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Biomedical subjects

L Campeau

Publications and source records attributed to L Campeau.

At least 73 records · Page 4Linked to original sources
PubMed1979

Natural history of saccular aneurysms of the left ventricle.

We have studied the natural history of left ventricular aneurysms (LVA) in 40 patients not treated surgically who were followed for a mean period of 5 years, 8 months. These patients have been divided into two groups according to the presence (Group B) or absence (Group A) of significant symptomatology. The causes of death are dominated by arrhythmias and congestive heart failure (CHF). The survival rate at 10 years is 66.7% for the entire group. In asymptomatic patients the 10 year survival rate is 90%, but it is only 46.3% in those who were symptomatic at the time of the initial diagnosis. In general, the clinical course of survivors is stable in Group A but has deteriorated steadily in Group B. Nonfatal complications include arrhythmias (observed in 34% of all patients), thromboembolic phenomena (29%), CHF (29%), and recurrent myocardial infarction (22.5%). Factors influencing prognosis are the extent of the aneurysm, the association of asynergic segments, the ejection fraction of the residual ventricle, the left ventricular end-diastolic pressure (LVEDP), and the presence of ventricular extrasystoles at the time of diagnosis. The mere presence of aneurysm is not, in itself, an indication for operation. Incapacitating angina and refractory CHF are the most valuable indications for surgical resection. The question is raised as to the value of operation in patients with little or no symptoms, in those with isolated life-threatening arrhythmias, and in those in whom a mural thrombus is the only distressing feature.

Adult↗
PubMed1978

Left main coronary artery stenosis: the influence of aortocoronary bypass surgery on survival.

A retrospective study was carried out in 114 unoperated and 197 operated patients having left main coronary artery (LMCA) stenosis greater than or equal to 50%. Including the operative mortality of 9.1%, survival at seven years was significantly greater following pure aortocoronary bypass graft surgery, 77.5% as compared to 48.5% for the unoperated patients (P less than 0.01). The surgical mortality was significantly less during the last five years (1972-1976), 6.2% as compared to 17% during 1969-1971 (P less than 0.025). The three year survival in patients operated since 1972 was 90.2% as compared to 60.4% for unoperated patients. Survival remained significantly higher in the operated patients when studied as subsets on the basis of the severity of the LMCA stenosis (less than 70% as opposed to greater than or equal to 70%), and on the extent of associated obstructive disease of major coronary arteries (0-1 versus 2-3 arteries). It was significantly higher, however, only in operated patients with associated stenosis greater than or equal to 70% of the right coronary artery. Survival was higher following surgery only when the ejection fraction was at least 0.45, or the left ventricular end-diastolic pressure below 20 mm Hg.

Adult↗
PubMed1978

Progression of obstructive coronary artery disease 5 to 7 years after aortocoronary bypass surgery.

Changes in the native coronary circulation were evaluated 5 to 7 years (72 +/- 10 months) after aortocoronary bypass surgery in 108 patients; 104 had had previous angiographic controls between 6 and 18 months following surgery. Coronary artery narrowings were graded on a scale of 0 to 6, 0 being normal, grade 1 and 2, < or = 50%; grade 3, 51-75%; grade 4, 76-90%; grade 5, 91-99% narrowing and grade 6 total occlusion. Progression of disease was significant when a preexisting stenosis increased at least 1 grade or a new lesion > 50% developed. Nongrafted vessels were compared to arteries with patent or occluded grafts. During the first year following surgery, the rate of progression was much higher in grafted arteries with patent or occluded grafts than in nongrafted arteries 157 and 53% vs 9.5% respectively, P < 0.001). During the subsequent period of approximately 5 years, however, grafted arteries did not change, whereas the rate of progression in nongrafted arteries increased from 9.5 to 46%. At 5 to 7 years after surgery, grade 1 and 2 (< or = 50%) narrowings progressed slightly more frequently in grafted arteries because of surgically related events. However, for narrowings > 50% and for new lesions, there was no difference in the rate of progression between grafted and nongrafted vessels. In conclusion, the rate of progression of atherosclerosis in nongrafted coronary arteries is important. At 5 to 7 years after surgery, there is little or no difference in the severity of the disease in the proximal segments of grafted and nongrafted coronary arteries.

Coronary Artery Bypass↗
PubMed1978

Aortocoronary saphenous vein bypass graft changes 5 to 7 years after surgery.

Control angiographic studies were carried out 54 to 88 months after aortocoronary saphenous vein bypass surgery (70 +/- 10 months) in 100 unselected patients who were known to have at least one patent graft 6 to 18 months following the operation. Only 17 of the 159 grafts were found occluded during this interval of 5 years, giving an average yearly attrition rate of 2.1% after the first year. The mean yearly attrition rate was 0.7% in our second series of near consecutive patients operated on after 2 years of experience and modifications of surgical techniques, and it compares favorably with the 2.4% yearly attrition rate found in our first series of patients (P < 0.05). Of the 37 grafts having localized stenoses at 1 year, eight became occluded (21.6%), and four became worse. Grafts with localized stenoses were more prone to late occlusion, whereas no late occlusion was observed in normally appearing grafts at 1 year. Diffuse graft narrowing noted during the first year showed no further change during the subsequent 5 years, and it did not appear to lead to late occlusion. Finally, in 14 grafts, localized narrowing developed after the first year, at a yearly rate of 1.5%. Atherosclerosis appears to be the most likely etiology, being found in two of these instances at reoperation.

Coronary Angiography↗
PubMed1978

Optimal patency rates obtained in coronary artery grafting with circular vein grafts.

Twenty-two patients underwent coronary artery grafting with a circular vein graft comprising four or five distal coronary anastomoses. Postoperative angiographic evaluation showed patency in 90 (95.7 percent) of the 94 coronary anastomoses fashioned in this manner. All four occlusions occurred in the one patient whose graft comprised five anastomoses and was occluded beyond the first anastomosis on the right coronary artery (RCA). Eleven of the 94 anastomoses were made onto arteries with limited runoff. Blod flow averaged 214 ml. per minute (range 130 to 320) in the main portion of the graft and 59 ml. per minute (range 35 to 100) in the most distal segment. Flow doubled (averaged 403 ml. per minute) in the 11 grafts injected with papaverine. The technique of circular vein grafting is described in detail and potential pitfalls are outlined. The reasons for the high early patency rate are believed to be the following: (1) high flow in the proximal segment of the graft insuring patency of said segment, (2) termination on the left anterior descending (LAD) coronary artery providing good distal flow and patency. (3) diamond-shaped side-to-side anastomoses (SSA's) preventing angulation of the graft at these crucial points, and (4) nearly equidistant anchoring at the site of the multiple anastomoses giving the graft a smooth, even contour.

Coronary Artery Bypass↗
PubMed1977

Risks of discontinuing anticoagulant therapy in a selected group of patients with atherosclerotic heart disease: a prospective study.

In 134 patients with coronary artery disease, long-term oral anticoagulant therapy (mean duration, 56 months) for acute myocardial infarction (98 patients), acute coronary insufficiency (25 patients) or severe chronic angina (11 patients) was terminated abruptly in 50 patients (group 1) and gradually in 84 (group 2). The 134 patients represented a homogeneous population of patients with coronary artery disease since most patients older than 75 years and those with conditions known to increase the risks of thromboembolic complications were excluded. The two groups were comparable in terms of sex, age, presence of risk factors, duration of anticoagulant therapy, and presence of angina and abnormal resting electrocardiograms during therapy. Patients were evaluated 6 months after cessation of anticoagulant therapy and, since abrupt withdrawal of therapy did not carry a higher risk than gradual discontinuation, data for groups 1 and 2 were tabulated together.Of the 84 patients with angina at the end of therapy 15 experienced an increase in its severity and this symptom appeared in another patient (relapse rate, 18%). Angina progressed to fatal acute myocardial infarction in four (mortality, 3%) and nonfatal infarction in two; however, all six had extensive coronary artery disease and poor left ventricular function. The results of this study suggest that neither abrupt nor gradual cessation of anticoagulant therapy is associated with an inordinate exacerbation of heart disease.

Adult↗
PubMed1977

Influence of left ventricular function and other parameters on early and late mortality following coronary bypass surgery.

Left ventricular performance, coronary anatomy and postoperative clinical parameters of 66 control patients (group 1) randomly selected from 797 survivors of coronary bypass surgery were compared with those of 45 patients who died within 30 days of operation (group II) and 53 patients who died late (average, 22+/-2 mo) (group III). Average preoperative left ventricular end-diastolic pressure, ejection fraction and mean circumferential fibre shortening rate were significantly better in group I than in group III patients. These same parameters were not significantly different when group I was compared to group II. Abnormal wall motion was significantly less frequent in patients from group I than in patients from group II and III. Triple-vessel disease was present preoperatively in 40 (61%) controls compared with 37 (82%) early deaths (P = 0.021) and 35 (66%) late deaths (NS). The number of grafts placed per patient was not significantly different in the three groups. Perioperative myocardial in farction (MI) and low cardiac output syndrome were the commonest causes of early death. Late complications such as MI and heart failure occurred in 4 (6%) v; 15 (32%) (P = 0.0006) and 4 (6%) v. 27 (57%) (Pless than 0.0001) group I v. group III patients, respectively. Surgical expertise, preoperative ventricular performance and triple-vessel disease are important determinants of early mortality following bypass surgery and preoperative left ventricular performance is one of the most important determinants of late mortality,

Coronary Artery Bypass↗
PubMed1976

Therapeutic implications of diazepam in patients with elevated left ventricular filling pressure.

Diazepam (0.1 mg. per kilogram) was given intravenously to 12 patients with hemodynamic left ventricular failure at the time of cardiac catheterization. Anxiety was effectively relieved in 10 patients. Systemic and coronary hemodynamic parameters were assessed before and 5 and 15 minutes after diazepam. Heart rate, cardiac index, and left ventricular stroke-work index did not change significantly. Mean aortic pressure decreased in all patients (average of 10 mm. Hg) and left ventricular end-diastolic pressure (LVEDP) decreased from a mean +/- S.E.M. of 24.3 +/- 3 mm. Hg at rest to 16 +/- 2.1 at 5 minutes (p less than 0.001) and 15.8 +/- 2.1 at 5 minutes (p less than 0.002). Left ventricular angiography performed 30 minutes after diazepam did not increase LVEDP above the pre-diazepam control value. Systolic ejection period and tension-time index also decreased significantly after diazepam. Coronary hemodynamics and myocardial metabolism were unaltered by diazepam. The fall in LVEDP induced by diazepam is probably secondary to a decrease in arterial pressure (afterload) possibly associated with a decrease in venous return (preload). Our data therefore suggest that diazepam exerts a beneficial action on depressed left ventricular function and, thus, may be a sedative agent of choice in patients with myocardial infarction and heart failure.

Anxiety↗
PubMed1976

[Effort electrocardiogram in woman].

On the basis of 150 results on patients who underwent an ECG at submaximal exercise, selective coronary arteriography and cine-arteriography, this study has established that: -- certain elecerographic criteria of coronary insufficiency which have a high predictive value in males (a "near ischeamic" appearance, an J depression at or above 4 mm) are not applicable to the female; -- where an ECG tracing which is abnormal at rest becomes normal on exercise, then in both males and females there is a healthy coronary tree; -- the incidence of false-positives is 22.9%, which is 4 times that found in males; -- propranolol (60 mg orally) returns these pseudo-ischaemic changes in the resting and exercise ECG to normal and affords a simple method of identifying the false positives.

Adult↗