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Biomedical subjects

P Ourbak

Publications and source records attributed to P Ourbak.

At least 37 records · Page 2Linked to original sources
PubMed1987

[Prognostic value of the exercise test after myocardial infarction].

A stress test performed in the early stage after myocardial infarction enables to evaluate directly or indirectly three of the main prognosis factors: alteration of ventricular function, presence of ventricular arrhythmias, residual ischemia. This test, performed around the 15th day, after previous anti-angina treatment have been discontinued, is only done in the absence of the classic contra-indications. It permits to detect abnormalities: electrical positivity (with or without pain), disorder of the ventricular rhythm, abnormality of the blood pressure profile, low stress level. The predictive value of these abnormalities has been the subject of many studies. Although all the results are not in agreement, each one of these abnormalities seems to carry an increased risk of cardiac occurrences after myocardial infarction. In addition, an early stress test enables to detect pluritroncular coronary lesions with, however, an average sensitivity. Thallium scintigraphy in conjunction with a stress test improves, however, the performances of this test. The advantage of an early stress test is the rapid screening of high risk patients who should benefit from additional exploratory measures and possibly of myocardial revascularization procedures.

Exercise Test↗
PubMed1986

[Ergometric effects of a single administration of trimetazidine].

The effects on exercise capacity of a single oral dose of 60 mg of trimetazidine were studied during a double-blind, placebo controlled cross-over study. Ten patients with stable angina and angiographically proven coronary artery lesions underwent ergometric bicycle exercise tests before and two hours after administration of the drug. A blood sample, for trimetazidine levels, was taken at the end of the recovery period. The homogeneity of the group and the lack of significance of the order of administration were established by cross-over analysis of the "control" tests and the "treated" tests. As compared with placebo, a statistically significant difference was noted after trimetazidine in the following parameters: total work (+31%, P less than 0.02), duration of exercise (+17%, P less than 0.02), percentage of the predicted maximal heart rate reached (+4%, P = 0.05), time to 1 mm ST segment depression (+17%, P less than 0.05) and degree of ST depression at maximum exercise level of the first control test (-31%, P less than 0.05); there was no significant difference in heart rate, blood pressure at rest and rate-pressure product during exercise between treatment and placebo. Two patients showed no response to trimetazidine. In the eight patients who did respond, there was a correlation factor of 0.73 between the plasma levels of trimetazidine and the increase in work performed. In conclusion, a single 60 mg dose of trimetazidine improves exercise tolerance and delays the ischaemic threshold during exercise without any detectable peripheral haemodynamic effects.

Administration, Oral↗
PubMed1986

[Abnormal origin of the left coronary artery. Pre- and postoperative hemodynamic and metabolic studies].

The authors report the case of an asymptomatic 45 year old man in whom an abnormal origin of the left coronary artery was discovered fortuitously. Coronary angiography was carried out for electrocardiographic signs of anterior myocardial infarction and showed the left coronary artery arising from the pulmonary artery: there was apical dyskinesia with alteration of global left ventricular function. The ostium of the left coronary artery was closed and a saphenous vein aorto-left anterior descending artery bypass was performed. There were no complications. Left ventricular function has not improved 8 months after surgery. The haemodynamic and coronary signs of myocardial ischaemia demonstrated preoperatively regressed after surgery: the coronary "steal" caused by the malformation which led to poor perfusion of the territory of the left coronary artery has therefore been corrected by surgery. This procedure should be carried out as early as possible in order to limit extension of the myocardial lesions.

Coronary Artery Bypass↗
PubMed1985

[Intravenous labetalol in normotensive coronary patients. Effects on hemodynamics and myocardial metabolism].

The haemodynamic and myocardial metabolic effects of intravenous Labetalol were studied in 7 normotensive coronary patients with at least one significant stenosis on the left anterior descending artery. The study consisted of 5 successive observation periods: basal (I); during atrial pacing at the theoretical maximal heart rate or when anginal pain occurred (II); return to basal conditions (III); 20 minutes after an injection of 1.5 mg/kg of Labetalol over 3 minutes into the pulmonary artery (IV); during repeat atrial pacing at the rate achieved during phase II (V). There was no significant difference between phases I and III except for a slightly faster heart rate in phase III. The effects of Labetalol were assessed by comparing the results during phases III and IV between phases II and V and by analysing the variations between phases I, II, IV and V. In comparison with basal conditions (phase III), Labetalol (phase IV) induced a slight decrease in cardiac output (p less than 0.05), a decrease in aortic pressure and systemic arterial resistances (p less than 0.01) and of the double product. Coronary sinus flow did not change but myocardial oxygen consumption fell by an average of 11% (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Comparison of quantitative data from two-dimensional echocardiography and anatomical examination in mitral stenosis].

This prospective study was undertaken to assess the results of 2D echocardiography in the assessment of valvular and subvalvular lesions in mitral stenosis. The echocardiographic findings (E) were compared with peroperative and laboratory anatomical examination of the excised valve (A). The following criteria were compared: 1) planimetry of mitral valve surface area, 2) mobility of the anterior leaflet, assessed anatomically by the flexibility of the tissue, and echocardiographically by the amplitude of early diastolic excursion, 3) length of anterior and posterior leaflets, 4) presence of calcification, 5) length of the longest tendinae chordae, measured from the papillary muscle to the insertion of the valve, 6) thickness of the thickest tendinae chordae attached to each leaflet. Echocardiography was carried out preoperatively by two different operators without knowledge of the haemodynamic and later anatomical findings. The anatomical results were taken as reference. Mitral valve surface area measured by both methods was comparable (A = 0,96 +/- 0,28 cm2; E = 1,04 +/- 0,33 cm2, N = 17, t = NS) and a good correlation was found between the two measurements (r = 0,79; p less than 0,01). 2D echo assessed the loss of valvular mobility by limitation of early diastolic opening of the AML with a sensitivity of 71 p. 100 and a specificity of 70 p. 100. Measurement of valve length of the anterior (N = 14) and posterior leaflets (N = 15) may be difficult in the presence of severe calcification. The results of both measurements were comparable. AML, 25,2 +/- 1,9 mm (A) and 24,6 +/- 2,1 mm (E); PML, 13,9 +/- 1,9 mm (A) and 14,2 +/- 2,2 (E) correlated well, r = 0,71 and r = 0,71 respectively (p less than 0,01).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

[Acute hemodynamic and coronary effects of captopril in chronic cardiac failure].

The acute effects of captopril on haemodynamics, coronary flow and myocardial metabolism were studied in 12 patients with chronic severe cardiac failure (primary cardiomyopathy: 10 cases; ischaemic: 2 cases) in functional Classes III or IV of the NYHA. All patients were male and their average age was 51.3 +/- 14.1 years (range 27 to 68 years). Measurements were carried out under basal conditions and 90 minutes after a single dose of 50 mg (5 cases) or 100 mg (7 cases) of captopril. Captopril administration leads to an increase in cardiac index from 2.05 +/- 0.32 to 2.34 +/- 0.35 l/min/m2 (p less than 0.05) and a greater increase in systolic index from 23.9 +/- 6.7 to 29.8 +/- 6.9 ml/syst/m2 (p less than 0.01), because the heart rate decreased slightly (p less than 0.05). These changes were the result of a decrease in afterload: mean aortic pressure fell from 85 +/- 11.8 to 68 +/- 19.6 mmHg (p less than 0.01) and systemic arterial resistance fell from 2 886 +/- 745 to 2 010 +/- 610 dynes/cm-5/sec/m-2 (p less than 0.01). Captopril also led to a fall in venous tone, i.e. pre-load: left ventricular end diastolic pressure fell from 26.9 +/- 6.1 to 20.8 +/- 6.6 mmHg: p less than 0.01. There was no change in contractility as shown by the absence of variation of the V.max (0.92 +/- 0.18 under basal conditions, and 0.90 +/- 0.15 after 90 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Recurrent ejection of aortic valve prostheses. Apropos of 22 case reports].

Twenty two cases of recurrent perivalvular leaks in aortic valve prostheses were reviewed in a multicentre cooperative study. From 1963 to 1978, 22 patients, mean age 39 years, underwent aortic valve replacement; 18 patients had aortic regurgitation, 6 due to infective endocarditis, and 4 patients had calcific aortic stenosis. Eight Starr-Edwards, 6 Smeloff-Cutter, 2 Braunwald-Cutter, 3 Björk, 1 Lillehei-Kaster and 2 bioprostheses were inserted. All 22 patients had to be reoperated for perivalvular leaks due to active or previous infective endocarditis in 7 cases. The prostheses implanted (3 reinsertions, 19 valve replacements) were 10 Starr-Edwards, 4 Smeloff-Cutter, 5 Björk, 1 Lillehei-Kaster, 1 Magovern and 1 bioprosthesis. All 22 patients had further perivalvular leaks, 6 caused by infective endocarditis, and 15 patients underwent a third operation. The prostheses implanted this time (2 reinsertions, 13 valve replacements) were 4 Starr-Edwards, 3 Smeloff-Cutter, 7 Björk and 1 bioprosthesis. Four patients had a third perivalvular leak, and 2 patients a fourth perivalvular leak. The first and second episodes of perivalvular leak were detected early in over half the cases. They were associated with cardiac failure, angina and hemolysis in 20 to 45% of cases. The average period between the first and second operations, and the 2nd and 3rd operations were 15 months and 9 months respectively. Overall, 11 patients died (50%), 4 due to cardiac failure and 3 of sudden death; 3 patients have been lost to follow-up (14%), and there are 8 survivors (36%) with a mean follow-up period of 5 years. However, the mortality rate when the cause of perivalvular leak was infective, was 82%, and only 18% when the cause was mechanical. The factors which favour recurrent perivalvular leaks are infection (30% of cases) and technical difficulties related to the poor quality of the aortic ring (calcification, dystrophy or dilatation). The prevention of this complication depends on careful peroperative technique, the use of certain surgical bypass techniques, a constant battle against infection, and regular examination of operated patients.

Adult↗
PubMed1981

[Mitral incompetence as presenting feature of idiopathic left ventricular aneurysm (author's transl)].

A further case of the exceptionally rare condition of idiopathic left ventricular aneurysm is reported in which the lesion was detected in a most unusual manner. The patient, a young 22-year-old negro woman, had been admitted for investigation of a mitral incompetence. The true diagnosis was established by angiography, which demonstrated a large multilobular left ventricular aneurysm, also communicating with the left auricle, this being the cause of the mitral incompetence. Surgical correction of the lesion suppressed the mitral leak without touching the normal mitral apparatus.

Adult↗
PubMed1978

[Continous electrocardiography recording in coronary insufficiency. Diagnostic value].

The accuracy of continuous 24 hour recordings (Holter's method) in the diagnosis of coronary insufficiency has been studied in 115 patients, by comparison with coronary arteriography. The technique was highly specific, but only fairly sensitive under the conditions of the study, because of the relative inactivity of the patients or the absence symptoms during the recording. It has allowed us to detect certain painfree or relatively painless forms of myocardial ischaemia which may be severe, and to have a clearer understanding of the effect of treatment. Comparison with the exercise electrocardiogram has shown inconsistencies due to the limitations of the two techniques. Holter's method is a particularly simple way of detecting coronary insufficiency, and is most useful when exercise tests are impossible or contraindicated.

Adult↗
PubMed1976

[Long-term fate of mitral valve prostheses].

The long term fate of mitral valve replacements (over 2 years) has been studied by the collection of information from many French cardiology centres. The Starr valve with a plastic ball-valve is by far the most commonly used prosthesis. The late complications are dominated by thrombo-embolic sequelae. The functional result seems to be proportionally better the earlier the stage at which the operation is carried out.

Adolescent↗
PubMed1976

[Hemodynamic effects of intravenous injections of amiodarone chlorhydrate in normal subjects and coronary patients].

A study has been made of the haemodynamic affects of a single intravenous injection of amiodarone chorhydrate (5 mg/kg); the injection was given at rest to six normal subjects and six patients with coronary insufficiency due to atherosclerosis. The effects of the drug are most marked at the fifteenth minute after injection, and are: slowing of the heart rate; lessened cardiac output and left ventricular effort; a significant increase in mean pulmonary arterial pressure and diastolic pressure; slight variations in flow in the coronary sinus, with an increase in the ratio of coronary sinus flow to cardiac output. Amiodarone chlorhydrate appears to exert a favourable action upon the heart because, while it maintains myocardial perfusion, it tends to diminish the myocardial oxygen requirement by decreasing the rate of contraction and the contractility of the myocardium.

Adult↗