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Biomedical subjects

J Delaye

Publications and source records attributed to J Delaye.

At least 109 records · Page 6Linked to original sources
PubMed1980

[Prognosis of primary non-obstructive cardiomyopathies].

The prognosis of congestive cardiomyopathy was studied in 132 consecutive patients (110 male, 22 female, average age 45 +/- 11 years) in whom a thorough clinical evaluation had excluded a secondary cause. The patients presented with left ventricular failure, a history of systemic embolism, syncope or radiological cardiomegaly. Right (100 p. 100) and left (81 p. 100) heart catheterisation was performed and left ventricular endiastolic volumes (202 +/- 77 ml/m2) and ejection fractions (31 +/- 12 p. 100) calculated from angiography in the 30 degrees right anterior oblique projection. Regional abnormalities of contraction were observed in 32 patients. The average follow up period was 40,4 +/- 23,8 months. At the end of the study 48 patients (37 p. 100) had died and 2 had been lost to follow up. Survival rates were calculated by actuarial methods. Age, sex, the period they had been symptomatic, alcoholic intoxication and the degree of cardiac dilatation were not significant prognostic factors. Patients in Class IV NYHA had the worst prognosis: 63 p. 100 2 year mortality. Atrioventricular conduction defects were observed in 56 patients and were associated with a significantly increased mortality rate (43 p. 100 compared with 23 p. 100, p < 0.001). Atrial fibrillation (32 patients) was a better prognostic factor than the persistence of sinus rhythm; 2 year mortality 11,1 p. 100 compared to 37,6 p. 100 (p < 0.001). Increased left ventricular end diastolic pressures greater than 20 mmHg were related with a mortality of 51,5 p. 100. Also, the patients with a ejection fraction of 30 p. 100 and a 2 year mortality rate of 44 p. 100 compared to 17,5 p. 100 when the ejection fraction was greater than 30 p. 100 (p < 0,001). In conclusion : 1. Regional abnormalities of left ventricular contraction are not rare in primary cardiomyopathy. 2. The prognosis is directly related to the degree of cardiac failure and the extent of left ventricular dysfunction.

Adolescent↗
PubMed1979

Effects of amiodarone on cardiac and coronary hemodynamics and on myocardial metabolism in patients with coronary artery disease.

While the antiarrhythmic effects of amiodarone are well-documented, its hemodynamic effects are not. We injected 5 mg/kg amiodarone i.v. in 16 patients undergoing coronary arteriography. Heart rate did not change. Aortic (systolic, diastolic and mean) and left ventricular (systolic and end-diastolic) pressures decreased significantly (p less than 0.01) at 5 and 15 minutes; systemic vascular resistance also fell significantly (p less than 0.05), while cardiac index increased slightly but significantly (p less than 0.05). Coronary vascular resistance decreased significantly (p less than 0.01) and coronary sinus blood flow rose in most patients, from a mean of 138 ml/min to 153 ml/min at 5 minutes (p less than 0.02); it then returned toward the control value at 15 minutes (mean 145 ml/min). Myocardial metabolism of O2 was normal and unchanged. Metabolism of lactate improved in five patients, remained unchanged in seven and deteriorated transiently in four. No undesirable hemodynamic and clinical side effects occurred when the drug was administered slowly. We conclude that amiodarone is a powerful systemic and coronary vasodilator. In addition to its present indications in the treatment of angina pectoris and arrhythmias, the drug might be very useful as an afterload-reducing agent.

Adult↗
PubMed1979

[Hemodynamic effects of beta blockers].

Beta-blockers have been used in cardiology for the past 15 years in three directions: angina pectoris, cardiac arrhythmias, and hypertension. The haemodynamic effects are real: --imposed bradycardia, whether the basal rhythm be sinus or atrial fibrillation; --confirmed myocardial depression which reduces the energy needs of the myocardium; --fall in systolic pressure, the mechanism of which remains open to discussion. The theories explaining these haemodynamic effects are reviewed. The harmful effects of these substances are defined, together with the drug combinations which may avoid or counteract them.

Adrenergic beta-Antagonists↗
PubMed1978

[Auricular and left ventricular compliance in acute and chronic mitral insufficiency].

Left atrial and ventricular compliance has been studied in 25 cases of chronic mitral incompetence (CMI) and 9 cases of acute mitrale incompetence (AMI). Left atrial compliance was evaluated by the ratio between maximal variation in volume and corresponding maximal variation in pressure; it was found to be higher in cases of CMI than in cases of AMI. Left ventricular compliance was evaluated by various indices (Diamond, Mirsky, Gaasch, Laird), and was found to be increased equally in the chronic and acute types. It is possible that an explanation of this increase incompliance is to be found in the rearrangement of myocardial fibres which follows the dilatation. It constitutes a fundamental means of chronic adaptation, and shows that the diastolic elastic properties of the cavities of the atrium and ventricle are as important in the evaluation of mitral incompetence as the properties of systolic contraction.

Acute Disease↗
PubMed1977

[The late results of aorto-coronary by-pass surgery. Minimum of 4 years follow-up (author's transl)].

Of 340 patients undergoing aorto-coronary surgery over a period of 6 years, the 136 cases in which there was a minimum follow-up of more than 4 years were analysed from the standpoint of the results. Overall amount annual postoperative mortality was low, less than 2,5%, even though the majority of patients undergoing surgery suffered from rest angina and had double or triple coronary stenoses. Analysis of prognostic parameters reveals the importance of the quality of the left ventricule, whilst age, sex, risk factors, the site of the bypass, the number of stenoses and the type of angina had little or no statistical influence on postoperative mortality. Six years after operation, there remained 66% of excellent results and 60% of the patients were able to work. One hundred and forty eight follow-up coronary arteriograms were carried out (including 33 repeated). During the first year after operation (184 by-passes examined) the percentage of permeability of the grafts was 84,8%. Later (86 bypasses examined) this fell significantly to 74,4% but 86,3% still had at least one permeable by-pass. Repeat late studies after four years showed the stability of the result. Investigation into the causes of postoperative infarctions ans analysis of the results in terms of the number of by-passes carried out in relation to the number of coronary stenoses, indicate that multiple by-passes should be avoided when technical conditions are difficult, with a narrowed coronary network and of little functional value.

Adult↗
PubMed1977

[Concomitant Prinzmetal angina and coronary angina. Angiographic study in 13 patients (author's transl)].

Is coronary spasm the explanation for the paroxysmal myocardial ischaemia of Prinzmetal angina? Although considered adventurous two or three years ago, this hypothesis has been supported by the publication of approximately 15 cases in which the cause and effect relationship seemed to be proven by spasm seen on coronary arteriography at the same time as a typical attack. The authors report 13 cases of this type (the first of which was published in 1972). Spasm occurred in a normal coronary system in 3 cases, whilst in 2 cases there were only non-stenotic plaques of atheroma. In 8 cases, spasm occurred at the site of or distant from a significant atheromatous lesion. In 8 cases, spasme involved the right coronary whilst in 3 cases the A.I.V. was affected and in 2, two of the three main coronary trunks. In the light of their experience, the authors stress two points: --in many cases, nitroglycerine alone is not sufficient to relieve the spasm, and only the in situ injection of papaverine had a constant effect; --it is essential to opacify both coronary systems during a typical attack in order to obtain proof of spasm.

Adult↗
PubMed1977

[Study of survival in angiographically determined ischemic cardiopathies: Apropos of 345 medically treated patients].

A study of 345 patients with ischaemic heart disease due to coronary arteriosclerosis which had been demonstrated by coronary arteriography, and seen between November 1967 and December 1974, was directed towards finding out what had happened to the patients so that, by an actuarial study of their survival, the prognostic significance of the arteriographic and ventriculographic studies could be determined. The prognostic value of the clinical findings has shown the importance:--of the presence of clinical left ventricular failure;--of the presence of coronary insufficiency with frequent attacks; of the presence of sequelae of infarction as seen on the ECG at rest;--on the length of the symptomatic history before arteriography. The assessment of the prognostic potential of the arteriographic findings has emphasised:--the fundamental importance of diffusion of stenoses and occlusions of several main coronary trunks;--the high risk if the lesion affects the left coronary trunk; the high risk of prognostic significance of lesions on the IVA. The prognostic significance of ventricular lesions as demonstrated on ventriculography in the right anterior oblique incidence has shown the sinister significance of extensive lesions of more than two or three of the seven ventriculographic segments and of lesions with dilatation, whereas very localised static plaques hardly influence the prognosis at all.

Adult↗
PubMed1977

[Echocardiographic criteria of obstructive cardiomyopathy].

In defining the characteristic abnormalities of obstructive cardiomyopathy (OCM), the echocardiogram appears to offer an excellent method. We have used this technique in 22 adults presenting with this condition, and have compared the results of echocardiography with those taken from 17 normal subjects. All those with OCM had asymmetrical hypertrophy of the septum (meaning hypertrophy of the septum without proportional thickening of the posterior wall of the left ventricle); certain other facts were noted: an undilated left ventricular cavity, good systolic function, and indications of poor diastolic compliance. In addition, from the thickeness of the posterior wall and the movement of the mitral valve complex during systole, it has been possible to draw a distinction between the patients with and those without obstruction while they were all at rest. These results confirm that it is possible to identify obstructive cardiomyopathy and the frequently associated defects of ventricular function by an echocardiographic method.

Adult↗
PubMed1976

[Electrocardiographic and radiographic course after aortic valve replacement].

On a series of 170 aortic valve replacement - 100 aortic stenoses (AS) and 70 aortic regurgitations (AR) - with an early post operative death rate of 5.3% and a late one of 8% (with a minimum follow up of 1 year and an average one of 25.4 months, two electrocardiographic and radiological checks could be done on 123 patients, 12 months on an average after the operation, and again for 116 patients, 21 months after the operation. After a year there was a significant and substantial decrease of the left ventricular hypertrophy (LVH) and a moderate one of the radiological heart area (HA). The decrease of LVH (Sokolow's index and AVL) tended to be more marked for the AS group and that of HA for the AR. At the second check no further significant change of LVH or HA was noted for either group, and the average HA of the patients remained high. The mean post-operative decrease of LVH and HA was all the greater as the pre-operative value was higher; but it was independent of the stage of heart failure and of the pre-operative hemodynamic data. There was no correlation demonstrated between the amplitude of post-operative variations of HA or LVH and the main operative stages (aortic clamping, ventricular fibrillation, coronary infusion). There was no significant difference between the mean values of LVH or HA of the survivors and those of the early post-operative deaths. The mean value of pre-operative HA was higher in the patients who were to die late than in the survivors, but the difference was not statistically significant after 25.4 months. The mean pre-operative values of HA and LVH did not influence the quality of the post-operative functional result.

Aortic Valve Insufficiency↗
PubMed1976

[Myocardial infarction in early postoperative complications in operations of myocardial revascularization: incidences, clinical study and mechanisms].

A study of the electrocardiograms and enzyme levels after surgery to revascularise the myocardium in a group of 174 consecutive patients has allowed us to demonstrate 19 cases of early postoperative myocardial infarction (EPOMI) (10.9%). 10 of these cases had no clinical features of EPOMI; 9 had clinical signs (collapse of altered systemic pressures, arrhythmias) or haemodynamic disorders (raised left atrial pressure). The EPOMI turned out to be fatal in 3 cases (19%), and to be complicated by left ventricular failure in 6 cases (32%). Post-operative coronary arteriography showed that 8 out of 20 grafts were occluded in 13 patients; ventriculography showed the myocardial damage consequent upon EPOMI in 8 patients out of 12; Autopsy showed graft occlusion in each of the two patients. The means of diagnosis of EPOMI must be electrocardiographic and enzymatic. An attempt has been made to study the causes of EPOMI: aortocoronary bypass hazardous because of poor distal supply (6 cases) or surgical difficulties (6 cases); progression of the atheromatous lesions (3 cases); infarct already inicipient at the time of surgery (1 case). EPOMI is a complication of cardiac surgery which must be recognised; the mechanisms are diverse, and any of the factors which are relevant to the surgical procedure may be a cause.

Adult↗
PubMed1975

[Hemodynamic effects of the intravenous form of acebutolol].

Acetubolol was administered intravenously to 11 patients with various heart disorders, without any adverse effects. The bradycardic effect of this compound is slight. It did not change the auriculo-ventricular conduction in 10 patients with sinus rhythm. The effect of acebutolol on myocardial efficacy is slight or absent in controls. At the doses studied, it did not alter systolic arterial pressure. Furthermore, the effect on the myocardial contractility is slight (-10 p.cent, mean). The important point noted is that the drug does not increase the pressure in ventricular filling, the first sign usually of left ventricular insufficiency caused by most other drugs of this pharmacological type.

Acebutolol↗
PubMed1975

[Tricuspid incompetence after surgical correction of mitral and mitrio-aortic value diseases. Reasons for its persistence or its recurrence].

53 patients with mitral or aortic valve disease, observed consecutively, had before operation a marked tricuspid incompetence. 24 had, in the course of corrective mitral or mitral-aortic correction, a surgical attempt at treatment of tricuspid regurgitation; in theremaining 29, tricuspid incompetence was not corrected surgically. The course of the latter group was studied (average follow-up period after operation = 18 months): the operative mortality was 10.3%, and secondary one 20.7%. The functional result was considered good in 55% of the patients, bad (classified III and IV of the NYHA) in 14% of the patients. The postoperative clinical and haemodynamic assessment showed that, in the patients in stages III and IV with persistent ou recurring tricuspid incompetence, the tricuspid lea was, in all cases, secondary to an anomalous function of the left heart (bad function of the prosthesis, persistence of aortic lesions either misvalued or uncorrected). Tricuspid repair in a second stage is unjestified in such cases.

Adult↗