Search PubMed⌕ Search

Biomedical subjects

G Hanania

Publications and source records attributed to G Hanania.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Registry of heart failure patients hospitalized in 2000. Data from the National College of Cardiology and General Hospital].

The French epidemiological data on cardiac insufficiency in the hospital environment are scarce. A register collecting 1772 patients was produced by the services of the National College of General Hospital Cardiologists (C.N.C.H.G.) during two periods: autumn 1999 (November) and spring 2000 (June). It involved completing a form for each of the first 20 patients with cardiac failure hospitalized over a month. 1011 and 761 observations from 59 and 47 centres (that is 17 and 16 observations per centre) were collected during the autumn and spring periods respectively. In France, in the general hospital centres (CHG) cardiology services during the year 2000, the characteristics and the medical treatment of hospitalized patients with cardiac failure are very similar to those presented in 1998 by A. Cohen-Solal in the name of the working group "Cardiomyopathy and Cardiac Insuficiency of the French Society of Cardiology". The hospitalized patient with cardiac failure is very old, usually male, has an ischaemic cardiopathy in one in two cases, and is at stage II and III on the New York Heart Association (NYHA) scale in 83% of cases. There is practically always an electrocardiographic anomaly. Loop diuretics are prescribed nine times out of ten, digitalis one in three, anagiotensin converting enzyme inhibitors are underused being prescribed two out of three times, but an increase in the prescription of anti-aldosterone and betablockers is found. The majority of patients improve during their stay, 7.8% dying and this mortality is influenced by age, ejection fraction (FE), functional NYHA class, causal cardiopathy, and the existence of severe renal failure. The data collected by the cardiology services of the C.N.C.H.G. are representative of the profile of the population affected and are important to know in order to improve the management of these patients.

Adrenergic beta-Antagonists↗
PubMed2001

[The best in 2000 on valve diseases].

During the year 2000, publications on valvular heart disease have concerned all aspects of this field of cardiology at a time when old and dated therapeutic procedures are being reassessed. The ageing population of the developed world has led to aortic stenosis playing a large part, and the study of its natural history has provided two keynote publications. Aortic valve replacement, increasingly involving older patients, led to the evaluation of this surgery in this age group in which bioprostheses are often associated with coronary bypass surgery. Conversely, in younger patients, there is a regain in interest in autograft (Ross' procedure) or homograft valve replacement which requires a rigorous infrastructure of supply. In mitral valve disease, the indications of conservative surgery of mitral incompetence, ideal in degenerative forms of the posterior leaflet, have been progressively extended to include bacterial endocarditis in many cases and ischaemic mitral regurgitation according to some authors. Rheumatic lesions are not commonly treated by this technique although some encouraging results have been reported. Percutaneous mitral commissurotomy has attained maturity in the treatment of mitral stenosis, even in the less favourable forms such as restenosis after an initial percutaneous procedure or even after surgical commissurotomy. Valve replacement surgery by prosthetic valves is forty year old and many long-term retrospective and prospective evaluations of the results on large patient population either with one type of prosthesis or comparing different bioprostheses or bioprostheses with mechanical valves have been performed. The ideal age for implanting bioprostheses remains uncertain, between 60 and 70, depending on the authors. Finally, problems of anticoagulation in patients with prosthetic valves were the object of three interesting publications about the use of low molecular weight heparin, aspirin and the risks during pregnancy. 2000 was a year of steady and regular progress in the study of valvular heart disease without any major revolutionary contributions.

Heart Valve Diseases↗
PubMed2001

[Anticoagulant therapy during pregnancy in patients with mechanical valvular prostheses].

Anticoagulant therapy (heparin or oral anticoagulants) during pregnancy in patients with mechanical valvular prostheses should take into consideration the respective risks of the usage of these two products: thromboembolic for the mother, congenital malformations for the children and haemorrhagic for them both. Basically, heparin therapy is useful by limiting the risk of foetal complication, but it increases maternal risk, especially related to thromboembolism. The risks of oral anticoagulants are concentrated in the second half of the first trimester (coumarin-related embryopathies) and in the peri-partum period (maternal and foetal haemorrhage). There is general agreement to use oral anticoagulants outside these periods, during the second trimester and most of the third. During the first trimester, the European and North American Recommendations make provision for parental consultation. Some authors recommend oral anticoagulants even during the first trimester because of the scarcity of coumarin-related embryopathies. In fact, the incidence greatly increases when the dosage required is over 5 mg of coumarin per day. Others continue anticoagulation until the end of pregnancy, stopping 48 hours before delivery, either vaginal or by caesarean section. These attempts to avoid heparin therapy are related to difficulties of obtaining stable anticoagulation with non-fractionated heparin which increases the risk of thromboembolism, especially prosthetic valve thrombosis. Low molecular weight heparin, which is widely used in venous and arterial thromboembolic disease, including during pregnancy, is not yet recommended for usage in pregnant women with mechanical valvular prostheses because there are not results from large series concerning their efficacy and safety in this particular indication. In the absence of randomised studies in pregnancy, the renewal of small series in specialised centres will probably open up the field for their usage in the years to come.

Abnormalities, Drug-Induced↗
PubMed2000

[Valvular prostheses and their follow-up].

In use since 1961, valvular prostheses allow the correction of the severe valvular diseases when conservative procedures are not possible. Current prostheses have outstanding haemodynamic features. Mechanical prostheses have a supposedly unlimited life span but require anticoagulant treatment. Bioprostheses do not need such treatment but end up to deteriorate and need reoperation. Both can be affected by valve-related complications (thromboembolic events, endocarditis deterioration, desinsertion...): an ideal prosthesis does not exist yet. All patients with valvular prosthesis require close follow-up, where echocardiography holds proeminent place.

Bioprosthesis↗
PubMed2000

A national survey of heart failure in French hospitals. The Myocardiopathy and Heart Failure Working Group of the French Society of Cardiology, the National College of General Hospital Cardiologists and the French Geriatrics Society.

Rationale The epidemiology of heart failure and patient management procedures may vary from one country to another. This study was designed to analyse the spectrum of patients hospitalized in France for heart failure. Patients and Methods A registry involving 120 departments (cardiology, general medicine and geriatrics) and 1058 patients.Results The patients' median age was 76 years, and the male/female ratio was 55/45. Echocardiography was performed in 77% of the cases: the left ventricular ejection fraction was <30% in 22%, between 30 and 40% in 25% and greater than 40% in 53%. Angiotensin-converting enzyme (ACE) inhibitors were prescribed to, respectively, 78% and 63% of patients with ejection fractions above and below 40%. Conclusion In France, patients hospitalized for heart failure tend to be old and are often women; about one in two have relatively preserved left ventricular systolic function. ACE inhibitor prescription seems to be more frequent than currently reported. This survey confirms the clear gap between the populations in clinical trials and those in routine clinical practice.

Aged↗
PubMed1999

Perivalvular abscesses associated with endocarditis; clinical features and prognostic factors of overall survival in a series of 233 cases. Perivalvular Abscesses French Multicentre Study.

AIMS: The purposes of this study were to determine the clinical features and to identify prognostic factors of abscesses associated with infective endocarditis. METHODS AND RESULTS: During a 5-year period from January 1989, 233 patients with perivalvular abscesses associated with infective endocarditis were enrolled in a retrospective multicentre study. Of the patients, 213 received medical surgical therapy and 20 medical therapy alone. No causative microorganism could be identified in 31% of cases. Sensitivity for the detection of abscesses was 36 and 80%, respectively using transthoracic and transoesophageal echocardiography. Surgical treatment consisted of primary suture of the abscess (38%), insertion of a felt aortic or mitral ring using Teflon or pericardium (42%), or debridment of the abscess cavity (20%). The 1 month operative mortality was 16%. Actuarial rates for overall survival at 3 and 27 months in operated patients were 75 +/- 10% and 59 +/- 11%, respectively. Increasing patient age, staphylococcal infection, and fistulization of the abscess were found to be independent risk factors in both 1 month and overall operative mortality. Renal failure was a risk factor predictive of operative mortality at 1 month, whereas uncontrolled infection and circumferential abscess were regarded as risk factors predictive of overall operative mortality. CONCLUSION: The data determined prognostic factors of abscesses associated with infective endocarditis.

Abscess↗
PubMed1999

Blood pressure response to the first 36 hours of heart failure therapy with perindopril versus captopril. French General Hospitals National College of Cardiologists.

An open randomized hospital study conducted in 169 centers in France compared the blood pressure response to the first 36 h of treatment with perindopril (PER), 2 mg once daily, with that to captopril (CAP), 6.25 mg t.i.d., in 725 patients (mean age, 70 years; men, 67%) with echocardiographic left ventricular systolic dysfunction (fractional shortening, < or = 28%) due to ischemia (56.7%) or hypertension (34.5%) and a systolic blood pressure (SBP) > or = 120 mm Hg. Each dose of CAP induced a sharp and rapid decrease in blood pressure (maximum, 1.5-2 h); with PER, the decrease was gradual (maximum, 6 h) and variation was less marked. However, at 36 h, the decrease in blood pressure versus baseline was similar on both treatments. Over the 36-h period, there were 22 (3%) dropouts due to marked orthostatic hypotension (SBP, <90 mm Hg), and they were fewer with PER than with CAP: 16 cases in the CAP group versus six in the PER group (p = 0.036). At 36 h, heart rate was lower with CAP than with PER: 75.2 versus 77.5 beats/min, respectively (p = 0.039). As initial therapy for stabilized left ventricular systolic dysfunction, the first dose of PER (2 mg) induced a significantly smaller decrease in blood pressure than the first dose of CAP (6.25 mg); dropouts due to orthostatic hypotension were also significantly fewer with PER than with CAP.

Aged↗
PubMed1998

[Cardiac abscess in infectious endocarditis. A multicenter study apropos of 233 cases. The Working Group on Valvulopathy of the French Society of Cardiology].

The aim of this retrospective multicenter study was to determine present characteristics of infectious endocarditis complicated by abscess and to identifying predictive factors of mortality. The files of 233 patients with infectious endocarditis complicated by perivalvular abscesses between January 1989 and December 1993 were analysed. Two hundred and thirteen patients underwent medico-surgical treatment (175 aortic and 38 mitral abscesses) and 20 patients underwent medical treatment alone (17 aortic and 3 mitral abscesses). The abscess was observed on native valves in 156 cases and valve prostheses in 77 cases. The causative organism was identified in 69% of cases : the commonest organism was the staphylococcus. The diagnostic sensitivity of transthoracic and transoesophageal echocardiography was 36 and 80% respectively. The operative mortality at one month was 16%. Patients over 65 years of age, staphylococcal infection, renal failure and fistulisation of the abscess, were identified as independent predictive factors of mortality at one month. The survival rate three months after surgery was 75 +/- 10% and 59 +/- 11% at 27 months. An age over 65, staphylococcal infection, uncontrolled infection, circumferential abscess and fistulisation were independent predictive factors of global mortality (the first month and after). The mortality rate in unoperated patients was 40%: cardiac failure and fistulisation of the abscess detected by echocardiography were predictive factors of mortality on univariate analysis.

Abscess↗
PubMed1997

Incremental cost-effectiveness ratio of alteplase in patients with acute myocardial infarction in the French setting.

On the basis of data collected from general hospital centres in France on 704 patients initially presenting with acute myocardial infarction, the mean 1-year cost of treatment was calculated to be 52,160 French francs (F) per patient (1994 values). This was independent of whether the patient received thrombolysis, and included all costs associated with initial hospitalisation including a stay in intensive care, cardiology or medical units, as well as rehospitalisations, revascularisation procedures and any drugs prescribed. When only those patients who survived the initial hospitalisation were considered, the mean cost of treatment was F58,184 per patient. Among patients who received thrombolysis during their initial hospitalisation, the respective mean 1-year costs were F74,684 per patient for those treated with alteplase and F64,866 per patient for those treated with streptokinase (p = 0.09). This nonsignificant difference can be explained by the higher cost of alteplase relative to that of streptokinase, the lower mortality rate associated with alteplase during the initial hospitalisation period (9.2% versus 10.6%) and the difference in the percentage of additional revascularisations required in the 2 treatment groups (32.8% versus 42.3%). Combining the pharmacoeconomic data collected in the French general hospital setting with incremental patient survival data stemming from the Global Utilisation of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) trial showed that the incremental cost-effectiveness ratio of alteplase versus streptokinase amounted to F70128 per life-year saved for the total group, and F52035 per life-year saved for those patients who survived the initial period of hospitalisation.

Acute Disease↗
PubMed1996

AREVA: multicenter randomized comparison of low-dose versus standard-dose anticoagulation in patients with mechanical prosthetic heart valves.

BACKGROUND: Moderate anticoagulation may be proposed to reduce the risk of hemorrhage for certain patients with a mechanical prosthesis, but the consequences for risk of thromboembolism are debated. METHODS AND RESULTS: The purpose of the AREVA trial was to compare moderate oral anticoagulation (international normalized ratio [INR] of 2.0 to 3.0) with the usual regimen (INR of 3.0 to 4.5) after a single-valve replacement with a mechanical prosthesis, either Omnicarbon or St Jude. Patients included were between 18 and 75 years old, in sinus rhythm, and with a left atrial diameter < or = 50 mm on the time-motion echocardiogram. Patients were randomized for INR after surgery. From 1991 to 1994, 433 patients underwent valve replacement (aortic, 414; mitral, 19) with 353 St Jude and 80 Omnicarbon prostheses; 380 patients were randomized for INR: 188 for INR 2.0 to 3.0 and 192 for INR 3.0 to 4.5. Mean follow-up was 2.2 years (1 to 4 years). Analysis of 18001 INR samples showed that the mean of the median of INR was 2.74 +/- 0.35 in the 2.0 to 3.0 group and 3.21 +/- 0.33 in the 3.0 to 4.5 group (P < .0001). Thromboembolic events, as assessed from clinical data and CT brain scans, occurred in 10 patients in the 2.0 to 3.0 INR group and 9 patients in the 3.0 to 4.5 INR group (P = .78). Hemorrhagic events occurred in 34 patients in the 2.0 to 3.0 INR group and 56 patients in the 3.0 to 4.5 INR group (P < .01), with 13 and 19 major hemorrhagic events, respectively (P = .29). CONCLUSIONS: In selected patients with mechanical prostheses, moderate anticoagulation prevents thromboembolic events as effectively as conventional anticoagulation and reduces the incidence of hemorrhagic events.

Administration, Oral↗
PubMed1996

[Therapeutic strategies in acute myocardial infarction. Results of STIM 93 registry].

A registry was set up by the national college of cardiologists practicing in general hospitals in February 1993. The data concerned mode of admission, demographic details, initial clinical and haemodynamic evaluation and hospital outcome. Special attention was given to the electrocardiographic changes before and, in patients receiving thrombolytic therapy, after treatment. An analysis of predictive factors for mortality was performed both in the group of patients "revascularised" and in the group treated conventionally. One thousand and twenty three cases from 327 centres were analysed. There were 1292 men and 531 women, with an average age of 67.9 years. The average time interval from onset of symptoms to hospital admission was 5 h 30 min, 56.8% of patients arriving within 6 hours. 36.4% of the population underwent thrombolysis or angioplasty, 75% of patients under 75 years of age admitted before the 5th hours underwent a procedure of myocardial revascularisation. The hospital mortality was 14%, 8.7% in those revascularised and 17% in patients treated conventionally. Factors predictive of mortality were age, female gender, Killip Classes III or IV, systolic blood pressure of less than 100 mmHg, heart rate of more than 100/min and contraindications of thrombolysis. The maximum ST depression, the sum of ST depression, the sum of ST elevation and depression, were also significant predictive factors of a fatal hospital outcome in the whole population group and in patients treated conventionally. In the reperfused group, only the initial sum of ST elevation and depression was predictive of mortality: 120 minutes after the beginning of thrombolysis, the sum of ST elevations and of elevations and depressions was predictive of twice the mortality when the values exceeded 0.6 mv and 1.4 mv respectively.

Adult↗
PubMed1994

Pregnancy and prosthetic heart valves: a French cooperative retrospective study of 155 cases.

A French cooperative retrospective study analysed 155 pregnancies in 103 women with prosthetic heart valves: 95 mechanical prosthesis (MP) and 60 bioprostheses (BP). Among them 13 MP and 10 BP were bivalvular and four were mixed implants. In all, 182 (108 MP and 74 BP) prostheses were exposed to the risk of pregnancy. Among the 108 MP-bearing patients, 16 thromboembolic accidents (TEA) were recorded: 10 thromboses in 13 mitral, two aortic and one pulmonary MP. TEA were four times more frequent under oral anticoagulant therapy. Among the 74 BP, seven suffered premature valve failure. Ninety-nine infants were born to 50 MP-bearing women (53%) and 48 BP-bearing patients (80%) (P < 0.001). Twenty miscarriages were reported; they occurred more often under anticoagulant treatment (17%) than without it (4%) P < 0.02). Coumarin-induced embryopathies were rare (only one definitively identified). Because pregnancy with an MP under anticoagulant therapy is dangerous for the mother and may effect the fetus, the therapeutic indications for women of child-bearing age must be taken into consideration. In a women already with an MP at the time of conception, the duration of heparin therapy should be limited to the following two periods: from the 6th to the 12th week (coumarin-induced embryopathies) and during the last 2 weeks of gestation (haemorrhages during delivery and the neonatal period).

Adult↗
PubMed1994

[Complex cardiac lesion diagnosed more than 20 years after the causal injury].

Penetrating wounds of the heart, when not immediately fatal, may give rise to complex lesions associating valvular regurgitations and fistulous connections. The authors report the case of a patient with mitral and aortic regurgitation associated with an aorto-left atrial fistula of traumatic origin and causing invalidating cardiac failure. The interest of this particular case lies in the duration of the interval between the causal trauma and the appearance of symptoms (over 20 years). Complete surgical repair of the lesions provided a good functional result. The authors discuss the different types of lesions which may be caused by wounds of the heart and their modes of presentation.

Aortic Valve Insufficiency↗
PubMed1994

[Pregnancy in patients with heart valve prosthesis. A French retrospective cooperative study (155 cases)].

A French cooperative study of 155 pregnancies in 103 women with valvular prosthesis (95 mechanical, 60 bioprostheses including 27 bivalvular prostheses) is reported. Therefore, a total of 182 prostheses (108 mechanical and 74 bioprostheses) were exposed to the risk of pregnancy. The maternal outcome in the group of 108 mechanical prostheses was complicated by 16 thromboembolic events (TE) including 10 prosthetic valve thromboses which required emergency valve replacement in 4 cases, 6 systemic TE in 13 mitral, 2 aortic and 1 pulmonary mechanical prostheses. The TE were four times more frequent in patients on heparin than in those on oral anticoagulants. There were 4 deaths, 3 among the 10 prosthetic valve thromboses (one reoperation, two sudden deaths). Seven of the 74 bioprostheses were reoperated for degeneration on average 5.9 years after the initial operation but there were no deaths or TE. The outcome of pregnancy was 99 children (63%), 49 of which were born to mothers with mechanical prostheses (53%) and 50 to mothers with bioprostheses (80%) (p < 0.001). Seven of the children were born prematurely, all mothers being on anticoagulant therapy. The birth weight was over 400 grams heavier (3 kg versus 2.6 kg) in the bioprosthesis group (p < 0.05). The 20 spontaneous abortions (13%) were more common in patients on anticoagulants (17%) than in those without (2%) (p < 0.02). Congenital defects due to oral anticoagulants were rare (one certain case). There was one case of phocomelia, an abnormality which has never been described in this context. The 36 remaining pregnancies were still deaths (N = 5), abortion due to maternal death (N = 4), maternal complications (N = 8), therapeutic (N = 9) or voluntary abortions (N = 10) (28 mechanical and 8 bioprostheses).(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗
PubMed1994

[Pregnancy in patients with heart valve prosthesis. Retrospective study apropos of 40 pregnancies].

In order to be able to offer pregnant artificial heart valve patients a practical management approach enabling reduction of maternal and fetal risks, the authors evaluated 40 pregnancies in 24 women. Thirty one valves had been inserted prior to these pregnancies: 24 mechanical valves and 7 biological valves. Different types of anticoagulation regimens were used in 32 pregnancies, while 8 took place without the use of anticoagulants (biological valves in sinus rhythm). From a clinical standpoint, almost all these pregnancies brought to term took place without cardiac decompensation. They resulted in the birth of 26 live infants, including one premature. One child was born at term with a phocomelia-type malformation and two were stillborn. There were five therapeutic abortions and six spontaneous abortions. There were four cases of thromboses of the artificial valve, three of which occurred in patients on heparin (dose of 5,000 IU/12 h). Three massive thromboses required emergency valve replacement surgery. There were also three embolic accidents, including one which regressed totally in a few hours. Two hemorrhagic complications occurred with subcutaneous heparin during the post-partum period. In practice, we feel that: when a young woman wishing to become pregnant requires valve replacement, a biological device is preferable; oral anticoagulants are contra-indicated during the first three months of pregnancy; the dose of 5,000 IU/12 h of heparin is insufficient to prevent thrombo-embolic accidents; when a mechanical valve is already implanted, the sequential treatment protocol of subcutaneous heparin--oral anticoagulant--subcutaneous heparin, with an initial dose of heparin of 5,000 IU/12 h then adjusted on the basis of APTT, is the best choice.

Adult↗
PubMed1993

[Prosthetic valve endocarditis: current problems].

Prosthetic valve endocarditis is a rare complication of valve replacement surgery but carries a grim prognosis. The physiopathology of this condition allows identification of two clinically distinct forms based on their bacteriological profiles and outcome: early endocarditis, diagnosed in the first year following valve replacement is observed in 0.7 to 3% of cases: staphylococci are the predominant organism as contamination usually occurs at operation. The prognosis is poor due to the high incidence of complications and the mortality rate is about 60 to 70%; late endocarditis: diagnosed after the second year, it is observed in 0.5 to 1% of cases per year. Contamination is due to bacteraemia and the commonest organisms are the streptococci. The mortality rate is over 20%. The diagnosis is particularly difficult in chronic forms and those with negative blood cultures. Cardiac imaging in prosthetic valve endocarditis is mainly dependent on Doppler echocardiography especially using the transoesophageal approach which allows evaluation of lesion such as abscesses, vegetations and perivalvular leaks, and enables planning of treatment. Management is medico-surgical. Apart from symptomatic treatment of complications, antibiotic therapy using synergistic drugs at bactericidal dosages intravenously is essential as soon as bacteriological specimens have been sent for culture. Surgery is essential in early forms but may be avoided in uncomplicated late forms. The timing of surgery (the objectives of which are to excise the infected material, to repair destructive lesions and to implant a new valve) is a decisive factor in reducing the morbidity and mortality of this condition. Prophylactic measures have a particularly important role to play: they are based on pre- per- and postoperative guide lines.

Echocardiography, Transesophageal↗