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Biomedical subjects

P Brenot

Publications and source records attributed to P Brenot.

At least 19 recordsLinked to original sources
PubMed2001

Percutaneous transluminal angioplasty of ostial lesions of internal mammary artery grafts.

The internal mammary artery (IMA) is currently the best graft for coronary bypass surgery and is therefore preferentially anastomosed to major arteries, usually the left anterior descending (LAD) artery. This graft may develop a stenosis, most often at the distal anastomosis. Ostial stenoses are rare and their pathophysiology uncertain. While angioplasty of distal anastomotic lesions provides adequate results, the very small number of published cases of angioplasty of ostial lesions explains the lack of knowledge on results of this type of procedure. The authors report six procedures of this type on five patients, including two with stenting. The primary success rate was 100%, with only one hospital complication in the form of pulmonary edema. Mean follow-up for 35 months revealed one sudden death due to probable restenosis, another death 3 years after angioplasty from rapid fatal shock without complementary investigation, and one case of unstable angina secondary to intrastent restenosis. These results suggest that this type of angioplasty is technically feasible with low risk, and that the restenosis rate seems relatively high, potentially presenting as sudden death, in the same way as unprotected dilatation of the native left main artery. A very close clinical follow-up of these patients is therefore necessary, with angiographic control in case of suspected ischemia.

Aged↗
PubMed2001

Percutaneous closure with Amplatzer device is a safe and efficient alternative to surgery in adults with large atrial septal defects.

BACKGROUND: In adults with atrial septal defect (ASD) and large right-to-left shunt, closure of the defect is recommended. Percutaneous closure is still rarely used in this population. This study presents the results of transcatheter closure with the Amplatzer occluder in such patients. METHODS AND RESULTS: We studied 44 consecutive adult patients with a secundum ASD and 2 of the 3 following criteria: QP/QS >/=2 by oximetry, echocardiographic right ventricle overload, and ASD size >20 mm. Forty-two patients had a successful implantation. In 1 patient an unstable device was withdrawn; in another one, the device embolized in the pulmonary artery. At 6-month median follow-up, 95% had a complete closure; 2 patients with an additional defect had a small residual shunt. Major complications were the aforementioned embolization and a cerebrovascular accident in a patient with atrial fibrillation treated with aspirin. Others were minor and transitory: premature atrial beats in 3 patients, and paroxysmal atrial fibrillation and pulmonary edema in 1 patient each. CONCLUSIONS: Transcatheter closure of large ASDs with the Amplatzer device is efficient with less morbidity than surgical closure.

Adolescent↗
PubMed1999

Pulmonary thromboendarterectomy for chronic thromboembolic obstruction of the pulmonary artery in piglets.

OBJECTIVE: The 2 main causes of death after thromboendarterectomy for chronic pulmonary thromboembolism are incomplete repermeabilization responsible for persistent pulmonary hypertension and acute high-permeability pulmonary edema. We wish to establish an experimental model of chronic pulmonary thromboembolism to replicate the conditions encountered during and after pulmonary thromboendarterectomy. METHODS: Multiple-curled coils and tissue adhesive were embolized in 6 piglets to induce complete obstruction of the left pulmonary artery, documented by angiography. After 5 weeks, the main pulmonary artery was repermeabilized by thromboendarterectomy during circulatory arrest. The left lung was reperfused ex vivo with autologous blood at constant flow, and patency of the pulmonary artery was evaluated on a barium angiogram. The endarterectomy-reperfusion procedure was also done in 6 nonembolized piglets that served as the controls. The severity of lung injury induced by 60 minutes of reperfusion was assessed on the basis of measurements of the lung filtration coefficient and of lung myeloperoxidase activity. RESULTS: Marked hypertrophy of the bronchial circulation was seen in the chronic pulmonary thromboembolism group. Thromboendarterectomy removed the organized obstructing thrombus that was incorporated into the arterial wall and restored patency of the pulmonary artery. Acute lung inflammation and high-permeability edema occurred after reperfusion, as indicated by a 1.5-fold increases in both lung filtration coefficient and lung myeloperoxidase values in the chronic pulmonary thromboembolism group; these 2 variables being correlated. CONCLUSIONS: Our model replicated the perioperative conditions of pulmonary thromboendarterectomy, suggesting that it may prove useful for improving the repermeabilization technique and for investigating the mechanisms and prevention of reperfusion injury.

Animals↗
PubMed1997

[Late complications of percutaneous closure of atrial septal defects with the Sideris occluder].

Between June 1992 and January 1996, 27 patients aged 3.9 to 74 years with an ostium secundum (22 patients) or patent foramen ovale with right-to-left shunts (5 patients) underwent percutaneous closure of their atrial septal defects with the Sideris occluder. After a thromboembolic complication, transesophageal echocardiography was performed routinely after the procedure in 15 patients between 1 month and 2 years, and in 6 patients on the 15th day. Two patients died, on the 2nd day and 21st month, of non-related causes. After an average follow-up of 33 months, 59% of patients had complete occlusion of the atrial septal defects or only a minimal residual shunt. Displacement of the prosthesis was defects or only a minimal residual shunt. Displacement of the prosthesis was observed in 7 cases with no relationship to size: 4 parallel to the septum with reappearance or increase in shunt, 3 with tilting of the prosthesis. All of these patients had a large residual defect compared with 20% with a normally positioned prosthesis (p < 0.05). Tilting of the occluder was associated with left atrial thrombosis (present in 40% of these patients), complicated by systemic embolism in one case: there were no cases of left atrial thrombus in the 9 with complete occlusion and the 5 patients with an isolated residual defect (p < 0.05). Occlusion of atrial septal defect with the Sideris device is effective and a safe method in the majority of cases. However, a badly positioned prosthesis with a residual shunt should be extracted as seen as possible or within three weeks if displacement is observed at control echocardiography.

Actuarial Analysis↗
PubMed1995

[Extraction of intravascular foreign bodies].

OBJECTIVE: Loss or displacement of foreign material within the cardiovascular system is not an uncommon event. Foreign bodies include fragments of diagnosis equipment, ruptured catheters or malpositioned or displaced intravascular prostheses. The incidence has increased with the development of endovascular catheterism and raises the problem of extraction. METHODS: We report our experience with percutaneous extraction of intravascular foreign bodies. RESULTS: There were 56 cases. Percutaneous extraction was successful in 53. In 11 cases, the procedure was carried out during a catheterism procedure and in the others the initial event had occurred earlier. The delay to extraction varied from a few hours to several years. CONCLUSION: Percutaneous extraction of intravascular foreign bodies should be attempted before surgical removal, an often difficult high-risk procedure. The literature does not provide data on the frequency of intravascular foreign bodies.

Adolescent↗
PubMed1995

[Does fetal sexuality exist?].

From a personal observation of a male fetus oro-genital contact we made a preliminary multicentric study which shows some rare similar cases. Others oral or manual behaviours, containing perhaps some sexual significance are frequently observed but not yet published.

Female↗
PubMed1990

[Coaxial catheterization with an ultra-flexible catheter (Tracker) in coronary angioplasty].

After experiencing problems of catheterisation during coronary angioplasty, the authors tried using a 3.2 F ultraflexible catheter with a 2.2 F tapered tip. In 2 patients, initial attempts at coronary catheterisation were failures but when this new catheter was used, angioplasty could be performed without any difficulty. This catheter was then used in 4 other patients and in all cases the Tracker enabled the operators to catheterise the coronary arteries and to perform angioplasty in 3 of the 4 cases. Therefore, this new ultraflexible catheter would seem to be a valuable alternative for catheterising particularly sinuous coronary arteries in which angioplasty is often technically difficult.

Adult↗
PubMed1988

Kinking of internal mammary grafts: report of two cases and surgical correction.

Two patients who underwent left internal mammary artery (IMA) anastomoses to the left anterior descending artery (LAD) developed sudden angina associated with anterior ischemic changes on EKG in the early postoperative period, one at 4 hr and the other at 3 days following operation. Digitalized arteriography via retrograde injection of the left brachial artery revealed the IMAs, which were partially obstructed because of looping and Kinking, although the anastomoses to the LAD were patent. Reoperation was successful in relieving obstruction by reducing these abnormalities and resulted in an uncomplicated postoperative course following the second operation. Discussion of the etiology, radiological technique of diagnosis, correction, and prevention of this cause of internal mammary graft failure is presented.

Graft Occlusion, Vascular↗
PubMed1988

[Videodensitometric analysis of venous digital angiography of the left ventricle: application to the measurement of the ventricular ejection fraction and volumes].

Intravenous digital angiography of the left ventricle (LV) was submitted to videodensitometric analysis in order to measure the ejection fraction (EF) and ventricular volumes. The video-densitometric method was first validated using an experimental model consisting of latex balloons filled with contrast medium. The correlation for ejection fraction measurements was satisfactory (r = 0.9449), with less than 10% errors. For ventricular volumes, the correlation was also good (r = 0.97 and 0.92 with the Chapman and Dodge methods respectively), but marked variations across individuals were found. Digital videodensitometry thus appears to be a feasible and reliable method for ejection fraction and ventricular volume measurements. Further studies are needed to determine the accuracy of measurements of ventricular volumes.

Densitometry↗
PubMed1987

Validation of a digital videodensitometric program analysis for measurement of left ventricular ejection fraction.

Left ventricular (LV) function was studied in 30 patients using digital subtraction angiography by the intravenous approach. Each ventriculogram was processed with a specific videodensitometric analysis to determine LV ejection fraction. The program was verified in an experimental set-up consisting of nine latex balloons filled with contrast medium. Its validation has been established by comparing videodensitometric results with classical results supplied by geometric methods. A good correlation was obtained (r = 0.9449) and, furthermore, with experimental models, videodensitometric analysis seemed to be more accurate than geometric analysis. Digital videodensitometry appears to be a valuable and accurate method for quantifying LV function, and a promising technique for determination of the real volumes.

Adolescent↗
PubMed1987

Local thrombolysis in peripheral arteries and bypass grafts.

Sixty-two patients hospitalized for recent angiographically documented arterial occlusion in the legs (46 femoropopliteal arteries and 16 grafts) benefited from local fibrinolytic therapy delivered at the site of the occlusion with a No. 4F or No. 5F catheter. This therapy combined a continuous urokinase (UK) infusion of 1000 U/kg/hr and a lysyl plasminogen (LYS-PLG) infusion of 15 mukat every 30 minutes. Angiographically confirmed lysis was obtained in 77% of the cases. Five percent of the patients had major and 8% had minor groin hematomas. Only two patients had concentrations of fibrinogen as low as 100 mg/dl. Intravascular infusion of UK and LYS-PLG is as effective as streptokinase but produces lower systemic fibrinolysis. However, local fibrinolysis remains a potentially hazardous procedure (10% suffered major complications) and must only be applied to patients with severe ischemia and little or no possibility of surgical intervention.

Adult↗