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Biomedical subjects

J Bardet

Publications and source records attributed to J Bardet.

At least 91 records · Page 5Linked to original sources
PubMed1978

[Moderate aortic incompetence due to traumatic rupture of a cusp].

The authors recall a case of moderate aortic incompetence caused by traumatic rupture of an aortic cusp occurring in a man of 36 years of age. Anatomical lesions of the aortic valve usually lead to severe incompetence for which surgical treatment is required. In this case, the lesion was well tolerated from the clinical and haemodynamic points of view, and surgery was not required; this tolerance has extended into the mid term. The authors emphasise the importance of echocardiography in the diagnosis of disturbance of an aortic valve, and also in following up the progress of the subsequent aortic incompetence.

Adult↗
PubMed1978

[Treatment of early post-infarction ventricular aneurysms by assisted circulation and surgery].

Ventricular aneurysm formation in the 3 months following transmural myocardial infarction is rare but may cause serious complications. Cardiac failure and/or ventricular arrhythmias resistant to medical treatment are indications for ventricular resection. The operative mortality is high in this group of patients. 8 patients with ventricular aneurysms of average volume (124 +/- 117 ml/m2) and very impaired left ventricular function (EF : 21 +/- 10%, akinesia : 53 +/- 10%) were operated on with two early deaths and one death in the 7th post operative month. The long term clinical result was satisfactory in the surviving patients, and confirmed by haemodynamic investigation in two of them. The benefical effects of intra-aortic balloon pumping, used preoperatively in all patients, and associated myocardial revascularisation procedures performed in some of them are discussed.

Aged↗
PubMed1978

Delayed semielective coronary bypass surgery for unstable angina pectoris: clinical follow-up and results of postoperative treadmill exercise.

Eighty patients with continued or repeated episodes of chest pain at rest and transitory ischemic electrocardiographic (ECG) changes were classified as having unstable angina pectoris. Following 10 days of intensive medical therapy, including beta blockade, all unerwent coronary arteriography. Medical treatment completely relieved the chest pain in 43 patients (Group I, 54 percent). In 37 patients (Group II, 46 percent) angina recurred within a week of admission (12 patients) or later (25 patients). Seventeen patients were not operated upon (nine were inoperable, four refused operation, and in four operation was not recommended). Sixty-three underwent saphenous vein bypass grafting either following a month of medical therapy (Group I) or within 24 to 48 hours of recurrent angina (Group II). The over-all operative mortality rate was 1.6 percent (1 patient) and the incidence of peroperative infarction was 11 percent. Of the 62 operative survivors, 71 percent were asymptomatic (mean follow-up period 22 months). The incidence of late operative myocardial infarction was 5 percent. Of 44 operative survivors tested by treadmill ECG, 66 percent had a negative response. Thirteen patients underwent postoperative angiographic evaluation (mean, 19.5 months). The over-all patency rate was 84 percent, and in 92 percent of patients at least one graft was patent. Thus, after stabilization by medical treatment, bypass operation could be performed with a low operative mortality rate and the long-term results compare favorably with those achieved with chronic stable angina.

Angina Pectoris↗
PubMed1978

[The value of dobutamine in cardiology].

The hemodynamic effects of dobutamine have been evaluated by catheterization for a limited duration in 17 patients. The cardiac index, the systolic index, the myocardial contractility given by the values dp/dt and Vmax, and the systolic work index have increased significantly while the increase in the mean aortic pressure and the cardiac rate were small. The left ventricular telediastolic pressure, and systemic and pulmonary arterial resistance diminished significantly. These results seen to authorise the prolonged use of this drug in the low output syndromes with left ventricular failure whether the cause be ischemic or due to a cardiomyopathy. Nine patients were then treated, with a dosage of 8 microgram/kg/min. The supervision of the treatment was composed of iterative readings of the arterial pressure, the cardiac rate, pulmonary capillary and arterial pressures, and the cardiac index. The hemodynamic results were similar to those obtained in the 17 patients. It seems that this product can be used in the acute stage of myocardial infarction. Indeed its action on the myocardial excitability is small and the moderate increase in the oxygen consumption can be compensated for by the improvement in the myocardial vascularisation.

Adult↗
PubMed1977

Comparative haemodynamic effects of dobutamine and isoproterenol in man.

Dobutamine was infused at a rate of 8 mcg/kg/min in 17 patients with or without congestive heart failure. Cardiac output increased from an average 2.92 to 4.45 1/min/m2(p less than 0.001) with no change in mean aortic pressure (93.4 to 97.8 mmHg) and only a slight increase in heart rate (78 to 87 beats/min). Left ventricular end-diastolic pressure decreased from an average 19 to 13.7 mmHg (p less than 0.01). Peak left ventricular dp/dt was doubled (1147 to 2370 mmHg/sec, p less than 0.001) and Vmax increased from 1.08 to 2.18 circ/sec (p less than 0.001). In 10 patients given equi-inotropic doses (100 per cent increase in peak dp/dt) Isoproterenol produced a greater increase in cardiac output (71 percent) than Dobutamine /51 percent). Isoproterenol caused mean aortic pressure to fall significantly (8 percent) while no change was noted with Dobutamine. Accordingly, peripheral vascular resistances were reduced to a greater extent with Isoproterenol than with Dobutamine (p less than 0.05). Mean pulmonary arterial pressure decreased significantly (25 +/- 5.9 to 22 +/- 5.7 mmHg, p less than 0.05) with Isoproterenol infusion and remained unchanged with Dobutamine infusion. Dobutamine increased both stroke work (57 percent) and minute work (83 percent). With Isoproterenol however, only minute work was significantly increased (90 percent). Dobutamine therefore is a potent inotropic drug, with mild chronotropic and peripheral vascular effect and may be valuable in the management of severe heart failure not associated with hypotension.

Adult↗
PubMed1977

Massive pulmonary embolism without arterial hypoxaemia: pathophysiology in two cases.

Two cases of massive pulmonary embolism, confirmed by angiographic or necropsy findings, were remarkable by the absence of arterial hypoxaemia. The various mechanisms responsible for arterial hypoxaemia in pulmonary embolism are discussed. It is suggested that in patients with massive pulmonary embolism a markedly decreased cardiac output might account for the absence of arterial hypoxaemia. In the light of these two cases the finding of a normal PaO2 does not rule out the diagnosis of pulmonary embolism.

Aged↗
PubMed1977

Clinical and hemodynamic results of intraortic balloon counterpulsation and surgery for cardiogenic shock.

Forty-two patients with cardiogenic shock (CS) secondary to myocardial infarction were treated with intra-aortic balloon pumping (I.A.B.P.). In 14 patients C.S. was associated with ventricular septal defect (V.S.D.) and in four with mitral regurgitation (M.R.) secondary to rupture of the posterior papillary muscle. All patients were resistant to conventional medical therapy. Shock was reversed in 20 of the 24 patients in C.S. without mechanical complications. After 24 to 48 hours of I.A.B.P., cardiax index (C.I.) increased from 1.38 to 2.00 L./min./M2, systolic arterial pressure (S.A.P.) from 83 to 96 mm. Hg, urinary output (U.O.) from 10 to 56 ml. per hour, and pulmonary wedge pressure (P.W.P.) decreased from 22 to 16 mm. Hg. Three patients treated with I.A.B.P. alone survived more than 1 year; of the 13 patients who were balloon dependent, four have undergone emergency surgical procedures and two were long-term survivors. In all patients with mechanical complications, I.A.B.P. resulted in significant clinical and hemodynamic improvement. P.W.P. decreased from 19 to 15 mm. Hg, and U.O. increased from 13 to 38 ml. per hour while S.A.P. remained unchanged. In patients with V.S.D. the pulmonary/systemic flow ratio (P/S) declined from 3.5 to 2.8; in patients with M.R., "V" wave amplitude decreased by 8 mm. Hg. Emergency surgery was performed in 10 patients with V.S.D. and in three patients with M.R. and there were eight long-term survivors (13 to 27 months). It is concluded that I.A.B.P. is an effective means of supporting the circulation in C.S. Of the 42 patients with C.S. treated by combining I.A.B.P. and emergency surgery, 13(31%) were long-term survivors (20 +/- 6 months).

Adult↗
PubMed1977

Posterior rupture of the interventricular septum after acute myocardial infarction: successful early surgical repair.

A patient with a large posterior ventricular septal defect complicating an acute inferior myocardial infarction is reported. Because of medically intractable biventricular failure, temporary circulatory assistance was initiated using intraaortic balloon pumping. Emergency coronary angiography, ventriculography, and subsequent operation were carried out. Operative repair involved closure of the septal defect with the use of a Dacron patch, infarctectomy, and aortocoronary bypass grafting and resulted in long-term survival of the patient.

Acute Disease↗
PubMed1977

Left ventricular compliance in acute myocardial infarction in man.

Left ventricular end-diastolic pressure (P) and volume (V) were measured in 12 patients with acute myocardial infarction. It was assumed that the diastolic P-V relationship was exponential and corresponded to the formula P=be KV. In 7 patients submitted to volume loading, several data points of this relationship were obtained and at zero volume, the mean intercept with the ordinates was 0.037+/-0.015 kPa (SEM) (0.28+/-0.12 mmHg). In the other 5 patients, the P-V curve was plotted through this intercept and the pressure and volume co-ordinates obtained by control. The K coefficient (passive elastic modulus) was greater, and the normalised left ventricular compliance index (dV/VdP) was smaller in the infarct group than in the control group. This suggests decreased left ventricular compliance during the acute phase of myocardial infarction. By comparing left ventricular function curves plotted using either end-diastolic pressure or end-diastolic volume as the stretch index it is possible to evaluate the relative participation of decreased compliance and depressed contractility in global left ventricular function.

Acute Disease↗
PubMed1977

Treatment of post-myocardial infarction angina by intra-aortic ballon pumping and emergency revascularization.

Twenty-one patients with postinfarction angina (2 to 15 days after acute myocardial infarction) unresponsive to medical therapy were treated by intra-aortic balloon pumping (IABP). Anginal pain and electrocardiographic (ECG) ST-segment changes were prevented in all patients. Coronary angiograms were obtained during IABP without complication and confirmed severe coronary artery disease. Of the four nonoperated patients, three had reinfarction and two died of cardiogenic shock. Seventeen patients underwent aorta-coronary bypass grafting, associated with aneurysmectomy in two patients and closure of a ventricular septal defect in one. Sixteen patients survived the operation. All survivors are in clinically improved condition and 14 are pain free from 9 to 28 months postoperatively, but three have mild heart failure.

Adult↗
PubMed1977

[Value of intra-aortic counterpressure as circulatory support in cardiac surgery. Apropos of 60 cases].

Assisted circulation (AC) by intra-aortic counterpressure (IACP) has been used in 60 patients either pre- and postoperatively after a complication of acute myocardial infarction (25 patients: group A), or for a low-output syndrome after extracorporeal circulation (ECC) occurring in the operating theatre (20 patients: group B), or secondarily (15 patients: group C). In group A cases, the IACP stabilised a the myocardial ischaemia, and permitted coronary arteriography and subsequent surgery with little risk. Out of the 8 patients in this group who had cardiogenic shock only 4 survived, whereas out of the 17 patients without shock, only one died. Of the group B and C patients, 58% responded favourably to IACP, and 75% of group B cases survived as against 33% of group C. The postoperative low-output syndrome is related not to the ECC itself but to ischaemia of the subendocardial vasculature during surgery. The incidence of this syndrome can be reduced by the use of improved techniques of myocardial protection. AC by means of IACP becomes an effective therapeutic weapon if it is used early, or even systematically when the ejection fraction is below 0.03 and/or the EVR is less than 0.80.

Adult↗
PubMed1977

[Arteriography in a case of single coronary artery with myocardial ischaemia (author's transl)].

Coronary arteriography is the only examination by which the diagnosis of single coronary artery may be made in vivo by demonstrating the presence of an entire coronary system arising from a common trunk. The discovery may be made under two distinct sets of circumstances: 1 degree Coronary ischaemia in a young subject. Arteriography confirms the diagnosis and the customary 2 degrees Coronary ischaemia in an older individual. Arteriography shows atherosclerotic lesions in a single coronary artery. The severity of the condition is related to the proximal character of the stenoses. The most logical therapeutic approach is aorto-coronary bypass if the quality of the distal network as seen at arteriography makes it possible.

Aged↗
PubMed1975

[Angiographic study of coronary artery disease patients receiving circulatory assistance by intra-aortic diastolic counter-pulsion (author's transl)].

In patients receiving circulatory assistance by intra-aortic counter-pulsion for myocardial infarction, angiography may be carried out by the retrograde femoral route. It should include left ventriculography makes it possible to assess the number of segments which contract and to draw a correlation between the kinetics of a segment and its vascularisation. Vascular studies should be carried out at the time of maximum effect of the pump, i.e. from the 18th hour onwards. Indications for angiography are as follows: isolated or mechanical cardiogenic shock, early recurrence of infarction, refractory left ventricular failure and persistent arrhythmias. In cardiogenic shock and refractory left ventricular failure, the coronary lesions are diffuse. All our patients died. By contrast, in the group with early recurrence of infarction or persistent arrhythmias surgical treatment is often possible.

Arrhythmias, Cardiac↗