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A Hernigou

Publications and source records attributed to A Hernigou.

At least 37 records · Page 2Linked to original sources
PubMed1997

Study of muscular and ventricular function in dynamic cardiomyoplasty: a ten-year follow-up.

BACKGROUND: The basic physiologic principle underlying cardiomyoplasty is long-term electrostimulation of a latissimus dorsi muscle (LDM) wrapped around the heart to obtain a phasic activity that could be integrated with ventricular kinetics. The aim of cardiomyoplasty is to prolong survival and to improve the quality of life of patients with severe chronic and irreversible myocardial failure by improving systolic contraction and correcting diastolic dysfunction. METHODS: To evaluate the long-term outcome of cardiomyoplasty, we investigated 82 patients electively undergoing this procedure in-our hospital. All patients had severe chronic heart failure that did not respond to optimal medical treatment. Patients had a mean age of 50 +/- 12 years (84% males). The cause of heart failure was ischemic (55%), idiopathic cardiomyopathy (34%), ventricular tumor (6%), and other (5%). The mean follow-up was 4.3 years. RESULTS: The mean New York Heart Association functional class improved after operation from 3.2 to 1.8. Average radioisotopic left ventricular ejection fraction increased from 17% +/- 6% to 28% +/- 3% (p < 0.05). Stroke volume index increased from 35 +/- 9 to 46 +/- 8 ml/beat/m2 (p < 0.05). The heart size remained stable at long term (evaluated by echo and computed tomography scanning). After cardiomyoplasty the number of successive hospitalizations resulting from congestive heart failure was reduced to 0.4 hospitalizations/patient/year (before operation 2.5, p < 0.05). Computed tomography scans showed at long-term a preserved LDM structure in 82% of patients who underwent operation. Survival probability at 7 years was 54% for the totality of patients, and 66% for patients who underwent operation in New York Heart Association functional class 3. Five patients underwent heart transplantation after cardiomyoplasty (mean delay 29 months), principally as a result of the natural evolution of their underlying heart disease, without major technical difficulties. CONCLUSIONS: Our 10-year clinical experience demonstrates that cardiomyoplasty increases ejection fraction, improves functional class, and ameliorates quality of life. Ventricular volumes and diameters remain stable long term. LDM structure is maintained long term if electrostimulation is performed avoiding excessive myostimulation. Patient selection is the most important determinant for early and late outcome. Late death in patients undergoing cardiomyoplasty is principally due to sudden death. Our future aim is to incorporate a cardioverter-defibrillator in the cardiomyostimulator, thus improving long-term results. Cardiomyoplasty may delay or prevent end-stage heart failure and the need for heart transplantation.

Adolescent↗
PubMed1996

Reproducibility of coronary calcification detection with electron-beam computed tomography.

If coronary calcification scores obtained with electron-beam computed tomography (EBT) were proved to be correlated to coronary atherosclerosis, the reproducibility of the technique had to be assessed before being used for patient follow-up. A total of 150 patients, selected as a result of a cholesterol screening programme, were studied by EBT. Twelve contiguous 3-mm-thick transverse slices beginning on the proximal coronary arteries were obtained through the base of the heart. The amount of calcium was evaluated as the calcified area weighted by a coefficient depending on the density peak level. The value was expressed as a logarithmic scale. Intra-observer, inter-observer and inter-examination reproducibilities were calculated. They were 1.9, 1.3 and 7.2%, respectively. These results were good enough to allow the use of EBT for longitudinal studies. The influence of acquisition and calculation conditions on score computation were also analysed.

Algorithms↗
PubMed1996

Evaluation by electron beam computed tomography of intracardiac masses suspected by transoesophageal echocardiography.

OBJECTIVES: To assess the suitability of electron beam computed tomography (EBT) in evaluating and subsequently managing cardiac masses suspected as a result of examination by transthoracic and transoesophageal cross sectional echocardiography. DESIGN AND PATIENTS: In 76 consecutive patients with suspected cardiac masses, the impact of the EBT examination was analysed by reviewing whether EBT examination altered management by confirming or excluding a mass, whether EBT imaging substantially contributed to decision-making, and lastly whether EBT influenced the decision to operate on the patient. RESULTS: EBT modified the diagnosis or confirmed results which had been questionable with cross sectional echocardiography in 53 cases (70%): these cases included those with anatomical features such as dense calcifications or fatty structures (n = 20), lipomatous lesions (n = 5), equivocal thrombi (n = 5), pericardial masses (n = 5), or hydatid cysts (n = 2). EBT gave information over and above cross sectional echocardiography in all patients with malignant tumours (n = 16) by providing a better delineation of the relation between intracavity masses and normal structures, including the mural site of tumour attachment and tumour extension to the great vessels and the adjacent extracardiac mediastinal structures. EBT provided no additional information over cross sectional echocardiography in the remaining patients (n = 23), particularly in those with myxomas (n = 11) or small valvar lesions (n = 6). EBT only confirmed that the lesion was well demarcated, limited in extent, or not associated with a mass. CONCLUSIONS: EBT has considerable potential for clinical management and surgical planning and may help clinicians to decide against surgery, particularly in patients with unresectable tumours.

Adolescent↗
PubMed1996

Endomyocardial fibrosis: electron-beam CT features.

PURPOSE: To present morphologic and functional electron-beam computed tomographic (CT) features of endomyocardial fibrosis. MATERIALS AND METHODS: Twelve patients with histologic evidence of endomyocardial fibrosis and/or definitive echocardiographic and angiocardiographic findings were examined with electron-beam CT. RESULTS: Endomyocardial fibrosis was depicted as linear calcifications and/or a thin tissue band of low attenuation within the endomyocardium. In right ventricular involvement, CT depicted obliteration of the apex associated with extension along the free wall and/or papillary muscles of the tricuspid valve. In left ventricular involvement, a large amount of endocardial tissue led to severe obliteration within the inflow tract and/or of the apex. At ventricular volume analysis, restrictive patterns of the disease were determined. CONCLUSION: Electron-beam CT allows direct visualization of endomyocardial fibrosis and the resulting volumetric changes and enables distinction of the disease from constrictive pericarditis.

Adolescent↗
PubMed1995

[Prospective comparison of ultrasound endoscopy and computed tomography in the assessment of locoregional invasiveness of malignant ampullar and pancreatic tumors verified surgically].

OBJECTIVE: To compare, in a prospective study, results of endoscopic ultrasonography and computed tomography in staging of pancreatic and ampullary carcinoma tumours, assessed surgically. METHOD: From January 1990 to May 1993, 37 patients with pancreatic tumours had per-operative endoscopic ultrasonography and computed tomography. All patients underwent surgery and surgical and histological staging were performed. RESULTS: All the tumours were visualized by endoscopic ultrasonography, and 92% were correctly localized; 63% of the tumours were visualized by computed tomography. In lymph node involvement diagnosis (23 patients), endoscopic ultrasonography. In major portal vessel involvement diagnosis (14 patients), endoscopic ultrasonography sensitivity and specificity were respectively 71.4% and 95.65%, and 21.4% and 100% for computed tomography. In a vessel-by-vessel analysis, endoscopic ultrasonography was superior to computed tomography for veinous involvement diagnosis (sensitivity: 68.4% vs 26.3%), and the results were similar for arterial involvement diagnosis (sensitivity: 55.5% vs 66.6%). CONCLUSION: Endoscopic ultrasonography is more accurate than computed tomography in detection of metastatic lymph nodes and portal involvement, and their results are similar in detection of arterial involvement.

Adenocarcinoma↗
PubMed1994

Primary bilateral B-cell renal lymphoma: a case report and review of the literature.

Renal lymphoma is commonly secondary to lymphomatous infiltration of the kidneys in disseminated lymphoma and advanced stage IV disease. We describe a 57-year-old white woman presenting with an acute renal failure due to a bilateral "primary" B-cell lymphoma infiltration of the kidneys. The diagnosis of the lymphoma was made by renal biopsy. The striking feature observed was a destructive infiltration of the kidney by a malignant B-cell lymphoma that left the renal capsule intact, without any sign of secondary localization on the hilar regions. Physical examination did not reveal any peripheral lymphadenopathy or hepatosplenomegaly. A bilateral infiltration of both kidneys was the only feature shown by computed tomography and renal angiography. This case raises the question of the occurrence of a primary B-cell lymphoma in a nonlymphoid organ, which was diagnosed by renal biopsy at a time when the development was exclusively renal in origin.

Female↗
PubMed1994

Cardiac lymphoma presenting as atrial flutter in an AIDS patient.

An increasing number of patients with the acquired immunodeficiency syndrome (AIDS) and cardiac lymphoma have been documented. Antemortem diagnosis of cardiac non-Hodgkin lymphoma in AIDS is difficult because of the non-specificity of the clinical findings. Rapid progression of cardiac dysfunction is common after symptoms appear. We report the case of a patient with AIDS and cardiac lymphoma revealed by an atrial flutter.

Atrial Flutter↗
PubMed1994

[Value and future of electron beam computed tomography].

Mecanic computed tomography would probably never reach the acquisition brevity obtained by EBT. This machine is the best for exploration of cardiovascular diseases, and non cooperative patients, and for cine and flow studies. Morever, there are never tube cooling delays or interruptions in any procedures. Its disadvantages are the price, the impossibility to tilt the gantry, and the computer which are to be improved. With "Evolution", Siemens proposes now improvements with the CVS mode and a computer release without increasing of the price.

Evaluation Studies as Topic↗
PubMed1994

[Presentation of the electron beam scanner (Imatron C100 scanner)].

Principles of Electron Beam CT are described and compared to conventional CT. Fast acquisitions and a short exposure time are the major qualities of the machine. Despite of a lower spatial resolution than in mechanical CT it allows exploration of moving organs and especially morphological and dynamic heart studies. The new possibilities of the Continuous Volume Scanning seems to present an promising future outlook.

Evaluation Studies as Topic↗
PubMed1994

[Dynamic cardiovascular studies with electron beam computed tomography].

Electron Beam CT (EBCT) is still emerging as a new functional imaging procedure in providing high morphological studies and dynamic quantitative functional data. Morphological EBCT studies have previously proven their usefulness in pathologic conditions of the thoracic aorta, in congenital diseases, in cardiac masses or tumors... Functional studies achieved using cine mode and/or flow mode are used to assess both mobility and perfusion of structures. Such dynamic analysis have confirmed that their applications will have a major impact on the knowledge of cardiac physiology, the understanding of cardiovascular diseases, if not in daily patient care. For instance, in studies on ventricular function, among the imaging modalities in current use, EBCT is probably most accurate for the evaluation of systolic regional or global function. EBCT is a cross-sectional imaging methods which overcome an important limitation shared by most other imaging modalities, namely the superimposition of overlapping cardiac and thoracic structures. Since in the method high spatial, contrast, and temporal resolution tomography displays the myocardial wall itself, an accurate delineating of endocardial and epicardial contours in contiguous levels can be obtained. Further developments in computer-automated analysis from dynamic EBCT studies have to be carried out to gain clinical acceptance and to facilitate the routine.

Cardiovascular Diseases↗
PubMed1994

[Electron canon computed tomography. Technique and clinical applications in cardiac imaging].

Electron Beam CT (EBCT) was initially devoted to both dynamic and morphological cardiac studies. ECG gated slices acquired in 100 milliseconds produce cardiac images without motion artefacts. Intracavitary tumors and thrombus are clearly detected and EBCT contributes to the stagging and follow-up of masses. Exploration of congenital abnormalities such as pulmonary atresia can be performed even in newborns. EBCT allows the diagnosis of tiny modifications of coronary arteries, endocardium or pericardium. EBCT offers a new modality of cardiac imaging which gives complementary informations to other modalities.

Coronary Disease↗
PubMed1994

[Electron beam scanner and thoracic transplantation].

To follow an heart transplantation, EBCT is more precise than ultrasonography and scintigraphy to calculate a stroke volume. In lung transplantation, it is important before surgery to know the value of right ventricule stroke volume in order to choice the surgical protocol. After lung transplantation SFE helps to follow the patient to look after complications, to drain a collection or to guide a biopsy. SFE contribution is discussed in rejection, infectious diseases, detection of immuno-induced carcinomas, in bronchiolitis obliterans and recurrence of the primitive disease.

Graft Rejection↗
PubMed1994

[Evaluation of the right ventricular function for lung transplantation. Value of the electron beam scanner].

Several invasive or not invasive technics were used to evaluate right ventricular insufficiency associated to severe chronic pulmonary insufficiency. But none of them were very accurate and now the use of EBT appears as a real improvement. We performed a prospective study with 50 patients waiting for a lung transplantation and we compared the values of right ventricular function obtained by EBT to those obtained by nuclear medicine and catheterism. Accuracy of EBT for left ventricule evaluation has already been proved. Stroke volumes calculated by EBT in right and left ventricules are similar and this constitutes a good validation of the method for right ventricule evaluation. Correlations with hemodynamic measurements are poor and nuclear medicine technics underestimate the ejection fraction. So, EBT is recommended for right ventricular study before and after lung transplantation.

Adult↗
PubMed1994

[Detection and significance of coronary calcinosis].

Coronary calcifications (CC) are the witness of atheromatous disease because they lies in intima. This is a best stamp of coronary atheromatosis than all the well know risk factors. CC scores is perfectly estimated by EBT. The reproductibility expressed in logarithm data is 7.2% in inter-examination, 1.3% in inter-observers, 2% in intra-observers [4]. CC detection is more specific in young population than in old population because CC appear and increase with age in asymptomatic patients [12]. But the score curve raised higher in symptomatic than in asymptomatic subjects. A patient with an abnormal score for his age will have 5 to 10% of ischemic cardiac disease during the following 6 months [11].

Adult↗
PubMed1994

[Contribution of the electron beam scanner (Imatron) in aortic pathology].

Electron Beam CT (SFE, Imatron) uses electron beam to generate X rays. This allows the shortest acquisition time today available (50-100 ms). It is the best CT examination for moving structures. In vascular disease arterial wall study is the most important end point, especially in aortic pathology. EBCT is effective in aortic aneurysm, dissection and aortitis diagnosis. It allows a pre-surgical mapping of the lesion and follow-up. We believe that EBCT is superior to other diagnostic mean in the assessment of the ascending aorta and of small arterial lesions.

Aortic Dissection↗