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Biomedical subjects

C Cabrol

Publications and source records attributed to C Cabrol.

At least 217 records · Page 12Linked to original sources
PubMed1984

[Surgical atrioventricular disconnection in Wolff-Parkinson-White syndrome].

Surgical atrioventricular disconnection is a possible means of treating patients with severe paroxysmal arrhythmias resistant to medical treatment due to the Wolff-Parkinson-White syndrome. Between 1971 and April 1982 we operated 50 patients (38 men and 12 women) with the WPW syndrome. Thirty seven patients were operated for arrhythmias (paroxysmal tachycardia) resistant to medical therapy or with a high risk of sudden death. Thirteen patients had associated cardiac disease with less severe arrhythmias (aortic valve disease: 6 cases; mitral and aortic valve disease: 3 cases; mitral valve disease: 3 cases, and atrial septal defect: 1 case). The causes of paroxysmal tachycardia were atrial fibrillation (13 cases), atrial flutter (2 cases), orthodromic reciprocating tachycardia (30 cases), with associated atrial fibrillation in 9 cases, and with associated atrial flutter in 4 cases. Antidromic reciprocating tachycardia was present in 2 cases. In 3 cases, the preexcitation was a chance finding. Electrophysiological studies performed before and after antiarrhythmic drug administration showed type A WPW (LV preexcitation) in 23 cases, and type B WPW (RV preexcitation) in 20 cases. The ECG was normal in the horizontal plane in 7 cases. The atrioventricular accessory pathway was permeable in both directions in 39 cases; in 9 cases the pathway was permeable only in the retrograde direction and in 2 cases it was permeable only in the anterograde direction. In 7 patients an atrio-hisian short circuit was demonstrated. The site of the accessory conduction pathway was located by epicardial mapping, the first surgical stage, in the left lateral region of the atrioventricular junction (28 cases), in the right lateral region (6 cases), in the posterior septal region (15 cases) (right sided in 4 cases, left sided in 11 cases), and in the anterior septal region (1 case). The accessory pathway (so-called Bundle of Kent) was interrupted by atrioventricular disconnection. Six patients died during surgery, mainly at the beginning of the series; the operative risk is now low (1 death in the last 34 cases: 2,95%). Complete interruption of the accessory pathway was obtained in 38 cases, 1 of which had to be reoperated. Three patients had an incomplete result due to partial interruption or the presence of a second accessory pathway. However, these patients no longer have severe arrhythmias. Surgical section failed in 3 cases, but the patients are now controlled by medical therapy.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

[Heart transplantation. Experience at La Pitié hospital. Apropos of 82 cases].

Since 1968, 320 patients with severe irreversible myocardial failure, have been referred to our department for transplantation; 78 p. 100 had dilated cardiomyopathies; 14 p. 100 had ischaemic heart disease and 8 p. 100 had valvular heart disease. One hundred and five patients had absolute contra-indications and were excluded (pulmonary hypertension, diabetes, gastro-duodenal ulcer, age, or other major organic disease). Of the remaining 215 patients, only 82 were transplanted because of the limited number of available donor hearts. The most commonly used technique was orthotopic grafting as described by Lower and Shumway; Barnard's method of heterotopic grafting was used in 1 case and a block heart and lung transplantation by Reitz and Shumway's method was performed in 3 cases. The main postoperative complications, apart from technical problems (7 deaths), were related to rejection (107 episodes, 27 deaths), infection (82 episodes, 13 deaths), atherosclerosis of the graft (4 cases, 2 deaths, 1 retransplantation) and malignant tumours (3 deaths). After transplantation, 82 p. 100 of patients were discharged after an average hospital stay of 2 months; 47 p. 100 survived the first year and lead almost normal socio-professional activities. Thirty patients are still alive, the longest postoperative survival being 9 years. Significant advances have been made in the last 3 years. Classical immuno-suppressor therapy (steroids, azathioprine, horse antilymphocytic serum) has given way to more effective antilymphocytic sera and more powerful immuno-suppressor drugs (cyclosporine A). This treatment has greatly changed the postoperative course of events. Rejection phenomena, though still as common, are much less serious and, above all, more insidious.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Open-heart surgery in patients over 65 years of age. Lesions encountered and immediate postoperative mortality].

Open heart surgery after 65 is more and more frequent (16% of our surgical cases). Between January 1971 and December 1982, 8 425 open heart operations were performed in this Department, 1 377 of them in patients over 65. Most were cases of aortic valvulitis (620), and calcific aortic stenosis in particular, but also dystrophic aortic insufficiency; 217 patients underwent surgery for mitral valvulitis (rheumatic or dystrophic in origin) and 84 for involvement of more than one valve. Of the 2 440 patients with coronary lesions who underwent surgery, 255 were over 65; beyond this age, a higher rate of association between coronary lesions and valvular disease was found (167 patients undergoing surgery). Surgical mortality (during the first postoperative month) was higher after 65: 11.1% in patients with valve disease, and 11.4% in those with coronary artery disease, whereas in patients under 65 the figures were 6.5% and 4% respectively. On the other hand, in those undergoing surgery for combined valve and coronary disease, mortality over 65 was hardly any higher than under 65 (13.7% as against 10.4%). This justifies screening for coronary artery disease in any candidate for valve surgery aged over 65. These results were achieved thanks to some technical and anaesthetic precautions, and though they may be less satisfactory than those for younger patients, they justify such surgery for all lesions that threaten survival in the short term.

Aged↗
PubMed1983

[Intraoperative insertion of a catheter to measure left atrial pressure].

In the procedure described an ordinary intravenous catheter with its normal trocar is passed through the abdomino-thoracic wall, and the trocar is removed. Another trocar with a longer (3 cm) bevel is then introduced into the heart, the long bevel ensuring that the trocar is in the lumen of the left atrium only. The tip of the catheter, slightly bevelled in situ, is pushed into the atrium along this second trocar, which is then removed. This simple and safe technique facilitates measurements of left atrial pressure during the post-operative period in open-heart surgery.

Atrial Function↗
PubMed1983

[Heart transplantation. Current status at La Pitié Hospital].

Since 1972, 280 patients with severe irreversible myocardial damage have been referred to La Pitié Hospital, Paris, for heart transplantation; 95 were excluded on account of absolute contra-indications. Owing to the limited number of available transplants, only 66 of the 185 remaining patients were transplanted. Transplantation was orthotopic in all but 3 cases: 1 patient had heterotopic transplantation and 2 had heart-lung transplantation. The most common post-operative problems were graft rejection and complications of the immunosuppressive treatment; 82% of the transplanted patients were discharged 2 months on average after surgery; 47% overcame the first year problems and resumed an almost normal social and professional life; 21 are still alive, one of them after 9 years. During the last 2 years, technical refinements and the advent of more potent immunosuppressive agents (anti-lymphocyte serum from rabbits, cyclosporin A) and better diagnostic methods (repeated endomyocardial biopsies and immunological surveillance) have resulted in considerable improvement in the patients' outcome, with an actuarial survival rate of 77% at one year and 70% at two years. Since transplants are now better tolerated after the second year and since they possess remarkably good and durable functional properties, this reduction in early and late mortality, which used to be the main cause of failure, raises hopes of a marked increase in prolonged and satisfactory survival.

Cardiomyopathies↗
PubMed1983

[Intra-atrial implantation of the mitral valve].

Infectious lesions of the mitral ring sometimes cause so much damage that insertion of the prosthesis in its normal place is impossible. In such cases, artificial valves with a dacron flange can be implanted into the left atrium, just above the mitral ring, and sutured to the atrial wall. These valves are generally used in first or second reoperations for recurrent desinsertion, but they have proved so reliable that their use can be extended to primary mitral valve replacement in cases where extreme calcification of the mitral ring throws considerable doubt on the success of conventional techniques.

Bioprosthesis↗
PubMed1983

Acute lymphoblastic leukemia in two children with a congenital chromosome anomaly: familial inv(11)(p15q13) in one and ring chromosome No. 21 in the other.

A congenital chromosome abnormality was found in two unrelated children with acute lymphoblastic leukemia (ALL). In the first case, a pericentric inversion of chromosome No. 11, inv(11)(p15q13), was observed and discovered to be familial, being present in five other members of the family over two generations. In the second case, the presence of a congenital ring chromosome No. 21, 46,XX,r(21), was considered to be the result of a de novo mutation. The possible relation between these congenital chromosome anomalies and a predisposition to neoplasia is discussed and could be explained by different mechanisms: (1) amplification of oncogenic determinants by gene duplication, and/or (2) alteration of the effects of wildtype alleles through deletion or changes in position.

Bone Marrow↗
PubMed1983

[Aortic insufficiency and Takayasu disease].

Six cases of this rare association (7 to 10 p. 100 of Takayasu's disease) are reported. The authors also review 73 previously reported cases. The valvular lesion is usually detected secondarily during follow-up (2/3 of cases), but is observed at the same time as the arterial disease in about 1 out of 5 cases. In rare cases, it may be the presenting feature before the vascular disease becomes clinically apparent. Quantification of the regurgitation may be difficult because of stenosis of the thoracic aorta and the supra aortic vessels. In some cases it is severe and poorly tolerated but has no particular distinguishing features apart from the incidence of aortic wall calcification (ascending aorta to all of the aortic arch). Twenty five anatomical observations (operative or autopsy) are sufficiently well documented to show the mechanism of the aortic incompetence. It is caused by an inflammatory aortitis: valvular lesions were found in 2/3 of cases but other causes may be observed, dilatation of the aortic ring (1 out of 4 cases), disunion of the commissures (1 out of 4 cases) and changes in aortic compliance causing systolic hypertension. Aortic valve replacement is rare (11 cases including 3 personal cases) and sometimes completed by resection of an aneurysmal ascending aorta.

Adolescent↗
PubMed1983

[Heart transplantations. Current status. Experience at the Hôpital de la Pitié].

The experience gathered over the last fifteen years of clinical application of heart transplants has resulted, in the last two years, in much improved results:the survival in our series is 77% at one year and 70% at 2 years. This progress is due to the following factors:improved patient selection, with strict respect of contraindications, in particular, patients over the age of 50 and patients with advanced multi-system failure; improved selection of donors, avoiding, within the limitations of immunological compatibility, grafts in poor condition from subjects over the age of 35 and a refinement of the operative techniques, especially the introduction of more potent immuno-suppressants such as Cyclosporin A and improved post-operative monitoring based on immunological examinations and repeated endo-myocardial biopsies. These advances will lead to a broadening of the operative indications and a wider use of this form of treatment.

Adolescent↗
PubMed1983

[Recurrent ejection of aortic valve prostheses. Apropos of 22 case reports].

Twenty two cases of recurrent perivalvular leaks in aortic valve prostheses were reviewed in a multicentre cooperative study. From 1963 to 1978, 22 patients, mean age 39 years, underwent aortic valve replacement; 18 patients had aortic regurgitation, 6 due to infective endocarditis, and 4 patients had calcific aortic stenosis. Eight Starr-Edwards, 6 Smeloff-Cutter, 2 Braunwald-Cutter, 3 Björk, 1 Lillehei-Kaster and 2 bioprostheses were inserted. All 22 patients had to be reoperated for perivalvular leaks due to active or previous infective endocarditis in 7 cases. The prostheses implanted (3 reinsertions, 19 valve replacements) were 10 Starr-Edwards, 4 Smeloff-Cutter, 5 Björk, 1 Lillehei-Kaster, 1 Magovern and 1 bioprosthesis. All 22 patients had further perivalvular leaks, 6 caused by infective endocarditis, and 15 patients underwent a third operation. The prostheses implanted this time (2 reinsertions, 13 valve replacements) were 4 Starr-Edwards, 3 Smeloff-Cutter, 7 Björk and 1 bioprosthesis. Four patients had a third perivalvular leak, and 2 patients a fourth perivalvular leak. The first and second episodes of perivalvular leak were detected early in over half the cases. They were associated with cardiac failure, angina and hemolysis in 20 to 45% of cases. The average period between the first and second operations, and the 2nd and 3rd operations were 15 months and 9 months respectively. Overall, 11 patients died (50%), 4 due to cardiac failure and 3 of sudden death; 3 patients have been lost to follow-up (14%), and there are 8 survivors (36%) with a mean follow-up period of 5 years. However, the mortality rate when the cause of perivalvular leak was infective, was 82%, and only 18% when the cause was mechanical. The factors which favour recurrent perivalvular leaks are infection (30% of cases) and technical difficulties related to the poor quality of the aortic ring (calcification, dystrophy or dilatation). The prevention of this complication depends on careful peroperative technique, the use of certain surgical bypass techniques, a constant battle against infection, and regular examination of operated patients.

Adult↗
PubMed1983

[Recurrence of mitral disease after commissurotomy. Criteria influencing operative mortality during reintervention using extracorporeal circulation].

Reoperation for secondary deterioration after mitral commissurotomy is associated with a higher immediate postoperative mortality than other open heart operations. We analysed the factors responsible for this increased mortality. A total of 232 patients reported for clinical deterioration after closed heart mitral commissurotomy were reviewed. Mitral valve prostheses were implanted in 202 cases; open heart commissurotomy was possible in 30 cases. Associated procedures included 14 tricuspid valve replacements, 53 tricuspid annuloplasties and 30 aortic valve replacements. The global mortality was 12 p. cent (30 deaths). The causes of death were myocardial failure (19 cases), cerebrovascular accidents (4 cases), prosthetic valve thrombosis (4 cases), infection (2 cases), section of the mitral annulus (1 case). The clinical hemodynamic and anatomical criteria influencing the operative prognosis were analysed: 1. Operative mortality was related to the clinical stage (zero mortality at Stage II, 10,3 p. cent at Stage III, 38 p. cent at Stage IV, p less than 0,001); 2. There was a significant correlation with cardiothoracic ratio: 23 p. cent mortality when greater than 0,60; 9,8 p. cent mortality when less than 0,60 (p less than 0,02); 3. There was a significant correlation with cardiac index: 19 p. cent mortality when less than 21; only 9 p. cent mortality when greater than 21 (p less than 0,04); 4. There was a significant correlation with systolic pulmonary arterial pressure: mortality of 11 p. cent when less than 60 mmHg; mortality of 22 p. cent when greater than 60 mmHg (p less than 0,06). 5. The presence of tricuspid regurgitation increased the operative risk (mortality rose from 12 to 22 p. cent, p less than 0,05) when the surgeon detected moderate or severe tricuspid regurgitation. These results show that the clinical, radiological and hemodynamic aggravation of these patients has a bad influence on operative mortality. This aggravation is not related to the delay between the initial commissurotomy and reoperation but to the delay between the recurrence of symptoms after the first operation and reoperation. Operative mortality was 12 p. cent when this delay was less than 10 years but 23 p. cent when the delay was over 10 years (p less than 0,02). Our findings suggest that these patients should be reoperated earlier if the prognosis of this type of surgery is to be improved.

Adolescent↗
PubMed1983

[Value of C-reactive protein in the cardiac postoperative period].

Twenty patients underwent special clinical and biological monitoring during their period of hospitalisation in the Department of cardiovascular surgery. The clinical monitoring concentrated on the patient's temperature and the search for postoperative complications; the biological part of the study was concerned with monitoring the levels of serum C-Reactive protein (CRP) as assessed by an immuno-nephelometric method. In 10 patients with a normal postoperative course the levels of this protein, an indicator of an inflammatory or infective process, were similar, giving an identical graph in all patients. On the other hand, in the 10 patients with inflammatory or infective postoperative complications, the levels of CRP were abnormal, parallel with the clinical state, sometimes rising even before the complication manifested itself clinically. It therefore seems useful and justified to measure CRP systematically, once before surgery and at least once daily in the postoperative period. The frequency of this investigation could be increased in patients with difficult or complex postoperative courses. A high CRP, even with a normal temperature, should alert the surgeon to a complication or to the inefficacy of anti-inflammatory or anti-infective therapy. These results confirm those published by other surgical teams, both in cardiovascular surgery and traumatology.

C-Reactive Protein↗
PubMed1983

[Evolution of myocardial temperature following cardioplegia with and without complementary pericardial cooling. Experimental study].

Myocardial temperatures were measured after cardioplegia during cardiac surgery with and without pericardial cooling by a cold bath. Eight animals (50 kg pigs) were placed on cardiopulmonary bypass using a protocol reproducing clinical operating conditions as closely as possible: myocardial mass, median sternotomy, general hypothermia at 25 degrees. Two injections of cardioplegic solution were administered, one at aortic clamping and the other, 30 minutes later. Four animals (Group A) were used as reference. The four animals in Group B underwent pericardial irrigation with serum at 4 degrees C. Myocardial temperatures were measured at 9 anatomical sites every 10 minutes, (a total of 1008 measurements) and compared statistically. The results in the control group showed that myocardial warming after cardioplegia was intense and rapid at all sites. The sub-epi and sub-endocardial temperatures rose from 7 to 24 degrees in 30 minutes, and in the first 10 minutes, a rewarming of 8,5 degrees was observed. When pericardial cooling was used with cardioplegia, myocardial refrigeration was improved. The temperature remained below 15 degrees C (p less than 0,05 compared with Group A). Only a 3 degrees rise in temperature was observed at the 10th minute after cardioplegia (p less than 0,001). The rise temperature was of 2 degrees at the 20th minute, and 1 degree at the 30th minute. All temperatures remained below 15 degrees C (p less than 0,01). The authors emphasise the benefits of pericardial irrigation associated with cardioplegia for constant, durable and stable myocardial protection by cooling.

Animals↗
PubMed1983

[Acquired interventricular communication and false left ventricular aneurysm caused by non-penetrating trauma of the thorax].

A 48 year old man, victim of a serious road traffic accident (multiple limb fractures, closed trauma of the left hemithorax) was immediately diagnosed as having a systolic regurgitant murmur. The initial ECG recordings showed anterior subepicardial ischemia, and later, a low antero-septal and apical infarction. The hemodynamic status progressively deteriorated, leading to catheterisation 7 months after the accident showing an inferiorly situated VSD (oxymetry and dye dilution techniques). Angiography visualised the traumatic rupture of the lower part of the septum and an inferior posterior left ventricular aneurysm. AT surgery, the septal rupture was repaired by a Dacron patch and a false aneurysm was plicated. The patient was asymptomatic after surgery, and control catheterisation and angiography one year later showed the absence of a residual shunt and good movement of the inferior posterior left ventricular wall. The lesional mechanisms associated instantaneous septal rupture by deceleration, contusion of the apex and progressive development of an inferior posterior wall false aneurysm.

Diagnosis, Differential↗
PubMed1983

[Surgical treatment of patent ductus arteriosus in adults].

The surgical treatment of patent ductus arteriosus (PDA) in adults as in children, usually comprises section and suture, but a certain number of technical precautions must be taken. The aortic wall is often fragile due to atheromatous lesions which are more common with increasing age. Associated hypertension may add to the fragility. Controlled medicated hypotension and reinforcement of sutures with a piece of pericardium may be useful in reducing the risk of haemorrhage. It is sometimes necessary to use partial femoro-femoral cardiopulmonary bypass circuit. The presence of an aneurysm at the aortic end of a calcified ductus necessitates the same precautions. When PDA is complicated by pulmonary hypertension, the surgical indication can only be considered when the left-to-right shunt remains voluminous and when pulmonary artery pressures fall significantly during catheter or peroperative trials of closure. The operative risk in these cases increases with age. Cardiopulmonary bypass may also be very useful in these cases. Secondary repermeabilisation of an operated ductus, and cases complicated by endocarditis require an endopulmonary approach under cardiopulmonary bypass because of the fragility of the ductus region and difficulty in controlling haemorrhage. This technique is also preferred when an associated intracardiac malformation is to be corrected. Between 1965 and 1981, 37 patients were operated in the department of thoracic and cardiac surgery at the Pitié Hospital. The ages ranged from 20 to 65 years with a mean of 34 years. Cardiopulmonary bypass was necessary in 5 cases, (partial in 4, and total in 1 case of endoaortic closure).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗