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Biomedical subjects

C Pernot

Publications and source records attributed to C Pernot.

At least 37 records · Page 2Linked to original sources
PubMed1989

Return to work after percutaneous transluminal coronary angioplasty: a continuing problem.

Earlier studies have shown that return to work following PTCA is frequent; however PTCA is now performed in patients with more extensive coronary artery disease. The present study was designed to compare the vocational outcome of patients who underwent PTCA in 1980-1982 with that of patients who underwent the procedure in 1985. From 1980 to 1982, 53 of 73 consecutive patients who were employed before PTCA returned to work (73%). Return to work was related to primary success of the procedure (85% vs 40%, P less than 0.01) age (46.1 +/- 7.9 vs 49.3 +/- 6.6 years, P less than 0.05) and clinical status at follow-up (72% feeling well or very well vs 30%, P less than 0.01). In 1985, although the primary success rate had increased to 89%, the overall rate of return to work in the 91 patients employed before PTCA was 64%. The decrease was particularly striking for patients with primary success of the procedure (64% vs 85%, P less than 0.01). The patients in the 1985 group had greater incidences of previous myocardial infarction (40% vs 11%, P less than 0.01) and multivessel coronary disease (43% vs 8%, P less than 0.01); however, these factors were not related to subsequent return to work. In contrast, the age of the patients, which was an important determinant of work resumption, was significantly higher in the 1985 patients (49.9 +/- 7.3 vs 46.4 +/- 9.1 years, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The tall R wave in lead V1 in posterior myocardial infarction: a reciprocal sign or a His-Purkinje conduction disturbance?

The significance of the tall R wave in lead V1 with an R/S ratio greater than or equal to 1 in posterior myocardial infarction (PMI) was investigated in 28 patients during programmed electrical stimulation. The patients had been admitted with acute PMI documented by electrocardiogram and proven by enzymatic increase. Electrophysiological study was performed 3 weeks after acute PMI. In 17 of the 28 patients (group 1), the tall R wave in V1 disappeared during stimulation: In 13 of them a premature atrial extrastimulus was responsible for an abrupt normalization of QRS complex in V1 related to an increase in AH or HV interval. In the 4 remaining patients the disappearance of the tall R wave in V1 was related to a sinus pause. In 14 patients of group 1, a different prematurity in atrial stimulation induced a right or left bundle branch block (BBB). In 11 of the 28 patients (group 2) the tall R wave in V1 was unchanged but a premature atrial extrastimulus induced a right BBB in 5 patients and a left BBB in 6. In conclusion, the normalization of QRS complex in lead V1 during atrial stimulation or alterations in cycle length suggests that the tall R wave in V1 in PMI is not a simple reciprocal sign of leads V8 V9. Its association with different varieties of BBB and changes in AH or HV intervals could suggest a relationship with a His-Purkinje conduction disturbance in some patients.

Adult↗
PubMed1989

Isoprenaline as an aid to the induction of catecholamine dependent supraventricular tachycardias during programmed stimulation.

The effects of isoprenaline on the induction of supraventricular tachycardia by programmed stimulation were studied in 67 patients to see whether they correlated with spontaneous catecholamine mediated symptoms during exercise testing and Holter monitoring. Thirty seven control patients (group 1) did not have spontaneous arrhythmias either during exercise testing or Holter monitoring. Thirty patients (group 2) had documented exercise or stress related supraventricular tachycardias--that is paroxysmal junctional tachycardia (24) or atrial arrhythmia (6). Programmed electrical stimulation was performed before and during the infusion of isoprenaline. No group 1 patient developed sustained supraventricular tachycardia during isoprenaline infusion. In 21 patients with paroxysmal junctional tachycardia and all the patients with atrial arrhythmias electrical stimulation during isoprenaline infusion produced the same tachycardia that had been seen during exercise testing and Holter monitoring. Changes in electrophysiological variables and the concentrations of serum potassium were not associated with the induction of supraventricular tachycardia by isoprenaline. Infusion of isoprenaline safely facilitated the induction of supraventricular tachycardia by programmed stimulation in patients who had spontaneously occurring catecholamine mediated symptoms.

Adolescent↗
PubMed1989

[Value of anthropometric techniques in pediatric otology].

The recurrent and severe infections of the ENT region during childhood are frequently related to cranio-facial malformations or/and deficiency of the immune system. The cranio-facial abnormalities are at risk to be complicated by transmission deafness either primary or secondary through recurrent middle ear infections. In our pediatric out-patient clinic, most of the patients suffering severe recurrent ENT problems show variable malformations: abnormal implantation or shape of the external ear, a microretrognathism, cervical or facial branchial fistulae, high or ogival palate with anomalies of the dental occlusion or a bifid uvula. All these abnormalities share their origins in a pathological development of the first branchial arch. These developmental anomalies may directly lead to deafness (especially due to an abnormal middle car ossicular development since they are derived in part from the first arch). They may also favor secondary pathologies (middle ear otitis, abnormal soft palate). Moreover the development of the immune system is also dependent of a normal function of the endoblastic epithelium of the pharyngeal pouches which is a part of the branchial system. Immune dysfunctions may therefore accentuate the severity of the ENT Infections.

Anthropometry↗
PubMed1989

[Malignant quadrivalvular dysplasia of Marfan syndrome in a neonate].

The authors report the case of a neonate who died early of refractory heart failure and presented with all the characteristics of Marfan's syndrome in its early form with articular retractions. There was clinical evidence of mitral, tricuspid and major aortic regurgitation. Two-dimensional and doppler echocardiography confirmed the prolapse of highly dystrophic valves and the quadrivalvar regurgitation. Typical lesions of the connective-elastic tissue were found at autopsy. The occurrence of malignant Marfan's syndrome in neonates seems to be exceptional; the syndrome may take the rare "en contractures" form. Death is not always ascribable to the cardiac pathology, this pathology being often less generalized than in our case which seems to be the first one where such diffuse and massive valval lesions have been observed. This particular form was comparable to the "congenital polyvalvular disease" described by Bahrati and Lev, except that the skeletal and visceral abnormalities of Marfan's syndrome are absent in that disease.

Aortic Valve↗
PubMed1989

[Arrhythmogenic effect of ajmaline on the atrial level].

The aim of this study was to determine whether an antiarrhythmic, Ajmaline, could have proarrhythmic effects on the atrium and to compare the results with those of other antiarrhythmic drugs. A total of 1950 patients without cardiac failure or recent (less than 6 weeks) myocardial infarction were given 1 mg/kg of Ajmaline intravenously during electrophysiological investigation. A proarrhythmic effect was defined as the occurrence of supraventricular tachycardia (SVT) in a patient without this arrhythmia before the test or the facilitation of its induction. Fifty five patients developed SVT (mainly atrial tachyarrhythmias: 48 cases, and some junctional tachycardia: 7 cases) which occurred spontaneously in 22 patients and during fixed atrial pacing in 33 patients. Fifteen patients developed ventricular tachycardia (VT). The predisposing factors for the development of SVT were: a previous history suggesting spontaneous SVT (28 patients; 51 p. 100); sinoatrial block (14 patients--the only abnormality in 10 cases). Seventeen patients had none of these factors but 8 had known cardiac pathology and the other 9 were relatively elderly patients (79 years). Twelve of the patients developing VT had known cardiac disease, bundle branch block in 12 cases and previous VT in 6 cases. In conclusion, proarrhythmic effects of Ajmaline are infrequent if its contraindications are respected, but they do exist at both atrial (2.8 p. 100) and ventricular levels (0.8 p. 100): the risk factors are comparable: previous spontaneous arrhythmias or ECG changes (SA block at the atrial and bundle branch block at the ventricular level).

Adolescent↗
PubMed1989

[Percutaneous transluminal angioplasty of stenosis of the pulmonary arteries after surgical repair of tetralogy of Fallot].

Post-surgical stenoses in patients operated upon for tetralogy of Fallot create difficult therapeutic problems. Between November 1985 and November 1988, we performed 17 percutaneous transluminal angioplasties in 13 children aged from 5 to 15.1 years (7.7 years) for stenosis of pulmonary artery branches after correction of tetralogy of Fallot. Group I consisted of stenoses consecutive to palliative anastomoses: 6 dilatations of 5 stenoses in 4 children. Group II concerned stenoses of the pulmonary artery at the top of widening patch on the pulmonary trunk of bifurcation: 5 dilatations of 5 stenoses in 4 children. Group III was made of congenital stenoses sometimes located upstream of a widening patch which made them worse: 6 dilatations of 6 stenoses in 5 children. Angioplasty was performed after catheterization and angiocardiography, the diameter of the balloon being 1.2 to 4-fold that of the stenosis (mean 2.65). There was no complication. In 7 cases the diameter of the stenosis increased by 27 to 96 p. 100. In 2 of these cases, this increase produced no change in pulmonary pressures and perfusion. In the remaining 5 cases, regarded as successful, the diameter of the stenosis increased from 5.7 mm to 9 mm on average, and the right ventricular pressure fell from 62.4 mmHg to 48.8 mmHg; the gradient was reduced by 24 to 50 p. 100 in 4 cases and the lung perfusion was improved in the 5th case. The proportions of successful angioplasties were: 2 out of 6 in group I, zero out of 5 in group II and 3 out of 6 in group III.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Percutaneous angioplasty of recoarctations of the aorta. Apropos of 11 cases].

Between January 1986 and October 1988, 11 young patients aged from 3 months to 29 years (10.6 years) underwent percutaneous transluminal angioplasty for recoarctation of the aorta. The procedure was performed 3 months to 21 years (6.7 years) after the initial operation for coarctation (9 cases: 8 terminoterminal sutures and 1 Waldhausen operation) or for complete interruption of the aortic arch (2 cases: direct terminoterminal suture with banding of the pulmonary artery in 1 case and closure of an aorto-pulmonary fistula in the other case). The diameter of the balloon selected was at most 1 to 1.5 mm wider than that of the smallest diameter of the aorta upstream or downstream of the stenosis, as measured by prior aortography. Adverse events recorded were thrombosis of the femoral artery in a 1-year old child, transient subendocardial lesion wave during dilatation in another child, and regressive left bundle branch block in a third patient. In one patient a small aneurysm developed at the site of dilatation: it was perfectly stable after 8 months. A satisfactory result was obtained in 4 cases, with a 52 to 95% increase in diameter of the stenosis and reduction of the gradient which fell from 56 mmHg on average to 18.25 mmHg. One child was lost sight of; in the remaining 3 patients the result remained stable after 6 to 20 months. A partial result (widening of the stenosis without change in gradient) was obtained in 2 cases. Five of the 11 cases were failures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Cayler's cardio-facial syndrome. Apropos of 19 cases].

Hypoplasia of the depressor angulae oris muscle can be detected in the crying newborn by an asymmetry of the facies, and it must be differentiated from facial palsy. Asymmetry of the facies during crying spells associated with a congenital cardiac abnormality constitutes the Cayler's cardiofacial syndrome. Nineteen cases of this syndrome are reported. A wide spectrum of congenital heart defects of varying severity was observed, ventricular septal defect being the most common along with frequent malformations involving systems and organs other than the heart.

Adolescent↗
PubMed1989

[Noonan's syndrome and its cardiovascular dysplasia. Apropos of 64 cases].

The multiple malformation syndrome described by Jacqueline Noonan in 1963 is one of the most commonly encountered syndromes in pediatric cardiology. The series presented here comprises 64 cases, 20% of which were familial. The morphotype can easily be recognized, but the variations and changes with age imply a detailed analysis of a wide range of discriminatory features. Cardiovascular lesions are very common and very specific, diffuse but above all characterized by "atypical" pulmonary stenosis, with dysplastic valves and a cardiomyopathy of the left ventricle, which is very particular, but also encountered in other polymalformation syndromes. Aortic lesions and dysplasia of other valves are not infrequent. The genetic mechanism is as yet unknown; at present, only certain hypotheses can be proposed.

Cardiomyopathy, Hypertrophic↗
PubMed1988

[Congenital tracheal stenosis due to complete circular rings. Tracheoplasty using autologous pericardium].

The case of a 9-month old infant with congenital tracheal stenosis due to complete tracheal rings, associated with an aberrant left pulmonary artery is reported. Surgery was carried out under extracorporeal circulation to ensure adequate oxygen supply. Extubation, thus made possible, enabled the lesion to located accurately by bronchoscopy. Tracheoplasty by means of an autologus pericardial patch was performed. The quality of the repair was checked by a second bronchoscopy. The long-term result is satisfactory.

Cartilage↗
PubMed1988

Effect of diltiazem on myocardial infarct size estimated by enzyme release, serial thallium-201 single-photon emission computed tomography and radionuclide angiography.

Diltiazem is a calcium antagonist with demonstrated experimental cardioprotective effects. Its effects on myocardial infarct size were studied in 34 patients admitted within 6 hours after the first symptoms of acute myocardial infarction. These patients were randomized, double-blind to placebo or diltiazem (10-mg intravenous bolus followed by 15 mg/hr intravenous infusion during 72 hours, followed by 4 X 60 mg during 21 days). Myocardial infarct size was assessed by plasma creatine kinase and creatine kinase-MB indexes, perfusion defect scores using single-photon emission computed tomography with thallium-201 and left ventricular ejection fraction measured by radionuclide angiography. Tomographic and angiographic scanning was performed serially before randomization, after 48 hours and 21 days later. Groups were comparable in terms of age, sex, inclusion time and baseline infarct location and size. Results showed no difference in creatine kinase and creatine kinase-MB data between controls and treated patients, a significant decrease in the perfusion defect scores in the diltiazem group (+0.1 +/- 3.0 placebo vs -2.2 +/- 1.9 diltiazem, p less than 0.02) and a better ejection fraction recovery in the diltiazem group (-4.2 +/- 7.4 placebo vs +7.7 +/- 11.2 diltiazem, p less than 0.05). Myocardial infarct size estimates from perfusion defect scores and enzyme data were closely correlated. These preliminary results suggest that diltiazem may reduce ischemic injury in acute myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Enzyme Tests↗
PubMed1988

Asymptomatic form of left pulmonary artery sling.

Eight patients with left pulmonary artery sling, which were asymptomatic at the time of the last consultation, are described: 2 adults and 1 child with no history of symptoms, 3 children with mild forms of airways obstruction and 2 patients with typical severe symptoms of airways obstruction in infancy. The mean follow-up of these 8 patients was 10 years (range 4 to 23), and in 1986, all were in good health and free of respiratory symptoms. The long-term prognosis is usually good.

Airway Obstruction↗
PubMed1988

Dilated cardiomyopathy: long-term follow-up and predictors of survival.

To determine long-term survival and the prognostic factors of dilated cardiomyopathy, we retrospectively studied a consecutive series of 111 patients (95 men, 16 women, mean age: 45.5 +/- 8.1 years) undergoing cardiac catheterization and diagnostic coronary angiography from January 1970 to December 1979. The inclusion criteria were: normal coronary angiography, diffuse hypokinesia of the left ventricle and left ventricular ejection fraction less than 50%. Base-line clinical data were collected from the hospital records and follow-up data were obtained from the general practitioners and cardiologists. A questionnaire was sent to all living patients. The length of follow-up ranged from 6 to 16 years. Six patients (5%) were lost to follow-up. At the time of catheterization, a majority of the patients had dyspnea and were in New York Heart Association (NYHA) classes II (41%) and III (31%). Clinical history revealed an excessive alcohol consumption in 56% of the patients. During follow-up, 66 patients (63%) died (heart failure: 37%; sudden death: 19%; non-cardiac death: 15%; unknown cause: 27%). Actuarial survival was 90, 50, and 33% at 1, 5, and 10 years, respectively. Univariate analysis revealed that 10-year mortality was related to: left ventricular ejection fraction less than 30%; left ventricular end-diastolic pressure greater than 10 mm Hg; cardiothoracic ratio greater than 54%; episodes of heart failure; left ventricular end-diastolic volume greater than 200 ml/m2, dyspnea of NYHA class III or IV; absence of smoking; absence of moderate systemic hypertension; electrocardiographic evidence of left ventricular hypertrophy and mean systemic arterial pressure greater than 95 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Sustained improvement in myocardial perfusion four to six years after PTCA in patients with a satisfactory angiographic result, six months after the procedure.

Of 46 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA) from April 1980 to August 1982 and who had a satisfactory angiographic result six months later, one died of cancer and 41 had a detailed evaluation with exercise single-photon emission computed tomography (SPECT, 40 patients) or repeat coronary angiography (one patient), 48-78 months after the procedure. During follow-up, two patients had recurrent angina due to progression of coronary artery disease requiring a second PTCA procedure of another coronary artery; one of them later had a limited myocardial infarction in an area supplied by the vessel initially dilated. At follow-up, only one patient had definite angina. All but one patient had a negative exercise test. Myocardial perfusion during exercise in the PTCA-related area, assessed by SPECT, was normal in 90% of the patients and showed a limited defect due to reversible ischaemia in the remaining four (10%). It is concluded that patients with a less than 50% stenosis six months after PTCA show sustained improvement in their functional status and myocardial perfusion, four to six years after the procedure suggesting continued patency of the coronary artery.

Adult↗
PubMed1988

Ten year follow up of patients with single vessel coronary artery disease that was suitable for percutaneous transluminal coronary angioplasty.

The 10 year outcome of patients with single vessel coronary artery disease who underwent coronary angiography more than 10 years before and who would have been potential candidates for percutaneous transluminal coronary angioplasty had it been available then is reported. Long term follow up data were obtained in 96 (91 men, five women; mean age 48 years) of 105 consecutive patients with single vessel coronary artery disease (greater than 70% stenosis), judged suitable for coronary angioplasty. Fifty patients had coronary bypass surgery within six months of catheterisation (surgical group) and 46 were treated medically (medical group). At entry to the study more patients in the surgical group had unstable angina, but fewer had a previous history of myocardial infarction. Ten year survival was 91% and remained excellent in all the subsets analysed. Moreover, the quality of life of these patients was good. Over the 10 year follow up, 16 (36%) of the patients treated medically and 13 (26%) in the surgical group were admitted to hospital because of cardiovascular events (including late coronary surgery in four of the patients treated medically). Lastly, 54/69 (78%) of the patients who were employed before catheterisation resumed work and 29 (42%) were still employed 10 years later. Although these data must be interpreted with care because of the limitations inherent in all retrospective studies, it appears that the long term results of conventional medical or surgical treatment are excellent in patients with single vessel coronary artery disease in whom percutaneous transluminal coronary angioplasty is now an option.

Adult↗