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Biomedical subjects

A Cribier

Publications and source records attributed to A Cribier.

At least 145 records · Page 8Linked to original sources
PubMed1986

Anterior ST depression in inferior myocardial infarction: correlation with results of intracoronary thrombolysis.

Thirty-eight patients underwent left ventricular angiography and coronary arteriography within the first 6 hours of inferior myocardial infarction, in an attempt at intracoronary thrombolysis with streptokinase. Twenty-three of these patients presented with ST segment depression of more than 1 mm on the anterior leads (V1 to V4) of ECGs done immediately before the attempt at thrombolysis (group I), whereas 15 did not (group II). Quantitative analysis of left ventricular angiography showed an ejection fraction significantly lower in group I (51 +/- 10%) than in group II (59 +/- 7%; p less than 0.01). This difference was the result of inferior hypokinesia which was larger both in surface area (group I = 11.5 +/- 6.5 cm2; group II = 4.2 +/- 2.7 cm2; p less than 0.001) and in percentage of ventricular perimeter (group I = 46 +/- 14%; group II = 27 +/- 12%; p less than 0.001). The prevalence of a left anterior descending artery lesion and the degree of stenosis were the same in both groups. The success rate of thrombolysis was not significantly different. However, in cases of persistent success, there was an improvement of regional contraction only in group I, as opposed to absence of change in group II. These results suggest that patients with inferior myocardial infarction and ST anterior depression have an extensive ischemic area rather than anterior wall ischemia. An attempt at coronary thrombolysis seems to be worthwhile only in these patients, as it results in appreciable myocardial salvage when successful.

Adult↗
PubMed1986

[Mortality of subjects with coronary insufficiency with severe, tritruncal and diffuse arterial lesions].

The cases of 151 patients with diffuse, severe, triple coronary vessel disease excluding any possibility of aortocoronary bypass surgery with a Ross and Friesinger index of over 10/15 were analysed for survival by direct methods up to 5 years and by actuarial methods up to 8 years. The global mortality rate was 36% at 5 years and 53% at 8 years. Excluding 10 non-cardiac deaths, the annual mortality rate was 7%. When the 9 cases of left main stem disease, responsible for 6 deaths in 5 years (annual mortality of 13%) were excluded, the annual mortality of the remaining 132 cases was 6% per year. The actual degree of arterial stenosis did not significantly affect the outcome in these patients selected by the severity of their coronary lesions. Mortality was significantly higher when there was a history of angina of over 3 years duration. All clinical, radiological and electrocardiographic parameters indicating myocardial dysfunction (cardiac failure, radiological cardiomegaly, intraventricular conduction defects, left ventricular hypertrophy) had a decisive influence on mortality. A decreased ejection fraction was a poor prognosis factor associated with a 2.5% increase in the annual mortality rate for each 10% decrease of ejection fraction under 50%. Although no differences were found irrespective of whether coronary angiography was performed in an acute context (during a preinfarction syndrome), most of the survival graphs showed a clearcut increase in the downward slope during the first 6 months, indicating a mortality rate four to eight times higher than during later periods.

Adult↗
PubMed1986

[Balloon catheter dilation of severe pulmonary restenosis 11 years after surgical valvulotomy].

A young girl who underwent repair of an atrial septal defect and pulmonary valvulotomy when 6 years of age, presented with clinical and haemodynamic signs of pulmonary restenosis 11 years later: right ventricular systolic pressure (RVSP) of 130 mmHg with a systolic RV/PA pressure gradient of 105 mmHg. Pulmonary valvuloplasty was performed using a balloon catheter (20 mm X 40 mm). Two inflations were necessary to correct the hour glass deformity of the balloon caused by the stenosis. After valvuloplasty the RVSP was 75 mmHg and the RV/PA gradient 55 mmHg. The calculated pulmonary valve surface area increased from 0.36 cm2 to 0.72 cm2. Angiography performed immediately after dilatation showed improved valvular mobility but here was persistant severe infundibular hypertrophy. The intensity of the pulmonary systolic murmur decreased. The good result obtained in this case shows that percutaneous valvuloplasty may be considered when restenosis occurs several years after surgical valvulotomy. Control catheterisation performed two months after dilatation confirmed the good initial haemodynamic result.

Adolescent↗
PubMed1986

[Spontaneous incomplete rupture of the supra-sigmoidal aorta presenting as aortic insufficiency. Apropos of an emergency surgical case].

We report a case of spontaneous incomplete rupture of the first segment of the ascending aorta presenting as aortic incompetence and acute tamponade confirmed by preoperative angiography in a 57 year old hypertensive woman. This patient underwent emergency conservative surgery with good results at 8 months' follow-up. This rare pathology occurs in the same terrain as dissection of the aorta. The diagnosis should be suspected not only when chest pain and/or aortic incompetence are associated or not with acute tamponade, contrasting with a normal electrocardiogram, but also in atypical presentations which necessitate angiography in multiple incidences in order not to miss the diagnostic signs which are often invisible in the standard projections. When there are no complications, this condition may pass undiagnosed. However, in most cases, it leads to acute tamponade due to intrapericardial rupture or to an aortic aneurysm or aortic incompetence. The latter complications are usually associated with severe regurgitation requiring surgical correction, which in some cases may be conservative.

Aorta↗
PubMed1986

[Percutaneous transluminal aortic valvuloplasty using a balloon catheter. A new therapeutic option in aortic stenosis in the elderly].

Aortic valvular dilatation with a balloon catheter was performed in 44 patients, 20 men and 24 women, most of whom were very elderly (average age 77 years). The indication for valvular replacement had not been retained in these cases because of surgical contra-indications or a very high operative risk and in 3 cases because of patient refusal. Twenty-nine patients were in functional classes III or IV of the NYHA classification; 12 had syncopal episodes and 18 had invalidating angina. The dilatation was performed by a femoral arterial approach in 34 cases, and by a brachial arterial approach in 10 cases. MEDI-TECH catheters with 15, 18 or 20 mm diameters when inflated were used in the majority of cases. Several inflations lasting 10 to 240 seconds were performed in each case with balloons of increasing size. This was well tolerated in all but one patients who had a sharp syncope. The immediate results confirmed valvular dilatation. The average transvalvular pressure gradient fell from 76 +/- 25 mmHg to 30 +/- 13 mmHg (p less than 0.001). The aortic valve surface area calculated by the Gorlin formula increased from 0.5 +/- 0.18 cm2 to 1 +/- 0.42 cm2 (p less than 0.01). After dilatation the gradient was less than or equal to 40 mmHg in 37 cases; aortic valve surface area was greater than or equal to 1 cm2 in 14 cases and less than or equal to 0.7 cm2 in only 5 cases. The left ventricular ejection fraction increased immediately after valvuloplasty from 44 +/- 16 p. 100 to 49 +/- 15 p. 100 (p less than 0.01). In the 18 cases in which it was less than 40 p. 100 before valvuloplasty, it increased from 30 +/- 6 p. 100 to 36 +/- 9 p. 100 (p less than 0.02). Residual aortic regurgitation was only observed in one case. Two patients died in the hospital period (4.6 p. 100). There were no other serious complications. During an average follow-up period of 60 days (3 weeks to 6 months) there was a big improvement in symptoms in the great majority of cases and, in particular, syncopal and anginal attacks disappeared. Only 4 patients remained in functional classes III or IV after valvuloplasty. Percutaneous aortic valvuloplasty is a new, relatively simple, low risk, economic and very effective therapeutic procedure in all cases in which aortic valve replacement is contra-indicated or refused by the patient.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗
PubMed1985

[Prazosin in the treatment of chronic cardiac insufficiency].

Vasodilators may be required when signs of cardiac failure persist, despite adequate digitalo-diuretic therapy. Prazosin is a post-synaptic alpha-blocker which acts on both cardiac preload and afterload. For this reason, it has been widely used in the treatment of cardiac failure. We used prazosin in an open uncontrolled trial in 17 patients with an average of 59 years, in whom Stage III or IV cardiac failure persisted despite digitalis and diuretic therapy. Haemodynamic data obtained with a Swan Ganz catheter was used to judge the effectiveness of an initial dose of prazosin and long-term results were assessed by repeat studies after 6 and 10 weeks of continuous therapy. After the first, we observed a marked fall in pulmonary capillary (15.5% 7.4 vs 22.9% 8.8 mm Hg, p less than 0.01) and mean pulmonary artery pressures (23.8% 9.2 vs 34.2 +/- 10.6 mm Hg, p less than 0.001). Systemic vascular resistances were also significantly reduced (1 370 +/- 406 vs 1 983 +/- 464 dynes.s.cm-5, p less than 0.001). There was a moderate fall in mean systemic blood pressure (80.8% 10.6 vs 95.6 +/- 129 mm Hg, p less than 0.001). Cardiac index increased significantly (2.7 +/- 0.68 vs 2.13% 0.56 1/min/m2, p less than 0.01). The heart rate was constant. The maintenance dose was 5 mg three times daily in 9 cases, and 10 mg three times daily in the other 8 cases. The medium term results were assessed in 14 patients as 2 patients died and 1 stopped treatment for undetermined reasons. The symptomatic improvement was marked (class 2.5 +/- 0.76 vs 3.64 +/- 0.49, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗
PubMed1985

[Evaluation of coronary reserve in angina pectoris with angiographically normal coronary arteries].

Coronary reserve was studied: 1) during rapid atrial pacing and then, 2) during dipyridamole infusion (0.6 mg/Kg/4 min) in 3 groups of subjects: 13 patients with angina pectoris and angiographically normal coronary arteries (ANC) with proven myocardial ischaemia during atrial pacing, 15 patients with coronary artery disease (COR) and 17 normal controls with normal coronary angiography and atrial pacing. Coronary sinus flow (QCS) was measured by thermodilution and myocardial metabolism studied by the coefficient of lactate extraction (K). At maximal pacing rates, K remained 15 p. 100 in the control group (average 24 +/- 7 p. 100) but was inversed in the ANC (-3 +/- 10 p. 100) and COR groups (-27 +/- 38 p. 100). The risk in QCS was low in the COR group (+60 +/- 33 p. 100) p less than 0.02, but significant in the ANC group (+104 +/- 57 p. 100) and normal controls (+107 +/- 41 p. 100). Coronary reserve, calculated as the percentage increase in QCS with dipryridamole, was found to be the same in the ANC group (+225 +/- 79 p. 100) as in normal subjects (+191 +/- 81 p. 100) but was low in the COR group (74 +/- 42 p. 100, p less than 0,001). Therefore, no reduction in coronary reserve was shown in patients with angina and normal coronary arteries whilst the myocardial ischaemia in coronary disease does seem to be related to an amputation of the coronary reserve.

Adult↗
PubMed1985

[Regression of residual coronary stenosis after recanalization by fibrinolysis in myocardial infarction. Quantitative analysis of coronary angiography immediately after obstruction removal, at a 15-day and 3-month follow-up].

There seems to be a high risk of reobstruction after local fibrinolytic therapy in myocardial infarction because the severity of the residual stenosis. However, it is quite common to observe a significant improvement of these stenoses at follow-up coronary angiography. Also, one may demonstrate a patent coronary artery after initial failure of the recanalisation procedure. The aim of this research was to study objectively the outcome of the residual coronary stenosis after intracoronary fibrinolytic therapy during myocardial infarction. The degree of stenosis expressed as a percentage reduction of the average diameter of the vessel measured in two perpendicular incidences was assessed immediately after initial fibrinolytic therapy, and at 15 days and 3 months' follow-up. The study group of 31 patients was divided into two subgroups: group I (16 patients) with successful revascularisation and a patent vessel at the first control; and group II (15 patients): unsuccessful revascularisation or with reobstruction at the first control angiography (2 cases). The coronary angiographies were interpreted by an observer who had no knowledge of the patients or of the order of the investigations. In group I, the degree of stenosis decreased from 74 +/- 18 p. 100 to 64 +/- 16 p. 100 (p less than 0.05) at the first control, and then to 47 +/- 24 p. 100 (p less than 0.001) at the second control (less than 50 p. 100 in 7 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Arterial Occlusive Diseases↗
PubMed1985

[Cerebral embolism without apparent cause: angiographic study of minor predisposing cardiac anomalies. Prospective study of 64 patients].

The heart is the source of about 50 p. 100 of cerebral emboli. In the absence of clinically obvious cardiac disease, the heart is nevertheless suspected to be the origin, especially in young patients without atherosclerosis. Cardiac catheterisation and angiography were performed systematically to detect minor predisposing cardiac abnormalities which did not appear on standard clinical examination, and which could increase the risk of recurrent embolism. 64 patients aged 21 to 69 years were studied prospectively a few weeks after a cerebral vascular accident attributed to embolism on the results of complementary neurological investigation, or, more rarely, after systemic embolism to one of the limb arteries. Clinical examination, chest X-ray and the electrocardiogram were normal in all cases. The investigation consisted in right and left cardiac catheterisation, global angiography after right atrial injection, selective left ventricular angiography and coronary angiography in all patients over 40 years of age. Unsuspected cardiac abnormalities were detected in 39 of the 64 patients (60 p. 100); the main abnormalities were mild or moderate mitral valve prolapse (30 p. 100 of cases) and slight decreases in left ventricular contractility possibly related to a minor form of cardiomyopathy (23 p. 100 of cases). Ambulatory 24 hour monitoring showed supraventricular arrhythmias in 30 p. 100 of cases. The results of echocardiography were disappointing in the diagnosis of these minor abnormalities. In conclusion, cardiac abnormalities were detected in the majority of cases of cerebral embolism by cardiac catheterisation. These results support the indications for long-term anticoagulant and/or anti-arrhythmic treatment in these patients.

Adult↗
PubMed1985

[Anterior lead ST-segment depression in inferior wall infarction. Early angiographic study. Effect on the results of intracoronary thrombolysis].

Of 32 patients with inferior myocardial infarction undergoing coronary angiography in the first 6 hours for intracoronary streptokinase thrombolysis, 19 (Group I) had ST depression of more than 1 mm in the anterior chest wall leads (VI-V4) whilst 13 (Group II) had no ST changes in these leads. Quantitative analysis of left ventricular angiograph showed a significantly lower ejection fraction in Group I (52 +/- 8.5%) compared to Group II (59 +/- 8%, p less than 0.05) and that this difference was due to a greater zone of inferior wall hypokinesia, irrespective of whether this was assessed by measuring its surface area (HKS cm2: Gr I: 11 +/- 6, Gr II: 4 +/- 3, p less than 0.01) or percentage ventricular perimeter (HK%: Group I 45 +/- 15, Group II 26 +/- 12, p less than 0.001). On the other hand, anterior wall motion was normal in both groups. Coronary angiography showed proximal obstruction of the right coronary artery in 84% of patients in Group I. In Group II, the coronary obstruction tended to be distal or incomplete. The prevalence and average severity of associated stenosis of the left anterior descending artery were the same in both populations. The success rate of thrombolysis was not significantly different between the two groups. In successful procedures with a patent artery on the 14th day, improved regional contractility was only observed in Group I (HKS cm2: 11.5 +/- 6 vs 8 less than 4.4, p less than 0.05; HK%: 47 +/- 14 vs 38 +/- 9, p less than 0.05): the hypokinetic zone was unchanged in Group II.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1985

[Aortic stenosis with low preoperative ejection fraction. Long-term postoperative hemodynamic and angiographic studies].

Twenty-two patients underwent aortic valve replacement for aortic stenosis with a preoperative ejection fraction less than 45%. Three patients died peroperatively and a fourth patient died 18 months later before the haemodynamic control. The other 18 patients were systematically reinvestigated, on average 16 months after surgery. Sixteen had a remarkable functional improvement and a significant increase in ejection fraction at haemodynamic control: 32 +/- 6% to 61 +/- 8%, p less than 0.001. They were surgical successes (Group I). In this group, the 7 patients with the most severe alteration of ventricular function and an average ejection fraction of: 26 +/- 3%, also improved to near normal function with a postoperative fraction of 62 +/- 11%. There was no significant improvement of the ejection fraction in 2 patients, and they were classified with the fatalities as surgical failures (Group II). The clinical, electrocardiographic, radiological, haemodynamic and angiographic data of these two populations were compared to try and identify preoperative indices of prognostic value. Only the angiographic left ventricular myocardial mass index (LVMI) was significantly higher in Group II (253 +/- 98 g/m2) than in Group I (156 +/- 56 g/m2, p less than 0.05). A discriminating analysis showed that the most important parameters to separate the 2 groups of patients were the LVMI and the thickness of the left ventricular wall. The marked increase of the postoperative ejection fraction in 3/4 of our patients confirmed the clinical value of valvular replacement justifying the indication for surgery in patients with severe aortic stenosis in spite of a severe alteration of left ventricular function.

Aged↗
PubMed1984

Angina pectoris with angiographically normal coronary arteries: a clinical, hemodynamic, and metabolic study.

Seventy-six patients with anginalike chest pain (ALCP) and angiographically normal coronary arteries (NCA) had a study of the myocardial metabolism at rest and during maximal atrial pacing. The results were compared with pain characteristics, electrocardiogram, left ventricular, and coronary hemodynamic data. Coronary blood flow (CBF) was measured by continuous thermodilution. At maximal paced heart rate, the study of the myocardial metabolism distinguished two groups: (1) a first group of 50 patients whose lactate extraction coefficient was equal to or exceeded 9% and was considered as normal (Gr. I, K greater than or equal to 9%); (2) a second group of 26 patients whose lactate extraction coefficient was below 9% (Gr. II, K less than 9%), significant of myocardial ischemia. In group I (K greater than or equal to 9%), chest pain was usually atypical (typical in only 25% of cases) and rapid atrial pacing most often caused neither pain nor ECG changes. The hemodynamic and angiographic study showed minor alterations of the left ventricular cavity in 50% of cases. In group II (K less than 9%), chest pain was typical in 50% of the patients and maximal atrial pacing most often caused chest pain (85%) and ST-segment depression (80%). In almost every case, the left ventricular and the coronary angiograms were normal. Only in this group, which had clinical, electrical, and metabolic signs of myocardial ischemia, could the diagnosis of angina pectoris with angiographically normal coronary arteries be upheld.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Coronary sinus lactate estimation and esophageal motor anomalies in angina with normal coronary angiogram.

Twenty-three patients (ages 44-82) with angina-like chest pain with a negative stress test and a normal coronary angiogram were studied for myocardial lactate metabolism during atrial pacing and for esophageal motor function with manometric measurements and acid infusion test. Eight patients had an abnormal myocardial lactate metabolism during maximal atrial pacing. Esophageal motor anomalies were observed in six of these eight patients and nine of the 15 subjects with normal myocardial lactate metabolism. The frequency and type of these anomalies were not different between the two groups of patients. Perfusion of acid into the esophagus reproduced the spontaneous pain syndrome in three patients, independent of any simultaneous motor dysfunction. These results suggest that esophageal motor anomalies must be interpreted with caution in patients with angina-like chest pain before affirming the exclusively esophageal origin of the pain.

Adult↗
PubMed1984

[Captopril in cardiac insufficiency. Immediate and long-term effects].

Captopril was administered to 23 patients in cardiac failure refractory to digitalo-diuretic therapy. Four patients had a large fall in systolic blood pressure (less than 70 mmHg) with a single dose of 25 mg of captopril. In the other 19 patients a significant fall in mean pulmonary capillary pressure (16,8 +/- 6,1 mmHg vs 27,2 +/- 8,5 mmHg, p less than 0,001), mean pulmonary artery pressure (26,3 +/- 11,3 mmHg vs 38,3 +/- 12,4 mmHg, p less than 0,001), mean right atrial pressure (5 +/- 5 mmHg vs 8 +/- 6 mmHg, p less than 0,01) was observed: there was a moderate fall in mean systemic arterial pressure (13%, p less than 0,001). There was a significant fall in pulmonary resistance (27%, p less than 0,001). The cardiac index increased (2,8 +/- 0,5 l/min/m2, p less than 0,001) and systemic resistance fell by 25% (p less than 0,001). The heart rate decreased by an average of 7 beats/min (p less than 0,02). The treatment was stopped in one patient because of the inefficacy of captopril at 100 mg per dose. The average daily dose in the 18 patients on long-term treatment was 212,5 +/- 106,8 mg. At the second month, the haemodynamic parameters were remeasured before the morning dose of captopril. The effects observed after the single dose were maintained apart from the systemic blood pressure, heart rate and systemic resistances which had returned to the value observed before administration of captopril. The mean pulmonary capillary pressure was significantly lower than before treatment but was higher than after the single dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗