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Biomedical subjects

C Le Pailleur

Publications and source records attributed to C Le Pailleur.

At least 19 recordsLinked to original sources
PubMed1992

[A rare cause of right cardiac insufficiency after pneumonectomy].

The authors report the case of a 55-year old patient, hospitalized for assessment of progressive right heart failure after left pneumonectomy due to bronchial epidermoid cancer. Right catheterization showed a dip-shaped right ventricular plateau and equal diastolic pressures (DOP 21 mmHg, diastolic pressure of the right ventricle 25 mmHg, capillary pressure 25 mmHg). A chest scan ruled out the possibility of pericardial invasion. Pericardial decortication was carried out on October 3, 1989. Six months later, the clinical signs of right heart failure had regressed. Chronic constrictive pericarditis (CCP) has been reported after cardiac surgery, but not cases have been reported after pulmonary surgery. In the absence of radiotherapy or metastatic invasion, this case leads to a discussion of the possibility of either pericardial trauma during surgery or, more probably, a fortuitous association with tubercular CCP.

Bronchial Neoplasms↗
PubMed1991

[Postinfarction segmental asynergy: correction after angioplasty. Predictive value of exercise thallium scintigraphy].

The aim of this study was twofold: to evaluate the frequency of reversibility of segmental post-subendocardial infarction asynergy after coronary angioplasty, and to test the predictive value of the redistribution phenomenon during stress Thallium scintigraphy with respect to the reversibility of segmental asynergy. The inclusion criteria for this study were: previous postsubendocardial myocardial ischaemia with residual resting or effort ischaemia documented with or without the Thallium test, segmented asynergy documented by quantitative analysis of the ventriculography, complete correction of coronary angioplasty of stenotic single or double vessel disease, a balanced coronary distribution or dominant left coronary in cases of lesion of the circumflex artery. Out of 254 consecutive angioplasty procedures 39 patients met these inclusion criteria. The location of the subendocardial infarct (SEI) was anterior in 17 cases and inferior in 22 cases. The study protocol included a Thallium scintigraphy from the 10th day after SEI, ventriculography 24 hours later, angioplasty and control ventriculography 24 hours after angioplasty. Comparison of the two ventriculographies opposed Group A (reversible asynergy) and Group B (irreversible asynergy) according to criteria defined in 15 normal subjects whose average regional ejection fraction (REF) was 0.53 +/- 0.11. This result enables definition of normal segmental motion if the REF greater than 0.30 (mean--2 SD); hypokinetic if the REF greater than 0.30 or akinetic if the REF less than 0.10 (mean--4 SD). An increase of REF of 0.15 (50% of the minimal normal value) allowed definition of reversibility of asynergy. By these criteria, 19 patients (48.7%) had reversible asynergy after PTCA; 20 had definitive asynergy (51.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Holter electrocardiography before and after coronary angioplasty. Angiographic correlation after 24 hours and 6 months].

Myocardial ischaemia was searched for by Holter monitoring before and after coronary angioplasty with primary success in 31 patients. Control angiography was performed at 24 hours and 6 months after angioplasty. Twelve patients had signs of myocardial ischaemia before angioplasty (cumulated ischaemia: 743 minutes). The degree of coronary stenosis was 92 +/- 6% before angioplasty, 25 +/- 17% immediately after the dilatation increasing to 34 +/- 25% at the 24th hour (p less than 0.002). Despite successful angioplasty myocardial ischaemia persisted in 6 patients (cumulated ischaemia: 184 minutes) and was silent in 5 of the 6 cases. In these 6 cases, control angiography at 24 hours showed either a dissection (n = 4) or a filling defect (n = 2). The angiographic outcome of the postangioplasty stenosis and at 24 hours was the same in Group I without restenosis (25 +/- 14% versus 33 +/- 22%) as in Group II with restenosis (25 +/- 22% versus 37 +/- 30%). In Group I, the degradation of the result at 24 hours was reversible at 6 months (33 +/- 22% vs 23 +/- 14%). After angiographic success, postangioplasty ischaemia present in 20% of cases was frequently silent. No correlation was observed with restenosis at 6 months which raises the possibility of a reversible microthrombotic etiology. These results justify antiaggregant and anticoagulant therapy in the 48 hours following angioplasty.

Adult↗
PubMed1991

[Doppler echocardiographic evaluation of aortic valve prosthesis. Analysis of the reproducibility of pressure gradients and surface measurements].

Doppler echocardiography has become the method of choice for the evaluation of cardiac valve prostheses. In order to determine the reproducibility of the measurements of pressure gradient and valve surface area, 55 patients with aortic valve prostheses without clinical dysfunction and having at most a trivial regurgitation on color Doppler examination underwent a double evaluation during an average interval of 9 +/- 5 months. The maximum and mean pressure gradients were recorded and the valve surface area calculated using the continuity equation in all cases. The subaortic diameter was taken to be constant and equal to the external diameter of the prosthesis. No significant differences were found between the two evaluations of mean pressure gradient and valve surface area. The intra-patient variability was +/- 8 mmHg for the maximum pressure gradient, +/- 6 mmHg for the mean pressure gradient, +/- 0.33 cm2 for valve surface area calculated using the maximum velocities and +/- 0.44 cm2 when the velocity-time integrals were used. When expressed as a percentage, the mean coefficient of variation was 21 +/- 17% for the maximum pressure gradient, 21 +/- 18% for the mean pressure gradients, 21 +/- 15% for the valve surface area calculated using the maximum velocities and 22 +/- 14% when the ratio of velocity-time integrals was used.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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

[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

[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

[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

[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

[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

[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↗