[Quantitative coronary angiography. Application to the evaluation of transluminal coronary angioplasty].
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Biomedical subjects
Publications and source records attributed to F Cherrier.
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The effective refractory period of the His bundle (ERP.H), the longest H1, H2 interval not followed by a V2 ventricular complex, was measured in 45 cases during the electrophysiological investigation of 500 Patients by premature atrial stimulation techniques. The patients were divided into two groups according to the result: Group I: 22 patients with syncope, a spontaneous HV interval greater than 60 ms, greater than 100 ms after Ajmaline or infrahisian block with atrial pacing at less than 150 bpm. Group II: 23 patients without these abnormalities. The ERP.H was significantly different (p less than 0,001) in the two groups with valves greater than 400 ms in Group I and less than 400 ms in Group II. It is suggested that in the absence of other electrophysiological abnormalities an ERP.H of 400 ms or over may be an indication for permanent pacing in patients with Stokes-Adams attacks. The finding of an ERP.H of over 400 ms is associated with severe infrahisian block. However, the ERP.H depends on the ERP of the AV node which must be shorter to calculate the refractory periods of the His bundle, and, above all, on the basal sinus cycle. The ERP.H decreases with shorter sinus cycles and cannot be calculated when the sinus cycle is less than 600 ms. Conversely, the critical value of 400 ms is not valid for cycles longer than 1000 ms as cycles of that length are associated with lengthening of the ERP.H. The regression of infrahisian block during programmed atrial pacing after Atropine does not seem to be a reliable method of distinguishing between physiological and pathological atrioventricular block.
Pulmonary vascularisation by the coronary vessels does not seem to have been previously described. The authors report 2 cases of vascularisation of the righ lower lobe by an atrial branch of the right coronary or circumflex arteries. Several pathogenic hypotheses are discussed. No definite conclusions can be drawn despite postmortem examination in one case. Pulmonary sequestration would seem to be very probably although there are a few contradictory findings. Acquired inflammatory conditions alone or associated with the congenital malformation cannot be excluded. These anomalies pose difficult therapeutic problems for cardiologists as they are discovered during coronary angiography for angina. The question of a "pulmonary steal" syndrome aggravating the coronary insufficiency possibly requiring both a pulmonary and a cardiac operation may be raised. From the pulmonary point of view, other methods of investigating patients with pulmonary sequestration and haemoptysis of unknown origin could be indicated.
The authors describe a new method of segmental analysis of the left ventricle by equilibrium gamma cinecardiography. The left ventricle in the left anterior oblique projection was divided into 16 triangular sectors with reference to the centre of gravity of the radioactivity of the end diastolic frame. The following parameters were calculated for each sector (the spatial equivalent of a quarter of an orange): end diastolic, end systolic and ejection activity and the regional ejection fraction. The percentage of normal and asynergic regions was deduced. The end diastolic activity of regions with ejection fractions of over 0,47 was compared to the total end diastolic activity to obtain the percentages. This method of segmental division has the advantages of being completely automatic, based entirely on an objective reference calculated by computer and of giving very reproductible quantitative results. The clinical applications in a series of I400 patients examined by this method were numerous (the detection of dyskinesia in acute myocardial infarction). It was particularly useful in chronological and follow-up studies (exercise scintigraphy before and after glyceryl trinitrite).
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25 patients (2 normal and 23 coronary artery disease) were studied by 99m Tc gated blood pool scans at rest, with right atrial pacing, right atrial pacing and nitroglycerine, and finally nitroglycerine alone. Total and regional ejection fractions were measured and the induced and reversible asynergy with right atrial pacing and nitroglycerine was also assessed.
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Of a total of 4,800 coronary arteriogrammes, 1,280 of which were carried out after myocardial infarction, 25 cases of proven infarction with normal coronary arteriography, confirmed by several "blind" interpretations, were retained. The interval between acute infarction and coronary arteriography was usually less than 6 months. The average age of the patients was 36.9 years, affecting more women than in classical coronary artery disease. The acute infarction was nearly always the first symptom. Cigarette consumption and hormonal factors is women were coronary risks factors of note. Ventricular sequellae were frequent, cardiac failure exceptional, exercise testing nearly always negative and occupational rehabilitation usually normal. It would seem that this affection is less serious than classical myocardial infarction due to atheroma probably because the non-infarcted myocardium is healthy, but the true prognosis of this type of coronary accident will only be revealed by long term studies. In the meantime the most useful investigations and the management of these patients are discussed.
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Seven new cases of right ventricular dysplasia are described, five of which were complicated by ventricular tachycardia. The frontiers of this syndrome are unclear and it is uncertain whether it should be considered as a separate disease entity, or as a minor form of "paper thin" right ventricle or Uhl's disease.
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Postero-inferior-myocardial-infarction (MI) results usually from the occlusion of the right coronary artery. Recent pathological and angiographic studies have pointed out that in such cases occlusion of the right coronary artery was often (30 to 80 per cent of cases) associated with a severe (greater than or equal to 70 %) stenosis of the left anterior descending coronary artery. Thus, serious left coronary artery disease is frequent and unrecognized in patients with chronic even uncomplicated MI. Exercise test does not allow to recognize accurately this high risk group of patients which should be identified by coronary arteriography.
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