Predicting ischemic complications after bailout stenting following failed coronary angioplasty.
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Aged↗
Biomedical subjects
D Metz
Publications and source records attributed to D Metz.
Evaluation of the systematic use of a new type of diagnostic/interventional 6F catheters for coronary angiography and angioplasty.
Coronary angioplasty performed immediately after coronary angiography has raised interest to develop diagnostic catheters potentially usable for interventions (i.e. Diaventional catheters). To evaluate the performance and cost-effectiveness of such material, we performed a prospective study in 100 consecutive patients with a > 50% pre-angiographic likelihood of coronary angioplasty in 85 of them. Angioplasty was actually performed in 61 patients. Of the 56 (92%) immediate angioplasty procedures, 33 (59%) were performed successfully with the Diaventional catheter chosen initially. In 23 cases, another guiding catheter was used for technical failure (2 cases) or because of operator's choice (21 cases). Angiographic success of angioplasty procedures was 97% with Diaventional and 91% with "standard" guiding catheters. Based on current market prices, the costs of the systematic use of such diagnostic/interventional catheters were 11% less than the projected costs of the standard strategy. Thus, this new type of catheter is both safe and cost-effective for the majority of coronary angioplasty procedures "at first sight." It could become a logical first choice for diagnostic coronary angiography, when the likelihood of immediate subsequent angioplasty is high and at relatively low risk.
Adult↗
Improving results of bailout coronary stenting after failed balloon angioplasty.
Stent implantation can be a valuable alternative to emergent bypass surgery to treat established or threatening abrupt closure following coronary balloon angioplasty. To evaluate several sequentially introduced changes in our practice of bail-out stenting, we compared the first (group I) and second half (group II) of our single center experience (n = 88). Use of bailout stenting increased over time (2% of all angioplasty procedures in group I vs. 6% in group II, P < 0.001), more often to prevent rather than to reverse abrupt closure. Technical success of stent implantation was unchanged (95% vs. 93%), and there was a decreasing trend for stent thrombosis (14% vs. 5%), in-hospital death (5% vs. 2%), Q-wave myocardial infarction (9% vs. 7%), and requirement for surgery (9% vs. 7%). The incidence of non-Q-wave myocardial infarction (29% vs. 7% P < 0.01), bleeding complications (27% vs. 7% P < 0.01), and hospital stay duration (11 +/- 11 vs. 8 +/- 5 days P < 0.05) decreased. Our data suggest that coronary stent implantation is currently an effective stand-alone bailout procedure for a large majority of failed angioplasty procedures.
Aged↗
Visualization of myocardial infarction six hours after injection of 111 In-antimyosin antibodies using an image subtraction technique.
111 In-antimyosin antibodies are capable of visualizing acute myocardial infarction (MI). Because of slow blood clearance, images are usually recorded 24 or 48 h postinjection. This pilot study was aimed at validating a blood pool subtraction technique, which makes it possible to visualize MI 6 h postinjection. Twenty-five patients with proven MI (16 anterior, 9 inferior) were imaged 10 minutes, 6 and 24 h after an injection of 110 MBq 111 In-labelled antimyosin antibodies, with a mean delay of two weeks after infarction. Three planar views were obtained each time. Using software which performs geometric registration, grey level normalization and subtraction of images, the blood pool image (obtained 10 minutes postinjection) was subtracted from the 6 hour image. The resulting image was the blood pool corrected 6 h image. The 24 h images and the blood pool corrected 6 h images were interpreted blindly and the number of correct, incorrect and indeterminate MI localizations were tabulated. The number of correct localizations was 19/25 for the standard 24 h images and 22/25 for the blood pool corrected 6 h images. With this blood pool subtraction method it was possible to visualize MI 6 h postinjection. Theoretically, this method could be applied six hours after myocardial infarction.
Antibodies, Monoclonal↗
Prevalence of valvular involvement in systemic lupus erythematosus and association with antiphospholipid syndrome: a matched echocardiographic study.
Antiphospholipid antibodies in patients with systemic lupus erythematosus (SLE) are often associated with thrombosis, recurrent abortions and thrombocytopenia. The purpose of this study was to evaluate the prevalence of cardiac valvular abnormalities in patients with SLE and to establish the relationship between the echographic findings and the presence of an antiphospholipid syndrome. A total of 52 consecutive patients with SLE and 52 healthy sex- and age-matched controls were therefore evaluated in a cross-sectional study. All underwent M-mode and two-dimensional echocardiography, color-flow imaging, pulsed and continuous-wave Doppler. In the SLE group, subjects exposed to antiphospholipid syndrome (n = 20) were compared to controls. Patients with SLE had significantly more mitral (p = 0.032; RR 2.48; 1.25-5.6) and tricuspid regurgitations (p = 0.0016; RR 2.41; 1.58-8.85). There was no significant difference between either group for mitral valve thickness (p = 0.66). The antiphospholipid syndrome was significantly associated with increased relative risk for tricuspid.
Adolescent↗
[Immediate results of coronary endoprosthesis in threatening or occlusive dissections complicating angioplasty; the Geneva experience].
Between April 1988 and September 1993, 123 patients (average age 60.4 +/- 8.9 years) underwent coronary stenting for threatening or occlusive dissection complicating angioplasty. The anterograde coronary flow was disturbed in 51% of cases (TIMI-0-2). The artery concerned was the left anterior descending in 59% of cases, the right coronary in 28% of cases, the circumflex in 12% and a coronary bypass graft in 1% of cases. Technically, the stenting was successful in 118 cases (98%) and, in 21 cases, complete stenting of the dissection required the insertion of several stents. The minimal coronary diameter after expansion of the stent was 3.1 +/- 0.6 mm. During hospital follow-up, 3 deaths (3%) and 7 Q-wave infarcts were observed. Twenty-eight patients (23%) developed a haemorrhagic complication, including 2 retroperitoneal and 2 intracerebral bleeds. Eight patients (6%) underwent coronary bypass grafting, as an emergency in 4 cases and semi-electively in another 4 cases. One hundred and five patients (89%) survived the intra-hospital period without major complications (death, Q-wave infarction, emergency coronary bypass surgery or severe haemorrhage). Coronary stenting for threatening or occlusive dissection complicating angioplasty seems to be a reasonable solution and a usually definitive one. The frequency of haemorrhagic complications underlines the need for strict clinical and biological surveillance.
Aged↗
[Cardiogenic shock caused by occlusive thrombosis of a mitral valve prosthesis treated by fibrinolysis].
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Heart Valve Prosthesis↗
What factors determine indium-111 antimyosin monoclonal antibody uptake in patients with myocardial infarction?
The intensity of indium-111 antimyosin monoclonal antibody uptake for visualization of myocardial infarction seems partially dependent on the state of the infarct related coronary artery. The aim of this study is to determine the factors which could account for the monoclonal antibody uptake variability. For this purpose, we investigated 27 patients (mean age 52.7 +/- 9.6 years) with a first proven myocardial infarction, by monoclonal antibody scintigraphy and coronary arteriography within the same period of time (7.12 +/- 6 days). The monoclonal antibody uptake was quantified by the heart/lung ratio on images recorded 24 h after injection. The infarct size was quantitatively estimated on wall motion analysis of twelve segments in 30 degree right anterior-oblique view with a radial method. The infarct related coronary artery state was assessed by the Thrombosis in Myocardial Infarction grade and the functional characteristics of collateral vessels by Rentrop's classification. These three variables as well as location of myocardial infarction, left ventricular ejection fraction, administration of a thrombolytic therapy, delay between myocardial infarction and monoclonal antibody scintigraphy were studied using non parametric test, or by linear regression method in order to determine whether these factors would influence the heart/lung ratio. None of these parameters except infarct size was related to heart/lung ratio. Consequently, monoclonal antibody uptake is only dependent on the extent of infarcted myocardium and the intensity of uptake cannot predict the patency of an infarct related coronary artery.
Adult↗
[Value of transesophageal echography in the detection of left intraventricular masses. Apropos of a case of apical thrombus].
The authors report a case of left intraventricular thrombus investigated by two-dimensional transesophageal echocardiography (TEE). Three longitudinal views obtained by rotation, left lateral inclination and by advancing the probe, enabled the precise evaluation of a mass situated at the apex of the left ventricle, together with ventricular morphology and kinetics. Two-dimensional TEE is electively indicated for confirmation of the diagnosis of left intraventricular apical masses, in particular in hypoechogenic patients and to guide possible surgery. The two-plane probe provides a certain number of sections which remain relatively limited but this problem is resolved with the development of multidimensional probes.
Echocardiography↗
[Value of transesophageal echography in the diagnosis of posterior ventricular septal rupture during the acute phase of myocardial infarction. Apropos of 2 cases].
The authors report two cases of posterior ventricular septal defects complicating acute myocardial infarction diagnosed by transesophageal echocardiography. Transesophageal echocardiography was well tolerated confirmed the diagnosis, and enabled accurate evaluation of the shunt in the transgastric view. The anatomical results guided the surgical approach and correlated well with the operative findings.
Acute Disease↗
[Doppler echocardiography under dipyridamole after thrombolyzed early myocardial infarction. Comparison with coronarographic data].
The reliability and safety of Doppler echocardiography with dipyridamole (0.84 mg/kg in 10 min) were evaluated in 63 patients an average of 7 days after a thrombolysed early lateral infarct and 24 hours before follow-up coronary arteriography. The aims of the test were the detection of tight stenoses (diameter reduced by more than 75%) affecting the artery responsible for the infarct as well as the other coronary vessels, using the vasodilator action of dipyridamole. The echocardiographic manifestation of induced coronary steal consisted of transitory asynergism in the territory of the artery involved. Clinical tolerability of the test was good. The brief onset of anginal pain was nevertheless seen in 6 patients. Analysis of the zone corresponding to the necrosed area was possible in only 43 cases. Sensitivity of the test for detection of a post-infarction residual stenosis was 64% (39-89) and specificity 90% (79-100). Study of other territories was possible in 59 cases. Sensitivity of the test for the diagnosis of multiple vessel disease was 70% (42-98) and specificity 94% (88-100). In the population as a whole, Doppler study of variations in anterograde mitral flow revealed a sensitivity of 40% (27-53) and specificity of 87% (78-96). Variations in sub-aortic flow were analysed only in the final 27 patients, with a sensitivity and specificity of 100%. The specificity of dipyridamole echocardiography after infarction is good, both for the detection of residual stenosis and that of multiple vessel disease, the chief limiting factor being the impossibility of analysis of the infarcted region in the presence of initial akinesis.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Mobile thrombus of the right heart and pulmonary embolism: diagnostic and therapeutic problems. Apropos of 12 cases].
The objectives of this report were to analyse clinical presentation, echocardiographic features and diagnostic and therapeutic problems posed by an unusual form of thrombo-embolic disease: mobile right heart thrombosis. Systematic echocardiography in 170 cases of severe pulmonary embolism identified mobile right thrombi in 12 cases. The auscultatory findings were abnormal in 6 cases, 3 showing signs of tricuspid obstruction. Two-dimensional echocardiography showed an extremely mobile right atrial mass, sometimes prolapsing across the tricuspid valve, which was variously spheric, ovoid or worm-like; dilatation of the right heart chambers and echocardiographic signs of cor pulmonale were observed in all cases. The differential diagnosis with other embolic masses of the right atrium and, above all, with well-developed Chiari networks, may be difficult and requires transoesophageal echocardiography. Pulmonary angiography is contra-indicated because of the risk of embolism. Embolectomy under cardiopulmonary bypass was carried out in 8 patients, immediately after echocardiography in 6 cases. The thrombus was recovered from the right atrium in 6 cases and from the pulmonary artery in 2 cases: there was one operative death. Medical treatment was administered to 3 inoperable patients. The clinical and echocardiographic outcome was good in 2 of these but the third patient died; autopsy revealed thrombi in the right atrium and pulmonary artery. One patient died before any treatment could be given and autopsy showed the thrombus in the pulmonary artery. These results confirm the extreme instability of this type of thrombus and the risk of death due to its embolism.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Late complication of blunt injuries of the thorax: acute pericarditis. Apropos of a case].
The authors report a case of closed trauma of the thorax, complicated after a symptom-free period by acute pericarditis, combined with pleural effusion. The clinical outcome was favorable and the pericardial effusion, which was considerable at the first ultrasound scan, spontaneously recovered fully. The incidence of this delayed complication of closed trauma of the thorax is unknown. Its mechanism, related to that of the Dresler syndrome and post-pericardiotomy syndrome differs from that of initial hemopericardium which is of mechanical origin. This case highlights the capital importance of ultrasound in the diagnosis and assessment of cardiac complications of thoracic trauma.
Acute Disease↗
[Thrombolysis and acute venous thromboembolic disease].
Thrombolytic agents are widely used as first line treatment in severe acute pulmonary embolisms. While their indications are well defined, no controlled trial exists to provide definite evidence of their ultimate effectiveness in terms of mortality. Nevertheless, therapeutic advances and the good results obtained in terms of satisfactory changes in hemodynamic and angiographic parameters have led to renewed evaluation at the present time of the ways in which they are used in thrombo-embolic disease: administration of thrombolytics as repeated boluses in order to decrease the risk of hemorrhagic complications; and extension of the indications of thrombolysis to the venous component of thrombo-embolic disease.
Acute Disease↗
[Paradoxical pulmonary embolisms with tricuspid valve incarceration syndrome revealing a biatrial thrombus].
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Heart Atria↗
Visualization of myocardial infarction 6 h after injection of 111In-antimyosin antibodies using a blood pool subtraction technique.
111In-antimyosin antibodies are capable of visualizing myocardial infarction (MI). Because of slow blood clearance, images are usually recorded 24 or 48 h postinjection. In this pilot study, a blood pool subtraction technique, which makes it possible to visualize MI 6 h postinjection, is validated. Twenty-five patients with proven MI (16 anterior, 9 inferior) were imaged a few minutes, 6 and 24 h after an injection of 111 MBq 111In-labelled antimyosin antibodies. Three planar views are obtained each time. Using software which performs the geometric registration, the grey level normalization and the subtraction of images, the blood pool image (obtained a few minutes postinjection) is subtracted from the 6 h image. The resulting image is the blood pool corrected 6 h image. The 24 h images and the blood pool corrected 6 h images were interpreted blindly and the number of correct, incorrect and impossible MI localizations was counted. The number of correct localizations is 19/25 for the standard 24 h images and 22/25 for the blood pool corrected 6 h images. Then, with this blood pool subtraction method, it is possible to visualize MI 6 h postinjection. This has to be taken into account when discussing the role of antimyosin scintigraphy in the management of patients with MI.
Antibodies, Monoclonal↗
[Anaphylactic shock complicated by myocardial infarction: side effect of glaphenine?].
The authors report a case of anaphylactic shock complicated by coronary spasm and infarction attributed to glafenine medication in a 43-year-old male patient. The outcome was positive and coronary angiography showed healthy coronary vessels. The ergonovine maleate was negative. A review of the literature confirms the rarity of this complication of anaphylactic shock and study the ECG changes induced by this type of reaction and to analyze the mechanisms responsible for this coronary spasm in this situation. These consists basically of histamine release and prostaglandin-synthesis inhibition.
Adult↗
[Predictive factors of regularization and maintenance of sinus rhythm in chronic atrial fibrillation].
The aim in treating chronic atrial fibrillation, is not limited to simply achieving immediate regularization. What matters, is sustaining the sinus rhythm. The various methods of regularization, using either medical procedures or cardioversion, involve constraints and risks. Investigation of the relapse predicting factor is of great value in evaluating the benefit/risk ratio. For regularization, the absence ultrasound signs of heart disease, an undilated left atrium, recent atrial fibrillation and all forms of heart disease which are curable, albeit surgically, are indicative of success. With regard to prophylaxis, relapses occur more frequently in cases involving mitral valve disease, long-standing atrial fibrillation or a dilated left atrium.
Age Factors↗