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Biomedical subjects

A Cabrol

Publications and source records attributed to A Cabrol.

At least 109 records · Page 6Linked to original sources
PubMed1978

Surgical correction of chronic postembolic obstructions of the pulmonary arteries.

Following episodes of pulmonary embolism, the presence of thrombi in the pulmonary arteries leads to severe respiratory insufficiency and chronic right heart failure. We have operated upon 16 such patients, nine men and seven women from 23 to 68 years of age. All had severe dyspnea, 14 had chronic cor pulmonale, six had mental disturbances with syncope, and four had severe cardiac failure. The presence of clots was demonstrated by pulmonary angiography, and the permeability of the distal arterial bed was ascertained by selective injection of the bronchial arteries. In all cases but two a lateral thoracotomy was used so that the obstructed arterial branches could be approached distally. The inferior vena cava was always ligated to prevent recurrences. There were six operative deaths, three from cardiac failure, one from acute pulmonary edema, one from hemothorax, and one following a pyothorax. Ten patients are surviving after 6 months to 10 years. One is still limited because of significant pleuropulmonary sequelae. Six are enjoying good results with marked improvement in their functional limitations, a significant drop in the pulmonary artery pressure, and radiological permeability of previously obstructed arteries. Three are excellent condition--completely asymptomatic.

Adult↗
PubMed1977

[Current aspects of human heart transplantation. II. Postoperative surveillance and results].

The cardiac transplantation program of the Pitié-Salpêtrière Hospital has, since October 1973, involved 17 transplants with 15 recipients. Seven patients are alive. Real progress has been achieved in all areas: --selection of the recipient, now more strict is dependent upon precise criteria; --choice of the donor should take into account the best possible tissue and haemodynamic compatibility; --immuno-depressive therapy involves the combination of corticosteroids, azathioprine, antilymphocytic globulins and heparin. It is varied as necessary in relation to episodes of rejection; --the diagnosis of rejection is based upon clinical, radiological and electrical criteria, but also upon new and precise haemodynamic and biological criteria; --long term control is facilitated by regular telephone transmission of the electrocardiogram. The prognosis remains reserved but with socio-professional rehabilitation to help in overcoming the initial slight degree of "hospitalism", the sensation of a new life is such that cardiac transplantation represents an acceptable solution in the treatment of certain cardiac diseases.

Bacterial Infections↗
PubMed1977

[Surgical treatment of obstructive cardiomyopathies by mitral valve replacement].

The authors present a series of 10 cases of OCM which were treated by replacement of the mitral valve. Mitral incompetence was present in all patients, and was major or massive in 7 of them. Direct surgery to the mitral valve area has demonstrated pathological lesions in the mitral valve mechanism in 7 patients. A formal indication for mitral valve replacement in the surgical treatment of cases of OCM therefore exists when there is major mitral incompetence, intraventricular conduction defect, cardiac failure, or failure of previous myotomy.

Adult↗
PubMed1977

[Aorto-coronary bypass. 1. Immediate results evaluated in a sample of 357 operated patients].

Over a period of 36 months, 357 patients have had one or several aorto-coronary bypass graft operations, either alone (305 patients) or in combination with another surgical procedure. 230 (66.4%) of these patients had acute coronary insufficiency: unstable angina or "menance syndrome" in 177, Printzmetal's angina in 34, threatened extension of an infarction in 14, and post-cannulation stenosis in 5. 75 patients had chronic coronary insufficiency, and in the 52 others the coronary lesions were associated with valvular or myocardial lesions. A total of 489 grafts were carried out, 261 of which (53.4%) were on the anterior descending artery. Of the 305 patients with grafting and no other surgical procedure, 190 (62,3%) had one single graft, 104 (34.1%) had 2 grafts, and 11 (3.6%) had 3 grafts. For theses 305 patients, the mortality during the first month (6.9%, or 4.5% for the last six months of the series) was influenced by age (a mean of 52.1 in the survivors and 57.1 in the deceased, p less than 0.001), a preoperative infarction less than 8 days old (p less than 0.001), significant changes in left ventricular function (a mean ejection fraction of 44.9% +/- 0.20 in the deceased, and 61.5% +/- 0.19 in the survivors, p less than 0.001), a mean end-diastolic volume of 252 ml +/- 98 in the former and of 136 ml +/- 51 in the latter, p less than 0.001). The advent of a postoperative infarct thus increases the mortality. An infarct complicated the progress of 11.1% of patients. The probability of such a complication occuring depends upon the state of the vascular bed distal to the bypassed artery and on the duration of the extracorporeal circulation.

Adult↗
PubMed1977

[Aortocoronary bypass. 2. Long-term results evaluated in 318 survivors].

Of the 318 patients surviving the first postoperative month 14 died secondarily, 5 were lost to follow-up, and 299 were therefore reviewed with a mean follow-up of 16.6 months (extremes of 2 and 42 months). The percentage of late infarcts was 5.9%. Complete disappearance of the angina occurred in 80.3% of patients. Persistant angina was commoner in females (p less than 0.05) and in patients with a lesion affecting all three trunks (p less than 0.05). On the other hand age, the clinical indications for bypass, the presence of an infarct preoperatively, and the development of an infarct immediately postoperatively did not affect the functional result. The cardio-thoracic ratio decreased significantly, from0.51 +/- 0.07 to 0.47 +/- 0.05 (p less than 0.001). 45 coronary arteriograms in a total of 63 grafts were analysed. 73% were patent after a follow-up period of 10.5 months. The patency rate was 88.6% when coronary arteriography was carried out systematically, and 63% (p less than 0.002) when it was indicated by persistant or recurrent angina. The actuarial survival curve in patients with 2 or 3 trunk involvement demonstrates clearly the superiority of surgical over medical treatment.

Adult↗
PubMed1977

[Value of intra-aortic counterpressure as circulatory support in cardiac surgery. Apropos of 60 cases].

Assisted circulation (AC) by intra-aortic counterpressure (IACP) has been used in 60 patients either pre- and postoperatively after a complication of acute myocardial infarction (25 patients: group A), or for a low-output syndrome after extracorporeal circulation (ECC) occurring in the operating theatre (20 patients: group B), or secondarily (15 patients: group C). In group A cases, the IACP stabilised a the myocardial ischaemia, and permitted coronary arteriography and subsequent surgery with little risk. Out of the 8 patients in this group who had cardiogenic shock only 4 survived, whereas out of the 17 patients without shock, only one died. Of the group B and C patients, 58% responded favourably to IACP, and 75% of group B cases survived as against 33% of group C. The postoperative low-output syndrome is related not to the ECC itself but to ischaemia of the subendocardial vasculature during surgery. The incidence of this syndrome can be reduced by the use of improved techniques of myocardial protection. AC by means of IACP becomes an effective therapeutic weapon if it is used early, or even systematically when the ejection fraction is below 0.03 and/or the EVR is less than 0.80.

Adult↗
PubMed1977

[Value of hemodynamic surveillance by radiocardiography in human heart transplants].

Eighteen cases of cardiac transplantation have been carried out for 16 recipients since October 1973, there being 8 survivors at present. The importance of screening in such a treatment is vital. It is a simple method, easy to control, can be carried out at the bedside, is reproducible, reliable, and completely harmless, and by allowing the haemodynamic function of the graft to be seen at all times, helps in the marching of the donor and the recipient, in following the function of the graft in the immediate post-operative period, and in discovering rejection crises, and evaluating the long-term fate of the transplant.

Adult↗
PubMed1976

[Tricuspid prosthetic replacements. Indications and results].

Out of 350 cases of tricuspid regurgitation operated between 1968 and 1975, a serie of 53 prosthetic replacements (3 of them isolated) was analysed, with specification of operative indications, pre-operative condition, operative findings, procedure used and results. Operative death rate was high (28 per cent) and remote results (6 months to 7 years) were not all satisfactory. This is because functional "tricuspid regurgitation", secondary to advanced mitral lesions, expresses in fact considerable myocardial weakening with severe polyvisceral implications. This picture, where tricuspid patency is in fact contingent, is not always improved by mitral correction and reestablishment of a satisfactory tricuspid function, whatever the procedure used. Thus in very advanced mitral lesions, tricuspid repair should be done only if regurgitation is real and severe. Tricuspid prosthetic replacement should be reserved to valvular destruction; semi-circular annulo-plasty, which is efficient and not very traumatising, is applicable to all the other cases. The best treatment of this syndrome is preventive: as aortic lestions, mitral lesions should be operated early to permit a low risk operation and complete functional recuperation.

Adolescent↗
PubMed1975

[Choice of recipent in human cardiac transplantation].

The favourable clinical results of cardiac transplantation merit wider application of this therapeutic measure in the management of non-obstructive primary cardiomyopathies and diffuse myocardial fibrosis secondary to coronary artery disease and in its terminal phase, in the absence of any absolute contraindication (pulmonary resistance too high, diabetes, gastrointestinal disorder, infection, patient too old.). Close cooperation between departments of cardiology and surgical transplantation centres, with systematic study of the patients pre-operatively and the setting up of a waiting list of recipients, will make possible in the future the improvement of the already encouraging results of cardiac transplantation.

Adult↗