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Biomedical subjects

E Baudet

Publications and source records attributed to E Baudet.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Comparative value of transthoracic echocardiography and angiography for measuring the pulmonary artery annulus in tetralogy of Fallot].

It may be necessary to perform an enlarging pulmonary annuloplasty during surgical cure of Tetralogy of Fallot (TOF) in order to optimise reconstruction of the right ventricular outflow tract. As this additional procedure implies an increase in perioperative mortality, it is useful to prepare for this eventuality before surgery. Two imaging techniques are available: transthoracic echocardiography (diameter of the pulmonary annulus obtained by averaging the measurements obtained in the subcostal and parasternal short axis views of the insertion of the pulmonary valve cusps at end systole) and selective angiography during right heart catheterisation (anteroposterior measurement with comparison to be projected and real size of the catheter at the point of insertion of the cusps at end systole). In this study, these two techniques were compared with reference to the peroperative measurement with Hegar dilators and criteria defined by Naito (minimal diameter of the pulmonary artery annulus with respect to the weight of the child). Seventy-eight children admitted to hospital between January 1986 and April 1994 for curative surgery of TOF were included. The calculation of the intra-class correlation coefficient showed a mediocre correlation with angiography and a very mediocre correlation with echocardiography compared with peroperative measurements. However, the calculation of sensitivities showed angiography to be the predictive investigation for annuloplasty in children not conforming to the Naito criteria: higher sensitivity (83% vs 26% for echocardiography), greater negative predictive value (84% vs 70%). This result holds for all categories of body weight (over and under 10 kg).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1995

A 8-year follow-up of the Edwards-Duromedics bileaflet prosthesis.

Following reports of leaflet escapes, distribution of the Edwards-Duromedics prosthesis (ED), introduced in 1982, was suspended from 1988 to 1990. From our experience of 257 patients operated on between March, 1983, and April, 1988, it appeared to us that, among the five key factors identified by extensive studies, surgical mishandling, specially in mitral position, could have been the main contributing factor. These 257 patients, mean age 57 years (range 2 to 75 years), underwent 138 aortic (AVR), 86 mitral (MVR), and 33 double valve (DVR) replacements. Hospital mortality was 2.3% (6 patients): 1.4% for AVR, 3.5% for MVR, and 3% for DVR, none of them being directly valve-related. But there were 3 early replacements of a mitral ED for intra or postoperative impingement of one leaflet. Follow-up has been 93%, with a total of 1.155 patient-years. Among the 20 late deaths (8%), 4 (20%) were considered as valve-related; there was one MV thrombosis and 7 non-fatal systemic emboli, the total incidence of thromboembolism being 0.7% patient-year. No structural failure or leaflet escape was observed in this series. At 8 years, actuarial survival, hospital mortality excluded, was 85.5% for AVR, 95% for MVR, and 89% for DVR. The ED prosthesis is, from a hydrodynamic point of view, an advance in terms of both mechanical and bileaflet valve: the valve design accounts for its low thrombogenicity. But its persistent drawback remains the prohibitive vertical exposure of leaflets in mitral position, that can be responsible for immediate or delayed leaflet entrapment, or for incautious handling for rotating the mechanism, leading to extensive fissuration of pyrolitic carbon and delayed rupture. (ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Cerebral protection by selective cerebral perfusion during surgery on the aortic arch].

The aim of this study was to evaluate the technique of cerebral protection by selective cerebral perfusion with moderate hypothermia during surgery of the transverse aortic arch. Twenty-three patients were operated for partial or total replacement of the transverse aortic arch between January 1987 and December 1993 by the technique of selective cerebral perfusion by bilateral carotid cannulation. There were 12 cases of aneurysm of the ascending aorta and/or transverse aortic arch, one aneurysm of the innominate artery and 10 Stanford type A aortic dissections. The selective cerebral flow rate was 1-1.5 l/min; the perfusion pressure 60-80 mmHg and the temperature of cerebral perfusion 25-28 degrees C. The perioperative mortality was 13%; the causes of death were not neurological (3 haemorrhages). The neurological morbidity was 10% (one brachial monoparesis and one bulbar tetraparesis). This is therefore a useful technique of cerebral protection which avoids the complications of deep hypothermia with circulatory arrest and does not limit the time of aortic repair.

Adult↗
PubMed1993

Hemocompatibility of diamond-like carbon coating.

The new prosthetic heart valve that has been designed by FII Company and Pr. Baudet involves a new "composite" material: titanium alloy T16A14V coated with Diamond-like Carbon. The purpose of this study was to evaluate the in vitro hemocompatibility of this new material in terms of protein adsorption and platelet retention. The static protein adsorption test gave interesting results, particularly for the albumin assay (237%) compared to the results obtained with a silicone elastomer chosen as a reference; the fibrinogen quantity, adsorbed on the surface of the material was slightly higher than that adsorbed on the silicone surface. Platelets adhere quite twice as much as they do on the reference surface. Such investigations showed good hemocompatibility results and should initiate further studies.

Adsorption↗
PubMed1992

Isolation of the right subclavian artery.

Loss of continuity between subclavian artery and aorta with persistent connection to the homolateral pulmonary artery through a ductus arteriosus is an uncommon malformation, involving generally the left subclavian artery and associated with intracardiac or aortic arch anomalies. We report a case of right subclavian isolation with a left-sided aortic arch, presenting as a single anomaly and surgically corrected by aortic reimplantation.

Aorta, Thoracic↗
PubMed1992

Bronchial revascularization in double-lung transplantation: a series of 8 patients. Bordeaux Lung and Heart-Lung Transplant Group.

Donor airway ischemia is the main cause for defective tracheal or bronchial healing after double-lung transplantation. Anatomical studies and bronchial arteriograms have shown that the right intercostal bronchial artery is constant (95% of instances) and provides an important blood supply to the distal trachea, the carina, and the right bronchial tree as well as to the left side through a subcarinal and periadventitial anastomostic network. To maintain this important bilateral bronchial circulation, it is of capital importance not to mobilize the arteries individually and to avoid large dissections around the carina. Both bronchi can thus be revascularized by indirect aortic reimplantation using a bypass graft to a single aortic patch that includes the origin of the right intercostal bronchial artery. Furthermore, the origin of other vessels (a common trunk and left arteries) can be found within a short distance of the right intercostal bronchial artery and possibly be contained within the same aortic patch. From a series of 56 lung transplantations, 8 patients underwent restoration of the bronchial vascularization using a recipient saphenous vein graft between the donor bronchial arteries and the anterior aspect of the recipient's ascending aorta. A lower tracheal anastomosis was performed. Bronchial arterial blood supply was evaluated both by endoscopy and by arteriography at about the 15th postoperative day. The bronchial circulation was visualized at this time in five of seven arteriographies, and this was associated with excellent tracheal healing in all 8 patients.

Adult↗
PubMed1992

Lung transplantation with bronchial revascularisation. Surgical anatomy, operative technique and early results.

Ischaemic anastomotic complications are an important cause of mortality and morbidity after lung transplantation. Anatomical studies have demonstrated that the pattern of bronchial arterial supply is relatively constant and therefore amenable to attempts at revascularisation. From May 1990, 10 patients who had a double lung transplantation (tracheal anastomosis) and 1 patient who had a right lung transplantation underwent concomitant bronchial revascularisation. There were two early and one late deaths. There were no anastomotic complications. Regular endoscopic examination showed satisfactory healing in all patients. Early angiography showed patent grafts in 7 of 9 patients. At a mean follow-up of 11 months (range 6-17 months) 8 patients are well and leading a normal life. This report describes the anatomical basis, technical aspects and early results of a promising operative procedure in the field of lung transplantation.

Adult↗
PubMed1992

Mechanical cardiac valve thrombosis. Is fibrinolysis justified?

BACKGROUND: Thrombosis is a serious complication of heart valve replacement, and management is often difficult. In recent years, thrombolytic therapy has been used as the primary technique by some investigators. METHODS AND RESULTS: Sixty-four consecutive patients presenting with 75 instances of prosthetic heart valve thrombosis (41 mitral, 33 aortic, one tricuspid) were treated with fibrinolytic agents. Obstructed prosthetic valves comprised 39 tilting disc and 36 bileaflet valves. The time interval between valve replacement and obstruction ranged from 15 days to 192 months (mean, 38 months). Fibrinolytic agents used were streptokinase (42 patients), urokinase (27 patients), or recombinant tissue-type plasminogen activator (six patients). Immediate results of fibrinolytic treatment were 1) full success after one or several consecutive fibrinolytic regimens in 55 cases (73%), 2) incomplete improvement in two cases, and 3) failure in 18 cases, leading to an emergency surgery in nine cases. Nine patients died (four strokes, four cardiac arrests, one hemorrhage). Only one severe hemorrhagic complication was observed, but 11 cases of embolism occurred during fibrinolytic treatment (14.6%) (four major cerebral embolisms with death). The immediate efficacy was better for thrombosed aortic prosthesis than with the mitral prosthesis (85% versus 63%). CONCLUSIONS: Fibrinolytic treatment appears to be an attractive nonsurgical alternative for prosthetic heart valve thrombosis, but because of the risk of cerebral embolism, its use should be reserved for tricuspid valve thrombosis or critically ill patients with mitral or aortic valve thrombosis. The use of a fibrinolytic agent in cases of small, nonobstructive paravalvular thrombosis demonstrated with transesophageal echocardiography needs further studies.

Aortic Valve↗
PubMed1991

[Aneurysms of the aortic arch. Experience of 19 cases].

From 1980 to 1990, 19 consecutive patients were operated for chronic aneurysm of the aortic arch: 16 men and 3 women with a mean age of 46 years (range: 20 to 72 years). Four aneurysms were proximal, with a distal limit in the left common carotid artery; 4 were distal, starting beyond the brachiocephalic trunk and 11 involved the entire aortic arch. Three were atheromatous, 9 were dystrophic, 1 was syphilitic, 1 was post-traumatic, 1 was secondary to coarctation and 4 was secondary to longstanding dissection. Four cases (21%) were in a state of pre-rupture. They were all operated under cardiopulmonary bypass with profound hypothermia and circulatory arrest in 11 cases (9 cases of aneurysm involving the entire segment II and two cases of distal aneurysms). Selective cannulation of the large cervical arteries supplying the brain was performed in 5 cases (3 cases of proximal aneurysms and 2 cases of aneurysms of the entire segment II). Seven patients simultaneously underwent aortic valve replacement and replacement of the ascending aorta. One patient underwent replacement of the descending aorta and another underwent an ascending aorta-supracoeliac aorta bypass graft. The early mortality was 10.5% (2 patients out of 19) and the late mortality was 5.8% (1 patient out of 17). The mean follow-up was 46 months (maximum: 9 years, minimum: 9 months), and the 9-year actuarial survival rate was 86%. This study demonstrated the superiority of selective carotid cannulation as a means of cerebral protection.

Actuarial Analysis↗
PubMed1991

[Leiomyosarcoma of the right ventricle. Report of a case and review of the literature].

Primary cardiac leiomyosarcoma is a very rare condition. Only 15 cases have been reported in the literature. We report the case of a 27 year old man admitted to hospital for chest pain in March 1985. Echocardiography showed a right ventricular tumour which was completely resected at surgery. The diagnosis of leiomyosarcoma was confirmed by histological examination. After 22 months follow-up, the patient was still alive despite pulmonary metastases. The diagnosis of cardiac tumour used to be made post-mortem but since the introduction of new methods of investigation, especially 2D echocardiography, the diagnosis can be made at an early stage and allows rapid surgical resection, the only means of obtaining the histological diagnosis and of completely curing benign tumours.

Adult↗
PubMed1991

[Tracheobronchial healing in lung or heart-lung transplantation. An anatomical study of forty anastomoses in men].

The post operative evaluation and endoscopic follow-up of 34 tracheal or bronchial anastomoses after lung or heart-lung transplantation show some aspects of the tracheobronchial healing and difficulties in the healing process: primary type I mucomucosal healing in only 6 cases, secondary type II mucosal healing in 15, delayed type III healing after mucosal or deep parietal necrosis in 13, type IV distant ulcerations of mucosa and spur lesions in 12. Type III difficulties of healing mainly occur after double-lung transplantations which always suffer from ischemia. Autologous tracheal or bronchial sutures in 3 transplanted patients submitted to standard immunosuppressive therapy including corticosteroids were uneventful and type I. This experience suggests that among all factors having an influence on bronchial healing, ischemia of the donor tracheobronchial tree is predominant, justifying all attempts of bronchial revascularization after double-lung transplantation. The efficacy of the arterial revascularization is verified in 3 cases of tracheal anastomosis after double-lung transplantation with type I or II tracheal healing.

Anastomosis, Surgical↗
PubMed1991

[Simultaneous tracheal resection-anastomosis and heart transplantation].

Advanced myocardial disease associated with a post-intubation tracheal stenosis due to acute cardio-pulmonary failure in a 52 year-old patient led to a difficult choice of priorities between tracheal resection-anastomosis and heart transplantation. A simultaneous surgical operation with both heart transplantation and tracheal resection-anastomosis was considered to be a safe solution and was performed successfully. No adverse effect of corticosteroid and immunosuppressive therapy was observed on tracheal healing despite the tension resulting from segmental resection of the trachea.

Anastomosis, Surgical↗
PubMed1990

Lung and heart-lung transplantation for end-stage lung disease. The Bordeaux Lung and Heart-Lung Transplant Group.

Between February 1988 and December 1989, 15 combined heart-lung, 2 double lung and 5 single lung transplants were performed at our institution for end stage lung disease. The indication for heart-lung transplantation was primary lung disease with associated secondary heart failure in 11 cases, diffuse pulmonary disease with extensive adenopathy of the hilum in 2 cases and profuse and antibiotic-resistant tracheobronchial infection due to Pseudomonas in 2 cases. A double lung transplant was performed in 2 patients with hypertensive emphysema. The indication for a single lung transplantation was emphysema in 2 cases and pulmonary fibrosis in 3 cases; in this last indication, transplantation should be performed on the right side with a slight lengthening of the main bronchus to avoid the side-effects of mediastinal shift. There were 2 early deaths, 7 secondary deaths (from the 2nd to the 5th month) due to viral or bacterial infectious complications, and 1 late death in the 7th month (infection due to a syncitial virus). All 12 surviving patients have an excellent functional result; the size of the tracheal or bronchial anastomosis ranges from 85% to 100% of normal. From this experience, we conclude that specificity and severity of lung hazards are mainly related to bronchial infection, dependence on steroids and pleural adhesions. Moreover, posttransplant pulmonary oedema, mucociliary dysfunction and the differential diagnosis between rejection and infection require careful endobronchial suction and periodical sampling.

Adult↗
PubMed1990

[Value of Naito's criteria in the surgical repair of tetralogy of Fallot].

Naito suggested criteria for the optimal reconstruction of the right ventricular outflow tract in total correction of tetralogy of Fallot based on the minimum acceptable diameter of the pulmonary artery. The value of these criteria was assessed in 78 operated patients by haemodynamic measurements at surgery and 6 months after operation. Using these criteria, a ratio of right ventricular/left ventricular systolic pressure less than 0.60 was obtained with the creation of pulmonary regurgitation which was usually moderate. Long-term assessment of these results is required.

Adolescent↗