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Biomedical subjects

F Cherrier

Publications and source records attributed to F Cherrier.

At least 91 records · Page 5Linked to original sources
PubMed1990

[Painless obstruction of the left coronary trunk. Apropos of a case].

The originality of this observation of the complete occlusion of the left coronary artery lies in its painless character on the angina level. The affection was revealed by the clinical manifestations of the left ventricular failure in severe ischaemic myocardiopathy. The diagnosis of the ischaemia was made during the physical exercise test coupled with thallium scintigraphy. It therefore seems to be a form of silent ischaemia in major coronary lesions, for which the only conceivable therapeutic option is surgery, considering the particularly pessimistic spontaneous prognosis.

Coronary Disease↗
PubMed1990

[Yes, routine coronary angiography is necessary after myocardial infarction].

The author first recalls the difficulties and inaccuracies of the exercise test, even when this is combined with an isotope test in post-infarction evaluation of the myocardium. In most cases, a coronography should be performed after about ten days (because most deaths following myocardial infarction occur either within the first three weeks or within the first three months). The risks are minimal. This exploration provides a more detailed assessment of the lesions as well as detecting severe latent lesions affecting other coronary circuits. In some cases, it assists in diagnosis and may even be a guide to treatment. However, it is not easy to evaluate stenoses, and one of the big drawbacks of the method is that it is not always possible to draw all the necessary conclusions regarding the therapeutic consequences of revascularization. Coronarography is indispensable after infarction in most subjects, but it must be evaluated with caution and must be combined with an exercise test, even though the information provided by this test is only incomplete.

Coronary Angiography↗
PubMed1989

[Survival in primary dilated cardiomyopathy as a function of tobacco smoking. A retrospective study].

In order to determine the influence of tobacco smoking on the course and long-term prognosis of idiopathic dilated cardiomyopathy, we conducted a retrospective study of 111 patients (95 men and 16 women, mean age 45.5 +/- 8.1 years) who had undergone cardiac catheterization between January 1970 and December 1979 and had been followed up for 6 to 16 years. The criteria of inclusion was diffuse hypokinesia of the left ventricle with an ejection fraction of 50 per cent or less, normal coronary arteriography and cardiomyopathy of unknown origin. The overall mortality rates at 1, 5 and 10 years were 10, 50 and 66 per cent respectively, and the main predictive factor was the left ventricular ejection fraction. Forty-six per cent of these patients were smokers, 19 per cent were non-smokers and 35 per cent had undetermined smoking habits. A univariate analysis showed a favourable predictive effect of smoking on survival (P less than 0.01), and this was confirmed by the statistical hypothesis of maximum bias for patients with undetermined smoking habits. On multivariate analysis, this predictive effect was superseded by the left ventricular ejection fraction, but after stratification of the sample according to the mean value of ejection fraction (30 per cent), the predictive value of smoking reappeared clearly in the group with a less than 30 per cent ejection fraction (P less than 0.003).

Adult↗
PubMed1989

Mitral valve prolapse as a risk factor for infective endocarditis.

The frequency of mitral valve prolapse was assessed in 48 patients with mitral valve endocarditis and in 96 controls matched for age and sex, attending a routine family screening clinic or having surgery of the limbs. The frequency of mitral valve prolapse in cases with endocarditis (9 of 48 patients) was more than three times that in controls (6 of 96) (odds ratio 3.5; 95% confidence interval [CI] 1.1-10.5). When patients with rheumatic heart disease, an established risk factor for infective endocarditis, were excluded from the study group, patients were nearly six times more likely to have infective endocarditis than were controls (odds radio 5.7; 95% CI 1.8-18.4). However, a higher risk of infective endocarditis was seen only in the subjects with mitral valve prolapse and a previously known systolic murmur (odds ratio 14.5; 95% CI 1.7-125). The results indicate that mitral valve prolapse constitutes a true risk factor for infective endocarditis only when associated with the presence of a precordial systolic murmur.

Adult↗
PubMed1989

Significance of spontaneous obstruction of high degree coronary artery stenoses between diagnostic angiography and later percutaneous transluminal coronary angioplasty.

Among 265 patients with severe coronary artery stenoses amenable to percutaneous transluminal coronary angioplasty, 13 (5%) developed new total coronary occlusion of the vessel to be dilated during the period between diagnostic coronary angiography and repeat coronary angiography at the time of the operation. Time from diagnostic to "therapeutic" angiography (76 +/- 74 vs 31 +/- 31 days, p less than 0.0001), degree of coronary stenosis on diagnostic angiography (85 +/- 7 vs 80 +/- 8%, p less than 0.05) and impaired coronary flow distal to the narrowing (Thrombolysis in Myocardial Infarction grade 2: 38 vs 10%, p less than 0.01) were the only variables related to the occurrence of spontaneous coronary occlusion. The clinical course of the patients who developed new total coronary occlusion was remarkably favorable. Twelve of the 13 patients had unchanged or improved anginal symptoms. The electrocardiogram at rest remained unchanged in 11 patients and there was no transmural myocardial infarction. Eight patients had 2 ventriculograms and the mean ejection fraction remained unchanged (only 2 patients had greater than 5% decrease in ejection fraction between the 2 examinations). Spontaneous occlusion of high degree coronary artery stenoses is not unusual and is usually well tolerated, presumably due to the development of collateral circulation.

Angiography↗
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

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

[Cardiac pheochromocytoma. Failure of classic non-invasive diagnostic methods].

We report an exceptional case of cardiac pheochromocytoma which raised problems of localization. A 30-year old man who for several years had been hypertensive was admitted for attacks of paroxysmal hypertension. Very high levels of urinary catecholamines suggested a diagnosis of pheochromocytoma, but no tumour was found at computerized tomography (CT) and metaiodobenzylguanidine (MIBG) scintigraphy. However, regional venous samplings detected two para-carotid phaeochromocytomas which were surgically removed. Thereafter, the symptoms persisted and investigations were resumed. As new regional venous samplings persisted and investigations were resumed. As new regional venous samplings showed high levels of catecholamines in the right atrium, a mediastinal and, chiefly, cardiac phaeochromocytomas was suspected. No tumour was visible at CT or ultrasonography and another MIBG scintigraphy proved negative. Coronary angiography showed a very large tumour behind the left atrium, well supplied by the circumflex artery and by a branch of the right coronary artery. The patient was operated upon and is now totally asymptomatic after a 9-month follow-up. This case emphasizes the value of invasive methods (i.e. regional venous sampling and coronary angiography) in the localization of this ectopic tumour. In most cases, however, phaeochromocytomas can be localized by MIBG scintigraphy.

3-Iodobenzylguanidine↗
PubMed1989

[Tamponade disclosed by functional right-left shunt reversible after surgical drainage].

The authors report a case of tamponade revealed by the discovery, during emergency radioisotope scanning of the lung, of an acquired right-to-left shunt which was reversed by surgical drainage. The patient was a 60-year old woman treated by anticoagulants for suspected pulmonary embolism who had sudden worsening of her symptoms on the 7th day of the disease.

Cardiac Tamponade↗
PubMed1989

[Difficulties in the echocardiographic diagnosis of false aneurysm of the left ventricle. Apropos of 2 cases].

The echocardiographic diagnostic criteria of left ventricular pseudo-aneurysm are well established: the demonstration of a narrow-necked communication between the left ventricular cavity and the aneurysm and endocardial discontinuity at the site of myocardial rupture. The authors report two cases in which these criteria were fulfilled, leading to an echocardiographic diagnosis of pseudo-aneurysm which was erroneous as the operative findings were those of true left ventricular aneurysms.

Diagnosis, Differential↗
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↗
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

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↗
PubMed1988

[Coronary angioplasty in the elderly patient. Immediate results and mid-term outcome].

Between April 1980 and July 1986, 50 patients over 65 (32 men and 18 women; mean age: 72 years) were treated by transluminal coronary angioplasty. Before the dilatation, 58 p. cent of the patients presented a severe angor (class III or IV) and 44 p. cent were multi-truncular. The dilatation was successful in 39 patients (78%) and 13 patients developed a recurrent stenosis successfully treated in 9 instances by re-dilatation. Among the complications, there were 2 deaths (4%), 3 infarctions (6%) and 3 emergency coronary bypass operations (6%). With a mean 28 months follow-up, the overall survival is 92 p. cent. After a successful dilatation, 49 p. cent of the patients are completely asymptomatic and the subsequent cardiological hospitalizations are rare (11%). These results show that coronary dilatation represents an interesting therapeutic option in elderly coronary patients.

Aged↗
PubMed1988

[Percutaneous transluminal angioplasty. Is there still a role for the surgeon?].

Relating their own clinical experience and that of the medical literature, the authors examined the role of the surgeon in coronary angioplasty. Despite the considerable progress made in the management of accidents, they believe that one must be able to resort to surgery--even if the percentage of patients who undergo emergency surgery decreases significantly--in the form of a standby procedure organized according to the difficulty of the angioplasty. Moreover, the surgeon uses this technique during the procedure for additional revascularization above the graft on collateral arteries and angioplasty can and should be used in a higher number of cases as a supplement for coronary bypass procedures.

Angioplasty, Balloon↗
PubMed1988

[Should the Isuprel test be performed systematically in Wolff-Parkinson-White syndrome?].

The isoprenaline (Is) test was designed by Wellens et al. in 1982 to evaluate the effect of catecholamines on the effective refractory period (ERP) of Kent's bundle (K). The purpose of our study was to assess the value of this test in the prognosis of Wolff-Parkinson-White syndrome (WPW), to define its criteria of severity and to determine the usefulness of the test. Out of 33 patients with WPW syndrome, 10 (group I) had a clinical history of severe arrhythmia and 23 (group II) were asymptomatic or had paroxysmal nodal tachycardia. The prognosis of WPW syndrome was evaluated by measuring Kent's bundle ERP under coupled atrial stimulation (S1 S2) and the shortest cycle conducted by K during induced atrial fibrillation (AF) and atrial pacing (AP) both in the basal state (B) and under a 20-30 micrograms Is infusion. (table; see text). Analysis of the results showed constant shortening of ERP in group I and reproduction of the clinical tachycardia in 6 cases. In group II patients isoprenaline unmasked the WPW syndrome in 3 cases and reproduced the clinical tachycardia in 5 cases. The ERP of Kent's bundle evaluated by S1 S2 became smaller or equal to 220 ms in 70 p. 100 of the cases, and this shortening was not specific. The shortest cycle in AF or AP became inferior of equal to 220 ms in only 6 cases, the history being concordant with clinical findings in 4 of them. Altogether, the most reliable and simplest way of evaluating the severity of WPW syndrome is the highest frequency conducted by Kent's bundle in atrial pacing during the Is test which should be performed in all patients in view of its specificity, simplicity and safety.

Adolescent↗