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Biomedical subjects

A Cabrol

Publications and source records attributed to A Cabrol.

At least 91 records · Page 5Linked to original sources
PubMed1983

[Heart transplantations. Current status. Experience at the Hôpital de la Pitié].

The experience gathered over the last fifteen years of clinical application of heart transplants has resulted, in the last two years, in much improved results:the survival in our series is 77% at one year and 70% at 2 years. This progress is due to the following factors:improved patient selection, with strict respect of contraindications, in particular, patients over the age of 50 and patients with advanced multi-system failure; improved selection of donors, avoiding, within the limitations of immunological compatibility, grafts in poor condition from subjects over the age of 35 and a refinement of the operative techniques, especially the introduction of more potent immuno-suppressants such as Cyclosporin A and improved post-operative monitoring based on immunological examinations and repeated endo-myocardial biopsies. These advances will lead to a broadening of the operative indications and a wider use of this form of treatment.

Adolescent↗
PubMed1983

[Recurrence of mitral disease after commissurotomy. Criteria influencing operative mortality during reintervention using extracorporeal circulation].

Reoperation for secondary deterioration after mitral commissurotomy is associated with a higher immediate postoperative mortality than other open heart operations. We analysed the factors responsible for this increased mortality. A total of 232 patients reported for clinical deterioration after closed heart mitral commissurotomy were reviewed. Mitral valve prostheses were implanted in 202 cases; open heart commissurotomy was possible in 30 cases. Associated procedures included 14 tricuspid valve replacements, 53 tricuspid annuloplasties and 30 aortic valve replacements. The global mortality was 12 p. cent (30 deaths). The causes of death were myocardial failure (19 cases), cerebrovascular accidents (4 cases), prosthetic valve thrombosis (4 cases), infection (2 cases), section of the mitral annulus (1 case). The clinical hemodynamic and anatomical criteria influencing the operative prognosis were analysed: 1. Operative mortality was related to the clinical stage (zero mortality at Stage II, 10,3 p. cent at Stage III, 38 p. cent at Stage IV, p less than 0,001); 2. There was a significant correlation with cardiothoracic ratio: 23 p. cent mortality when greater than 0,60; 9,8 p. cent mortality when less than 0,60 (p less than 0,02); 3. There was a significant correlation with cardiac index: 19 p. cent mortality when less than 21; only 9 p. cent mortality when greater than 21 (p less than 0,04); 4. There was a significant correlation with systolic pulmonary arterial pressure: mortality of 11 p. cent when less than 60 mmHg; mortality of 22 p. cent when greater than 60 mmHg (p less than 0,06). 5. The presence of tricuspid regurgitation increased the operative risk (mortality rose from 12 to 22 p. cent, p less than 0,05) when the surgeon detected moderate or severe tricuspid regurgitation. These results show that the clinical, radiological and hemodynamic aggravation of these patients has a bad influence on operative mortality. This aggravation is not related to the delay between the initial commissurotomy and reoperation but to the delay between the recurrence of symptoms after the first operation and reoperation. Operative mortality was 12 p. cent when this delay was less than 10 years but 23 p. cent when the delay was over 10 years (p less than 0,02). Our findings suggest that these patients should be reoperated earlier if the prognosis of this type of surgery is to be improved.

Adolescent↗
PubMed1983

[Value of C-reactive protein in the cardiac postoperative period].

Twenty patients underwent special clinical and biological monitoring during their period of hospitalisation in the Department of cardiovascular surgery. The clinical monitoring concentrated on the patient's temperature and the search for postoperative complications; the biological part of the study was concerned with monitoring the levels of serum C-Reactive protein (CRP) as assessed by an immuno-nephelometric method. In 10 patients with a normal postoperative course the levels of this protein, an indicator of an inflammatory or infective process, were similar, giving an identical graph in all patients. On the other hand, in the 10 patients with inflammatory or infective postoperative complications, the levels of CRP were abnormal, parallel with the clinical state, sometimes rising even before the complication manifested itself clinically. It therefore seems useful and justified to measure CRP systematically, once before surgery and at least once daily in the postoperative period. The frequency of this investigation could be increased in patients with difficult or complex postoperative courses. A high CRP, even with a normal temperature, should alert the surgeon to a complication or to the inefficacy of anti-inflammatory or anti-infective therapy. These results confirm those published by other surgical teams, both in cardiovascular surgery and traumatology.

C-Reactive Protein↗
PubMed1981

[Abdominal complications of heart surgery].

Abdominal complications after cardiac surgery (excluding "medical" jaundice) are rare. Twenty six cases were observed out of a total of 7 847 operations (0.33%) performed between 1973 and 1980. The causes were very diverse; the most common being gastroduodenal ulceration, usually acute (9 cases). Other cases included intestinal (3 cases of postoperative ileus, 4 cases of mesenteric infarction, 2 cases of necrosing enterocolitis), biliary (2 cases of acute cholecystitis) and splenic pathology (2 cases of splenic infarction, one associated with necrosing enterocolitis). Anticoagulant therapy was implicated in 3 cases. Diagnosis is difficult in the immediate postoperative period, some complications only being recognised at autopsy. The clinical signs may be misleading and the interpretation of complementary investigations difficult. Therefore, the possibility of abdominal complications must be kept in mind, especially in patients with one or more predisposing factors. Excluding accidents due to anticoagulant therapy the following factors were associated with an increased risk of abdominal complications: previous history of gastro intestinal pathology (ulcer, gall stone, alcoholism) the nature of the underlying cardiac disease (coronary artery and aortic valve disease), cardiopulmonary bypass, and, above all, per- and postoperative incidents: hypovolaemia, low output syndrome (half the patients in this series) respiratory and infectious complications. The inappropriate use of vasoconstricting agents may also play a role. The majority of abdominal complications seemed to be related to ischaemia and anoxia in the splanchnic territory, which explains the important role of the preceding factors. The prognosis of abdominal complications after cardiac surgery was poor, mortality reaching 50 to 100% in some causes: in this series, 12 of the patients died. This justifies certain prophylactic measures: strict selection of patients, diagnosis and treatment of associated abdominal pathology before operation, prevention of low output states, respiratory and infectious complications ... and careful examination of the abdomen after operation to ensure the early diagnosis and treatment of complications, should they develop.

Acute Disease↗
PubMed1979

[Results of open heart mitral commissurotomy in 85 patients].

Open heart mitral commissurotomy was performed in 85 patients between January 1973 and January 1976. This series comprised 38 patients with pure mitral stenosis and 47 patients with associated mitral and aortic or tricuspid lesions. Mitral commissurotomy, always complete, was associated with correction of mitral incompetence, either preexisting or peroperative, in 19 cases; in 44 cases with correction of an aortic lesion and in 10 cases with correction of a tricuspid lesion. The surgical mortality was 2.3 p. 100 (2 deaths); one post-operative myocardial infarction and one spontaneously regressive post-operative jaudice was observed. No cases of post-operative systemic embolism was observed. A short apical systolic murmur was detected in 12 cases. The results of this series together with those already published suggest that the indications of this operation should be widened and that it should be employed whenever the best immediate anatomical result and long-term prognosis are desired.

Adolescent↗
PubMed1979

[Retrospective study of recent variations in patient recruitment for aorto-coronary bypass surgery and the prognostic significance of new therapeutic propositions].

Seventy four records of aorto-coronary bypass surgery have been examined. Three groups were made up, succeeding each other in time, characterised by changes in factors of gravity, therapeutic solutions and early clinical results. Five patients underwent peroperative haemodynamic assessment in order to attemps to define the role of nitroglycerine used during this period. The results obtained were such that it is reasonable to suspect the existence of potentialisation of therapeutic benefits under the influence of nitroglycerine for injection, in patients previously treated with beta-inhibitors.

Coronary Artery Bypass↗
PubMed1978

[Total replacement of the ascending aorta with reimplantation of the coronary arteries. Technic and indications].

Our experience with nine total replacement of the ascending aorta with reimplantation of the coronary arteries has led us to advocate this as the technique of choice for curative treatment of ascending aortic aneurysms when these involve the sinus of Valsalva, and of acute dissecting aneurysms of the aorta when the tear in the intima is situated in the ascending portion. An endo-aneurysmal approach simplifies the operation and considerably reduces the blood loss during surgery.

Adult↗
PubMed1978

[Aneurysm of Valsalva's sinus, apropos of 7 surgical cases[].

The authors describe 7 cases of rupture of the Valsalva sinus. Until rupture the aneurysm is silent. Aortic insufficiency and left to right shunt are major components of this syndrome. Surgical treatment under extra-corporal circulation needs aortotomy and an approach of the ruptured extremity to close the defect and maintaining the integrity of the valvular structures.

Adolescent↗
PubMed1978

[Pseudoaneuysms of the heart after myocardial infarct. Apropos of 5 operated cases].

The authors base themselves on 5 personal cases and a review of the literature to summarise the clinical and paraclinical features of false aneurysms of the heart. The clinical features differ from those of true aneurysms only slightly. It is only arteriography, which shows up the collar and the slow evacuation of the cavity, which makes the real distinction and argues in favour of operation. The results of surgical treatment have been satisfactory, especially considering the natural outcome, which is always death from rupture.

Aged↗