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Biomedical subjects

A Carpentier

Publications and source records attributed to A Carpentier.

At least 253 records · Page 14Linked to original sources
PubMed1989

Aberrant right subclavian artery aneurysm: report of a case and review of the literature.

Aneurysms of an aberrant subclavian artery are rare. They are usually secondary to atherosclerosis. Dysphagia is the most common presenting symptom. The diagnosis of these lesions is most easily established by CT scan. Biplane arteriography is necessary in order to clearly analyze the aortic arch and its branches. Surgical resection is usually indicated. Numerous procedures have been proposed to treat these lesions and controversy exists concerning the best surgical technique. We treated a patient who suffered from an aneurysm of an aberrant subclavian artery. The surgical technique is detailed as well as a review of all the cases of the literature.

Aged↗
PubMed1989

[Right ventricular assistance by intrapulmonary counterpulsation].

Right ventricular failure is relatively frequent and constitutes one of the causes of post-operative heart failure. Few drugs are available to treat right ventricular failure. We present a simple and effective means of mechanical support available in all cardiovascular units: counterpulsation in the pulmonary artery. Our experience and a review of the literature have enabled us to determine the indications for this method to support a failing heart.

Assisted Circulation↗
PubMed1989

[Limitations of the feasibility of right catheterization in the evaluation for cardiac transplantation].

The number of patients who survive heart transplantation has considerably increased in recent years, but mortality during the first 3 months still reaches 10 to 20 p. 100 depending on the authors. Among the various causes of death, acute graft deficiency due to pulmonary arterial hypertension plays an important role. In most cases, pulmonary vascular resistance has been misevaluated or its progress has not been foreseen. Between January 1985 and June 1988, 96 heart transplantations were performed at the Broussais Hospital, Paris. We thought that pulmonary vascular resistance could be better evaluated by using dobutamine to mimick transplantation and to assess pulmonary pressure and resistance variations associated with the increase in cardiac output. High doses of dobutamine ranging from 10 to 30 mcg/kg/min were administered to bring the basal cardiac output level up to the theoretical output level or to increase it by 50 p. 100. The 96 patients who had heart transplantation during the aforementioned period were divided into two groups: group I comprised 35 patients who were transplanted before dobutamine was used, while group II comprised 61 patients for whom the dobutamine test was always considered. The mortality rate was 11.75 p. 100 (4/35) in group I and nil in group II as regards death from pulmonary arterial hypertension (p = 0.04). We demonstrate that a single resistance value is not reliable, even when it is normal, when the cardiac output is low. Furthermore, there is no threshold value for contraindication, and indexing resistance alters the scale of values but does not enable normality to be defined. By using the dobutamine test we were able to reduce considerably the mortality due to pulmonary arterial hypertension and also to exclude orthotopic transplantation in some patients.

Arterioles↗
PubMed1989

Induction of interleukin-1 production in patients undergoing cardiopulmonary bypass.

Systemic reactions resembling inflammation occur in patients undergoing cardiopulmonary bypass. We now report that interleukin-1, an endogenous pyrogen and a key mediator of inflammation, is transiently and consistently generated in vivo by circulating monocytes within hours after cardiopulmonary bypass. Interleukin-1 production was assessed by measuring interleukin-1 functional activity and interleukin-1 beta antigen concentration in cell lysates from monocytes of patients during and after bypass. There was no increase in intracellular interleukin-1 activity during bypass and within the first hours after bypass, possibly because of a suppressive effect of hypothermia on interleukin-1 production, as documented in vitro. Maximal generation of interleukin-1 was observed 24 hours after extracorporeal circulation, concomitantly with the occurrence of a peak in body temperature. The amount of interleukin-1 generated at that time was linearly correlated with the increase in patients' body temperature. The peak in interleukin-1 production followed by 20 hours the peak in complement activation as assessed by determining C3a desArg and C5a desArg concentrations in patients' plasma. These results indicate that interleukin-1 may be involved in the pathogenesis of adverse systemic reactions associated with cardiopulmonary bypass.

Adult↗
PubMed1989

[Postoperative iatrogenic coronaro-ventricular fistula].

Acquired coronary cardiac fistulas are rare. To date, thirty cases have been published in the literature, all secondary to thoracic trauma. The right cardiac chambers were more frequently involved. A recent continuous cardiac murmur is the most constant finding. Nontreated, these lesions tend to induce coronary insufficiency and congestive heart failure. 22 of the 30 reported cases were managed surgically. We hereby report a case of postoperative coronary cardiac fistula secondary to left ventricular venting, in which the fistula involved the left ventricular cavity.

Aortic Valve↗
PubMed1989

[Endomyocardial fibrosis].

Since the first case of endocardial resection I have performed in 1971, many similar cases have been operated on in the world, principally in Equatorian areas such as Africa, Northeastern Brazil and Southern India. In caucasian race, cases are less frequent but are similar to the other ones: in fact, endomyocardial fibrosis which was described by Davies in 1948 in Africa and Löffler's fibroplastie endocarditis, associated with hypereosinophylia (1936) are similar and respond to the same treatment. Our purpose in this paper is to present the long term results of the 34 cases operated at the Broussais Hospital in Paris since 1971. There were 21 males and 13 females, mean age 32 years (8 to 64), 22 were caucasians, 12 black africans. The sites of resection were 8 right ventricular, 4 left and 22 biventricular. Valve replacement was monovalvular in 11 cases and bivalvular in 23, mainly with bioprostheses. There were 7 early deaths and 6 late deaths, 2 after 30 months and 4 after 45, 60, 84, 85 months; only 2 of them were due to cardiac causes. We have not observed any case of recurrence. All surviving patients were in class I/II of N.Y.H.A. despite the fact that 4 have had valvular replacement due to alteration of the bioprosthesis.

Endomyocardial Fibrosis↗
PubMed1989

[Experience at an Internal Medicine service in the postoperative follow-up of 403 patients operated on at a cardiovascular surgery service].

Over the last 3 years, 403 patients operated in the Department of Cardiovascular Surgery of Broussais Hospital have been transferred to a Department of Internal Medicine for secondary postoperative care. A total of 245 non-cardiac complications (64%) and 134 cardiac or vascular complications (36%) were observed in 321 of these 403 patients (80%). Infections accounted for 26% of non-cardiac complications (63/245). They included 9 cases of mediastinitis, 2 cases of septicemia, 6 endocarditis, 6 wound infections, and 40 other infections (ENT, gastrointestinal, pulmonary, urogenital). The non-cardiac, non-infectious complications comprised mainly delayed healing (39 cases) and pleuropulmonary (29 cases), ENT (9 cases), gastrointestinal (31 cases), urogenital (12 cases), hematological (17 cases) and neuropsychiatric (9 cases) complications; and, finally, 37 inflammatory syndromes. The cardiac complications were pericarditis with or without tamponade (24 cases), arrhythmias or conduction disturbances (50 cases), haemodynamic (54 cases) and vascular (6 cases complications. These very varied complications sometimes occurred late and could be latent. They resulted in prolongation of the duration of hospitalization, so increasing the overall health costs.

Cardiovascular Diseases↗
PubMed1989

Echocardiography and color-flow mapping evaluation of a new reconstructive surgical technique for Ebstein's anomaly.

Eight patients with Ebstein's anomaly, corrected by the Carpentier technique between 1984 and 1987, were evaluated by echocardiography and by conventional Doppler and color-flow Doppler mapping. Because this technique aims at restoring not only tricuspid valve function but also right ventricular size and geometry, the following parameters were studied: 1) right ventricular size, by measuring the apex-annulus distance compared with that of a group of 30 normal volunteers; and 2) tricuspid valve motion and function. The apex-annulus distance ranged from 5.8 to 8 cm (mean, 6.4 cm) in the Ebstein group and 3.8 to 5.1 cm (mean, 4.3 cm) in the control group. There was no tricuspid stenosis. Right ventricular filling was normal as documented by color-flow mapping. Tricuspid regurgitation was trivial in three patients, mild in four, and severe in only one, in whom a significantly restricted motion of the leaflets was demonstrated.

Adolescent↗
PubMed1989

Use of surgical glue without replacement in the treatment of type A aortic dissection.

Between 1984 and 1988, 15 patients with type A aortic dissection were treated by direct suturing of the intimal tear and extensive sticking of the dissected aortic layers with surgical (gelatin-resorcin-formaldehyde) glue without prosthetic graft replacement. Aortic incompetence was present in 10 patients, a situation that required valvular replacement in five and valvular repair in five. In 10 patients, the dissection extended to the transverse aortic arch, requiring profound hypothermia and circulatory arrest. All patients survived the operation. Follow-up ranged from 6 to 44 months. All patients were monitored by Doppler echocardiographic studies. In addition, 10 underwent angiography; six, a computed tomographic scan; and five, magnetic resonance imaging. In all patients but two, the ascending aorta and transverse arch had a normal appearance. In three patients, a limited dissection persisted that did not require reoperation. Dissection of the descending aorta was present in 10 patients. One patient required a valvular replacement 18 months after surgery, and one underwent heart transplantation for an associated cardiomyopathy 14 months after surgery. These preliminary results indicate that surgical glue can be used safely and efficiently in type A aortic dissection as an alternative to aortic replacement.

Acute Disease↗
PubMed1988

[Infectious complications, delayed wound healing and inflammatory syndromes as late complications of cardiovascular surgery].

Four-hundred and three patients were admitted to an internal medicine unit for late complications of cardiac or vascular surgery; 321 of these patients (80 per cent) had a total of 379 complications or intercurrent disease, 147 (40 per cent) of which were infections (71 cases), delayed healing of the operative wound (39 cases) or inflammatory syndromes (37 cases). Such complications are notable for their immediate or secondary severity, the diagnostic problems sometimes raised by their latency, their repercussions on the length of hospitalization and cost of surgery, and the thoughts they inspire concerning the minimal stay in hospital required after this type of surgery.

Cardiovascular Diseases↗
PubMed1988

Clastogenic factor in ischemia-reperfusion injury during open-heart surgery: protective effect of allopurinol.

The hypothesis tested was that free radicals generated following ischemia and reperfusion in cardiac operations can produce clastogenic factor that results in chromosomal aberration. Fourteen randomized patients undergoing coronary artery bypass grafting were divided into two groups. In Group 1 (7 patients), myocardial protection was achieved using a cardioplegic solution without allopurinol. In Group 2 (7 patients), 100 mg of allopurinol (xanthine oxidase inhibitor) was added to the solution. In both groups, blood samples were taken from the coronary sinus before the aorta was clamped and 20 minutes after myocardial reperfusion was achieved. The blood samples were used to study the patients' chromosomes. The results were given as the percentage of chromosomal aberrations observed in 100 mitoses. There were no significant differences between the preischemic values in both groups and the postischemic values in Group 2. On the other hand, there was a significant difference between the postischemic values in Groups 1 and 2 (p less than 0.01). In conclusion, reperfusion following myocardial ischemia in cardiac operations can produce clastogenic aberrations. This clastogenic activity can be reduced by adding allopurinol to the cardioplegic solution.

Allopurinol↗
PubMed1988

Clinical comparison of mitral valve replacement using porcine, Starr, and Bjork valves.

The choice of a cardiac prosthesis for mitral valve replacement remains controversial, and thromboembolic complications are still a major cause of morbidity and mortality in patients with mechanical valves. Because of this, permanent anticoagulation with its risks and constraints on daily life is necessary. Bioprostheses, however, are associated with a lower rate of thromboembolic events. Therefore, the need for long-term anticoagulation is minimized. These advantages are counterbalanced by the limited durability of tissue valves. In an effort to give some perspective to this balance, we compared the long-term results of three commonly used mitral valve prostheses. Three hundred patients operated on in the same institution January 1974 to December 1978 form the basis of this evaluation.

Adolescent↗