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Biomedical subjects

C Cabrol

Publications and source records attributed to C Cabrol.

At least 91 records · Page 5Linked to original sources
PubMed1991

Cardiac tumors: clinical experience and surgical results in 74 patients.

A series of 75 cardiac tumors in 74 patients were operated on at La Pitie Hospital between 1972 and 1989. There were 73 primary and 2 metastatic tumors. Among the benign neoplasms, 58 were myxomas; seven of the nine malignant tumors were primary heart tumors. The mean age of the patients was 48 years (range, 9 to 75 years); 46 patients were female and 28 male. Fifty-seven percent of the patients had congestive heart failure, 13% had chest pain, 17% had neurological symptoms, and only 1 patient was totally asymptomatic. The cardiac tumors were incidental findings in 3 patients. Complete resection was carried out in 66 benign lesions and only four of the malignant tumors. All patients survived operation, although 4 died in the early postoperative period. Long-term results were excellent in patients with benign lesions, and no recurrences were found. In patients with malignant tumors, surgical procedures were only palliative and aimed at prolonging life; hence, prognosis remained unchanged.

Adolescent↗
PubMed1991

Preoperative risk analysis in patients receiving Jarvik-7 artificial heart as a bridge to transplantation.

To distinguish high-risk patients prior to implantation of a Jarvik-7 artificial heart as a bridge to transplantation, our 37 attempts were reviewed retrospectively. Arbitrary scores of 1 to 4 were given for nine preoperative factors on the basis of results obtained by uni- and multivariate analyses between successful cases and failed attempts; transplant rejection (scored 4: S4) or postoperative heart failure (S3) as the indication, recipient height less than 175 cm (S3), body surface area less than 1.8 m2 (S3), hyperbilirubinemia greater than 24 microM/l (S2), preoperative renal failure requiring dialysis (S2), weight less than 60 kg (S2), and age greater than 40 years (S1). All except one of the 16 patients with successful bridge had a total score of less than 4, with an average score of 1.3 in contrast to 6.6 in the 21 failed cases (p less than 0.001). Among the 17 patients who scored less than 4, 15 received transplants (specificity 90%), while only one qualified for transplantation among 20 patients who scored 4 or more (sensitivity 94%). The two unpredicted failures resulted from mediastinitis and pulmonary infarction, both attributable to postoperative management. Multiple preoperative factors in combination could have successfully predicted the outcome of mechanical support in our experience. These results underscore the importance of patient selection to achieve successful and effective use of the Jarvik-7 as a bridge to heart transplantation.

Adolescent↗
PubMed1991

[Training of microsurgery in the laboratory of the Hôpitaux de Paris].

The Microsurgical Laboratory of Paris Hospitals' Anatomy Amphitheater has been organizing an initiation into microsurgery since 1976 and the University Diploma of Microsurgical Techniques of Paris VI University since 1977. Since this time, 1,426 surgeons have been trained in the laboratory. The geographic origin of the students is worldwide, but predominantly European. The success rate at the final examinations is relatively constant and averages 60%. The results have been compared to the number of sessions in which the candidates had taken part, and a correlation between a number of sessions exceeding 30 and results above 90% at the examinations was established; A minimum number of sessions of vascular microsurgery was therefore laid down in order to ensure the serious training of the students.

General Surgery↗
PubMed1991

Prognostic indices of survival in patients supported with temporary devices (TAH, VAD).

In an attempt to identify current indications and patient selection criteria for the use of mechanical circulatory support, we reviewed our experience in 83 patients who received a total artificial heart (TAH; n = 43), ventricular assist device (VAD) (n = 13), centrifugal pump (n = 17) or extracorporeal membrane oxigenation (ECMO) (n = 8) as a bridge to transplantation (Group I, n = 50) or for recovery from heart failure (Group II, n = 33). Comparing patients successfully transplanted (n = 20) or weaned (n = 9) who survived initial hospitalization, and those who died on mechanical support, there were no differences in preoperative renal, hepatic or pulmonary functions. Postoperative urinary output and bilirubin levels were the earliest variables affecting survival, and urinary output 24 hours after implant was discriminative in patients who survived (p less than 0.01). Age (above or below 40 years) and modality of terminal heart failure (acute versus chronic) were the most important factors affecting survival in the bridge to transplant group: 82% of young patients with acute decompensation were transplanted and 63% are long-term survivors while all patients over 40 years with chronic heart failure died on mechanical support (MS). In postcardiotomy patients, duration of cardiopulmonary by-pass (CPB) was significantly different comparing survivors with those who died in either bridge or recovery groups and all patients who had a CPB greater than 4 hours died on MS or after transplantation or weaning. In conclusion, preoperative indices indicating reversibility of multiple organ dysfunction remain to be identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Value of the association of blood cardioplegia and energetic warm reperfusion in cardiac transplantation].

Blood cardioplegia at 8 degrees C results in cardiac standstill whilst maintaining minimal metabolic functions of the cardiac cell. Reinjection every 20 minutes allows cellular reoxygenation, the delivery of essential elements (Tham, CPD), and the elimination of products of myocardial degradation accumulated during ischemia. Before declamping the aorta, a reperfusion with warm blood (34 degrees C) containing glutamate and GTN enables restocking of the energy reserves (Krebs' cycle) and a lowering of coronary and systemic resistances. This technique used systematically if even more effective when the ischemic time is prolonged as is the case in cardiac transplantation. The 50 transplants performed since January 1989 with this form of myocardial protection were compared with 50 procedures performed in 1988 with crystalloid cardioplegia. There was no significant difference in the duration of ischemia or of cardiopulmonary bypass between the two groups. Patients benefitting from blood cardioplegia defibrillated spontaneously more frequently, required lower doses of Dopamine for shorter periods and were extubated earlier.

Adult↗
PubMed1991

[Heart transplantations: impact on female fertility].

Improvements in the management of patients with cardiac transplantation make it possible for these patients in the child-bearing age to expect a pregnancy. In fact, since 1987, several cases of pregnancy after cardiac transplantation have been reported. We report here two cases of successful pregnancy two years after cardiac transplantation. First Case. Pregnancy was uneventful until 36 weeks of gestation with no evidence of transplant rejection. At 38 weeks of gestation, a cesarean section was performed for increasing blood pressure, cholestatic pruritus and cephalopelvic disproportion. Cesarean section was performed under regional anesthesia and a healthy baby boy of 2680 gr was delivered. The patient was discharged one week after. Eighteen months after, both the mother and the baby are in good condition. Second case. Pregnancy was complicated by severe maternal anemia and fetal hypotrophia. Because of increasing renal insufficiency and pre eclampsia, a cesarean section was performed under regional anesthesia at 36 weeks of gestation. Delivery of a healthy baby girl of 1700 g. Five other cases have been reported. Cesarean section performed in september 1984 for a patient who underwent cardiac transplantation in 1980. Delivery of a healthy baby of 3280 gr. Death of the mother five months after following heart transplant rejection. Vaginal delivery performed in august 1986 for a patient who underwent cardiac transplantation in 1984. Delivery of a preterm baby at 31 weeks of gestation who survived without any sequelae. Vaginal delivery performed in august 1987 for a patient who underwent cardiac transplantation in april 1985. Delivery of a healthy baby of 2550 gr at 38 weeks of gestation. Vaginal delivery of twins (baby girl of 1200 and 1100 gr) in april 1988 of a patient who underwent cardiac transplantation in 1986. Vaginal delivery at 38 weeks of gestation performed in november 1990 for a patient who underwent cardiac transplantation in 1986. All the cases reported showed that: The foetus is not affected by the immuno-suppressive treatment of the mother. This was already known for pregnant patients with renal transplant. The cardiovascular changes associated with pregnancy are well tolerated by the heart transplant. Preexisting hypertension is increased, particularly during the third trimester of pregnancy and during labour. The incidence of preterm labor is increased in patients with heart transplant. Transplant rejection never occurred during pregnancy.

Adult↗
PubMed1991

[Our experience with bioprostheses in French Polynesia. A follow-up study from 1975 to 1988].

French Polynesia has unique social, cultural and geographic features. The prevalence of acute rheumatic fever (ARF) of 1.2 % population justified the health authorities' classification of this endemic as "major, severe, and prioritary" in 1984. Seventy per cent of patients with ARF develop cardiac sequellae which require surgery in 25 per cent of cases. Bioprostheses were considered from 1975 as the ideal valve replacement for these young, often undisciplined patients with no facilities for haemostatic control. Reoperation for valve degeneration has been increasingly frequent since 1982 and poses an acute problem leading to this statistic study and to a reflection as to the value of continuing to use this type of valve in this population. Analysis of 178 Polynesians with one or more cardiac bioprostheses in 1988, totalling 221 valves with a mean follow-up of 55 months, shows an actuarial survival rate excluding operative mortality of 86.7 +/- 3 % at 5 years (93.8 +/- 2.5 % in patients under 25 years of age, p = 0.001). Fifty-two patients (29 %) have been reoperated with a probability of being free of reoperation at 5 years of 70.1 +/- 4.2% (85.2 +/- 3.9 % in patients over 25 years of age and 43.8 +/- 7.8 % in patients under the age of 25, p = 0.002). The authors discuss the alternative of bioprostheses in this population : mechanical valves with anti-coagulant or anti-aggregant therapy, frozen aortic homografts, mitral valvuloplasty.

Actuarial Analysis↗
PubMed1990

[Surgical strategy in polyarterial disease. Value and results of combined surgery].

Patients with coronary disease associated with carotid artery stenosis and/or abdominal aortic aneurysm often raise problems of operative strategy; in particular, the order in which these lesions must be treated is a frequent source of controversy. We report the results of sequential or simultaneous combined surgery for multiple arterial lesions. Between 1979 and 1988, 65 patients with such lesions underwent either cerebral revascularization simultaneously with coronary bypass (n = 48) or repair of infrarenal aortic aneurysm a few weeks after myocardial revascularization (n = 17). After simultaneous surgery on the carotid and coronary arteries, the postoperative mortality rate was 4.2 per cent (2 patients). Myocardial infarction occurred in 3 cases (6.2 per cent). No neurological disorder consecutive to carotid endarterectomy was observed. Late postoperative mortality involved 5 patients; in 2 of these the cause of death was non-cardiovascular. No other late complication due to coronary or carotid artery disease was noted. The 5-year survival rate, operative mortality included, was 74.8 +/- 8.6 per cent. After coronary bypass followed by abdominal aortic aneurysm repair, there was no operative death, and no perioperative complication due to coronary disease was observed. Late mortality involved 2 patients. One patient underwent bilateral femoro-popliteal bypass 4 years after repair of an aortic aneurysm. Percutaneous angioplasty for proximal stenosis of a venous coronary graft implanted 8 years previously was performed in one patient with primary success. All other patients are now asymptomatic as regards both coronary and peripheral arteries. The 7-year survival rate is 85.7 +/- 9.4 per cent. The absence of neurological disorders after simultaneous myocardial and cerebral revascularization, and the absence of cardiac complications after aortic aneurysm repair preceded by coronary bypass enable us to recommend systematic combined or sequential vascular surgery. The long-term survival rate obtained in this series supports this recommendation.

Aged↗
PubMed1990

Atrial natriuretic peptide level and intracardiac pressure in cardiac transplant recipients.

Blood pressures and plasma atrial natriuretic peptide (ANP) concentrations have been measured in venous and intracardiac sites in 11 patients (10 men and 1 woman) given cardiac transplants. The mean plasma ANP level was 214.4 pg.ml-1 in the superior vena cava and 281 pg.ml-1 in the right atrium. This significantly higher level was maintained in the right ventricle (269) and in the pulmonary artery (295). The level in controls was 25 pg.ml-1. Intra cardiac and mean arterial pressures were in normal range in all patients, and there was no correlation between plasma ANP level and intracardiac pressure. The data suggest that in cardiac transplant patients right atrial pressure does not have a primary role in releasing ANP. The transplanted heart is denervated and remains so for many months after operation, thus suggesting that innervation is not obligatory for ANP secretion. Further studies are required to determine the relative contribution of donor and recipient atrial tissues to ANP secretion.

Atrial Natriuretic Factor↗
PubMed1990

Surgical treatment of chronic aortic dissections.

Between January 1976 and March 1987, 78 patients underwent surgery for chronic aortic dissection at our institution. The ascending aorta was involved in 66 cases (Stanford type A) and was not involved in 12 cases (Stanford type B), wherever the initial dissection was suspected. Aortography remains the main preoperative investigation. The surgical technique varies according to the type of dissection. It seems essential to exclude the primary intimal tear and all dilated segments of the aorta must be replaced. The overall operative mortality was 11.5% (7.5% in type A, 33.3% in type B dissection). Sixty-three patients have been followed for a period varying between 6 months and 10 years (mean 5 years). The overall survival at 6 years is 60% +/- 5.6%. Because of the ultimate risk of aneurysmal dilatation of the false channel, these patients must be followed by CT scanning, colour flow Doppler echocardiography, magnetic resonance imaging, and in some cases, aortography.

Aortic Dissection↗
PubMed1990

Peripheral vascular effects of halothane and isoflurane in humans with an artificial heart.

The peripheral vascular effects of isoflurane and halothane were compared in five critically ill patients in whom a Jarvik-7 artificial heart had been implanted. The lungs of all patients were mechanically ventilated in the postoperative period and the patients were monitored with an arterial catheter and with catheters that had been surgically inserted into the right and left atria and into the pulmonary artery. Norepinephrine and epinephrine plasma concentrations were measured using a radioenzymatic assay. The Jarvik-7 settings were modified to render the artificial heart "preload independent" and to maintain cardiac output constant. Each patient was anesthetized twice using halothane and isoflurane at two different MAC levels, 1 and 1.5 (Datex vapour analyzer), with the interval between each anesthetic ranging from 12 to 26 h. Both anesthetics significantly decreased mean arterial pressure (from 100 +/- 11 mmHg to 66 +/- 13 mmHg for halothane and from 102 +/- 17 mmHg to 48 +/- 11 mmHg for isoflurane; mean +/- SD) and systemic vascular resistance index (from 27 +/- 11 Wood units/m2 to 18 +/- 6 Wood units/m2 for halothane and from 30 +/- 6 Wood units/m2 to 13 +/- 3 Wood units/m2 for isoflurane; mean +/- SD), but with isoflurane to a significantly greater extent than with halothane (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Approach to advanced aortic root infection.

Among our first 11,620 cases of valvular replacement, we observed 285 cases of valvular endocarditis and 59 cases (20.7%) in which the importance of the infectious lesions of the aortic or mitral annulus required complex valvular repair. In 23 patients with aortic valvular endocarditis, the presence of an abcess of the aortic annulus required its closure with a patch resulting in one early and one late death and five reinterventions with one death. Twenty patients are alive and well, 1 to 9 years after operation. In 11 patients, the extent of annular abcesses required the insertion of a subcoronary valved conduit. After a maximum follow-up of 8 years there were two early deaths, two late deaths, one reoperation, and seven good results. Twelve patients had a supracoronary valved conduit resulting in four early deaths, one late death, and two reoperations; seven are alive and well, 2 to 6 years later. Three patients previously operated on had a left ventricular abdominal aorta valved conduit, two of them are alive and well up to 6 years later. Severe infectious lesions of the valvular rings (aortic root) can require complex repairs that can be lifesaving and provide excellent long-term results.

Abscess↗
PubMed1990

[Intracardiac myxoma: surgical treatment with trans-septal approach].

In the last 15 years, fifty-two cases of cardiac myxoma underwent surgical excision at La Pitié Hospital-Paris. They were 19 male and 32 female aging from 16 to 75 years (mean 15 +/- 10). Symptoms were congestive heart failure (55%), constitutional syndrome (35%), peripheral embolization (25%) and syncopal episodes (7%). Echocardiographic diagnosis was done in almost all cases. 47 tumors were found in the left atrium, 4 in the right and 1 in the right ventricule. Transeptal approach was used in most of the patients and myxomas were totally removed including a part of atrial septum, requiring patch reconstruction in 35 patients. Postoperative mortality was very low (1.9%). No complications nor recurrences have been reported in the long-term follow-up.

Adolescent↗
PubMed1990

[Results of thrombo-endarterectomy of chronic pulmonary embolism].

Between 1973 and 1987, 33 patients underwent pulmonary thromboendarterectomy for chronic pulmonary embolism. Twenty-six patients were in Class III of the NYHA Classification, 5 in Class IV with overt right ventricular failure and 2 in Class II. The average pO2 was 60 mmHg under basal conditions without oxygen therapy. The amputation of the pulmonary vascular tree was greater than 50 per cent in all patients. The average systolic pulmonary artery pressure was 70 mmHg. Twenty patients were operated by a lateral thoracotomy without CPB and 6 by sternotomy with CPB under normothermia with or without cardiac fibrillation. The later method avoids having to open the pleura and seemed to give better haemodynamic control. Interruption of the inferior vena cava was systematic in all cases. The global operative mortality was 20 per cent but this seemed to be less in the patients operated by sternotomy under normothermic CPB (no deaths in 6 patients). The authors consider that this technique should be studied in a larger series of patients. Eighteen patients are still being followed up; the clinical and scintigraphic and/or angiographic improvement is clearcut in the majority of cases.

Chronic Disease↗