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J Fourny

Publications and source records attributed to J Fourny.

52 records · Page 3Linked to original sources
PubMedDate not supplied

Surgical technique for cardiomyoplasty and iterative transthoracic biopsies in an experimental goat model.

Cardiomyoplasty is a new surgical procedure using transformed skeletal muscle to reinforce or substitute for the myocardium. For the purpose of studying surgical technique and investigating basic questions, we have developed a model of reinforcement cardiomyoplasty. Herein, we describe anesthetic management, surgical technique, and the technique for iterative transthoracic biopsies. This model has proven to be valuable in several long-term studies involving more than 30 goats. Preliminary data to ascertain the efficacy of the proposed technique are provided.

Anesthesia↗
PubMedDate not supplied

Coronary artery reoperations.

From June 1976 to June 1989, 138 previously revascularized coronary patients were reoperated upon. This represents 3.28% of all aortocoronary bypass procedures performed during the same period in our institution. Characteristics of this group, risk factors, coronarographic data, perioperative morbidity and mortality are analyzed and compared to the data of the general population undergoing bypass surgery. The mean age of individuals requiring reoperation was 59 years. The mean interval between the two operations reached 73 months (5 to 180 months). Angiographic lesions were more extensive with three-vessel disease in 65% of the reoperated patients. The mean ejection fraction was 55%. A mean of 2.1 bypass grafts per patient were inserted with 60% of cases having an internal mammary artery graft. Perioperative infarction occurred in 8.0% of the reoperations and an intraaortic balloon counterpulsation was necessary in 4.3% at the end of the procedure. Operative mortality was 5%. Symptomatic improvement was obtained in 85% of the cases. In recent years, cardiac transplantation has been performed for 11 previously bypassed patients with severely impaired ventricular function. There were no postoperative deaths. Cardiac transplantation can be considered as a more valuable alternative to repeat coronary artery bypass grafting in such cases.

Angina, Unstable↗
PubMedDate not supplied

[Simultaneous coronary and carotid surgery: apropos of 73 cases].

A series of 73 simultaneous carotid and coronary revascularizations (Group I) is presented (January 1980-December 1988). Age, sex, risk factors, severity of angina, coronarography, neurological symptoms, angiographic carotid lesions and operative outcome of these 73 patients are compared with the aspects of 3544 coronary bypass patients (Group II) and 1001 carotid endarterectomized patients (Group III) during the same period. The angina in Group I is more severe, with 22% belonging to NYHA class IV and 26% having a stenosis of the left main coronary artery, vs 14% and 13% in Group II. Seventy percent of the carotid lesions in Group I are asymptomatic vs 33% in Group III. Group I patients had more problems in the perioperative period, with 16.4% needing prolonged high-doses analeptics and 5.4% intraaortic counterpulsation balloon. Operative mortality is higher (7%) in Group I compared with Group II (2.3%) and Group III (1.7%). These results permit to define a population of polyvascular patients with concomitant coronary and carotid disease, characterized by a more diffuse atherosclerosis and a higher operative risk. Operative morbidity and mortality after combined myocardial and cerebral revascularization remains nevertheless inferior to the cumulated surgical risk of the sequential procedures (74 patients with coexistant coronary and carotid lesions operated in two sessions before 1986).

Carotid Artery Diseases↗
PubMedDate not supplied

[Reoperation for aortocoronary bypass].

Iterative aorto-coronary bypass. From 1978 to 1988, 106 previously revascularized coronary patients were reoperated. This represents 3.01% of all aorta-coronary bypass procedures performed in the same period. Characteristics of this group, risk factors, coronary anatomical data, perioperative morbidity and mortality are analyzed and compared to the data of primary revascularization. The progression of atherosclerotic disease, with an annual 2% attrition rate of bypass grafts after the first year, is evidenced by this study. The success rate of coronary reoperations approaches the results of primary bypass surgery. The causes of recurrent angina and graft failure are discussed. The mean age of individuals requiring reoperation is 58.5 years. The mean interval between the two operations reaches 66 months (5 to 168 months). Angiographic lesions are more extensive, with a three vessel disease in 75% of the reoperated patients and an ejection fraction lowered at 55%. A mean of 2.7 bypass grafts per patient is realized, with in 60% of cases an internal mammary artery graft. Perioperative infarction occurs in 10.5% of the reoperations and in 4.5%, an intraaortic counterpulsation balloon is necessary at the end of the procedure. Symptomatic improvement is obtained in 85% of cases. Operative mortality is 5.7%. These findings suggest that coronary reoperation can be accomplished with low morbidity, low mortality and a therapeutic benefit in the majority of cases. In recent years, cardiac transplantation has been considered for some patients with impaired ventricular function. This procedure is only limited by the insufficient number of donors.

Coronary Artery Bypass↗
PubMedDate not supplied

[Combined treatment of carotid and coronary artery insufficiency (author's transl)].

The association of a coronary insufficiency and a significant stenosis of the carotid trunks brings up a difficult problem of operative strategy. In a series of 142 patients operated by an aortocoronary vein graft 5 presented a bilateral carotid stenosis, of which two had a history of transient ischemic accidents. These were operated either in sequence: carotid then coronary, or by a simultaneous procedure. In conclusion it appears the planning of surgical procedures in cases of such combined vascular insufficiencies depends on the relative severity of both lesions, and in a case of unstable angina a simultaneous carotid-coronary operation is warranted.

Carotid Artery Diseases↗
PubMedDate not supplied

[Reno-vascular hypertension surgery and renal: systemic renin index (author's transl)].

Thirty-two consecutive hypertensive patients with renal artery stenoses have been operated on. Surgical procedures were aorta-renal artery grafting, renal artery endarteriectomies and resection-anastomosis. Results were analysed with respect to the radiologic type of the stenosis (i.e. arteriosclerosis (AS) or fibromuscular dysplasia (FMD) and to the value of Renal: Systemic Renin Indices (RSRI) available in 30 cases. Out of 15 FMD cases, 14 are completely cured while in 5/15 cases RSRI values were not significant. 1/15 case is a failure, RSRI was here not significant. Out of 16 AS cases, 2 died in the immediate postoperative period. Out of 14 AS survivors, 11 are completely normotensive, 2 are only improved (in 11/13 cases where RSRI were available, they were significant) and 1 is a failure (in that case RSRI was not significant). One case of arteriovenous fistula is reported; reliable RSRI determination can not be obtained in that pathology. It is the author's suggestion that every case of FMD related renovascular hypertension should be operated on irrespectively of RSRI value. Opposingly, in AS case, operative decision is dependent on prior determination of RSRI.

Adolescent↗
PubMedDate not supplied

Pacemaker implantation for early sinus node dysfunction after orthotopic heart transplantation.

Among 60 patients who received OHT at our institution between November 1986 and January 1990, 4 actually needed implantation of a permanent pacemaker. Three patients with symptomatic early sinus node dysfunction were identified and were satisfactorily paced on the VVIR mode. All three showed sinus recovery within three months following implantation and had their pacemaker switched from the VVIR mode to a simple ventricular demand pacing. Interestingly, administration of beta-blocking drugs quickly reinstituted pace dependence. The patients' outcome is excellent (18 to 48 months follow-up). No difference with the global cohort of our OHT recipients was noticed, apart from an apparent high incidence of infections (3/3) with (2/3) CMV and severe rejection (3/3) during the first month postoperatively. This data suggests that sinus dysfunction may be the result of a multifactorial (rejection, CMV, ...) injury to the conduction system, and is only clinically relevant beyond a threshold level. Denervation hypersensitivity, together with correction of these factors, may account for the restoration of a sufficient reserve of conduction system, and therefore appropriate sinus node function in basal conditions.

Arrhythmia, Sinus↗
PubMedDate not supplied

Technique for ventricular wrapping in experimental dynamic cardiomyoplasty.

Cardiomyoplasty is a wrapping of an electrostimulated latissimus dorsi muscle flap around the heart for substitution and/or reinforcement. The surgical technique for reproducible cardiomyoplasties in the goat model is presented. The methods combine the direction of wrapping (clockwise, counter-clockwise) and the orientation of muscle fibers. A cardiomyoplasty model using right and left latissimus dorsi or left latissimus dorsi and pectoralis major as well as a split muscle technique are illustrated.

Animals↗
PubMedDate not supplied

Surgical technique for reinforcement cardiomyoplasty.

The current technique for reinforcement cardiomyoplasty in man is detailed. The authors emphasize the critical points that determine the perfect execution of this operation. This innovative surgical approach to heart failure is continuously evolving and, therefore, may be subject to improvement. The major principles however remain valuable.

Cardiomyoplasty↗