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Biomedical subjects

J Acar

Publications and source records attributed to J Acar.

At least 145 records · Page 8Linked to original sources
PubMed1987

[Doppler measurement of transvalvular gradients. Simultaneous Doppler-catheterization recordings on 78 patients].

Several studies have demonstrated the value of Doppler ultrasound as a means of measuring gradients across cardiac valves. However, in view of sudden variations in cardiac output gradients should be measured simultaneously by Doppler and catheterization in order to validate the former method and determine its accuracy. We conducted a prospective study with simultaneous recordings in 78 patients with aortic valve stenosis (33) or mitral valve stenosis (19) or cardiac valve prosthesis (26). Mean age of the patients was 55 +/- 14 years, and 50% of them were male. Subjects with pure or predominant regurgitation were excluded from the study. In the whole of the population studied, correlation between Doppler ultrasound and haemodynamics was very good with r = 0.98, p less than 0.001 for maximum gradient and r = 0.96, p less than 0.001 for mean gradient. The perfect simultaneity of the haemodynamic and ultrasonic recordings was confirmed by comparing the duration of gradients measured by the two methods (r = 0.996, p less than 0.001). There also was very close correlation between ultrasounds and catheter in patients with mitral stenosis (maximum gradient r = 0.98, p less than 0.001; mean gradient r = 0.97, p less than 0.001). Mean Doppler-catheter differences were not significant, and no underestimation by Doppler reached or exceeded 5 mmHg. Correlations were also satisfactory in patients with aortic stenosis (maximum gradient r = 0.97, p less than 0.01; mean gradient r = 0.90, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Stenosis↗
PubMed1987

Mitral balloon valvuloplasty in adults.

To assess the feasibility of percutaneous mitral commissurotomy, we undertook dilatation of mitral stenosis in 26 adults. The procedure was unsuccessful in six patients (hemopericardium in one, and five failures). In 20 patients (mean age: 41 +/- 13 years) the procedure was successful. We used a single balloon (Trefoil 3 X 12 mm) in eight patients and two balloons in 12 (Trefoil 3 X 10 mm + 19 mm). After valvuloplasty, valve function was improved: the mean transvalvular gradient decreased from 14 +/- 4 mm Hg to 7 +/- 2 mm Hg (P less than 0.001) and valve area increased from 1.1 +/- 0.2 cm2 to 2.2 +/- 0.4 cm2 (P less than 0.01). In a patient with severe valvular and subvalvular disease, mitral regurgitation increased from grade I to grade III. From this preliminary series, we conclude firstly that percutaneous valvuloplasty is feasible in adults with mitral stenosis, and secondly, that it results in a significant improvement in valve function with a low incidence of complications.

Adult↗
PubMed1987

[Surgery of bacterial aortic insufficiency. Indications and results].

Seventy nine patients were operated for aortic regurgitation due to bacterial endocarditis confirmed anatomically at surgery between 1968 and 1984. They were classified into 3 groups according to the stage of endocarditis at the time of operation: progressive endocarditis (21 cases), recent endocarditis (39 cases) and late endocarditis (19 cases). The patients were adults (21 to 70 years) and predominantly male (82 p. 100). Previous valvular disease was found in 38 cases, bicuspid aortic valves were found in 21 cases. Most of the patients operated early (recent progressive endocarditis) had cardiac failure and the surgical indication was nearly always poor haemodynamic tolerance. In addition, this indication was also retained in late forms of the disease in patients usually panci-symptomatic in the presence of signs of increasing left ventricular dysfunction. The aortic lesion was the only pathology in 55 cases and was associated with periannular abscess in 8 cases, septal abscess in 5 cases including one with septal perforation, and mitral endocarditis in 12 cases. Seven patients died during surgery, in low output states in 6 cases (global mortality 8.9 p. 100). The 72 survivors were followed up for an average period of 5 years (4 to 168 months); three patients were lost to follow-up. The actuarial survival rate including the operative mortality was 77 p. 100 at 5 years and 64.6 p. 100 at 10 years. Valve dehiscence was common (52 p. 100); although the perivalvular leak was usually small, in 11 cases it was quite severe and 7 patients had to be reoperated. An excellent functional result was observed in 30 cases, especially in those patients operated early.

Adult↗
PubMed1987

[Percutaneous mitral valvuloplasty].

Thirty six adults with severe mitral stenosis underwent attempted percutaneous mitral commissurotomy. The valvuloplasty could not be performed in 6 cases; post-transseptal haemopericardium (1 case), inability to cross the mitral valve or the septum (5 cases). Therefore percutaneous commissurotomy was performed in 30 cases; the average age was 43 +/- 17 years (range 20-79 years). Eight patients had undergone previous valve surgery; 24 patients were very symptomatic (NYHA Classes III or IV). The valvuloplasty was performed with a single balloon in 22 cases and by simultaneous inflation of two balloons in 8 cases. Moderate mitral regurgitation present before the procedure was significantly aggravated in 2 cases leading to secondary surgery. In the other patients percutaneous commissurotomy led to a clear-cut haemodynamic improvement; the transvalvular pressure gradient fell from 15 +/- 4 to 6 +/- 2 mm Hg, p less than 0.01 and mitral valve surface area increased from 1.1 +/- 0.2 to 2.2 +/- 0.4 cm2, p less than .001. The best results were obtained with the double balloon technique in patients with little valve destruction. Percutaneous mitral valvuloplasty is therefore a tempting alternative to closed heart mitral commissurotomy in pure mitral stenosis with pliable valves. Larger series with a longer follow-up are needed to assess the morbidity and long-term results of this technique.

Adult↗
PubMed1986

[Traumatic aorto-right ventricular fistula. Apropos of a case].

The authors report the case of a 19 year old young man with an aorto-right ventricular fistula caused by a stab wound. The diagnosis was not made initially during surgery to control haemorrhage (left hemothorax due to a damaged internal mammary artery). However, three weeks later, a continuous murmur was detected and the diagnosis established by echocardiography and cardiac catheterisation. The lesions were repaired by open heart surgery under cardiopulmonary bypass. The authors describe the main features of this condition based on their own experience and a review of the literature.

Adult↗
PubMed1986

[Midpoint follow-up results of aortic valve replacement with the Ionescu-Shiley pericardial bioprosthesis. Apropos of 109 patients].

Between March 1980 and May 1985, 109 adults with an average age of 59 years underwent aortic valve replacement with a pericardial Ionescu-Shiley xenograft. Twenty six of the prostheses were of small size (N 19 and 21). In 20 patients, the operation was associated with another procedure (15 aorto coronary bypass grafts and 5 conservative mitral valve procedures). Before surgery, 73.4% of patients were in functional Stages III or IV, and 9.2% had permanent or paroxysmal atrial fibrillation. The average follow-up period was 24 months (4 to 59). The operative mortality was 5.5%. The 4 year actuarial survival rate was 86% with 82% good functional results. At the same date, 96.4% of patients had not developed endocarditis, 96% had not been reoperated and 93.8% had no prosthetic valve dysfunction. No cases of primary degeneration were observed but a diastolic murmur without any haemodynamic consequences was detected in 20% of patients at 4 years. Seventy four per cent of subjects were not anticoagulated at 1 year and 85% were without anticoagulants after one year. Only one haemorrhagic complication was noted (0.46% patient/years). There were no cases of occlusive thrombosis; the incidence of thromboembolism was 3.7% patient/years in aortic without mitral valve disease, irrespective of the cardiac rhythm and 2.7% patient/years in patients in sinus rhythm. In this subgroup, 88% had not had any thrombo-embolic complication despite the absence of anticoagulants at 4 years. An Indium III labelled platelet scan was positive in 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Potential course of lesions of the ascending aorta in dystrophic aortic insufficiency].

Dystrophic aortic insufficiencies represent at present time an important etiology of operated on pure and voluminous aortic regurgitations (n = 95, i.e. 28.1% of cases followed by our working team). The valvular dysplasic lesions by which they are characterized were associated in 2 out of 3 cases with parietal lesions of the ascending aorta: annulo-ectasic disease (n = 42) or important non-aneurysmal dilatation of the ascending aorta (n = 20). However, these valvular dysplasias may also appear isolated in an aorta morphologically normal at peroperative examination (n = 33). Among the 42 patients suffering from, annulo-ectasic disease (group 1) the type of surgical correction varied with the period of operation. Valvular replacement isolated (n = 3, group 1 a) or associated with aortic supracoronary surgery (n = 17, group 1b) were the procedures before 1978. Since then, 22 patients (group 1c) had a total replacement of the ascending aorta were subjected to valvular interventions (19 replacements, 1 valvuloplasty). When performed, parietal biopsy of the aorta showed in 11 out of 15 cases signs of cystic medio-necrosis. After a delay of 53 +/- 40 months, 11 out of 20 patients of group 1a and 1b died, 5 of them from the evolution of lesions at the ascending aorta (3 ruptures and 2 dissections); one patient was reoperated 12 years after the placing of a supracoronary tube, because of the development of a voluminous aneurysm of the sinuses of Valvalva which initially were only simply dilated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Tissue plasminogen activator (t-PA) in myocardial infarction. Biological aspects].

A group of 37 patients with myocardial infarction less than 6 hours old was given 5,000 IU of heparin and 0.75 mg/kg of tissue plasminogen activator (rt-PA) (Group A, N = 18) or placebo (Group B, N = 19) intravenously over 90 minutes in a double blind study. Blood sampling was performed before, during and after treatment. The plasma rt-PA concentrations (micrograms/ml) of Group A were as follows: (Table: see text) The concentrations of plasminogen and antiplasmin have decreased significantly as did the fibrinogen level: a concentration of 1 g/l was observed in 7 cases during rt-PA therapy, lasting for 4 to 8 hours after the end of the infusion of rt-PA in 3 cases. The increase of FDP during rt-PA (m = 551 and 222 micrograms/ml at the 60th and 90th minutes) was relatively moderate considering the average level of defibrination (61%). No significant biological changes were observed in Group B. These results support those of our in vitro trials: at comparable thrombolytic activities, the reduction of plasma fibrinogen is less with rt-PA than with streptokinase (SK) or urokinase (UK). However, at concentrations 1 microgram/ml, rt-PA causes almost complete defibrination.

Double-Blind Method↗
PubMed1986

[Percutaneous mitral valvuloplasty in the adult. Apropos of 5 cases].

The results of percutaneous mitral valvuloplasty in 5 adult patients with mitral stenosis are presented. The average age was 55 years (37-72 years); 4 patients were in functional Class III and 1 in Class IV. The three oldest patients were in atrial fibrillation, and 2 of them had severe valvular and subvalvular lesions. Valvuloplasty was carried out with a "Trefoil" balloon (3 X 12 mm; effective cross sectional area at maximal inflation: 3.8 cm2). The procedure was successful in 4 patients. In the other patient, it was not possible to position the balloon across the stenotic valve. After valvuloplasty, the mean mitral gradient decreased (14 +/- 5 to 6 +/- 2 mmHg, p less than 0.05) without a significant change in cardiac index (2.9 +/- 0.5 vs 2.7 +/- 0.4 l/mn/m2; NS): this indicated an increased mitral valve surface area (1.1 +/- 0.2 to 1.8 +/- 0.05 cm2, p less than 0.05). In parallel, echocardiographic measurements of mitral valve surface area increased from 0.9 +/- 0.2 to 1.8 +/- 0.3 cm2, p less than 0.05, and Doppler pressure halt time fell from 220 +/- 50 to 116 +/- 13 ms, p less than 0.05. There were no operative complications and, in particular, no resulting angiographic mitral regurgitation. These preliminary results suggest that percutaneous mitral valvuloplasty may be a valuable alternative therapeutic procedure to surgery in selected patients.

Adult↗
PubMed1986

[Thrombolytic treatment in the acute phase of myocardial infarction. Evaluation in 1986].

Fibrinolytic therapy is effective in reducing the extent of myocardial infarction by lysing intracoronary clots. An overview of twelve trials of prolonged intravenous infusion of SK showed a highly significant reduction in short term mortality. Intra coronary SK infusion achieved reperfusion of the coronary artery in 60 to 90 p. 100 of patients and improvement of left ventricular function was reported. Mortality was also significantly reduced at 6 months. The frequency of bleeding was relatively low and ventricular arrhythmias were not a serious problem. High dose brief duration intravenous SK therapy achieved reperfusion of the occluded coronary artery in 44 to 60 p. 100 of patients. Left ventricular function was also improved. An Italian multicentre trial has shown a significant decrease in the overall hospital mortality of a randomized population. There is no evidence that UK was more effective than SK. New fibrinolytic agents (T-PA, acylated SK-plasminogen activator), with more fibrin specific activity, were successful in inducing coronary thrombolysis in patients with acute myocardial infarction. The rate of reocclusion was about 20 p. 100 and additional stabilising procedure (percutaneous transluminal coronary angioplasty) was necessary in many patients.

Fibrinolytic Agents↗