as well as diastolic turbulence in the left ventricular outflow tract. Tiered oxymetry showed a left-to-right shunt in the right ventricle with a pulmonary/systemic flow ratio of 1.9. The diagnosis was confirmed by angiography which demonstrated a fistula between the right anterior sinus of Valsalva and the right ventricular outflow tract, and aortic regurgitation. In a second operation, performed under extracorporeal circulation, the traumatic lesions were repaired, and the patient thereafter recovered. This unusual case highlights the value of combined two-dimensional echocardiography, pulsed doppler ultrasound and contrast echocardiography in the diagnosis of traumatic ventriculo-aortic lesions.


Subject(s)
Aortic Rupture/etiology , Heart Injuries/complications , Sinus of Valsalva , Wounds, Stab/complications , Adolescent , Aortic Rupture/surgery , Aortic Valve Insufficiency/etiology , Cardiac Catheterization , Echocardiography , Heart Failure/etiology , Heart Ventricles , Humans , Male , Reoperation , Thoracotomy
14.
Arch Mal Coeur Vaiss ; 79(2): 244-8, 1986 Feb.
Article in French | MEDLINE | ID: mdl-3085624

ABSTRACT

Two cases of primary cardiac tumour are reported. The first was that of a 16 year old girl investigated after the detection of a systolic murmur on routine examination. The clinical signs suggested a diagnosis of pulmonary stenosis. The second case was that of a 36 year old man admitted to hospital for right ventricular failure. Echocardiography revealed right ventricular tumours in both cases and also indicated their size, form, mobility and site of implantation. The outcome of the first case, a fibromyxoma, was favourable with no detectable recurrence after one year. In the second case, the patient unfortunately died of cardiogenic shock in the immediate preoperative period. These two cases emphasise the value of echocardiography in the diagnosis of isolated right ventricular tumours, especially considering the difficulty of clinical diagnosis and the risks of angiocardiography.


Subject(s)
Heart Neoplasms/diagnosis , Myxoma/diagnosis , Adolescent , Adult , Angiocardiography/adverse effects , Diagnosis, Differential , Echocardiography , Female , Fibroma/diagnosis , Heart Murmurs , Heart Neoplasms/pathology , Heart Neoplasms/surgery , Heart Ventricles/pathology , Humans , Male , Myxoma/pathology , Myxoma/surgery , Polycythemia/etiology , Pulmonary Valve Stenosis/diagnosis
19.
Arch Mal Coeur Vaiss ; 77(12): 1411-5, 1984 Nov.
Article in French | MEDLINE | ID: mdl-6239601

ABSTRACT

The authors underline the value of echocardiography in the diagnosis and postoperative management of a case of cor triatrium. The patient was a 22 year old male who presented with dyspnoea of effort (stage III of the NYHA classification) and clinical signs of an infundibulo-pulmonary syndrome with tricuspid regurgitation. Chest X-ray revealed cardiomegaly (CTI = 61%) and filling-in of the aorto-pulmonary window. The electrocardiogram showed left atrial and right ventricular hypertrophy. The echocardiogram, the key to diagnosis, showed an abnormal echogenic structure within the left atrium. Cardiac catheterisation demonstrated pulmonary hypertension and a difference of pressure between the two lungs. The membrane dividing the left atrium and partial anomalous pulmonary venous drainage from the left lung into the superior vena cava were visualised on late stage pulmonary angiography. Surgical excision of the membrane in the left atrium and ligation of the anomalous venous drainage provided a radical cure to all these malformations.


Subject(s)
Heart Atria/abnormalities , Pulmonary Veins/abnormalities , Adult , Cardiomegaly/etiology , Echocardiography , Electrocardiography , Humans , Male , Pulmonary Veins/diagnostic imaging , Radiography
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