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Biomedical subjects

A Cribier

Publications and source records attributed to A Cribier.

At least 127 records · Page 7Linked to original sources
PubMed1989

[Treatment of acquired aortic stenosis in adults by percutaneous valvuloplasty with balloon catheterization. Experience of 245 cases].

In our department, percutaneous balloon valvuloplasty has become the routine treatment of aortic valve stenosis in adults. We report here the results obtained in 245 consecutive patients. The patients' age varied between 30 and 98 years (mean 74 +/- 11 years), 77 of them (31 p. 100) being 80 years' old or older. The initial peak to peak ventriculo-aortic gradient was 72 +/- 25 mmHg and the aortic valve area was 0.53 +/- 0.17 cm2. After dilatation the gradient was reduced to 29 +/- 14 mmHg (p less than 0.001) and the aortic valve area was increased to 0.95 +/- 0.33 cm2 (p less than 0.0001). The aortic valve area was increased by 100 p. 100 or more in 83 patients (34 p. 100) and by less than 25 p. 100 in only 17 patients (7 p. 100). The ventricular ejection fraction rose slightly but significantly from 48 +/- 18 p. 100 to 51 +/- 17 p. 100 (p less than 0.01). One patient developed massive regurgitation and had to undergo semi-emergency surgery. The experience acquired and the use of better catheters enabled us to improve these results by almost doubling the number of patients whose aortic valve area became 1 cm2 or more and by reducing by half those whose aortic valve area remained 0.7 cm2 or less. Three patients aged 82, 91 and 98 respectively died, and there was one cerebral vascular accident in the catheterization room. Nine patients (4 p. 100) died in hospital during the following days.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[A european multicenter and randomized study of APSAC versus streptokinase in myocardial infarction].

In a multicentre randomized open study conducted on two parallel groups the effectiveness of APSAC was compared with that of streptokinase (SK) in 116 cases of myocardial infarction treated during the first 2.75 hours. APSAC (30 IU) was administered by intravenous bolus injection over 2 to 5 minutes, and SK (1.5 million IU) by intravenous infusion over 60 minutes. The patency of the coronary artery responsible for myocardial infarction was evaluated by coronary arteriography performed 1.74 h on average after the beginning of treatment; it was 70 p. 100 in the APSAC group and 51 p. 100 in the SK group (p less than 0.05). The fall in plasma fibrinogen was similar in both groups (mean minimum level; 0.2 g/l). Haemorrhages occurred in 9/58 patients treated with APSAC (15.5 p. 100) and in 13/58 patients treated with SK (22.4 p. 100); these haemorrhages took place during the first 24 hours in 4 patients of the APSAC group and in 10 patients of the SK group. Five patients died: 2 in the APSAC group and 3 in the SK group. In a subgroup of 38 patients who underwent 3 control coronary arteriographies (at 90 min, 24 hours and 3 weeks), the patency rates were 63 p. 100, 82 p. 100 and 93 p. 100 respectively with APSAC and 44 p. 100, 86 p. 100 and 92 p. 100 respectively with SK (NS). No coronary reocclusion occurred in the APSAC group, as against 3 (1 early, 2 delayed) in the SK group. It is concluded that APSAC seems to be more effective than intravenous streptokinase; it is easier to administer (bolus injection) and does not carry a higher risk of haemorrhage.

Anistreplase↗
PubMed1988

[Percutaneous valvuloplasty using a balloon catheter in acquired mitral and aortic stenosis in adults].

Since 1984 to 1985, catheter dilation of mitral stenosis and aortic stenosis has been added to the arsenal of interventional cardiology. In mitral valvuloplasty the left atrium is approached by transseptal catheterization. Dilation is normally performed by two balloon catheters of 20 mm diameter. One or two dilations of 20 sec duration are usually sufficient to open the mitral valve by cracking one or two fused commissures. In our series of 61 patients the mitral valve area had more than doubled (from 1.03 +/- 0.27 cm2 to 2.17 +/- 0.71 cm2). The most suitable subjects for the technique are young patients in sinus rhythm with relatively elastic valve leaflets, few calcifications, little distortion of the subvalvular apparatus and no major regurgitations. However, mitral valvuloplasty can also be tried in less favourable conditions where there are surgical contraindications, particularly in elderly patients. The complications of the technique are in fact rare. The functional improvement is spectacular and control studies over two years show no tendency to restenosis. --In aortic valvuloplasty a retrograde arterial approach is used. Balloon catheters of increasing size are consecutively employed, starting from 15-20 and even 23 mm diameter. Forceful dilation is needed not only to overcome leaflet fusion but also to compress the valvular structures against the aortic wall to render them more pliable and break the calcifications. --Since September 1985 over 400 patients have undergone valvuloplasty at Rouen with satisfactory overall results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Results of percutaneous transluminal valvuloplasty in 218 adults with valvular aortic stenosis.

The results of balloon aortic valvuloplasty (BAV) in 218 adult patients with valvular aortic stenosis (AS) are reported. In most cases, 3 transcutaneously introduced balloons of successively increasing size were used. Tolerance was excellent in 64%, whereas a decrease in blood pressure below 60 mm Hg during inflation was observed in 36%. The left ventricular-aortic peak to peak gradient decreased from 72 +/- 25 to 29 +/- 14 mm Hg (p less than 0.001) and the aortic valve area increased from 0.52 +/- 0.18 to 0.93 +/- 0.33 cm2 (p less than 0.001). The final aortic valve area was greater than or equal to 1 cm2 in 69 patients (32%). In only 6 cases (3%) the aortic valve area did not change or increased by less than 10%. A clear improvement in the results was observed with gained experience and better catheters. There was 1 death and 1 stroke in the procedure room, and 3 strokes after BAV. Nine patients died shortly after the procedure. There were local complications (hematoma or thrombosis) at the femoral puncture site in 28 (13%) patients. Clinical follow-up was obtained for 144 patients (mean 8 months). There were 24 deaths. In the 120 remaining cases, symptomatic improvement was good in 84%, with decrease or disappearance of dyspnea, angina or both. This study demonstrates that BAV is feasible in adult AS at a low risk and is able to produce marked clinical improvement in most cases.

Adult↗
PubMed1988

[Bundle branch reentry tachycardia: a possible mechanism of flecainide proarrhythmia effect].

A 42-year old man with non-obstructive myocardiopathy complicated by paroxysmal atrial fibrillation treated with amiodarone (200 mg per day) received flecainide in daily doses of 400 mg for undocumented palpitations. Ten syncopes and numerous malaises occurred during the following two months. Electrophysiological testing was performed, showing prolongation of HV to 80 ms and discreet widening of QRS to 100 ms. Programmed atrial stimulation failed to demonstrate a second degree subnodal block and to induce tachycardia. In contrast, ventricular stimulation elicited a critical SH delay (260 ms), always followed by a left delay-type complex preceded by His bundle deflection which suggested reentry within the His-Purkinje system. Three extrasystoles on imposed rhythm started sustained ventricular tachycardia with the same 270 ms cycle morphology and reproducing the symptoms. Each V wave was preceded by an H potential, with HV varying from 100 to 300 ms. Three weeks after flecainide was discontinued, HV was 60 ms, and no ventricular tachycardia could be triggered by programmed stimulation. The patient remained symptom-free throughout the 5-month follow-up. This case illustrates the proarrhythmic effect of the flecainide-amiodarone combination. The mechanism of provoked tachycardia probably involves ventricular reentry through the His bundle branches, induced by a critical depression of conduction below the His bundle.

Amiodarone↗
PubMed1988

Two years' experience of percutaneous balloon valvuloplasty in aortic stenosis.

To provide an overview of our experience with percutaneous balloon valvuloplasty in aortic stenosis, the results obtained in 218 patients have been analyzed. During the two years of its use, the technique of the procedure has been subsequently modified with increasing balloon diameters, initially 15 mm, 18 mm and then 20 mm; currently, a balloon diameter of up to 23 mm or even two balloons may be used. Accordingly, in our last 70 patients, significantly larger valve orifice areas have been achieved. The mean postinterventional valve orifice area was 1.06 cm2. In 73% of the patients valve orifice area was 0.9 cm2 or greater, in 60% 1 cm2 or more. In consideration of the high prevalence of elderly, severely-ill patients in our series, the in-hospital mortality of 4.5% (ten of 218 patients) was relatively low. Nonfatal complications included stroke in three, tamponade in three, and myocardial infarction in one patient with severe coronary artery disease. In 25 patients (13%) there were bleeding complications at the site of vascular puncture, nine of which required surgical revision. Valvuloplasty usually did not result in worsening of aortic incompetence and, consequently, up to grade II regurgitation need not be considered a contraindication. Follow-up data was obtained at an average of eight months (three to 18 months) after the procedure in the first 148 patients. During this period, 24 patients had died, 19 of whom were in functional class IV and all of whom had impaired left ventricular function and residual severe aortic stenosis after the procedure. Most of the survivors were stable and had marked clinical improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1987

Percutaneous transluminal balloon valvuloplasty of adult aortic stenosis: report of 92 cases.

Percutaneous transluminal balloon valvuloplasty was attempted in 92 adult patients with severe calcific aortic stenosis. The mean age was 75 +/- 11 years (range 38 to 91) and 35 patients were more than 80 years old. Most of the patients were severely disabled; 66 were in New York Heart Association functional class III or IV, 27 had syncopal attacks and 21 had severe angina pectoris. Because of unacceptably high surgical risk or contraindication to thoracic surgery, 42 patients could not be considered for valve replacement. Other patients either were in a category of high operative risk or refused the surgical intervention. Valvuloplasty was performed by way of the femoral route (82 patients) or the brachial route (10 patients). Catheters of size 15, 18 and 20 mm were successively placed across the aortic valve and three inflations were usually done with each of them, lasting 80 seconds on average, until a decrease in peak to peak systolic pressure gradient to 40 mm Hg or less was attained, a result considered satisfactory. The inflated balloons were not totally occlusive in most cases and clinical tolerance of inflation was good. Valvuloplasty resulted in a reduction of mean systolic gradient from 75 +/- 26 to 30 +/- 13 mm Hg (p less than 0.001); the final gradient was less than 40 mm Hg in 78 patients. Mean calculated aortic valve area increased from 0.49 +/- 0.17 to 0.93 +/- 0.36 cm2 (p less than 0.001). Immediately after the procedure, ejection fraction increased from 48 +/- 16 to 51 +/- 16% (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

A case of spontaneous incomplete non-traumatic rupture of the ascending aorta with acute aortic insufficiency (successful emergency surgical repair).

Spontaneous incomplete non traumatic rupture of the ascending aorta is rare but life-threatening; it may well remain unnoticed until emergency surgery becomes necessary. Its possibility should be considered in all patients presenting signs of tamponade, chest pain or aortic regurgitation, and it must be diagnosed by appropriate procedures.

Aortic Rupture↗
PubMed1987

Unusual electrocardiographic patterns of modulated parasystole.

Modulation of a parasystolic rhythm implies that the latter is affected by nonparasystolic beats in predictable ways. When modulation occurs the diagnosis of ventricular parasystole cannot be made by applying the well-known 'classical' criteria. This report deals with clinical tracings from three cases having modulated parasystole with unusual characteristics. Case 1 showed a 24-hour diurnal variability of parasystolic modulation characterized by its occurrence during only part of the period of sleep (from 1 to 5 am). In case 2, modulated ventricular parasystole produced episodes of intermittent ventricular bigeminy with fixed coupling resembling those attributed to a reentry mechanism. The proper diagnosis was made when the sinus cycle length changed abruptly. Finally, in case 3, the idionodal rhythm from a patient with complete AV block was shown to be not only parasystolic, but also modulated. In addition, the idionodal rhythm was entrained (captured) in a concealed fashion by paced beats so that the post-pacing events did not conform with those occurring during overdrive pacing of parasystolic nonmodulated, or nonparasystolic, idionodal rhythms. These findings constitute the clinical counterpart of experimental studies performed with microelectrode techniques.

Adult↗
PubMed1987

Intravenous anisoylated plasminogen streptokinase activator complex versus intravenous streptokinase in evolving myocardial infarction. Preliminary data from a randomised multicentre study.

The efficacy of a single intravenous bolus of anisoylated plasminogen streptokinase activator complex (APSAC 30U in 4 to 5 minutes) versus an intravenous infusion of streptokinase (1.5 X 10(6) U in 60 minutes) was assessed in 86 patients with evolving myocardial infarction of less than 6 hours duration in a cooperative randomised study. The patency of the infarct-related artery was assessed by coronary angiography at, on average, 90 minutes after therapy (mean time: APSAC 95 minutes, streptokinase 105 minutes). The treatment groups were similar with respect to sex, age, location of myocardial infarction and the delay from onset of pain to treatment. The 90-minute patency rate (grade 2 to 3) was 71.8% in the APSAC group and 55.8% in the streptokinase group; the difference was not statistically significant. There was no difference between the drop in fibrinogen concentrations in the 2 groups at 3 or 24 hours. The minimal concentration obtained at the first assessment was +/- 0.2 g/L in the streptokinase group and 0.5 g/L in the APSAC group. One patient in the APSAC group, who had a previous meningeal bleeding, had a non-fatal cerebrovascular accident. In a subgroup of 38 patients who had 3 control coronary angiograms at 90 minutes, 24 hours and 3 weeks, the patency rate was 63, 82 and 93%, respectively, in the APSAC group and 48, 88 and 92%, respectively, in the streptokinase group (the difference was not statistically significant). None of the patients in the APSAC group presented with reocclusion, whilst 3 patients in the streptokinase group had reocclusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Circadian variations and modification of ventricular parasystole].

As shown by Jalife and Moe, brief subliminar depolarizations induced upstreams of the protection zone may predictably modify the discharge from a parasystolic focus. In the biological and mathematical models of parasystole, numerous arrhythmias which do not fulfil the classical criteria of parasystole have been identified, some of them even mimicking a re-entry mechanism. In this paper we report the electrocardiograms of three patients in whom an electrotonic modulation mechanism may be involved. In the first patient the classical pattern of continuous parasystole without exit block was observed throughout daytime. However, between 1 and 5 a.m. non parasystolic beats lengthened or shortened the parasystolic rhythm, depending on their time-related position in the cycle. Later, the usual continuous parasystole pattern reappeared. In the second patient the patent 1:1 entrainment of parasystole by sinus beats resulted in long episodes of ventricular bigeminy with fixed coupling. A sudden slowing down of the cardiac rate disrupting the harmony of the two rhythms and, consequently, the regular entrainment of the ectopic focus, shortened the parasystolic cycle and suppressed bigeminy. In the third patient ventricular stimulation produced a hisian parasystolic rhythm resembling intermittent parasystole on surface ECG. It is concluded that, as suggested by experimental models, many disorders of cardiac rhythm which do not fulfil the criteria of parasystole can be explained in terms of modulated parasystole.

Adolescent↗
PubMed1987

[Systemic and coronary hemodynamic effects of intravenous nicardipine at rest and in ischemia induced by rapid atrial stimulation].

The systemic and coronary haemodynamic effects of intravenous nicardipine were investigated in 10 patients with a more than 70 p. 100 stenosis of the left coronary artery. Two brief atrial pacing tests (ST1 and ST2) were performed. ST2 was performed 30 minutes after an intravenous injection of nicardipine 2.5 mg over 5 minutes. Nicardipine produced a 25 p. 100 decrease in ventricular systolic pressure and a substantial increase in cardiac index (from 2.74 +/- 0.48 to 3.46 +/- 0.35 l/min/m2, p less than 0.001). Measurement of the coronary flow rate by the thermodilution method showed a 40 p. 100 increase in sinus blood flow while coronary resistance decreased not only in territories with normal supply but also in myocardial territories distal to the coronary stenosis (from 2.76 +/- 2.3 to 1.83 +/- 1.5 mmHg/ml, p less than 0.02). With the same paced heart rate the ventricular function parameters were significantly improved during ST2 (cardiac index ST2 3.56 +/- 0.65 vs ST1 2.8 +/- 0.48, p less than 0.001; dp/dt max ST2 2143 +/- 369 vs ST1 1874 +/- 301 mmHg/sec, p less than 0.05), reflecting a lower degree of myocardial ischaemia. This was confirmed by the lower amplitude of electrocardiographic depression and by a higher lactate extraction coefficient (LE ST1 6 +/- 7 p. 100 vs LE ST2 12 +/- 12 p. 100, p less than 0.05). Mean arterial blood pressure and coronary sinus blood flow rate values were identical during the two atrial pacing tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Comparison of the effects of ajmaline and procainamide in the diagnosis of paroxysmal atrioventricular block].

14 suspected of having a paroxystic atrio-ventricular block underwent a complete electrophysiological exploration including an ajmaline test. It was administered at the standard dose of 1 mg/kg at the rate of 1 mg/s. In order to evaluate a replacement test, an equivalent dose of procainamide was injected at the same rate (10 mg/kg, 10 mg/s) a few hours later. In 4 out of 14 cases the ajmaline test was positive. In only one patient, procainamide was able to demonstrate a sub-nodal block. The maximal lengthening of HV occurred at an earlier time after ajmaline than after procainamide (2.2 +/- 0.75 min. versus 4.1 +/- 1.59 min, p less than 0.02) and certainly more clear-cut (MaxHV = 73.5 +/- 12.9 ms versus 59.5 +/- 12.1 ms, p less than 0.01). The lengthening of HV after administration of these two products was significantly correlated but always markedly lesser with procainamide. In conclusion, the procainamide is less sensitive than the ajmaline test in the positive diagnosis of paroxystic atrio-ventricular blocks concerning absolute criteria in the positive diagnosis as well as relative criteria such as a definite lengthening of HV with ajmaline.

Aged↗
PubMed1986

Percutaneous transluminal valvuloplasty of acquired aortic stenosis in elderly patients: an alternative to valve replacement?

Percutaneous transluminal balloon catheter aortic valvuloplasty (PTAV) was carried out in three elderly patients with acquired severe aortic valve stenosis. Transvalvular systolic pressure gradient was considerably decreased at the end of the procedure, during which there were no complications. Increased valve opening was confirmed by angiography and echocardiography. Subsequent clinical course showed a pronounced functional improvement. PTAV is recommended as a simple alternative to aortic valve replacement in elderly and/or high-risk patients.

Aged↗