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Biomedical subjects

J Hélias

Publications and source records attributed to J Hélias.

At least 19 recordsLinked to original sources
PubMed1994

Acute effects of urapidil on left ventricular function in hypertensive patients: comparison with clonidine using radionuclide angiography.

We have studied the effects of urapidil 0.4 mg kg-1 i.v. and clonidine 2.5 micrograms kg-1 i.v. on left ventricular volume and function in 20 patients with chronic coronary artery disease and essential hypertension. Patients were studied using 99mtechnetium radionuclide angiography with first-pass and ECG-gated equilibrium blood-pool techniques and non-invasive sphygmomanometry. Administration of both urapidil and clonidine caused a similar decrease in mean arterial pressure (20%), associated with an equivalent reduction in systemic vascular resistance. Despite the decrease in mean arterial pressure, heart rate did not change after administration of clonidine, but there was an early and transient increase of 13% after urapidil. There were no changes in cardiac index, but in contrast with clonidine, urapidil caused a decrease in stroke index. In both groups, global left ventricular ejection fraction did not change. Urapidil produced a mean decrease in end-diastolic volume of 8% and a mean decrease in end-systolic volume of 13%, in contrast with clonidine which caused little change. Reduced arterial pressure, systemic vascular resistance and preload after urapidil 0.4 mg kg-1 i.v., associated with lack of prolonged tachycardia and preserved global left ventricular performance, may have obvious clinical implications in anaesthesia.

Adrenergic alpha-Antagonists↗
PubMed1993

[Thallium 201 myocardial scintigraphy and left branch block. Comparative value of exercise test and dipyridamole test].

Stress Thallium 201 myocardial scintigraphy in patients with left bundle branch block often shows reversible septal perfusion defects even in the absence of coronary artery disease. This phenomenon seems more common when the patients have tachycardia. With the working hypothesis that dipyridamole stress testing, which does not greatly increase the heart rate, would be more appropriate than exercise stress testing to unmask coronary artery disease in this condition, the authors compared the results of two Thallium 201 scintigraphies performed after exercise and then after dipyridamole under the same conditions three weeks later, in 67 patients with complete left bundle branch block. Scintigraphy showed one or more reversible perfusion defects in 64/67 patients after exercise but only 32/67 patients after dipyridamole (p < 0.001). There was poor uptake in the septal region in 59 patients (88%) after exercise and in 25 patients (37%) after dipyridamole (p < 0.001). The specificity was evaluated in 23 patients estimated to have no coronary artery disease. If only unequi vocal perfusion defects were considered, the specificity after dipyridamole was higher than that after exercise, increasing from: 35% to 83% for septal defects (p < 0.01); 65% to 96% for anterior wall defects (p < 0.05); 61% to 87% for inferior wall defects (p < 0.05); 57% to 91% for apical defects (p < 0.01); 17% to 83% overall (p < 0.001). Lower values but with a comparable difference were observed when all forms of hypofixation (even minimal) were taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Detection of residual myocardial ischemia by Thallium-201 myocardial scintigraphy after myocardial infarction. Apropos of 53 patients treated with thrombolytic agents during the acute phase and with coronary transluminal angioplasty].

The prognosis of silent ischemia after myocardial infarction is similar to that of post-infarction angina. In order to detect this condition two stress myocardial scintigraphies were performed: three weeks after hospital admission for myocardial infarction treated by thrombolytic therapy without any complications or recurrence of chest pain; one month later, after percutaneous transluminal coronary angioplasty on the infarct-related artery in 24 patients or after medical therapy alone when this procedure was not possible (29 patients). Silent ischemia, initially present in two thirds of patients, was less frequently observed in the patients undergoing angioplasty (p < 0.05). In the remaining one third of patients with no silent ischemia, myocardial scintigraphy was unchanged at the follow-up procedure whether or not angioplasty had been performed. These results show that silent ischemia is commonly observed during stress myocardial scintigraphy after acute myocardial infarction treated by thrombolysis, but that this condition can be significantly reduced by coronary angioplasty. When no silent ischemia is observed, coronary angiography and angioplasty do not seem to be indicated.

Adult↗
PubMed1990

[Comparison of magnetic resonance imaging, echocardiography and catheterization in the diagnosis of congenital heart diseases].

The authors compared the diagnostic value of magnetic resonance imaging (MRI), echocardiography and cardiac catheterisation with angiography in 66 patients with congenital heart disease, to determine a diagnostic strategy in the use of these methods of cardiac imaging. The patients were 8 days to 44 years old. The congenital cardiac malformations were classified in three groups: 29 isolated vascular malformations (Group 1), 17 isolated intracardiac malformations (Group 2) and 20 complex malformations (Group 3). MRI was performed in all patients using a high field (1.5 tesla) magnet and spin-echo sequences in multiple incidences. The results were compared with those of echocardiography in 60 patients and/or cardiac catheterisation in 39 cases. Technical evaluation of MRI showed images of diagnostic quality in 62/66 cases (93.9%). MRI provided a diagnostic contribution in 56 cases (85%) which was less important in intracardiac malformations than in the other groups (p less than 0.05). In comparison with other imaging techniques, globally, the diagnostic value of MRI was lower than that of cardiac catheterisation (p less than 0.005) but there was no significant difference between MRI and echocardiography. When the type of malformation was taken into account, MRI was not as useful as catheterisation and echocardiography for the diagnosis of isolated intracardiac malformations (p less than 0.01) but gave comparable results in other malformations. On the other hand, MRI associated with echocardiography was more useful (p less than 0.05) than catheterisation in the diagnosis of complex congenital lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Analysis of word perception in deaf children. A longitudinal study].

The assessment of speech perception and speech reading has been studied with the phonetic test of J.C. Lafon (lists of 17 french words with 3 phonemes each). 168 children from 7 to 17 have been collected. Deafness was moderate, severe or profound. It was always congenitaly sensoneural hearing loss. In order to precise data, results are giving regard to educational program: mainstream or special classes. Comparative data for each degree of deafness are given for speech perception, lipreading and both auditory and visual sensorial ways.

Adolescent↗
PubMed1988

Early detection of hearing loss in children with cleft palates by brain-stem auditory response.

The hearing of 23 children with cleft palates was studied at an early age (before 12 months) and before pharyngoplasty using the electrophysiologic method of auditory brain-stem response. Nineteen children showed important degrees of conduction deafness of 50 or 60 dB. Results were compared with those obtained for a group of normal children tested under the same method before age 6 months. No hearing loss was observed in this group. It is concluded that hearing defects appear at an early age in children with cleft palates and are in direct relationship to the malformation. Hypotheses concerning the etiopathogeny of these hearing losses are proposed.

Brain Stem↗
PubMed1987

[Effect of propofol on left ventricular function in the coronary patient. Combined isotopic and hemodynamic studies].

The present study investigated the effects of propofol (P) as sole anaesthetic agent of left ventricular (LV) function using gated radionuclide ventriculography (RNV) in unpremedicated patients with chronic coronary arterial disease (CAD). After informed consent, seven ASA 111 patients (51-74 yr) undergoing major urologic surgery took part in this study. All patients suffered from documented angina pectoris secondary to CAD. None gave a history of congestive heart failure or valvular heart disease. No patients were premedicated, but all received their chronic medications (nifedipine and isosorbide) up to and including the morning of surgery. The study was performed in the Nuclear Medicine Laboratory just before surgery. Heart rate (HR) was obtained from standard limb lead II of the ECG. A 7.5 F thermodilution Swan-Ganz catheter and a radial artery cannula were inserted under local anaesthesia. All patients were studied by RNV using red blood cells (RBC) labelled in vivo with 99m-technetium (Tc). A first RBC-Tc preparation containing 2-3 mCi f Tc was counted 10 cm from a gamma-camera. A first-pass study was carried out in the left anterior oblique position following the bolus i.v. injection of the source, allowing the evaluation of the isotopic dilution cardiac output (COiso) and the attenuation factor (F). Then, a second RBC-Tc preparation containing 20-25 mCi of Tc was injected intravenously. At equilibrium, 16 ECG-synchronized frames were acquired by computer for processing. Mean end-diastolic (ED) and end-systolic (ES) counts, left ventricular-end diastolic and systolic areas and ejection fraction (EF) were calculated every 1.5 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Gamma-angiography in the diagnosis of akinesia and dyskinesia after myocardial infarction].

A one year prospective double blind trial included all patients with myocardial infarction and clinical, electrocardiographic or radiographic signs of left ventricular aneurysm. All 36 patients underwent ventriculography and radionuclide angiocardiography in the same projections: right anterior oblique, antero-posterior, left anterior oblique and left lateral. The angiographic diagnosis of left ventricular aneurysm was based on the finding of a deformation of the ventricular contour persisting in diastole; 22 patients were classified as having a left ventricular aneurysm and the 14 others had akinesia alone. The radionuclide diagnosis of left ventricular dyskinesia was based on the finding of the following 3 criteria in at least one projection: crossing of the systolic and diastolic isocontours; over 4 p. 100 of LV pixels having a negative ejection fraction; the dephased infarcted region having a movement separate from that of the remaining healthy myocardium. None of the clinical criteria of inclusion allowed diagnosis of LV aneurysm when compared with the results of ventriculography. The results of radionuclide and conventional ventriculography correlated 100 p. 100 in the diagnosis of severe contractile abnormalities. When compared with ventriculography, radionuclide angiocardiography had a specificity of 95 p. 100 and a sensitivity of 86 p. 100 for the diagnosis of aneurysm. The only false negative was a non-surgical septal aneurysm. The multiplication of the incidences of examination increases the sensitivity of the results of radionuclide angiography.

Adult↗
PubMed1986

[Myocardial contusions. Contribution of scintigraphy using thallium-201. A prospective series].

Traumatic myocardial contusion is observed in 15% of autopsy studies; however, it is much more difficult to detect in survivors. Thirty-two consecutive, unselected patients admitted to the intensive care unit for serious thoracic injuries, underwent Th 201 myocardial scintigraphy in 2 to 4 different projections, 2 to 13 days after admission. The results were interpreted double blind and considered positive when a zone of hypofixation creating a defect greater than 25% was observed. The results were correlated with daily ECG recordings, serum CPK MB levels and echocardiography. Thirteen patients (41%) had abnormal scintigraphy. Border line appearances in 1 case excluded any severe myocardial lesions. The other investigations (56%) were normal. These results did not correlate with the ECG or echocardiographic appearances but a significant relationship was found with serum CPK MB levels (p less than 0.05). Therefore, the first investigations did detect cardiac damage but were not specific for myocardial lesions. Thallium 201 myocardial scintigraphy is superior to other non-invasive investigations. It provides information as to the size of the lesion and, by repeated studies, can differentiate simple myocardial contusion from a true traumatic myocardial infarction.

Adolescent↗
PubMed1983

Can the mode of death be predicted in patients with angiographically documented coronary artery disease?

To determine whether sudden versus non-sudden cardiac death could be predicted in high risk patients, 1157 medical patients were followed for an average of 46 months after a diagnostic coronary angiogram and 18 clinical, hemodynamic, and angiographic variables known to be associated with a high risk of mortality were analyzed. The total group of 141 deaths was classified into 3 subgroups: (1) 82 sudden deaths (less than 1 hour after onset of symptoms); (2) 46 deaths due to acute myocardial infarction with or without heart failure, and (3) 13 deaths unrelated to cardiac symptoms. In a subset of 64 patients, the duration of electrical systole (QTc) was calculated before angiography and before death. A comparison was made of QTc measurements at entry with QTc values of subjects with normal coronary arteries and normal left ventricular function. Deaths from cardiac causes could often be predicted from older age, male sex, history of myocardial infarction, unstable angina, congestive heart failure, abnormal cardiothoracic ratio, multivessel disease, abnormal left ventricular contraction, and abnormal ejection fraction. However, these variables did not discriminate between sudden and nonsudden cardiac deaths and both modes of death were characterized by depressed left ventricular function and multivessel coronary disease. During follow-up the incidence of acute myocardial infarction was not different in patients with cardiac and noncardiac deaths and in long-term survivors. However, patients dying from cardiac causes had a higher incidence of heart failure. Patients dying suddenly did not present new infarctions during follow-up whereas patients dying from acute myocardial infarction had a 13% incidence of prior infarction and a higher incidence of heart failure. In addition, QTc at entry was longer in nonsurvivors than in normal subjects (p less than 0.0001) and patients experiencing sudden death exhibited the highest incidence of QTc prolongation (greater than or equal to 440 ms) during follow-up (p less than 0.05). We conclude that: (1) although the severity of coronary disease and left ventricular dysfunction are closely related to cardiac mortality, they do not discriminate between sudden and nonsudden cardiac deaths; (2) patients experiencing sudden death are characterized by a low incidence of new myocardial infarction or congestive heart failure and prolongation of the QTc interval during follow-up.

Adult↗
PubMed1982

Myocardial protection through cold cardioplegia with potassium or diltiazem. Experimental evidence that diltiazem provides better protection even when coronary flow is impaired by a critical stenosis.

Intermittent aortic root infusion of a cold solution containing either potassium chloride (KCl) or diltiazem was performed in 32 dogs during a 2-hour aortic clamping. Half of the dogs in each group had a critical stenosis created on the circumflex artery before cardiopulmonary bypass. Global left ventricular (LV) function was determined 1 hour after bypass by means of LV pressure, peak dP/dt, LV end-diastolic pressure, cardiac and stroke work indexes. Regional function was assessed through microcrystals in the areas of the circumflex and left anterior descending coronary arteries. LV pressure decreased in all dogs, but more so with the KCl solution (p = 0.02). The stenosis had no specific effect on LV pressure, but affected peak positive dP/dt (p = 0.007) and LV end-diastolic pressure (p less than 0.0001). Cardiac and stroke work indexes decreased more in the KCl group than in the diltiazem group (p less than 0.002) with or without stenosis. Both positive and negative dP/dt were affected by the type of solution (a greater decrease with KCl), but the narrowing affected only the positive dP/dt. Regional LV function remained unchanged in the absence of a narrowing and was depressed equally in dogs with a narrowing whether they received KCl or diltiazem. Overall LV function appeared to be better preserved with diltiazem, with or without impairment of circumflex flow.

Animals↗
PubMed1980

Myocardial protection through cold cardioplegia using diltiazem, a calcium channel blocker.

During two hours of aortic clamping, two groups of 10 dogs each were given an intermittent infusion of a cold solution in the aortic root. In one group, the solution contained 20 mEq per liter of potassium chloride (KCl) and in the other, a calcium channel blocker (diltiazem). Left ventricular (LV) performance was measured by calculation of LV pressure, left ventricular end-diastolic pressure (LVEDP), cardiac index (CI), and stroke-work index (SWI). Regional myocardial function was assessed through ultrasonic crystals implanted in the subendocardial areas of both the left anterior descending (LAD) and circumflex coronary arteries. Dogs receiving KCl displayed deterioration of LV performance as evidenced by a return of maximal LV pressure, maximal rate of rise of LV pressure (dP/dtmax), CI, and SWI to 74 +/- 4%, 87 +/- 5%, 74 +/- 6%, and 59 +/- 6%, respectively, of the initial (before clamping) values. Animals that received diltiazem, on the other hand, had for the same variables a return to 85 +/- 4%, 99 +/- 7%, 129 +/- 8%, and 111 +/- 10% of the initial values. The rate of relaxation (peak negative dP/dt) decreased in both groups but less in dogs receiving diltiazem. Regional function in the area of the LAD and circumflex arteries showed little change in either group. We conclude that cold cardioplegia with a solution containing KCl or diltiazem protects the myocardium during prolonged ischemic cardiac arrest. Return of LV function on the whole is superior when diltiazem is used.

Animals↗
PubMed1980

[Recurrent angina after coronary surgery. Results of reoperations for myocardial revascularization].

40 patients presented with invalidating angina after initial revascularisation surgery (44 operations). The relapse of angina was attributed to thrombosis or stenosis of the graft (33 p. 100), graft failure plus the presence of non-bypassed coronary lesions (progression of coronary artery disease or incomplete initial revascularisation) (52 p. 100) or to the presence alone of coronary lesions which had not been bypassed (15 p. 100). At reoperation 37 stenosed or thrombosed grafts were replaced or repaired and 36 new aortocoronary bypasses were implanted. The perioperative risk was comparable to that of the initial operation (4,5 p. 100 mortality, 13,6 p. 100 myocardial infarction). The long term clinical improvement (34 months) was however less satisfactory (30 p. 100 unimproved). Several factors may account for the relatively high failure rate: the incidence of incomplete revascularisation; perioperative myocardial infarction and, above all, rapid progression of the coronary artery disease. Reoperation for myocardial revascularisation should therefore be restricted to patients with severe angina despite medical therapy, in whom the angiographic appearances suggest that optimal revascularisation might be possible.

Adult↗