RESUMEN
Collisional mountain belts grow as a consequence of continental plate convergence and eventually disappear under the combined effects of gravitational collapse and erosion. Using a decade of GPS data, we show that the western Alps are currently characterized by zero horizontal velocity boundary conditions, offering the opportunity to investigate orogen evolution at the time of cessation of plate convergence. We find no significant horizontal motion within the belt, but GPS and levelling measurements independently show a regional pattern of uplift reaching ~2.5 mm/yr in the northwestern Alps. Unless a low viscosity crustal root under the northwestern Alps locally enhances the vertical response to surface unloading, the summed effects of isostatic responses to erosion and glaciation explain at most 60% of the observed uplift rates. Rock-uplift rates corrected from transient glacial isostatic adjustment contributions likely exceed erosion rates in the northwestern Alps. In the absence of active convergence, the observed surface uplift must result from deep-seated processes.
RESUMEN
Thrombolytic treatment efficacy is greater when the delay between onset of pain and treatment is short. To give treatment before admission to a coronary care unit, responsibility needs to be transferred from cardiologists to other physicians working in mobile care units. We conducted a 2-part feasibility study to investigate this strategy. Part 1 evaluated the diagnostic accuracy of mobile care unit physicians. Results from this study indicate that with regard to the diagnosis of acute myocardial infarction, the risk of a wrong diagnosis is low. Part 2 was a placebo-controlled trial involving 100 patients in which 57 received anisoylated plasminogen streptokinase activator complex (APSAC) (30 U) at home and 43 received placebo at home. Patients receiving placebo at home were reevaluated on arrival in a coronary care unit and received APSAC (30 U) if indicated. The main results were that (1) diagnostic accuracy was good--all patients had an acute coronary syndrome and 97 of 100 patients had myocardial infarction; (2) time gain was approximately 60 minutes; (3) coronary patency rate was 72%; (4) ejection fraction was higher in the prehospital group (56.7%) than in the control group (53.4%), but the difference was not significant; (5) there was no rhythmic or bleeding complication related to the prehospital treatment; (6) 5 patients died from cardiogenic shock--2 between home and hospital and 3 in the hospital (3 received thrombolytic treatment at home and 2 received placebo at home and APSAC in the hospital); and (7) prehospital administration of APSAC did not induce a delay in arrival to the coronary care unit.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Fibrinolíticos/administración & dosificación , Infarto del Miocardio/tratamiento farmacológico , Plasminógeno/administración & dosificación , Estreptoquinasa/administración & dosificación , Adulto , Anciano , Anistreplasa , Electrocardiografía , Servicios Médicos de Urgencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Unidades Móviles de Salud , Monitoreo Fisiológico , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/fisiopatología , Distribución Aleatoria , Volumen Sistólico/efectos de los fármacos , Factores de Tiempo , Grado de Desobstrucción Vascular/efectos de los fármacosRESUMEN
Previous clinical studies with intravenous enoximone have used cumulative dosing to quantify enoximone's hemodynamic effects. The magnitude and duration of the hemodynamic effects of single intravenous doses of enoximone were evaluated in patients with congestive heart failure. Sixty patients, who were in New York Heart Association functional classes III and IV, received single intravenous doses of enoximone, either 0.25 (12 patients), 0.5 (13 patients), 1 (14 patients), 1.5 (10 patients) or 2 mg/kg (11 patients). Cardiac index was increased by 20% with the 0.25 mg/kg dose and by 48% and 42% with the 1.5 and 2 mg/kg doses, respectively. These increases were statistically significant (Student's paired t test with Bonferroni's correction, p less than 0.007) for 1 hour after 0.25 and 0.5 mg/kg, for 2 hours after 1 mg/kg and for 4 hours after 1.5 and 2 mg/kg. Enoximone also reduced pulmonary artery diastolic pressure by 19% with 0.25 mg/kg and by 29% with 2 mg/kg. The duration of effect varied from 1 hour with 0.25 mg/kg to 4 hours with 2 mg/kg. Enoximone produced no consistent or dose-related effects on heart rate or blood pressure. Eighteen adverse reactions were reported by 15 patients, of which 11 were minor and transient (vein pain, flushes, nausea). In 5 patients ventricular or supraventricular arrhythmias were observed, including nonsustained ventricular tachycardia and extrasystoles; 3 of these patients had evidence of arrhythmias before enoximone. Laboratory studies before and after treatment showed no drug-related effects. Dose-related effects on the magnitude and duration of hemodynamic responses to intravenous enoximone were evident within the dose range of 0.25 to 2 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Cardiotónicos/administración & dosificación , Insuficiencia Cardíaca/fisiopatología , Hemodinámica/efectos de los fármacos , Imidazoles/administración & dosificación , Adulto , Anciano , Gasto Cardíaco/efectos de los fármacos , Cardiotónicos/uso terapéutico , Ensayos Clínicos como Asunto , Relación Dosis-Respuesta a Droga , Enoximona , Femenino , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Imidazoles/uso terapéutico , Infusiones Intravenosas , Masculino , Persona de Mediana EdadRESUMEN
The results of 20 medico-surgical teams were combined to give a total of 93 patients aged less than 14 years, with a total of 94 replacement valves. The intra-operative and subsequent mortality rate, the complications and the results have been analysed. The best results are found amongst the severe rheumatic valve disorders in older children, while the worst are amongst the valvular malformations in the infant.
Asunto(s)
Prótesis Valvulares Cardíacas , Adolescente , Niño , Preescolar , Femenino , Cardiopatías Congénitas/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/mortalidad , Válvulas Cardíacas/cirugía , Humanos , Lactante , Masculino , Cardiopatía Reumática/cirugíaRESUMEN
The association of aortic incompetence and ventricualr septal defect is rare, but justifies the regular supervision of all patients with VSD. It seems to be found more commonly in cases where the VSD is above the crista. Early operation appears to be justified, and in a large number of cases this avoids the progressive worsening of the aortic incompetence; this in turn leads to better results with the conservative surgical procedures.
Asunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Defectos del Tabique Interventricular/cirugía , Adolescente , Adulto , Insuficiencia de la Válvula Aórtica/complicaciones , Niño , Preescolar , Femenino , Estudios de Seguimiento , Defectos del Tabique Interventricular/complicaciones , Prótesis Valvulares Cardíacas , Hemodinámica , Humanos , Masculino , Complicaciones Posoperatorias , SíndromeRESUMEN
Report of the case of a child in whom a marked dilatation of the ascending aorta was discovered at the age of 7 years, because of a symptomless systolic murmur, and who developed at the age of 10 a clinical picture of dissecting aneurysm. He was operated upon successfully, and was shown to have on operation a stenotic bicuspid aortic valve. There were no signs of fibrous tissue dystrophy. Death occured suddenly at the age of 14.
Asunto(s)
Derrame Pericárdico/etiología , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/cirugía , Niño , Humanos , Masculino , Derrame Pericárdico/cirugía , Rotura EspontáneaRESUMEN
Report of the case of a 50-year woman with a cyanotoc congential heart disease, relatively well tolerated up to the age of 49. The diagnosis was made at autopsy only. No case published in the literature till now had exceeded the age of 45 years, although the types of truncus arteriosus.
Asunto(s)
Conducto Arterioso Permeable/diagnóstico , Arteria Pulmonar/anomalías , Aorta/anomalías , Aorta/patología , Autopsia , Cardiomegalia/etiología , Cianosis/etiología , Diagnóstico Diferencial , Disnea/etiología , Femenino , Cardiopatías Congénitas/diagnóstico , Insuficiencia Cardíaca/etiología , Soplos Cardíacos , Defectos del Tabique Interventricular/patología , Válvulas Cardíacas/anomalías , Humanos , Pulmón/patología , Persona de Mediana Edad , Miocardio , Tetralogía de Fallot/diagnósticoRESUMEN
Seven out of 348 cases of Fallot's tetralogy (2 %) referred over an eight year period were complicated by aortic incompetence (AI). The incidence of AI was much lower than in VSD (7.6 %), probably because of the prevailing haemodynamics: in high VSD, the left-to-right shunt may damage the aortic cusps whilst in Fallot's tetralogy the output of both ventricles is ejected directly into the aorta with no alteration of aortic valve function. In this series, infective endocarditis was the predominant cause of AI (3 cases); surgery had to be undertaken in the infectious phase in 2 cases. AI was coincidental in two other cases (rheumatic valvular disease and calcified bicuspid valve). In the remaining two cases, the role of increased aortic flow in late distension of the aortic valve ring is discussed. AI should be corrected in the same operative time as the Fallot's tetralogy. Late onset AI occurring after repair of Fallot's tetralogy should also be corrected; in this situation, it is often difficult to diagnose the origin of the diastolic murmur. Without surgery the prognosis is poor as the diastolic regurgitation occurs in a ventricle whose function is often already compromised.
Asunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Tetralogía de Fallot/complicaciones , Adolescente , Adulto , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/cirugía , Endocarditis Bacteriana/complicaciones , Femenino , Defectos del Tabique Interventricular/complicaciones , Defectos del Tabique Interventricular/fisiopatología , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Fiebre Reumática/complicacionesRESUMEN
120 cases of the Williams-Beuren syndrome were collected by 11 cardiological centres in France, to determine the incidence of the various clinical signs and to obtain information on its aetiology, outcome and treatment. The selection criteria for inclusion in the series was typical facies. No particular complications were reported during pregnancy. Boys were a little more affected than girls. The birth weight was low and problems, especially digestive, often occurred in the first months. Cardiac signs were usually detected from the first year, although the exact diagnosis was usually made later on. 3/4 patients had subaortic stenosis, which was severe in 1/3 cases. Involvement of the branches of the aorta was not looked for systematically: the incidence (1/5 cases) found was lower than the true figure. Half the patients also had stenoses on branches of the pulmonary artery, but only rarely were they severe. These vascular malformations often seem to be progressive and, over a 10 year period, half the patients deteriorated. Many extracardiac abnormalities were reported. The most frequently encountered were inguinal and/or umbilical hernia. Surgery on the subvalvular stenosis gave good results in over 80 p. 100 cases; operative mortality was about 10 p. 100. Surgery should be performed before irreversible coronary or myocardial lesions develop. The study of the previous history did not give any new information on the cause of the syndrome, whose association with idiopathic hypercalcaemia of infancy is emphasised once again.
Asunto(s)
Estenosis de la Válvula Aórtica/diagnóstico , Discapacidad Intelectual/diagnóstico , Estenosis de la Válvula Pulmonar/diagnóstico , Enfermedades de la Aorta/diagnóstico , Arteriopatías Oclusivas/diagnóstico , Femenino , Humanos , Masculino , SíndromeRESUMEN
The records of 43 patients older than 18 years presenting with tetralogy of Fallot were retrospectively examined to determine the semiological characteristics of the disease in adults. One or more palliative operations had previously been performed in 27 patients. Full correction was carried out in 38 patients with results described below. Tetralogy of Fallot has the following characteristics in adults as compared with children: clinically, heart failure, attacks of angina, haemoptysis and sequelae of previous complications are more frequent; at electrocardiography, right atrial hypertrophy, right bundle disorders of conduction and ventricular extrasystoles are also more frequent; radiology shows that cardiomegaly is no longer exceptional; haemodynamic studies demonstrate an increase in right atrial and right ventricular end-diastolic pressures. These characteristics indicate a deterioration of haemodynamic adjustment to the disease with age. The operative morbidity mostly consisted of haemorrhages (55% of the patients), more frequent in subjects with permeable anastomoses (p less than 0.01), and heart failure (50% of the patients) the frequency of which increased with the subject's age, the duration of the operation and the use of an infundibulo-pulmonary prosthesis (p less than 0.05). The operative mortality (18%) depended on the extent of the pulmonary stenosis and on the presence of a previous anastomosis (p = 0.04). An analysis of the causes of death reported in the literature showed that in adults the presence of an anastomosis constitutes a separate risk factor in complete repair. The excellent long-term results of corrective surgery concerning cardiac function and survival suggest that except for those rare cases where the operative risk is very high all adults with tetralogy of Fallot should undergo complete repair.
Asunto(s)
Tetralogía de Fallot/cirugía , Adulto , Envejecimiento , Femenino , Estudios de Seguimiento , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Embarazo , Estenosis de la Válvula Pulmonar/cirugía , Reoperación , Estudios Retrospectivos , Tetralogía de Fallot/fisiopatologíaRESUMEN
High-output states combining tachycardia, increased cardiac output and raised blood pressure are often seen in clinical practice with causes other than the classical ones (hyperthyroidism anaemia and arterio-venous fistulae). Noticing how these syndromes ressemble cardiac beri-beri, the authors looked for hypothiaminaemia in these patients. On the 25 cases studied, two were particularly interesting as there was frank hypothiaminaemia, and also as treatment with vitamin B1 corrected not only the biochemical disorder but also the clinical symptoms, and led to lessening of the trachyardia and a reduction in cardiac output and blood pressure.
Asunto(s)
Hipertensión/etiología , Taquicardia/etiología , Deficiencia de Tiamina/complicaciones , Tiamina/uso terapéutico , Adolescente , Adulto , Gasto Cardíaco , Cardiomiopatías/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Síndrome , Deficiencia de Tiamina/tratamiento farmacológicoRESUMEN
The authors report a case of a lady of 45 years of age who presented with a cardiomyopathy with hypothiaminaemia which had been made considerably worse by treatment with imipramine. Once treatment with the antidepressant was stopped, her condition returned to its previous status. The very high plasma imipramine level recorded in his case is undoubtedly the reason for the cardiac toxicity. The mechanism and role of hypothiaminaemia have not far been explained logically.
Asunto(s)
Cardiomiopatías/inducido químicamente , Imipramina/efectos adversos , Deficiencia de Tiamina/complicaciones , Cardiomiopatías/sangre , Depresión/tratamiento farmacológico , Electrocardiografía , Femenino , Humanos , Imipramina/sangre , Imipramina/uso terapéutico , Persona de Mediana Edad , Tiamina/sangreRESUMEN
Transverse sections of the heart and great vessels may be obtained by tomodensitometry using an exposure time short enough to carry out the investigation during apnoea, and an infusion of contrast medium. The definition is good enough for the investigation to be considered as a useful adjunct to the normal investigations in complex congenital cardiac abnormalities. All measurements are instantaneous, including the study of pulmonary density which allows assessment of the pulmonary vascularisation.
Asunto(s)
Cardiopatías Congénitas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Niño , Estudios de Evaluación como Asunto , Femenino , Humanos , MasculinoRESUMEN
19 patients were studied after operation for coarctation of the aorta. The average age at operation was 13.7 years. Crafoord's operation was performed in 16 cases and in the other three an aortic patch was necessary. The average post-operative period was 4.7 years. 14 cases were classified as good results: normal femoral pulses and arterial blood pressure. The other 5 cases were considered as unsatisfactory: 2 mediocre results with normal arterial blood pressure but diminished femoral pulses and oscillometric indices; 3 poor results with hypertension at rest. On exercise with bicycle ergometry the following results were obtained: the systolic blood pressure rose in a comparable manner to that observed in normotensive individuals of the same age on exercise except in 2 cases. These two patients had an aortic patch and one had a residual intraaortic pressure gradient. The pronostic significance of these findings is not known. However the use of an aortic patch is often associated with abnormal blood pressures at rest or on exercise. The fact that the majority of patients operated for coarctation of the aorta have normal blood pressure profiles on exercise should be emphasised.
Asunto(s)
Coartación Aórtica/fisiopatología , Coartación Aórtica/cirugía , Presión Sanguínea , Esfuerzo Físico , Adolescente , Adulto , Niño , Diástole , Prueba de Esfuerzo , Humanos , SístoleRESUMEN
The case is reported of carcinoid heart disease in a lady of 70 with intractable congestive cardiac failure 5 years after the removal of a primary carcinoid tumour of the ovary. The special features of primary carcinoid tumours of the ovary are recalled, with emphasis on their rarity and of the absence of liver metastases. The various features of carcinoid syndrome are recalled in the light of current knowledge of the pathogenesis. A review of the literature on cardiac involvement in primary carcinoid tumours of the ovary, amounting to 10 cases, is included. The possibility of surgical cure of the heart lesions in carcinoid tumour by a prosthetic tricuspid valve are discussed, in the light of the 6 reported cases and the present one. Our report is the first one of replacement of the valve after removal of a primary ovarien carcinoid tumour, and the excellent result has been maintained after three years.
Asunto(s)
Tumor Carcinoide/complicaciones , Prótesis Valvulares Cardíacas , Neoplasias Ováricas/complicaciones , Insuficiencia de la Válvula Tricúspide/cirugía , Anciano , Femenino , Estudios de Seguimiento , Humanos , Insuficiencia de la Válvula Tricúspide/etiologíaRESUMEN
The following observations were made on a series of 15 cases of bacterial endocarditis on congenital cardiac lesions admitted between 1971 and 1980, in 13 patients aged 6 to 48 years old (average 21 yrs old): --The low but constant incidence of endocarditis--The majority of causal lesions were ventricular septal defects of Fallot's tetralogy--The portal of entry diagnosed in 2/3 of cases was usually dental--The causal organism was a streptococcus in 80% of cases--The long period of pyrexia before, the diagnosis of endocarditis was made--M mode, and above all, 2D echo detected vegetations in half the cases where it was performed--The gravity of the immediate prognosis due to a 25% mortality and a high incidence of complications--Early complications present in 2/3 of cases were dominated by true "oslerian" lesions, cardiac failure, cerebral complications, pulmonary embolism and early relapse. --The relatively good secondary prognosis.
Asunto(s)
Endocarditis Bacteriana/etiología , Cardiopatías Congénitas/complicaciones , Adolescente , Adulto , Niño , Ecocardiografía , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/terapia , Femenino , Insuficiencia Cardíaca/etiología , Enfermedades de las Válvulas Cardíacas/etiología , Humanos , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
Idiopathic right atrial dilatation is a rare and probably congenital malformation. Two new cases are reported, in an 18 months old infant and a six week old baby, both presenting with supraventricular tachyarrhythmias. Clinical examination was normal. Chest X-ray showed bulging of the right heart border and electrocardiography revealed partial right bundle branch block. The diagnosis was made by echocardiography which showed aneurysmal dilatation of the right atrium. There were no signs of valvular heart disease or of an intracardiac shunt; the septal tricuspid leaflet was in its normal position. M-mode recordings showed no signs of Ebstein's anomaly. The diagnosis was confirmed by cardiac catheterisation in the first case; this investigation seemed to be pointless in the second case. Both children experienced many episodes of supraventricular tachyarrhythmias. The first developed tricuspid regurgitation but the second remains asymptomatic.
Asunto(s)
Atrios Cardíacos/anomalías , Taquicardia/etiología , Ecocardiografía , Femenino , Hemodinámica , Humanos , Lactante , Masculino , Taquicardia/fisiopatología , Válvula Tricúspide/anatomía & histología , Válvula Tricúspide/fisiologíaRESUMEN
An aneurysm of the membranous part of the interventricular septum associated with a complex congenital malformation of the endocardial cushions was diagnosed in a 39 year old woman who presented with syncope. Diagnosis was made by echocardiography and confirmed by angiography. The operative findings were: a double aneurysm of the membranous septum, a left ventricular--right atrial fistula and two hemivalves attached to papillary muscles. The usfulness of echocardiography in the diagnosis of aneurysm of the membranous interventricular septum and in the follow up of ventricular septal defects from which they arise is emphasised. The pathogenesis of the arrhythmias observed (accelerated idioventricular rhythm, reciprocating tachycardias and syncope possibly related to transient heart block) is discussed.
Asunto(s)
Arritmias Cardíacas/etiología , Aneurisma Cardíaco/complicaciones , Defectos de los Tabiques Cardíacos/complicaciones , Adulto , Angiocardiografía , Ecocardiografía , Femenino , Humanos , Síncope/etiologíaRESUMEN
The patency of 24 aorto-coronary grafts was studied by tomodensitometry. --16 out of the 18 bypasses examined within the two weeks following surgery were seen. --4 older bypasses were not visible, either by scanner or by angiography and were therefore occluded: two more, performed more than a year previously, were patent on tomodensitometric examination. The interpretation of the results, discussed taking into account the small number of angiographic check ups does not permit any formal conclusion as to the validity of the procedure. The results of this technique seem satisfactory and quite comparable with other non invasive methods used in the study of aorto-coronary grafts.
Asunto(s)
Puente de Arteria Coronaria , Tomografía Computarizada por Rayos X , Adulto , Anciano , Aortografía , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
An angiographic study of 231 patients with tetralogy of Fallot (TOF) in both neonatal and adult age groups (0 to 49 years) was in this condition. Cases of pulmonary atresia with ventricular septal defect were excluded. Two types of collateral pulmonary circulation were observed: the most common form is the result of distal intrapulmonary anastomosis between systemic parietal, mammary and bronchial vessels with the pulmonary arteries. This type of collateral circulation represents an evolutive stage of TOF and is directly related to age and to the degree of hypoxia; the other, oa rare and probably congenital form (1.7 p. 100 of cases) observed even in young children, consisting of proximal anastomoses between systemic vessels arising from the aorta (1 to 3 vessels) and the pulmonary arterial tree. The rare forms of TOF with single pulmonary arteries acquired after palliative or congenital anastomoses (1.4 p. 100) have both types of collateral circulation. Preoperative diagnosis of the collateral pulmonary circulation requires opacification of the aorta especially of the descending thoracic segment and its branches, completed in cases of an absent pulmonary artery by wedged pulmonary venous opacification. The haemodynamic effects of this collateral circulation on the pulmonary bed to a variable degree of histological change. This may partially explain some of the poor surgical results of repair of TOF and, in view of recent progress in cardiopulmonary bypass techniques in children, incite to earlier surgical correction of this condition.