Search PubMed⌕ Search

Biomedical subjects

C Rioux

Publications and source records attributed to C Rioux.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Calcified aortic stenosis in patients over 80 years of age. Results of surgical treatment. Observations in 67 consecutive cases].

The authors report the results of surgery performed between 1978 and 1988 for calcific aortic stenosis in 67 consecutive patients over 80 years of age; the operative risk is assessed ant the results are compared with those of balloon valvuloplasty. The operative risk seems to be relatively low (6 deaths; 8.9%). All survivors were followed-up and evaluated. The long-term results show a big improvement in survival (78.2% at 3 years) and in functional class (96% of patients in Classes I and II of the NYHA Classification). By comparison, the results of balloon valvuloplasty were very mediocre and are now generally considered to be disappointing to such an extent that the indications of dilatation seem very limited and difficult to define.

Aged↗
PubMed1990

[Traumatic rupture of the aortic isthmus. Apropos of 31 surgically treated cases from 1976 to 1988].

The authors start by presenting a series of 31 traumatic ruptures of the thoracic aorta operated at the stage of fresh rupture between January 1976 and January 1988. These lesions were caused by sudden anteroposterior (29 cases), vertical (1 case) or lateral (1 case) deceleration. The diagnosis was most frequently suggested (by enlargement of the mediastinum in 84% of cases) and was confirmed by aortography which was readily indicated. The aortic lesion was circumferential, respecting the adventitia (122 cases) or partial (8 cases). Surgical treatment consisted of restoring the aortic continuity under partial cardiopulmonary by-pass by direct suture (7 cases) or by means of a prosthesis (23 cases). The hospital mortality was 10%; the 28 survivors were reviewed with a mean follow-up of 5 years. One patient died on the 45th day after the operation due to complications of an oesophagotracheal fistula. The functional result evaluated in the 27 survivors was excellent or good in 87% of cases and poor in 13% of cases. In the light of the literature, the authors then define the principal clinical and radiological signs, discuss the various ways of medullary protection during aortic clamping, discuss the chronology of the operations to be performed (gastro-intestinal, vascular, neurosurgical and orthopaedic).

Adolescent↗
PubMed1990

[Current operative risk in emergency coronary surgery. Experience of the last 5 years].

Technique of fibrinolysis and angioplasty have changed the face of emergency coronary artery surgery, which had developed considerably over recent years. Between 1982 and 1986, in the Department of Cardiovascular and Thoracic Surgery of the University Hospital of Rennes, 1,232 patients underwent isolated coronary artery revascularisation (with the exclusion of mechanical complications of infarction). 1,040 patients were operated electively and 192 patients underwent emergency surgery with very different results: mortality of 2.4% with elective surgery versus 12.5% with emergency surgery, divided into four subgroups: revascularisation after thrombolysis (gradually being replaced by angioplasty), by-pass surgery after a complication of angioplasty (or coronary angiography), by-pass surgery in threatened unresponsive infarction (now less common), by-pass surgery in the context of threatened extension of pre-existing myocardial infraction. The factors of mortality are analysed according to the circumstances (emergency, presence or absence of haemodynamic repercussions), clinical context (age, sex, previous infarction, myocardial function) and lastly the surgical possibilities (complete or incomplete revascularisation in vessels of variable quality ...). In relation to this last point, the authors stress the limitations of reasonable indications for emergency surgery, although surgery is readily proposed in deteriorating patients unresponsive to medical treatment, on vessels with a severely pathological disal bed and in myocardia with severely altered ventricular function.

Aged↗
PubMed1989

[Long-term results of isolated aortic valve replacement using a Bjork-Shiley prosthesis. A clinical study of a series of 365 patients with a postoperative follow-up of 8 to 16 years].

365 patients (mean age: 59 years) surviving isolated aortic valve replacement performed between 1971 and 1978 by means of a standard flat disk Bjork-Shiley prosthesis, underwent regular and complete follow-up (100% survival rate) representing 3,248 patient-years with a maximum follow-up of 15.4 years (mean: 8.9 years). All of these patients received anticoagulant treatment, which was considered to be well-controlled in 90.5% of cases. 121 secondary deaths (33.1%) were observed. Cardiac causes were the most frequent (35/121, i.e., 28.9%). Four deaths were directly related to the prosthesis (2 infections, 1 thrombosis, 1 dysfunction). Twenty deaths (16.5%) were related to cerebral vascular accidents and 2 (1.6%) to haemorrhagic complications. In 24 cases, the cause of death could not be determined (19.8%). Overall, 1 out of 5 deaths (21.4%) was directly or indirectly related to the prosthesis. The actuarial survival rate was 85.5% at 5 years and 67.9% at 10 years. Seventeen thromboembolic complications (7 lethal, 10 non-lethal) were observed and represented a linear incidence of 0.5% per patient-year. Fourty-one haemorrhagic complications were observed in 28 patients, i.e. a linear incidence of 1.26% per patient-year. Nine reoperations were necessary, responsible for 3 deaths. No cases of mechanical failure of the prosthesis were observed. All of the lethal and non lethal complications related to the prosthesis represented a linear incidence of 2.6% per patient-year. AT 5 and 10 years after the operation, 89.2% and 79.6% of the patients were free of any valve-related complications. The functional results was considered to be good or excellent in the very great majority of surviving patients (97.8%).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1988

[Aortic valve replacement in persons over 75. 128 operated patients].

Aortic valve replacements are performed in ever older subjects. In the surgical cardiovascular clinic of Rennes, 128 patients aged 75 or over (up to 85 years) and presenting with solitary or predominant (126 cases) aortic stenosis underwent aortic valve replacement between 1976 and 1985 inclusive. Pre-operative evaluation consisted, on principle, of non-invasive explorations. Myocardial protection was ensured by hypothermic cardioplegia. We used a mechanical (Björk-Shiley) prosthesis in the 19 patients operated upon before 1980, and a bioprosthesis (Carpentier-Edwards porcine, supra-annular type since 1983), in the 109 patients operated upon since 1980. The operative mortality rate was 8.6% (11 deaths). The survival curve was similar to that of a control population of the same age-group (survivors 75% at 4 years, operative mortality included). The quality of survival was remarkable since 96% of survivors were in NYHA stages I or II, the poor results being due to early or late cerebral vascular accidents. Advances in surgery (notably myocardial protection), anaesthesia and intensive care make it possible reasonably to operate upon very old patients, provided they have remained in good general and cerebral vascular condition. Non-surgical alternatives, such as percutaneous valvuloplasty, now used in elderly patients can only be reliable if results of similar quality and durability can be expected from them.

Aged↗
PubMed1988

Angiographic and surgical aspects of compressive muscular bridges and intramyocardial paths of the anterior interventricular artery (based on 12 cases).

The authors report 12 cases of myocardial bridges over the anterior interventricular artery discovered surgically. In 5 the compressive myocardial bridges were limited; in 7 the intramyocardial course of the anterior ventricular artery was discovered at operation. Comparison of the operative appearances with the angiographic findings affords a basis for anatomico-radiologic correlation. The authors stress the difference in frequency and significance between the compressive myocardial bridge (an indication for surgery) and the intramyocardial anterior interventricular artery discovered by chance during a procedure for coronary revascularization indicated for stenosing atherosclerotic lesions.

Adult↗
PubMed1988

Valvular replacement for aortic stenosis in patients over 70 years: immediate risk and long-term results (from a consecutive series of 355 patients).

From 1971 to 1985, 355 patients over 70 years of age (mean age 73.7) underwent isolated aortic valve replacement, most of them for pure calcified stenosis (78.6%). Mechanical valves (group A) were used in 112 cases (109 Bjork-Shiley; 3 SJM) and bioprostheses (group B) exclusively implanted since 1981 (192 Edwards-Carpentier; 51 Ionescu-Shiley). Thirty-six patients died post-operatively (10.1%). 36% of the deaths were related to cardiac causes, and 14% to cerebral damage. The follow-up involved 100% of the 319 survivors and spanned 12 years (1 month to 11.8 years), with an average of 3.2 years. The follow-up was almost equally distributed between groups A and B: 474 and 453 patient-years, respectively. Sixty late deaths (18.8%) occurred: 26.7% of them related to cardiac causes, and 20% to cerebral accidents. Twenty-nine cases were in group A (6.1% patient-years), and 31 in group B (5.7% patient-years). Acturial analysis shows that, at five years, 94.1% of patients in group A and 96% in group B were free of valve-related complications, and that 88.9% in group A and 89% in group B were free of valve-related non-lethal complications. Actuarial calculation of survival rates shows that, at five years, the probability of survival was 70.8% for the entire series, including the operative deaths. This curve of survival is similar to that of the normal population of the same age. Moreover, the functional status is dramatically improved by surgery: 99.6% of patients are in the NYHA classes I or II.

Aged↗
PubMed1986

[Vascular injuries of the limbs. Evaluation of 106 lesions in 76 patients].

A total of 106 lesions due to vascular injuries (noniatrogenic) to limbs were treated in 81 patients at the CHR, Rennes (Cardiovascular and Thoracic Unit) between 1970 and 1983. Analysis of data allowed a profile of arterial lesions (type and location) to be retraced, and demonstrated the high frequency of associated lesions, these varying in distribution according to whether the upper limbs (major seriousness of neurologic sequelae) or lower limbs (very high incidence of osteoarticular lesions) were involved. Among the "immutable" severity factors (related to the injury) emphasis has to be placed on "contending or crush injuries", widely displaced lesions, extensive arterial dilacerations (middle segments of limbs) and multiple vascular lesions. This study focused attention mainly on the tactical and technical factors allowing improvement in the always reserved prognosis of these lesions. Firstly, by maximum reduction in the duration of ischemia by early diagnosis (to avoid referral to a "second hand") and by judicious indication for angiography (conducted preferably in the operation room and if necessary repeated after vascular repair surgery). Secondly, by repair of lesions in conformity with well established rules and principles: bone stabilization initially, formal venous repair surgery for large venous trunks, preferably "conservative" surgery of arterial vessels to ensure a perfect result initially (any recovery operation results in a very high incidence of failures).

Adolescent↗
PubMed1986

[Mural thrombosis of the abdominal aorta. A sometimes unrecognized cause of recurrent embolisms].

A 23 year old patient with an infrarenal abdominal aorta mural thrombosis developed recurrent peripheral emboli. This case underlines the etiologic investigation necessary in cases of peripheral emboli unexplained by the conventional cardiac examinations. Filling of total aorta with contrast is essential (assisted if necessary by oblique projections) to detect possible mural thrombi carrying the risk of recurrent emboli.

Adult↗
PubMed1985

[Fissuration of post-infarction left ventricular aneurysms. 2 surgically treated cases].

The authors report two cases of fissures of a left ventricular aneurysm diagnosed on the 8th and 21st days following an anterior myocardial infarction. In both cases, the clinical presentation consisted of a new episode of pain associated with a low cardiac output syndrome and adiastole. The diagnosis was confirmed by the simultaneous discovery of a pericardial effusion and a left ventricular aneurysm on echocardiography and cardiac catheterisation. An emergency operation, with circulatory assistance by means of intra-aortic counter-pressure, was performed and the infarcted area was excised. The post-operative course was uncomplicated in one case, but the other patient developed a false aneurysm of the left ventricle, requiring a second operation. The long term results were excellent with a follow-up of 30 months and 12 months respectively.

Aged↗
PubMed1985

[Partial interruption of the inferior vena cava by an endovenous filter. Apropos of 98 patients].

94 partial interruptions of the inferior vena cava (PIIVC) were carried out in 98 patients between May 1979 and November 1983 with a Mobin-Uddin umbrella filter (58 cases) or a Kim-Ray Greenfield filter (36 cases); one patient who had a double inferior vena cava underwent double PIIVC with a Greenfield filter. The patients (56 women and 42 men) were between 22 and 84 years old (average 60.6 years). Phlebocavography was performed pre-operatively in 93 patients (95 p. 100) and showed thrombus in the IVC (21 cases), common iliac vein (20 cases), ilio-femoral vein (32 cases), femoral vein (15 cases), popliteal and/or sural vein (4 cases); the investigation was considered normal in 1 patient. The diagnosis of pulmonary embolism (PE) was made in 86 patients (87.7 p. 100) on clinical and/or pulmonary scintigraphy and/or angiography data. The main indications for PIIVC were major PE (56 cases) or a threatening venous thrombosis (27 cases); other indications included recurrent PE despite adequate anticoagulation, patients with contra-indications to anti-coagulant therapy and pulmonary hypertension due to thromboembolism; 4 PIIVC were carried out during pulmonary embolectomy on cardiopulmonary bypass. The operative mortality was 3.06 p. 100 (3/98) with a global early mortality of 10.2 p. 100 (10/98); morbidity was 12.2 p. 100 (12/98); there were 5 failures of PIIVC. The long-term outcome was studied in the first 80 cases with a mean follow-up of 18 months (4 to 48 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1985

[Left ventricle-right atrium communications acquired in bacterial endocarditis].

Three cases of acquired LV-RA communication during bacterial endocarditis are reported. The causal organisms were Staphylococcus aureus and Streptococcus. The endocarditis complicated aortic valve disease in 2 patients and a congenital aneurysm of the membranous interventricular septum in the third case. Perforation of the septal abscess was preceded by 1st and 2nd degree AVB in all cases associated with bursts of intrahisian tachycardia in 1 case. The clinical presentation was that of an acute VSD; LV-RA communication was diagnosed by the radiological demonstration of systolic expansion of the RA, by 2D echocardiography using constant and Doppler techniques which gave the exact diagnosis in 1 case, by oximetry showing a large left-to-right shunt situated in the RA, and finally by selective left ventriculography. Surgery is essential and urgent and comprises repair of the fistula by two patches, one atrial shown on via a right atrial approach and the other ventricular via aortotomy associated with correction of the valvular lesions. Third degree AVB is observed in all cases, due to the anatomical location of the His bundle and requires permanent pacing. Good results were observed in 2 cases with follow-up periods of 14 and 48 months respectively.

Acute Disease↗