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Biomedical subjects

P Montgermont

Publications and source records attributed to P Montgermont.

12 recordsLinked to original sources
PubMed1992

[Can patients with severe left ventricular dysfunction be treated by coronary artery bypass surgery?].

Forty three men and 3 women, with an average age of 59 years (13 to 78 years) underwent aorto-coronary bypass surgery despite severe left ventricular dysfunction (ejection fraction < 35%); 96% of the patients had previous infarction; 60% (N = 28) had unstable angina, 52% (N = 24) had had pulmonary oedema or an episode of congestive cardiac failure. The average ejection fraction was 29 +/- 4%, range 17 to 35%. Thirteen patients had ventricular aneurysms, 4 had grade 3 or 4 mitral regurgitation. The coronary lesions were usually multivessel left main coronary (6), triple vessel disease (27), double vessel disease (12), single vessel disease (1). The average number of bypass grafts per patient was 2.3. The average aorting clamping time was 63 minutes (range 26 to 133 minutes). There were 4 mitral valve replacements, 4 resections of ventricular aneurysms and 1 double procedure (aneurysmectomy and valve replacement). The operative mortality was 2.1% (1 death). During an average follow-up period of 27 months (range 3 to 90 months), there were: 2 recurrent infarctions, 13 episodes of cardiac failure and 8 cardiac deaths (cardiac failure: 5, sudden death: 2, recurrent infarction: 1). Two patients underwent cardiac transplantation. The regression of angina (90% of operated patients were asymptomatic) and the low operative risk, justify aortocoronary bypass surgery despite left ventricular dysfunction in patients with severe symptoms (unstable angina, chronic, invalidating angina). The medium-term results indicate a high risk of cardiac failure which is partially responsible for the secondary mortality rate of 17% at 2 years.

Actuarial Analysis↗
PubMed1992

[Clinical and angiographic results of delayed revascularization by angioplasty or bypass after intravenous thrombolysis in myocardial infarction].

Between 1988 and 1990, 150 patients treated for an infarction by intravenous thrombolysis underwent coronary arteriography. Sixty seven were managed by revascularisation by angioplasty (n = 49) or bypass (n = 18) more than 48 hours after thrombolysis. In this delayed revascularisation group, the time before initial fibrinolysis was 114 +/- 55 minutes. The artery responsible for the infarction was patent in 88 per cent of cases at 12 +/- 9 days, with ejection fraction being 56 +/- 12 per cent. Indications for revascularisation were: recurrence of angina, Thallium stress test showing redistribution (n = 9), diffuse lesions (n = 11) or tight (greater than 75 per cent) proximal stenosis without vessel wall sequelae (n = 10). Comparison of the bypass and angioplasty groups showed a lower ejection fraction in the former than the latter (47% VS 58%, p less than 0.01), more frequent three-vessel disease (50% VS 6%, p less than 0.01) and more frequent revascularisation of the anterior interventricular (100% VS 37%, p less than 0.01). There were 2 deaths and 5 recurrences of infarction at one year. Follow-up arteriography was performed between at 2 and 6 months in 72% of the patients: 16 had restenosis after angioplasty and 4 occlusion of the graft after bypass. A second revascularisation procedure was necessary 15 times (14 angioplasties, 1 bypass). The outcome after bypass or angioplasty was favourable in 90% of cases in this group of patients exposed to a recurrence of infarction.

Adult↗
PubMed1991

[Doppler echocardiographic evaluation of aortic valve prosthesis. Analysis of the reproducibility of pressure gradients and surface measurements].

Doppler echocardiography has become the method of choice for the evaluation of cardiac valve prostheses. In order to determine the reproducibility of the measurements of pressure gradient and valve surface area, 55 patients with aortic valve prostheses without clinical dysfunction and having at most a trivial regurgitation on color Doppler examination underwent a double evaluation during an average interval of 9 +/- 5 months. The maximum and mean pressure gradients were recorded and the valve surface area calculated using the continuity equation in all cases. The subaortic diameter was taken to be constant and equal to the external diameter of the prosthesis. No significant differences were found between the two evaluations of mean pressure gradient and valve surface area. The intra-patient variability was +/- 8 mmHg for the maximum pressure gradient, +/- 6 mmHg for the mean pressure gradient, +/- 0.33 cm2 for valve surface area calculated using the maximum velocities and +/- 0.44 cm2 when the velocity-time integrals were used. When expressed as a percentage, the mean coefficient of variation was 21 +/- 17% for the maximum pressure gradient, 21 +/- 18% for the mean pressure gradients, 21 +/- 15% for the valve surface area calculated using the maximum velocities and 22 +/- 14% when the ratio of velocity-time integrals was used.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Annulo-ectasing disease of the aorta: apropos of 10 cases].

Ten patients were investigated and operated for severe aortic regurgitation due to dystrophic aortic dilatation. This is the third commonest cause of pure aortic regurgitation (18 p. 100) operated at Necker Hospital during the same period. This condition, comprising aneurysm of the ascending aorta, dilatation of the aortic ring and dystrophic aortic valves, is often responsible for severe aortic regurgitation and is noteworthy because of the associated risk of aortic dissection. Cardiovascular surgery is indicated and usually includes replacement of the ascending thoracic aorta with aortic valve replacement.

Adult↗
PubMed1987

[Fitness for sports of patients with Wolff-Parkinson-White syndrome].

The fitness of patients with Wolff-Parkinson-White syndrome to indulge in sporting activities is a practical cardiology problem. The major risk is sudden death due to atrial fibrillation deteriorating to ventricular fibrillation. This risk is small or even theoretical, but signing a fitness certificate engages the clinician's responsibility. Non invasive complementary examinations are useful. Echocardiography may detect a heart disease that would preclude any sport. Exercise tests explore the behaviour of the accessory pathway and rarely trigger off arrhythmias. Holter recordings mainly investigate disorders of the atrial rhythm. The decision concerning fitness may be based on clinical symptoms. Exercise-induced tachycardia is a classical contra-indication to competitive sports. In patients whose tachycardia is unrelated to exercise, fitness may be discussed according to the results of exercise tests and of the electrophysiological study. A refractory period which would be considered as rather prolonged at rest does not protect against fast ventricular rate during passage to atrial fibrillation. If pre-excitation disappears during the exercise test in an asymptomatic patient, then competitive sports can be authorized without limitations. If not, only surgical excision or fulguration would provide full protection against a potentially dangerous fibrillation. It is concluded that Wolff-Parkinson-White syndrome contra-indicates competitive sports in most cases. Games played outside competitions remain possible in the absence of symptoms or when arrhythmias are well controlled by medical treatment.

Ajmaline↗
PubMed1986

[Perioperative myocardial infarct following aortocoronary bypass. Clinical aspects, causes, consequences].

Perioperative infarction is a significant factor of morbidity of coronary bypass surgery. The aim of this study was to review peri-operative infarction and its complications over a 10 year period (1974 to 1984) and to determine its consequences on left ventricular function and life expectancy. The material included 514 patients who underwent coronary bypass surgery. Perioperative infarction was defined as the association of a postoperative Q wave and increase in creatinine phosphokinase after the 24th postoperative hour: this diagnosis was made in 31 cases (Group A), 6 per cent of the series; 483 patients (Group B) had no signs of infarction. The necrosis involved the revascularised zone in 26 cases and other zones in 5 cases. The acute phase of infarction was associated with major complications in 9 patients of Group A. In 22 patients (70 per cent of cases) the initial evolution was uncomplicated. There was no significant difference in the number of patients with unstable angina between Groups A and B (52 per cent vs 67 per cent), with single vessel disease (25 per cent vs 28 per cent), double vessel disease (45 per cent vs 34 per cent) or with triple vessel disease (30 per cent vs 38 per cent). The average number of bypasses was higher in Group A (2.06 per cent vs 1.4 per cent, p less than 0.05), as was the duration of cardiopulmonary bypass (117 min vs 91 min, p less than 0.05) and of aortic clamping (45 min vs 31 min, p. less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina, Unstable↗
PubMed1986

[Clinical and developmental aspects of 1-vessel right coronary atheroma. Therapeutic consequences].

This study analysed the clinical profile, prognosis and consequences on left ventricular function of isolated obstructive atherosclerosis of the right coronary artery in order to establish the indications of percutaneous angioplasty. The inclusion criteria were at least one stenotic lesion greater than 75 p. 100 of a dominant or equilibrated right coronary artery and exclusion of stenosis of the other coronary vessels. A questionnaire was sent to the treating physician and to the patient to establish the actuarial survival (Cutler and Ederer's method). The average period of follow-up was 56 months (range 12 to 70 months). Seventy one patients (average age 53 years) were selected from a series of 2,675 consecutive coronary angiograms performed between 1979 and 1984 (2.7 p. 100). The incidence of previous infarction was 60 p. 100; this was located on the inferior wall in 75 p. 100, inferobasal wall in 12 p. 100 and infero-latero-basal wall in 13 p. 100. Bypass surgery was performed in 7 cases and percutaneous angioplasty in 2 cases. Sixty-two cases were managed medically. Analysis of the 71 angiographic films of the series showed in retrospect an indication for percutaneous angioplasty in 29 patients (42 p. 100 of the series). The 5 year mortality rate was 5.6 p. 100. Death was sudden in the 4 cases observed, including one on the 28th day after bypass surgery complicated by perioperative infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Hemodynamic effects of intravenous acebutolol in the acute phase of myocardial infarction].

The haemodynamic tolerance of intravenous acebutolol was evaluated during the acute phase of myocardial infarction. This is a beta-blocker with an intrinsic beta-stimulant effect. The study consisted of 14 patients (10 cases of inferior infarction and 4 cases of anterior infarction) with a mean capillary pressure of less than 20 mmHg and a cardiac index greater than 2 l X min-1 X m-2. The minimal dose of acebutolol was 0.05 mg X kg-1 X h-1 and the maximal dose was 0.125 mg X kg-1 X h-1. The intravenous infusion of acebutolol was commenced between 3 and 12 hours (average: 7.5 hours) after the infarction and was continued for 48 hours, at which time it was replaced by oral administration. The mean total intravenous dose was 409 mg (from 190 to 510 mg). Two patients were excluded from the protocol because of the development of 2nd degree atrioventricular block several minutes after the beginning of the infusion. The basal values of the cardiac index (2.7 l X min-1 X m-2 +/- 0.37), the mean capillary pressure (9.4 mmHg +/- 2.7) and the systolic index (38.3 ml/m2 +/- 6.4) did not change significantly during the infusion, in the 14 patients studied. The double product, heart rate x blood pressure, decreased from the mean basal value of 9,443 to 7,680 at 24 hours and to 7,000 at 48 hours (p less than 0.05). Acebutolol does not depress left ventricular function, provided that it is reserved for patients with class I or II disease according to Killip and Kimball's classification.(ABSTRACT TRUNCATED AT 250 WORDS)

Acebutolol↗
PubMed1984

[Computerized management of the medical record in cardiac surgery. Experience at Foch Hospital].

Between 1979 and 1983, about 2 000 case reports of patients undergoing cardiac surgery were computerised. The availability of the centralised computer facilities of Hôpital Foch made this experiment possible. The computerised case notes were divided into several chapters in which a certain amount of data was compulsive and provision was made for the addition of further information. The data was introduced in the form of a numerical code out of a possible choice of 700 contained in a dictionary. A terminal located in the department was used to introduce the information or to consult a given case file directly. Statistical analysis of the cases was performed using APL language, the basis of which must be known in order to continue interrogation, the reply being almost immediate. Several examples of the use of the system are given: number of patients, average duration of surgery, characteristics of the ten oldest patients. Other studies include the use of double entry tables to determine the relationship between two variables such as the variation of cardiothoracic index and the degree of postoperative bleeding. Each case takes about 20 minutes to be coded; the number of cases not entered has decreased greatly year by year. The differences in language used in comparison with already existing systems are: the use of syntax, the possibility of dating events, an "open" dictionary. The main drawbacks of the system are: forgetting to code certain data and restrictions of interrogation (easier for fixed than for facultative data). The overall results have been clearly positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1984

[Tamponade].

Explore the source record for details and available documents.

Cardiac Tamponade↗
PubMedDate not supplied

[Development of the heart rate in the first year of life and infant ill health].

Heart rate during the 1st year of life decreases from 149 to 117/min (mean) and 227 to 186 (upper range), as determined by Holter monitoring. There is little change in those at the lower frequencies. A decrease in nocturnal rhythm becomes evident by 3 months of age. In comparison to these controls, near-miss infants or their sibs and infants with "spells" demonstrate a lower basal rate with longer pauses and wider range of instantaneous variability from the 1st days of life. Near-miss infants and sibs of sudden infant death syndrome infants are harder to differentiate. However, the "sibs" + "spells" groups show prolonged pauses over 1 second in the first weeks of life and become even more prominent at 3 months. This vagal hyperreactivity may be due to immature or poorly regulated cholinergic bulbar centers.

Apnea↗