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Biomedical subjects

P Boissonnat

Publications and source records attributed to P Boissonnat.

46 records · Page 3Linked to original sources
PubMed1988

[Intracoronary treatments in emergency situations].

Mechanical and medicinal therapies are widely used in coronary disease patients for emergency or semi-emergency situations. Vasodilator drugs injected into arteries that are occluded or narrowed-drugs injected into arteries that are occluded or narrowed by spasm rapidly relieve that spasm; injecting these drugs prior to angioplasty renders the myocardium more tolerant to the ischaemia created by the dilated balloon. In unstable angina coronary angioplasty has a 90 p. 100 primary success rate with immediate complications that are slightly more frequent than in stable angina; compared to historical series with medicinal treatment, angioplasty reduces the risk of myocardial infarction and/or secondary death. In evolving myocardial infarcts the respective values of intracoronary thrombolysis and angioplasty are still under discussion, although the results of recent studies tend to favour intravenous thrombolysis and secondary, elective angioplasty.

Angina, Unstable↗
PubMed1988

Infective endocarditis on stenotic aortic valves.

Charts were reviewed of 42 adult patients (27 men, 15 women, mean age 55 years, with 17 older than 60) hospitalized and/or autopsied between 1970 and 1986 with diagnosis of definite or highly probable infective endocarditis (IE) on pure aortic stenosis (AS). Ring and/or septal abscesses were found in 18/37 patients who were operated upon and/or autopsied. IE was recognized in 32 patients, undiagnosed in 10 (revealed at autopsy in seven, at operation in three). Infecting organisms were identified in 26 patients (Str. viridans, 16; Str. D, three; Staphylo., four; other, three). Twenty-seven patients were treated in our institution, 14 of them more than four weeks after the beginning of the symptoms. Echocardiograms were recorded in 17, with vegetations in only six. Severe cardiac failure was present in 17 cases. One patient was lost to follow-up. Fourteen patients died (mean delay between IE and death 22.4 months): eight of the 13 non-operated patients (cardiac failure, four; myocardial infarction, two; neurological complications, two) and six of the 14 operated patients (peri-operative death, four; late sudden death, two). Twelve patients are alive (mean follow-up 51.6 months), eight of them in NYHA class 1. IE on pure AS is rare, difficult to recognize echocardiographically, and of poor prognosis. It usually requires rapid aortic valve replacement.

Adult↗
PubMed1987

[Are there risk factors for pure systolic hypertension?].

Pure systolic hypertension (PSH) is mainly observed in subjects over 60 years of age, and it is always due to a loss of compliance of the greater arteries. Blood pressure itself is partly responsible for loss of compliance, but other factors have been suggested. We have investigated this matter in a study of 3,388 subjects aged from 20 to 69 years. In a first stage, PSH patients (systolic BP greater than or equal to 160; diastolic BP less than 95 mmHg), aged from 50 to 59 years, were compared with normotensive subjects (systolic BP less than 140; diastolic BP less than 95 mmHg) and with other types of hypertensive patients with regard to cigarette smoking, alcohol consumption, obesity and plasma cholesterol, triglycerides, gamma-GT, glucose and uric acid levels. Several of these variables were significantly higher in all hypertensive patients than in normotensive subjects, but cigarette smoking and gamma-GT levels were predominantly or exclusively higher in PSH patients. In a second stage, correlations between differential BP and the variables listed above were studied in subjects with two levels of diastolic BP: 70-79 and 80-89 mmHg, thus taking into account all degrees between normal BP and PSH proper. Weakly positive correlations were found with alcohol consumption, plasma gamma-GT and glucose levels, and with percentages of smokers or ex-smokers. It is therefore conceivable that in addition to BP itself other factors, such as alcohol consumption, cigarette smoking and hyperglycaemia, contribute to the loss of arterial compliance progressively leading to pure systolic hypertension.

Adult↗
PubMed1987

[Methods of evaluating myocardial revascularization surgery].

The quality of revascularization is evaluated by measurements of blood flow and various imaging methods. The quality of the anastomosis and the graft flow are evaluated per-operatively by ultrasounds and by measurements of intramyocardial pH. After surgery, Doppler velocimetry and radioisotope scanning assess the basal coronary flow and the coronary reserve. Graft patency can be studied by noninvasive methods (Doppler and kinetic CT with contrast injection), but conventional or digital angiography is irreplaceable for visualization. Residual myocardial ischaemia and left ventricular function are evaluated by the usual methods. Angina is not sensitive enough to serve as an indicator of residual or recurrent myocardial ischaemia. ECG at rest detects most peri-operative infarctions; Holter recordings may reveal a silent myocardial ischaemia; exercise stress ECG evaluates (albeit with insufficient sensitivity) post-bypass changes in myocardial ischaemia. Myocardial scintigraphy with thallium-201 is more sensitive, and it locates low perfusion areas. Cardiac wall kinetics and left ventricular function at rest and during exercise are studied by echocardiography and contrast or isotopic ventriculography, pending advances in nuclear magnetic resonance imaging. Surgical results have never been compared with other methods of direct myocardial revascularization, but only with medical treatments. Outstanding among the controlled studies carried out are a European study (E.C.S.S.) and two North American studies (V.A.S. and C.A.S.S.); they have shown what can be expected from coronary bypass, globally and in some subgroups of patients.

Angiography↗
PubMed1986

[Atrial fibrillation: some current practical problems].

We emphasize: the great frequency of atrial fibrillation, present in approximately 10% of men and more than 20 p. cent of women hospitalized in a cardiology department; the advantage of a comprehensive etiological survey, reducing to less than 10 p. cent the percentage of idiopathic permanent atrial fibrillations, in this department; the need to take into account all factors determining the prognosis of atrial fibrillation: ventricular contractility and hemodynamic consequences of the rhythm disorder, volume of the left atrium, condition of the valvular orifices, risk of thrombo-emboly, etc., as well as the difficulty of therapeutic indications, linked on the one hand to the multiplicity of etiologies and prognosis factors, and on the other hand to the diversity of the therapeutic approaches, of which we are here reminded.

Adult↗
PubMedDate not supplied

Increased platelet aggregation after heart transplantation: influence of aspirin.

Accelerated graft coronary artery disease remains the most dramatic complication in long-term survivors of heart transplantation. The main purpose of this study was to evaluate ex vivo platelet function of heart transplant recipients as compared with that of healthy subjects and nontransplant coronary patients. The influence of aspirin, the chief antiplatelet agent, was also evaluated. The heart transplant recipients exhibited a marked platelet hyperaggregation to adenosine diphosphate as compared with the two control groups. In addition, platelets of the heart transplant recipients appeared to be resistant to the inhibitory effect of aspirin. These results could, at least partly, explain the failure of antiplatelet agents to prevent myocardial infarction in these patients.

Adenosine Diphosphate↗