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Biomedical subjects

N Danchin

Publications and source records attributed to N Danchin.

At least 253 records · Page 14Linked to original sources
PubMed1988

Work capacity after myocardial revascularization: factors related to work resumption.

For patients with coronary artery disease the ability to retain or resume a normal occupation must be one of the goals of myocardial revascularization procedures. Provided myocardial revascularization is sufficiently complete and left ventricular function is not severely impaired, this goal should be achieved in virtually all cases. The rates of return to work after coronary surgery, however, are often lower than what could be expected. Analysis of the factors related to work resumption after coronary surgery shows that non-medical preoperative parameters (age, educational level, type of occupation, and, most of all, length of preoperative unemployment) are major predictors of subsequent re-employment, whereas medical preoperative factors have little or no influence on return to work. In contrast, re-employment following coronary surgery is strongly influenced by the success of the revascularization procedure, with much fewer patients resuming work in case of poor exercise capacity or persisting angina after surgery. Percutaneous transluminal coronary angioplasty is usually given to patients with less extensive coronary artery disease, and rates of return to work higher than after surgery are observed; re-employment after PTCA is also influenced by the initial result of the procedure. Recognition of the factors negatively influencing return to work after myocardial revascularization is important in an attempt to improve work resumption by appropriate medical, psychological and social measures.

Angina Pectoris↗
PubMed1988

Exercise training, cardiac rehabilitation and return to work in patients with coronary artery disease.

Few studies have analysed the influence of exercise training or cardiac rehabilitation on return to work in patients with coronary artery disease. In a consecutive series of 41 men less than 60 years of age admitted for acute myocardial infarction, 19 participated in a comprehensive rehabilitation programme focused on physical training, and 22 received standard care. The baseline clinical and social variables of the two groups were comparable except for left ventricular ejection fraction which was significantly lower in the intervention group. Work resumption was not significantly different between the two groups (9/19, 47% in the intervention group vs 17/22, 77% in the control group); after three years, 42% and 73%, respectively, were still employed. These results are in keeping with that of most controlled studies of cardiac rehabilitation after myocardial infarction or coronary artery surgery, which fail to demonstrate a significant improvement in work resumption. Psychosocial factors are probably more important determinants of work resumption than is exercise training.

Coronary Artery Bypass↗
PubMed1988

Sustained improvement in myocardial perfusion four to six years after PTCA in patients with a satisfactory angiographic result, six months after the procedure.

Of 46 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA) from April 1980 to August 1982 and who had a satisfactory angiographic result six months later, one died of cancer and 41 had a detailed evaluation with exercise single-photon emission computed tomography (SPECT, 40 patients) or repeat coronary angiography (one patient), 48-78 months after the procedure. During follow-up, two patients had recurrent angina due to progression of coronary artery disease requiring a second PTCA procedure of another coronary artery; one of them later had a limited myocardial infarction in an area supplied by the vessel initially dilated. At follow-up, only one patient had definite angina. All but one patient had a negative exercise test. Myocardial perfusion during exercise in the PTCA-related area, assessed by SPECT, was normal in 90% of the patients and showed a limited defect due to reversible ischaemia in the remaining four (10%). It is concluded that patients with a less than 50% stenosis six months after PTCA show sustained improvement in their functional status and myocardial perfusion, four to six years after the procedure suggesting continued patency of the coronary artery.

Adult↗
PubMed1988

Ten year follow up of patients with single vessel coronary artery disease that was suitable for percutaneous transluminal coronary angioplasty.

The 10 year outcome of patients with single vessel coronary artery disease who underwent coronary angiography more than 10 years before and who would have been potential candidates for percutaneous transluminal coronary angioplasty had it been available then is reported. Long term follow up data were obtained in 96 (91 men, five women; mean age 48 years) of 105 consecutive patients with single vessel coronary artery disease (greater than 70% stenosis), judged suitable for coronary angioplasty. Fifty patients had coronary bypass surgery within six months of catheterisation (surgical group) and 46 were treated medically (medical group). At entry to the study more patients in the surgical group had unstable angina, but fewer had a previous history of myocardial infarction. Ten year survival was 91% and remained excellent in all the subsets analysed. Moreover, the quality of life of these patients was good. Over the 10 year follow up, 16 (36%) of the patients treated medically and 13 (26%) in the surgical group were admitted to hospital because of cardiovascular events (including late coronary surgery in four of the patients treated medically). Lastly, 54/69 (78%) of the patients who were employed before catheterisation resumed work and 29 (42%) were still employed 10 years later. Although these data must be interpreted with care because of the limitations inherent in all retrospective studies, it appears that the long term results of conventional medical or surgical treatment are excellent in patients with single vessel coronary artery disease in whom percutaneous transluminal coronary angioplasty is now an option.

Adult↗
PubMed1988

[Coronary angioplasty in the elderly patient. Immediate results and mid-term outcome].

Between April 1980 and July 1986, 50 patients over 65 (32 men and 18 women; mean age: 72 years) were treated by transluminal coronary angioplasty. Before the dilatation, 58 p. cent of the patients presented a severe angor (class III or IV) and 44 p. cent were multi-truncular. The dilatation was successful in 39 patients (78%) and 13 patients developed a recurrent stenosis successfully treated in 9 instances by re-dilatation. Among the complications, there were 2 deaths (4%), 3 infarctions (6%) and 3 emergency coronary bypass operations (6%). With a mean 28 months follow-up, the overall survival is 92 p. cent. After a successful dilatation, 49 p. cent of the patients are completely asymptomatic and the subsequent cardiological hospitalizations are rare (11%). These results show that coronary dilatation represents an interesting therapeutic option in elderly coronary patients.

Aged↗
PubMed1988

[Percutaneous transluminal angioplasty. Is there still a role for the surgeon?].

Relating their own clinical experience and that of the medical literature, the authors examined the role of the surgeon in coronary angioplasty. Despite the considerable progress made in the management of accidents, they believe that one must be able to resort to surgery--even if the percentage of patients who undergo emergency surgery decreases significantly--in the form of a standby procedure organized according to the difficulty of the angioplasty. Moreover, the surgeon uses this technique during the procedure for additional revascularization above the graft on collateral arteries and angioplasty can and should be used in a higher number of cases as a supplement for coronary bypass procedures.

Angioplasty, Balloon↗
PubMed1988

[10-year results of anastomoses of the left internal mammary artery to the anterior interventricular artery. Angiographic and radionuclide controls].

The long term patency of left internal mammary artery graft is better than that of saphenous vein graft. The aim of this study was to determined if this high patency rate was accompanied by a satisfactory myocardial perfusion. Among 143 patients treated with an internal mammary artery graft on the left anterior descending artery between 1972 and 1976, 42 patients underwent coronary angiogram and exercise tomoscintigraphy (thallium 201) over 10 years after surgery. The left internal mammary artery was patent in 92% without any atheromatous lesions. The myocardial perfusion in the area supplied by the left anterior descending artery was normal in 74%. A slight ischemia appeared during exercise in 19% without any clinical symptoms. This long term study shows excellent anatomical results correlated with a good myocardial perfusion during exercise in most cases.

Adult↗
PubMed1987

[Prognosis of spontaneous occlusions in tight coronary stenosis].

Eighteen out of 408 patients assigned to coronary angioplasty rapidly developed complete obstruction of the vessel to be dilated. The results of a retrospective study of clinical, biochemical, angiographic and/or angio-scintigraphic events in these 18 patients are reported. The interval between the two coronary arteriographies was 67 +/- 66 days. Angina was initially unstable in 9 patients and stable in 6; 3 patients were asymptomatic. Coronary lesions followed the usual distribution pattern: the left anterior descending artery was involved in 11 cases, the circumflex artery in 4 cases and the right coronary artery in 3 cases. Overall, the degree of stenosis was high (86 +/- 7%); Following obstruction the course of the disease was favourable in 11 patients (61%), with complete remission of all symptoms in 5. Six patients remained with unstable angina. Apart from one case of sudden death, none of the patients developed myocardial infarction, as shown by the absence of significant biochemical, electrical and angiographic changes. The importance of pre-existing or newly developed collateral circulation as a good prognosis factor is highlighted.

Adult↗
PubMed1987

Two-dimensional echocardiographic assessment of the right ventricle in patients with chronic obstructive lung disease.

A consecutive series of 40 patients (39 men, one woman; mean age 54.1 +/- 8.2 years) with chronic obstructive lung disease (COLD) underwent right heart catheterization and 2-D echocardiographic examination within 72 hr. An adequate 2-D echocardiographic study was obtained in 32 patients (80 percent) using the apical and/or subcostal views. Mean pulmonary artery pressure at rest and during exercise were correlated with right ventricular diameters and areas in end-systole and end-diastole (r = 0.63 to 0.73). Correlations between right ventricular free wall thickness and pulmonary artery pressure were weak (r = 0.51 and 0.57). Right ventricular end-diastolic pressure was also weakly correlated with right ventricular dimensions (r = 0.45 to 0.51), whereas right ventricular area fractional shortening was not correlated with hemodynamic parameters. Patients with previous episode of right heart failure had larger right ventricles than those without such episodes. Thus, 2-D echocardiography appears useful to study the right heart chambers in patients with COLD.

Adult↗
PubMed1987

[Prognostic value of a new perfusion index calculated from coronarography].

A new perfusion index was determined from the study of the coronary vascular bed in 8 myocardial territories: upper septal, lower septal, upper anterior, lower anterior, apical, lateral, posterior and inferior. Stenosis of a vessel reduces perfusion in all territories fed by that vessel, downstream of the stenosis. The perfusion index is calculated by adding up the lesions in all 8 territories. In a population of 418 consecutive patients who had undergone coronary arteriography in 1972 and 1973, survival was evaluated according to the perfusion index and to those parameters which classically have the greatest influence on survival. The perfusion index came out as the most important prognostic factor since such parameters as the number of stenotic vessels and ventricular kinetics lose their prognostic value when adjusted to that index. According to the perfusion index, the 8-year prognosis is the same as in subjects without coronary disease when the reduction in overall perfusion does not exceed 40%. With a 40 to 79% reduction the death risk at 8 years is 30% whatever the exact percentage in each individual. When perfusion is reduced by 80% the death risk at 8 years rises to 72%. This perfusion index, easy to determine, provides a better evaluation of prognosis than the conventional parameters.

Adult↗
PubMed1986

Echocardiographic features of right atrial thrombi.

The clinical and echocardiographic features of six patients in whom a right atrial thrombus was detected using two-dimensional echocardiography are reported. In four patients with acute cor pulmonale, the thrombus appeared as a coiled mass moving freely within the right atrium and prolapsing through the tricuspid valve. In another patient referred for syncope, a large coiled mass attached to the lateral wall of the right atrium was seen prolapsing regularly through the tricuspid valve, simulating an atrial myxoma. In the remaining patient who presented with chronic cor pulmonale, two-dimensional echocardiography demonstrated a motionless ovoid mass with a broad base of attachment to the interatrial septum.

Aged↗
PubMed1986

[10-year outcome of patients with isolated anterior interventricular stenosis technically accessible to coronary angioplasty].

Between April 1972 and March 1976, 70 patients were found to have an isolated stenosis of the left anterior descending artery at coronary angiography which could have been treated by coronary angioplasty, had the technique been available at that time. A questionnaire was sent to these patients and 65 (93 p. 100) replies were received 9 to 13 years after initial coronary angiography. They provided information about 61 men and 4 women with an average age of 48.1 +/- 8.4 years. Thirty eight patients had undergone surgery and 27 were treated medically, each group having distinct clinical characteristics. The 10 year survival rate was excellent (91 p. 100) and was high in both groups. The quality of life was good: 56 p. 100 claimed to be in good or very good health and 67 p. 100 were improved with respect to their functional state at the time of coronary angiography; only one quarter of these patients had been readmitted to hospital for cardiac problems during the follow up period, and 76 p. 100 of patients in work before the coronary angiography had returned to work. This date illustrates the excellent results of classical medical and surgical management of potential candidates for coronary angioplasty for isolated left anterior descending artery stenosis.

Adult↗
PubMed1986

[Clinical, echocardiographic and evolutive aspects of right atrial thrombosis].

The clinical and echocardiographic features of right atrial thrombi were examined in 9 patients, 5 men and 4 women aged 16 to 86 years. The 2D echocardiographic diagnosis was confirmed at autopsy (4 cases) or by the association of severe recurrent pulmonary embolism (5 cases). Three patients had associated ischaemic heart disease and on patient had dilated cardiomyopathy. The clinical presentation was: acute cor pulmonale (5 cases including 2 patients which biventricular myocardial infarction), chronic post-embolic cor pulmonale (1 case), tricuspid valve obstruction (1 case), general ill health with pyrexia (1 case) and heparin-induced thrombocytopenia (1 case). Predisposing factors included: absence of anticoagulent therapy (7 cases), previous supraventricular arrhythmias (2 cases) and right ventricular failure (6 cases, including 2 of right ventricular infarction). In 2 patients the thrombi were relatively immobile and had a wide base of implantation on the interatrial septum; in 1 patient, multiple thrombi were observed lining the right heart cavities from the inferior vena cava to the pulmonary infundibulum. In the other 6 patients, the thrombi were very mobile with a visible pedicule of implantation (2 cases) or totally free (4 cases). The variable polylobulated appearances, completely irregular whirling motion and intermittent prolapse into the tricuspid valve were characteristic features of the latter 4 cases. They disappeared spontaneously (2 cases) or after fibrinolytic therapy (2 cases) in under 36 hours. Three patients were operated with one postoperative death. The global hospital mortality was 22%. The present occasional detection of right atrial thrombosis will certainly become more common if patients with pulmonary embolism, right ventricular infarction or deep venous thrombosis are systematically examined by 2D echocardiography in the acute phase of their illness.

Adolescent↗