Search PubMed⌕ Search

Biomedical subjects

G Fournial

Publications and source records attributed to G Fournial.

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

[Carpentier's supra-annular bioprosthesis in aortic position: a mid-term evaluation].

The aim of this study was to assess the medium and long-term results of the Carpentier-Edwards supra-annular (CESA 2650) bioprosthesis. From the end of 1984 to January 1993, 160 patients aged 71.6 +/- 8.6 years underwent aortic valve replacement alone or associated with coronary revascularisation. The postoperative mortality was 11 patients (6.8%): follow-up included 749 patient-years with an average period of 60 +/- 29 months, which was complete in 96% of operated patients. The late mortality was 30 patients (4% patients/year): the actuarial 5 year and 10 year survival was 78.6% and 59.1% respectively (hospital mortality included). The linear complications rates were: major thromboembolism: 1.3% patients/year; structural deterioration: 1.5% patients/year; reoperation: 0.75% patients/year; total morbid/fatal complications: 5% patients/year. Despite the limited follow-up, the authors' analysis confirmed the low rate of structural deterioration requiring reoperation, especially in patients over 70 years of age in whom there were no cases of reoperation at 9 years. They conclude that the medium-term results of the CESA 2650 bioprosthesis are comparable to those of first generation porcine bioprostheses: the absence of reoperation related to valve complications in the over 70s during the study period suggests that this is the replacement of choice in this category of patients.

Actuarial Analysis↗
PubMed1994

Balloon dilatation and self-expanding metal Wallstent insertion. For management of bronchostenosis following lung transplantation. The Toulouse Lung Transplantation Group.

Here we report our experience on the use of balloon dilatation or self-expandable metal Wallstent implantation, or both, for the management of twelve bronchial stenoses in ten lung transplant recipients during the past two years. Both techniques were carried out endoscopically, under fluoroscopic guidance and without general anesthesia. Both methods were straightforward, well tolerated, and resulted in immediate symptomatic and functional improvement. The first-line treatment relied on Wallstent insertion (n = 4) or on balloon dilatation (n = 8). Early restenosis occurred in four of eight dilated stenoses and subsequently led to Wallstent insertion. Following Wallstent implantation, growth of granulation tissue occurred in one case and necessitated repeated balloon dilatations inside the stent during the following months. On two occasions, the stenosis was located such that the lower end of the Wallstent overlapped the upper lobe bronchus orifice. This necessitated laser therapy to eliminate the filaments of the stent crossing the lobar orifice, preventing subsequent obstruction. Laser therapy was followed, in one case, by a fibroinflammatory stenosis which was successfully treated by balloon dilatation inside the prosthesis. At the time of writing, the mean +/- SE of the follow-up after Wallstent implantation is 15.3 +/- 2.7 (range: 6 to 32) months. Most Wallstent prostheses are overgrown with bronchial epithelium. We conclude (1) that self-expanding metal Wallstent implantation is a safe procedure and good alternative to silicone stent insertion for the treatment of bronchostenosis following lung transplantation, provided granulomas are not present and (2) that balloon dilatation, although possibly leading to recurrences, can be used to allow inflammatory tissue to mature or to dilate restenoses inside the Wallstent.

Adult↗
PubMed1993

[Beta-adrenergic receptivity and left ventricular hypertrophy caused by pressure overload in man].

The effect of left ventricular chronic pressure overload on right atrial (RA) and left ventricular (LV) myocardial beta-adrenoceptor (beta-AR) density and subtypes ([I125] cyanopindolol binding), adenylate cyclase activity (AC) and ADP-pertussis toxin ribosylated proteins was investigated in 13 patients with aortic stenosis (AO) and compared with the results obtained in 10 patients with mitral stenosis (MI) taken as controls. None of the patients included had any impairement of systolic function or increased plasma catecholamine levels. The total number of beta-AR in RA (62 +/- 6 vs 77 +/- 12 fmoles/mg prot) and LV (39 +/- 7 vs 32 +/- 2 fmoles/mg prot) was similar in AO and in MI. The percentage of beta 1-AR was significantly lower in LV from AO (35 +/- 11 vs 73 +/- 5% in MI) but identical in RA (79 +/- 5 vs 73 +/- 8%). The basal activity of AC was similar in membranes from patients with AO (19 +/- 4 and 22 +/- 5 pmol.mg-1 prot in RA and LV) and in controls (21 +/- 6 and 27 +/- 3 pmol.mg-1 prot in RA and LV). Isoprenaline-induced stimulation of AC was significantly lower in LV membranes from patients with AO (7 +/- 6 vs 45 +/- 6% in MI) but remained identical in RA membranes (51 +/- 18 vs 36 +/- 18% in MI). The quantification of ADP-pertussis toxin ribosylated proteins indicated a lower substrate concentration in myocardial membranes from patients with AO when compared with controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenylyl Cyclases↗
PubMed1992

Cardiac surgical aids: heart cup and stentless valve holder.

We present two new cardiac surgery instruments that we perfected in our department. The heart cup holds the donor's heart vertically within a cold saline solution, thus allowing adequate preparation of the heart for transplantation, as well as the excision of valvular homografts from the recipient's heart. The stentless valve holder is used to hold valvular homografts to ease both their preparation and implantation.

Cardiac Surgical Procedures↗
PubMed1991

Early postoperative sternal approximation after ITA harvesting: computed tomographic evaluation.

Between November 1989 and February 1990, 66 randomized sternotomized patients underwent aortocoronary bypass and were subjected to a sternal scanner in the early postoperative period. Each examination included a manubrial and a sternal body print. At each level, we studied the occurrence of spacing or misalignment of the sternal layers. The 66 patients were subdivided into four groups according to the type of conduit harvested (single left internal thoracic artery or saphenous vein) and the type of material used for the sternal closure (steel wires or nylon yarns). In all cases, adequate early sternal approximation, which is represented by a good alignment as well as by an excellent contact of the sternal layers, was infrequently demonstrated. Moreover, the two abnormalities most often observed were manubrial spacing and sternal body misalignment. The sternal closure technique and internal thoracic artery harvesting had no significant effect on the sternal approximation. To minimize manubrial spacing and sternal body misalignment, we propose that the surgeon should apply three threads through the manubrium, withdraw the shoulder roll beforehand, elevate both of the patient's shoulders, and maintain the two xyphoid layers in the same plane and in fairly close contact during the tightening of the wires.

Aged↗
PubMed1990

[Cardiac tumor mass. Diagnostic and therapeutic approach. Apropos of 46 cases].

The authors analyse a series of 46 operated intracardiac tumours (0.4% of all cases of cardiac surgery). The predominant symptoms were episodes of heart failure and pseudo-valvular disease. Peripheral emboli and pericardiac syndromes with tamponade occurred more rarely and constituted surgical emergencies. Non-invasive investigations, dominated by echocardiography, allow early diagnosis. The majority of tumours were situated in the left atrium and consisted, histologically, of myxomas, the surgical treatment of which consists of wide excision of the pedicle. Malignant tumours (17.7%) were dominated by cardiac sarcomas. When possible, extensive resection of these tumours may improve the chances of medium-term and long-term survival. The operative mortality was 8.8%. The delayed mortality was due to malignant tumours (17.3%). Myxomas must be followed in the long-term by systematic echocardiography. The authors observed 11% of recurrences occurring after a interval of 12 to 144 months (3 cases).

Adolescent↗
PubMed1989

New helper instrument in cardiac surgery.

A new instrument has been designed for cardiac surgery. It frees the hands of the surgical assistant and is effective either for valve replacement or coronary graft anastomosis. The use of this instrument makes the operation quicker and easier.

Anastomosis, Surgical↗
PubMed1989

[Hancock pericardial prosthesis. Intrinsic dysfunctions].

The frequency of primary dysfunction of 432 Hancock pericardial bioprosthesis was evaluated during a mean follow-up period of 53.1 months per patient. This frequency was 3.20% valve-year in mitral valve prosthesis and 0.92% valve-year in aortic valve prosthesis. Only one case of calcification was noted. Dysfunction was usually due to tearing of one or several pericardial cusps (25 cases), occasionally to tissue retraction (4 cases). Pathological examination of the explanted valves showed fibrin formation followed by organization into fibrous tissue in the host, retracting or fragilizing the pericardial valvular tissue. A preliminary study of the same group had led to discontinuation of Hancock prosthesis. The long follow-up period makes it possible to compare the results obtained with those of pericardial prosthesis of the same generation, to stress the need for echocardiographic monitoring of the implanted valves and to hope that new techniques of pericardial valve fitting will improve the mechanical reliability of prosthesis which, from the point of view of thrombogenesis and haemodynamics, have unquestionable advantages.

Adolescent↗
PubMed1989

[Primary failure of pericardial valvular heterografts].

From July 1981 to October 1984, 79 Hancock pericardial valves were implanted in 74 patients surviving the hospital period and with a mean age of 64.2 years. Fifty-two patients underwent aortic valve replacement, 16 had mitral valve replacement, 5 bad a double replacement and 19 associated procedures were performed. The mean survival is 48 months. Until 1st June 1987, 11 primary failures have required reoperation (14.9%), 4 in the mitral position (4.6% patient-years), 7 in the aortic position (3.01% patient-years). The time to reoperation was 48.4 months for the aortic orifice and 36.5 months for the mitral orifice. The lesions most frequently encountered were tears (7 cases), calcifications (5 cases) and stretching of valvular tissue (2 cases); two patients died during the postoperative phase of this operation. Despite the small number of patients followed, this series demonstrates of high incidence of dysfunction due to primary tissue degeneration as, after the 5th year, the actuarial rate of absence of primary lesion is 85.3 +/- 8% with no significant difference between the aortic and the mitral orifices, although dysfunction appears to occur more rapidly in mitral prostheses. These results are much less favourable than those obtained with Ionescu bioprostheses in the aortic position of those obtained with porcine bioprostheses in either position. This justifies very regular clinical and echocardiographic follow-up of patients with Hancock pericardial valvular heterografts.

Actuarial Analysis↗
PubMed1988

Actuality in the treatment of unstable angina pectoris.

In an attempt to relieve ischaemic symptoms and to prevent progression to myocardial infarction, coronary angioplasty was attempted in 236 multivessel coronary heart disease patients with unstable angina, refractory to medical treatment including oral Ca2+ antagonists, beta blockers and nitroglycerin drugs. Unstable angina was defined as ischaemic chest pain at rest lasting for at least 20 min, accompanied by reversible ST-T changes. The initial angioplasty success rate was 87% (205/236 cases). Vessel occlusion necessitating urgent bypass surgery occurred in five patients (2.1%). There was evidence of myocardial infarction in eight patients (3.4%). There were seven deaths (2.9%) related to the procedure. 191 of the 205 successfully dilated patients were followed up for 14 months on the average. Late mortality occurred in 4.2% (8/191), late nonfatal infarction in 2.6%, 127 patients remained asymptomatic and 11 were considered to be disabling angina (New York Heart Association classification III or IV). Recurrent angina rate with progression in ischaemic disease (restenosis and native vessel stenosis) occurred in 30%. For this reason, repeated angioplasty and elective bypass surgery were performed in 48 and 14 cases, respectively. These results support the growing evidence that angioplasty as an emergency procedure in multivessel disease patients with unstable angina pectoris refractory to intensive medical treatment can restore coronary blood flow with an acceptable risk and a good initial and short-term success rate.

Adult↗
PubMed1986

Argon laser recanalization of three totally occluded human right coronary arteries.

We report the successful recanalization, in vivo, of three totally occluded human right coronary arteries with an argon laser catheter during coronary artery bypass surgery. The laser catheter and technique of laser recanalization are described. At 15 days postoperatively, two of the laser-treated arteries were reoccluded angiographically. The third patient refused postoperative angiography.

Cardiac Catheterization↗
PubMed1985

Complete patency in thrombus-occluded arteries two weeks after laser recanalization.

The potential problem of rethrombosis after laser recanalization was studied in 16 thrombus-occluded canine femoral arteries. Balloon de-endothelialization and thrombin-human blood injection produced adherent, completely occlusive thrombi 4.13 +/- 1.54 cm in length; laser exposure of the thrombi occurred at 18.35 +/- 22.1 hours. The argon laser catheter was introduced via a proximal arteriotomy and a power of 3.83 +/- 0.58 W delivered for 411.3 +/- 296.87 seconds. Follow-up period was 14 days. All arteries were patent immediately after and 14 days following lasing, as demonstrated by angiography. There was no vessel perforation. Seven of the dogs were maintained on aspirin and dipyridamole 4 days before and throughout the study, but there were no differences in thrombus length, laser power, or duration of laser exposure between these dogs and those receiving no anti-platelet therapy. Control thrombosed arteries (without laser energy application) showed no autolysis within 14 days in all dogs and up to 95 days in three dogs followed for this period of time. These data show that rethrombosis of totally occluded, thrombosed arteries is not present up to 2 weeks later after laser recanalization, with or without the aid of anti-platelet therapy.

Animals↗
PubMed1985

Changes in plasma fibronectin levels after cardiac and pulmonary surgery: role of cardiopulmonary bypass.

The changes in immunoassayable plasma fibronectin were studied during seven days after cardiac surgery with cardiopulmonary bypass (group A, 19 patients) or lung surgery without bypass (group B, 11 patients). In group A the fibronectin showed a series of rapid changes during the 24 perioperative hours. Simultaneous assessment of other plasma proteins (albumin, fibrinogen and immunoglobulin G) suggested that these changes mainly reflected hemodilution and hemoconcentration processes following the cardiopulmonary bypass, being influenced by the necessarily large transfusions of plasma. The fibronectin level decreased after day 1, with maximum depletion (averaging -32% of preoperative value) on day 3. Despite subsequent progressive rise, full restoration had not been reached by day 7. Group B did not show the initial rapid changes, but progressive fall in fibronectin level to a nadir on day 2 (-20% of preoperative) was followed by gradual return to outset value on days 4-5. The study demonstrated 1) that cardiac or lung surgery induces transient fibronectin depletion on days 2 to 3 postoperatively, and 2) that in surgery with cardiopulmonary bypass the decrease is significantly greater and more prolonged. It is proposed that this supplementary decrease is due to the large amounts of particulates of various origin entering the blood during the bypass.

Blood Proteins↗