Search PubMed⌕ Search

Biomedical subjects

T Corcos

Publications and source records attributed to T Corcos.

At least 55 records · Page 3Linked to original sources
PubMed1993

Role of the different percutaneous revascularization techniques in single and multivessel coronary artery disease.

Over the past 16 years coronary angioplasty has become an established therapy for coronary artery disease. Advances in technology and growing operator experience have improved initial success rates, lowered the complications associated with coronary angioplasty and expanded the indications of percutaneous revascularization to include large numbers of patients with complex lesions. The mechanisms of coronary angioplasty include plaque fracture, intimal atherosclerotic flaps, localized medial dissection and stretching of plaque-free segments. The problems and limitations of coronary angioplasty are: unfavourable lesion morphology which may preclude complete revascularization or increase the risk of major complications, "high-risk" patients requiring pharmacological or mechanical support, acute coronary occlusion, and restenosis, the 2 latter problems being related to the very mechanisms of coronary angioplasty. Recently, new interventional devices have been introduced: intracoronary stents, directional coronary atherectomy, rotational atherectomy, transluminal extraction atherectomy, excimer laser coronary angioplasty. A multidevice lesion-specific approach integrated with balloon angioplasty may optimize procedural results in a growing number of patients with complex coronary lesions. However, restenosis occurring within 6 months after successful angioplasty remains the "Achilles' heel" of coronary interventional procedures and erodes the potential advantages angioplasty holds over coronary bypass surgery. These 2 forms of myocardial revascularization are currently compared for the treatment of multivessel disease in randomized trials.

Angioplasty, Balloon, Coronary↗
PubMed1992

Percutaneous transluminal coronary angioplasty of oversized saphenous coronary bypass grafts: 'hugging balloons' or single peripheral dilatation catheter technique?

The use of angioplasty in patients with previous coronary bypass grafts (CABG) has been described in several reports. CABG diameter often exceeds the size of the available coronary balloon dilatation catheters. Simultaneous inflation of two side-by-side balloons or a peripheral angioplasty catheter have been used to achieve optimal balloon-vessel ratio. We describe our experience with the two-balloon technique (case 1) and with a single peripheral angioplasty balloon (case 2) to dilate oversized CABG.

Aged↗
PubMed1992

[Ambulatory coronary arteriography with 5 French catheters: experience with 604 procedures].

Ambulatory coronary arteriography was carried out in 604 patients, 143 women and 461 men, mean age 53 +/- 14 years. An absolutely stable clinical condition was the main criterion of selection for this investigation and the protocol consisted in day-hospital admission, absence of routine anticoagulation, small calibre (5 French = 1.7 mm diameter) catheters, mobilization 4 hours and discharge 6 hours after the end of the procedure. The percutaneous femoral approach was used in 95% of cases; 56% of patients presented significant single-or multi-vessel coronary artery disease: there were 7 cases of left main coronary artery narrowing; 31 patients required full hospital admission, mainly because of the severity of coronary lesions. Minor complications occurred in 2% of cases.

Adult↗
PubMed1992

[Tetralogy of Fallot and mitral valve stenosis].

The association of tetralogy of Fallot and mitral stenosis is extremely rare. This is probably the first description of this association. The clinical and haemodynamic presentation is similar to that of cyanotic heart disease with pulmonary stenosis and post-capillary pulmonary hypertension. The mitral stenosis was probably congenital as it was diagnosed at 14 months of age.

Adult↗
PubMed1990

Orion, an improved balloon on a wire system: initial experience.

The Orion coronary angioplasty improved balloon on a wire system was used in 42 patients (53 stenoses) including 5 patients with acute myocardial infarction, 18 patients with unstable angina, and 4 patients with kissing balloon angioplasty via a single guiding catheter. All stenoses were crossed successfully and the immediate and in-hospital success rates were 98 and 93%, respectively. The simple construction, low profile, and improved steerability allowed successful and quick angioplasty of high grade stenotic lesions. This balloon catheter represents a significant advance in angioplasty technology.

Angiography↗
PubMed1990

[Efficacy and safety of ambulatory coronary angiography].

Ambulatory coronary arteriography was carried out in 160 patients in the first 18 months' activity of our department (9.5% of all cardiac catheterisations and 16% of all coronary arteriographies during the same period). An absolutely stable clinical condition was the main criterion of selection for this investigation and the protocol consisted in day hospital admission, absence of routine anticoagulation, small calibre (5 French = 1.7 mm) catheters, mobilisation 4 hours and discharge 6 hours after the procedure. The patients were 38 women and 122 men whose average age was 55 years. The percutaneous femoral approach was used in most cases (95%). Single or multiple coronary artery disease was documented in 55 per cent of these patients: there were 2 cases of left main stem stenosis. Eight patients required full hospital admission, mainly because of the severity of the coronary lesions. Minor complications occurred in 2 per cent of cases. These results indicate that ambulatory coronary arteriography is safe, effective and economic. It could be used more extensively always providing that the contra-indications are respected.

Ambulatory Care↗
PubMed1989

[Spontaneous development and prognostic factors in patients needing heart transplantation. Multivariate analysis of 171 patients].

In an attempt to determine predictive factors of spontaneous death in patients needing heart transplantation, we studied 27 clinical and paraclinical variables in 171 patients aged from 14 to 61 years. Sixty-one of these patients died before transplantation could be performed, 59 were still alive awaiting transplantation and 51 received a heart transplant. The actuarial survival rate with or without transplantation was 65 percent at 1 year and 51 percent at 2 years. Univariate analysis showed that the following factors were associated with a higher mortality rate: age, history or symptoms of right heart failure, poor general condition, end-diastolic left ventricular diameter and ejection fraction. There was no correlation between high mortality rate and type of heart disease, sex, duration of symptoms, NYHA functional class, cardiothoracic ratio and data obtained from electrocardiography and right heart catheterization. At multivariate analysis (Cox's model), no variable could be selected as predictive factor of mortality. The natural outcome of patients needing heart transplantation therefore is globally unfavourable. This means that once has been decided to perform heart transplantation the operation should not be delayed.

Actuarial Analysis↗
PubMed1989

[Coronary angioplasty].

Since the first percutaneous transluminal coronary angioplasty performed in 1977 by Andreas Grüntzig, this non surgical technique has become an established method of myocardial revascularization. This overall report reviews the experience of the last ten years, acquired on several hundred thousand patients. We have especially detailed the chapters concerning the immediate and late results, restenosis, the "Achilles" heel of angioplasty, and concerning the indications, especially stressing multivessel disease and acute myocardial infarction, topics which are currently relatively controverted.

Angioplasty, Balloon↗
PubMed1988

Early and late hemodynamic evaluation after cardiac transplantation: a study of 28 cases.

Right heart catheterization was performed in 28 patients 1 week and 6 to 24 months after orthotopic cardiac transplantation. All patients were receiving cyclosporine and methylprednisolone orally. At early catheterization, right heart pressures as well as pulmonary capillary wedge pressure still remained above normal values in the majority of patients. Systemic arterial hypertension was already present in 29% of the patients and cardiac index was usually in the normal range, without any inotropic support. Results of late catheterization showed continuing improvement with return of right heart pressures to normal values in most but not all patients. Systemic arterial hypertension was noted in nearly all patients and is likely to be the result of hypervolemia secondary to cyclosporine-induced sodium retention. The increase in cardiac index, which was above normal values in 39% of the patients, was also consistent with hypervolemia in the setting of cardiac denervation. Thus, cardiac function at rest is satisfactory at short- and long-term assessment after cardiac transplantation, but the development and persistence of systemic arterial hypertension associated with cyclosporine use are a matter of concern in such patients.

Adolescent↗
PubMed1988

Doppler echocardiography for the diagnosis of acute cardiac allograft rejection.

To evaluate the changes in left ventricular filling associated with acute cardiac rejection, serial Doppler echocardiographic examinations were prospectively performed on the same day as endomyocardial biopsy in 55 consecutive patients who successfully underwent orthotopic transplantation and were free of a previous episode of rejection. On average, 8.6 Doppler studies per patient were performed within a 6 month period after transplantation. Recordings of mitral flow were made with pulsed Doppler and two-dimensional echocardiography from an apical four chamber view; isovolumic relaxation time, peak early mitral flow velocity and pressure half-time were measured. The patients were classified into two groups on the basis of the histopathologic findings: group I (25 patients with at least one episode of mild or moderate rejection) and group II (30 patients without rejection). In group I, rejection was associated with a significant decrease of isovolumic relaxation time (p less than 0.005) and especially pressure half-time (p less than 0.0005) with no change in heart rate and peak early mitral flow velocity. In group II, Doppler indexes remained unchanged. These changes were not associated with alterations in left ventricular systolic function assessed by echocardiography. Isovolumic relaxation time and pressure half-time both returned to values similar to baseline values after immunosuppressive therapy (p less than 0.05 and p less than 0.0005, respectively). With 20% decrease in pressure half-time as a criterion for acute rejection, sensitivity was 88%, specificity 87% and positive predictive value 85%. Thus, Doppler echocardiographic evaluation of left ventricular diastolic function provides an excellent tool for early detection of acute rejection and noninvasive monitoring of the cardiac transplant recipient.

Adolescent↗
PubMed1988

[Evaluation by Doppler echocardiography of left ventricular diastolic function in acute graft rejection after heart transplantation].

In order to study abnormalities of left ventricular diastolic function (LVDF) in heart transplant patients and their possible association with graft rejection, 21 patients who had recently undergone orthotopic heart transplantation were evaluated prospectively, on the day of endomyocardial biopsy, by pulsed and continuous Doppler echocardiography (DEC). Investigation of the LVDF consisted of pulsed DEC of the mitral valve in apical projection (4 cavities) with measurement of isovolumetric relaxation time (IVR), peak velocity of rapid ventricular filling (E), peak velocity of graft atrial contraction (A) and transmitral gradient decrease half-time (mitral T1/2). Each patients had 5 DEC examinations on average over a 2-month period. In patients with subsevere to severe rejection mitral T1/2 decreased significantly from 76.46 +/- 11.6 ms in the absence of rejection to 47 +/- 13.7 ms during rejection (P less than 0.001). When mitral T1/2 decreased by 25 p. 100 or more between two successive DEC, rejection was present in 89 p. 100 of the cases. It is concluded that Doppler echocardiographic studies of left ventricular diastolic function provide useful information in the follow-up of heart transplant recipients and offer hopes, in a not too distant future, of non-invasive detection of cardiac graft rejection.

Diastole↗
PubMed1988

[Percutaneous femoral artery coronary arteriography. 300 consecutive cases with French 5 catheters].

Owing to the ever growing practice of coronary angioplasty, each patient is subjected to multiple examinations and it has become imperative, both for ethical and functional reasons, to reduce the morbidity of coronary arteriography. For this purpose, reduction in the caliber of catheters is a step forward which must be made without altering the procedure and even while making it simpler (shorter stay in bed and in hospital). Between april, 1986 and january, 1987, 300 consecutive coronary arteriographies were performed in a uniform manner and using 5 French catheters in 239 men (mean age 55.4 years) and 61 women (mean age 60.3 years). There were 13 "failures" (4 p. 100) in the sense that the examination was pursued with conventional 7 F or 8 F catheters, or that the brachial route was used. Bilateral femoral puncture was necessary in 6 cases (2 p. 100), and 2 complications (0.7 p. 100) were observed: subacute femoral thrombosis in one case, and regressive cerebral vascular accident in another patient. Thus, it seems permissible and more convenient nowadays to perform all coronary arteriographies with a 5 French catheter. The femoral route can be used in ambulatory patients who get up 4 hours after the procedure.

Adult↗
PubMed1987

[Operative risk in coronary bypass. A multivariate analysis of prognostic factors].

In order to determine the predictors of operative risk in coronary bypass surgery, we have studied 2112 consecutive patients who underwent isolated coronary bypass surgery between January 1979 and September 1984. The overall operative mortality (OM) was 4.4 percent (3.5 percent during the last 3 years). OM increases significantly with age (from O before the age of 30 to 12.3 percent after 70), the functional class (FC) of angina, the FC of dyspnea (NYHA), the creatinine blood level (23.5 percent if greater than 200 mumol/l), the left ventricular end-diastolic pressure and in case of reoperation (16.7 percent), as well as in women (11.6 percent). There is a trend toward higher OM in case of past history of ventricular tachycardia or arterial hypertension, atherosclerotic disease of the lower extremities, left ventricular dysfunction or severe stenosis of the left main coronary artery. OM is not increased in patients with multivessel disease, diabetes or with a past history of myocardial infarction, and is even decreased in obese patients. The variables selected by multivariate analysis were: creatinine blood level, then angina FC, sex, dyspnea FC, age, the absence os obesity, left ventricular dysfunction, the year of surgery and finally reoperation. These results, mainly based on simple clinical variables, should facilitate the therapeutic decisions in borderline indications of coronary bypass surgery.

Aged↗