37 results on '"Chabert JP"'
Search Results
2. Risk factors for infection of implantable cardiac devices: data from a registry of 2496 patients.
- Author
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Hercé B, Nazeyrollas P, Lesaffre F, Sandras R, Chabert JP, Martin A, Tassan-Mangina S, Bui HT, and Metz D
- Published
- 2013
- Full Text
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3. Prognostic value of ventricular arrhythmia in early post-infarction left ventricular dysfunction: the French nationwide WICD-MI study.
- Author
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Echivard M, Sellal JM, Ziliox C, Marijon E, Bordachar P, Ploux S, Benali K, Marquié C, Docq C, Klug D, Eschalier R, Maille B, Deharo JC, Babuty D, Genet T, Gandjbakhch E, Da Costa A, Piot O, Minois D, Gourraud JB, Mondoly P, Maury P, Boveda S, Pasquié JL, Martins R, Leclercq C, Guenancia C, Laurent G, Becker M, Bertrand J, Chevalier P, Manenti V, Kubala M, Defaye P, Jacon P, Desbiolles A, Badoz M, Jesel L, Lellouche N, Milliez PU, Ollitrault P, Fareh S, Bercker M, Mansourati J, Guy-Moyat B, Chabert JP, Luconi N, Winum PF, Anselme F, Extramiana F, Delahaye C, Jourda F, Bizeau O, Nasarre M, Olivier A, Fromentin S, Villemin T, Levavasseur O, Hammache N, Magnin-Poull I, Blangy H, Sadoul N, Duarte K, Girerd N, and de Chillou C
- Abstract
Background and Aims: Prophylactic implantable cardioverter-defibrillators (ICDs) are not recommended until left ventricular ejection fraction (LVEF) has been reassessed 40 to 90 days after an acute myocardial infarction. In the current therapeutic era, the prognosis of sustained ventricular arrhythmias (VAs) occurring during this early post-infarction phase (i.e. within 3 months of hospital discharge) has not yet been specifically evaluated in post-myocardial infarction patients with impaired LVEF. Such was the aim of this retrospective study., Methods: Data analysis was based on a nationwide registry of 1032 consecutive patients with LVEF ≤ 35% after acute myocardial infarction who were implanted with an ICD after being prescribed a wearable cardioverter-defibrillator (WCD) for a period of 3 months upon discharge from hospital after the index infarction., Results: ICDs were implanted either because a sustained VA occurred while on WCD (VA+/WCD, n = 72) or because LVEF remained ≤35% at the end of the early post-infarction phase (VA-/WCD, n = 960). The median follow-up was 30.9 months. Sustained VAs occurred within 1 year after ICD implantation in 22.2% and 3.5% of VA+/WCD and VA-/WCD patients, respectively (P < .0001). The adjusted multivariable analysis showed that sustained VAs while on WCD independently predicted recurrence of sustained VAs at 1 year (adjusted hazard ratio [HR] 6.91; 95% confidence interval [CI] 3.73-12.81; P < .0001) and at the end of follow-up (adjusted HR 3.86; 95% CI 2.37-6.30; P < .0001) as well as 1-year mortality (adjusted HR 2.86; 95% CI 1.28-6.39; P = .012)., Conclusions: In patients with LVEF ≤ 35%, sustained VA during the early post-infarction phase is predictive of recurrent sustained VAs and 1-year mortality., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
- Published
- 2024
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4. Relationship between Exercise Test Parameters, Device-Delivered Electric Shock and Adverse Clinical Events in Patients with an Implantable Cardioverter Defibrillator for Primary Prevention.
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Théry G, Faroux L, Boyer F, Nazeyrollas P, Chabert JP, Metz D, and Lesaffre F
- Abstract
(1) Background: Receiving the first internal electric shock is a turning point for patients with an implantable cardioverter defibrillator (ICD) for primary prevention. However, no study has investigated whether patients who receive a first device-delivered electric shock have a poor prognosis even at the time of ICD implantation. (2) Methods: We retrospectively identified 55 patients with ischemic (n = 31) or dilated (n = 24) cardiomyopathy who underwent ICD implantation for primary prevention with exercise test at the time of implantation. We recorded baseline characteristics, exercise test parameters, and clinical events. (3) Results: After a median follow-up of 5 years, we observed an association between an appropriate device-delivered electric shock, the occurrence of death or heart transplant, and the occurrence of the composite endpoint. There was also a significant relation between a VE/VCO
2 slope >35 and the occurrence of the composite endpoint. Conversely, there was no significant association between negative outcomes on the exercise test and the occurrence of a device-delivered electric shock. (4) Conclusions: The exercise test performed at the time of ICD implantation do not predict the occurrence of device-delivered electric shock. The exercise test and the first electric shock are two independent markers of poor prognosis.- Published
- 2023
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5. Transseptal versus retrograde approach for ablation of left-sided accessory pathways: impact on radiation exposure.
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Bouchiat L, Faroux L, Chabert JP, Mauran P, Blanpain T, Metz D, and Lesaffre F
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- Adolescent, Adult, Fluoroscopy, Humans, Middle Aged, Young Adult, Catheter Ablation, Radiation Exposure
- Abstract
Management of left-sided accessory pathways (APs) is based on catheter ablation through an antegrade or retrograde approach. Both are safe and effective but are associated with exposure to x-rays; however, recipients of ablation are generally young. We sought to evaluate the impact of the approach chosen on dose-area product (DAP). A total of 95 patients who underwent radiofrequency ablation of a left-sided AP between January 2011 and January 2020 were included. The primary endpoint was the radiation dose received by the patient. Secondary endpoints were procedural success and complication and recurrence rates. The mean age of the study population was 34.3 ± 16.6 years. The antegrade transseptal approach was used in 63.5% of cases. By multivariate analysis, the antegrade transseptal approach was associated with a 53% reduction in DAP ( p < 0.001). The radiation dose received was also significantly associated with body mass index and total fluoroscopy time ( p < 0.001). There was no significant difference in other secondary endpoints between approaches. The use of an antegrade transseptal approach is associated with a significant reduction in DAP compared with the retrograde approach, and procedural success and complication and recurrence rates are similar., (© 2022 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights reserved.)
- Published
- 2022
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6. Physicians' exposure to radiation during electrophysiology procedures.
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Faroux L, Daval C, Lesaffre F, Blanpain T, Chabert JP, Martin A, Guinot M, Luconi N, Espinosa M, Nazeyrollas P, Tourneux C, and Metz D
- Subjects
- France, Humans, Radiometry, Risk Factors, Cardiologists, Electrophysiologic Techniques, Cardiac, Occupational Exposure, Radiation Exposure
- Abstract
Purpose: Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no study comparing the level of exposure of physicians during different electrophysiology procedures. We aimed to measure and compare cardiologists' exposure to radiation during different electrophysiology procedures., Methods: The study population comprised all electrophysiology procedures performed over a 6-month period in a large referral centre. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on the operator's left arm., Results: In total, 150 electrophysiology procedures were analyzed. Compared with electrophysiology studies (reference category), physician radiation exposure was 3-fold greater during ablation of atrial fibrillation, 9-fold greater during ablation of atrioventricular nodal reentrant tachycardia (AVNRT)/atrioventricular reentrant tachycardia (AVNT), and 10-fold greater during ablation of atrial flutter (p < 0.001). Physician exposure was mainly related to X-ray time (R
2 = 0.28)., Conclusions: Our study showed significant differences in cardiologists' exposure to ionizing radiation depending on the type of electrophysiology procedure. Atrial flutter and AVNRT/AVNT ablations are the procedures in which operators are most exposed to ionizing radiation.- Published
- 2019
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7. Impact of cardiac resynchronisation therapy on cardiologists' exposure to radiation during implantation of pacemakers and implantable cardioverter-defibrillators.
- Author
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Daval C, Faroux L, Lesaffre F, Blanpain T, Chabert JP, Martin A, Guinot M, Luconi N, Espinosa M, Nazeyrollas P, Tourneux C, and Metz D
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- Aged, Aged, 80 and over, Epidemiologic Studies, Female, Humans, Male, Middle Aged, Prospective Studies, Cardiac Resynchronization Therapy adverse effects, Cardiology, Defibrillators, Implantable, Occupational Exposure analysis, Pacemaker, Artificial, Prosthesis Implantation adverse effects, Radiation Exposure analysis
- Abstract
Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no recent study quantifying overexposure of physicians during cardiac resynchronisation therapy (CRT) procedures compared to 'classical' implantation of pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs). We aimed to measure and compare operator exposure to radiation during implantation of PM and ICD with or without CRT. The study population comprised all PMs and ICDs implanted in a large referral centre over a six months period. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on operator's chest. In total, 169 PM/ICD implantations were analysed, 19 of which included CRT. Compared with 'classical' implantation, cardiologist radiation exposure was 9-fold greater during CRT procedures (p < 0.001). Physician exposure was related to dose-area product (R
2 = 0.21 during 'classical' implantations and R2 = 0.57 during CRT procedures). Our study shows that cardiologists' exposure to radiation during CRT implantation was 9-fold greater than during procedures without CRT.- Published
- 2019
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8. [Intracardiac catheter migration revealed by an ischemic stroke].
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Faroux L, Domnariu PA, Chabert JP, Rubin S, and Metz D
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- Antineoplastic Agents administration & dosage, Breast Neoplasms therapy, Chemotherapy, Adjuvant instrumentation, Combined Modality Therapy, Device Removal, Echocardiography, Transesophageal, Female, Foramen Ovale, Patent complications, Foreign-Body Migration diagnosis, Foreign-Body Migration surgery, Humans, Intracranial Embolism surgery, Mastectomy, Middle Aged, Quadriplegia etiology, Radiotherapy, Adjuvant, Thrombophilia complications, Tomography, X-Ray Computed, Vertebrobasilar Insufficiency surgery, Catheters, Indwelling adverse effects, Foreign-Body Migration complications, Infusion Pumps, Implantable adverse effects, Intracranial Embolism etiology, Vertebrobasilar Insufficiency etiology
- Published
- 2016
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9. [A rare cause of stroke in a patient with a cardiac pacemaker].
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Laury P, Chabert JP, Blaise C, Pérotin S, Brasselet C, Schlick C, Tassan-Mangina S, Metz D, and Elaerts J
- Subjects
- Aged, Echocardiography, Embolism, Female, Heart Ventricles, Humans, Recurrence, Risk Factors, Foreign-Body Migration, Pacemaker, Artificial adverse effects, Stroke etiology
- Abstract
The authors report the case of a 78 year old woman admitted to hospital for recurrent cerebrovascular accidents, the initial investigation of which was normal. This pacemaker patient had a displacement of the definitive ventricular pacing catheter which was positioned in the left ventricle through a patent foramen ovale. The diagnosis was suspected on clinical and echocardiographic examination and confirmed by transthoracic and transoesophageal echocardiography. In view of the risk of systemic embolism, the pacing catheter was repositioned by an endovascular approach in the right ventricle.
- Published
- 2002
10. [Comparative evaluation of hydrophilic and standard guide wires for retrograde catheterization of severe aortic stenosis].
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Jamet B, Metz D, Brasselet C, Chabert JP, Blaise C, Tassan-Mangina S, Deschildre A, Nazeyrollas P, and Elaerts J
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- Aged, Cardiac Catheterization methods, Equipment Design, Female, Humans, Male, Middle Aged, Treatment Outcome, Aortic Valve Stenosis therapy, Cardiac Catheterization instrumentation
- Abstract
The feasibility and safety of using hydrophilic guide wires were compared with those of standard guide wires for retrograde catheterization of aortic stenosis in a prospective randomised study. The performances of the guide wires were assessed by the time taken to catheterize the aortic valve (minutes) and the duration of radioscopy (minutes: grays). The success of the procedure was defined as presence of the guide in the left ventricle in less than 8 minutes. The two patient groups were comparable with respect to the severity of the aortic stenosis. Two failures of catheterisation were observed in the "standard guide wire" group compared with three failures with the hydrophilic guide wire. The mean catheterisation time of the "standard" group was 2.56 minutes compared with 3.12 minutes with the hydrophilic guide wire (p = 0.35 NS). This result was correlated with the duration of radioscopy and number of groups (respectively p = 0.18 NS and p = 0.5 NS). One case of tamponade and a transient ischaemic cerebral attack were observed in the "standard" group. This study does not show the hydrophilic guide wire to be superior to the standard guide wire for catheterisation of aortic stenosis. However, the hydrophilic guide wires were perfectly innocuous for this procedure.
- Published
- 2000
11. [Acute aortic insufficiency].
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Jamet B, Chabert JP, Metz D, and Elaerts J
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- Acute Disease, Humans, Aortic Valve Insufficiency diagnosis, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency therapy
- Abstract
Acute aortic insufficiency can now be diagnosed rapidly and accurately thanks to Doppler echocardiography. The etiologies include infectious endocarditis, aortic dissection, bioprosthesis degeneration and thoracic injury. The clinical diagnosis is substantiated by the particular etiological context, dyspnea and pulmonary edema being the main factors involved. Examination includes finding out whether there is a reduction in the first sound, S1 a generally brief apical diastolic murmur. Echocardiography detects the presence of aortic leakage, the acute character of which is confirmed by the findings of a premature closure of the mitral valve, the existence of telediastolic mitral leakage, a restriction in the transmitral flow, and finally, the absence of left ventricular dilatation. An emergency operation is recommended by most authors in the case of acute aortic leakage due to the major risk or mortality resulting from pulmonary edema, ventricular arrhythmias, electromechanical dissociation or cardiogenic shock.
- Published
- 2000
12. [Werner's disease presenting as ischemic mitral incompetence].
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Jamet B, Wagner E, Tassan Mangina S, Chabert JP, and Elaerts J
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- Coronary Angiography, Dyspnea etiology, Echocardiography, Electrocardiography, Female, Genes, Recessive genetics, Humans, Middle Aged, Mitral Valve Insufficiency diagnosis, Myocardial Ischemia diagnosis, Rare Diseases diagnosis, Werner Syndrome diagnosis, Mitral Valve Insufficiency etiology, Myocardial Ischemia etiology, Rare Diseases genetics, Werner Syndrome genetics
- Abstract
Werner's syndrome or progeria, described for the first time in 1886, is a rare disease with autosomal recessive transmission, characterized by premature ageing of connective tissues. About 200 cases have since been reported in the literature. Most patients die young, generally from heart failure due to early coronary atherosclerosis [1]. The authors report the case of a 46-year-old woman presenting with cardiovascular abnormalities, unusual for her age, associated with a particular morphotype belonging to Werner's syndrome.
- Published
- 1999
13. [Peripheral embolic arterial accident due to pulmonary vein thrombosis revealing bronchial carcinoma].
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Tassan S, Chabert JP, Tassigny C, Jamet B, Ribere R, Deslee G, Metz D, and Elaerts J
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- Aged, Anticoagulants therapeutic use, Carcinoma, Squamous Cell complications, Echocardiography, Transesophageal, Female, Heparin therapeutic use, Humans, Lung Neoplasms complications, Pulmonary Artery diagnostic imaging, Pulmonary Embolism diagnostic imaging, Pulmonary Embolism drug therapy, Pulmonary Veno-Occlusive Disease diagnostic imaging, Pulmonary Veno-Occlusive Disease drug therapy, Radiography, Thoracic, Treatment Outcome, Carcinoma, Squamous Cell diagnostic imaging, Lung Neoplasms diagnostic imaging, Pulmonary Embolism etiology, Pulmonary Veno-Occlusive Disease etiology
- Abstract
The authors report a case of left superior pulmonary vein thrombosis discovered on transoesophageal ultrasonography in the context of aetiological assessment of a systemic vascular accident. This unusual site of a thrombus on an anatomically perfectly normal left atrium led the authors to perform a more detailed assessment, revealing a previously undiagnosed lung cancer on thoracic CT scan.
- Published
- 1998
14. [Transthoracic echocardiography and diagnosis of acute pulmonary embolism. Change in the diagnostic valve with respect to thresholds of classification].
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Nazeyrollas P, Metz D, Maillier B, Jennesseaux C, Maes D, Tassan S, Jolly D, Chabert JP, Chapoutot L, and Elaerts J
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- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Diagnosis, Differential, Female, Heart Ventricles diagnostic imaging, Hemodynamics, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Pulmonary Embolism classification, ROC Curve, Radiography, Radionuclide Imaging, Sensitivity and Specificity, Severity of Illness Index, Echocardiography, Doppler methods, Pulmonary Embolism diagnostic imaging
- Abstract
The diagnostic value of transthoracic echocardiography in acute pulmonary embolism is not well established. Although many parameters are abnormal, the thresholds used vary according to the authors, limiting the contribution of the investigation to the diagnosis. In a prospective study of 70 patients with suspected acute pulmonary embolism without previous cardio-respiratory disease, the authors tried to determine the diagnostic thresholds using discriminating linear analysis and ROC curves. Parameters easily recorded in an emergency were analysed: end diastolic ventricular dimensions, ratio of these diameters and maximal velocity of tricuspid regurgitant flow. Thirty-one patients had pulmonary embolism quantified by the Miller index (average: 16 +/- 7, range 2 to 28). Measurements of left ventricular dimension were disappointing (sensitivity: 0.52, specificity: 0.73 for a threshold value of 45 mm). The right ventricular dimension was a better predictive parameter (sensitivity: 0.70, specificity: 0.86 for a threshold value of 25 mm). However, the ratio of right to left ventricular dimension had a better diagnostic value (sensitivity: 0.85, specificity: 0.78 for a threshold value of 0.5). The best diagnostic parameter was the maximal velocity of tricuspid regurgitation (sensitivity: 0.93, specificity: 0.82 for a threshold value of 2.5 m/s). The authors conclude that the maximal velocity of tricuspid regurgitation with a threshold of 2.5 m/s and the ratio of the ventricular dimensions with a threshold value of 0.5 are valuable diagnostic indicators for acute pulmonary embolism.
- Published
- 1997
15. [Ventricular late potentials and sleep apnea syndromes].
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Maillier B, Metz D, Nazeyrollas P, Prevost A, Boudjedien S, Maes D, Chapoutot L, Chabert JP, and Elaerts J
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- Adult, Aged, Arrhythmias, Cardiac etiology, Echocardiography, Electrocardiography, Ambulatory, Female, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Sleep Apnea Syndromes complications, Arrhythmias, Cardiac diagnosis, Electrocardiography, Sleep Apnea Syndromes physiopathology
- Abstract
This prospective study in 37 patients evaluated the prevalence of ventricular late potentials in sleep apnea syndrome, a condition associated with an increased risk of ventricular rhythm disorders and sudden death. A comparative analysis was conducted among a group of patients considered free of coronary heart disease and admitted for suspected sleep apnea syndrome based on clinical symptoms and simple blood gas measurements. The prevalence of ventricular late potentials was 56% in the subgroup with and 14% in the subgroup without polygraphy evidence of apnea (F < 0.01). The analysis of clinical, respiratory, and echocardiographic findings in the apneic subgroup failed to detect any factors associated with the presence of ventricular late potentials. Only long-term follow-up studies involving invasive heart rhythm testing could define the prognostic significance of ventricular late potentials in sleep apnea syndrome. However, our data demonstrate that there is an association between ventricular late potentials and sleep apnea syndrome.
- Published
- 1996
16. [Estimation of left ventricular volumes and ejection fraction with acoustic quantification in myocardial infarction. Comparison with echocardiographic, angiographic and scintigraphic data].
- Author
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Jennesseaux C, Metz D, Maillier B, Nazeyrollas P, Maes D, Tassan S, Chabert JP, and Elaerts J
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- Acoustics, Adult, Aged, Female, Humans, Male, Middle Aged, Prospective Studies, Radiography, Radionuclide Ventriculography, Reproducibility of Results, Sensitivity and Specificity, Signal Processing, Computer-Assisted instrumentation, Echocardiography methods, Heart Ventricles, Myocardial Infarction diagnostic imaging, Stroke Volume, Ventricular Function, Left
- Abstract
The object of this study was to assess the reliability of measurements of left ventricular volumes and ejection fraction by acoustic quantification by the method of summation of discs in acute myocardial infarction. Thirty-two patients with an average age of 55.9 +/- 12 years were studied prospectively on average 6 +/- 2 days after the onset of myocardial infarction. Within 48 hours, the patients underwent TM echocardiography (Teichholz's method) two-dimensional echocardiography (Simpson's method on freeze frames and acoustic quantification) before left ventricular angiography and isotopic ventriculography, considered as the reference methods for comparing left ventricular volumes and ejection fractions. The data displayed in real time by acoustic quantification correlated well with the results of left ventricular angiography (r = 0.77; p = 0.0001) and moderately underestimated (+4.1 +/- 11.9%) the ejection fraction, but were relatively disappointing for estimating volumes. When compared with isotopic ejection fraction, the correlation coefficient was r = 0.71 (p = 0.0004) and the values were overestimated. In this study, acoustic quantification was the most reliable echocardiographic method of assessing the left ventricular ejection fraction with reference to contrast angiography (Teichholz: r = 0.56; p = 0.0014; Simpson: r = 0.76; p = 0.001). The authors conclude that assessing the left ventricular ejection fraction with acoustic quantification is reliable in acute myocardial infarction. However, the method is not very accurate in measuring end systolic and end diastolic volumes.
- Published
- 1996
17. [Value of transesophageal echocardiography in post-infarction septal ruptures].
- Author
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Maillier B, Metz D, Nazeyrollas P, Maes D, Chapoutot L, Jennesseaux C, Torossian PF, Tassan S, Chabert JP, and Elaerts J
- Subjects
- Aged, Coronary Angiography, Feasibility Studies, Female, Humans, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity, Echocardiography, Transesophageal, Heart Rupture, Post-Infarction diagnostic imaging, Heart Septum
- Abstract
The role of transoesophageal echocardiography in the diagnosis of ventricular septal defect in the acute stage of myocardial infarction, was evaluated in 15 consecutive patients (10 men and 5 women) with a mean age of 72 years in the period between June 1991 and April 1995. The patients had 11 anterior infarcts and 4 inferior infarcts with extension to the right ventricle. One patient was in Killips class I,7 patients in class II, 2 in class III and 5 in class IV. Only 8 of the 15 septal ruptures could be visualised directly by conventional transthoracic echocardiography, though all 15 were suspected from continuous Doppler and colour Doppler analysis. Transoesophageal echocardiography was successfully performed in 14 of the 15 patients with a monoplane probe in 11 cases and a multiplane probe in 3 cases. The average duration of the procedure was 12 minutes and clinical and haemodynamic tolerance was good. Ventricular septal defect was directly visualised in all cases in the short axis transgastric view and in 7 cases in transoesophageal views. Transoesophageal echocardiography was concordant with peroperative findings with regards to the site of ventricular septal defect (8 apical, 5 postero-basal and 1 median), their type (6 punched-out defects, 5 fissures, and 3 perforated aneurysms), their size (average 9.3 mm), their number with 5 multiple defects, and associated lesions (4 right ventricular extensions, 4 hemopericardiums and 1 free wall fissure). Transoesophageal echocardiography completes traditional transthoracic echocardiographic examination in the diagnosis of post-infarction ventricular septal defect. It is well tolerated and, in the authors' experience, allows limitation of invasive procedures to coronary angiography alone.
- Published
- 1996
18. Use of transthoracic Doppler echocardiography combined with clinical and electrocardiographic data to predict acute pulmonary embolism.
- Author
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Nazeyrollas P, Metz D, Jolly D, Maillier B, Jennesseaux C, Maes D, Chabert JP, Chapoutot L, and Elaerts J
- Subjects
- Acute Disease, Adult, Aged, Diagnosis, Differential, Female, Forecasting, Humans, Male, Middle Aged, Multivariate Analysis, Prospective Studies, Echocardiography, Doppler, Electrocardiography, Pulmonary Embolism diagnosis
- Abstract
Transthoracic echocardiography and continuous wave Doppler were prospectively performed in 132 out-patients with suspicion of pulmonary embolism, and who had no previous history of severe cardiac or pulmonary disease. Bedside echocardiography determined diagnosis other than pulmonary embolism in 55 patients. Further study was completed in 70 patients; pulmonary embolism was found in 31 and excluded in 39. Significant differences were found as regards right ventricular diameter (27 +/- 8 vs 22 +/- 5 mm, P < 0.001), left ventricular diameter (41 +/- 9 vs 49 +/- 7 mm, P < 0.001), right over left ventricular diameter ratio (0.67 +/- 0.23 vs 0.43 +/- 0.15, P < 0.0001), tricuspid regurgitant flow peak velocity (2.9 +/- 0.4 vs 2.4 +/- 0.7 m.s-1, P < 0.0001), and abnormal septum motion (12 vs 4, P < 0.01). Multivariate analysis of echocardiographic data included a tricuspid regurgitant flow peak velocity greater than 2.5 m.s-1 and a right over left ventricular diameter ratio greater than 0.5 in a logistic model (sensitivity 93%, specificity 81%). The combination of echocardiographic and non-echocardiographic data included the two previous echocardiographic variables, together with signs of deep vein thrombosis, a deep S wave in lead D1, and a Q wave in lead D3 on the electrocardiogram in a logistic model (sensitivity 96%, specificity 83%). It can be concluded that emergency echocardiography, alone or combined with clinical examination and electrocardiogram, satisfactorily predicts acute pulmonary embolism.
- Published
- 1996
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19. [Deformation of the tricuspid annulus by pericardial adhesions: a rare cause of early tricuspid regurgitation after mitral valve replacement].
- Author
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Tapia M, Latrémouille C, Chabert JP, and Fabiani JN
- Subjects
- Echocardiography, Transesophageal, Female, Follow-Up Studies, Humans, Middle Aged, Pericardial Effusion etiology, Reoperation, Tissue Adhesions, Tricuspid Valve, Tricuspid Valve Insufficiency diagnostic imaging, Tricuspid Valve Insufficiency pathology, Tricuspid Valve Insufficiency surgery, Heart Valve Prosthesis adverse effects, Mitral Valve Insufficiency surgery, Tricuspid Valve Insufficiency etiology
- Abstract
The authors report the case of major tricuspid regurgitation occurring early after mitral valve replacement. The mechanism was demonstrated at reoperation: the heart was deformed by a posterior pericardial effusion and cardiodiaphragmatic pericardial adhesions.
- Published
- 1995
20. [Transesophageal echocardiographic diagnosis of left ventricular parietal rupture, a complication of myocardial infarction].
- Author
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Maes D, Chapoutot L, Maillier B, Metz D, Chabert JP, Nazeyrollas P, Torossian F, Baehrel B, and Elaerts J
- Subjects
- Heart Rupture, Post-Infarction complications, Heart Rupture, Post-Infarction surgery, Heart Ventricles, Humans, Male, Middle Aged, Thrombosis etiology, Treatment Outcome, Echocardiography, Transesophageal, Heart Rupture, Post-Infarction diagnostic imaging, Thrombosis diagnostic imaging
- Abstract
The authors report the case of postero-lateral myocardial infarction complicated by free wall rupture at the 48th hour. The diagnosis was suspected clinically and transoesophageal echocardiography showed the appearance of pericardial effusion in a patient difficult to examine by conventional echocardiography. Transoesophageal echocardiography was performed and well tolerated. The transgastric view showed a thrombus adjacent to a thinned and lacerated postero-lateral wall. The clinical outcome was favourable after surgical repair.
- Published
- 1995
21. Diagnostic accuracy of echocardiography-Doppler in acute pulmonary embolism.
- Author
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Nazeyrollas P, Metz D, Chapoutot L, Chabert JP, Maillier B, Maes D, and Elaerts J
- Subjects
- Acute Disease, Adult, Aged, Angiography, Case-Control Studies, Electrocardiography, Female, Humans, Logistic Models, Male, Middle Aged, Prospective Studies, Pulmonary Embolism diagnosis, Sensitivity and Specificity, Echocardiography, Doppler, Pulmonary Embolism diagnostic imaging
- Abstract
We studied prospective recording of clinical, electrocardiographic, Doppler and echographic parameters in 32 patients with proven pulmonary embolism, matched with 32 patients with clinically suspected pulmonary embolism and normal perfusion scan or angiography. Thirty-seven per cent of cases and 16% of control subjects had clinical signs of right ventricular overload; S1-Q3-T3 ECG pattern was found in 11 cases and one control. Other clinical and ECG parameters did not reach significant difference. Echographic septum motion was abnormal in 42% of cases and 9% of controls (P < 0.05), end-diastolic right ventricular diameter was > 25 mm in 67% of cases and 11% of controls, ratio of end-diastolic right over left ventricular diameters increased over 0.6 in 67% of cases and 11% of controls, while Doppler examination found tricuspid regurgitant peak flow velocity > 2.5 m/s in 84% of cases vs. 10% of controls. According to these parameters, Doppler-echocardiography was normal in 6% of cases and 87% of control subjects (P < 0.001 for each). In suspected pulmonary embolism, our study shows that Doppler-echocardiography may be both sensitive and specific in emergency conditions and help the decision making for further invasive investigations.
- Published
- 1995
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22. [Cardiac anomalies in disseminated lupus erythematosus diagnosed by Doppler ultrasonography. Prevalence and association with antiphospholipid syndrome].
- Author
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Metz D, Jolly D, Graciet-Richard J, Pennaforte JL, Nazeyrollas P, Chabert JP, Elaerts J, and Etienne JC
- Subjects
- Adult, Cross-Sectional Studies, Echocardiography, Doppler, Color, Echocardiography, Doppler, Pulsed, Female, Heart Diseases diagnostic imaging, Heart Diseases epidemiology, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases epidemiology, Heart Valve Diseases etiology, Humans, Lupus Erythematosus, Systemic diagnostic imaging, Male, Prevalence, Prospective Studies, Risk Factors, Antiphospholipid Syndrome complications, Heart Diseases etiology, Lupus Erythematosus, Systemic complications
- Abstract
Objectives: Antiphospholipid antibodies in patients with systemic lupus erythematosus (SLE) are widely associated with thrombosis, recurrent abortions and a thrombocytopenia. The purpose of this study was first to evaluate the prevalence of cardiac abnormalities in patients with SLE and secondly to establish the relationship between the findings and the presence of an antiphospholipid syndrome., Subjects and Methods: First of all, a total of 52 consecutive patients with SLE and 52 healthy sex-and-age-matched control subjects were evaluated in a cross sectional study. All underwent M mode and two dimensional echocardiography, color flow imaging, pulsed and continuous wave Doppler. Secondly, in the SLE group, subjects exposed to antiphospholipid syndrome (n = 20) were compared to the control subjects., Results: Compared with the control group, patients with SLE had significantly more pericardial abnormalities [(p = 0.0006) RR [3.36-infinity], mitral regurgitation [(p = 0.032) RR 2.48 [1.25-5.6]], tricuspid regurgitation [(p = 0.0016) RR 2.41 [1.58-8.85]. There was no significant difference between both groups for the left ventricular mass (p = 0.07), posterior wall (p = 0.25) and interventricular septum dimension (p = 0.16), and mitral valve thickness (p = 0.66). The antiphospholipid syndrome was significantly associated with increased left ventricular mass (p = 0.0054), posterior wall (p = 0.022) and interventricular septum dimension (p = 0.026). The relative risk increased for tricuspid and pulmonary regurgitation in SLE patients who had the antiphospholipid syndrome., Conclusion: The prevalence of left ventricular hypertrophy and right heart valvular regurgitation is significantly raised in SLE patients who have the antiphospholipid syndrome. However, antiphospholipid syndrome does not modify the prevalence of pericardial abnormalities which seems to be due to SLE alone.
- Published
- 1994
23. Prevalence of valvular involvement in systemic lupus erythematosus and association with antiphospholipid syndrome: a matched echocardiographic study.
- Author
-
Metz D, Jolly D, Graciet-Richard J, Nazeyrollas P, Chabert JP, Maillier B, Pennaforte JL, and Elaerts J
- Subjects
- Adolescent, Adult, Aged, Antibodies, Anticardiolipin analysis, Antiphospholipid Syndrome diagnostic imaging, Case-Control Studies, Cross-Sectional Studies, Echocardiography, Female, France epidemiology, Heart Valve Diseases diagnostic imaging, Humans, Lupus Coagulation Inhibitor analysis, Lupus Erythematosus, Systemic diagnostic imaging, Male, Middle Aged, Mitral Valve Insufficiency epidemiology, Prevalence, Prospective Studies, Tricuspid Valve Insufficiency epidemiology, Antiphospholipid Syndrome epidemiology, Heart Valve Diseases epidemiology, Lupus Erythematosus, Systemic epidemiology
- Abstract
Antiphospholipid antibodies in patients with systemic lupus erythematosus (SLE) are often associated with thrombosis, recurrent abortions and thrombocytopenia. The purpose of this study was to evaluate the prevalence of cardiac valvular abnormalities in patients with SLE and to establish the relationship between the echographic findings and the presence of an antiphospholipid syndrome. A total of 52 consecutive patients with SLE and 52 healthy sex- and age-matched controls were therefore evaluated in a cross-sectional study. All underwent M-mode and two-dimensional echocardiography, color-flow imaging, pulsed and continuous-wave Doppler. In the SLE group, subjects exposed to antiphospholipid syndrome (n = 20) were compared to controls. Patients with SLE had significantly more mitral (p = 0.032; RR 2.48; 1.25-5.6) and tricuspid regurgitations (p = 0.0016; RR 2.41; 1.58-8.85). There was no significant difference between either group for mitral valve thickness (p = 0.66). The antiphospholipid syndrome was significantly associated with increased relative risk for tricuspid.
- Published
- 1994
- Full Text
- View/download PDF
24. [Doppler echocardiography under dipyridamole after thrombolyzed early myocardial infarction. Comparison with coronarographic data].
- Author
-
Metz D, Pommier JL, Nazeyrollas P, Chapoutot L, Graciet J, Chabert JP, Elaerts J, and Bajolet A
- Subjects
- Adult, Constriction, Pathologic, Coronary Angiography, Coronary Disease diagnostic imaging, Coronary Disease prevention & control, Evaluation Studies as Topic, Female, Humans, Male, Middle Aged, Myocardial Infarction drug therapy, Dipyridamole, Echocardiography, Doppler, Myocardial Infarction diagnostic imaging
- Abstract
The reliability and safety of Doppler echocardiography with dipyridamole (0.84 mg/kg in 10 min) were evaluated in 63 patients an average of 7 days after a thrombolysed early lateral infarct and 24 hours before follow-up coronary arteriography. The aims of the test were the detection of tight stenoses (diameter reduced by more than 75%) affecting the artery responsible for the infarct as well as the other coronary vessels, using the vasodilator action of dipyridamole. The echocardiographic manifestation of induced coronary steal consisted of transitory asynergism in the territory of the artery involved. Clinical tolerability of the test was good. The brief onset of anginal pain was nevertheless seen in 6 patients. Analysis of the zone corresponding to the necrosed area was possible in only 43 cases. Sensitivity of the test for detection of a post-infarction residual stenosis was 64% (39-89) and specificity 90% (79-100). Study of other territories was possible in 59 cases. Sensitivity of the test for the diagnosis of multiple vessel disease was 70% (42-98) and specificity 94% (88-100). In the population as a whole, Doppler study of variations in anterograde mitral flow revealed a sensitivity of 40% (27-53) and specificity of 87% (78-96). Variations in sub-aortic flow were analysed only in the final 27 patients, with a sensitivity and specificity of 100%. The specificity of dipyridamole echocardiography after infarction is good, both for the detection of residual stenosis and that of multiple vessel disease, the chief limiting factor being the impossibility of analysis of the infarcted region in the presence of initial akinesis.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1993
25. [Thrombolysis and acute venous thromboembolic disease].
- Author
-
Nazeyrollas P, Metz D, Chabert JP, Perelstein L, Maillier B, Chapoutot L, Elaerts J, and Bajolet A
- Subjects
- Acute Disease, Hemorrhage chemically induced, Humans, Pulmonary Embolism drug therapy, Thrombolytic Therapy adverse effects, Thrombophlebitis drug therapy
- Abstract
Thrombolytic agents are widely used as first line treatment in severe acute pulmonary embolisms. While their indications are well defined, no controlled trial exists to provide definite evidence of their ultimate effectiveness in terms of mortality. Nevertheless, therapeutic advances and the good results obtained in terms of satisfactory changes in hemodynamic and angiographic parameters have led to renewed evaluation at the present time of the ways in which they are used in thrombo-embolic disease: administration of thrombolytics as repeated boluses in order to decrease the risk of hemorrhagic complications; and extension of the indications of thrombolysis to the venous component of thrombo-embolic disease.
- Published
- 1993
26. [Value of transesophageal echography in the diagnosis of posterior ventricular septal rupture during the acute phase of myocardial infarction. Apropos of 2 cases].
- Author
-
Maillier B, Metz D, Théolade R, Chapoutot L, Chabert JP, Baehrel B, Elaerts J, and Bajolet A
- Subjects
- Acute Disease, Aged, Esophagus, Humans, Male, Echocardiography methods, Heart Rupture, Post-Infarction diagnostic imaging, Heart Septum
- Abstract
The authors report two cases of posterior ventricular septal defects complicating acute myocardial infarction diagnosed by transesophageal echocardiography. Transesophageal echocardiography was well tolerated confirmed the diagnosis, and enabled accurate evaluation of the shunt in the transgastric view. The anatomical results guided the surgical approach and correlated well with the operative findings.
- Published
- 1993
27. [Predictive factors of regularization and maintenance of sinus rhythm in chronic atrial fibrillation].
- Author
-
Théolade R, Chauvin M, Metz D, Chabert JP, Bajolet A, and Brechenmacher C
- Subjects
- Age Factors, Anti-Arrhythmia Agents therapeutic use, Atrial Fibrillation physiopathology, Atrial Function, Cardiomegaly complications, Chronic Disease, Electric Countershock, Electrocardiography, Heart Valve Diseases complications, Humans, Predictive Value of Tests, Atrial Fibrillation therapy
- Abstract
The aim in treating chronic atrial fibrillation, is not limited to simply achieving immediate regularization. What matters, is sustaining the sinus rhythm. The various methods of regularization, using either medical procedures or cardioversion, involve constraints and risks. Investigation of the relapse predicting factor is of great value in evaluating the benefit/risk ratio. For regularization, the absence ultrasound signs of heart disease, an undilated left atrium, recent atrial fibrillation and all forms of heart disease which are curable, albeit surgically, are indicative of success. With regard to prophylaxis, relapses occur more frequently in cases involving mitral valve disease, long-standing atrial fibrillation or a dilated left atrium.
- Published
- 1992
28. [Postoperative hemopericardium compressing the left atrium. Apropos of 8 cases].
- Author
-
Laudinat JM, Chapoutot L, Metz D, Chabert JP, Metivet F, Taupin JM, Ehrhard V, Baehrel B, Elaerts JL, and Bajolet A
- Subjects
- Adult, Aged, Aortic Valve, Female, Humans, Male, Middle Aged, Reoperation, Retrospective Studies, Coronary Artery Bypass adverse effects, Heart Atria, Heart Valve Prosthesis adverse effects, Pericardial Effusion etiology
- Abstract
The authors report 8 cases of hemopericardium compressing the left atrium occurring at varying intervals after cardiac surgery. This is an unusual anatomical and classically rare site of pericardial effusion. This type of tamponnade has special clinical features, leading to a picture of subacute left ventricular failure, by interference with filling and typical echocardiographic appearances, with special features in two-dimensional mode and, in TM mode, an abnormal anterior movement of the posterior wall of the left atrium, which is studied. CT scan of the thorax, when performed, confirms this highly specific topographic situation. This type of effusion must be managed surgically as quickly as possible, with an anterior approach, either by left thoracotomy or by midline sternotomy.
- Published
- 1991
29. [Doppler echocardiographic evaluation of the efficacy of fibrinolytic treatment of pulmonary embolism].
- Author
-
Chapoutot L, Metz D, Chabert JP, Laudinat JM, Metivet F, Doucet J, Graciet J, Grentinzger A, Elaerts J, and Bajolet A
- Subjects
- Adult, Aged, Female, Hemodynamics, Humans, Male, Middle Aged, Prospective Studies, Pulmonary Embolism diagnostic imaging, Pulmonary Embolism physiopathology, Echocardiography, Doppler, Pulmonary Embolism drug therapy, Thrombolytic Therapy
- Abstract
The efficacy of the fibrinolytic therapy in pulmonary embolism was studied by Doppler echocardiography: the evolution of the cardiac and angiographic changes could be studied in parallel. Thirty patients with severe pulmonary embolism and vascular obstruction greater than 40% (67.2 +/- 9.9%) were examined prospectively by Doppler echocardiography before and after thrombolysis. The following parameters were studied: systolic pulmonary artery pressure calculated from the jet of tricuspid regurgitation and left and right ventricular diameters for the calculation of the ratio of the ventricular dimensions. All patients underwent Doppler echocardiography and pulmonary angiography immediately after thrombolysis. The average improvement of the percentage vascular obstruction was 37%. The hemodynamic and echocardiographic changes were globally favourable. The pulmonary artery systolic pressure fell from 51 +/- 10 to 33 +/- 6.7 to 25.3 +/- 6.3 mm and the ratio of ventricular dimension from 0.87 +/- 0.3 to 0.60 +/- 0.16 (p less than 0.001). Only 4 patients had pulmonary artery systolic pressures over 40 mmHg after therapy compared with 26 before therapy. However, the hemodynamic and angiographic correlations were poor (r = 0.37; p less than 0.001). In the 6 patients in whom treatment was ineffective according to angiographic criteria (less than 20% improvement of vascular obstruction), the echocardiographic changes were small or absent, the improvement in the ratio of ventricular dimensions being less than 20%. However, a satisfactory correlation was observed between the percentage improvement of the ratio of ventricular dimensions and that of vascular obstruction (r = 0.59; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1991
30. [Therapeutic value of esophageal stimulation. Factors influencing the results in flutter and atrial tachysystole].
- Author
-
Chabert JP, Metz D, Chapoutot L, Doucet J, Laudinat JM, Elaerts J, Blaise C, and Bajolet A
- Subjects
- Adult, Aged, Aged, 80 and over, Electrocardiography, Esophagus, Female, Humans, Male, Middle Aged, Prospective Studies, Atrial Flutter therapy, Electric Stimulation Therapy, Tachycardia therapy
- Abstract
The aim of this prospective study was to identify factors predicting the efficacy of atrial stimulation by esophageal route in 57 nonselected patients between 37 and 88 years of age and admitted for intensive care due to flutter or atrial tachycardia. It was impossible to perform the procedure correctly in 4 patients. The restoration of sinus rhythm was achieved in 28.3% of cases at the end of the procedure and in 47.2% of cases after 24 hours. These results were influenced by the duration of the arrhythmia, the underlying cardiopathy and the diameter of the left atrial, but were not affected by the stimulation parameters.
- Published
- 1991
31. [Diagnosis and evaluation of mitral endocarditis complicating obstructive cardiomyopathy using cardiac echo-Doppler].
- Author
-
Chapoutot L, Graciet J, Metz D, Sal R, Chabert JP, Slimani S, Penalba C, Fontaine JF, Metz J, and Bajolet A
- Subjects
- Adult, Endocarditis, Bacterial etiology, Female, Humans, Cardiomyopathy, Hypertrophic complications, Echocardiography, Doppler, Endocarditis, Bacterial diagnosis, Mitral Valve
- Abstract
The authors report a case of mitral endocarditis diagnosed by cardiac echo-Doppler and complicating an obstructive cardiomyopathy (OCM) in a 37-year-old woman. Despite the high degree of sub-aortic obstruction and the existence of an apparently severe mitral leak by Doppler analysis, the patient remained totally asymptomatic and the outcome was favourable with appropriate antibiotics. A review of the literature revealed 11 cases of endocarditis in a context of OCM, documented by echocardiography. Echo-Doppler enables precise evaluation of this grave and often poorly tolerated complication of OCM.
- Published
- 1991
32. [Differential analysis of mitral and tricuspid regurgitation by continuous Doppler].
- Author
-
Pollet E, Jolly D, Metz D, Chabert JP, Doucet J, Elaerts J, and Bajolet A
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Mitral Valve Insufficiency complications, Mitral Valve Insufficiency diagnosis, Prospective Studies, Tricuspid Valve Insufficiency complications, Tricuspid Valve Insufficiency diagnosis, Echocardiography, Doppler, Mitral Valve Insufficiency physiopathology, Tricuspid Valve Insufficiency physiopathology
- Abstract
The following parameters have been measured by continuous Doppler in 40 patients with both mitral failure (MF) and tricuspid failure (TF): effusion time (ET), peak time (PT), maximum effusion speed (S. max), maximum anterograde speed (S. ant), taking into account the cardiac rate and the ejection fraction. Only the S. max. and the S. ant. are significantly different and enable the determination of the effusion origin with a percentage error of about 4%. When a straight line is drawn to joint 3.7 m/s on the ordinate (S. ant) and 5 m/s on the abcissa (S. max), the TF lie below the line and the MF above it. The selection of the sub-groups with low ejection fraction (less or equal to 30%) or with arterial pulmonary hypertension (S. max MF higher or equal to 3 m/s) does not modify the precision of the discrimination. The graph suggested seems therefore to be a rapid and reliable means of characterizing TF in order to assess the arterial pulmonary hypertension of dilated hypokinetic cardiomyopathies.
- Published
- 1990
33. [Comparative study of cibenzoline and flecainide administered via an intravenous route in reducing auricular arrhythmia].
- Author
-
Metz D, Chapoutot L, Laudinat JM, Ehrhard V, Taupin JM, Chabert JP, Metivet F, Pollet E, and Bajolet A
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Flecainide administration & dosage, Humans, Imidazoles administration & dosage, Injections, Intravenous, Injections, Jet, Male, Middle Aged, Anti-Arrhythmia Agents therapeutic use, Arrhythmias, Cardiac drug therapy, Flecainide therapeutic use, Imidazoles therapeutic use
- Abstract
The efficacy of intravenous flecainide and cibenzoline acetate in the reduction of atrial rhythm disorders was compared in two groups of 30 patients. These arrhythmias are divided in 31 atrial fibrillation, 11 tachy-systoles, 18 atrial flutters. Parenteral administration of the anti-arrhythmic drug over a 24 hour-period is preceded by a bolus injection of 1.5 mg/kg of flecainide acetate for group I, and a bolus of 1 mg/kg of cibenzoline for group II. The overall efficacy of the two molecules is comparable (53%) as well as the reduction of the atrial fibrillations (65% vs 57%). Flecainide acetate seems more effective in treating effectively atrial tachycardias (66.6% vs 40%), and cibenzoline is more effective in the treatment of atrial flutters (54% vs 14%). The functional, electrical and haemodynamic tolerance has always been good in both group, except in 2 patients, because of the indirect pro-arrhythmic effect of cibenzoline. We are concluding that the efficacy of both molecules is satisfactory and we advocate their use, as first intention, in recent and idiopathic atrial fibrillation; it seems that cibenzoline is more effective on ischemic cardiopathies and flecainide acetate is more effective on valvular cardiopathies. Nevertheless, the possible indirect pro-arrhythmic effect, sometimes poorly tolerated in the first minutes following administration of the bolus, only on organized atrial rhythm disorder, leads us to advocate the prescription of these two drugs when attempts of transesophageal or endocardiac atrial stimulation have failed.
- Published
- 1990
34. [Ultrasonic diagnosis of biventricular thrombus during the acute phase of myocardial infarction].
- Author
-
Taupin JM, Laudinat JM, Metz D, Chapoutot L, Pollet E, Chabert JP, and Bajolet A
- Subjects
- Aged, Coronary Disease drug therapy, Coronary Disease etiology, Heart Ventricles, Heparin therapeutic use, Humans, Intracranial Embolism and Thrombosis etiology, Male, Coronary Disease diagnosis, Echocardiography, Myocardial Infarction complications
- Abstract
The occurrence of a left ventricular thrombus is a classic complication of acute myocardial infarction. On the contrary, this is much less frequent in the right ventricle. The authors report the case of a patient presenting a biventricular thrombus resulting as a complication of an anterior myocardial infarction, diagnosed by bidimensional ultrasonography. The course is characterized by the occurrence of a cerebral vascular accident. The sonogram following this neurological accident shows that the left ventricular thrombus has disappeared, confirming its migration. On the contrary, the right ventricular thrombus regressed under appropriate heparin treatment, without any embolic complication.
- Published
- 1989
35. [Aortic dissection with normal aortography and x-ray computed tomography. A diagnostic trap not to be ignored].
- Author
-
Metz D, Chabert JP, Beruben E, Chapoutot L, Blaise C, Baehrel B, Elaerts J, and Bajolet A
- Subjects
- Female, Humans, Middle Aged, Tomography, X-Ray Computed, Aortic Dissection diagnosis, Aortic Aneurysm diagnosis, Aortography, Echocardiography
- Abstract
We are reporting the case of a 63 y.old patient whose initial clinical examination and ultrasonographic data had led to the diagnosis of acute aortic dissection. Only an emergency surgical procedure was able to confirm the diagnosis, after failure of angiography and CT-scan to do so. In the light of this example, we are presenting a reminder of the sensitivity of various paraclinical examinations, classically accepted to establish this diagnosis.
- Published
- 1988
36. [Diagnostic and prognostic value of continuous Doppler in pulmonary embolism].
- Author
-
Metz D, Chapoutot L, Pollet E, Jolly D, Chabert JP, Elaerts J, and Bajolet A
- Subjects
- Acute Disease, Adult, Aged, Angiocardiography, Blood Flow Velocity, Female, Hemodynamics, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Pulmonary Embolism diagnostic imaging, Tricuspid Valve Insufficiency physiopathology, Echocardiography, Doppler, Pulmonary Embolism diagnosis
- Abstract
A prospective study of 18 patients admitted to hospital for acute pulmonary embolism confirmed the reliability of continuous wave cardiac doppler as a non-invasive method of evaluating systolic pulmonary artery pressures. These pressures were calculated by applying the simplified Bernoulli equation to the maximal velocity of regurgitant tricuspid flow and compared with the results of cardiac catheterisation and angiography, the percentage of vascular obstruction being assessed using Miller's index. The correlations between the two methods were good, r = 0.96; p less than 0.001, with a standard error of +/- 5.2 mmHg. The correlations between the velocity of tricuspid flow and the percentage of obstruction were less significant (r = 0.65; p less than 0.005) but improved when patients with pre-existing cardiopulmonary disease were excluded. This technique of non-invasive assessment of haemodynamic parameters also helps in evaluating the underlying pathology; tricuspid regurgitation with velocities greater than 3.5 m/s is associated with pre-existing chronic cor pulmonale, information of prognostic interest which would guide therapeutic management.
- Published
- 1988
37. [Acute dysfunction of mitral bioprosthesis: Doppler expression of a musical holosystolic murmur. Apropos of 2 cases].
- Author
-
Metz D, Laudinat JM, Chapoutot L, Taupin JM, Chabert JP, Pollet E, and Bajolet A
- Subjects
- Aged, Female, Hemodynamics, Humans, Mitral Valve, Prosthesis Failure, Bioprosthesis adverse effects, Echocardiography, Doppler, Heart Auscultation, Heart Murmurs, Heart Valve Prosthesis adverse effects
- Abstract
Two women who had been fitted with a porcine mitral valve seven years previously suddenly developed acute dysfunction of the bioprosthesis with regurgitation. In both patients physical examination revealed an intense, vibrating, musical holosystolic murmur sounding like a "goose cry" and located at the apex. Pulsed doppler showed major, jet-like, central orothetic mitral regurgitation. A harmonic graph was recorded when the doppler window was positioned upstream of the porcine valve leaflets. The finding of such a doppler signal in this clinical context suggests tearing or perforation of one cuspid and rules out the possibility of bioprosthesis degeneration.
- Published
- 1989
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