Biomedical subjects

L Maillard

Publications and source records attributed to L Maillard.

46 records · Page 3Linked to original sources

PubMed1996

[A rare cause of pure isolated chronic aortic insufficiency: congenital quadricuspid aortic valve. Apropos of 2 cases].

The authors report two new cases of congenital quadricuspid aortic valve complicated by pure, severe, chronic, aortic regurgitation. This abnormality was diagnosed fortuitously at transoesophageal echocardiography in one case and at aortography in the other, and confirmed at surgery. This congenital abnormality was associated with superior displacement of the left coronary ostium.

Aged↗

PubMed1996

[Transesophageal echography and systemic ischemic incidences: 235 cases].

From the first of June 90 to the thirty first of January 94, transesophageal echocardiography was performed in 235 consecutive patients (mean age 56+/-16 years), presenting either with cerebral ischemic event (n = 202) or a peripheral arterial embolism (n = 33). All patients had normal echocardiographic and Doppler examinations of the carotid arteries, and transthoracic echocardiography did not show any possible cardiac origin for stroke. Ninety seven patients (41.2%) had documented cardiac disease and/or atrial fibrillation (group 1); 138 patients (58.8%) had no previous cardiovascular history (group 2). Transesophageal echocardiography revealed a possible embolic source in 65.9% of cases (group 1) compared with 29.7% of cases in group 2 (p < 0.001). Intracavitary thrombus and spontaneous contrast in the left atrium were detected only in group 1 (21.6% vs 0%, p < 0.001 and 24.7% vs 0%, p < 0.001 respectively). Patent foramen ovale was more frequent in group 2: 14.5% of cases vs 4.1% of cases, p < 0.01. There was no significant difference between atheromatous aortic plaques and interatrial septam aneurysm incidence in the two groups. Patent foramen ovale and interatrial septal aneurysm were more frequent in group 2: 85% of cases vs 10% of cases in group 1. Transesophageal echocardiography contributes more in patients with a history of cardiac disease. In patients without cardiac disease, patient with foramen ovale and interatrial septal aneurysm were mainly detected: their association represented a risk factor of cerebral ischemic event. Therefore transesophageal echocardiography should be performed in young patients or in case of recurrent event.

Adult↗

PubMed1996

[Coronary embolism disclosing thrombosis on a Medtronic-Hall aortic valve prosthesis in aortic position].

A 32 year-old-man admitted to hospital on the third day of myocardial infarction, three months after aortic valve replacement with a mechanical Medtronic-Hall prosthesis. The embolic character of the disease was evident on coronary angiography which showed a large thrombus in the left main coronary artery. The thrombosis of the valve prosthesis was not detected by non-invasive investigations but at aortography, confirmed at surgery. Thrombolysis with rt-PA did not dissolve the clot and reoperation was necessary (valve replacement with aorto-coronary bypass grafting).

Adult↗

PubMed1995

[Infarction in young women caused by intracoronary thrombosis on angiographically normal arteries: apropos of a case].

Myocardial infarction is a rare clinical event in young women. The usual presentation is similar to that of older adults. The authors report a case of anteroseptal infarction in a 24 year old woman presenting with paroxysmal epigastric pain without irradiation with fever, during menstruation. The electrocardiogram was compatible with acute pericarditis. The diagnosis was rectified by echocardiography which showed anteroseptal akinesia. Coronary angiography performed as an emergency showed a radiolucent mobile image in the mid segment of the left anterior descending artery with appearances of a distal embolism which were attributed to thrombosis. Intracoronary thrombolysis was associated with a good outcome.

Adult↗

PubMed1995

[Anterior mediastinal cyst disclosed by protracted thoracic pain].

The authors report a case of anterior mediastinal cyst discovered incidentally in a 71-year-old man presenting with prolonged chest pain and a history of chronic renal failure secondary to polycystic kidney disease. The diagnosis of these cysts, which are benign congenital tumours usually asymptomatic and with a favourable course, was established by thoracic CT. In difficult cases, magnetic resonance imaging allows precise analysis of pericardial masses. Clinicians should think of this possibility in the presence of an opacity of the cardiophrenic angle associated with chest pain.

Aged↗

PubMed1995

[Value of early stress test during treatment after myocardial infarction with Q wave in patients under 55 years of age].

We studied one hundred consecutive patients, under the age of 55 years (mean age: 45.6 years), with myocardial infarction and a Q wave, in order to assess the prognostic value of an early stress test. Thirty five patients were excluded: 2 deaths, 21 revascularizations during the acute phase, 4 tests were performed without treatment, 6 tests were unable to be performed and 2 patients left hospital against medical advice. Sixty five patients [males, n = 60 (92.2%), anterior infarction, n = 25 (38.5%), thrombolysed n = 35 (53.8%), intact left ventricular ejection fraction (mean: 54.7%)] systematically underwent a stress test limited by symptoms, in hospital, on the tenth day of infarction, using an ergometric bicycle and under medical treatment (including beta blockers n = 47 (72.2%)] and cardiac catheterization. The test was considered positive when it was accompanied by angina and/or ST depression (n = 19), negative in the absence of these criteria for a level of 120 watts (n = 23), inadequate when the duration was less than 9 minutes and when the heart rate was less than or equal to 70% of the theoretical maximal heart rate (n = 11), doubtful when there was accentuation of ST elevation in the infarcted territory with mirror ST depression (n = 12). Only 30.7% of patients had multi-vessel coronary lesions (two- and three-vessel disease). The mortality was 4.6% with a mean follow-up of 27.4 months (range: 3-38). The sensitivity of the test for detection of multi-vessel disease was 62.5%, the specificity was 65.3%, the positive predictive value was 52.6%, and the negative predictive value was 73.9%. The sensitivity of this test, with beta-blocker treatment, to predict coronary lesions or cardiac events, fell to 33.3% and 37.5%, respectively. The stress test during the post-infarction period, with beta-blocker treatment, appears to be less sensitive for the identification of multivessel disease and cardiac events: this treatment should therefore be suspended before performing this test when allowed by the patient's clinical state.

Adrenergic beta-Antagonists↗

PubMed1992

[Angioplasty after failure of thrombolysis in myocardial infarction. Hospital results apropos of 40 consecutive patients].

Intravenous thrombolysis during the acute phase of myocardial infarction is successful in restoring perfusion in 60 to 80% of cases. When it is unsuccessful, there is disagreement about the best approach to adopt. The article reports the results obtained in 40 consecutive patients treated by angioplasty after thrombolysis had been unsuccessful. Reperfusion was achieved in 92.5% of cases, with a hospital mortality rate of 7.5% (2.5% if patients admitted in a stage of cardiogenic shock are excluded). There was no mortality related to the procedure itself and an emergency aorto-coronary by-pass was not required in any case. Since it is accepted that the subsequent prognosis depends on coronary patency, coronary artery assessment after thrombolysis, followed by angioplasty if the occlusion persists seems to be a logical strategy if the myocardial territory is compromised.

Adult↗

PubMed1991

[Partial abnormal pulmonary venous return. An underestimated and unknown association in Turner-Ullrich syndrome. Presentation of an original case].

The authors report the case of a 59-year-old woman with a complex cardiac lesion consisting of degenerative major mitral insufficiency masking partial abnormal pulmonary venous return. These cardiac abnormalities fell within a context of genetic disease since the patient had Turner's syndrome, confirmed at the age of 58 by a 45 x 0 karyotype. They detail the originality of the clinical manifestations of partial abnormal pulmonary venous return and review the literature concerning cardiac malformations in Turner's syndrome.

Angiography↗

PubMedDate not supplied

Primary coronary angioplasty in acute myocardial infarction excluded from thrombolysis: in-hospital and mid-term results.

The clinical, in-hospital and mid-term (14 +/- 12 months), results of primary percutaneous coronary angioplasty (PTCA) were investigated in 74 consecutive patients (pts) with acute myocardial infarction excluded from thrombolysis, of whom 9 pts with cardiogenic shock. In pts without cardiogenic shock at admission, the success rate of primary PTCA was high (92.3%) and the in-hospital mortality was low (3%). There were 89.2% asymptomatic pts during the in-hospital period. During the mid-term follow-up, pts without cardiogenic shock at admission had a mortality of only 4%, 66% of them remained asymptomatic, 24% developed angina pectoris and 6% had a new myocardial infarction. In pts with cardiogenic shock at admission to the hospital, the success rate of primary PTCA was of only 55.5% and the in-hospital mortality was high, 77.7%. In conclusion, primary PTCA in acute myocardial infarction excluded from thrombolysis is particularly useful in patients without cardiogenic shock.

Adult↗

PubMedDate not supplied

[Study of combined anticoagulant (fluindione)-aspirin therapy in patients with atrial fibrillation at high risk for thromboembolic complications. A randomized trial (FFAACS)].

BACKGROUND: A combination of low-dose aspirin (A) and anticoagulation (AC) may provide better protection against thromboembolic events compared with AC alone in high-risk patients with atrial fibrillation (AF). METHODS: We performed a multicentric placebo-controlled double blind-trial to test the preventive efficacy against thromboembolic events of the addition of aspirin (A) (100 mg) or placebo (P) to anticoagulant treatment in patients with high-risk atrial fibrillation. A total of 157 patients were included, with atrial fibrillation and previous thromboembolic event or older than 65 years with either a history of hypertension, a recent episode of heart failure or a left ventricular dysfunction. All patients received fluindione (F) and P or F and A, with an INR target between 2 and 2.6. The primary endpoint was a combined endpoint of stroke (ischaemic or haemorrhagic), myocardial infarction, systemic arterial emboli or vascular death. RESULTS: The study had to be stopped prematurely owing to a too low recruitment rate. During follow-up (0.84 years) 3 non-fatal thromboembolic events were recorded (1P, 2A) and 6 patients died (3P, 3A), none of them from a thromboembolic complication. However, 3 deaths were secondary to severe haemorrhagic complications (1P, 2A). Non-fatal haemorrhagic complications occurred more often in group A (n = 10, 13.1 pour cent) compared with group P (n = 1, 1.2 pour cent), p = 0.003. CONCLUSION: The FFAACS study was not able to show any therapeutic benefit from the addition of aspirin to anticoagulant in patients with high-risk AF. Such a combination increased the incidence rate of bleeding complications, which therefore greatly reduces its potential overall benefit.

Aged↗