Search PubMed⌕ Search

Biomedical subjects

A Cribier

Publications and source records attributed to A Cribier.

180 records · Page 10Linked to original sources
PubMed1978

Large ventricular aneurysms occurring after myocardial infarction.

We have studied 33 patients with a large ventricular aneurysm complicating an anterior myocardial infarction. The features of myocardial infarction progressing towards an aneurysm were no previous history of coronary disease, severe infarction as shown by the severity of pain and the presence of pericardial rub and heart failure, and large increase in serum levels of cardiac enzymes. A large aneurysm usually follows a large infarction resulting from the total or partial occlusion of the left anterior descending artery, which is involved alone in about half the patients and is associated with lesions of the circumflex and right coronary arteries in the other half. In most cases, standard radiography showed an abnormal cardiac configuration, but in 7 patients (21%) there was no radiological evidence of aneurysm. ST segment elevation (mean 2.7 mm) was reported in all subjects but one. Heart failure was present in most patients and was an indication for surgical treatment in one-third of the patients. A large aneurysm was not a contraindication to operation even when at angiography the aneurysm seemed to occupy almost all the left ventricle. Twenty-one patients were operated upon for resection of the aneurysm with a mortality rate of 14 per cent.

Adult↗
PubMed1978

[Analysis of factors which can influence results of aortocoronary bypass surgery].

The various factors influencing the result of treatment have been studied in a series of 100 consecutive patients undergoing aorto-coronary bypass graft surgery. There were three operative deaths and twelve cases of post-operative infarction. Longterm, 85% of them were three year survivors, clinical improvement being maintained in 84% of them. Post-operative tests showed that 70% of patients have no pain on the maximal exercise test, but 48% had ischaemic depression of the ST segment. From among the 47 patients who had follow-up arteriography, 78% of the grafts were patent, but no improvement of the contractility of the left ventricle could be demonstrated (pre-operative ejection fraction 47 +/- 3%, post-operative 49+/- 3%). The pre-operative clinical features rarely give any indication of the prognosis. The same is true in the present series of the condition of the left ventricle, bearing in mind the fact that patients with grossly impaired ventricular contractility (ejection fraction below 30%) were routinely excluded from surgery. It is essentially the state of the coronary arterial network, as assessed by a score made up from the degree and number of stenoses, the quality of the distal bed, and the anatomical distribution, which will pick out those patients more at risk both from the surgery and from post-operative death and in whom the longterm result is likely to be disappointing with no improvement in function, with obstruction of the grafts, or with secondary death.

Adult↗
PubMed1977

A study of left ventricular function in coronary patients before and after physical training.

Fifteen subjects recovering from a myocardial infarction or suffering from angina were given a maximum effort test on a bicycle ergometer and hemodynamic and angiographic investigations before and after a period of physical training. The training program consisted of three sessions of 60 to 75 min each week for two months. Maximum effort tests showed that physical capacity had increased by 17% (P less than 0.02) and that for the same amount of effort the heart rate had decreased by 13% and the blood pressure by 7% (P less than 0.01). Hemodynamic and angiographic investigations showed no significant changes after training in the left ventricular end-diastolic pressure, ventricular volume, ejection fraction, VCF, percentage of shortening and segmental contractility, in the total group, in those patients whose contractility was considerably impaired, or in those who had large dyskinetic areas or widespread akinesia. It is concluded that training had no direct influence on the myocardium, either beneficial or detrimental.

Adult↗
PubMed1975

[Physical training in patients with coronary insufficiency. 2 year report of 2 center's activities].

One hundred and twenty patients went through a complete cycle of physical training. Eighty seven of them were recovering from recent myocardial infarction, eighteen had angina pectoris and fifteen were recovering from operation of aorta-to-coronary by-pass. Physical training was considered to be contra-indicated in the presence of evolutive angina pectoris, obvious signs of cardiac failure and a voluminous ventricular wall aneurysm. Severity of the anginal pains and intensity of the coronary artery lesions were not contra-indications. In all the cases, there was a decrease of the number and intensity of the pains while the extent of physical performance increased. The psychological effect was remarkable. Comparison between the maximal exercise tests before and after re-education showed an improvement of the cardio-circulatory function, as evidenced by a decreased cardiac rate, of the blood pressure and of the degree of the downward displacement of the ST segment for efforts of equal intensity.

Adult↗
PubMedDate not supplied

Comparison of two three-dimensional gated SPECT methods with thallium in patients with large myocardial infarction.

BACKGROUND: Two different commercially available gated single photon emission computed tomography (GSPECT) methods were compared in a population of patients with a major myocardial infarction. METHODS: Rest thallium GSPECT was performed with a 90-degree dual-detector camera, 4 hours after injection of thallium-201 (Tl-201; 185 MBq) in 43 patients (mean age, 62+/-12 years) with a large myocardial infarction (mean defect size, 33%+/-16%). End-diastolic volume (EDV), end-systolic volume (ESV), and left ventricular ejection fraction (LVEF) were calculated by using QGS (Cedars Sinai) and MultiDim (Sopha Medical Vision International, Buc, France). Images were reconstructed by using a 2.5 zoom and a Butterworth filter (order, 5; cut-off frequency, 0.20). LVEF was calculated in all patients by using equilibrium radionuclide angiocardiography (ERNA). EDV, ESV, and LVEF were also measured by using left ventriculography (LVG). RESULTS: Compared with LVG, QGS underestimated LVEF by means of an underestimation of mean EDV. MultiDim overestimated EDV and ESV. GSPECT EDV and ESV overestimation was demonstrated by means of Bland-Altman analysis to increase with left ventricular volume size (P<.05). The difference between LVG and GSPECT volumes was demonstrated by means of regression analysis to be correlated with infarction size. This effect was particularly important with MultiDim (P<.0001). CONCLUSION: In Tl-201 GSPECT, LVEF and volume measurements will vary according to the type of software used.

Female↗
PubMedDate not supplied

Diagnostic value of Tl-201 lung uptake is dependent on measurement method.

BACKGROUND: Increased lung uptake during exercise thallium 201 single photon emission computed tomography is related to left ventricular dysfunction and extent of coronary artery disease (CAD). We studied the influence of the lung region of interest (ROI), used to quantify Tl-201 lung uptake, on the diagnostic value of the lung-to-heart uptake ratio (LHR) in detecting CAD with Tl-201 myocardial single photon emission computed tomography. METHODS AND RESULTS: We retrospectively studied 152 consecutive patients referred to our center for stress Tl-201 scanning. Of these, 116 had proven multivessel CAD and 36 had either normal findings on coronary angiogram or a low likelihood (<5%) of CAD. Poststress quantitative analysis was performed from a 4 x 4-pixel ROI over the hottest myocardial region, an 8 x 8-pixel left lung ROI, an 8 x 8-pixel right lung ROI, and a manual ROI encompassing the whole right lung. The LHR was calculated for each lung ROI. Right LHR (R-LHR) provided the best interobserver and intraobserver reproducibility. R-LHR and total R-LHR values were significantly higher in patients with CAD. Only history of myocardial infarction significantly influenced the R-LHR measurement. CONCLUSIONS: The methodology of LHR measurement significantly influences the clinical contribution of Tl-201 lung uptake evaluation. Optimal reproducibility and diagnostic accuracy are provided by a right lung ROI.

Aged↗
PubMedDate not supplied

Percutaneous transluminal therapy of occluded saphenous vein grafts: can the challenge be met with ultrasound thrombolysis?

BACKGROUND: Percutaneous transluminal treatment of a thrombotic vein graft yields poor results. We have previously reported our experience with transluminal percutaneous coronary ultrasound thrombolysis (CUT) in the setting of acute myocardial infarction (AMI). This report describes the first experience with ultrasound thrombolysis in thrombus-rich lesions in saphenous vein grafts (SVGs), most of which were occluded. METHODS AND RESULTS: The patients (n=20) were mostly male (85%), aged 64+/-4 years old. The presenting symptom was AMI in 2 patients (10%) and unstable angina in the rest. Fifteen patients (75%) had totally occluded SVGs. The median age of clots was 6 days (range, 0 to 100 days). The ultrasound thrombolysis device has a 1.6-mm-long tip and fits into a 7F guiding catheter over a 0.014-in guidewire in a "rapid-exchange" system. CUT (41 kHz, 18 W, </=6 minutes) led to device success in 14 (70%) of the patients and residual stenosis of 65+/-28%. Procedural success was obtained in 13 (65%) of the patients, with a final residual stenosis of 5+/-8%. There was a low rate of device-related adverse events: 1 patient (5%) had a non-Q-wave myocardial infarction, and distal embolization was noted in 1 patient (5%). Adjunct PTCA or stenting was used in all patients. There were no serious adverse events during hospitalization. CONCLUSIONS: Ultrasound thrombolysis in thrombus-rich lesions in SVGs offers a very promising therapeutic option.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Relation between serum cardiac troponin I values and severity of clinical, electrocardiographic and quantitative angiographic features in unstable angina.

This study sought to find out a correlation, if any, between serum cardiac troponin I values and extent and severity of coronary artery disease in patients with unstable angina. Eighty patients with unstable angina and normal serum creatine kinase values were studied and a comparative evaluation of serum cardiac troponin I values with clinical findings, electrocardiography, quantitative coronary angiography and follow-up events was performed. Among 80 patients, 34 (43%) had cardiac troponin I values of 0.6 microgram/L or higher (group I) and 46 (57%), below 0.6 microgram/L (group II). The mean cardiac troponin I in group I was 2.6 +/- 1.7 micrograms/L and 0.2 +/- 0.1 microgram/L in group II. The patients in group I had more type C lesions, frequent triple vessel and left main coronary artery involvement, and higher mean percentage diameter stenosis in the coronary arteries than those in group II. Early follow-up showed that more patients in group I required procedures earlier (including PTCA and CABG) than those from group II. Mid-term follow-up (9.5 +/- 4 months) data also showed greater occurrence of cardiac events (i.e. myocardial infarction and the increased need of PTCA) in group I. Patients with elevated cardiac troponin I more often experienced Braunwald's class III (A and B) unstable angina associated with presence of marked ST-T changes on the electrocardiography than those from group II. Our study suggests elevated values of serum cardiac troponin I to be evenly associated with the severity and extent of coronary lesions, clinical severity of unstable angina and marked electrocardiographic changes. Follow-up results confirm the potential value of this marker in predicting the course of coronary artery disease.

Angina, Unstable↗
PubMedDate not supplied

Non-surgical mitral commissurotomy using metallic commissurotome.

Percutaneous transatrial mitral commissurotomy using a new miniaturised metallic commissurotome mounted on a 12 F catheter was done in 24 patients with severe mitral stenosis. There were 17 (70.8%) females and seven (29.2%) males with age ranging from 12-42 years (mean 26.0 +/- 6.7 years). Atrial fibrillation was present in three (12.5%) patients. Three (12.5%) patients had restenosis following closed mitral commissurotomy. The mitral valve score on echocardiography ranged from 6 to 10 (mean 7 +/- 1.3). The procedure was performed with one device which was reused after sterilisation with glutaraldehyde. The device was opened maximally upto 39.0 +/- 1.7 mm (range 35-40 mm). The procedure was successful in 23 (95.8%) patients. The mean left atrial pressure decreased from 26.8 +/- 8.0 to 9.3 +/- 7.1 mm Hg (p < 0.001). There was a fall of mean pulmonary artery pressure from 47.2 +/- 18.6 (range 20-29 mm Hg) to 23.6 +/- 9.6 mm Hg (range 12-51 mm Hg) (p < 0.001). The mitral valve area as assessed by Doppler echocardiography (pressure half time) increased from 0.9 +/- 0.1 (range 0.6-1.2 cm2) to 2.1 +/- 0.4 cm2 (range 1.6-2.6 cm2) (p < 0.001), with split in both commissures in 22 (95.6%) cases. One patient developed severe mitral regurgitation with tear in the anterior mitral leaflet needing immediate mitral valve replacement. One patient developed transient aphasia which recovered completely within four hours. Percutaneous transatrial mitral commissurotomy using metallic commissurotome offers reliable and effective alternative to balloon mitral commissurotomy and may be more cost-effective because of its reusability.

Adolescent↗