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H Eltchaninoff

Publications and source records attributed to H Eltchaninoff.

At least 55 records · Page 3Linked to original sources
PubMed1996

Effects of prolonged sequential balloon inflations on results of coronary angioplasty.

In percutaneous transluminal coronary angioplasty (PTCA), prolonged balloon inflations using perfusion balloon catheters have shown a higher procedural success rate and fewer in-hospital complications than short balloon inflations. However, perfusion balloons have well-recognized limits for routine use. This study assessed the effects of a prolonged cumulative occlusion time obtained with sequential balloon inflations using a routine balloon catheter, applicable to all lesions, and compared these results with those obtained with standard short balloon inflations. Three hundred ten lesions (in 289 patients) were randomized to either standard (3 to 5 inflations < or = 1 minute each; n = 161) or prolonged (3 to 5 inflations of 3 to 5 minutes each; n = 149) balloon inflations. Angiographic success (residual stenosis <50% and no dissection > or = D1) was assessed at the end of this "protocol" phase. Further dilatation was performed if required ("adjunctive" phase). Systematic repeat catheterization was scheduled 4 to 6 months later. Cumulative inflation time was 198 +/- 58 seconds in the "standard" group versus 782 +/- 303 seconds in the "prolonged" group. At the end of the protocol phase, the success rate was higher after prolonged than after standard dilatation (92% vs 80%; p <0.002), with less frequent dissections (14% vs 30%; p = 0.0009). At the end of the adjunctive phase, required for 12 patients in the prolonged group and 32 patients in the standard group (p = 0.003), results were comparable in the 2 groups and the restenosis rate was similar at 6 months. The prolonged cumulative occlusion time achieved with sequential balloon inflations using a routine balloon catheter improves the immediate results of PTCA. Repeat catheterization shows no effect of prolonged sequential inflations on the restenosis rate.

Aged↗
PubMed1996

[Myocardial adaptation to ischemia. A study during repeated prolonged coronary occlusions in angioplasty].

Coronary angioplasty provides an ideal model for studying ischemic preconditioning in humans. Four coronary occlusions, each lasting 5.2 +/- 1.3 min, separated by 3 min of reperfusion, were performed during angioplasty of isolated stenosis of the left anterior descending artery of 18 patients with stable angina and normal left ventricular function. The ischaemia was evaluated and compared during the first and fourth coronary occlusion with the aid of clinical, electrocardiographic, echocardiographic and metabolic parameters. We analysed: 1) interval to chest pain and its intensity; 2) degree of ST change on the intracoronary electrocardiogram; 3) regional wall motion abnormalities on 2D echocardiography; 4) coefficient of myocardial lactate extraction. The results showed that during the fourth occlusion: chest pain occurred later (93 +/- 57 vs 60 +/- 49 s; p < 0.05) and ST elevation was less (0.69 +/- 0.5 vs 1.03 +/- 0.8; p < 0.05). During the fourth occlusion, there was a delay in appearance and a decrease in the regional wall motion abnormalities: anterior wall hypokinesia occurred later: 26 +/- 15 vs 19 +/- 19 s (p = 0.08). Akinesia observed in 10 patients out of 13 (77%) during the first occlusion, was only observed in 8 patients (62%) and dyskinesia, observed in 5 patients out of 13 (38%) during the first occlusion was not observed thereafter in any patient. The production lactate was less important during the fourth occlusion than during the first one: -3 +/- 17% vs -12 +/- 19% (p < 0.05). This study confirms that, in man, preconditioning allows myocardial adaptation to successive episodes of acute ischaemia.

Adaptation, Physiological↗
PubMed1995

Early and 1-year survival rates in acute myocardial infarction complicated by cardiogenic shock: a retrospective study comparing coronary angioplasty with medical treatment.

Cardiogenic shock remains a frequently lethal complication of acute myocardial infarction. Early revascularization of the infarct-related artery by coronary angioplasty has been suggested to significantly improve patient survival. In-hospital and 1-year survival was assessed in 50 patients hospitalized for acute myocardial infarction complicated by cardiogenic shock. All patients received medical treatment and intraaortic balloon pump support. Thirty-three patients underwent coronary angioplasty (PTCA group), while 17 patients remained on conventional therapy (no PTCA group). The two groups were comparable for all baseline characteristics. Survival was significantly better in the PTCA group than in the no PTCA group: 64% versus 24% in-hospital survival (p = 0.007) and 52% versus 12% at 1 year (p = 0.006). When angioplasty was successful in achieving reperfusion, survival was further enhanced: in-hospital survival rate was 76% versus 25% in patients with unsuccessful angioplasty and 60% versus 25% at 1 year.

Aged↗
PubMed1995

Angioscopic evaluation of prolonged vs standard balloon inflations during coronary angioplasty. A randomized study.

UNLABELLED: To study the immediate effects of prolonged total balloon inflation during PTCA, 41 patients (44 lesions) with chronic stable angina were randomized for prolonged sequential inflations (three to five inflations of 3 to 5 min each, for a total duration of > or = 12 min, group 1, n = 20 lesions) or 'standard' sequential inflations (three to five inflations of < or = 1 min each, for a total duration of < or = 3 min, group 2, n = 24 lesions). The mean duration of total balloon inflation time was 958 +/- 129 s in group 1 vs 205 +/- 46 s in group 2. Results of angioplasty were assessed on both angiography and percutaneous transluminal coronary angioscopy performed immediately after the procedure. High quality imaging of the coronary lumen and lesion morphology was possible on angioscopy in all patients without any complications. Post-PTCA angiographic percent diameter stenosis was significantly less in group 1 compared to group 2: 26 +/- 10% vs 36 +/- 8% (P < 0.05). On angioscopy, flaps were seen in 16 patients in group 2, but in only six in group 1 (P < 0.02). There was no difference in the incidence of thrombi on angioscopy between the two groups (group 1: nine cases, group 2: 10 cases). Sensitivity of angiographic detection of flaps and thrombi was poor: 10% and 12% respectively. One patient in each group developed a longitudinal dissection, detected on both angiography and angioscopy. CONCLUSIONS: (1) prolonged sequential balloon inflations lead to less residual luminal stenosis after PTCA, with a decreased incidence of intimal flaps in comparison with standard inflations. (2) Post-PTCA transluminal coronary angioscopy is safe and offers better assessment of luminal effects of PTCA than angiography.

Adult↗
PubMed1995

Balloon aortic valvuloplasty in elderly patients at high risk for surgery, or inoperable. Immediate and mid-term results.

Although aortic valve replacement is undoubtedly the treatment of choice for aortic valve stenosis, balloon aortic valvuloplasty may represent the only possible treatment for some frail elderly patients who may have additional medical problems. We evaluated immediate and 1-year results of balloon aortic valvuloplasty in 86 patients > or = 80 years with severe aortic stenosis. Mean age was 84 +/- 3 years. Forty-four % were 85 years or older. Mean gradient decreased from 68 to 26 mm Hg and valve area increased from 0.53 to 0.96 cm2 (P<0.05). There were two per-procedural deaths. No local vascular complication was observed. During the follow-up (13 +/- 9 months), 27 patients died, four had repeat balloon aortic valvuloplasty and eight underwent aortic valve replacement. Persistent clinical improvement was observed in 78% of the surviving patients. One-year actuarial survival rate was 73%. Balloon aortic valvuloplasty appears to be a safe and valuable technique in cases where surgery cannot be performed or carries a very high risk.

Aged↗
PubMed1994

Late results of coronary angioplasty in patients with left ventricular ejection fractions < or = 40%.

Left ventricular (LV) function is the most important independent predictor of long-term survival in patients with coronary artery disease, and results of bypass surgery improving survival in the setting of depressed LV function are well documented. Data regarding long-term outcome in patients undergoing coronary angioplasty are limited. From 1983 through 1989, 343 consecutive patients with an ejection fraction (EF) < or = 40% (mean 34% +/- 5%) undergoing elective coronary angioplasty were evaluated, retrospectively. The mean age was 61 +/- 10 years and 80% were men. Angiographic success (469 of 496 narrowings) was 95%. Major complications occurred in 26 patients (7.6%): emergency bypass surgery (n = 11), nonfatal myocardial infarction (n = 8), and death (n = 9). Follow-up was available for 99% of patients with clinical success (mean = 36 +/- 22 months). Fourteen patients (4.5%) developed nonfatal myocardial infarction and 72 patients (23%) had symptomatic restenosis, 32 patients requiring repeat angioplasty or atherectomy and 29 bypass surgery. Fifty-six patients (18.2%) died. Three-year survival was 84%. EF was a significant predictor of death: 3-year survival was 69%, 83% and 92%, respectively, in patients with EF < or = 30%, 31% to 35%, and 36% to 40% (p = 0.0001). A high angiographic success rate and an acceptable procedural risk were encountered in patients with depressed LV function undergoing angioplasty. The 3-year mortality rate, however, is substantial and directly related to the degree of LV dysfunction.

Adult↗
PubMed1994

[Angioscopic evaluation of the immediate result of coronary angioplasty in relation to balloon inflation time].

The aim of this study was to assess the effects of coronary angioplasty on the intima with respect to the duration of balloon inflation by percutaneous angioplasty. Twenty-seven patients were randomized according to the total duration of balloon inflation: Group I "standard" duration (total duration < or = 3 min, N = 13) and Group II: prolonged duration (total duration > or = 12 min, N = 14); the type and distribution of the lesions were comparable in the two groups. The results of angioplasty were evaluated immediately after dilatation by angiography and angioscopy. Angioscopy was performed without failure or complications with perfect definition of the images in all cases. Angioscopy showed 1) intimal tears, 2) thrombi, 3) longitudinal dissections. A classification in three grades was used taking the apparent gravity of the lesions into consideration. The mean duration of balloon inflation in Group I was 205 +/- 45 s and 958 +/- 129 s in Group II. The residual stenosis was 36 +/- 8% in Group I and 26 +/- 10% in Group II (p < 0.05). Angioscopy showed the frequency of intimal tears to be twice greater in Group I (9 cases) than in Group II (4 cases) (p = 0.05). Intravascular thrombi were observed in 13 cases, 6 in Group I and 7 in Group II. One case of longitudinal dissection was observed in each group: only one of these two cases was detected at angiography. The authors conclude that repeated and prolonged balloon inflations improve the immediate results of angioplasty with less residual stenosis at angiography and a lower incidence of intimal tears at angioscopy.

Aged↗
PubMed1994

[Effects of repeated and prolonged inflations on immediate angiographic results and complications of coronary angioplasty. Prospective and randomized study].

The effects of the duration of balloon inflation on the immediate and mid-term results of angioplasty were assessed in a randomized study initiated in June 1992. To date, 239 lesions in 224 consecutive patients were allocated randomly into 2 groups according to the duration of balloon inflation: short duration (123 lesions): 3 or 4 successive inflations, each < or = 1 mn, for a total duration < or = 3 min; long duration (116 lesions): 3 to 5 inflations, each of 4 to 5 minutes each for a total duration > or = 12 min. Patients with acute myocardial infarction, restenosis and lesions of bypass grafts were excluded. Stenosis (% of reduction of the internal diameter) was calculated with a digitalised Philips DCI system. Success was defined by < 50% residual stenosis in the absence of severe complications: death, emergency bypass surgery, infarction and extensive and/or occlusive dissection. The baseline clinical, haemodynamic and angiographic parameters of the two groups were comparable. The residual stenosis after angioplasty in the "short duration" group was 33 +/- 11% and 29 +/- 11% in the "long duration" group (p < 0.05). The primary success rate was 75% in the "short duration" compared to 89% in the "long duration" group (< 0.001). Angiographic dissection after angioplasty was observed in 38 cases in the "short" but only in 17 cases in the "long duration" group (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Immediate and long-term results of coronary angioplasty in patients with low ejection fraction].

Left ventricular function is the main predictive factor for survival in coronary patients and the results of coronary bypass surgery in left ventricular dysfunction have been widely reported. The authors undertook a retrospective study of the success rate, the risks and clinical outcome after coronary angioplasty of 182 patients with a left ventricular ejection fraction < or = 35% (30 +/- 4%). The average age was 61 +/- 10 years and 78% were men. One hundred and fifty three patients had a history of myocardial infarction. The primary success rate of angioplasty was 95% (271/284 lesions) including the multiple procedures in 24% of cases. There was a 7.1% frequency of major complications (7 deaths, 3 non-Q wave infarctions, 4 emergency coronary bypass procedures). An average follow-up period of 32 months was obtained in 98.4% of patients. Seven patients developed a myocardial infarction and 14 patients were rehospitalized for cardiac failure (N = 6) or severe ventricular arrhythmias (N = 8). A control coronary angiography was performed in 100 cases either as a routine investigation or for recurrence of symptoms. Restenosis was demonstrated in 33 cases, an aggravation of lesions on another vessel in 12 cases and restenosis associated with aggravation of other lesions in 5 cases, leading to redilatation in 26 cases, atherectomy in 2 cases and coronary bypass surgery in 16 cases. Forty-one patients died (25%). Ten patients died before the 6th month and 31 died secondarily. The only parameter which was significantly correlated with survival was the value of the ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1994

[Ablation by radiofrequency in the treatment of atrial arrhythmia].

Atrial arrhythmias resistant to medical therapy are still a common indication for ablation of the normal atrioventricular conduction pathway (Tawara node and His Bundle). However, the development of catheter techniques of intra-atrial ablation to destroy arrhythmogenic myocardial zones enables radical cure of the arrhythmias with the respect of the nodo-hisian pathway. With respect to common flutter, a number of series, including our own, show a 50 to 75% long-term success rate. We believe that a very high success rate in the ablation of flutter will probably be achieved in a reproducible manner but this will require a more accurate understanding of the tachycardia circuit and technological developments allowing controlled radio-frequency destruction of bigger atrial myocardial zone. Experience of radio-frequency ablation atrial of atrial extrasystoles is more limited than that of flutter and there are fewer published series. Globally, catheter ablation of atrial tachycardia remains a more difficult and a less well codified procedure than that of accessory pathways or of intra-nodal reentry. Radio-frequency ablation in this indication is not without danger in view of the thinness of the atrial wall. We believe that radio-frequency catheter ablation for atrial arrhythmias should, for the moment, be reserved for centres specialised in the techniques of electro-physiological investigation and ablation.

Atrial Flutter↗
PubMed1993

Complications associated with percutaneous placement and use of intraaortic balloon counterpulsation.

In-hospital and late complications related to percutaneous placement of 240 intraaortic balloon pump catheters in 231 consecutive patients from March 1985 through June 1990 were reviewed. Mean age was 64 +/- 11 years and 34% were women. Average duration of counterpulsation was 44.2 hours. Indications for counterpulsation included complications of myocardial infarction (34.6%), prophylactic placement before high-risk coronary angioplasty (20.0%) or open heart surgery (12.9%), complicated coronary angioplasty (18.3%), end-stage cardiomyopathy (5.4%) and miscellaneous (8.8%). Early major complications occurred in 11 cases (4.6%) and included limb ischemia requiring surgery (n = 9), bleeding requiring arterial repair (n = 1) and septicemia (n = 1). Other complications included hematoma requiring transfusion (n = 7), limb ischemia resolving with balloon catheter removal (n = 12), and superficial wound infection (n = 1). Overall in-hospital complication rate was 13% (31 of 240). Peripheral vascular disease and diabetes were found to be significant predictors of limb ischemia (p = 0.01 and p = 0.02, respectively). Follow-up information was obtained in 97% of patients with a mean duration of 19 months: 2 patients (1.1%) required vascular surgery for femoral false aneurysms and 1 patient experienced new onset of claudication. In conclusion, compared with previous experience, contemporary intraaortic balloon counterpulsation with percutaneous placement of smaller size (8.5Fr to 10.5Fr) catheters is associated with improved complication profile. This will further enhance the current trend for an expanding role of intraaortic balloon counterpulsation in complex interventional procedures.

Adult↗
PubMed1993

Progressive decrease in myocardial ischemia assessed by intracoronary electrocardiogram during successive and prolonged coronary occlusions in angioplasty.

Progressive decrease in chest pain and surface ECG changes are commonly observed during successive balloon inflations in coronary angioplasty, which suggests a decrease in myocardial ischemic response. To assess this hypothesis, we continuously recorded intracoronary ECGs during four balloon inflations; each of the inflations was maintained to a minimum of 120 seconds in 19 patients who had significant stenosis in the left anterior descending artery and normal left ventricular function. Three successive QRS-T complexes were analyzed on surface and intracoronary ECGs for measurements of ST-segment elevation 60 milliseconds after the J point. Surface ECG changes were compared with intracoronary ECG changes. On intracoronary ECG, ST area (in square millimeters) and T wave amplitude (in millimeters) were also computed. Chest pain was noted as present or absent during each successive balloon inflation. Ability of intracoronary ECG to detect myocardial ischemia, which was defined as ST-segment elevation greater than 1 mm during balloon inflations 1 to 4, was 89%, 89%, 84%, and 74%, respectively and was higher than that of surface ECG, which was 68%, 63%, 68%, and 58%, respectively. On intracoronary ECG, when compared with the first balloon inflation, a significantly smaller increase in ST-segment elevation was noted during each subsequent balloon inflation, whereas a significantly smaller increase in ST area and T wave amplitude was noted only during balloon inflation 4. The number of patients who experienced chest pain decreased from 15 to 13, 10 and 6 from the first to the fourth balloon inflation. This report demonstrates a progressive decrease in myocardial ischemic response during successive and prolonged balloon occlusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Immediate and long-term complications of counterpulsation balloon. Recent data apropos of a series of 200 consecutive patients].

The value of intra-aortic balloon counterpulsation as a means of circulatory assistance and of myocardial protection has been widely established, however percutaneous insertion has been associated with a high incidence of complications, reaching 50% in some series. The authors evaluated the immediate and secondary complications of percutaneous insertion under fluoroscopic control of 209 catheters (8.5F to 10.5F) in 200 consecutive patients. The average age was 64 +/- 11 years and 32% were female. The indications of the procedure were: cardiogenic shock (32.5%), high risk coronary angioplasty (19.2%), complications of coronary angioplasty (18.1%), prophylactic insertion before aorto-coronary bypass surgery (13.8%), unstable angina (2%), terminal cardiomyopathy (5.7%), shock (6.7%), others (2%). There were major complications in 10 cases (4.8%): acute lower limb ischaemia requiring surgery (8 cases), bleeding from the femoral artery requiring surgical repair (1 case) and septicaemia (1 case). Minor complications were observed in 19 cases (9%): haematoma (6 cases), lower limb ischaemia reversible with removal of the catheter (10 cases) or with medical treatment (2 cases), superficial infection (1 case). With a mean follow-up of 17 months for 97% of patients, only one false aneurysm of the femoral artery requiring surgery and one case of intermittent claudication were observed. These results suggest that, in operators trained in femoral artery catheterization, the percutaneous insertion of an intra-aortic balloon under fluoroscopic control is justified by the simplicity of the procedure and low rate of complications.

Aged↗
PubMed1993

[Current status of aortic valvuloplasty in patients aged 80 and over. Apropos of a recent series of 70 patients (1989-90)].

In contrast with aortic valve replacement, the treatment of choice for severe aortic stenosis because of the better long-term results, percutaneous aortic valvuloplasty, has only limited indications, mainly because of the high rate of restenosis. However, in very elderly patients, the surgical risk is high, sometimes prohibitive. For this reason, the authors report their latest results with this technique in a series of octogenarians. Between January 1989 and December 1990, 70 aortic valvuloplasties were performed in octogenarians (average age 85 +/- 3 years). The indications were advanced age > or = 85 years (46%), poor left ventricular ejection fraction < 40% (20%), secere associated coronary artery disease (3%), associated extracardiac pathology (11%), poor general condition (11%) or refusal of surgery (4%). The great majority of these patients (83%) were very symptomatic: 70.5% had Grade III-IV dyspnoea, 20% had Grade III-IV angina and 20% had syncopal attacks. Valvuloplasty reduced the mean transvalvular pressure gradients from 61 +/- 23 to 30 +/- 11 mmHg (p < 0.01) and increased aortic valve surface area from 0.53 +/- 0.19 to 0.94 +/- 0.12 cm2 (p < 0.001). There were two deaths (2.9%) in the catheterization laboratory and 4 (5.7%) complications during the hospital period (myocardial infarction: 1, cerebrovascular accident: 1, severe aortic regurgitation: 1 and complete atrio-ventricular block: 1). There were no serious vascular complications. The average duration of the hospital period was 6 +/- 5 days. Clinical follow-up of 17 +/- 7 months was obtained in 97% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1993

[Extensive isolated aneurysm of the right coronary vessel developing within 4 years].

The authors report the case of a 64 year old man on chronic haemodialysis therapy in whom coronary angiography showed a right coronary artery aneurysm. This patient had undergone coronary angiography 4 years previously and no aneurysm had been found on that occasion. The aneurysm occurred in the context of coronary atherosclerosis, coronary angiography showing typical appearances of double vessel disease. There were several special features of this aneurysm which contribute to the originality of the case: its rapid development within 4 years, its large size and the fact that it was an isolated finding on the right coronary artery. Several aetiologies are discussed but none can be formally confirmed.

Angina Pectoris↗