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Biomedical subjects

H Warembourg

Publications and source records attributed to H Warembourg.

At least 37 records · Page 2Linked to original sources
PubMed1998

Takayasu's arteritis diagnosed at the early systemic phase: diagnosis with noninvasive investigation despite normal findings on angiography.

We describe a case of Takayasu's arteritis discovered at the early systemic phase. Ultrasonography and computed tomography show thickening of the walls of the superior mesentery and common carotid arteries despite normal findings on angiography. Diagnosis was confirmed by arterial biopsy. We emphasize the importance of noninvasive vascular investigation to support the diagnosis of Takayasu's arteritis.

Adult↗
PubMed1998

Long-term results with the Sorin Pericarbon valve in the aortic position: a multicenter study.

BACKGROUND AND AIM OF THE STUDY: A multicenter study was designed to evaluate the Pericarbon pericardial bioprosthesis for up 10 years after implantation in the aortic position. METHODS: Between January 1986 and November 1996, 321 patients (mean age 75.8 +/- 7.3 years) received 325 Pericarbon pericardial valves in the aortic position. Four patients underwent redo surgery and each received a second Pericarbon prosthesis. Associated cardiac procedures in 80 patients were mainly coronary bypass (n = 66). Follow up extended up to 10 years (cumulative follow up of 931.0 patient-years; mean follow up 3.1 +/- 2.2 years). RESULTS: There were 19 late deaths, with seven valve-related. Twelve patients suffered an embolic complication (transient cerebral attack in four, peripheral in six and induction of a myocardial infarction in two). Of these complications, five occurred within 30 days of surgery and seven beyond the first year. Ten patients were reoperated on, six for primary tissue failure, two for prosthetic endocarditis and two for paraprosthetic leak. Primary failure was due in all cases to leaflet mineralization. No primary tear of the leaflet was reported. Actuarial freedom after 10 years from primary tissue failure was 83.9 +/- 7.4% and from major embolic events 97.6 +/- 1.0%. Freedom from valve-related mortality at 10 years was 92.1 +/- 4.9%. CONCLUSIONS: These results indicate that, over a period of up to 10 years, the Pericarbon pericardial bioprosthesis compares favorably with other replacement valves.

Aged↗
PubMed1998

[Long-term outcome of a false lumen after surgical correction of type A acute aortic dissection].

The long-term outcome (64.3 +/- 45 months) of 44 patients operated for acute dissection of at least the ascending aorta was assessed by regular clinical examination and annual CT scan. The diameter of the aorta at different levels was measured at each CT scan for all patients. Initially, 7 patients (16%) had acute dissection limited to the ascending aorta; none had a false lumen after surgery. No signs of aneurysmal dilatation were observed during follow-up of these patients. In the 37 other cases (84%) dissection of the aorta extended beyond the innominate artery; the false lumen remained patent distal to the prosthetic tube replacing the ascending aorta in 34 patients (92%). The false lumen was partially thrombosed in 8% of patients, leading to distal emboli in 1 patient. Moderate increases (less than 15 mm) in diameter of the false lumen were observed in 32% of patients; more severe dilatation (over 20 mm) was observed in 12% of patients. The management of dilatation of the false lumen is not standard; it depends mainly on the rate of progression and the clinical consequences. It is hoped that extension of the initial repair to the aortic arch, when the intimal tear is situated in this zone, will reduce the short and long-term progression of the false lumen.

Acute Disease↗
PubMed1997

Successful treatment of primary pneumococcal multilocular mycotic aneurysms.

We report the case of a patient with five primary pneumococcal multilocular mycotic aneurysms located in the left femoral artery, the descending thoracic aorta and the right internal iliac artery. A successful treatment combining three different procedures was performed, including the use of two cryopreserved thoracic homografts. At a 54-month follow-up, the patient is alive and leads a normal life. Regular evaluation including computed tomographic scans of the thorax and abdomen showed no recurrence of infectious aneurysmal process. Moreover, this latter examination confirmed no dilatation nor significant calcifications of the thoracic arterial allograft, though chest roentgenogram showed discrete calcifications along the borders at the 50th month.

Aneurysm, Infected↗
PubMed1997

[Mobile thrombi of the right heart in pulmonary embolism].

Systematic transthoracic echocardiography in all cases of pulmonary embolism may demonstrate right heart thrombi. The results of this monocentric series of 28 consecutive cases observed between 1987 and 1996 were analysed. Twenty-four patients were in NYHA Class IV: thirteen were in cardiogenic shock. Echocardiographic signs of acute cor pulmonale were usually observed: 96.3% of patients had right ventricular dilatation, 85.2% paradoxical interventricular septal motion, 88.9% pulmonary hypertension. The thrombus was typical serpentine (27/28 cases) arising from the lower limb veins. Passage into the left heart chambers through a patent foramen ovale was observed in 3 cases. Pulmonary embolism was confirmed in all cases. This is an extreme therapeutic emergency and 13 patients (46.4%) died despite treatment: surgery (7/16), thrombolysis (2/5), heparin (3/4) or interventional radiology (1/3). After the acute phase, the prognosis was generally good, as demonstrated by the 100% survival rate at 28.6 +/- 25 months. This study confirms the gravity of mobile right heart thrombi in pulmonary embolism. The diagnosis is echocardiographic. No significant difference in mortality was observed between the different therapeutic approaches used in this series. The echocardiographic finding of these thrombi is a traditional indication for emergency surgical embolectomy. Thrombolysis is rapid and readily available and seems to provide promising results alone or before surgery. In patients with contraindications to thrombolysis, interventional radiology or simple heparin therapy may be proposed.

Adult↗
PubMed1996

Relationship between CMV and graft rejection after heart transplantation.

This study, which included 153 heart transplant patients, was designed to determine whether the cytomegalovirus (CMV) status of both donor and recipient may influence graft rejection. The follow-up was 1 year and they all received the same triple-drug immunosuppressive regimen with induction (antilymphocyte serum). There was no difference in the total rejection rate, but an increase in repeated rejection rate was shown in transplant recipients with hearts from CMV seropositive donors (P < 0.05). These data strongly suggest the impact of CMV in enhancement but not in induction of rejection. To prevent iterative rejection in the CMV seropositive donor group, antiviral therapy could be proposed during enhancement of antirejection therapy.

Cytomegalovirus Infections↗
PubMed1996

[Value of mapping in surgical treatment of ventricular tachycardia].

Surgery may be proposed for patients with a localised aneurysm or akinesia for treatment of monomorphic ventricular tachycardia resistant to antiarrhythmic therapy after myocardial infarction. The multiplicity of tachycardia forms in the same patient, the variability of their mechanism which is not necessarily limited to the subendocardia layers, require mapping to guide the surgeon in the destruction of the anatomical substrates. In a series of 57 ventricular tachycardias recorded in 17 patients with myocardial infarction the authors demonstrated that a system of computerised mapping of the epicardial and endocardial regions optimised the results of this form of surgery. Mapping localised, sometimes at a distance from the scar, classical subendocardial reentry, implicated on occasion the mitral papillary muscle in the mechanism or a tachycardia in cases of inferior or lateral infarction and localised the reentry in the epicardium of the lower layers of the septum. The identification of these "atypical" mechanisms significantly improves the number of patients without inducible arrhythmias after surgery (from 50 to 87% in the authors' experience), without changing the operative mortality. The only really curative approach because of the limitations of catheter ablation, this surgery is a complementary method to implantable defibrillators in the management of post-infarction ventricular tachycardia.

Aged↗
PubMed1996

[Surgical management of ventricular arrhythmia after myocardial infarction].

From December 1986 to December 1994, 36 patients underwent surgical treatments for intractable ventricular tachyarrhythmias after myocardial infarction. Preoperative electrophysiological studies confirmed inducibility of sustained monomorphic ventricular tachycardia and its resistance to antiarrhythmic drugs in all patients, 2 different concepts were assessed: 1) 22 non-guided surgical procedures were performed. 17 patients underwent Encircling thermic exclusion by Nd-Yag laser beam (Group A) and 5 patients underwent extended cryoablations (n = 5) with endocardial resections. Mean preoperative value of left ventricular function in Groups A and B were 35.23% and 30.20% respectively. 10 coronary bypasses (Group A: n = 8; Group B: n = 2) and 1 mitral valve replacement (Group A) were also performed. Perioperative mortality was 5.5% in Group A. No perioperative deaths occurred in Group B. Ventricular tachycardias recurred spontaneously in 2 patients (Group A) and 7 remained inducible after evaluation by electrophysiological studies. 2) 14 patients underwent extended cryoablations guided by intraoperative cardiac mapping, including endocardial resections in all cases. Mean preoperative value of left ventricular function was 32.80%. Mitral valve replacements were achieved in 2 cases, 1 perioperative death occurred (7.14%). Clinical recurrence of ventricular tachycardias concerned 1 patient (7.69%) and 2 remained inducible after electrophysiological studies (15.38%). We conclude that the better results obtained with cardiac mapping and cryoablations may be due to available detection and destruction of deep septal arrhythmogenic substrates. Moreover, cryoablation creates a nonarrhythmogenic scar and can be performed in papillary muscles while preserving the structure of the tissue. No postoperative alteration of left ventricular function was therefore observed.

Adult↗
PubMed1996

[Prognostic factors after sustained ventricular fibrillation or tachycardia. A multivariate study apropos of 160 cases].

The authors analysed survival of 160 patients (121 men and 31 women; average age 57.2 +/- 12.5 years; follow-up 29 +/- 20 months) treated for malignant ventricular arrhythmias (sustained ventricular tachycardia, ventricular fibrillation, syncope with inducible ventricular tachycardia). The therapeutic evaluation was frequently invasive (145 patients underwent at least programmed ventricular stimulation, 108 patients underwent full endocavitary electrophysiological studies) and non-pharmacological therapy was widely used (defibrillator n = 44; antiarrhythmic surgery n = 28; ablative procedures n = 19; transplantation n = 7). The following underlying pathologies were observed: ischaemic heart disease n = 120; non-ischaemic left heart disease n = 19; right heart cardiac disease n = 4; and apparently normal hearts n = 17). The average ejection fraction was 40.5 +/- 15.5% and 29 patients were in the NYHA functional classes III or IV. Fifty-five patients had life-threatening arrhythmias whilst receiving amiodarone. At 2 years, the actuarial sudden death rate was 5.9 +/- 2.1% and the actuarial total cardiac mortality rate was 13.1 +/- 2.9%. Univariate analysis showed age, the presence of underlying cardiac disease, the presence of dilated cardiomyopathy, the absence of an invasive approach, the need for basal pacing in electrical cardioversion, the absence of betablocker therapy, a decreased left ventricular ejection fraction and a high NYHA functional class, to be predictive of sudden death. In multivariate analysis, age, the NYHA class for total cardiac mortality and the NYHA class for sudden death, were the only independent predictive factors. The authors conclude that in the era of invasive methods of evaluation and widespread use of non-pharmacological therapeutic methods, the symptomatology of cardiac failure assessed by the NYHA classification remains the most powerful independent prognostic factor after an episode of malignant ventricular arrhythmia.

Actuarial Analysis↗
PubMed1995

[Automatic implantable defibrillators. Clinical experience apropos of 45 patients].

The aim of this study was to analyse the efficacy and survival after implantation of an automatic cardioverter-defibrillator.. Forty-five patients including 37 men were followed up for 0 to 51 months. The indications were ventricular fibrillation with no curable cause (n = 27) and sustained resistant or poorly tolerated ventricular tachycardia (n = 17) when programmed ventricular pacing with antiarrhythmic therapy was not applicable or gave poor results. One patient was implanted with this device for torsades de pointes. The underlying cardiac disease was ischaemic in 34 cases, non-ischaemic in 8 cases, and 3 patients had no apparent cardiac disease. Twenty patients were implanted with an epicardial system (group I) and 25 patients with endocardial system (group II). In group II, there was one complete failure of implantation requiring the use of an epicardial system and 2 partial failures requiring an additional epicardial patch electrode. The perioperative mortality was 2/45 (4.4%), both cases being due to permanent arrhythmias. In 5 patients, the minimal effective energy of defibrillation was over 25 Joules at implantation, without any untoward consequences on the clinical outcome. Ten non-fatal complications were observed including two major problems (haemopericardium); there were two cases of late increase of the minimal effective energy of defibrillation requiring the addition of a subcutaneous patch. Twenty-four patient (53%) received at least one appropriate therapy; 14 patients (36%) had at least one inappropriate shock during follow-up. During follow-up, 7 patients died, 6 of a cardiac cause and 3 of an arrhythmic problem.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Automatic implantable defibrillator and antiarrhythmic surgery in ischemic cardiopathies. Apropos of 53 cases].

The automatic implantable defibrillator (AID) and antiarrhythmic surgery are the two therapeutic options after failure of catheter ablation and/or antiarrhythmic therapy for sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients with coronary artery disease. The authors undertook retrospective study of the characteristics of two groups of patients treated between November 31st 1987 et December 31st 1993 either by AID (28 men and 4 women with an average age of: 56.1 +/- 11.2 years) or by surgery (19 men and 2 women with an average age of: 60.6 +/- 6.8 years). The "surgical" patients differed from "defibrillator" patients in the fewer number of cardiac arrests, a higher proportion of sustained monomorphic VT, better tolerated sustained monomorphic VT (rarely syncopal), fewer early post-infarction arrythmias (< or = 8 weeks), more anterior wall infarction and a higher proportion of aneuvrysms. The perioperative mortality was 6.2% in the "defibrillator" group and nil in the "surgical" group (p = NS). At 2 years, the sudden death rate in the "defibrillator" and "surgical" groups was 7.5% and 0% respectively and total cardiac mortality was 17% and 20% respectively (p = NS). The authors conclude that perioperative mortality and the sudden death rate at 2 years are relatively low in the two groups. However, the total cardiac mortality remains high, largely related to perioperative death and secondary cardiac failure. Nevertheless, compared with defibrillator patients and with identical average ejection fractions, there was no extra mortality due to cardiac failure after antiarrhythmic surgery.

Aged↗
PubMed1994

[Follow-up study, using dynamic transcutaneous oximetry in 17 patients with stage II Leriche and Fontaine occlusive arterial disease of the lower limbs].

We evaluated the value of dynamic transcutaneous oxygen pressure measurement (TcPO2) in 17 patients with stage II occlusive arterial disease of the lower limbs treated with exercise only. We studied 17 patients (15 men, two women) with an average age of 63 years (range 39-80 years). Claudication perimeter and dynamic TcPO2 were evaluated before and after 6 month walking exercise and tabac stopping. Four different sites of TcPO2 were studied: precordium (reference probe), thigh, calf and foot in the dorsal recumbent position after 30 minutes rest, during a standardised exercise stress test at 50 watts and during the recovery phase. The results were expressed as ratio of tissue oxygenation (RTO): thigh, calf or foot TcPO2/precordial TcPO2 x 100 in order to take into account the patients cardiorespiratory status and adaptation to exercise. Claudication perimeter was 255 m +/- 221 before 6 months exercise and 835 m +/- 539 after (P < 0.01). The duration of significative ischemia was significantly reduced after 6 months exercise (P = 0.02 calf, P < 0.01 foot). Dynamic transcutaneous oxymetry would therefore seem to be a useful method of assessing stage II occlusive peripheral arterial disease and the topography of tissue hypoxia. It could be valuable in orientating treatment and the first method to provide and objective evaluation of the efficacy of medical or surgical treatment.

Adult↗
PubMed1993

[Surgical treatment of ventricular tachycardia].

Refractory ventricular tachycardia, resistant to antiarrhythmic drug therapy either because of inefficacy unwanted secondary effects or failure to comply with treatment, is not rare in the chronic phase of myocardial infarction. These considerations reinforce the value of curative therapeutic options, especially those related to antiarrhythmic surgery in these patients. Surgery is usually reserved for those with a ventricular aneurysm where the exclusion of arrhythmogenic zones may be performed with the scalpel, a cryoprobe, laser ... Procedures guided by peroperative endo end epicardial mapping, if possible simultaneous with computerised assistance, are more effective than procedures relying only on visual guiding. The clinical success rate is about 90% and the operative mortality tends to decrease (5 to 6%) with successive improvements to surgical technique. These satisfactory results show the reliability of this therapeutic approach applied to patients exposed to malignant arrhythmias.

Cryosurgery↗
PubMed1993

[Primary aorto-digestive fistulas. Four cases and review of the literature].

Four cases, three fatal and one with long term recovery, of patients treated surgically for primary aorto duodenal fistulas are reported. The involved lesion was an infrarenal aortic aneurysm. Two patients had an extra-anatomic vascular procedure and two patients an in situ repair. In connection with these cases, two hundred and fifty three primary aorto enteric fistulas were reviewed in the world's literature. The difficulties in the diagnosis and treatment are pointed out. Emergency operation should be performed in all cases of gastrointestinal bleeding associated with an abdominal aneurysm. The best diagnostic approach is CT scan combined to gastro-duodenoscopy. Overall mortality in our review of the literature was seventy one per cent. Closure of the enteric component should be performed with lateral repair. Management of the aortic component remains controversial: closure of the aorta and axillo-bi femoral by pass or in situ repair. The operative mortality in our review of the literature was thirty seven per cent. Interposition of viable tissue is necessary according to the risk of recurrent infection and bleeding with consequent death (twelve per cent). So, long term control is of paramount importance.

Aged↗
PubMed1992

[Primary Aspergillus endocarditis. Apropos of a case and review of the international literature].

The authors report a case of primary aspergillus endocarditis with endophthalmitis and vertebral osteomyelitis. No underlying disease and no predisposing factors were found. Valve replacement plus combined antifungal chemotherapy proved to be effective as the patient is asymptomatic 18 months after the first symptoms. 48 cases of aspergillus endocarditis, without prior cardiac surgery have been reported in the literature. Aspergillus endocarditis was valvular or mural. Extracardiac dissemination was common but endophthalmitis and osteomyelitis were infrequent. In 11 cases, the diagnosis was made by histologic examination of embolectomy or ocular, skin biopsy tissue. All patients were febrile. Blood cultures showed no Aspergillus species. Clinical manifestations of endocarditis were described in less than fifty per cent of cases. Echocardiographic visualization of vegetations was obtained in 5 cases. Many patients experienced embolic phenomena. Mortality from Aspergillus endocarditis is extremely high (96%). Surgery is the main treatment, consisting of valve replacement. Antifungal chemotherapy should be combined. The proper duration and dosage and the combination of antifungal drugs have not been clearly defined.

Amphotericin B↗
PubMed1991

Bipolar atrial triggered pacing to restore normal chronotropic responsiveness in an orthotopic cardiac transplant patient.

A not uncommon arrhythmia in cardiac orthotopic transplantation patients is sinus node dysfunction with chronotropic incompetence. This is a result of the surgical procedure that denervates the donor heart while the native sinus node may be normal but isolated in the remnant of the recipient atrial wall that serves as the anastomotic site. We were able to restore "normal sinus node function" in a heart transplant patient utilizing a bipolar single chamber pacemaker programmed to the triggered mode. A single unipolar active fixation lead was positioned in each atria. Both leads were connected to a bipolar AAT pulse generator utilizing a Y adaptator. The native atrium with its innervated intact sinus node effectively drove the donor atrium and thus the heart.

Arrhythmia, Sinus↗