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Biomedical subjects

G Champsaur

Publications and source records attributed to G Champsaur.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Assisted circulation by external heterotopic prosthesis as a bridge to heart transplantation].

Eleven patients aged 7 to 58 years were placed on assisted circulation with Pierce (2 cases) or Abiomed (9 cases) external prosthetic ventricles as a bridge to cardiac transplantation. The indications were terminal cardiac failure following cardiomyopathy (7 cases), decompensated ischemic heart disease (3 cases) and subacute post-transplantation rejection (1 case). The duration of the assisted circulation ranged from 24 hours to 11 days. All patients were transplanted but 3 died after transplantation (27%). The circulatory assistance was satisfactory in all patients as shown by the regression of clinical signs of low cardiac output and the normalisation of diuresis. The complications observed during assisted circulation and after cardiac transplantation were: haemorrhage (36%), infection (27%) and thromboembolism (9%). These preliminary results with a 72% post-transplantation survival rate, show that both systems are effective "bridges to cardiac transplantation". The Abiomen device is excellent value for money and relatively simple to install and represents a good compromise between the sophisticated techniques of circulatory assistance and the problems of the cost of health care.

Adolescent↗
PubMed1990

Use of the Abiomed BVS System 5000 as a bridge to cardiac transplantation.

The Abiomed BVS System 5000 (Abiomed Cardiovascular, Inc., Danvers, Mass.) is a gravity-filled, pneumatically driven external prosthetic ventricle that has been implanted as a circulatory support device in six patients 9 to 58 years of age, presenting with a refractory heart failure nonamenable to any type of corrective operation. Three (including a 9-year-old girl) had an end-stage nonobstructive myocardiopathy, and two (including one patient who had had a massive recent myocardial infarction) had an ischemic heart disease. When first seen, the 58-year-old patient had an acute rejection and graft failure occurring 2 months after a first transplantation. All patients showed evidence of a low-output state (cardiac index less than 1.5 L/min/m2), with renal failure (mean urinary output, less than 27 ml/min) and hypoxia (mean arterial oxygen pressure = 56 torr under 80% forced inspiratory oxygen), despite maximum pharmacologic support (dobutamine, 16 to 18 gamma/kg/min; dopamine, 3 to 18 gamma/kg/min; adrenaline, 0.2 to 0.7 gamma/kg/min; furosemide, 7 to 17 gamma/kg/min). The device was implanted through a midline sternotomy and under peripheral normothermic bypass. Five patients received a biventricular support, and one a single left prosthetic ventricle. The cannulation included a right-angled cannula in both the left and right atrium and a suture of the arterial Dacron tubes onto the ascending aorta and main pulmonary artery. After careful deairing of the tubing and ventricles, the console was activated and the bypass progressively discontinued. Heparin infusion was begun 3 hours after chest closure and was continued for the duration of assist pumping, which was 2 to 11 days (mean duration, 7.43 days). The system could provide a complete support of the circulation with both right and left ventricular index remaining stable at 2.4 to 3 L/min/m2. After a dramatic improvement at the time of the system activation, the urinary output remained adequate, thus allowing for a decreasing need for diuretic therapy. In two cases, including one of isolated left ventricular assist pumping, the circulation could be totally supported during 11 hours and 23 hours, respectively, of refractory ventricular tachycardia. Four of six patients were shortly weaned from inotropic agents. Hematologic studies showed a moderate decrease of the coagulation factors level during the first 6 hours of circulatory support, and this remained stable and within normal limits thereafter. There have been three cases of bleeding complications necessitating surgical revision on the sixth hour, the twelfth hour, and the sixth day, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

[Peroperative ultrafiltration in complete repair of ventricular septal defect in infants].

Ventricular septal defect in infants induces peroperative fluid overload (particularly extravascular lung water overload) which causes some morbidity after surgical closure of the defect. Thirty infants undergoing the conventional complete correction procedure were retrospectively compared with 32 infants operated upon using ultrafiltration at the end of the cardiopulmonary bypass. There was no difference between the two groups in biological data, haemodynamic parameters and either morbidity or mortality. Nevertheless, a clinical impression of smooth follow-up in patients with ultrafiltration encourages to carry out a prospective and randomized study.

Extracorporeal Circulation↗
PubMed1989

[Technic for implanting biventricular external assistance devices. Pending cardiac transplantation].

The extensive development of orthotopic heart transplantation results in a relative shortage of grafts. When cardiac grafts are unavailable, some patients at the end-stage of decompensated heart failure may benefit from a biventricular external circulatory assistance device as a "bridge" to transplantation. We describe a reproducible technique for the implantation of such external devices, based on the systematic use of extracorporeal circulation. This technique was tested in 8 patients. Its main advantage is that it prevents thromboembolic complications which are a constant threat when the devices are used for a prolonged period.

Adult↗
PubMed1989

[Results of coronary surgery in patients over 70 years of age].

Among the 628 consecutive patients who underwent coronary bypasses performed by the same surgical group between January 1, 1982 and December 31, 1987, 71 (11 p. 100) were aged 70 years or more (mean: 72.5 years; range: 70-83 years). 99 p. 100 of the patients had a history of severe, disabling exertional angina (46 p. 100) or unstable angina (52 p. 100) of 55 months' duration on average; 35 patients (49 p. 100) had already experienced myocardial infarction. Coronary angiography showed a one-vessel disease in 1 case, a two-vessel disease in 1 case, a two-vessel disease in 31 cases and a three-vessel disease in 39 cases; 11 patients (15 p. 100) had stenosis of the left main coronary artery. The ventricular function was considered unaltered in 59 cases (83 p. 100). Altogether, 155 bypasses, including 25 internal mammary grafts, were performed, i.e. an average of 2.2 bypasses per patient. There was only one early (21st day) post-operative death. The post-operative period was uneventful in 57 patients (60 p. 100); 9 developed peri-operative necrosis. Seventy patients have been followed up for a mean period of 24 months: there were 3 late deaths of non-cardiac origin; 60 patients (84.5 p. 100) are now asymptomatic and 3 (4.5 p. 100) are suffering from residual angina. Early mortality excluded, the cumulative probability of survival at 5 years is 94 p. 100.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Surgical treatment of complete atrioventricular canal. Value of the "composite double patch" technic].

Between January 1, 1982 and January 1, 1988, 49 complete corrections of complete atrioventricular canal were performed in children aged from 4 months to 8 years. 41 were infants less than 2 years' old and 31 were less than one year old. In the last 35 patients the "composite double patch" technique was used, consisting of closure of the interventricular septal defect with a dacron patch, followed by closure of the ostium primum with a pericardial patch. The mitral cleft was left intact in the last 6 operations. The overall mortality rate was 35 p. 100 (17 patients). It was 23 p. 100 in infants under 1 year and 17 p. 100 in infants aged from 6 to 12 months at the time of surgery (p less than 0.01). Seven of the 35 children in whom the "composite double patch" technique was used died (20 p. 100). Only one early death was recorded among the last 15 children operated upon. Two reoperations were performed: one within one month of the first operation, the other 4 months later for residual mitral regurgitation with haemolysis. 32 children were followed up for periods of 2 months to 6 years, 10 of them for more than 3 years. Two late deaths occurred during the follow-up. Grade 2 or 3/4 residual regurgitation was found in 14 patients who have regular clinical and echocardiographic examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1989

[Prognosis of chronic non-dystrophic and surgically treated aortic insufficiency].

Between January 1972 and March 1983, 123 patients with isolated non dystrophic aortic insufficiency underwent aortic valve replacement. During a mean follow-up period of 4.3 years per patient, 25.6 p. 100 of the patients died, including a 4.1 p. 100 hospital death rate. The actuarial survival rate was 74 p. 100 at 5 years and 62 p. 100 at 10 years. The main causes of mortality were heart failure, dysrhythmias and sudden death. A study of prognostic factors based on the preoperative data showed that clinical, radiological, electrocardiographic and haemodynamic signs were informative. In agreement with other authors, we found that preoperative cardiac dilatation and left ventricular dysfunction were predictive of a poor prognosis.

Adult↗
PubMed1988

[Surgery of the thoracic aorta. Value of tissucol].

The techniques for sealing with the Tissucol fibrin glue, used in repair of aortic dissections and aneurysms, are described. We applied this method to 24 patients operated upon for acute (9 cases) or chronic (15 cases) lesions of the thoracic aorta. No patients died of haemorrhage, and post-operative bleeding was only 500 ml on average. Provided strict precautions are taken, this adjuvant haemostatic method considerably improves the immediate prognosis of acquired aortic lesions. Other operations of cardiac surgery may benefit from these sealing techniques the cost of which must be weighed against the blood transfusion units that are saved.

Aortic Dissection↗
PubMed1988

[Aortic valve replacement using the Björk-Shiley valve. Long-term results (268 patients)].

From 1974 till November, 1986, 268 adult patients aged from 15 to 84 years (11 p. cent over 70) underwent isolated aortic valve replacement by Björk-Shiley prosthesis. 81 p. cent of the prosthetic valves implanted were size 21 or over. The initial lesion was aortic stenosis (AS) in 40 p. cent, aortic regurgitation (AR) in 35 p. cent and aortic disease (AD) in 25 p. cent of the cases. The aortic valve lesions were degenerative (46 p. cent), rheumatismal (18 p. cent), congenital (12 p. cent), infective (19 p. cent including acute infective endocarditis) or dystrophic (7 p. cent) in origin. Pre-operatively, 54 p. cent of the patients were in NYHA functional class III and 14 p. cent in NYHA functional class IV. 7 p. cent presented with permanent atrial fibrillation. Mean pre-operative cardiac index was 2.49 1/mn/m2. Peri-operative mortality (up to 30 days) was 7.09 p. cent in both the 1974-79 period and the 1980-86 period; it was 3.4 p. cent in AS, 7.4 p. cent in AD and 10.7 p. cent in AR. The 249 survivors were followed up for a mean period of 5.3 years, or 1313 patient-years. 30 patients (11 p. cent) died subsequently (11 of prosthesis-related cause), giving an actuarial survival rate of 81.7 p. cent at 5 years and 71.4 p. cent at 10 years. 12 patients were reoperated upon, including 2 for prosthesis-related reasons (2.4 p. cent patient-years).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Traumatic tricuspid insufficiency. An underdiagnosed disease.

Twelve cases of traumatic tricuspid insufficiency (only three of which already have been published), collected in the same city, are reported. This figure strongly contrasts with the limited number of cases published to date in the literature. Emphasis is placed on the difficulty of diagnosis, the utility of echocardiography and Doppler ultrasound and therapeutic problems of this lesion.

Adult↗
PubMed1987

[Evaluation of the size of atrial septal defects by subxiphoid approach in two-dimensional echocardiography].

In order to assess whether subxiphoid two-dimensional echography is a reliable method to evaluate the size of atrial septal defects (ASD), we compared echocardiographic and per-operative measurements. We then tried to determine whether the size of the defect correlated with the importance of the shunt at catheterization. The records of 23 patients (16 female, 7 male) operated upon for uncomplicated ASD were selected. Mean age was 23.5 +/- 17.3 years (range: 8 months to 62 years). Two-dimensional echocardiography was performed by the "reversed" subxiphoid route, using two projections: "4-cavity section" and an oblique section, perpendicular to the first one, through the atria and the aortic arch. The greater echographic diameter was compared with the greater diameter measured at surgery. The ASD area, assimilated at echography to a circle, was compared with the per-operative area (elliptic or circular opening depending on whether 1 or 2 dimensions were available). Per-operative diameter and area related to body surface were then correlated with the haemodynamic QP/QS ratio. The location of the ASD proved correct in all cases (ostium secundum 19, sinus venosus 3, inferior vena cava 1). Mean diameters were 22.4 +/- 6.4 mm (range: 12-40 mm) at echocardiography and 23.6 +/- 7 mm (range: 12-45 mm) at surgery. The mean area at echography was slightly superior to that measured per-operatively: 4.3 +/- 2.6 cm2 (1.4-12.5 cm2) versus 3.8 +/- 2.1 cm2 (1.4-8.9 cm2). There was a very good correlation between echographic and per-operative diameters (r = 0.91; p less than 0.001) and areas (r = 0.89; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Current results of the treatment of transposition of the great vessels. Apropos of a series of 168 cases including 138 physiologic corrections].

This study takes stock of the current results of physiological correction (Mustard's or Senning's operation) in simple transposition of the great vessels, at a time when anatomical corrections, or detranspositions, are developing. Between January 1, 1974 and December 31, 1984, 168 neonates with simple transposition of the great vessels were operated upon and followed up for a mean period of 3.67 years (up to 11 years and 10 months). Thirty of them died before correction (12.7% mortality rate with palliative surgery) and 15 immediately after corrective surgery (11.2%). Among the 111 children who survived corrective surgery, the results were satisfactory in 62.7%, fair in 17.8% and poor in 10.2%; the late mortality rate was 9.3%. Post-correction morbidity mainly consisted of mechanical complications suspected in one-third of the patients (with 3 consecutive deaths) and heart rhythm disorders (50% of patients in this series had abnormal Holter recordings), with predominance of atrial rhythm disorders (regression of sinus rhythm was 3.82% per annum). This, after correction the survival curve underwent an actuarial regression of 1.31% per annum. This primary and secondary morbidity and mortality justifies a switch to anatomical corrections the results of which remain to be fully evaluated.

Arrhythmias, Cardiac↗
PubMed1987

[Valvular replacement for isolated aortic stenosis. Predictive value of the preoperative cardiac index in survival].

The immediate and long-term results of aortic valve replacement for pure or predominant aortic valve stenosis were evaluated in 186 patients operated upon since 1975 and followed for up to 10 years. This population fell into two groups depending on whether the pre-operative cardiac index was superior (group I, n = 111) or inferior (group II, n = 75) to 2.3 l/min/m2. There was no significant difference between the two groups as regards the immediate (i.e. within 30 days) post-operative mortality rate (6.6% vs 8.1% respectively). In contrast, the cardiac index proved to be a significant post-operative prognostic factor in aortic stenosis, since the probability of survival at 5 years was 96.4% in group I and only 71.7% in group II (p less than 0.001). This high rate of mortality in group II was exclusively due to myocardial dysfunction (sudden deaths included) in these patients with low cardiac index. When late mortality was analyzed according to age (over or below 60 years) and to pre-operative cardiothoracic ratio (over or below 50), these two criteria also proved to be significant prognostic factors. However, considering the poor prognosis of unoperated aortic stenosis, these long-term results in group II should encourage surgical treatment in many cases, even those with advanced cardiopathy.

Aged↗
PubMed1987

[Surgical treatment of coarctation of the aorta in the infant less than a year old].

Between 1972 and 1984, 141 infants of less than 12 months of age were operated upon for coarctation of the aorta. The abnormality was isolated in 41 cases (29 p. 100) and associated with ventricular septal defect (VSD) in 58 cases (41 p. 100), with transposition of the great vessels with or without VSD in 16 cases (11.3 p. 100), with cardiac valve disease with or without VSD in 11 cases (7.8 p. 100) or with miscellaneous intracardiac lesions in 15 cases (10.6 p. 100). Resection-anastomosis (Crafoord) was performed in 89 cases (63 p. 100), subclavian flap aortoplasty (Waldhausen) in 36 cases (26 p. 100) and dacron aortoplasty in 16 cases (11 p. 100). Cerclage of the pulmonary artery was combined with one or another of these operations in 65 cases (46 p. 100). Twenty-five patients (17.5 p. 100) died within 30 days of the operation, and 28 patients (24.7 p. 100 of those who survived surgery) died at a later stage. Three infants were lost sight of. Follow-ups ranged from 1 to 13 years (mean: 4.01 years). Fifteen infants (13.3 p. 100 of those who survived surgery) were reoperated upon for recurrence of the coarctation. Four infants (3.5 p. 100) now present with clinical signs of recoarctation and are awaiting treatment.

Actuarial Analysis↗
PubMed1986

[Primary tumors of the heart. Diagnostic, anatomic and therapeutic aspects].

Primary cardiac tumours are rare. They are usually benign, the most common ones being left atrial myxomas. The authors report their experience of 16 cardiac tumours operated between 1978 and 1985. The patients were 12 adults and 4 children. The tumours were benign in 14 cases and malignant in 2 cases. Complete (14 cases) or incomplete ablation of the tumour was carried out under cardiopulmonary bypass with an early mortality of 6.25 per cent (1 case) and late mortality of 12.5 per cent (the two malignant tumours). The tumours were identified as myxomas in 11 cases, rhabdomyomas in 2 cases, fibroma in 1 case and malignant sarcomas in 2 cases. The average follow-up period of the 13 survivors is 30 months (range 4 months to 5 years) with excellent clinical and anatomical results. Clinical and paraclinical diagnosis of these tumours does not pose any major problems nowadays because of the reliability of the methods of investigation. However, the nature of the tumour is not always predictable and the operative findings are fundamental, not so much for the treatment which is relatively stereotyped but for the prognosis. Age is not a significant prognostic factor as excellent results may be obtained in the very young and the very old despite a sometimes precarious preoperative clinical condition. The benign or malignant nature of the tumour is the only real factor which affects the prognosis.

Adult↗