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J Puel

Publications and source records attributed to J Puel.

At least 163 records · Page 9Linked to original sources
PubMed1988

[Transluminal coronary angioplasty. Ambitions and difficulties of the second generation].

Proposed in all functional forms of coronary heart disease and by gradually surmounting the obstacles of coronary arteriography, ballon catheter angioplasty, at the same time measures its limitations. These are recurring stenoses and failure of this procedure to cure chronic coronary occlusions, and they specifically characterize a method which, at the expense of unavoidable parietal lesions, does not eliminate the cause of the stenosis. It appears more desirable to remove atheromatous tissue by its extraction, vaporization or pulverization, to reinforce the wall of the coronary vessel, and these are the objectives of second-generation procedures. Development of angioscopy, lasers, atherotomies, and endoprostheses illustrates the vitality and the innovation present in invasive methods of cardiac therapeutic management. However, for the time being their clinical development of such procedures is incomplete and has not been sufficiently perfected. Future methods of angioplasty will be more satisfactory and have better control, but at present it is difficult to accurately predict the future aspects of such procedures.

Angioplasty, Balloon↗
PubMed1987

Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.

Occlusion and restenosis are the most common reasons that transluminal balloon angioplasty may fail to provide long-term benefit. An intravascular mechanical support was therefore developed with the aim of preventing restenosis and sudden closure of diseased arteries after angioplasty. The endoprosthesis consists of a self-expandable stainless-steel mesh that can be implanted nonsurgically in the coronary or peripheral arteries. Experiments in animals showed complete intimal coverage within weeks and no late thrombosis during a follow-up period of up to one year. We performed 10 implantations in 6 patients for iliac or femoral arterial disease; 24 coronary-artery stents were implanted in 19 patients who presented with coronary-artery restenoses (n = 17) or abrupt closure (n = 4) after transluminal angioplasty or deterioration of coronary-bypass grafts (n = 3). We observed three complications in the group with coronary disease. One thrombotic occlusion of a stent resulted in asymptomatic closure, a second acute thrombosis was managed successfully with thrombolysis, and one patient died after bypass surgery for a suspected but unfound occlusion. Follow-up in the patients has continued for nine months without evidence of any further restenoses within the stented segments. Our preliminary experience suggests that this vascular endoprosthesis may offer a useful way to prevent occlusion and restenosis after transluminal angioplasty. Long-term follow-up will be required to validate the early success of this procedure.

Angioplasty, Balloon↗
PubMed1987

Self-expanding endovascular prosthesis: an experimental study.

A new type of endovascular prosthesis was inserted in 28 animals and evaluated for several factors, including thrombogenicity, tendency to migrate, critical implant zones, and incorporation into the vascular wall. The new prosthesis is a woven, multifilament structure of stainless steel alloy; its inherent elastic, self-expanding characteristics hold it against the vessel walls. Forty-seven endoprostheses (3-5 mm in diameter, 15-50 mm long) were percutaneously implanted with either a 6-F introducer sheath, a coaxial 9-F catheter, or a 0.014-inch (0.036-cm) guide wire into the femoropopliteal, coronary, carotid, and renal arteries and iliac veins. Anticoagulant or platelet antiaggregating agents were not used before or after implantation. Angiographic and histologic analyses showed that the prosthesis had a very low thrombogenicity when it was well adapted to the native vessel diameter and that it was incorporated into the vessel wall by a new intima by the 3d week after implantation. No migration occurred, and branch vessel flow was preserved even in those vessels in which ostia were traversed by the prosthesis. This prosthesis has potential for clinical application in the treatment of postangioplasty restenoses, particularly in the coronary arteries.

Animals↗
PubMed1987

[HIV seropositivity and pregnancy. Apropos of 48 cases (how should they be managed at the present time?)].

We describe the gynaecological and obstetrical management of 48 HIV seropositive, pregnant women and review the literature. We did not find that pregnancy aggravated the development of the condition from the asymptomatic anti-HIV related complex (ARC) and AIDS. It seemed that fetal malformations, especially of the face, occurred most frequently in babies born to HIV seropositive mothers. Materno-fetal transmission of HIV was found in the uterus in 50% of our cases. In conclusion, we recommend safe contraception to prevent pregnancies in anti HIV seropositive women. If that fails, induced first trimester abortion is medically indicated and should be carried out if possible, as should strict medical control post-partum of both mother and child if the pregnancy is carried to term.

AIDS-Related Complex↗
PubMed1986

[Coronary revascularization at the acute phase of myocardial infarction. Short and median-term survival of 359 patients. Multicenter study].

Three hundred and fifty nine consecutive patients from 4 different French centres who underwent attempted early coronary revascularisation during the acute phase of myocardial infarction by intracoronary thrombolysis (309 cases) intravenous thrombolysis (26 cases) and transluminal angioplasty (24 cases) were reviewed to evaluate the short and medium term results of these non-surgical techniques. Three groups of patients were identified from the results of initial and secondary coronary angiography: 1) deaths during the procedure (1.9%), 2) successes, with immediate and stable revascularisation (65%), 3) failures, also including initial successes with secondary reocclusion (33.1%). The global mortality at one month was 10.9%. This was significantly lower after revascularisation (p less than 0.001): 4.7% in patients with successful procedures and 17.6% in the others. The one year survival rate was also significantly higher in patients successful revascularisation (93 +/- 4% vs 75 +/- 8%, p less than 0.001). There were more recurrent infarctions and residual angina in patients with successful early coronary revascularisation: 7.7% and 12% respectively vs 4.2% and 8.4% respectively in the other patient group. In the successful group, 200 patients (86%) had one or more stenoses greater than 70% narrowing after coronary revascularisation. The recurrent infarction rate in the 94 patients treated medically was 9% and 17% had residual angina compared to 6% and 10% respectively in the 106 patients referred for coronary bypass surgery or undergoing complementary angioplasty. Three conclusions may be drawn from this non-randomised study of coronary revascularisation during the acute phase of myocardial infarction: attempts at coronary revascularisation do not aggravate the immediate prognosis of myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Immediate coronary angioplasty in the acute phase of myocardial infarction. French multicenter study: December 1983].

Following the introduction of intracoronary thrombolysis in the acute phase of myocardial infarction (AMI), transcutaneous coronary angioplasty (TCA) was originally conceived as a logical complementary procedure to treat residual stenosis and so prevent the frequent post-thrombolysis reocclusion (20-30 p. 100 of cases). With increasing experience TCA of first intent appeared rational, more rapid and effective, ensuring coronary recanalisation (CR), suppression of residual stenosis and the prevention of reocclusion in the same procedure with with the objective of reducing the number of coronary bypass grafts (CBG) in patients with single vessel disease. A French multicentre study of 22 cases was organised by 9 centres. The average period between onset of symptoms and intervention was 2 hours 10 mins (range 30 mins-5 hours 30 mins). The average duration of the procedure was only 30 mins. 16 patients had anterior and 6 patients inferior AMI. Coronary angiography showed 12 occlusions (54.5 p. 100) and 10 sub-occlusions with 6 cases of delayed opacification. All patients had successful initial TCA with no major complications. The arterial occlusions decreased from 100 p. 100 to 31 p. 100 and the subocclusions from 94 to 12 p. 100. 2 patients died in the hospital period, one at the 48th hour of controlateral AMI and the other one at the 5th day of reocclusion. Three patients developed reocclusion at the site of the original TCA. Complete regression of ECG changes was observed in 31.8 p. 100 of cases. Complete recovery of normal left ventricular function was observed in 8 of the 17 patients who underwent follow-up investigations (47 p. 100 of cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Effects of amrinone administered orally and by injection in heart failure].

Amrinone is a new positive inotropic agent available in oral and intravenous preparations. Twelve patients with Stage III cardiac failure of ischaemic (6 cases), myocardial (5 cases) or valvular (1 case) origin, were treated with oral amrinone. The protocol included a complete clinical, radiological and biochemical work-up, an exercise stress test, cardiac catheterisation and echocardiography before entering the trial. The patients underwent clinical examination, stress testing and echocardiography at the 4th, 8th and 12th week of treatment with 300 mg daily of amrinone. Two patients had to be withdrawn from the trial because of thrombocytopaenia; one patient deteriorated and eventually died of pulmonary embolism. There was a marked improvement in the 8 patients who achieved the trial, with an average gain of 40 watts on exercise testing, a mean reduction of 16 mm Hg in diastolic pulmonary pressures, and an increase of 11 p. 100 in EF and velocity of circumferential fibre shortening. Four additional patients were given intravenous amrinone (1 cc/kg relayed with an infusion of 1 ng/kg/min). Ventricular end-diastolic pressures fell by 9 mm Hg and cardiac index rose by 1.02 1/min/m2. Tolerance was good with no arrhythmic complications or significant variations in mean arterial pressure or heart rate. Although certain reserves have to be made with regards of tolerance of oral amrinone, the drug would seem to be useful and effective in the intravenous form. Further studies are under way.

Administration, Oral↗
PubMed1985

[Topographic aspects of threatened extension of transmural myocardial infarction. Electrocardiographic and coronarographic data].

The topographical and physiopathological aspects of the danger of extension of infarction of the myocardium are defined with the aid of data collected by electrocardiogram and coronarography in 50 patients. The danger of extension in situ, observed in 64% of the cases, is the most frequent and complicates particularly the progression of anterior infarcts. In fact, it is located in the same area as the initial infarct in 91% of the cases for anterior infarcts and in 40% of the cases for inferior infarcts. It is expressed by an elevation of the ST segment in 84% of the cases and corresponds to a monotruncular attack in 63% of the cases. The downstream bed of the vessel destined for the infarcted area and threatened secondarily remains permeable in the anterograde sense. Apart from infarcts, the danger of extension is less frequent, found in 36% of the cases, and complicates preferentially the progression of inferior infarcts. It finds expression in a depression of the ST segment in 77% of the cases and the coronary attack is always pluritruncular. The mortality in one month is 35% of 17 patients treated medically and 3% of 33 patients who have been equipped with a shunt or angioplasty. In situ the danger of extension denotes the presence of cellular islets, which are still healthy, in the region of an infarcted myocardial zone, the viability of which may be threatened secondarily by a phenomenon of coronary occlusion, which is intermittent and repeated. Except for an infarct, the danger of extension implies the diffusion of an atheromatous effect. The good results of surgical treatment or dilatation argues in favour of an early coronarographic exploration.

Coronary Angiography↗
PubMed1984

Selective coronary arteriography by percutaneous transaxillary approach.

Coronary angiography by the percutaneous femoral approach is widely used. This technique is potentially dangerous or impossible in patients with advanced arterial disease of the lower limbs, whether or not surgically treated. In these cases, percutaneous left or right axillary approach is an alternative to brachial approach. In this article, we report our multicenter experience involving 120 patients. The left axillary artery was used in 94 cases (78%) and the right in 26 cases (22%). We used performed coronary catheters usually associated with the femoral approach. The left axillary artery was used preferentially since this avoids catheterization of the innominated trunk and allows easier catheterization of the coronary ostia and aortic ends of aorto-coronary bypass grafts. The routine use of a sheath (arterial introducer) avoided arterial compression during catheterization, prevented hemorrhagic suffusion when the catheters were exchanged, and reduced the risk of thrombosis or laceration of the axillary artery. There were no failures in the catheterization of the axillary artery and no complication was observed during or after the procedure. Axillary percutaneous technique appears to have the following advantages over the brachial arteriotomy: 1) Investigation time is equivalent to the time needed for the femoral percutaneous approach. 2) There is the possibility of lateral and simultaneous bi-plane angiograms. 3) Arterial puncture is preferable to arteriotomy. The axillary approach could also be used for percutaneous transluminal coronary angioplasty.

Adult↗
PubMed1984

[Coronary angioplasty immediately after intracoronary thrombolysis during the acute phase of myocardial infarction].

Since the introduction of intracoronary thrombolysis in the acute phase of myocardial infarction, all workers have observed a high incidence of coronary reocclusion (about 20%) essentially in the first hours and days after coronary recanalisation (CR). This had led to some groups carrying out transluminal coronary angioplasty (TCA) at the same time as CR by thrombolysis in situ to treat significant residual postthrombolysis stenosis. This french multicentre study carried out in 5 centres concerned 9 men (average age: 46.1 years) with 5 anterior infarcts (total thrombosis of the LAD artery) and 4 inferior infarcts (total thrombosis of the right coronary artery-RCA). Intracoronary trinitrate was ineffective in relieving the occlusion in all cases. In 5 cases, the thrombolytic protocol was streptokinase (SK) 3 000 u/min for 60 minutes; in the other 4 cases, the plasminogen-urokinase (Pg-UK) protocol was used. Thrombolysis was successful in all 9 cases. The results of TCA performed at the same time were also good (8/9 successes; 4 LAD and 4 RCA) without any complications during the procedure. There was only one immediate post-TCA reocclusion on a LAD artery. In all cases the initial ECG appearances of infarction remained, CR only appearing to prevent extension of the necrosis. The successful results of CR + TCA were maintained in 6 out of 7 patients reinvestigated 2 days to 6 months (average 6 months) after the initial procedure: the only case of reocclusion occurred after 48 hours on a RCA. The overall procedure never exceeded 2 hours.

Adult↗
PubMed1984

[Evaluation of ventricular tachycardia by endocavitary stimulation. Apropos of 46 cases].

Thirty six patients (21 coronary artery disease, 8 cardiomyopathy, 3 mitral valve prolapse and 4 apparently normal) underwent endocavitary stimulation studies. The protocol consisted in delivering one or two right ventricular extrastimuli and twice the diastolic threshold either during spontaneous rhythm (S2 and S2-S3) or a paced ventricular rhythm (S1-S2 and S1-S2-S3). In 9 patients overdrive ventricular pacing at 150-200 bpm was required. Thirteen of the 15 documented sustained ventricular tachycardias could be induced by electrical stimulation (87%). In addition, 9 sustained ventricular tachycardias were induced in patients in whom the symptomatology corresponded to poorly tolerated tachycardia but in whom the documented arrhythmia was non-sustained ventricular tachycardia (4 cases), frequent ventricular extrasystoles with doublets (2 cases) or rare, isolated ventricular extrasystoles (3 cases). The method was less sensitive in non-sustained ventricular tachycardia in which the arrhythmia was induced in 10 of the 17 cases (59%). An antiarrhythmic drug was selected on the basis of these studies in 28 patients, 21 of whom had sustained ventricular tachycardia. There were 6 therapeutic failures with a follow-up of 6 to 24 months, three of which were observed in patients with coronary artery disease and a precarious haemodynamic state. This subgroup is not suitable for this type of evaluation. After reviewing other published series the authors emphasise the value of these investigations in chronic sustained ventricular tachycardia, in ventricular tachycardia with cardiovascular collapse and in the assessment of syncope of unknown origin. However, the systematic investigation of repetitive ventricular responses after ventricular stimulation in patients at high risk of sudden death remains controversial.

Adult↗
PubMed1984

[Electrophysiological effects of encainide in man].

Encainide is an antiarrhythmic agent under evaluation; it is effective in ventricular and supraventricular arrhythmias. Its electrophysiological effects seem to differ according to the route of administration, oral or intravenous, probably because of the effects of active metabolites. Two electrophysiological studies were carried out in 20 patients, under basal conditions, and after 4 to 10 days oral administration at doses ranging from 75 to 300 mg/day. Encainide depressed intra-atrial conduction (prolongation of the P-A interval from 29,7 +/- 2,2 to 36 +/- 4,5 ms, p less than 0,01), slowed conduction in the atrioventricular mode (prolongation of the A-H interval from 74 +/- 14 to 98 +/- 15 ms, p less than 0,01) and the His-Purkinje system (lengthening of H-V from 50 +/- 3 to 70 +/- 6,2 ms, p less than 0,001). The sinus node function was depressed with lengthening of the corrected sinus node recovery time (297 +/- 64 to 387 +/- 71 ms, p less than 0,01) and of the sinoatrial conduction time (173 +/- 25 to 219 +/- 43, p less than 0,01). The atrial and ventricular refractory periods were significantly longer (245 +/- 16 ms to 273 +/- 10 ms, p less than 0,001, and 237 +/- 12 to 266 +/- 19 ms, p less than 0,01, respectively). This new antiarrhythmic agent therefore seems to act at all levels which suggests that it may have wide ranging antiarrhythmic effects.

Administration, Oral↗
PubMed1984

[Value of provocation tests in the evaluation of the treatment of ventricular tachycardias with amiodarone].

The role of provocation tests for the assessment of amiodarone therapy in patients with ventricular tachycardia remains a subject of controversy: recent studies seem to show that the ability to initiate VT in patients on amiodarone is compatible with a good long-term result. Eighteen patients, 16 male and 2 female, average age 56 years, were treated with amiodarone (600 mg/day in 15 cases, and 400 mg/day in 3 cases) and submitted to provocative tests before and after treatment. The mean follow-up period was 14 +/- 4 months. In Group I (5 patients), VT could not be initiated after treatment and there were no relapses of the arrhythmia. In Group II (6 patients), non-sustained VT could be initiated and only one relapse was observed after a close reduction from 600 to 400 mg/day; Group III comprised 5 patients with spontaneous recurrences. An identical VT could be initiated during electrophysiological investigation which served as a basis for selection of an effective antiarrhythmic association. Two patients could not be studied after drug impregnation (1 sudden death, 1 exacerbation of VT). The results of this study show that provocative pacing can be useful in evaluating the efficacy of amiodarone, as in Groups I and II (61% of patients) a favourable prognosis could be predicted in 91% of cases. In cases of therapeutic failure with spontaneous recurrences of VT, the same provocation tests enabled a more effective drug combination to be selected.

Adult↗
PubMed1984

[So-called rudimentary or nontransmural myocardial infarction. Coronary lesions, course and prognosis].

Eighty patients admitted to hospital between 1975 and 1980 for "non-transmural" myocardial infarction (72 men, 8 women, mean age 56 +/- 9 years) were studied. The diagnosis was based on a severe attack of pain of over 30 minutes duration, increased serum cardiac enzyme levels (CKMB greater than 24 U; SGOT greater than 60 U), pyrexia and signs of inflammation. The patients were divided into two groups according to their ECG changes: Group A: "rudimentary" infarction with prolonged T wave inversion from V1 to V5, narrow transient Q waves and reduction of R wave amplitude in the corresponding leads; Group B: persistant prolonged, intercritical ST depression greater than 2.5 mm (subendocardial infarct). All patients underwent selective coronary angiography and left ventriculography in the RAO projection within 15 days of admission. The angiographic data (coronary score, ejection fraction, alinetic perimeter) were compared to those of 2 randomly chosen control groups: Group C: 30 inferior wall infarcts with coronary angiography and regularly followed-up; Group D: 30 transmural anterior infarcts with coronary angiography, regularly followed-up. Four factors were analysed during follow-up: the incidence of death after discharge from hospital, transmural infarction, unstable angina and cardiac failure. All patients were treated medically (nitrate derivatives, betablockers, calcium antagonists). Sixteen patients in Group A (p less than 0,025) were operated and excluded from the prognostic study. The angiographic data showed a high incidence of isolated, severe LAD disease in Group A (59.2% of cases) and that multivessel disease was commoner in Group B (78.4%). A collateral circulation revascularising the LAD was observed in 42% of patients in Group A. (ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗