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Biomedical subjects

P Vernant

Publications and source records attributed to P Vernant.

At least 37 records · Page 2Linked to original sources
PubMed1984

Long-term evaluation of bioprosthetic valves: 615 consecutive cases.

From January 1975 to September 1983, 615 patients underwent valve replacement using 698 bioprosthetic valves for selected indications. This group represents the third of all patients having valve replacement during the same period. Children younger than 15 years were excluded. The mean pre-operative functional class was 2.9. The early mortality rate was less than 5% and the follow-up range 3 months to 9 years (3.2 yrs). The symptomatic improvement was attested by a mean post-operative functional class of 1.4. In a linear study the following rates of valve related complications were noted: thromboembolism 4.6%, endocarditis 2.5%, primary tissue valve degeneration 1.1%, paraprosthetic leak 2.5%. In an actuarial study, at 8 years, 83% of patients were free from any valve failure. The probability rates of complications were the following: thromboembolic events 8%, endocarditis 5%, degeneration 3%, reoperation 7%. The probability of survival at 8 yrs was 69% and the probability rates of late mortality were noted as follow: cardiac related mortality 27%, valve-related mortality 4%. Despite an expected increasing rate of degeneration, the results warrant the use of bioprostheses in a selected group of patients.

Actuarial Analysis↗
PubMed1984

[Subvalvular aortic stenosis in adults. Apropos of 31 cases].

The aim of this cooperative study was to analyse the clinical profile of subvalvular aortic stenosis (SVAS) in adults. Thirty one cases were collected : patients aged 17 to 60 years (average 34 years). The diagnosis was confirmed in all patients either at surgery (30 cases) or at autopsy (1 case). The overall incidence of SVAS in patients with fixed obstruction to left ventricular ejection operated in the same period was 3.5%. Associated congenital malformations were detected in 15% of cases but intracardiac shunts were rare. Adult SVAS is a purer malformation than in children, probably because of spontaneous and surgical selection. The anatomical type of stenosing lesion in this series was a subaortic ring or membrane; 45% of patients, usually over 40 years of age (7 out of 9) had localised septal hypertrophy at the level of the diaphragmatic obstruction. The clinical presentation was that of mixed aortic disease with associated stenosis and regurgitation. Over 80% of patients had aortic incompetence diagnosed clinically (26 out of 31 cases) or on aortography (24 out of 25 cases); the regurgitant flow was assessed as mild in 15 cases, moderate in 6 cases and severe in 3 cases. There were obvious valvular lesions at surgery in 19 cases, especially in patients over 40 years of age (8 out of 9 cases). The mechanism was variable : non-specific (8 cases), destructive (6 cases), rheumatic (2 cases) or congenital (3 cases). Bacterial endocarditis was particularly common (26% of cases). Adult SVAS is a particularly difficult clinical diagnosis : the electrocardiogram and chest X-ray are not very informative.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Idiopathic dilatation of the right atrium in 2 infants disclosed by arrhythmia].

Idiopathic right atrial dilatation is a rare and probably congenital malformation. Two new cases are reported, in an 18 months old infant and a six week old baby, both presenting with supraventricular tachyarrhythmias. Clinical examination was normal. Chest X-ray showed bulging of the right heart border and electrocardiography revealed partial right bundle branch block. The diagnosis was made by echocardiography which showed aneurysmal dilatation of the right atrium. There were no signs of valvular heart disease or of an intracardiac shunt; the septal tricuspid leaflet was in its normal position. M-mode recordings showed no signs of Ebstein's anomaly. The diagnosis was confirmed by cardiac catheterisation in the first case; this investigation seemed to be pointless in the second case. Both children experienced many episodes of supraventricular tachyarrhythmias. The first developed tricuspid regurgitation but the second remains asymptomatic.

Echocardiography↗
PubMed1983

Myocardial macroaggregate uptake on successive lung perfusion scans.

In a patient with an Eisenmenger syndrome and multiple intraventricular communications, myocardial uptake of macroaggregated albumin appeared during a perfusion lung scan. This pattern can be explained by an increase of arterial pulmonary hypertension heightening the proportion of the right-to-left shunt.

Adolescent↗
PubMed1983

Comparison of short-term efficacy of diltiazem and propranolol in unstable angina at rest--a randomized trial in 70 patients.

The short-term efficacy of diltiazem (D) has been compared to that of propranolol (P), in a group of 70 patients hospitalized in the Coronary Care Unit for unstable angina, defined as recent (less than one month) appearance or aggravation of spontaneous chest pains. Among the 70 patients, 24 had angina only at rest. The patients have been divided into two groups according to ST-T changes during chest pain: 29 with ST elevation (group A) and 41 with other repolarization abnormalities (group B). Treatment was then randomized in each group. Treatment Treatment was considered successful only if spontaneous chest pains disappeared completely. Thirty-four patients were treated with D (282 +/- 102 mg/day) and 36 with P (158 +/- 81 mg/day). In the whole group and in groups A and B considered individually, responses to D and P did not differ. Among the 24 patients with angina exclusively at rest, nine successes and four failures were observed with D. There was no symptomatic relief among the 11 patients treated by P (P = 0.001). Moreover, the number of episodes of angina was decreased by D and unchanged by P, while eight out of the 11 failures with P were immediate successes when treatment was replaced with D. These results suggest that D is preferable to P for management of unstable angina in patients with angina which is exclusively spontaneous.

Adult↗
PubMed1983

[Noninvasive evaluation of aortocoronary bypass graft patency with tomodensitometry and exercise myocardial scintigraphy].

The control of the patency of aortocoronary bypass grafts necessitates further coronary angiography, an invasive investigation which is difficult to perform routinely because over 60 p. cent of operated patients are asymptomatic. Non-invasive methods have been proposed for this task, including computerised axial tomography (CAT) and exercise Thallium 201 myocardial scintigraphy (EMS). The aim of this study was to assess the relative value of CAT and EMS, alone and in association, in comparison with coronary angiography. Thirty six patients (35 men, 1 woman) with a mean age of 54 years were studied. These patients had a total of 59 bypass grafts inserted an average of 23 months before investigation (20 single, 10 double, 5 triple and 1 quadruple bypass grafts). CAT scanning was performed the day before coronary angiography. Sections of the thorax 7 mm thick were recorded after intravenous injection of contrast medium. A patent graft was identified as an opacity increasing after the injection of contrast on one of the aortic walls. During coronary angiography a graft was declared to be patent when it was opacified selectively or during aortography, and when the grafted coronary artery was seen to be revascularised. The quality of the distal coronary bed was also evaluated (implantation of the graft, distal and collateral vessels). Twenty three patients (with a total of 36 grafts) also underwent EMS on the same day as CAT scanning. Normal fixation in the revascularised territory was taken as evidence of a patent graft. --Coronary angiography showed that 44/59 grafts were patent at 24 months. --CAT scanning was unable to evaluate 12/59 grafts. Thoracic metallic clips created stratified artifacts and analysis of the section was impossible (20 p. cent of CAT investigations were non-contributive); of the interpretable investigations, 40/47 grafts were correctly assessed (85 p. cent): 30/32 patent grafts and 10/15 occluded grafts. --The results of EMS were less reliable; 23/36 grafts correctly assessed (64 p. cent), 18/27 patent grafts and 5/9 occluded grafts. However, EMS provides complementary information to that provided by CAT scanning, especially with respect to the distal coronary bed. When the two methods were used together, 15/15 good surgical results (patent grafts with good distal vascularisation) and 6/8 poor results (patent grafts but poor distal vascularisation), were identified. We conclude that these two atraumatic methods, CAT scanning and EMS, which may be performed on out-patients, are valuable for the routine assessment of the patency of coronary bypass grafts. Coronary angiography could therefore be reserved for those patients in whom further surgery is being considered.

Adult↗
PubMed1983

[Myocardiopathies and tricyclic antidepressants. Apropos of 3 cases].

The authors report three cases of cardiac failure induced or aggravated by chronic tricyclic antidepressant therapy. Tricyclic antidepressants have a negative inotropic effect both when administered acutely or chronically in animals. This action is related to plasma concentrations. However, the association of chronic tricyclic antidepressant therapy and cardiac failure is rare. The implication of these drugs in the cause of cardiac failure requires: --improvement of cardiac failure on withdrawal of therapy, as observed in our three cases; --the presence of underlying cardiac disease, as was the case in our patients; --abnormally high plasma levels of the antidepressant drugs despite normal dosage, as was verified in two of our patients. The measurement of plasma concentrations of antidepressant drugs would seem to be necessary when this form of treatment is to be administered to patients predisposed to cardiac failure.

Antidepressive Agents, Tricyclic↗
PubMed1982

[Haemodynamic and coronary effects of Risordan injection in patients with coronary disease (author's transl)].

Nitro-compounds exert a preventive action on myocardial ischaemia through their peripheral effects (reduction of left ventricular preload) and their effects on the coronary system (increase of collateral flow and imprevement in the endocardium: epicardium perfusion ratio). The haemodynamic, coronary and metabolic effects of Risordan i.v. infusions (5 mg/h) in acute myocardial ischaemia induced by rapid atrial stimulation (RAS) were investigated in 15 male patients with angiographic or ECG signs of non-perfusion of the coronary network. Coronary sinus blood flow was measured by the thermodilution method. The values measured or calculated were: heart rate (HR), cardiac index (CI), aortic pressure (PAo), pulmonary capillary pressure (PCP), right atrial pressure (RAP), systemic arterial resistance (SAR), double product (DP), coronary blood flow (QCcor), total coronary resistance (TCR), O2 arterio venous difference (DAVO2), myocardial O2 consumption (MVO2) and myocardial lactate extraction (K %). RAS produced a significant increase of PAo, CI, DP, MVO2 and QCcor, with inversion of K % (-3.3%) indicatif anaerobic metabolism by myocardial ischaemia. Risordan produced significant diminution of PAo and CI with subsequent increase of HR; there was little increase of DP, MVO2 and QCcor and little change n myocardial metabolism (K % = 14 %). Risordan corrected the myocardial ischaemia induced by RAS, with decrease of PAo, PCP, RAP, CI, DP and QCcor, K % became positive (+ 11.5 % vs -3.3 % during RAS) suggesting a decrease in myocardial ischaemia.

Aged↗
PubMed1982

[Aortic insufficiency caused by incomplete rupture of the ascending aorta. Conservative surgical treatment].

Commissural disorganisation secondary to incomplete rupture of the ascending aorta was found at surgery for massive aortic incompetence in a young man with previous hypertension. The lesions were repared by a conservative procedure with an excellent result 3 years after surgery. Incomplete spontaneous rupture of the ascending aorta occurs in the same terrain as dissection of the aorta (hypertension, aortic media necrosis) of which it represents a minor form. It may remain asymptomatic but it is usually complicated either by secondary intrapericardial rupture, by aortic aneurysm or by aortic incompetence due to valvular prolapse. When valvular prolapse is associated with another lesion which aggravates the regurgitation (aortic valve disease, aortic ring dilatation) aortic valve replacement should be performed with a prosthesis; on the other hand, when commissural disorganisation giving rise to valvular prolapse is the cause, a conservative procedure may be envisaged.

Adult↗
PubMed1982

[Bacterial endocarditis in congenital heart diseases].

The following observations were made on a series of 15 cases of bacterial endocarditis on congenital cardiac lesions admitted between 1971 and 1980, in 13 patients aged 6 to 48 years old (average 21 yrs old): --The low but constant incidence of endocarditis--The majority of causal lesions were ventricular septal defects of Fallot's tetralogy--The portal of entry diagnosed in 2/3 of cases was usually dental--The causal organism was a streptococcus in 80% of cases--The long period of pyrexia before, the diagnosis of endocarditis was made--M mode, and above all, 2D echo detected vegetations in half the cases where it was performed--The gravity of the immediate prognosis due to a 25% mortality and a high incidence of complications--Early complications present in 2/3 of cases were dominated by true "oslerian" lesions, cardiac failure, cerebral complications, pulmonary embolism and early relapse. --The relatively good secondary prognosis.

Adolescent↗
PubMed1981

[Tetralogy of Fallot and aortic insufficiency].

Seven out of 348 cases of Fallot's tetralogy (2 %) referred over an eight year period were complicated by aortic incompetence (AI). The incidence of AI was much lower than in VSD (7.6 %), probably because of the prevailing haemodynamics: in high VSD, the left-to-right shunt may damage the aortic cusps whilst in Fallot's tetralogy the output of both ventricles is ejected directly into the aorta with no alteration of aortic valve function. In this series, infective endocarditis was the predominant cause of AI (3 cases); surgery had to be undertaken in the infectious phase in 2 cases. AI was coincidental in two other cases (rheumatic valvular disease and calcified bicuspid valve). In the remaining two cases, the role of increased aortic flow in late distension of the aortic valve ring is discussed. AI should be corrected in the same operative time as the Fallot's tetralogy. Late onset AI occurring after repair of Fallot's tetralogy should also be corrected; in this situation, it is often difficult to diagnose the origin of the diastolic murmur. Without surgery the prognosis is poor as the diastolic regurgitation occurs in a ventricle whose function is often already compromised.

Adolescent↗