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Biomedical subjects

A Carpentier

Publications and source records attributed to A Carpentier.

At least 307 records · Page 17Linked to original sources
PubMed1984

[Triple valve replacement. Evaluation of 90 surgically treated patients].

Ninety patients, aged 17 to 59 years (average 39.8 yrs) underwent triple valve replacement from January 1967 to December 1979. The aetiology was rheumatic carditis in 84% of cases. There had been previous surgery in 29 cases (19 mitral commissurotomies). All patients were severely symptomatic: 68 (76%) had atrial fibrillation and the cardiothoracic ratio was 0.70 +/- 0.085. In 24 cases, triple valve stenosis (aortic, mitral and tricuspid) was observed; 13 patients had triple regurgitation and 53 patients had mixed lesions (stenosis and regurgitation). Triple mechanical valve prostheses were implanted in 35 cases (Björk or Starr), triple bioprostheses were implanted in 12 cases, and 43 patients received a combination of mechanical and bioprostheses (tricuspid bioprostheses in all 43 cases). The patients were divided into two groups according to the type of valve replacement; Group I: 57 patients, subdivided into Group IA (35 cases, 39%) with triple mechanical prosthesis, and Group IB (22 cases, 25%) with mechanical aortic and mitral valve prostheses and tricuspid bioprostheses; Group II, 33 patients, subdivided into Group IIA (12 patients, 13%) with triple bioprostheses, and Group IIB (21 patients, 23%) with mitral and tricuspid bioprostheses and a mechanical aortic valve prosthesis. Techniques of myocardial protection have have improved since the beginning of this series and at present comprise cardioplegia associated with general hypothermia to 25 degrees C and pericardial irrigation with ice cold saline. The overall operative mortality was 37% (34/90) but in 1979 alone it was only 10%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Rare complication of extracorporeal circulation: diffuse coronary fibrosis; giant cell myocarditis].

A 38 year old woman developed severe coronary stenosis several months after double valve replacement. Aorto-coronary bypass surgery was performed but the patient died of a peroperative myocardial infarction. Histological studies showed not only fibrous thickening of the intima of the whole coronary arterial tree, but also variable medial changes with inflammatory infiltration. In addition, inflammatory granulomata with giant cells were found in the myocardium. These coronary lesions and their association with a giant cell myocarditis cannot be satisfactorily explained by known pathological conditions. The usual mechanisms of coronary disease were not operative in this case. There remains the hypothesis of a primary change of the coronary wall related to either cannulation, anoxic arrest or perfusion fluid, or a combination of these factors. The coronary lesions could have developed by an immunological process which would also explain the giant cell myocarditis.

Adult↗
PubMed1984

[Acute suppurative mediastinitis in heart surgery performed under extracorporeal circulation].

The incidence of acute suppurative mediastinitis after open heart cardiac surgery in a 5 year retrospective study was found to be 1.56%. The commonest causal agent was the DNAse + coagulase + staphylococcus (68.8%). All cases were treated with bactericidal antibiotics and local measures (dosed chest irrigation-drainage in 1 or 2 stages). Adult men, early and/or late reoperation, immediate postoperative complications (cardiovascular collapse, haemorrhage) were positive risk factors. On the other hand, the type of underlying cardiac disease, the duration of surgery and bypass time, emergency surgery, and protocols of prophylactic antibiotic therapy did not seem to influence this risk. No sources of exogenous contamination, no notions of epidemics or periodicity were discovered in this study. The clinical course may be complicated, especially by renal failure. Thirty-two of the 109 patients studied died. However, the prognosis has improved in the last 5 years in relation to technical advances in intensive care and, above all, to adoption of 1 stage dosed chest irrigation-drainage: the mortality rate has fallen from 37.2% in the first period to 20% more recently. When a cure is obtained, it is complete and there are no sequellae. Nevertheless, irrespective of the adoption of draconian measures of asepsis and protocols of prophylactic antibiotic therapy, the risk of acute postoperative mediastinitis persists. This suggests that the efficacy of the patient's local (and general) anti-infective immunity defenses may vary in the presence of constant mediastinal bacterial contamination despite aleatory preventive measures, due to the remenance of the skin flora.

Acute Disease↗
PubMed1984

[Comparative evaluation of various methods of treatment of mitral valve diseases. Apropos of 4 series of 100 patients operated on using the Starr prosthesis, Bjork prosthesis, bioprosthesis and valve reconstruction].

The results of 4 groups of 100 patients undergoing mitral valvuloplasty (group I), isolated mitral valve replacement by a bioprosthesis (group II), a Starr-Edwards prosthesis (group III) and a Björk prosthesis (group IV) between 1974 and 1977 were compared. The selection of patients for each group was identical and made according to strict criteria. The average age was between 47.1 +/- 12.5 years and 51.8 +/- 10.5 years according to the particular group; the average functional classification was 2.4 +/- 0.4 to 2.5 +/- 0.6; the average cardiothoracic ratio was 0.58 +/- 0.07. Most patients were in atrial fibrillation. Ninety-seven per cent of patients were followed-up by questionnaires. The results were expressed with respect to simple clinical events used in all previously reported series. The long-term mortality was identical in the 3 groups undergoing valve replacement (40 p. 100 at 7 years) but was much less in the group undergoing valvuloplasty (18 p. 100 at 7 years). The mortality rate due to valvular problems was significantly less in the valvuloplasty group (2 p. 100 at 7 years) than in the groups with mechanical prostheses (20 p. 100 at 7 years). Intermediate results were observed in the bioprosthetic group (9 p. 100 at 7 years). Thrombo-embolism was significantly less common in the groups undergoing valvuloplasty and bioprosthetic valve replacement (2 p. 100 and 6 p. 100 at 7 years) than in the group with Starr-Edwards and Björk prostheses (30 p. 100 and 32 p. 100 at 7 years).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Techniques for prevention of calcification of valvular bioprostheses.

Calcification of valvular bioprostheses in children is a major problem that has stimulated extensive research in our laboratory. In previous reports, we have shown that the rate of calcification could be reduced by decreasing the phosphate content in the tissue or by blocking calcification binding sites with Mg++ and/or with a surfactant (Tween 80). Since then, we have systematically investigated incorporation of numerous other surfactants and of polyacrylamide within the tissue, and these investigations form the basis of this report. The methods of investigation included subcutaneous implantation of treated tissues in growing rabbits, stability tests, and intracardiac implantation in sheep. Results showed that surfactants differed in their efficacy in mitigating calcification, with N-lauroylsarcosine and triton X-100 being the most efficient. Polyacrylamide incorporation was also efficient in calcification mitigation, but this effect was lost after flexibility testing in vitro or implantation in vivo, a drawback that suggests further research is necessary into stabilization of this polymer. This report not only brings attention to new alternatives in calcification mitigation treatment of bioprosthetic tissues but also underlines important points of methodology.

Acrylic Resins↗
PubMed1983

[Importance of external carotid compensation to cerebral vascularization and surgical indications. Apropos of 5 cases].

External carotid artery, to a peripheral destination, becomes most important when it is a supplying artery. The work about 5 cases, followed up 2 to 21 months, confirms the importance of this artery, in its substitute function in case of internal carotid artery thrombosis. The problem is its functional future inside the atheriosclerosis evolutivity. All the patients had a revascularization of the stenotic external carotid artery. Therefore, we proposed revascularization indications of the stenotic supplied external carotid artery: --When a neurologic ischemic attack exists, from stenosis or ulcerative plaques, revascularization surgery of this artery is indicated like for internal carotid artery. --Asymptomatic significant stenosis or ulcerative plaque of supplied external carotid artery are indications for prophylactic surgery, knowing the evolutive risk and the insufficiency of the concerned hemispheric vascularization. --But, frequent controls are sufficient when the stenosis is not significant.

Aged↗