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Biomedical subjects

G Champsaur

Publications and source records attributed to G Champsaur.

At least 37 records · Page 2Linked to original sources
PubMed1997

Malignant neoplasms following cardiac transplantation.

OBJECTIVE: Malignancies have long been recognized as a complication of long lasting immunosuppressive therapy. We reviewed our experience to investigate the incidence and the spectrum of non cutaneous de novo malignant neoplasms. METHODS: Between March 1987 and March 1996, 296 patients underwent 303 cardiac transplantation in our service. The population at risk consists of all patients surviving more than 1 month after transplantation, leading to a total of 267 patients. A triple-immunosuppressive therapy was employed. Moderate doses of antilymphocyte globulin was used as an induction immunotherapy. RESULTS: Neoplasms developed in 18 (6.7%) of the 267 patients at risk. Seventeen patients were male. Mean age was 56 +/- 7 years. Fourteen patients (78%) reported a significant smoking history. Mean interval between transplantation and clinical diagnosis was 36 months. Lung neoplasms (especially adenocarcinoma) were the most commonly encountered tumors (11 of 268 patients, 4.1%). Three Non-Hodgkins' Lymphoma (NHL) were identified (1.1%). No Kaposi's sarcoma were diagnosed. Mean survival after a diagnostic of tumor was 11.7 months. CONCLUSIONS: The incidence of NHL is low in our transplant recipients. Conversely, we observed a high incidence of lung neoplasms (especially adenocarcinoma) which can be correlated with a heavy cigarette use in the study population.

Adenocarcinoma↗
PubMed1997

Glucose versus lactated Ringer's solution during pediatric cardiac surgery.

OBJECTIVE: Whether intraoperative fluid infusion should contain glucose during pediatric cardiac surgery remains controversial. This study was performed to compare the effects of glucose and glucose-free solutions on blood glucose and blood insulin levels during total repair of congenital heart diseases. DESIGN: Prospective randomized and blinded study. SETTING: Cardiovascular university center. PARTICIPANTS: Forty nondiabetic children, weight ranging from 4 to 10 kg, scheduled for cardiac surgical procedures requiring cardiopulmonary bypass (CPB) without total circulatory arrest. INTERVENTIONS: Group R (n = 20) was administered lactated Ringer's solution intraoperatively, and group G (n = 20) received 5% glucose. Fluids were infused at a rate of 3 mL/kg/h in the two groups from the induction of anesthesia to the end of the surgical procedure. Blood glucose and insulin were sampled before infusion (Tzero), before CPB (T1), 10 minutes after initiation of CPB (T2), 10 minutes after initiation of rewarming (T2), and at the end of the procedures (T4). Postoperatively, blood glucose was measured at the first, 12th, and 24th hours. MEASUREMENTS AND RESULTS: During the prabypass period, three children in group R had severe hypoglycemia (blood glucose < 40 mg/dL). After initiation of CPB, blood glucose increased in both groups, with a small difference at the end of the procedure. No infants in the two groups had blood glucose higher than 239 mg/dL. CONCLUSIONS: Glucose withdrawal during pediatric cardiac surgery induces threatening hypoglycemia during the prabypass period, and moderate intraoperative glucose administration (2.5 mg/kg/min) is not responsible for major hyperglycemia.

Anesthesia Recovery Period↗
PubMed1997

[Medium-term results of non-invasive follow-up after cardiac transplantation in childhood and in adolescence].

Between December 1984 and September 1996, 43 cardiac transplantations were carried out in 40 patients aged 2 days to 21 years (one third under 10 years of age) for cardiomyopathy (21 cases), congenital heart disease (19 cases) or retransplantation (3 cases). The average waiting time for transplantation was 80 days: this delay increased by a factor of five in 2 years (from 1 month, before 1994, to 5 months at present). Twelve patients dies, including 6 before the 8th day. The 28 survivors were prescribed triple immunosuppressive therapy: the average follow-up was 4.4 years (range 3 months to 11 years). Monitoring rejection was carried out by non-invasive methods based on clinical, electrocardiographic and Doppler echocardiographic observations. Any suspicion of acute rejection led to endomyocardial biopsy for confirmation and therapeutic guidance. There was a total of 47 episodes of acute rejection (0.3 per patient), mainly in the first 3 months: acute rejection was less common in the younger children. Graft function was normal in 71% of cases. Five children have a pacemaker implanted during the first month. Despite continuous steroid therapy, 82% of patients had normal staturo-ponderal growth. The myocardial mass of the graft increased in parallel with the body surface area. Nephrotoxicity of ciclosparine was responsible for significant renal failure in 19% of patient and seemed more common in the young children. Psychological disturbances were commonest in adolescence and could result in poor treatment compliance (4 cases, with 1 death and 2 retransplantations). Despite satisfactory medium-term results, nephrotoxicity of ciclosporine, long-term graft function and psychological difficulties of adolescents remain unresolved so that transplantation is reserved for terminal cardiac disease resistant to all other forms of treatment.

Adolescent↗
PubMed1997

[Left ventricular assistance by postoperative mechanical devices in neonates].

Circulatory assistance in children and neonates has not been extensively reported. It poses specific problems related mainly to miniaturisation of systems. The authors report three cases of left ventricular assistance with the Biomedicus centrifugal pump followed by functional recovery in neonates operated for d-transposition of the great arteries. The assistance was installed by cannulation of the left atrial appendage and the ascending aorta, the canules being connected to the Biomedicus pump. The duration of assistance was 53, 116 and 120 hours respectively. The beginning of left ventricular recovery was observed after 24, 48 and 70 hours of assistance and the patients were weaned of assistance under stable haemodynamic conditions. One of the major problems during the period of assistance is decoagulation, 2 out of 3 patients requiring removal of thrombi during the first 12 hours of assistance. On the other hand, no cases of systemic embolism or thrombosis in the pump itself were observed. Decoagulation was maintained by continuous intravenous heparin with an initial dosage of 5 U/kg/h adapted to the activated cephalin time and anti Xa levels measured every 6 hours. No infectious complication was observed and the sternal wound healed satisfactorily despite systematic delayed closure of the thorax. The quality of results requires cooperation of a surgical infrastructure used to techniques of circulatory assistance, a well equipped neonatal intensive care unit and a permanently accessible laboratory for monitoring coagulation status.

Cardiac Surgical Procedures↗
PubMed1997

[Coarctation of the aorta and its surgical treatment].

Coarctation or isthmic stenosis of the aorta is defined as an abnormal obstruction situated at the junction of the aortic arch and the descending aorta near the site of ligamentus arteriosus. It is a common malformation representing 5 to 7.5% of all congenital heart diseases. Coarctation of the aorta is 2 to 3 times commoner in boys than in girls. Two clinical forms may be distinguished: asymptomatic isolated coarctation of childhood, the surgical treatment of which was first performed by Crafoord in 1944, and coarctation of the neonate and infant associated in over 2/3 of cases with other cardiovascular malformations, especially tubular hypoplasia of the aortic arch. The surgical correction of isolated coarctation is best performed between 6 months and 1 year of age in other to limit the incidence of residual hypertension. A modified Crafoord technique decreases the risk of restenosis and enables treatment of associated hypoplasia of the aortic arch in the same surgical procedure.

Adult↗
PubMed1996

Long-term results of heart transplantation deteriorate more rapidly in patients over 60 years of age.

It is generally agreed that the upper age limit for heart transplantation is 60 years. However, an increasing number of elderly candidates are accepted for heart transplantation. We retrospectively analyzed our experience with a total of 204 consecutive transplantations, performed in 195 adult patients (9 retransplantations) between March 1987 and September 1993. There were 48 patients older than 60 years (mean 62.9 +/- 3), group I (gr I) and 156 patients between 20 and 59 years old (mean 47.5 +/- 8), group II (gr II). The two groups were matched for sex-ratio (female 10.4 vs 14.2%), indications (cardiomyopathy, ischemic, others), and hemodynamic parameters (pulmonary artery pressure, capillary wedge pressure, cardiac index). A ventricular assist device was used in 14 patients as bridge to transplantation in gr II vs 0 to gr I. There were seven early deaths in gr I (14.6%) vs 14 in gr II (8.97%, NS). A total of 183 survivors (41 vs 142) have been followed up for 1 month-6.3 years (mean follow-up 20.4 +/- 19.3 months in gr I, 35.4 +/- 23 in gr II). No patient was lost to follow-up. There were 11 late deaths in gr I vs 16 in gr II. The most common cause was malignancy (n = 4) in gr I and sudden death (n = 9) in gr II, with a significant difference. The actuarial survival was 68.8% in gr I vs 88.5% in gr II at 1 year 43.5% in gr I vs 76.4% in gr II at 5 years. In conclusion, transplanted patients over 60 years of age have a significantly poorer late survival than younger patients, despite similar good early results. Moreover, the causes of late deaths were different in the two groups. So, heart transplantation in patients over 60 years of age should be carefully considered.

Adult↗
PubMed1996

Primary melanoma of the heart: case report of an association with coronary stenosis.

A 63-year-old man presented with unstable angina. The coronary angiogram revealed a proximal left anterior descending artery (LAD) stenosis and an irregularity on the anterior wall of the left ventricle. Intraoperatively, a malignant melanoma, independent of the coronary stenosis, was identified and resected, and an internal mammary graft was inserted. No primary tumor was found. The patient is alive 18 months after operation, with a normal magnetic resonance imaging (MRI), which seems to be the technique of choice for following-up heart melanomas.

Coronary Disease↗
PubMed1996

Myocardial protection during coronary artery bypass graft surgery: a randomized, double-blind, placebo-controlled study with trimetazidine.

We conducted a randomized, double-blind, placebo-controlled study to assess the cardioprotective effects of trimetazidine (TMZ), an antiischemic drug, on left ventricular function using transesophageal echocardiography (TEE) after coronary artery bypass grafting (CABG). Forty patients undergoing elective CABG received either TMZ or a placebo (PCB). The primary measures of efficacy were serial measurements of fractional area change (FAC), percent of systolic wall thickening (SWT), and malonedialdehyde (MDA) production. The two groups were similar for the following variables: number of vessels revascularized (2.5 +/- 0.2 in the TMZ group and 2.8 +/- 0.1 in the PCB group), duration of aortic clamping (46 +/- 4 min in the TMZ group and 48 +/- 3 min in the PCB group), and bypass time (63 +/- 4 min in the TMZ group and 70 +/- 4 min in the PCB group). FAC increased by 12% in both groups 20 min after aortic unclamping (P < 0.05) and remained above the initial value at the sixth postoperative hour. SWT was 23.8% +/- 1.6%, 25.4% +/- 1.9%, then 21.6% +/- 1.5% in the TMZ group and 22.8% +/- 1.6%, 23.8% +/- 1.4%, then 22.3% +/- 1.6 % in the PCB group, after induction of anesthesia and 1 and 6 h after aortic unclamping (not significant). MDA increased by 24% in the PCB group and 25% in the TMZ group 20 min after aortic unclamping (P < 0.01). Lactate levels were lower in the TMZ group (P < 0.05) and patients from the TMZ group received less intravenous calcium before aortic clamping (P < 0.02) and less calcium channel entry blocking drugs in the early phase after aortic unclamping (P < 0.01) compared to the PCB group. We conclude that in patients with good preoperative ejection fraction undergoing CABG, TMZ as administered did not demonstrate clinically significant cardioprotective effects on left ventricular performance and lipid peroxidation compared to PCB.

Coronary Artery Bypass↗
PubMed1996

[Hemodynamics of right circulation in ewes: normal values].

The right cardiac pressure was measured on 24 anesthetized adult ewes (Halothane) with a Swan Ganz catheter. After a review of the catheterization technique, the results (mean +/- standard deviation) in mmHg were: right auricle 17 +/- 5, right ventricle 30 +/- 6 (systolic) and 12 +/- 6 (telediastolic), pulmonary artery 29 +/- 6 (systolic), 13 +/- 6 (diastolic) and 20 +/- 6 (mean), capillary pressure 17 +/- 7. We observed slight variations in the pressure curve morphology compared to those found for man and the pressures were 5-10 mmHg higher than what is observed in man and slightly higher than those observed in dogs. These results also demonstrate a great variation between animals.

Anesthesia, General↗
PubMed1995

[Thrombolytic therapy with rt-PA for thrombosis of tricuspid valve prosthesis during pregnancy].

The authors report the case of a woman with thrombosis of a tricuspid Saint Jude prosthesis during the fourth month of pregnancy. A first course of thrombolytic therapy with rt-PA reestablished normal prosthetic valve function but was followed by a threatened abortion and severe uterine haemorrhage. An early rethrombosis of the prosthetic valve led to interruption of the pregnancy after failure of a second course of thrombolysis, and to replacement of the tricuspid valve prosthesis. This case illustrates the problems of pregnancy in women with mechanical cardiac prosthetic valves and the difficulties of treatment.

Abortion, Therapeutic↗
PubMed1994

[Post-infarction rupture of the heart into the pericardium. Surgical treatment combining synthetic patch and biological fibrin glue].

A 66-year old man was hospitalized with chest pain and acute ischaemia of the lower limbs highly suggestive of dissection of the aorta. Computed tomography and aortography however showed pericardic effusion and thrombosis situated in the iliac bifurcation of the aorta. During the emergency operation, acute tamponade required sub-xyphoid drainage. The haemodynamic situation was reestablished and the operation continued but within minutes a cataclysmal haemorrhage occurred through the drainage tube due to ischaemic rupture of the lateral wall of the heart into the pericardium. Extra-corporal circulation was installed immediately and a large polytetrafluoroethylene patch was sutured to the epicardium, distally from the necrosed area, in healthy tissue. A biological fibrin glue was injected under the patch. The operation was terminated with an axillo-bifemoral bypass. The postoperative period was satisfactory and the patient was discharged. At the six months examination, the patient was in NYHA class II and the echography showed moderate left ventricular dysfunction with grade II mitral regurgitation and a false aneurysm facing the area of necrosis. This technique allowed us to patch the rupture without excessive tension on the sutures in the fragile tissue which would have increased the risk of secondary rupture. In addition, the large patch avoided excessive reduction in volume of the left ventricular cavity and saved the mitral chordae which would have been destroyed by direct suture. This method can be an effective salvage technique for heart rupture during the acute phase of myocardial infarction and offers the possibility of a second look in case of a secondary false aneurysm.

Aged↗
PubMed1994

Bipolar intramyocardial electrogram from an implanted telemetric pacemaker for the diagnosis of cardiac allograft rejection.

Noninvasive detection of acute cardiac allograft rejection remains a challenge. Analysis of the epicardial electrogram transmitted by unipolar telemetric pacemaker can be of help in the detection of rejection with myocytolysis but is hampered by extracardiac factors. Instead, the contribution of a bipolar pacemaker for this purpose was studied. The bipolar peak-to-peak amplitude of epicardial electrograms (BPPA) from 25 patients implanted with a bipolar pacemaker at the time of heart transplantation was measured at the time of endomyocardial biopsies. BPPA was expressed as a percent of the baseline value. A voltage drop of more than 10% was considered an indication of rejection. Of 118 biopsies, 80 were free of rejection and 38 showed mild to moderate rejection (Grade 1A = 12; Grade 1B = 17; Grade 2 or 3 = 9). The mean value of BPPA was less for grade 2 biopsies (86.4 +/- 17%) than for biopsies with no or mild rejection (101.3 +/- 14.3% for Grade 0, 101.4 +/- 13.8% for Grade 1A, and 98.6 +/- 18% in Grade 1; P < 0.05). Diagnostic concordance between BPPA measurement and biopsy results increased with the histological severity of rejection (Grade 1A = 1/12, Grade 1B = 5/17, Grade > 2 = 7/9). Acute rejection was diagnosed with a sensitivity of 34% for Grade 1A, 46% for Grade 1B, and 78% for rejection episodes with myocytolysis (Grade > or = 2). Specificity remained approximately 90% for all histologic grades.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1994

[Re-stenosis of aortic coarctation in children. Comparison between aortic angioplasty and surgery].

The use of aortic angioplasty rather than surgery for restenosis of coarctation of the aorta after initial surgery remains controversial. The efficacy and complications of these two techniques have never been compared in prospective and retrospective studies. Between 1976 and 1992, 56 patients were treated for secondary restenosis of coarctation of the aorta: 29 by angioplasty and 27 by surgery. The case reports of these patients were reviewed retrospectively. The average follow-up was 1.5 +/- 0.3 years of the angioplasty group and 5.4 +/- 0.8 years for the surgical group. The reduction of systolic blood pressure in the right arm was significant and identical in the two groups (p < 0.05). The residual pressure gradient was less immediately and at term in the surgical group (p < 0.05). No fatalities were observed in either group. There were no aneurysmal complications. A neurological complication (posterior column syndrome) was observed after surgery (3.7%). The global rate of complications was higher after surgery (6.7% vs 33%). The rate of further restenosis was higher after angioplasty (18.5% vs 3.7%). The low rate of complications, the shorter hospital stay without repeat thoracotomy were in favour of the angioplasty procedure but the greater immediate and long-term efficacy of surgery on the pressure gradient was in favour of the latter solution. A prospective long-term study is necessary.

Adolescent↗
PubMed1994

[Echocardiographic evaluation of the growth of cardiac graft in children with heart transplantation].

The evaluation of the growth of the cardiac transplant in children was studied in four young children and three infants by echocardiography after orthotopic transplantation. These children were all under 13 years of age at the time of transplantation and have been followed up for more than two years. The age of the recipients ranged from 2 days to 12.8 years (average 10.7 years) and that of the donors from 7 days to 27 years (average 6.7 years). All patients received triple immunosuppressor therapy. The follow-up was 29 to 48 months (average 39.7 months) in the infants and 28 to 71 months (average 50.25 months) in the children. In the 7 patients the global follow-up period ranged from 28 to 71 months (average 45.8 months). No episodes of acute rejection or hypertension were observed during the study period. The echocardiographic parameters studied were the left ventricular end diastolic dimension, left ventricular end systolic dimension, left ventricular mass, left ventricular mass index. The date was gathered prospectively during the study at monthly intervals after the 3rd postoperative month. The donor/recipient weight ratio varied from 0.83 to 5 (average 1.89). The growth of the recipients was normal in 5 out of 7 cases and moderately retarded in 2 cases. The left ventricular end diastolic dimension, left ventricular end systolic dimension and left ventricular mass increased linearly with the body surface area of all patients. The growth was faster in the infant patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Surface Area↗
PubMed1994

[Prognostic study of single ventricle with respect of anatomical and clinical data].

The authors analysed the anatomical and clinical prognostic factors of single or common ventricle. This retrospective study was based on a series of 185 patients hospitalised between 1/2/70 and 31/12/91 in the paediatric cardiological unit of the Cardiological Hospital of Lyon with this condition. A number of anatomical and clinical parameters were identified in this population. For each parameter, a given patient could only relate to single modality and a survival graph determined by Kaplan-Meier analysis was established for each modality. For each variable, the survival curve of the most frequently encountered modality served as a reference and the other modalities were compared with it using a logrank test. The different modalities potentially related to patient survival were then entered into a multivariable model using logistic regression. The results of this study of multivariable analysis using the Odds-Ratio (OR) independently suggest that four variables may influence negatively survival of patients with a single ventricle: pH < or = 7.3 on admission (OR = 3.55), a non-left ventricular morphology of the main ventricular chamber (OR = 3.11), the presence of an obstacle on the aortic outflow (OR = 5.58) and a total anomalous pulmonary venous drainage (OR = 26.88).

Adolescent↗
PubMed1994

[Prognostic study of 3 main palliative surgical procedures in patients with single ventricle].

In emergency cases of babies with a single ventricle and an obstruction to aortic outflow, low pulmonary flow or, on the contrary, high pulmonary flow, only palliative surgical procedures can be proposed. The authors set out to determine the prognosis of a population with this type of lesion having undergone one of the three following procedures: systemic pulmonary shunt, pulmonary artery banding, repair of the aortic arch (usually associated with pulmonary banding). One hundred and nineteen (63%) of the 185 patients hospitalised between 1/01/1970 and 31/12/1991 in the paediatric cardiology unit of the Cardiac Hospital of Lyon with a diagnosis of single ventricle, underwent one of these three procedures as a treatment of first intention. The survival of the 22 patients who underwent pulmonary artery banding (90 +/- 6%, 85 +/- 8%, 85 +/- 8% at 1.5 and 10 years respectively) was significantly better than that of the patients undergoing systemico-pulmonary shunt (63 +/- 6%, 53 +/- 6% and 49 +/- 6% at 1.5 and 10 years respectively). On the other hand, repair of an obstacle of the aortic arch was a precarious procedure as the survival was only 23 +/- 11%, 16 +/- 11% and 16 +/- 11% and 1.5 and 10 years respectively). These results suggest, with the reserve inherent to the methodology of retrospective studies of small populations, that it is not illogical to continue to propose pulmonary artery banding for babies with single ventricle associated with high pulmonary flow. This procedure should only be envisaged after strict selection of candidates and providing there are facilities for intensive postoperative care.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1994

[Mitral valve replacement in infants using the "Saint-Jude Médical" prosthesis].

The authors report their experience of mitral valve replacement in infants under 2 years of age. A St Jude medical mitral prosthesis was implanted in 8 children, 7 with mitral regurgitation and 1 with mitral stenosis. The average age at surgery was 9 months with an average body weight of 6.6 Kg. Two children had prior mitral valvuloplasty. All patients were in the NYHA functional Class IV. One patient died after surgery (12.5%). There was one secondary death during follow-up. Six children were followed up for an average of 61 months (range 34 to 104 months). The 6 survivors are asymptomatic and receive oral anticoagulant therapy. Regular postoperative Doppler echocardiographic assessment has shown a gradual increase of the mean transprosthetic pressure gradient in all children. To date, no reoperation on the prosthetic valve has been necessary. Mitral valve replacement is an effective option in infants with severe cardiac failure in whom mitral valve repair is impossible. In these cases, the St. Jude medical prosthesis is a good choice. Effective anticoagulation is recommended, even at this age. Growth of the child will necessitate changing the prosthesis in later years.

Anticoagulants↗