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Biomedical subjects

A Vacheron

Publications and source records attributed to A Vacheron.

At least 127 records · Page 7Linked to original sources
PubMed1988

[Annulo-ectasing disease of the aorta: apropos of 10 cases].

Ten patients were investigated and operated for severe aortic regurgitation due to dystrophic aortic dilatation. This is the third commonest cause of pure aortic regurgitation (18 p. 100) operated at Necker Hospital during the same period. This condition, comprising aneurysm of the ascending aorta, dilatation of the aortic ring and dystrophic aortic valves, is often responsible for severe aortic regurgitation and is noteworthy because of the associated risk of aortic dissection. Cardiovascular surgery is indicated and usually includes replacement of the ascending thoracic aorta with aortic valve replacement.

Adult↗
PubMed1987

Results of percutaneous catheter valvuloplasty for calcified aortic stenosis in the elderly.

Percutaneous catheter valvuloplasty was performed in 37 patients between 60-88 years of age (mean age 74.5 years): 16 of these patients were in functional class IV, with pulmonary oedema at the time of the procedure. A good haemodynamic result was obtained in 32 patients, but 3 of them had to be operated upon subsequently, because of persistence of their symptoms. Two successfully dilated patients died in the hospital, one of cardiac failure following myocardial dysfunction caused by multiple infarcts which had no relation to the aortic dilatation, the other of neurological complications after dilatation. Thus, the primary success rate was 27/37 (73%). The first 10 patients with good initial results have been followed up for more than 6 months. The functional result has been maintained in 8 cases with moderate myocardial dysfunction (left ventricular ejection fraction 0.41 to 0.7), one with restenosis at Doppler assessment. Two patients with severe myocardial dysfunction (left ventricular ejection fraction 0.22 and 0.25) had recurrent cardiac failure, with valvular restenosis in one case. One of them died at home. Percutaneous aortic valvuloplasty is therefore an effective means of treating calcified aortic stenosis in elderly patients. The benefits of this procedure have been maintained for as long as 6 months provided myocardial dysfunction was moderate. At its present stage of development, the technique allows only partial reduction of the aortic stenosis, which may explain the absence of long-term improvement in patients with severe myocardial disease.

Aged↗
PubMed1987

[Circumferential analysis of digitalized gamma angiocardiography by assessment of regional left ventricular contraction].

After acquisition of a digital equilibrium gamma-angiocardiographie, circumferential analysis of end-diastolic and end-systolic frames gives 120 points diastolic and systolic curves. Their difference represents systolic volume and leads to regional left ventricular ejection fraction assessment at the considered radius level. The circumferential analysis evolute gives the regional left ventricular ejection fraction representative curves which allows especially differential diagnosis between left ventricular akinesia and dyskinesia.

Angiocardiography↗
PubMed1987

[Fitness for sports of patients with Wolff-Parkinson-White syndrome].

The fitness of patients with Wolff-Parkinson-White syndrome to indulge in sporting activities is a practical cardiology problem. The major risk is sudden death due to atrial fibrillation deteriorating to ventricular fibrillation. This risk is small or even theoretical, but signing a fitness certificate engages the clinician's responsibility. Non invasive complementary examinations are useful. Echocardiography may detect a heart disease that would preclude any sport. Exercise tests explore the behaviour of the accessory pathway and rarely trigger off arrhythmias. Holter recordings mainly investigate disorders of the atrial rhythm. The decision concerning fitness may be based on clinical symptoms. Exercise-induced tachycardia is a classical contra-indication to competitive sports. In patients whose tachycardia is unrelated to exercise, fitness may be discussed according to the results of exercise tests and of the electrophysiological study. A refractory period which would be considered as rather prolonged at rest does not protect against fast ventricular rate during passage to atrial fibrillation. If pre-excitation disappears during the exercise test in an asymptomatic patient, then competitive sports can be authorized without limitations. If not, only surgical excision or fulguration would provide full protection against a potentially dangerous fibrillation. It is concluded that Wolff-Parkinson-White syndrome contra-indicates competitive sports in most cases. Games played outside competitions remain possible in the absence of symptoms or when arrhythmias are well controlled by medical treatment.

Ajmaline↗
PubMed1987

[Results of percutaneous valvuloplasty in calcified aortic stenosis in the adult].

Aortic valvuloplasty by percutaneous valve dilatation was attempted in 52 patients aged from 60 to 88 years, 20 of whom were in functional stage IV with pulmonary oedema at the time of the procedure. Forty-seven stenoses could be dilated, with haemodynamic success (50 p. 100 increase of aortic valve area) in 44 patients. Among these 44 patients, 3 had to be operated upon because of persistent functional symptoms and 3 died during their stay in hospital (2 as a result of the procedure or the cardiopathy, 1 of heart failure unrelated to the aortic stenosis or the dilatation). The primary success rate therefore was 38/52 attempts, or 72.9 p. 100. The first 11 patients regarded as initial success could be followed up for at least 6 months: functional improvement with moderate myocardial alteration persisted in 9 of them, but Doppler examination in one showed restenosis. Two patients with severe myocardial dysfunction relapsed into cardiac failure; restenosis could be dilated in one of them. Percutaneous aortic valvuloplasty is an effective treatment of calcified aortic stenosis in elderly people who remain improved for at least 6 months when myocardial lesions are mild or moderate. The procedure incompletely reduces the aortic stenosis, which may account for the left of improvement in left ventricular function in patients with severe myocardial damage prior to dilatation. For this subgroup of patients, the choice lies between percutaneous valvuloplasty, which avoids surgery, and surgery which ensures a more complete haemodynamic result in the valve.

Aged↗
PubMed1987

[Value of early vasodilator treatment with prazosin in chronic cardiac insufficiency].

The purpose of the present study was to find out whether the beneficial effect of prazosin in congestive heart failure persists after 2 and 6 months of treatment and whether the clinical and haemodynamic data obtained correlate with the response to treatment. Twenty-four patients of mean age 50.0 +/- 3.00 years presenting with congestive heart failure stage II (3 cases), stage III (18 cases) or stage IV (3 cases) in the NYHA functional classification were treated. All abstained from taking digitalis at least one week before treatment and were given prazosin 14.5 +/- 0.77 mg/day together with spironolactone 25 to 100 mg/day. The results of treatment were assessed by its effects on echocardiography, systolic time intervals, ejection fraction and cardiac index measured by the radioisotope method, and maximal duration of a 60-watt exercise on an ergometric bicycle. Treatment was discontinued before the 6th month in 9 out of 10 non-responders. The remaining 14 patients responded to treatment and their condition improved. Mean blood pressure rose in 6 months from 95.4 +/- 3.92 to 104 +/- 3.06 mmHg (p less than 0.05). The cardiothoracic ratio was reduced at 2 months (-0.05 +/- 0.01, p less than 0.01) and at 6 months (-0.08 +/- 0.02, p less than 0.01). Systolic time intervals were not significantly altered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Perioperative myocardial infarct following aortocoronary bypass. Clinical aspects, causes, consequences].

Perioperative infarction is a significant factor of morbidity of coronary bypass surgery. The aim of this study was to review peri-operative infarction and its complications over a 10 year period (1974 to 1984) and to determine its consequences on left ventricular function and life expectancy. The material included 514 patients who underwent coronary bypass surgery. Perioperative infarction was defined as the association of a postoperative Q wave and increase in creatinine phosphokinase after the 24th postoperative hour: this diagnosis was made in 31 cases (Group A), 6 per cent of the series; 483 patients (Group B) had no signs of infarction. The necrosis involved the revascularised zone in 26 cases and other zones in 5 cases. The acute phase of infarction was associated with major complications in 9 patients of Group A. In 22 patients (70 per cent of cases) the initial evolution was uncomplicated. There was no significant difference in the number of patients with unstable angina between Groups A and B (52 per cent vs 67 per cent), with single vessel disease (25 per cent vs 28 per cent), double vessel disease (45 per cent vs 34 per cent) or with triple vessel disease (30 per cent vs 38 per cent). The average number of bypasses was higher in Group A (2.06 per cent vs 1.4 per cent, p less than 0.05), as was the duration of cardiopulmonary bypass (117 min vs 91 min, p less than 0.05) and of aortic clamping (45 min vs 31 min, p. less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina, Unstable↗
PubMed1986

[Clinical and developmental aspects of 1-vessel right coronary atheroma. Therapeutic consequences].

This study analysed the clinical profile, prognosis and consequences on left ventricular function of isolated obstructive atherosclerosis of the right coronary artery in order to establish the indications of percutaneous angioplasty. The inclusion criteria were at least one stenotic lesion greater than 75 p. 100 of a dominant or equilibrated right coronary artery and exclusion of stenosis of the other coronary vessels. A questionnaire was sent to the treating physician and to the patient to establish the actuarial survival (Cutler and Ederer's method). The average period of follow-up was 56 months (range 12 to 70 months). Seventy one patients (average age 53 years) were selected from a series of 2,675 consecutive coronary angiograms performed between 1979 and 1984 (2.7 p. 100). The incidence of previous infarction was 60 p. 100; this was located on the inferior wall in 75 p. 100, inferobasal wall in 12 p. 100 and infero-latero-basal wall in 13 p. 100. Bypass surgery was performed in 7 cases and percutaneous angioplasty in 2 cases. Sixty-two cases were managed medically. Analysis of the 71 angiographic films of the series showed in retrospect an indication for percutaneous angioplasty in 29 patients (42 p. 100 of the series). The 5 year mortality rate was 5.6 p. 100. Death was sudden in the 4 cases observed, including one on the 28th day after bypass surgery complicated by perioperative infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Acute degenerative mitral insufficiency caused by rupture of the chordae in the elderly patient].

Five cases of degenerative mitral incompetence due to rupture of the chordae tendinae in patients over 70 years of age were reviewed to determine the clinical features of this pathology which is not rare in elderly patients. Chordal rupture usually involves the posterior leaflet and is a sign of generalised disease of the mitral apparatus of two main types: myxoid infiltration or pellucid degeneration. Although the clinical syndrome of rupture is rare (10 p. 100), the mechanism of the mitral regurgitation can be identified by 2D echocardiography with a sensitivity of 92 p. 100, and the consequences of regurgitation on the left ventricle can also be evaluated. Rapid progression to acute cardiac failure is often observed and early surgical cure may be necessary (valvular replacement with a bioprosthesis is more common than mitral valvuloplasty). Further justification for this surgical approach is the improved myocardial protection which has reduced the perioperative mortality rate to less than 10 p. 100.

Acute Disease↗
PubMed1985

[Critical study of the stress electrocardiogram after aortocoronary bypass, based on 95 coronary angiographic correlations].

This paper studies the correlations between the stress electrocardiogram and the angiographic findings after aorto-coronary bypass grafts. 95 correlations were established in 75 patients (coronary angiography and stress tests were performed on two occasions after the operation in 20 patients). 32 patients had a past history of myocardial infarction. The stress test was positive when the ST depression was equal to or greater than 1 mm, over more than 80 milliseconds. Four groups could be defined on the basis of the angiography: patient graft(s) with no residual stenosis; old or new coronary lesions; occlusion of one or more grafts; malfunction of the graft(s). The stress test and the coronary angiography were separated by a mean delay of 4.6 days. The stress test was positive in 43 cases, due to the residual postoperative stenoses in 63% of cases, due to occlusion of the graft(s) in 25% of cases and due to malfunction of the graft(s) in 9% of cases. In 3% of cases, the signs of ischaemia were due to an old infarct. The stress test was negative in 52 cases. This negative result corresponded to the 66% of cases with complete revascularisation of the coronary system; in 34% of cases, there were persistent angiographic abnormalities, consisting of uncorrectable coronary stenoses in half of the cases. When the coronary revascularisation was complete, the stress test was negative in every case. Residual coronary lesions were associated with a positive stress test in 66% of cases and with a negative test in 34% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗
PubMed1985

[Lipomyxosarcoma of the pulmonary veins extending into the left atrium. Repetitive surgical treatment].

The case reported here of a 54-year old woman with lipomyxosarcoma of the pulmonary veins successfully excised is the first in the literature. The initial symptoms were febrile left ventricular failure with pulmonary oedema and haemoptysis. The diagnosis was made by angiocardiography. The tumour was excised in two stages: cardiac first, under cardiopulmonary bypass, then thoracic with left pneumonectomy. Two years after surgery, the patient is in good condition without chemotherapy.

Female↗
PubMed1985

[Myocardial infarction caused by electric injury. Value of coronarography].

The authors report the case of a 54 year old surgeon who received an electric shock from his diathermy equipment. The shock caused an anteroseptal myocardial infarction complicated by an apical aneurysm. The clinical course was followed up by myocardial and cavitary scintigraphy. Coronary arteriography was carried out after convalescence and showed proximal occlusion of the left anterior descending artery and an apical aneurysm on ventriculography. Myocardial infarction after electrical injury is a rare event and its pathogenesis remains controversial. Although electrical currents can damage the walls of the coronary arteries, they may also have a direct thrombogenic effect. This would appear to be the most probable mechanism in the case reported in which the myocardial lesions corresponded to acute occlusion of the left anterior descending artery, perhaps favoured by the presence of an atheromatous plaque. Coronary arteriography was the most helpful investigation in assessing the physiopathology of this rare event.

Coronary Angiography↗