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Biomedical subjects

A Vacheron

Publications and source records attributed to A Vacheron.

At least 145 records · Page 8Linked to original sources
PubMed1985

[Hemodynamic effects of intravenous acebutolol in the acute phase of myocardial infarction].

The haemodynamic tolerance of intravenous acebutolol was evaluated during the acute phase of myocardial infarction. This is a beta-blocker with an intrinsic beta-stimulant effect. The study consisted of 14 patients (10 cases of inferior infarction and 4 cases of anterior infarction) with a mean capillary pressure of less than 20 mmHg and a cardiac index greater than 2 l X min-1 X m-2. The minimal dose of acebutolol was 0.05 mg X kg-1 X h-1 and the maximal dose was 0.125 mg X kg-1 X h-1. The intravenous infusion of acebutolol was commenced between 3 and 12 hours (average: 7.5 hours) after the infarction and was continued for 48 hours, at which time it was replaced by oral administration. The mean total intravenous dose was 409 mg (from 190 to 510 mg). Two patients were excluded from the protocol because of the development of 2nd degree atrioventricular block several minutes after the beginning of the infusion. The basal values of the cardiac index (2.7 l X min-1 X m-2 +/- 0.37), the mean capillary pressure (9.4 mmHg +/- 2.7) and the systolic index (38.3 ml/m2 +/- 6.4) did not change significantly during the infusion, in the 14 patients studied. The double product, heart rate x blood pressure, decreased from the mean basal value of 9,443 to 7,680 at 24 hours and to 7,000 at 48 hours (p less than 0.05). Acebutolol does not depress left ventricular function, provided that it is reserved for patients with class I or II disease according to Killip and Kimball's classification.(ABSTRACT TRUNCATED AT 250 WORDS)

Acebutolol↗
PubMed1985

[Evaluation of post-infarction disorders of left ventricular contraction by echocardiography and scintigraphy of the cardiac cavities].

The comparison in 36 patients of two-dimensional echocardiography and scintigraphy of the cardiac cavities in the steady state with left cineventriculography selective for the evaluation of anomalies in left ventricular contraction post infarction shows good agreement between these techniques for the detection of major segmental anomalies, a higher sensitivity being found for echocardiography in dyskinesis. The overall rejection fraction calculated by two-dimensional echocardiography is correlated with the ejection fraction calculated in left cineventriculography (r = 0.57; p less than 0.001). The same is true of the overall ejection fraction obtained by cavitary scintigraphy (r = 0.62; p less than 0.01). The indices of residual myocardium in the anterior wall (IRM ant) and the posterior wall (IRM post) calculated in apical echographic section for the two cavities and in left cineventriculography (oblique anterior right) are also well correlated (IRM ant: r = 0.70 and p less than 0.001; IRM post: r = 0.46 and p less than 0.01). The determination of these parameters as well as the percentage of shortening of the left ventricular small axis measured by echocardiography TM, to the smallest value, permits a valid assessment of ventricular function and makes it possible to avoid coronaroventriculography when this function is too impaired.

Adult↗
PubMed1984

[Survival of patients with triple-vessel stenosing coronary atheroma].

This study analysed the survival rate of 179 patients with triple vessel coronary artery disease, 168 men and 11 women (mean age 54 years). Seventeen cases of left main stem disease were excluded. The patients presented with unstable angina (64 cases), stable angina (66 cases), recent myocardial infarction (26 cases) or chronic invalidating angina (23 cases). Coronary bypass surgery was undertaken whenever possible (64 cases, 34% of patients). Medical therapy (115 cases) was based on betablockers (61%), amiodarone (22%) and perhexiline (17%). The study was carried out by a double questionnaire sent to the patient and treating physician, 6 months to 76 months after coronary angiography (average 30 months). The response to these questionnaires was 100%. Survival rates were calculated by actuarial methods. Comparisons of survival graphs was made using the Log Rang test. The overall survival rate was 89% at 1 year, 84% at 2 years, 82% at 5 years and 71% at 6 years. There seemed to be a lower mortality in the surgical group (p less than 0,28). The 2 year survival rate in the group with cardiac failure was 40% compared with 88% in the group without cardiac failure (p less than 0,001). There was no statistically significant difference in mortality except in patients with ejection fractions lower than 0,30. Analysis of survival with respect to mode of presentation did not show any significant difference between patients with unstable angina, stable angina or chronic invalidating angina. Mortality was higher when triple vessel disease was discovered during myocardial infarction, reaching 33% at 4 years, compared to 15% in the other subgroups (p less than 0,05).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1984

[Pheochromocytoma and aortocoronary bypass. Double surgical procedure].

Based on a personal case of a 47 year old woman with an adrenal medullary pheochromocytoma and stenosis of the left anterior descending artery treated by aorto-coronary bypass grafting after ablation of the pheochromocytoma, the authors illustrate the frequency and precocity of organic coronary artery disease in 27 cases in the literature. Chest pain and electrocardiographic changes are often attributed to functional ischaemia but the high incidence of organic coronary artery disease in the series analysed confirms the need for coronary angiography in doubtful cases. It is reasonable to start by removing the pheochromocytoma and, only then, consider coronary angiography with a view to coronary bypass surgery: the risks of a hypertensive crisis seem to be reduced when this protocol is followed.

Adrenal Gland Neoplasms↗
PubMed1984

[Enhancement of the effect of captopril in the 1st 48 hours of treating refractory heart failure. A comparison with intravenous trinitrine].

The favourable haemodynamic effects of vasodilator drugs in refractory cardiac failure sometimes alter rapidly after the initial dose. This tachyphylactic phenomenon was looked for during captopril therapy in 14 patients with chronic cardiac failure resistant to digitalo-diuretic therapy and conventional vasodilator drugs. The average age of the patients was 64,4 +/- 3,8 years. Eleven patients had signs of congestive cardiac failure while the remaining three patients had only left ventricular failure. Four patients were classified as Stage III and the other ten Stage IV of the NYHA classification. Right heart catheter studies were performed with a Swan Ganz catheter and systemic pressures were measured by femoral artery catheterisation. Right and left pressures and cardiac output were measured under basal conditions, and 1 and 5 hours after a single dose of captopril (early and late periods). Captopril was given in between meals in 3 to 6 daily doses; in 10 of the 14 cases the dose was 50 mg 6 hourly. The haemodynamic parameters were recorded again during the early and late periods after the dose of captopril 24 and 48 hours after starting therapy. Captopril is a mixed vasodilator and is effective from the first hour of administration. It preferentially lowered pulmonary capillary pressure (PCP) from 29,6 +/- 0,92 mmHg to 21,4 +/- 1,04 mmHg (delta PCP: -27,7%, p less than 0,01). Mean systemic blood pressure (MBP) fell less from 92,4 +/- 3,51 mmHg to 76,6 +/- 3,4 mmHg (delta MBP: -17%, p less than 0,01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Surgical management of late prosthetic valve endocarditis.

Among 32 patients with late prosthetic valve endocarditis selected from two cooperative retrospective studies, ten had valve replacement: six men and four women, mean age being 48 years, ranging from 23 to 65 years old. An emergency reoperation was undertaken for refractory heart failure in seven out of ten cases, with an average delay of 6.6 days after the beginning of antibiotic therapy. In the other three cases, the operation was carried out at the end of 40 days of antibiotic therapy, once for recurrent endocarditis and twice for severe aortic insufficiency. The most common causative micro organism was the staphylococcus (7 out of 10 cases). The infected prosthetic valves were, in 8 out of the 10 cases, in the aortic position. The outcome was poor as the mortality rate was 60% (6 out of the 7 patients operated on in an emergency). Death was attributed to heart failure with conduction disturbances and severe aortic regurgitation (2 cases), cerebral emboli (2 cases), septicopyemia (2 cases). Four patients of the ten, after a mean follow up of 10 months, are cured without prosthetic valve dysfunction. The extreme gravity of prognosis seems related to the microorganism (staphylococcus), to the delay between the beginning of antibiotic therapy and the onset of the fever, and finally to the extension of destructive lesions under the prosthetic valve implantation base; the reimplantation of the prosthesis on frail and abscessed tissue implies a substantial risk of disinsertion. The indications for systematic early reoperation in cases of severe acute heart failure are discussed.

Adult↗
PubMed1983

[Secondary prevention of myocardial infarct with beta blockers].

At the present time, the mortality during the first year following an acute myocardial infarction is in the order of 10%. It subsequently drops to 4 or 5% per year. In more than one half of cases, the death of a postinfarct patient is sudden, with the major cause being ventricular fibrillation. These patients are also threatened by another risk: recurrent infarction. For Kannel, its incidence is 13% in men and 40% in women within 5 years of the first infarct. Its mortality is higher than that of the first infarct. Beta-blockers and calcium blockers reduce the myocardial oxygen consumption by a variety of mechanisms: beta-blockers block the beta-adrenergic receptors and calcium blockers inhibit the entry of calcium into the myocardial cells. Apart from their action on the process of excitation-contraction of myocardial fibres, the calcium blockers have also an action on the coronary vessels where they suppress or prevent spasm, and on peripheral arteries, where they cause vasodilatation thereby reducing the left ventricular afterload. The anti-ischaemic activity of these molecules is demonstrated by the reduction or elimination of angina, by the improved cardiac performance during stress test and by myocardial isotopic scans. The beta-blockers have other beneficial effects, in particular, antiarrhythmic and antiplatelet aggregation related to the neutralisation of catecholamines. Their antihypertensive action is also useful in coronary patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1983

[The classic anti-anginal agents and molsidomine].

In the face of the recent introduction of beta-blockers and calcium inhibitors, the author examines the role of Amiodarone, Perhexiline and Molsidomine in the treatment of angina pectoris. Amiodarone, introduced in 1967, remains a very useful anti-anginal drug. The beta and alpha-sympathetic inhibition it produces, makes it effective in effort and resting angina. It is particularly useful in anginal patients with arrhythmias as it has a potent anti-arrhythmic effect at all levels. It can be used in patients with bronchial asthma, in elderly patients and in cardiac failure. However, it may give risk to hypo or hyperthyroidism and so, should not be used in patients with a history or thyroid disorders. Perhexiline has been used in France since 1973 and is a second-line drug to be used in cases of intolerance or contraindications to other anti-anginal drugs. It is effective but may cause severe, undesirable hepatic and neurological complications. These side effects are however rare at low doses. Molsidomine, a more recent molecule, has an action similar to that of the nitrate derivatives: it mainly reduces left ventricular preload. It has a slower onset of action than the classical nitrate derivatives but its duration of action seems to be longer; Molsidomine and betablockade can be a useful therapeutic association.

Amiodarone↗
PubMed1983

[Cardiac complications of radiotherapy].

Radiotherapy is an effective tool in the treatment of thoracic cancers. However, radiotherapy also carries a risk of severe cardiac complications. The cancers most commonly concerned are Hodgkin's and non-Hodgkin's lymphomas (90 per cent of cases), breast cancers, especially on the left side (4 per cent) and bronchogenic cancers (2 per cent). Ionizing radiation can damage the three layers of the heart and the coronary arteries. Pericardial involvement is the most frequent, occurring in 10 to 12 per cent of cases. It generally occurs 6 to 18 months after the radiotherapy and may present either acutely (35 per cent of cases) or chronically (65 per cent of cases). It is often latent, only detected on X-rays or on ultrasound. Constrictive forms can occur, which require pericardiectomy. Myocardial fibrosis, which is anatomically common, may present as disturbances of repolarization, arrhythmia or disturbances of conduction, or even cardiac failure. Rarely, radiation damage of the coronary arteries can cause angina or myocardial infarction. These cases can benefit from coronary artery by-pass grafts. All of these lesions have a common anatomical denominator:fibrosis, which develops progressively following the radiotherapy. It has now been demonstrated that the incidence of cardiac radiation lesions can be reduced by homogeneous distribution of the dose of radiation administered to the mediastinum, by treating each side alternately, by fractionating the radiation and staggering the sessions and by reducing the cardiac mass which is irradiated.

Adult↗
PubMed1982

[Rupture of a post-infarct ventricular aneurysm. Apropos of 3 cases cured surgically].

The authors report 3 cases of post-infarction left ventricular aneurysm with localised rupture into the pericardium. The patients (3 men aged 54, 58 and 67 years old) had left ventricular aneurysms (2 anterior, I posterior) which ruptured early, between the second and tenth week. All presented with cardiogenic shock. The diagnosis was made by 2D echocardiography (I case) or by pericardial aspiration and angiography (2 cases). Good results were obtained by surgical evacuation of the hemopericardium and resection of the ventricular aneurysm with a follow-up of 3 to 12 months. The rarity of these cases is underlined: only three other similar cases appear to have been previously reported.

Aged↗
PubMed1980

[Bridge grafting between the ascending and lower thoracic aorta using the right side approach (author's transl)].

We describe a method aimed at reconstituting the thoracic aorta by means of a graft located on the right side of the heart. The method is original in that the graft is entirely intra-thoracic and not thoraco-abdominal, as in previously reported similar operations, its advantages are demonstrated by reference to one case where it was used for the treatment of a relapsed congenital atresia of the aortic arch.

Adolescent↗
PubMed1980

[Study of coronary perfusion by radioisotopes].

The study of coronary blood flow by radio isotpopes may determine the casual relationship between coronary artery narrowing and myocardial ischemia. Total coronary flow is measured without cardiac catheterisation by double counter technique using 84 Rb and by radionuclide angiography using 42 K and 113m in fixed on siderophilin. This is an easier method, which is very reproductible and which may be sensitised by atrial pacing. The measurement of regional coronary flow gives a better estimation of the physiological effects of coronary artery disease. Two indicators are used; radioactive gases (113 Xe and more recently 81 m Kr) and microspheres tracers. Selective coronary injection of biodegradable microspheres labelled with 99m Tc and 113m In may be used to assess the hyperemic reaction in the coronary arteriolar territory to the triiodide contrast media used in coronary angiography, and to estimate the reserve coronary blood flow. The transmural perfusion may be studied in animal experiments with non-biodegradable microspheres. Tomographic techniques should allow quantification of myocardial perfusion in man.

Animals↗
PubMed1980

[Induced coronary spasm: immediate revascularization by the opposite coronary artery. Use of myocardial scintigraphy].

The case reported analyses the instantaneous revascularisation distal to a coronary spasm by electrocardiography and thallium scintigraphy. The patient, a 48 year old man, had an 18 months history of spontaneous anginal chest pain sensitive to trinitrin. No electrocardiogrammes had been recorded during an attack. Coronary angiography was normal apart from a slight reduction in calibre of a dominant right coronary artery. Injection of 0.4 mg methylergometrine provoked an occlusive spasm of this artery after 4 minutes. At the same time the patient experienced angina and 4,5 mm depression of the ST segment, without ST changes in D3 and AVF, was observed. Opacification of the left coronary artery during spasme of the right showed retrograde revascularisation of the posterior interventricular artery which was reversed when the coronary spasm was terminated with trinitrin. Thallium scintigraphy was performed during another spasm provocation test four days later which gave identical clinical and electrical changes. A zone of hypofixation with blurred limits over the inferior myocardial wall was demonstrated. In the absence of ST elevation and of lacuna on myocardial scanning, the myocardial ischaemia induced by this occlusive spasm could not be considered to be total. Therefore the immediate revascularisation of the coronary artery in spasm seemed to have played the role of an effective collateral circulation.

Angina Pectoris↗