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C Tribouilloy

Publications and source records attributed to C Tribouilloy.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Aortic stenosis with left ventricular dysfunction].

Patients affected by aortic stenosis with severe systolic left ventricular dysfunction have a poor spontaneous prognosis. The results of valvular replacement are globally good, at the price of an acceptable operative mortality. The existence of surgical failure has however prompted much work aimed at better definition of prognostic factors and for proposing new methods of specifying surgical indications. In this article based on a review of the literature, we discuss the physiopathology of left ventricular dysfunction, predictive factors for operative risk and survival, and the elements to be taken into account in order to adjust therapeutic decisions in these severe cases.

Aortic Valve Stenosis↗
PubMed2001

[Dissection of the aorta complicated by aorto-pulmonary fistula].

The authors report the case of chronic dissection of the aorta presenting with congestive cardiac failure. The diagnosis was made for the first time by transoesophageal echocardiography which showed both the dissection of the aorta and its fistulalisation into the pulmonary artery. Aortography confirmed the diagnosis. The patient underwent surgery which consisted of suture of the fistula and replacement of the ascending aorta with a prosthetic tube. The outcome was favourable after 8 months follow-up.

Aged↗
PubMed2000

[Fibrinogen: a cardiovascular risk factor].

AN INDEPENDENT RISK FACTOR: Pathophysiological and epidemiological data show that fibrinogen is an independent risk factor for atherosclerosis with a synergistic effect on classical risk factors. CORONARY ARTERIES: Serum fibrinogen level is an independent predictor of the presence and severity of atheromatous lesions of the coronary arteries. It is also predictive of coronary events such as sudden death, myocardial infarction or angina pectoris. OTHER VESSELS: Fibrinogen is also a marker of cerebrovascular events or transient ischemia and a factor predictive of recurrent cerebrovascular events. Serum fibrinogen level is correlated with the progression of carotid lesions. Finally, fibrinogen is an independent predictive factor of the severity of atherosclerosis of the thoracic aorta, lower limb arteriopathy, and more generally silent atherosclerotic plaques. PERSPECTIVES: A large-scale prospective study is needed to determine whether drug-induced reduction in serum fibrinogen can reduce the rate of cardiovascular events.

Adult↗
PubMed2000

[Epidemiology and etiology of acquired heart valve diseases in adults].

Acquired valvular heart disease remains common. Their causes have changed during the past 30 years with the increase in life expectancy and with the decrease in the incidence of rheumatic fever. Calcific aortic stenosis is currently the predominant cause, followed by left heart valvular regurgitations due to degenerative disease and infective endocarditis. Post-radiation valvular disease might become more frequent in the future. More recently, left heart valvular diseases were observed in the United States in patients treated by anorexigen treatment.

Adult↗
PubMed2000

Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: A quantitative clinical study.

BACKGROUND: Functional mitral regurgitation (FMR) occurs with a structurally normal valve as a complication of systolic left ventricular dysfunction (LVD). Determinants of degree of FMR are poorly defined; thus, mechanistic therapeutic approaches to FMR are hindered. METHODS AND RESULTS: In a prospective study of 21 control subjects and 128 patients with LVD (defined as ejection fraction <50%, mean 31+/-9%) in sinus rhythm, we quantified simultaneously by echocardiography the effective regurgitant orifice (ERO) of FMR by using 2 methods: mitral deformation (valve and annulus) and left ventricular (LV) global (volumes, stress, function, and sphericity) and local (papillary muscle displacements and regional wall motion index) remodeling. A wide range of ERO (15+/-14 mm(2), 0 to 87 mm(2)) was observed, unrelated to ejection fraction (P:=0.32). The major determinant of ERO was mitral deformation, ie, systolic valvular tenting and annular contraction in univariate (r=0.74 and r=-0.61, respectively; both P:<0.0001) and multivariate (both P:<0. 0001) analyses, independent of global LV remodeling. Systolic valvular tenting was strongly determined by local LV alterations, particularly apical (r=0.75) and posterior (r=0.70) displacement of papillary muscle, with confirmation in multivariate analysis (both P:<0.0001), independent of LV volumes, function, and sphericity. CONCLUSIONS: The presence and degree of FMR complicating LVD are unrelated to the severity of LVD. Local LV remodeling (apical and posterior displacement of papillary muscles) leads to excess valvular tenting independent of global LV remodeling. In turn, excess tenting and loss of systolic annular contraction are associated with larger EROs. These determinants of FMR warrant consideration for specific approaches to the treatment of FMR complicating LVD.

Aged↗
PubMed1998

Comparative value of Doppler echocardiography and cardiac catheterization in the decision to operate on patients with aortic stenosis.

With the use of Doppler echocardiography, severity of valvular stenosis, etiology and type of valve lesions, and left ventricular function can be assessed accurately in patients with aortic stenosis. The purpose of this study was to compare the value of noninvasive clinical and Doppler echocardiographic findings, with cardiac catheterization, in the management decision-making for patients with aortic stenosis. One hundred and seventy consecutive patients with aortic stenosis who underwent cardiac catheterization and Doppler echocardiography were prospectively studied. A decision to operate, not operate or remain uncertain was made independently by experienced cardiologists given clinical information in combination with either Doppler echocardiographic (group I) or cardiac catheterization (group II) data. The severity of aortic stenosis agreed between Doppler echocardiography and cardiac catheterization in 168 patients (98.8%), and disagreed in two patients. There was agreement on clinical decision to operate or not operate between Group I and Group II in 160 patients (94.1%) and a discrepant decision in only two patients (1.1%). In eight patients (4.7%) with poor echogenecity or with discordance between clinical and echocardiographic data, the decision made by group I remained uncertain. We conclude that in a large majority of patients with aortic stenosis, Doppler echocardiographic assessment provides the same management decision reached by cardiac catheterization findings.

Aged↗
PubMed1998

Paradoxical embolism following acute pulmonary embolism: diagnosis and outcome.

We report on ten cases of paradoxical embolism that occurred following pulmonary embolism and emphasize the echocardiographic contribution. Two patients had a thrombus trapped in a foramen ovale. An embolectomy was performed on one of those patients and the outcome was post-operative death. The other patient died suddenly prior to planned surgery. The remaining eight had inter atrial communication or foramen ovale that were highly patent upon contrast echography. Two of them who presented cardiogenic shock died rapidly despite resuscitation measures. The remaining six patients were treated medically with anticoagulants and have experienced no recurrence of embolism after a mean follow up 34+/-31 months.

Aged↗
PubMed1998

Fibrinogen is an independent marker for thoracic aortic atherosclerosis.

The fibrinogen level is an independent risk factor for coronary events and stroke, but no detailed data are available concerning fibrinogen and atherosclerotic disease of the thoracic aorta. This prospective study using multiplane transesophageal echocardiography examined the relation between atherosclerotic thoracic aortic plaque and fibrinogen level. One-hundred forty-eight patients (65 +/- 11 years) with valvular heart disease underwent multiplane transesophageal echocardiography and coronary angiography. We measured plasma fibrinogen level for each patient and recorded the following cardiovascular risk factors: age, sex, systemic hypertension, history of smoking, hypercholesterolemia, diabetes mellitus, body mass index, and family history of coronary artery disease (CAD). Patients with thoracic aortic plaque had a higher level of plasma fibrinogen (p = 0.0001), were older (p = 0.0001), and had significantly more risk factors: history of smoking (p = 0.009), hypertension (p = 0.008), hypercholesterolemia (p = 0.0001), diabetes mellitus (p = 0.01), and family history of CAD (p = 0.003). Multivariate logistic regression analysis of fibrinogen level and risk factors revealed 4 independent predictors of thoracic aortic plaque: fibrinogen, age, hypercholesterolemia, and history of smoking. Fibrinogen was also an independent predictor of CAD. There was a relation between fibrinogen levels and the severity of aortic atherosclerosis (r = 0.46; p = 0.0001) and the severity of CAD (r = 0.30; p = 0.0001). This prospective study indicates that fibrinogen is an independent marker for thoracic aortic plaque related to the severity of thoracic aortic atherosclerosis and confirms that fibrinogen constitutes an independent marker for CAD related to the severity of angiographically evaluated coronary atherosclerosis.

Adult↗
PubMed1998

[Transesophageal echocardiography before electric cardioversion for supraventricular arrhythmia].

OBJECTIVES: The aim of this prospective study was to assess the risks of electrical shock cardio-version in the treatment of supraventricular rhythm disorders when administered under effective-dose but short duration anticoagulation in patients with no intracavitary thrombus detectable by transesophageal echocardiography. PATIENTS AND METHODS: One hundred nineteen patients, mean age 66 years, with permanent arrhythmia due to atrial fibrillation (n = 102), atrial flutter (n = 16) or atrial tachycardia (n = 1) and taking no long-term anticoagulant therapy were treated by electrical shock cardioversion. The patients were given heparin at an effective dose 72 hours prior to cardioversion. A transthoracic and a transesophageal echocardiography were performed less than 24 hours prior to cardioversion. RESULTS: Twenty-one thrombi were evidenced in 16 patients (14.6%) including 18 in the left auricle, 1 in the left atrium and 2 in the right atrium. A spontaneous contrast was visualized in 38 patients (32%). Cardioversion was performed in 103 patients without thrombus and later in 9 of the 16 patients with thrombus after absorption under anticoagulant therapy as evidenced on the control transesophageal echocardiography. A sinus rhythm was obtained in 82% of the cases. All patients were given anti-vitamin K anticoagulants for one month. There were no clinical manifestation of ischemic vascular events during cardioversion nor during the one-month follow-up. CONCLUSION: Early use of electrical shock cardioversion in patients with supraventricular rhythm disorders can be proposed without long-term anticoagulation therapy if the absence of thrombi is demonstrated by transesophageal echocardiography and short-term heparin is given followed by oral anticoagulants for at least 4 weeks. A large-scale randomized prospective study comparing the conventional strategy with the protocol used in this study would be required to definitively validate this approach and determine its possible advantages.

Adult↗
PubMed1998

Single-lead VDD pacing: long-term experience with four different systems.

BACKGROUND: Previous multicenter studies have shown that single-lead VDD pacing systems provide satisfactory atrial-triggered ventricular pacing at middle term for treatment of atrioventricular block without sinus dysfunction. However, we lack data on long-term results obtained with different VDD systems implanted in a large number of patients from a single center. METHODS: One hundred fifty patients (76 +/- 11 years) with second- or third-degree atrioventricular block (n = 147) or symptomatic hypertrophic cardiomyopathy (n = 3) without sinus dysfunction were paced with four different VDD pacing systems able to sense the atrium and to pace the ventricle. Atrioventricular synchronization was assessed during follow-up by ECG and Holter monitoring. RESULTS: Mean value of the atrial electrogram during implantation was 2.01 +/- 0.94 mV without any differences among the four systems. With a mean follow-up of 24 +/- 11 months, 95% of patients remain paced in VDD mode, whereas 5% have been reprogrammed in VVI or VVIR mode for permanent atrial fibrillation or loss of atrial sensing; 96% of patients with sinus atrium have atrioventricular synchronization >90% and 94% of patients have >95%, without significant difference between the four systems used. CONCLUSIONS: These different single-lead VDD systems can provide satisfactory long-term atrioventricular synchronization; results are comparable to those obtained with conventional DDD pacing systems with two leads.

Aged↗
PubMed1998

Use of transesophageal echocardiography to predict significant coronary artery disease in aortic stenosis.

STUDY OBJECTIVES: This study was conducted to examine if the use of multiplane transesophageal echocardiography (TEE) could predict the absence or the presence of significant coronary artery disease (CAD) in patients with aortic stenosis. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Clinical, angiographic features and TEE findings were prospectively analyzed in 132 consecutive patients with aortic stenosis. MEASUREMENTS AND RESULTS: In 63 patients with significant CAD, 57 had thoracic aortic plaque on TEE studies. In contrast, aortic plaque existed in only 19 of the remaining 69 patients with normal or mildly abnormal coronary arteries. Therefore, the presence of aortic plaque on the TEE identified significant CAD with a sensitivity of 90.5%, a specificity of 72.5%, and with positive and negative predictive values of 75.0% and 89.3%, respectively. There was a significant relation between the severity of thoracic aortic atherosclerosis and the severity of CAD (p<0.0001). Multivariate logistic regression analysis revealed that aortic plaque, angina, and age were independent predictors of CAD. Aortic plaque was the most significant independent predictor. CONCLUSION: This prospective study indicates that TEE examination of thoracic atherosclerotic plaque is a powerful predictor of absence of significant CAD in patients with aortic stenosis.

Adult↗
PubMed1998

[Diagnostic value of echocardiography and thoracic spiral CT angiography in the diagnosis of acute pulmonary embolism].

The objective of this study was to define the limits of echocardiography and to evaluate thoracic spiral CT angiography (TSCTA) for the diagnosis of pulmonary embolism (PE). One hundred twelve consecutive patients, hospitalised for suspected PE, were included in this prospective study. All were investigated by pulmonary ventilation-perfusion scintigraphy (Sc) and 50 had a high probability of PE on this examination. Sc was normal in 22 patients. Forty patients were excluded because of an intermediate probability. In 50 patients with PE confirmed on Sc, transthoracic echocardiography (TTE) showed only indirect evidence of PE (intracavitary thrombus in 4% of cases). TSCTA demonstrated PE in 82% of cases and did not show any thrombus image when Sc was normal. Its negative predictive value was therefore 70% and its positive predictive value was 100%. Its sensitivity varied according to degree of perfusion defect (96% in the case of lobar lesion, 66% in the case of segmental lesion and 16% for a subsegmental lesion). Multidimensional transoesophageal echocardiography (TOE), performed in 37 of the 50 patients with PE, only revealed thrombi in the pulmonary tree in 3 patients (8%), all presenting severe PE. No thrombus was visualized on TOE in patients with non-serious PE. All thrombi observed on TOE were also demonstrated by TSCTA. In conclusion, TTE usually provides only indirect signs of PE. TOE has a poor diagnostic sensitivity for PE. TSCTA has a better sensitivity than TOE for the detection of thrombi in the pulmonary artery trunk and proximal centimetres of its two branches, but normal CT angiography cannot exclude a distal PE.

Acute Disease↗