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Biomedical subjects

A Cohen-Solal

Publications and source records attributed to A Cohen-Solal.

116 records · Page 7Linked to original sources
PubMed1986

[Hemodynamic evaluation of the Carpentier-Edwards porcine bioprosthesis and the Hancock pericardial bioprosthesis in aortic position].

Forty-four asymptomatic patients were catheterised at Boucicaut Hospital 9.5 months after aortic valve replacement to assess the haemodynamic performances of 21 Hancock pericardial (HP) and 23 porcine Carpentier-Edwards (CE) (standard model) bioprostheses, implanted in the aortic position. Left heart catheterisation was performed from a femoral approach; the simultaneous gradient was measured by planimetry and the functional valve surface area calculated at rest and after exercise. The resting calculated surface area of the HP was greater than that of the CE bioprostheses (equation: see text). The transvalvular pressure gradient was lower in the HP than in the CE group (7.8 +/- 4 vs 15.3 cf243 6 mmHg; p less than 0.005). After exercise (15 patients) the calculated surface area increased with the increased transvalvular blood flow in both groups but at each flow rate the calculated valve surface area was greater in the HP group. The haemodynamic performance of the CE bioprosthesis is inferior to that of the HP bioprosthesis, especially in the smaller models. However, the CE bioprosthesis would seem to be mechanically more reliable in the long term than the HP bioprosthesis has since been withdrawn from the market.

Adult↗
PubMed1986

[Thrombolysis in acute myocardial infarction. Re-evaluation].

The responsibility of a thrombus and the feasibility of saving an ischemic myocardium by early revascularization explain the development of thrombolysis. Streptokinase administered intravenously rather than intracoronary restores coronary patency in 45 p. cent of the cases, improves the total and segmental left ventricular function if an early and complete revascularization is performed before the 3rd hour, helped eventually by a sequential angioplasty. At the cost of an acceptable hemorrhagic risk, thrombolysis reduces in-hospital mortality in patients under 65 years, with anterior primary infarctions. New thrombolytic agents, standardized protocols, decreased length of hospitalization and optimization of infrastructures should improve these first results.

Fibrinolytic Agents↗
PubMed1985

[Coronary angiography and coronary bypass in patients over 70 (valvular disease excluded). Indications and results].

Between 1982 and 1984, 30 patients aged 70 or over underwent coronary angiography for isolated coronary artery disease, complicated in 8 cases by an infarct and uncontrolled by major medical treatment, including triple therapy on 28 mmHg (range 5-30 mmHg). Coronary angiography was performed under intravenous trinitrin in 9 cases, under intra-aortic balloon pumping in 1 case, without any serious complications. The majority of patients had triple vessel disease (18 cases) and stenosis of anterior interventricular (27 cases). The left main stem was diseased in 5 patients. Twenty-four patients, with an EF of over 0.40, underwent a coronary bypass with an average of 27 grafts/patients; 4 myocardial infarcts and 5 postoperative deaths were observed. Nineteen patients survived at medium term follow-up and had an excellent clinical result. Of the non operated patients, there was one early death and 3 patients remained severely incapacitated. In the absence of a major contra-indication to surgery, coronary angiography can be offered to patients over 70 years old in cases of severe coronary insufficiency, resistant to major medical treatment. Coronary bypass is justified by the spectacular functional improvement which it alone can bring about.

Age Factors↗
PubMedDate not supplied

[Heart insufficiency in the elderly].

Congestive heart failure in the elderly differs from the one in the younger. The ageing of the cardiovascular system makes the organism weaker. When a myocardial infarction or an other cardiovascular disease happens, the occurrence of congestive heart failure is precipitated. The symptoms which are often misleading and the polypathologies make the assumption of relationship difficult between a symptom like dyspnea and congestive heart failure. Further examinations are limited because of the reduced physical performances in the elderly (stress test) or because of an increased risk of side-effects (coronary angiogram). The echocardiography has a central role in the exploration of congestive heart failure. The medical treatment has the same principles than in the younger but with cautions especially regarding the renal insufficiency and the multiple treatments that an elderly patient has.

Age Factors↗
PubMedDate not supplied

[Sudden death in heart failure. Analysis and prevention].

Sudden death is a frequent complication of heart failure occurring in 35 to 45 per cent of the cases. This multifactorial event may be of haemodynamic origin (acute heart failure, electro-mechanical dissociation) or, more often, of rhythmic origin (torsade de pointe, sustained ventricular tachycardia, ventricular fibrillation, bradycardia, asystole). Numerous structural, haemodynamic, metabolic, ionic, neurohormonal and iatrogenic factors facilitate ventricular hyperexcitability. The main predictive factors of sudden death in heart failure are the presence of coronary heart disease and of reduced left ventricular ejection fraction; the prognostic value of ventricular rhythm disorders is controverted. Prevention of sudden death begins with correcting those factors which facilitate disturbances in rhythm and conduction. Beta-blockers are effective in the post-infarction period, but there is no evidence that other drugs are useful. Identifying patients at high risk and determining the therapeutic approach that reduces this risk are still incompletely resolved problems.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Acute myocardial infarction. Experiences of the referral network of the Beaujon and Bichat hospitals (with the collaboration of the Emergency Medical and Resuscitation Service of Beaujon)].

OBJECTIVES: Hospital management of acute myocardial infarction raises many problems in terms of medical care and organization, especially concerning the use or not of emergency corongraphy and angiography. We assessed the pertinence and consequences of a referral network operating between two cardiology units at the Beaujon and Bichat hospitals in Paris. All interventional procedures were performed at the Bichat unit. Prehospital emergency care units were integrated into the exprience and informed of indications for first line coronarography. METHODS: All cases of myocardial infarction admitted within 6 hours to the two units between 1993 to 1996 were analyzed and compared. RESULTS: Indications for referral from Beaujon to Bichat for emergency coronarography and possible angioplasy declined from 21% in 1993 to 10% in 1996. This decline was particularly noteworthy for first intention indications suggesting improved prehospital selection since the number of cases of acute myocardial infarction admitted to Beaujon remained unchanged. Certain patient characteristics differed between the two units: age (68.4 +/- 12.9 years at Beaujon versus 60.5 +/- 13.6 years at Bichat in 1996, p < 0.01) and reperfusion attempts (73% versus 90% in 1996 respectively, p < 0.01). The rate of fatal and non-fatal events were not different: 40 and 40% at Beaujon and 38 and 28% at Bichat in 1993 and 1996 respectively. CONCLUSION: These findings demonstrate that a management network can operate effectively between two hospital cardiology units and emergency care structures, allowing better patient selection for emergency coronography and possible angioplasty.

Age Factors↗