Biomedical subjects

R Limet

Publications and source records attributed to R Limet.

386 records · Page 22Linked to original sources

PubMedDate not supplied

Pacemaker implantation for early sinus node dysfunction after orthotopic heart transplantation.

Among 60 patients who received OHT at our institution between November 1986 and January 1990, 4 actually needed implantation of a permanent pacemaker. Three patients with symptomatic early sinus node dysfunction were identified and were satisfactorily paced on the VVIR mode. All three showed sinus recovery within three months following implantation and had their pacemaker switched from the VVIR mode to a simple ventricular demand pacing. Interestingly, administration of beta-blocking drugs quickly reinstituted pace dependence. The patients' outcome is excellent (18 to 48 months follow-up). No difference with the global cohort of our OHT recipients was noticed, apart from an apparent high incidence of infections (3/3) with (2/3) CMV and severe rejection (3/3) during the first month postoperatively. This data suggests that sinus dysfunction may be the result of a multifactorial (rejection, CMV, ...) injury to the conduction system, and is only clinically relevant beyond a threshold level. Denervation hypersensitivity, together with correction of these factors, may account for the restoration of a sufficient reserve of conduction system, and therefore appropriate sinus node function in basal conditions.

Arrhythmia, Sinus↗

PubMedDate not supplied

Technique for ventricular wrapping in experimental dynamic cardiomyoplasty.

Cardiomyoplasty is a wrapping of an electrostimulated latissimus dorsi muscle flap around the heart for substitution and/or reinforcement. The surgical technique for reproducible cardiomyoplasties in the goat model is presented. The methods combine the direction of wrapping (clockwise, counter-clockwise) and the orientation of muscle fibers. A cardiomyoplasty model using right and left latissimus dorsi or left latissimus dorsi and pectoralis major as well as a split muscle technique are illustrated.

Animals↗

PubMedDate not supplied

Echographic characterization of carotid plaques.

The histology of the endarterectomy specimen was compared with the preoperative echopattern of 154 plaques. Thirty-four ultrasound images were of poor quality. The 120 adequate echographies revealed 22 dense hyperechogenic homogeneous plaques, 28 soft hypoechogenic homogeneous plaques, 53 inhomogeneous plaques, and 13 mixed plaques. According to the surface, lesions were subdivided as smooth (n = 63) or irregular (n = 57). Echography recognized fibrous plaques (dense homogeneous hyperechogeneous lesions), with a specificity of 87% and a sensitivity of 56%. Recent intraplaque haemorrhage is echographically apparent as a hypoechogenic area in 88% of cases, what corresponds to a specificity of 79% and a sensitivity of 75%. Echography proved to be more accurate than angiography in determining the presence or absence of ulceration. The ability to characterize the pathology of carotid atheroma by duplex scan make the clinicopathologic correlation of carotid plaques of practical importance.

Arteriosclerosis↗

PubMedDate not supplied

Association of aortic stenosis and gastrointestinal bleeding (Heyde's syndrome). Report of two cases.

The association between aortic stenosis and digestive angiodysplasia has been described for the first time by Heyde in 1958. This entity is thus known as Heyde's syndrome. In many instances, the recurrent small intestinal bleeding originating from angiodysplasia stopped after aortic valve replacement. We report two cases of patients presenting with a recurrent small intestinal bleeding originating from digestive angiodysplasia and suffering from aortic stenosis. Diagnosis of both pathologies is well documented in both cases. The replacement of the aortic valve by a biologic prosthesis stopped the bleeding. Prior to aortic valve replacement, the two patients suffered severe recurrent blood loss from intestinal angiodysplasia. The treatment of aortic stenosis greatly favored both cardiac and general status. We recommend aortic valve replacement with a biologic prosthesis prior to intestinal resection in patients presenting with Heyde's syndrome. We stress on the fact that anticoagulants must be stopped in order to minimize the risk of further bleeding.

Aged↗

PubMedDate not supplied

Surgical technique for reinforcement cardiomyoplasty.

The current technique for reinforcement cardiomyoplasty in man is detailed. The authors emphasize the critical points that determine the perfect execution of this operation. This innovative surgical approach to heart failure is continuously evolving and, therefore, may be subject to improvement. The major principles however remain valuable.

Cardiomyoplasty↗

PubMedDate not supplied

Successful tricuspid valve replacement and pulmonary valvulotomy for carcinoid heart disease.

A case of successful tricuspid valve replacement with a mechanical prosthesis and pulmonary valvulotomy for carcinoid heart disease is reported. The patient was a 61 years old women. The primary tumor was in the terminal ileum. Liver metastasis and carcinoid syndrome were present since 8 years. After cardiac surgery, the patient survived 38 months and late death was related to disseminated metastasis. Even in case of metastasis, carcinoid tumor is slow growing. Without cardiac operation for correction of valvular lesions, terminal symptoms and death may often be related to cardiac operation for correction of valvular lesions, terminal symptoms and death may often be related to cardiac failure rather than to tumoral growth. Thus, even in presence of metastasis, cardiac surgery may be mandatory to improve both quality of life and survival.

Carcinoid Heart Disease↗

PubMedDate not supplied

Abdominal aortic aneurysms in octogenarians.

The decision on whether to operate or not abdominal aortic aneurysms (AAA) in elderly depends on the relative risk of the operation versus the natural course of the unoperated AAA. From January 1984 to December 996, 138 patients, aged 80 years and older, were referred to our department for an aneurysm of 40 mm or more (transverse diameter) of the infrarenal abdominal aorta (95 asymptomatic, 15 painful, and 28 ruptured AAA). For 58 patients with asymptomatic AAA, operation was denied at referral because of transverse diameter less than 50 mm (n = 21), patient refusal (n = 10) or unacceptable operative risk or poor general condition (n = 27). Thirty-four of these observed AAA were ultimately operated after a mean delay of 41 months because of aneurysm enlargement (n = 15), aneurysm tenderness (n = 6) or rupture (n = 13). Overall, 52 patients had immediate (n = 37) or delayed (n = 15) elective repair of their AAA, with an in-hospital mortality of 5.7%. Urgent operation was done for 21 patients with a painful AAA. Six patients died at hospital (28% mortality rate). Emergent surgery was applied to 41 patients with ruptured AAA (including 13 AAA who ruptured during surveillance). The operative mortality in this subgroup attained 68%. Follow-up for the 77 survivors and the 24 non-operative patients averaged 43 months. The 5-year survival (operative mortality included) is 47% for electively operated patients, 30% for urgently and 20% for emergently operated patients. For comparison, the 5-year survival of an age and sex matched Belgian population is 63%. For the 24 medically followed AAA, the 5-year survival was 33%. In six cases, the cause of death was rupture of the AAA. Of the 58 patients for whom operation was initially not considered, 19 (33%) presented AAA rupture (13 operated in emergency and 6 who never came to surgery). The operative outcome of AAA repair in octogenarians is less favourable than in the younger age group (3.6% mortality after elective repair, 44% after operation for AAA rupture, according to our institution data). The authors conclude that AAA surgery should not be denied to octogenarians on the basis of advanced age alone. They recommend a straightforward surgery for otherwise healthy octogenarians with AAA of 50 mm diameter, surveillance up to 60 mm for high-risk patients and no surgery for unfit, bedridden or demented patients.

Aged↗

PubMedDate not supplied

Successful bridge to transplantation with Pierce Donachy (Thoratec) ventricular assist device.

Biventricular assistance with the Thoratec ventricular assist device was performed in a 48-year-old man waiting heart transplantation since 6 months. Indication for circulatory support was considered because of the development of progressive irreversible right heart failure with deterioration of the hepatic and renal functions. Orthotopic heart transplantation was performed after 13 days of circulatory support. No complications occurred during the assistance and in the posttransplant period. The patient was discharged on day 21 after transplantation. Five months after transplantation he is well and alive.

Cardiomyopathy, Dilated↗