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P Besse

Publications and source records attributed to P Besse.

At least 109 records · Page 6Linked to original sources
PubMed1984

Quantitative analysis of left-ventricular function using gated single photon emission tomography.

We describe a quantitative method that measures segmental motion of the left ventricle, using tomographic slices obtained by gated single photon emission tomography (GSPECT). These slices contain the major axis of the left ventricle and are presumed to show wall motion directed towards a center of contraction. Values of parameters describing segmental wall motion in GSPECT were obtained from 61 patients, who received a left cardiac catheterization 1 hr later. These values were compared with results of similar calculations applied to data from contrast ventriculography. We conclude that GSPECT allows a detailed and quantitative, noninvasive study of wall motion of all left ventricular segments, with high inter- and intraobserver reproducibility.

Angiocardiography↗
PubMed1984

[Left ventricular global and segmental function in pure mitral valve prolapse with poor tolerance for exertion].

Poor effort tolerance is observed in a small percentage of cases of idiopathic mitral valve prolapse (IMVP). The aim of this study was to assess the possible left ventricular dysfunction in such cases, responsible for poor effort tolerance. Left ventricular function and segmental wall motion were studied retrospectively in a group of 17 patients with IMVP. The patients, average age 53 +/- 12 years, had poor effort tolerance (ST segment depression of 2 to 4 mm in 15 cases, drop in blood pressure in 6 cases) justifying catheter and angiographic studies. All patients had IMVP confirmed on RAO left ventriculography. There was no associated mitral regurgitation or coronary artery disease. Left ventricular function was studied by parameters of global function (systolic and diastolic parameters, volume measurements) and by a quantitative study of segmental wall contraction. The method used for studying regional wall motion was an application of the Stanford method in which segmental shortening is studied over all the endocavitary contour of the LV during an angiographic cycle filmed at 50 frames/second in the RAO projection. The time and velocity amplitudes of wall motion were measured during systole and diastole. The same methodology was applied to 21 normal control subjects. The results showed abnormal volumic compliance and wall motion in the IMVP group. Asynergy was mainly confined to the antero-lateral wall of the LV. The amplitude of contraction was generally normal but the contraction was slower and finished earlier. In the same zone, relaxation was abnormally early and lasted longer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Hemodynamic effects of a new positive inotropic agent (AR-L 115 BS) in ischemic and nonischemic myocardiopathies].

AR-L 115 BS is an imidazo-pyridine derivative with a positive inotropic action associated with peripheral and coronary vasodilatory properties. The effects of intravenous administration (a bolus of 0,45 mg/kg/min) were studied in 19 patients in functional class III of the NYHA classification in the absence of any previous drug therapy. Twelve patients had a primary myocardiopathy and the other 7 had coronary artery disease with akinetic anterior walls. A Swan-Ganz thermodilution catheter and a Millar microtransducer were used to measure pressures (pulmonary artery, left ventricular, aorta) and cardiac output under basal conditions and then every 2 minutes during intravenous administration of AR-L 115 BS. Left ventriculography in the 30 degrees RAO plane was performed under basal conditions and at the end of the investigation to measure volumes, ejection fraction, volumic compliance and segmental wall motion by the Stanford method. A stable concentration of circulating AR-L 115 BS was obtained (1 500 ng/ml). The positive inotropic action of the drug was responsible for a significant increase of all ejectional indices (cardiac and systolic index X 24 p. 100, p less than 0.01; ejection fraction +14 p. 100, p less than 0.01), of all indices of isometric contractility (dP/dt max +25 p. 100, velocity of contractile elements +35 p. 100, V max +30 p. 100 (p less than 0.01) and of the velocity of circumferential fibre shortening (+65 p. 100, p less than 0.001). All segmental shortening was improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Fibrinolytic treatment of valve thrombosis. Apropos of 16 cases].

Sixteen cases of prosthetic valve thrombosis (9 mitral, 5 aortic), occurring in 14 patients, were treated by fibrinolysis. All were disc prostheses. The clinical state of the patients was very poor in 11 of the 16 cases with pulmonary oedema, low output and arrhythmias, but less dramatic in the 5 others who presented with thromboembolism and left ventricular failure. The diagnosis was made by echocardiography (9 cases), radio-cinema of the valve (9 cases) and/or angiography (4 cases). The therapy comprised Urokinase (UK) 4,500 U/kg/hour (6 cases) of Streptokinase (SK) 2,000,000 U in 10 hours (7 cases) or SK and UK at equal doses (3 cases). The outcome was assessed clinically, echocardiographically and radiologically. There were 11 definite successes, 2 partial improvements requiring surgical revision, 2 apparent successes but with massive recurrence at the 7th and 10th days, and 1 failure. Although the biological activity of SK is greater than that of UK, the clinical results were comparable with both fibrinolytic agents. Four patients had regressive embolic episodes during lysis of the valvular thrombosis. As fibrinolytic therapy was effective in 70 p. 100 of patients in this series, it could provide an acceptable alternative to surgery, especially in patients who would be poor operative risks. The management of patients after successful fibrinolysis remains divided between intensive medical follow-up or prosthetic valve replacement.

Adult↗
PubMed1983

Diagnosis of dissecting aortic aneurysm by two dimensional echocardiography: experience with 58 patients.

UNLABELLED: Recent improvements in surgical technics have dramatically changed the outcome of patients with aortic dissection (AD). The aim of this work is to evaluate the reliability of two dimensional echocardiography (2DE) in the diagnosis of AD. The 2DE was recorded in all patients with a systematic approach in order to visualize the entire aorta (Ao). 58 cases were studied in a three years period. At the beginning of this study we validate 2DE by comparison with angiography (angio) in 14 of our first patients: the 2 angio criteria (dilatation, abnormal intraluminal image) have been found on 2DE in 12 pts (92%), with intraluminal image) have been found on 2DE in 12 pts (92%), with no significant difference between internal diameter of Ao on angio and 2DE. In our experience with 58 pts a positive diagnosis was possible in 90% of AD type I and only 18% of AD type III. IN CONCLUSION: 2DE is a practical and valuable method for the assessment of type I and II AD. Two 2DE criteria must be present at the same anatomical level (dilatation, abnormal intraluminal echo). In these conditions we have been able to avoid aortography in 26 of our last patients with type I and II.

Adult↗
PubMed1982

Bidirectional tachycardia. Mechanism derived from intracardiac recordings and programmed electrical stimulation.

His bundle recordings and programmed electrical stimulation were performed in a 70-year-old woman with bidirectional tachycardia; the recordings demonstrated the infra-Hissian origin of the tachycardia. Occurrence of the His deflection slightly after the onset of ventricular depOlarization suggested that the origin of the tachycardia was located near the His bundle bifurcation. Recording of three atrial sites during tachycardia allowed the study of retrograde atrial activation. Two sets of fairly constant and alternating VA intervals were recorded. This fact is consistent with two ventricular circuits used alternatively. The tachycardia could also be interrupted with a single atrial or ventricular premature beat. It is postulated that the tachycardia is due to macroreentry involving the two fascicles of the left branch. This study suggests that reentry may be a possible mechanism in some cases of bidirectional tachycardia.

Aged↗
PubMed1982

[Anti-arrhythmic effects of mexiletine].

Mexiletine was used in 12 patients. Serum drug levels and the antiarrhythmic effects were studied in a therapeutic protocol comprising an initial intravenous administration (3,5 mg/Kg over 10 mins, then 450 mg in 5 hours) followed by oral administration (200 mg eight hourly). The serum drug levels of Mexiletine were high (1,46 +/- 0,47 microgram/ml) as from the first hour in all patients, and remained constant during intravenous administration (average: 1,59 +/- 0,72 microgram/ml). On oral therapy the average mexiletine level was 1,18 +/- 0,21 microgram/ml with two lows (1,02 microgram/ml) six to eight hours after the ingestion of the 200 mg gelules. Ventricular extrasystoles completely regressed after the initial rapid intravenous injection in 7 out of the 12 patients (58,3 p. 100) and this efficacity was maintained throughout the trial. In two patients with low serum mexiletine levels at the end of oral therapy (less than 1 microgram/ml), ventricular extrasystoles were much less frequent during the intravenous phases but reappeared during oral therapy. The clinical, electrocardiographic and hemodynamic tolerance was good (withdrawn in only one patient). The dose should be adapted to the patient's weight and hemodynamic status. When ineffective, the serum mexiletine level can be estimated and when less than 1 microgram/ml, the dose may be increased, in particular by adjusting oral dosage to 200 mg six hourly.

Administration, Oral↗
PubMed1982

[Left ventricular aneurysms. Prognostic study. Operative results].

Eighty three patients with symptomatic post-myocardial infarction left ventricular aneurysms (cardiac failure: 62 cases; angina; 41 cases; ventricular arrhythmias: 37 cases; systemic embolism: 8 cases) underwent surgery between 1975 and March 1981. Preoperative investigations comprised clinical examination, left heart catheterisation and ventriculography. End systolic and end diastolic volumes, ejection fraction velocity of circumferential fibre shortening, and the akinetic surface area were calculated firstly for the whole of the left ventricle and then for the contractile zones after hypothetical resection of the aneurysm. Selective coronary angiography was carried out in 75 patients. The results were as follows: 16 perioperative fatalities (19.2 p. 100): Group IA; 14 late deaths or not improvement after surgery (17 p. 100): Group IB; 53 patients had little or no symptoms after surgery (63 p. 100), Group II. The 5 year survival rats is 69.7 p. 100. Severe cardiac failure (Stages III or IV of the NYHA Classification) is associated with a poor prognosis (33 p. 100 mortality). The hemodynamic parameters of the whole ventricle (end diastolic volume, global ejection fraction) had little or no correlation with the outcome. The ejection fraction of the contractile zones was significantly lower in Groups IA and IB (0.39 +/- 0.08, and 0.41 +/- 0.05) than in Group II (0.51 +/- 0.05), p less than 0.001). When the ejection fraction of the contractile zone exceeded 0.45, good results were obtained in 90 p. 100 of cases. The velocity of circumferential fibre shortening was also a good prognostic index (0.63 +/- 0.18 in Group IA compared to 1.10 +/- 0.09 in Group II, p less than 0.001). On the other hand, the diastolic volume of the contractile zone was very variable in all three groups. Extensive coronary artery disease not treated surgically worsened the prognosis (50 p. 100 mortality in triple vessel disease.) Seven of the 8 patients operated during the acute phase of myocardial infarction (less than I month) died, but they all had very poor hemodynamic parameters.

Adult↗
PubMed1981

Surgical constriction of the pulmonary artery. A new experimental technique.

The classical "banding" of the pulmonary arterial trunk (PAT) is often difficult to remove at the time of definite repair of the cardiac congenital malformation; often its removal alone requires the use of a cardiopulmonary bypass and an angioplasty of the PAT. These difficulties have led the authors to study experimentally, in 16 dogs, the value of a palliative stenosis of the PAT by lateral compression (LC) of the arterial wall. Three types of compressing materials have been used: Teflon band wrapped in pericardium (5 dogs), cuneiform pieces made of either Teflon (5 dogs), or stainless steel (6 dogs). The experiment has led to the following conclusions: 1. The LC of the PAT is able to create a pressure gradient which tends to decrease when the animal is growing. 2. Cuneiform pieces made of Teflon or stainless steel should be used to realize the LC. 3. After the LC has been removed the PAT recovers its normal shape, as attested by absence of a systolic pressure gradient across the PAT. This technique of LC seems to be an interesting alternative to creating a temporary palliative stenosis of the PAT.

Animals↗
PubMed1981

[Hemodynamic effects of percutaneous trinitrin].

The haemodynamic effects of nitroglycerin (NG) ointment were studied in 13 patients, 6 with congestive cardiac failure. After two basal measurements 30 minutes apart, heart rate (HR), right atrial pressure (RAP), pulmonary artery diastolic pressure (PADP), mean systemic arterial pressure (MAP) and cardiac index (CI) were measured every fifteen minutes for one hour, and every hour for five hours. Two patients were given one capsule, and nine patients two capsules of 10 mg NG, applied on separate 15 cm2 skin patches and covered with plastic dressings. There was a slight fall of 1,9% in HR from the 45th minute to the 5th hour. A large increase in HR was only observed in one patient who had low basal filling pressures. A moderate decrease in MAP was recorded (4,6%, p less than 0,05) The greatest changes were observed in RAP which decreased (p less than 0,05) from the 30th to the 60th minute with a maximum at the 45th minute (17,4%) and in PADP which fell from the 15th minute to the 5th hour (p less than 0,005) with a maximum at the 120th minute (21,9%). Local tolerance was good. The systolic blood pressure did not fall below 90 mm Hg in any patient. A case by case analysis showed falls of RAP and PADP of over 20% in 10 and 9 patients respectively. The decrease in PADP was not proportional to the basal value but patients with the highest initial values had the least changes. A 20% fall in PADP was observed in only one of four patients with PADP of over 25 mm Hg at rest. A greater dose of NG might have had a greater effect in these patients. There was no significant change in CI, probably due to the stability of peripheral arterial resistances during the study. The value of this preparation of NG lies in its long duration of action. A fall in PADP of over 15% was observed up to the 150th minute, and persisted to a lesser degree up to the 5th hour. This makes it very suitable for the treatment of nocturnal angina as conventional antianginal delayed release nitrate derivatives usually have a shorter duration of action.

Adult↗
PubMed1981

The contribution of bidimensional echocardiography in the diagnosis of cardiac tumours. Based on 25 observed cases.

This paper reviews 25 intracardiac tumours (12 myxomas and 13 thrombi) studied by T.M. echography, bidimensional (2-D) echography and cineangiography during a two year period. In addition, five cardiac tumours (two myxomas, three thrombi) were studied by echography alone, and correctly diagnosed. T.M. echography gives false negative results, whereas both 2-D echo and cineangiography give reliable diagnosis. However, 2-D echo should be the procedure of choice as it is non-invasive, and may be used on patients with equivocal symptoms. Since bidimensional echography has become available during the past two years, 12 myxomas have been correctly diagnosed, compared to 14 found during the previous 13 years.

Cineangiography↗