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Biomedical subjects

C Leclercq

Publications and source records attributed to C Leclercq.

At least 73 records · Page 4Linked to original sources
PubMed1999

Pacemaker lead infection: echocardiographic features, management, and outcome.

OBJECTIVE: To compare transthoracic and transoesophageal echocardiography (TTE, TOE) in patients with permanent pacemaker lead infection and to evaluate the safety of medical extraction in cases of large vegetations. METHODS: TTE and TOE were performed in 23 patients with definite pacemaker lead infection. Seventeen patients without previous infection served as a TOE reference for non-infected leads. RESULTS: TTE was positive in seven cases (30%) whereas with TOE three different types of vegetations attached to the leads were visualised in 21 of the 23 cases (91%). Of the 20 patients with vegetations and lead culture, 17 (85%) had bacteriologically active infection. Left sided valvar endocarditis was diagnosed in two patients. In the control group, strands were visualised by TOE in five patients, and vegetations in none. Medical extraction of vegetations >/= 10 mm was performed in 12 patients and was successful in nine (75%) without clinical pulmonary embolism. After 31.2 (19.1) months of follow up (mean (SD)), all patients except one were cured of infection; three died from other causes. CONCLUSIONS: Combined with bacteriological data, vegetations seen on TOE strongly suggest pacemaker lead infection. Normal TTE examinations do not exclude this diagnosis because of its poor sensitivity. Medical extraction of even large vegetations appeared to be safe.

Adult↗
PubMed1998

Anatomy of the adductor pollicis muscle. A basis for release procedures for adduction contractures of the thumb.

Release of the origins of the adductor pollicis muscle is used to treat adduction contractures of the thumb. A knowledge of the anatomy of the adductor pollicis muscle is therefore the basis for this technique. A study of 20 specimens showed that the origins of the adductor pollicis are more extensive than generally described. This must be taken into account in release procedures in the first web space.

Cadaver↗
PubMed1998

Kienböck's disease in cerebral palsy.

The incidence of Kienböck's disease is known to be higher in cerebral palsy patients, but little has been written on treatment. We report a case of Kienböck's disease in a young man affected by cerebral palsy. A proximal row carpectomy was done, which relieved spasticity at the same time as treating the disease.

Adult↗
PubMed1998

Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure.

OBJECTIVES: The aim of this study was to assess the potential acute benefit of multisite cardiac pacing with optimized atrioventricular synchrony and simultaneous biventricular pacing in patients with drug-refractory congestive heart failure (CHF). BACKGROUND: Prognosis and quality of life in severe CHF are poor. Various nonpharmacological therapies have been evaluated but are restricted in their effectiveness and applications. In the early 1990s, dual chamber pacing (DDD) pacing was proposed as primary treatment of refractory CHF but results were controversial. Recently, tests to evaluate the effect of simultaneous pacing of both ventricles have elicited a significant improvement of cardiac performance. METHODS: Acute hemodynamic study was conducted in 18 patients with severe CHF (New York Heart Association class III and IV) and major intraventricular conduction block (IVCB) (QRS duration = 170+/-37 ms). Using a Swan-Ganz catheter, pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) were measured in different pacing configurations: atrial pacing (AAI) mode, used as reference, single-site right ventricular DDD pacing and biventricular pacing with the right ventricular lead placed either at the apex or at the outflow tract. RESULTS: The CI was significantly increased by biventricular pacing in comparison with AAI or right ventricular (RV). DDD pacing (2.7+/-0.7 vs. 2+/-0.5 and 2.4+/-0.6 l/min/m2, p < 0.001). The PCWP also decreased significantly during biventricular pacing, compared with AAI (22+/-8 vs. 27+/-9 mm Hg; p < 0.001). CONCLUSIONS: This acute hemodynamic study demonstrated that biventricular DDD pacing may significantly improve cardiac performance in patients with IVCB and with severe heart failure, in comparison with intrinsic conduction and single-site RV DDD pacing.

Aged↗
PubMed1998

Permanent left ventricular pacing with transvenous leads inserted into the coronary veins.

This paper describes a preliminary experiment-conducted jointly by 2 centers-of permanent left ventricular pacing using leads inserted by the transvenous route and through the coronary sinus into the cardiac veins of the left ventricle free wall. The aim was to obtain permanent biventricular pacing in a totally endocavitary configuration in patients with severe LV dysfunction and drug-refractory heart failure. Two types of leads were used: nonspecific unipolar leads at the beginning of the experiment, followed by leads specifically designed to be used in the coronary sinus in a second step. The electrode could be fitted in an adequate location in 35 of the 47 patients (75.4%), with a 1.15 +/- 0.7 V acute pacing threshold and 11.8 +/- 5.7 mV R wave amplitude. The success rate was significantly higher with the specific electrodes (81.8% vs 53.3%, p < 0.001). The pacing and sensing thresholds upon implantation were not influenced by the type of lead or by the localization of the cardiac vein that was catheterized (great cardiac vein, lateral vein, postero-lateral or posterior vein, mid cardiac vein). In contrast, the pacing threshold was significantly lower (0.8 +/- 0.2 vs 1.8 +/- 0.8 V; p = 0.002) and the R wave amplitude tended to be greater (13.1 +/- 4.5 mV vs 9.3 +/- 6.5 mV; p = 0.07) when the tip electrode could be inserted distally into the vein, by comparison with a proximal site near the ostium. At the end of follow-up (10.2 +/- 8.7 months), 34 out of the 35 leads were still fully functional, with a chronic pacing threshold of 1.8 +/- 0.7 V and a R wave amplitude of 10.7 +/- 6 mV. To conclude, permanent LV pacing via the transvenous route is possible in most patients, with excellent safety and long-term results.

Aged↗
PubMed1998

Aneurysms and pseudoaneurysms of saphenous vein coronary artery bypass grafts.

Aneurysms of saphenous vein grafts to coronary arteries are unusual complications of coronary artery bypass graft (CABG) surgery. Three patients (men aged 47, 62, and 68 years) are presented with spontaneous chest pains 10, 21, and 17 years after CABG surgery. In one case, the saphenous vein graft had eroded into the right atrium and had established a fistula between the graft and the right atrium. Diagnosis of saphenous vein graft aneurysms was confirmed by echocardiography, computed tomography or magnetic resonance imaging, and by arteriography. Two patients were treated surgically, the third by percutaneous coil embolisation followed by balloon angioplasty of the right coronary artery.

Aged↗
PubMed1998

[Pacing and heart failure].

Conventional dual-chamber cardiac pacing with the right ventricular pacing catheter positioned at the apex of the right ventricle was proposed eight years ago by Hochleitner as primary treatment of refractory cardiac failure. Although the preliminary results were encouraging, those at long-term and subsequent studies were less favourable in this indication. Biventricular pacing is now a technical possibility and allows at least partial correction of the electromechanical abnormalities observed in dilated cardiomyopathy. The preliminary results of biventricular pacing in patients with refractory cardiac failure due to dilated cardiomyopathy with major intraventricular conduction defects are very encouraging. This new therapeutic approach should now be validated by controlled, randomised therapeutic trials.

Cardiac Catheterization↗
PubMed1997

Permanent left atrial pacing with a specifically designed coronary sinus lead.

This article reports the original use of a specifically designed coronary sinus (CS) lead for permanent left atrial (LA) pacing. The device is characterized by its distal end shape featuring a double 45 degree angulation, which ensures very close contact with the CS upper wall. The device was successfully implanted in 39 out of 40 patients (97.5%). The tip electrode was eventually positioned in the distal CS in 9 patients, in the middle CS in 21 patients, and close to the ostium in the proximal CS in 9 patients. The mean acute pacing threshold voltage was 0.9 +/- 0.5 V with a mean impedance of 578 +/- 144 omega as measured in unipolar distal configuration at 0.5 ms pulse width (PW). The mean A wave amplitude was 3.5 +/- 2.1 mV. Early lead dislodgment occurred only once (3%) when the tip electrode was placed in the distal or middle CS, but more often (4/9 cases) when it was placed in the proximal CS. After a mean follow-up duration of 14 +/- 8.5 months, 35 of the 39 successfully implanted leads (89.7%) were still functional in terms of LA pacing and sensing. The mean chronic pacing threshold voltage was 1.5 +/- 0.8 V and the mean A wave amplitude was 2.7 +/- 1.6 mV. There were no lead related complications. In conclusion, the device proved to be safe and highly effective for permanent LA pacing, provided the distal tip could be positioned in the distal or middle part of the CS.

Aged↗
PubMed1997

[Accessory pathways of decremential conduction (Mahaim fibers). Treatment by endocavitary ablation; apropos of 8 cases].

Mahaim fibres are rare, right sided accessory pathways comparable with respect to certain properties (slow, decremential conduction) with "accessory atrioventricular node" located on the lateral tricuspid annulus at a distance from the Aschoff-Tawara node. Atriofascicular and atrioventricular fibres may be distinguished, both responsible for wide complex tachycardia (left bundle branch block pattern with left axis deviation). The authors report a series of 8 patients (6 women, 2 men: age: 27 +/- 11 years) without underlying cardiac disease, incapacitated by episodes of antidromic reciprocating tachycardia related to the atriofascicular fibres and justifying the indication of treatment by endocavitary ablation. In all cases, the authors tried to identify a specific potential of the Mahaim fibres on the lateral aspect of the tricuspid annulus. When the potential was recorded (7 out of the 8 cases) ablation was successful (procedure time 160 +/- 11 min; average number of applications: 9). It was not possible to identify a specific Mahaim potential in 1 case and so ablation was performed on the distal right ventricular site of insertion with no criterion of efficacy. In one woman, manipulation of the ablation catheter led to prolonged mechanical block in the Mahaim fibres, so suppressing the usual criteria of evaluation of the initial result of ablation: an early recurrence of tachycardia was observed in this case. No complications occurred during the 8 procedures. These results and those of other published cases, showed that radiofrequency ablation of Mahaim fibres is feasible with a high success rate without any immediate or long-term complications. This reliable and effective technique should form one of the therapeutic options for these invalidating junctional tachycardias.

Adolescent↗
PubMed1996

Combined antiplatelet therapy with ticlopidine and aspirin. A simplified approach to intracoronary stent management.

Intravascular metallic stents are increasingly used in the non-surgical management of coronary atherosclerosis. Despite intensive anticoagulation, subacute stent thrombosis, which usually has serious clinical consequences, and major haemorrhagic complications remain major problems after stent implantation. In addition, conventional management with anticoagulant therapy requires prolonged hospitalization. In a prospective multicentre study, we investigated the efficacy of a combination of two antiplatelet agents, ticlopidine 500 mg daily and aspirin 200 mg daily, without oral anticoagulation after stent implantation. Since November 1993, 529 consecutive patients, in whom 545 vessels were successfully stented with conventional (non-heparin coated) stents have been enrolled. Stenting was performed as a bailout procedure for failed angioplasty in 112 patients, for a suboptimal result after angioplasty in 314 patients, and electively in the remaining 103 patients. Coronary events related, or possibly related, to stent thrombosis occurred in 5.4% of patients stented as a bailout procedure and in 1.8% of patients stented for a suboptimal result. Serious bleeding complications occurred in 5.4% of patients stented as a bailout procedure and 1.5% of patients stented for a suboptimal result. Neither stent thrombosis nor serious bleeding complications were seen in patients stented electively. Ticlopidine therapy was discontinued in 1.9% of patients due to neutropenia (0.6%) or rash (1.3%). Mean hospital stay decreased from 6.16 +/- 2.14 days to 4.2 +/- 2.15 days during the study period. A combination of two antiplatelet agents can be employed in the vast majority of patients after coronary stent implantation. Subacute stent thrombosis rates and bleeding complications compare favourably with those reported using conventional therapy and the duration of hospitalization is reduced.

Adult↗
PubMed1996

[Is isolated atrial fibrillation genetically determined? Apropos of a familial history].

The authors report five cases of apparently lone atrial fibrillation in five members of the same family from three generations. The atrial fibrillation occurred at an early age and rapidly became permanent in all cases. With time, in the absence of complications, structural cardiac abnormalities were documented by echocardiography (biatrial dilatation and mitral and tricuspid regurgitation). These observations raise the question of genetic predisposition to lone atrial fibrillation at least in this particular clinical context.

Adult↗
PubMed1996

[Surgical rehabilitation of the upper limbs in tetraplegic patients].

Use of the hands is highly limited in most tetraplegia patients considerably reducing their self-sufficiency. Over the last fifteen years, surgical rehabilitation of the upper limb has been undertaken with satisfactory results. We report our personal series of 62 operations in 28 patients over the last 6 years. Satisfactory results were obtained in all cases. The patients must be fully informed about the operation in order to understand what can be expected and the need for prolonged care in a rehabilitation center. Close collaboration with the rehabilitation physician is essential.

Adolescent↗
PubMed1996

[Acute relapsing pericarditis induced by screw-in atrial pacing lead. Apropos of 3 cases].

Contrary to the ventricle where pacing leads remain passively implanted, the use of active screw-in atrial pacing leads has rapidly developed during the last few years. This type of fixation in a thin and fragile cardiac wall carries a risk of perforation and thereby of pericardial complications. The authors report three original cases of a period of time. The responsibility of the atrial lead was highly probable given the presence of suggestive symptoms (pericardial pain) or of pericardial complications confirmed at surgery, of the presence of radiological changes in 2 cases (localised bulges of the cardiac silhouette opposite the site of implantation of the pacing lead), the absence of any other detectable cause and, finally, cure after explantation of the causal pacing lead and anti-inflammatory drug therapy. Some simple preventive measures based on the properties of the material (screw length < 2 mm), the technique of implantation, should help avoid these complications or, at least, to reduce their frequency.

Acute Disease↗
PubMed1996

[Loss of a stent in the left main coronary artery and secondary migration into the left circumflex artery needing surgical extraction. Apropos of a case].

The authors report a case of accidental loss of a coronary stent in the coronary arteries and its migration into the circumflex artery. This complication occurred during revascularisation of the left anterior descending artery. In view of a dissection at the site of angioplasty and the migration of the stent, emergency surgery was undertaken comprising bypass grafting of the left anterior descending and arteriology of the left circumflex arteries to recover the stent. This is a rare complication, the frequency is probably underestimated. The authors discuss the factors predisposing to failure of implantation and the means of recovering the stents. The consequences of loss of a stent in the coronary or systemic circulations are also commented.

Angioplasty, Balloon, Coronary↗