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Biomedical subjects

A Watel

Publications and source records attributed to A Watel.

At least 37 records · Page 2Linked to original sources
PubMed1986

[Surgery of acquired heart valve diseases in France: developments in a 10-year period. A multicentric study].

A multicenter study compares the surgery of acquired valvular diseases in France in 1974 and 1984. This study concerns etiology, surgical procedures and postoperative results within 3 months after operation. 2718 observations issued from 20 medical and surgical centers are divided in 2 groups: the first includes 856 patients who underwent surgical operation in 1974, the other group with 1862 patients was operated on in 1984. Significant differences may be observed. The mean age is higher in 1984 (55 vs. 47 years); the rheumatismal etiology decreases from 50.2% in 1974 to 35.1% in 1984; the degenerative and dystrophic causes increase from 13.8% in 1974 to 32.9% in 1984; while the monovalvular mitral lesion is more frequent (42%) than the aortic one (32.7%) in 1974, the proportion is reversed in 1984 where 47% aortic and 34.5% mitral lesions are found; the number of surgical treatments of mitral stenoses in 1984 is half of those in 1974, but the number of surgically treated aortic stenoses and mitral regurgitations is double of those in 1974; the preoperative examination includes left-side heart catheterization in 81.1% and coronary angiography in 64% of surgically treated patients en 1984, the respective percentages en 1974 being 57.8% and 16.1%. In 1974, 27.6% of patients are in a preoperative functional stage I or II, in contrast to 42.8% in 1984. Mitral commissurotomy represents 29.3% of mitral surgery in 1974 (25.6% of them with closed operation), the respective percentage in 1984 being only 10.5% (2.5% of them with closed heart operation).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Hematologic changes induced by extracorporeal circulation].

The plasma and cellular changes seen during the use of extracorporeal circulatory circuits define the system's degree of haemocompatibility. Heparin is still very much used to prevent activation of the blood clotting mechanisms and to reduce their effects. The fall in concentration of the clotting factors and their inhibitors is usually moderate; it is due to haemodilution, particularly important in cardiac surgery and during plasma exchanges. Fibrinolysis is often activated. In cardiac surgery, it is seen in nearly 20% of cases straight after the end of the ECC, and in nearly 80% of cases during the ECC. In all cases of resin haemoperfusion, there is an early transitory fibrinolytic burst, seen only rarely during haemodialysis and plasma exchanges. This phenomenon is usually well controlled by the natural inhibitors; it can be prevented by antifibrinolytic drugs. Cellular changes show the same trends during cardiac surgery, haemoperfusion and haemodialysis. Thrombopaenia is seen within a few minutes starting of ECC. It is caused by platelet activation, with aggregate formation; these are then trapped by the microcirculation. Leukopaenia occurs at the same time, later followed by rebound; complement activation could be the main cause by forming aggregates of polymorphonuclear cells and monocytes. Intravascular mechanical haemolysis reaches significant levels only in a few cardiac surgical procedures. The great speed of activation of the plasma and platelet enzyme systems by the ECC circuits explains these early changes. They are not only due to direct effects of the physiological circulatory characteristics and to contact with artificial surfaces, but also to plasma-cell interactions and to the patients' reaction to these first alterations.

Blood Cell Count↗
PubMed1984

[Use of intraluminal dilatation catheters in the surgical treatment of pulmonary atresia with intact septum].

Despite considerable progress in surgery and intensive care and the advent of prostaglandins, pulmonary atresia with intact ventricular septum remains a severe heart disease. The authors describe a technique of pulmonary valve plasty across the right ventricule, using dilatation balloon catheters for peripheral arteries. This technique proved successful after a 4 to 12 months follow-up in 2 out of 4 neonates who underwent surgery. It is fast, causes little damage to the right ventricle and could be improved by using catheters specifically designed for this type of surgery.

Angioplasty, Balloon↗
PubMed1984

Experience with 813 aortic or mitral valve replacements with the Carpentier-Edwards bioprosthesis: Five year results.

813 patients underwent aortic (AVR) or mitral valve replacement using the Carpentier-Edwards bioprosthesis from 1976 to 1983. Operative mortality was 5.49% for AVR and 4.59% for MVR. Late mortality and complications were classified using criteria described by the Stanford Group. Actuarial survival at 5 years was 87.9% +/- 2.7% for AVR and 91.1% +/- 1.4% in MVR. Thromboembolism occurred at low rates of 0.48% pt yr for AVR and 0.90% pt yr for MVR. 98.2% +/- 0.90% of AVR and 96.9% +/- 1.3% of MVR pts were free from thromboembolism at 5 years. The low incidence of thromboembolism during the early postoperative period played a role in the low rates observed in the complete study. There was no valve thrombosis. Anticoagulation with warfarin was used in 35% AVR and 75% MVR with rates of bleeding complications of 1.20% pt yr and 1.10% pt yr. Overall valve failure rate was 2.04% pt yr at 5 years for AVR and 1.55% pt yr for MVR. Rates of reoperation for tissue failure remained low (0.24% pt yr for AVR and 0.32% pt yr for MVR). The advantage of a low rate of thromboembolism was not outweighed by the specific problems of bioprosthesis at 5 years.

Actuarial Analysis↗
PubMed1983

[Acute lymphoblastic leukemia with major eosinophilia. Inaugural cardiac insufficiency, endocarditis grafting and valve replacement].

Acute lymphoblastic leukemia (cytologically typical) was diagnosed in an 18-year-old man presenting with major eosinophilia. Prednisone therapy was initiated but sudden congestive heart failure occurred (left ventricular insufficiency with pulmonary edema). Concomitantly, blood counts became normal. Remission of the leukemic process was obtained while severe mitral regurgitation developed, due to bacterial endocarditis. Successful mitral valvuloplasty was achieved. Remission is still persisting one year after diagnosis.

Adolescent↗
PubMed1983

[Value of vasodilators in decreasing the afterload during infrarenal abdominal aorta cross-clamping].

Adverse effects of aortic crossclamping (A. C. C.) have been shown by a retrospective study and a literature review. A. C. C. results in increased afterload with ensuing left ventricular function alteration and low cardiac index (C. I.). 15 P. T. S. sustaining an operation with A. C. C. below the renal arteries were studied. A Swan-Ganz catheter was positioned with recording of pressures, including radial artery pressure and repeated cardiac output determinations. Prior to A. C. C., vascular filling and nitroprusside (N. P.) infusion improved hemodynamic conditions. Increase of C. I. (1.8 to 2.8 l/mm-1/m2) was observed with important decrease in peripheral vascular resistance (from 2,346 to 1,425 dyne/s-1/cm-5), pulmonary capillary pressure was lowered slightly and heart rate as well as mean arterial pressure remained stable. During A. C. C., rate of N. P. infusion was increased to maintain stable arterial pressure. Hemodynamic improvement observed prior to A. C. C. was maintained.

Aged↗
PubMed1982

[Surgical treatment of Prinzmetal variant angina. Coronary artery by pass and plexectomy (author's transl)].

Aorto-coronary by pass, widely accepted in the treatment of patients with coronary artery disease is still controversial in the treatment of Prinzmetal variant angina. Recurrence of attacks, occlusion of grafts and post-operative infarction were frequent by described and seem to be related with the persistence of coronary spasm. Authors propose the association of myocardial revascularization and coronary denervation by resection of periaortic plexi. Results of 50 surgical plexectomies associated with coronary by pass appear far better than by pass alone (mortality 4%, myocardial necrosis 4%, persistence of attacks 4%).

Adult↗
PubMed1982

[The long term results of reparative surgery for aorto-iliac stenosis and chronic obstruction. 563 cases followed up for 2 to 13 years (author's transl)].

The results of surgery for aorto-iliac obliterative arterial disease deteriorate progressively over 10 years to leave only 44% good results, 39% deaths, 3% poor results and 14% amputations. Nevertheless, the quality of the surviving patients is satisfactory with 72% good functional results at 10 years and a permeability rate of 76% of reparative procedures at the same period. It is certain that current improvements having resulted in a decrease in early mortality will affect the long-term results in view of the tendency to horizontalisation of graphs beyond the first six months.

Aged↗
PubMed1981

[Circulating anticoagulant and open heart surgery (author's transl)].

Two patients presenting an unsettled mitral cardiopathy had to receive a valve replacement under cardiopulmonary by-pass in spite of a circulating anticoagulant with antiprothrombinase activity. A higher risk of thromboembolic trouble required an increase of heparin administration, under a strict biological control. Nevertheless both patients died: the first of coronary thrombosis, the second of cataclysmic bleeding, associated to severe and diffused thrombosis. Thus it is essential to insist upon the risk occurred by those patients and the difficulty of adaptation and control of heparin administration.

Blood Coagulation Disorders↗
PubMed1981

[Mediastinal pseudo-tumor from portal hypertension (author's transl)].

A radiological opacity of the posterior and inferior mediastinum should evoke a lesion of vascular origin. The venous nature of the mass can be easily confirmed by morphological changes apparent during the respiratory cycle and changes in position. Investigations to establish etiology of this venous ectasia arising from the azygos vein require more extensive radiological examinations, and computed tomography may be of value. Portal hypertension is one cause of increased venous blood flow in the azygos systems, and should be systematically considered.

Azygos Vein↗
PubMedDate not supplied

Treatment of lymphorrhea with exposed or infected vascular prosthetic grafts in the groin using sartorius myoplasty.

Thirteen myoplasties using the sartorius muscle were performed on 12 patients from 1980 to 1985 for "healing problems" in the groin with subjacent synthetic grafts. Persistant aseptic lymphorrhea was the indication for 4 patients. In 3 other cases, bacterial cultures from the wound were positive. In 2 other patients there was clinical evidence of sepsis with purulent discharge from the wound and an exposed graft. In 3 cases myoplasty was used as a preventive measure after reoperation on patients in poor general condition. Follow-up extends from 3 to 54 months. There was only one recurrence observed at 19 months which was successfully treated by segmental resection of the infected graft and insertion of a new prosthesis through the obturator canal. No recurrence was observed among the other patients as judged by clinical observation and biological tests for inflammation, echotomography, CT scan and indium scintigraphy. The treatment of choice for an infected prosthesis should be removal of the graft and extra-anatomic bypass in the majority of cases. However in some situations, excision of the wound and myoplasty using the sartorius muscle may be of some value and needs further evaluation.

Blood Vessel Prosthesis↗