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Biomedical subjects

J M Juliard

Publications and source records attributed to J M Juliard.

At least 73 records · Page 4Linked to original sources
PubMed1992

[Feasibility, indications and immediate results of direct angioplasty without thrombolysis during the acute period of myocardial infarction].

Between June 1988 and November 1991, 64 out of 200 consecutive admissions (32%) before the 6th hour of myocardial infarction underwent angioplasty of first intention. Fifty men and 14 women (average age 62 +/- 11 years) benefitted from this 24 hour emergency interventional cardiology service. The indication was formal in 22% of patients because of a contra-indication to thrombolysis (N = 40) or cardiogenic shock (N = 4); in 6%, the choice was logical because of diagnostic uncertainty (N = 12); it was a deliberate choice in 4% of cases (N = 8). Successful angioplasty was defined as reperfusion of the occluded artery without circulatory delay or > 50% residual stenosis. Arterial recanalisation was attempted in all patients (associated with intraaortic balloon pumping in 3 cases) and was successful in 59 patients (92%) within 231 +/- 100 minutes of the onset of chest pain and within 49 +/- 29 minutes of hospital admission. The outcome was uncomplicated without any other intervention in 81% of patients (48/59). Three reocclusions were observed, two of which were symptomatic and treated successfully by repeat emergency angioplasty. Six surgical revascularisations were necessary (2 emergency, 4 secondary). One major complication related to the angioplasty was observed (haemopericardium). Global hospital mortality was 9% (6/64): three of the 4 patients admitted in cardiogenic shock, 3 of the 40 high risk patients with contra-indications to thrombolytic therapy, none of the 20 patients considered to be at low risk (uncertain diagnosis and deliberate choice).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[How to evaluate the hemodynamic risk after myocardial infarction?].

The hemodynamic prognosis of myocardial infarction is determined, at medium and long term, by the function of the left ventricle. This is related to the infarct size, the dilatation and geometry of the ventricle secondary to left ventricular remodeling which often follows infarction. In addition to clinical criteria, the hemodynamic parameters which are essential for patient evaluation are the ejection fraction (by radionuclide or conventional ventriculography), rapidly progressive ventricular dilatation (by repeated echocardiography) and circulatory reserve from the exercise stress test data.

Angiocardiography↗
PubMed1992

Non-invasive identification of severe coronary artery disease in patients with long-standing diabetes mellitus.

OBJECTIVES: To detect severe coronary artery disease in asymptomatic middle-aged diabetic patients exposed to coronary artery disease risk factors. PATIENTS AND METHODS: Forty-four middle-aged patients (30 to 65 years of age) with a known duration of diabetes exceeding 10 years and at least one additional cardiovascular risk factor were studied. Patients were free of anginal chest pain and had a normal 12-lead ECG at rest. All patients underwent 24-hour ambulatory ECG, maximal bicycle exercise electrocardiography and intravenous dipyridamole thallium myocardial scintigraphy. If one of these 3 non-invasive tests revealed signs of myocardial ischaemia, a coronary angiography was performed. RESULTS: Non-invasive investigation yielded the diagnosis of myocardial ischaemia in 9/44 patients (20%). Six of the 9 patients had significant coronary artery stenoses (> 70% narrowing) and 5 exhibited severe triple-vessel disease. With dipyridamole thallium scintigraphy, the positive predictive value for diagnosis of coronary artery disease was optimal. CONCLUSION: In diabetic patients with additional coronary risk factors, periodical thorough clinical examination and resting ECG may fail to detect severe coronary disease. More sophisticated cardiovascular non-invasive tests should then be proposed as part of the periodical care of these patients.

Coronary Angiography↗
PubMed1992

[Negativity of the exercise thallium test despite tight stenosis of the common trunk of the left coronary artery].

The authors report a case of severe angina linked to subocclusive ostial stenosis of the common trunk of the left coronary, characterised by the contrast between a very positive stress test on the basis of clinical and electrocardiographic parameters and a negative Thallium stress test. The occasion is taken to review the sensitivity of Thallium stress testing in lesions of the common trunk.

Constriction, Pathologic↗
PubMed1991

[Left ventricular remodeling and ischemic heart diseases. Therapeutic possibilities].

Left ventricular modeling after myocardial infarction may be modified in three ways: firstly, by limiting the infarct size; secondly, by administering ACE inhibitors: these drugs limit infarct expansion and ventricular dilatation. They reduce the prevalence of secondary left ventricular failure and, in the animal, improve the prognosis. Glyceryl trinitrate also appears to be effective. The third therapeutic option is maintaining the patency of the artery responsible for the infarction, which has a beneficial effect on ventricular remodeling. The respective therapeutic indications of these three options are still a matter of discussion.

Adrenergic beta-Antagonists↗
PubMed1991

[Hemopericardium caused by coronary perforation during angioplasty. A surgical diagnosis].

A case of haemopericardium occurring during angioplasty of the left anterior descending artery complicated by an occlusive dissection is reported. The haemopericardium was diagnosed and evacuated during surgical myocardial revascularisation indicated by the failure of angioplasty. This complication, though rare, underlines the necessity of a real surgical stand-by for this procedure.

Angioplasty, Balloon, Coronary↗
PubMed1990

[The risks of bronchoscopy in coronary patients].

In order to study the electrical changes that may occur during bronchoscopy in coronary patients we have carried out continuous electrocardiographic recordings during the course of endoscopy in 36 patients. We have been able to compare two groups: Group 1 consisting of 18 patients with coronary disease, and Group 2 with 18 non-coronary patients. There was no difference for sex, age or blood gases at the time of the examination in either group. Continuous electrocardiographic recording was started one hour before the examination and went on until two hours after, and was analysed as a function of the different durations of the endoscopy and any possible incidents. The blood potassium and the lidocaine blood levels at the end of the examination did not differ between the two groups. We observed no disorders of rhythm or of conduction. The only common change in the two groups was a frequent elevation of heart rate. There was no difference between the two groups. We have on the other hand been able to show in 3 coronary patients problems of repolarisation, which looked like current ischaemia occurring during the bronchoscopy and disappearing after the examination. We had no clinical upsets and do not have to regret having done any of the examinations, but these observations suggest we should be particularly careful in considering the indications for bronchoscopy, and the surveillance of patients during bronchoscopy where there is coronary disease.

Adult↗
PubMed1989

Hemodynamic action of nicorandil in chronic congestive heart failure.

Nicorandil is a new compound that has shown potent vasodilator activities on venous and arterial beds in experimental pharmacology. This study was designed to evaluate the magnitude and the time course of hemodynamic effects of different doses of nicorandil in congestive heart failure. Eleven patients with severe congestive heart failure (New York Heart Association class III or IV), with a cardiac index less than 3 liters/min/m2 and a pulmonary wedge pressure greater than 15 mm Hg were enrolled in the study. Three patients had ischemic dilated cardiomyopathy and 8 had idiopathic dilated cardiomyopathy. Hemodynamic assessments were performed by right-sided cardiac catheterization (Swan-Ganz catheter) with cardiac output determination (thermodilution) at baseline and from 30 minutes to 12 hours after single oral administration of nicorandil; 3 patients were given 40 mg, 6 patients 60 mg, and 2 patients 80 mg. Maximal hemodynamic changes were observed 30 minutes after dosing and remained statistically significant at 3 hours. Thirty minutes after drug administration, pulmonary wedge pressure decreased 34 +/- 6%, cardiac index increased by 55 +/- 13% and diastolic and mean arterial pressures decreased by 15 +/- 3% and 9 +/- 2%, respectively, from baseline values. The decrease in systolic blood pressure was slight (5 +/- 2%) and not statistically significant. Calculated systemic vascular resistances decreased by 36 +/- 6% and heart rate did not significantly change. Nicorandil was well tolerated. Thus, the results of this first study of nicorandil in congestive heart failure demonstrated the unloading action of this compound on the failing heart, leading to an improvement in cardiac function; further investigation of nicorandil in this therapeutic area is needed.

Adult↗
PubMed1988

[Neuroendocrine changes in chronic cardiac insufficiency].

Throughout the course of chronic congestive heart failure cardiac and peripheral compensatory mechanisms are at play, most of them under the influence of the neuroendocrine system. The reserves of heart rate and contractility are regulated essentially by the noradrenergic system (NAS), but this mechanism is partial and transient owing to the gradual decrease in the density and sensitivity of myocardial beta-adrenergic receptors induced by overstimulation. Adaptation of the heart to exercise may be reduced. This escape phenomenon is also observed with almost all cardiotonic drugs which interfere with cyclic adenosine monophosphate (cAMP), in contrast with the paradoxically favourable effects of beta-blockers in small doses or of drugs that are both agonists and antagonists of beta-adrenergic receptors. The mechanisms which contribute to the induction of left ventricular hypertrophy are imperfectly known. The noradrenergic system and the renin-angiotensin-aldosterone system (RAAS) are probably not the only ones involved. The setting in action of Frank-Sterling heterometric regulation, at first during exercise then permanently, requires an increase in filling pressure obtained by venous constriction (predominantly controlled by the NAS) and, mostly, by an increase in circulating blood volume. NAS and RAAS intervene in the kidneys to produce water-and-salt retention.(ABSTRACT TRUNCATED AT 250 WORDS)

Arginine Vasopressin↗
PubMed1988

[Physical properties of the aorta and left ventricular geometry evaluated by Doppler echocardiography in normal subjects].

UNLABELLED: In 45 normotensive subjects (21-84 years) we simultaneously measured: 1) arterial pressure (AP) according to guidelines of the World-health-organization; 2) left ventricular (LV) wall thickness (WT) and antero-posterior radius (r), aortic diameter (AD) by M-mode echo with 2D echo control; 3) isthmus--diaphragm pulse wave delay (PWD) by measurement of time, between the foot of aortic velocity curves, respectively in the isthmus and near the diaphragm; 4) sternal length (L). We derived WT/r ratio, pulse wave velocity (PWV) as the ratio L/PWD, the product AD X PWD and the PWD/AD. RESULTS: AP, WT/r, PWD, PWV, AD, AD X CFD, PWD/AD are significantly correlated with age (respective r = 0.30, p = 0.05; r = 0.61, p less than 0.001; r = -0.67, p less than 0.001; r = 0.73, p less than 0.001; r = 0.61, p less than 0.001; r = -0.49, p less than 0.001; r = 0.52, p less than 0.001. WT/r is significantly correlated with PWD (r = -0.52, p less than 0.001); PWV (r = 0.50, p less than 0.001); AD (r = 0.44, p less than 0.03); AD X PWD (r = -0.38, p = 0.01) and PWD/AD (r = 0.35, p less than 0.02) but not systolic AP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Selective embolization of mycotic aneurysm of the branches of the abdominal aorta].

We report two cases of multiple aneurysm complicating bacterial endocarditis and involving the hepatic, renal and superior mesenteric arteries. The aneurysms were treated by the superselective embolization technique hitherto restricted to cerebral arteries. The first patient had been operated upon for mitral valve endocarditis. Because of a persistent anicteric cholestasis, repeat ultrasonography and computerized tomographic scan were performed which revealed two intrahepatic aneurysms associated, at arteriography, with an aneurysm of the superior mesenteric artery. The patient underwent superselective embolization of one of the intrahepatic aneurysms, then of the superior mesenteric artery aneurysm. Angiographic cure was obtained and persists after a 17-month follow-up. In the second patient, persistent clinical and biochemical hepatic abnormalities after mitral and aortic valve replacements for endocarditis prompted us to perform an ultrasonography which showed a large hepatic aneurysm, and an abdominal arteriography which disclosed the presence of several aneurysms. Because of its size and suspected fissuration, the hepatic aneurysm was treated by superselective embolization, and this was followed by embolization of a renal artery. The immediate post-treatment period was uneventful, and complete angiographic cure was confirmed after 6 months. Superselective embolization seems to give good results at mid-term and should therefore be considered for fragile patients with multiple abdominal aneurysms.

Adult↗
PubMed1987

[Left ventricular hypertrophy. Advantages and disadvantages].

The increase in left ventricular myocardial mass is a mechanism of adjustment of the ventricular pump to a normal process, such as growth or sports, or a pathological process (mechanical overload or cardiomyopathy). The associated geometrical changes tend to normalize systolic performance and/or strain--one of the main determinants of myocardial metabolic requirements. When left ventricular hypertrophy is inadequate quantitatively, geometrically and functionally, and when contractility and preload reserves are exhausted, the systolic performance of the ventricular pump becomes narrowly dependent upon the increased systolic strain. some types of "pathological" hypertrophy may ultimately result in alteration of myocardial intrinsic properties during contraction, relaxation and/or extension, and this in turn may induce or aggravate ventricular failure. The causes of left ventricular hypertrophy are imperfectly known, the views most commonly held being metabolic imbalance of the myocardium due to increased demands, and reduction of coronary reserve and exchange capacities.

Cardiomegaly↗
PubMed1987

[Coronary angioplasty 1987].

Percutaneous transluminal coronary angioplasty (PTCA) is currently a common technique in the treatment of coronary artery disease, since the first dilatation was performed with success by A. Gruentzig (1977). If clinical indication is reserved to symptomatic angina pectoris, angiographic indications have been enlarged on account of progress in techniques and technology. Immediate success is good, about 90% with a low rate of mortality (1%), sometimes despite an emergency surgical revascularization. Restenosis is frequent, about 30% a few months after PTCA, with necessity of a new PTCA in almost half the cases. Long-term follow-up is satisfactory, about two third patients are asymptomatic. Immediate efficacy of this simple technique, and good results on a long-term follow-up, are explications of the increase in the number of PTCA during the last ten years.

Angioplasty, Balloon↗
PubMed1987

[Aortic valvuloplasties: treatment of calcified aortic stenosis in elderly subjects].

Since September 1985, transluminal balloon catheter aortic valvuloplasty has been developed in France (Cribier and al.) and all around the world. Indications are still limited, in almost all catheterization laboratories, to elderly patients, with Monckeberg's disease, and with a very high operative risk. Immediately after aortic valvuloplasty, there is a moderate but a significant increase in valve area, without serious complications. Subjective improvement is often spectacular during few months after the valvuloplasty. In long-term evolution, there is sometimes a symptomatic restenosis which require a new valvuloplasty. So, if percutaneous valvuloplasty is efficacy in aortic stenosis in the elderly, long-term evaluation of this new technique is necessary.

Aged↗