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H Poulain

Publications and source records attributed to H Poulain.

At least 19 recordsLinked to original sources
PubMed2004

Aortic valve replacement with the minimal extracorporeal circulation (Jostra MECC System) versus standard cardiopulmonary bypass: a randomized prospective trial.

BACKGROUND: We prospectively evaluated a newly introduced minimal extracorporeal circulation system (Jostra MECC System; Jostra AG, Hirrlingen, Germany) for aortic valve surgery. METHOD: In a prospective, randomized study, 100 patients underwent aortic valve replacement either with standard cardiopulmonary bypass (n = 50, group B) or with the MECC System (n = 50, group B). The myocardial protection and the left vent were identical for the two groups. The intrapericardial suction device was never used (only the cell salvage device was used) to reduce the air-blood contact area. RESULTS: No significant differences were noted in patient characteristics and operative data between groups. Operative mortality (<30 days) was 2% for group A and 4% for group B (difference not significant). From the preoperative period to the postoperative period, the increase in C-reactive protein was significantly higher for group B (P <.001). The postoperative troponin I level was significantly lower in group A (mean 4.65 +/- 2.9 microg/L at 24 hours) than in group B (8.2 +/- 4.4 microg/L, P <.03). On the other hand, the MECC System was associated with platelet preservation. Renal function was better preserved and the neurologic event rate was significantly lower for the MECC group (P <.02). CONCLUSION: The MECC System is safe and allows aortic valve replacement under the most favorable conditions. The system is more biocompatible than standard cardiopulmonary bypass and provides a good postoperative biologic profile and good clinical results, particularly for high-risk patients.

Aged↗
PubMed1999

[Papillary fibroelastoma. Report of 3 cases].

Papillary fibroelastoma is a rare, benign, primary cardiac tumour. The authors report three cases presenting with transient or full cerebrovascular accidents. The tumours were diagnosed during investigation by echocardiography, especially transoesophageal echocardiography. In view of the severity of symptoms and the high risk of recurrence, the patients were rapidly referred for surgery. In two cases, the tumour was located on the aortic valve at several sites. In one case, the tumour was single and implanted on the mitral valve. Surgery was successful with the pathology reports confirming complete ablation. The patients have not had any recurrence to date. The multiple nature of these tumours raises the questions of local spread, secondary degeneration of valvular nodes? The problem of possible recurrences is discussed.

Adult↗
PubMed1993

Diffuse subaortic stenosis: modified Konno procedures with aortic valve preservation.

The Konno procedure provides adequate relief of diffuse subaortic stenosis but requires aortic valve replacement. This may be questionable in patients without aortic valve lesions. Eleven patients had diffuse subaortic stenosis and normal aortic orifice: tunnel subaortic stenosis (6 patients) or diffuse hypertrophic obstructive cardiomyopathy (5 patients). The mean age was 16 +/- 14 years (range: 3 months to 45 years). The mean subaortic gradient was 95 +/- 24 mmHg (range: 60 to 150 mmHg). Two patients had previously undergone resection of discrete subaortic stenosis. Modified Konno procedures were used: aortoseptal approach with aortic annulus division in 5 patients, conal enlargement without aortic annulus division in 6 patients. There was one early death (9%, 70% CL = 1%-27%) and no late deaths. Reoperation was required in two patients: one early for iatrogenic aortic regurgitation and one late for residual ventricular septal defect and mitral regurgitation. The mean follow-up was 3.8 +/- 4.2 years (range: 2 months to 10 years). The survivors were in functional class I (8/10), had a normal left ventricular function (9/10), were in sinus rhythm (10/10) and had left ventricular outflow tract gradients ranging up to 25 mmHg (mean = 6 +/- 10 mmHg). Residual surgery-related defects included ventricular septal defect (one) and aortic regurgitation (one). In patients with diffuse subaortic stenosis and normal aortic orifice, modified Konno procedures with aortic valve preservation are preferable, effective and can be safely performed in infants and children.

Adolescent↗
PubMed1993

Ligation of the patent ductus arteriosus in premature infants--indications and procedures.

Premature newborns with patent ductus arteriosus can be managed by prostaglandin inhibition, but this medical treatment carries a high risk of renal failure, and other complications such as necrotizing enterocolitis and hematologic disorders have been described. Echocardiography gives an early confirmation of shunt and surgical treatment may be proposed. The aortic arch anatomy in the premature infant may not be as simple to determine as the anatomy of an older child. In the premature infant the use of a clip for patent ductus arterious closure seems the best technique, avoiding circular dissection of the ductus. We report our experience of 68 cases operated upon.

Cause of Death↗
PubMed1993

[Echocardiographic diagnosis of a thrombus trapped in a patent foramen ovale. Apropos of a case].

The authors report the case of a patient presenting with pulmonary embolism in which transthoracic echocardiography showed the presence of an intracardiac thrombus trapped in a patent foramen ovale; this was confirmed at surgery. It is rare to see this type of thrombus (which usually gives rise to paradoxical embolism) by transthoracic echocardiography. Previously, this used to be a postmortem diagnosis but the condition is often suspected nowadays when deep venous thrombosis and/or pulmonary embolism, an unexplained systemic embolism and a right-to-left interatrial shunt, are associated. However, the diagnosis can only be confirmed by the visualisation of the thrombus crossing the interatrial septum.

Aged↗
PubMed1991

[Free-wall rupture during the acute phase of myocardial infarction. Apropos of 2 cases surgically treated with success].

The authors report two cases of cardiac rupture during acute myocardial infarction successfully treated surgically. In the first case, rupture occurred 7 days after hospital admission for anteroseptal myocardial infarction. The patient developed sudden cardiogenic shock with signs of venous hypertension without left ventricular failure. The second patient was admitted for syncopal chest pain with transient hypotension which regressed after volume repletion and pressor amine therapy. On admission, the patient had signs of cardiac tamponade. The ECG showed recent inferolaterobasal myocardial infarction. In both cases the diagnosis was made by 2D echocardiography which showed voluminous circumferential pericardial effusions probably due to haemorrage, with an image very suggestive of a blood clot in the effusion of the second patient. The two patients underwent emergency cardiac surgery and both survived with a 4 and 1.5 month follow-up respectively. These two cases confirm the value of 2D echocardiography as an emergency bedside procedure for the diagnosis of cardiac rupture, especially when images of intrapericardial thrombosis are observed, as in our second patient. In addition, the first case raises once again the question of the role of late thrombolysis as a predisposing factor of cardiac rupture at a time when this technique is proposed up to 24 hours after the onset of symptoms.

Aged↗
PubMed1990

[Course of the first one hundred bioprostheses implanted between 1975 and 1977. A 10-year follow-up study].

Long-term performance of the first one hundred bioprostheses (BP) implanted was evaluated in 100 patients (pts) surviving isolated aortic valve replacement, mitral valve replacement and tricuspid replacement from October 1975 to March 1978. Follow-up was always more than 10 years. Cumulative duration of follow-up was 7,048 months. Follow-up ranged from 112 to 139 months. Overall late mortality was 16.13 thromboembolic episodes occurred in 11 pts. Reoperation was performed in 14 pts due to primary tissue failure in 11 pts. 64 patients were free from mortality and valve-related reoperation.

Adolescent↗
PubMed1989

[Prevention of nosocomial infections at a cardiovascular surgery unit: therapeutic tactics, efficacy and results].

The experience of prevention of nosocomial infections inside a cardiovascular surgical unit leads to insist, among the various tactics, on the quality and the mode of disinfection of the operating room and the intensive care unit, in particular, the technics of air and surface processing (by Anios) of sterilizing water (by Hyconium B and Filtranios), of sterilized respirators (by Formobloc). Quality and efficiency are bacteriologically controlled. The good results, obtained for 3 years, testify of the efficiency of such technics. However some architectural and structural drawbacks can jeopardize a strict compliance towards prevention of nosocomial infections.

Cardiovascular Diseases↗
PubMed1984

Long-term evaluation of bioprosthetic valves: 615 consecutive cases.

From January 1975 to September 1983, 615 patients underwent valve replacement using 698 bioprosthetic valves for selected indications. This group represents the third of all patients having valve replacement during the same period. Children younger than 15 years were excluded. The mean pre-operative functional class was 2.9. The early mortality rate was less than 5% and the follow-up range 3 months to 9 years (3.2 yrs). The symptomatic improvement was attested by a mean post-operative functional class of 1.4. In a linear study the following rates of valve related complications were noted: thromboembolism 4.6%, endocarditis 2.5%, primary tissue valve degeneration 1.1%, paraprosthetic leak 2.5%. In an actuarial study, at 8 years, 83% of patients were free from any valve failure. The probability rates of complications were the following: thromboembolic events 8%, endocarditis 5%, degeneration 3%, reoperation 7%. The probability of survival at 8 yrs was 69% and the probability rates of late mortality were noted as follow: cardiac related mortality 27%, valve-related mortality 4%. Despite an expected increasing rate of degeneration, the results warrant the use of bioprostheses in a selected group of patients.

Actuarial Analysis↗
PubMed1984

[Surgical treatment of aortic subvalvular obstruction. Experimental study of a new approach].

The aortic subvalvular region is difficult to approach. The results after resection through a pure transaortic approach are often unsatisfactory. An aorto-septal approach derived from the Konno-Rastan aortoventriculoplasty was experimented in animals. This technique involves opening the ascending aorta and the pulmonary infundibulum, section of the aortic annulus at the left anterior commissure and incising the muscular interventricular septum. The results of this aorto-septal approach show: - that the whole left ventricular ejection tract can be exposed; - that the incision can be closed without damage to the heart, i.e. creation of atrioventricular block, and with reconstruction of an intact interventricular septum and a normally functioning aortic valve. This approach could therefore be used for the treatment of diffuse subvalvular aortic stenosis: - subaortic fibromuscular tunnel without hypoplasia of the aortic ring (one personal case has already been reported); - severe forms of hypertrophic obstructive cardiomyopathy with asymmetric septal hypertrophy.

Animals↗
PubMed1984

Aortoseptal approach for optimal resection of diffuse subvalvular aortic stenosis.

The results of conventional operative resection of diffuse subaortic stenosis (tunnel subaortic stenosis and diffuse idiopathic hypertrophic subaortic stenosis) have been less than satisfactory. A new approach using the concept of aortoventriculoplasty was designed to allow adequate surgical resection of a diffuse subvalvular aortic stenosis. The aorta, the right ventricle, and the septum are incised in the same way as during aortoventriculoplasty , with the aortic anulus being divided carefully across the commissure between the left and right aortic cusps. The septotomy is extended beyond the limits of the stenosis, and fibrous and/or muscular tissue is removed from each edge of the septal incision. After adequate widening of the subvalvular area, the various incisions are closed and the aortic valve is reconstructed. This aortoseptal approach was studied experimentally in the dog and then carried out on two patients, both of whom had excellent hemodynamic and functional results. The aortoseptal approach may be the procedure of choice in the treatment of diffuse stenoses limited to the subvalvular area, whereas other procedures ( aortoventriculoplasty , and apico-aortic valved conduit) should be used when the valvular and/or supravalvular levels are involved.

Adolescent↗
PubMed1984

[Gangrenous cellulitis of the face. Apropos of a case].

Gangrenous cellulitis of the face of dental origin had a very abrupt onset, spread rapidly in spite of treatment and led to severe pleuropericardial complications. The outcome was favorable after repeated thoracic surgery. Preventive therapeutic measures for these major accidents are discussed, following a detailed report on the case presented and treatment modalities applicable, fatal outcomes still being possible in 1984 in spite of progress in therapy.

Cellulitis↗
PubMed1982

[Surgical treatment of subvalvular aortic obstructions. A new approach].

Approaching the region below the aortic valve is notoriously difficult. The new technique described, derived from the Konno-Restan technique, provides wide exposure of the infra-aortic canal through the right ventricle, the aorta and the septum. Experiments on animals have shown that it entails no risk of heart damage. This technique was used on one patient with sub-aortic fibromuscular tunnel with excellent post-operative results.

Aorta↗
PubMed1982

[Aortic insufficiency caused by incomplete rupture of the ascending aorta. Conservative surgical treatment].

Commissural disorganisation secondary to incomplete rupture of the ascending aorta was found at surgery for massive aortic incompetence in a young man with previous hypertension. The lesions were repared by a conservative procedure with an excellent result 3 years after surgery. Incomplete spontaneous rupture of the ascending aorta occurs in the same terrain as dissection of the aorta (hypertension, aortic media necrosis) of which it represents a minor form. It may remain asymptomatic but it is usually complicated either by secondary intrapericardial rupture, by aortic aneurysm or by aortic incompetence due to valvular prolapse. When valvular prolapse is associated with another lesion which aggravates the regurgitation (aortic valve disease, aortic ring dilatation) aortic valve replacement should be performed with a prosthesis; on the other hand, when commissural disorganisation giving rise to valvular prolapse is the cause, a conservative procedure may be envisaged.

Adult↗