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Biomedical subjects

A Pavie

Publications and source records attributed to A Pavie.

At least 163 records · Page 9Linked to original sources
PubMed1988

[Evaluation by Doppler echocardiography of left ventricular diastolic function in acute graft rejection after heart transplantation].

In order to study abnormalities of left ventricular diastolic function (LVDF) in heart transplant patients and their possible association with graft rejection, 21 patients who had recently undergone orthotopic heart transplantation were evaluated prospectively, on the day of endomyocardial biopsy, by pulsed and continuous Doppler echocardiography (DEC). Investigation of the LVDF consisted of pulsed DEC of the mitral valve in apical projection (4 cavities) with measurement of isovolumetric relaxation time (IVR), peak velocity of rapid ventricular filling (E), peak velocity of graft atrial contraction (A) and transmitral gradient decrease half-time (mitral T1/2). Each patients had 5 DEC examinations on average over a 2-month period. In patients with subsevere to severe rejection mitral T1/2 decreased significantly from 76.46 +/- 11.6 ms in the absence of rejection to 47 +/- 13.7 ms during rejection (P less than 0.001). When mitral T1/2 decreased by 25 p. 100 or more between two successive DEC, rejection was present in 89 p. 100 of the cases. It is concluded that Doppler echocardiographic studies of left ventricular diastolic function provide useful information in the follow-up of heart transplant recipients and offer hopes, in a not too distant future, of non-invasive detection of cardiac graft rejection.

Diastole↗
PubMed1988

[Heart-lung transplantation].

In this study the transplantation group of La Pitié Hospital, Paris, review heart-lung transplantation on the basis of data from the literature and of their own experience. Successively, the history, indications, pre-operative evaluation, donor selection, operative procedure with its immediate, mid-term and late complications, as well as treatment and post-operative follow-up are described.

Heart Transplantation↗
PubMed1988

[Surgical treatment of arrhythmia].

The surgical treatment of rhythm disorders began with interruption of the atrio-ventricular conduction by surgical section of the His bundle, then of the accessory path (Kent bundle) in the Wolff-Parkinson-White syndrome. Later on, surgery was extended to the treatment of chronic ventricular tachycardias. At a time when surgery seems to be progressively replaced by ablation methods using physical agents, electric shock or radio-frequency current, applied through endoluminal probes, it seemed justified to evaluate the established surgical procedures in the treatment of rhythm disorders. Therefore, this study proposes to review the current place of these methods which, in the last few years, have been modified in order to improve the quality of the results, decrease the mortality and specify their indications.

Arrhythmias, Cardiac↗
PubMed1987

Emergency percutaneous coronary dilatation for acute myocardial infarction in Behçet's disease.

We describe a young man with Behçet's disease who presented with acute coronary insufficiency: emergency coronary arteriography revealed 2 coronary aneurysms and a left anterior descending (LAD) artery stenosis which was successfully dilated. The reduction of the coronary stenosis by balloon angioplasty induced immediate relief of chest pain and decrease of ST segment elevation, and was probably responsible for the satisfactory evolution, with limited myocardial infarction on the ECG and no akinetic segment on the left ventricular angiogram 3 weeks after the acute event. Cardiac surgery was performed to avoid possible relapse or aneurysmal rupture with hemopericardium. Surgery confirmed the destructive arterial lesion of Behçet's disease with false aneurysms of the LAD and left circumflex arteries.

Adult↗
PubMed1987

[The low-profile Liotta valve. Mid-term results].

We report the mid-term results obtained with 279 "low profile" Liotta xenografts implanted at the Hôpital de la Pitié, Paris, in 257 patients between February, 1981 and November, 1984. There were 86 aortic, 138 mitral, 11 triscupid and 22 mitral-aortic valve replacements. The wavy suture ring of the prosthesis makes it "low profile". The Liotta valve is of particular interest in certain anatomical situations such as aortic annulus more dilated than the supra-coronary aorta, or small right and left ventricular cavities. The overall operative mortality rate was 8.6%. The 236 survivors were followed up for 3 to 48 months, a total of 374.3 patients-years. The overall actuarial survival rate at 3 years is 92.2%. Although there were few thromboembolic accidents, about one-third of the patients remain under anticoagulant therapy (0.86 episodes for 100 patients-years). Globally, 98.1% of the patients are free of any thromboembolic accident. Deterioration occurred 29 and 44 months respectively after implantation in two patients aged 9 and 20 years (0.57 episodes for 100 patients-years). Three cases of endocarditis on prosthesis were observed. Altogether, almost 91.2% of the patients have had no complication for 3 years, and indeed they functionally improved, most of them now being in class I or II (aortic valve 97%, mitral valve 87.2%). Thirty-eight patients underwent repeated catheterization at rest and during exercise. Mean transvalvular gradient was 12.4 mmHg in aortic valve patients and 5.9 mmHg in mitral valve patients. Mean functional valve area was 1.6 cm in aortic valve patients and 2.1 cm in mitral valve patients, and it clearly increased during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Current problems in cardiac transplantation.

In conclusion, after almost 20 years of clinical application and due to much progress during that time by the pioneers of the method, cardiac transplantation is now a safe and reliable treatment for patients in intractable cardiac failure untreatable by other medical or surgical means. Several challenging problems remain to be resolved by the many active and excellent centers now engaged in this promising field.

Heart Transplantation↗
PubMed1987

[Cardiac transplantation. Selection of patients and long-term results].

Performed for the first time in the world, in December 1967, by Barnard in Capetown, and for the first time in Europe by our team in April 1968, cardiac transplantation has now 20 years of clinical applications. A best selection of the recipients, a more precise selection of donors, refinements in surgical technique, a better and earlier diagnosis of post-operative complications, more effective therapeutic means especially cyclosporin, have brought us, from 1981, such major improvements that many teams were prompted to resume the procedure. In our experience of more than 400 transplants at La Pitié Hospital, a five-year follow-up shows that 70 p. cent of the patients are alive, having resumed a normal familial, social, professional and often sporting life. Much progress remains to be achieved, but this procedure now seems to be quite common if not routine, only limited by the insufficient number of donors.

Adult↗
PubMed1987

[Operative risk in coronary bypass. A multivariate analysis of prognostic factors].

In order to determine the predictors of operative risk in coronary bypass surgery, we have studied 2112 consecutive patients who underwent isolated coronary bypass surgery between January 1979 and September 1984. The overall operative mortality (OM) was 4.4 percent (3.5 percent during the last 3 years). OM increases significantly with age (from O before the age of 30 to 12.3 percent after 70), the functional class (FC) of angina, the FC of dyspnea (NYHA), the creatinine blood level (23.5 percent if greater than 200 mumol/l), the left ventricular end-diastolic pressure and in case of reoperation (16.7 percent), as well as in women (11.6 percent). There is a trend toward higher OM in case of past history of ventricular tachycardia or arterial hypertension, atherosclerotic disease of the lower extremities, left ventricular dysfunction or severe stenosis of the left main coronary artery. OM is not increased in patients with multivessel disease, diabetes or with a past history of myocardial infarction, and is even decreased in obese patients. The variables selected by multivariate analysis were: creatinine blood level, then angina FC, sex, dyspnea FC, age, the absence os obesity, left ventricular dysfunction, the year of surgery and finally reoperation. These results, mainly based on simple clinical variables, should facilitate the therapeutic decisions in borderline indications of coronary bypass surgery.

Aged↗
PubMed1986

Long-term results with total replacement of the ascending aorta and reimplantation of the coronary arteries.

From November, 1976, to June, 1983, 100 patients, 84 male and 16 female patients ranging in age from 13 to 74 years, were operated on for aortic insufficiency associated with an aneurysm of the ascending aorta. Twenty patients were in New York Heart Association Class I, 22 in Class II, 51 in Class III, and seven in Class IV. The surgical treatment in all cases consisted of total replacement of the ascending aorta with a tube graft containing a prosthetic aortic valve and reimplantation of the coronary arteries by an intermediate tube graft according to the technique already reported. In 68 patients an uncomplicated annulo-aortic ectasia existed, and in 32, an aortic dissection; nine of the latter group were operated on during the acute phase. The operative mortality for the entire group was 4% (four deaths). One patient has been lost to follow-up during a period ranging from 18 months to 8 years (average 54 months). The late mortality has been 11/96. Among the 84 survivors, clinical improvement is readily apparent (89% are in Class I or II). Twenty-five patients have been restudied by angiography, which revealed a satisfactory coronary and aortic appearance in all cases with neither stenosis nor aneurysm. The actuarial survival rate is 75% at 8 years. In conclusion, the treatment of aortic insufficiency associated with an aneurysm of the ascending aorta by insertion of a composite graft and reimplantation of the coronary arteries through an intermediate Dacron tube is a reliable method with low mortality and excellent long-term results.

Actuarial Analysis↗
PubMed1986

[Acute native endocarditis. The results of surgical treatment].

Between January 1978 and December 1984, 141 cases of acute native valve endocarditis were treated surgically in the Department of Thoracic and Cardiovascular Surgery of the Pitié Hospital. The diagnostic criteria of acute native valve endocarditis were the duration of treatment (antibiotic therapy for less than 40 days), the characteristic operative appearances of the lesions, and the results of anatomo-pathological examination of the excised valves. The infecting organism was not isolated in 35% of cases. The aortic valve was the commonest site of infection (65.2% with a high incidence of abscess of the aortic ring, irrespective of the causal organism. The operative mortality was 5.6%. This depended mainly on the preoperative haemodynamic status of the patient. The duration of antibiotic therapy prior to surgery did not seem to be relevant. The 3 years survival rate was 78%. The secondary reoperation rate was 7%. There was a higher incidence of secondary perivalvular regurgitation in patients who had previously had an abscess of the aortic ring.

Acute Disease↗
PubMed1986

[Heart transplantation 1985. Experience of the Pitié].

Heart transplant surgery has come of age over the last four years, after 17 years of clinical application: indications have been specified, techniques systematized and treatment and post-operative follow-ups have been clarified. The results are remarkable: survival at four years is more than 80 per cent, with normal socio-familial and often professional reintegration for almost all heart transplant patients. Increased application of heart transplant surgery in the months to come will transform prognosis in patients presenting irreversible cardiac lesions, but will raise the problem of the supply of donor organs.

Adult↗