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32 records · Page 2Linked to original sources
PubMed1992

[Should inferior myocardial infarction be thrombolysed?].

Recent randomised studies have demonstrated the benefits of administration of intravenous thrombolytic agents in the acute phase of myocardial infarction. Though the benefits are generally acknowledged in cases of anterior wall necrosis, the results in inferior infarction have been discordant. The early patency rate at 90 minutes after thrombolysis is lower in the right coronary and left circumflex than in the left anterior descending artery. The secondary reocclusion rate is twice as high on the right coronary artery. The significant increase in ejection fraction after thrombolysis has only been demonstrated in 2 of the 8 studies in the literature. The benefits in terms of early mortality were not significant in the GISSI study. A significant decrease in early mortality (7.2% vs 8.8%) was observed only in the ISIS 2 study with streptokinase. The reinfarction rate at 1 year was twice as high when the initial infarct was on the inferior wall. Analysis of the results in the literature shows that the benefits of intravenous thrombolysis was clearcut in certain subgroups of inferior infarction: ST elevation in over 3 leads, mirror-image anterior lead changes, very early treatment (before the 3rd hour), complicated infarcts (atrioventricular block, right ventricular extension, hypotension) or in inferior infarcts occurring after previous anterior infarction.

Humans↗
PubMed1991

[Postinfarction segmental asynergy: correction after angioplasty. Predictive value of exercise thallium scintigraphy].

The aim of this study was twofold: to evaluate the frequency of reversibility of segmental post-subendocardial infarction asynergy after coronary angioplasty, and to test the predictive value of the redistribution phenomenon during stress Thallium scintigraphy with respect to the reversibility of segmental asynergy. The inclusion criteria for this study were: previous postsubendocardial myocardial ischaemia with residual resting or effort ischaemia documented with or without the Thallium test, segmented asynergy documented by quantitative analysis of the ventriculography, complete correction of coronary angioplasty of stenotic single or double vessel disease, a balanced coronary distribution or dominant left coronary in cases of lesion of the circumflex artery. Out of 254 consecutive angioplasty procedures 39 patients met these inclusion criteria. The location of the subendocardial infarct (SEI) was anterior in 17 cases and inferior in 22 cases. The study protocol included a Thallium scintigraphy from the 10th day after SEI, ventriculography 24 hours later, angioplasty and control ventriculography 24 hours after angioplasty. Comparison of the two ventriculographies opposed Group A (reversible asynergy) and Group B (irreversible asynergy) according to criteria defined in 15 normal subjects whose average regional ejection fraction (REF) was 0.53 +/- 0.11. This result enables definition of normal segmental motion if the REF greater than 0.30 (mean--2 SD); hypokinetic if the REF greater than 0.30 or akinetic if the REF less than 0.10 (mean--4 SD). An increase of REF of 0.15 (50% of the minimal normal value) allowed definition of reversibility of asynergy. By these criteria, 19 patients (48.7%) had reversible asynergy after PTCA; 20 had definitive asynergy (51.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Dysfunction of aortocoronary bypass. Prognosis].

From 1978 to 1988, 108 patients with at least one occluded or stenosed aorto-coronary bypass graft (over 75% stenosis) underwent coronary angiography on average 31 months after the initial coronary bypass surgery. The occluded or stenosed coronary graft was either a saphenous vein (n = 126 including 9 sequentials) or internal mammary artery (n = 5). The bypassed artery was the left anterior descending (n = 66), right coronary (n = 40), left marginal (n = 25) or diagonal (n = 9). The number of occluded or stenosed grafts by patient was 1.2. The left ventricular ejection fraction was 55% (range 25 to 77%). During a mean follow-up period of 60 months after coronary angiography, there were 14 cardiac deaths and 15 non-lethal myocardial infarctions. Treatment comprised 12 angioplasties, 26 new bypass grafts and 3 cardiac transplantations. The 8 year actuarial survival was 84%. The survival without infarction at 8 years was 69%. Survival was significantly decreased to 72% when the occluded or stenosed graft was located on the left anterior descending artery. The survival without infarction at 8 years was 52% in the patients with dysfunction of left anterior descending artery grafts and 89% when the diseased graft was located on another artery (right coronary, left marginal, diagonal). Therefore, the data of this retrospective study show that coronary graft dysfunction on the right coronary, left marginal or diagonal arteries do not greatly influence life expectancy in the medium term after coronary bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1991

[Prognosis of ischemic mitral valve insufficiency].

Seventy-nine patients with ischemic mitral regurgitation were followed up for a period of 20 +/- 8 months. The risk of death increased with age and cardiac failure at the time of inclusion. The risk of cardiac events increased with these factors and also with raised serum creatinine and decreased echocardiographic fractional shortening. The global 2 year survival was 72.8% and survival without a further cardiac event was 48.7%. Surgery and angioplasty increased global survival and freedom from cardiac events of patients with severe regurgitation (74.9% and 68.8% versus 59.4% and 46.1% for medical therapy alone). The functional improvement was also greater in patients undergoing surgery or angioplasty (80% of patients in NYHA Stage I versus 53.8% in the medical group). Angioplasty was only performed in cases of paroxysmal mitral regurgitation by reversible papillary muscle ischemia. Surgery (coronary bypass usually associated with mitral valve replacement) was associated with better results than medical therapy alone in permanent mitral regurgitation by papillary muscle dysfunction or rupture. Despite a high immediate mortality, this option should be considered rapidly in cases of severe ischemic mitral regurgitation with pulmonary oedema.

Actuarial Analysis↗
PubMed1990

[Initial and mid-term results of coronary angioplasty in early post-infarction unstable angina].

The aim of this study was to assess the immediate efficacy and the medium-term risks and results of percutaneous transluminal coronary angioplasty (PTCA) in early post-infarction unstable angina. Thirty-six patients were included for a series of 248 consecutive PTCA procedures performed between December 1985 and January 1989. The average age was 56 years (range 35 to 84 years). The initial infarct was anterior (N = 16), inferior (N = 15), lateral (N = 5), without a Q wave (N = 22), transmural (N = 14) and treated by thrombolysis in 42 p. 100 of cases. The interval between initial infarction and PTCA was 16 +/- 3 days. A primary success was obtained in 33 cases (92%). One patient died of electromechanical dissociation at the beginning of the procedure. Two infarcts occurred due to acute coronary occlusions. None of the patients required emergency coronary bypass surgery. The specific risk of PTCA in early post-infarction unstable angina is acute coronary occlusion. This complication was observed in 9 patients (25%) and it required immediate repeat PTCA, associated with thrombolytic therapy in four cases. Coronary occlusion was more common in patients with transmural infarcts than in those without Q-waves (43% vs 14%; p less than 0.01) and in patients treated initially by thrombolysis compared with those not treated by thrombolysis (40% vs 15%; p less than 0.05). No fatalities or reinfarctions occurred during follow-up (average 9 +/- 8 months, range 2 to 35 months). A good clinical result was maintained in 71 per cent of patients treated by PTCA alone. Seven repeat PTCA procedures and 3 coronary bypass operations were performed during follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Is the prognosis of non-thrombolysed inferior infarction benign?].

Between 1978 and 1983, 2,970 coronary angiographies were performed at the Cardiology Clinic of Necker Hospital; 220 survivors of an initial Q-wave inferior infarction who had not received thrombolytic therapy were selected. The ejection fraction was 55 +/- 11 per cent, and the indexed end diastolic left ventricular volume was 108 +/- 29 ml/m2. The left anterior descending artery was diseased in 57 per cent of cases. The incidence of multivessel disease was 67 per cent. Two hundred and eleven patients (96%) were followed up for 79 +/- 22 months. The prevalence of cardiovascular events was: cardiac deaths: 22 (10%), recurrent infarction: 20 (9%), angina requiring coronary bypass surgery: 60 (28%), cardiac failure: 22 (10%). The 10 year actuarial survival was significantly lower in patients with an ejection fraction less than 45 per cent (46% vs 91%) and in patients with triple vessel disease (62% vs 92% and 88%). The survival was not lower in patients with stenosis of the left anterior descending artery.

Actuarial Analysis↗
PubMed1990

[Restenosis after transluminal coronary angioplasty. Clinical and therapeutic aspects].

To assess the incidence and clinical presentation of restenosis after successful coronary angioplasty, and the short- and mid-term results of its treatment, 160 patients, who underwent a first coronary angioplasty between May 1987 and December 1988, were closely monitored. Restenosis is defined as a loss of 50% or more of the initial gain in area and/or 30% or more in diameter, or chronic coronary occlusion. These criteria were met in 43 patients (27%) within 5.1 months (1-6 months), on the average, after angioplasty. Restenosis was expressed as unstable angina in 51% of the patients, stable angina in 30%, and abnormal thallium myocardial scintigraphy under exercise in 14%. Myocardial infarction was never the revealing symptom. In 63% of the cases, the pain caused by restenosis repeated the initial angina. A second angioplasty was performed in 75% of the patients with a success rate of 93%, in the absence of an occlusion, and a 37% rate of further restenosis.

Angina Pectoris↗
PubMed1990

[Late occlusive thrombosis of mitral prosthesis with sinus rhythm. Report of two surgically treated patients].

Two cases are reported of late occlusive thrombosis of a mitral bioprosthesis with sinus rhythm. Two men were concerned (40 and 54 years of age), hospitalized for acute pulmonary oedema which was resistant to medical treatment, 3 years after replacement of a mitral valve (Carpentier Edwards No. 31 and Liotta No. 25). Catheterization showed that in both cases there was an average transmitral holodiastolic gradient greater than 25 mmHg. Emergency surgery revealed two anatomical forms of occlusive thrombosis: in one case, a localized red thrombus hindered the opening of a valve cusp; in the other, exuberant fibrin deposits lined the ventricular face of the valve cusps. There were no signs of degeneration of the bioprostheses and, in particular, there was no calcification. Both patients were asymptomatic 1.5 years and 3 years respectively after their operations. Late occlusive thromboses of mitral bioprostheses are exceptional (13 detailed cases collected from the literature).

Adult↗
PubMed1990

[The hospital course of thrombolyzed myocardial infarction: role of bypass and angioplasty].

The frequency of indications for revascularization (bypass and angioplasty) after intravenous thrombolysis in myocardial infarction (MI) varies from 3.3% (Gissi) to 60% (Tami). Initial progress in 30 patients hospitalized consecutively for MI treated by thrombolysis (group A) was compared with that of 30 MI patients treated conventionally (group B) over the same period. There were no between group differences in age, sex, infarction history, bypass history, topography of infarction or extent of coronary lesions. Group A was characterized by a larger ejection fraction (51.7 +/- 9.2% vs 44.9 +/- 10%; p less than 0.05), a higher frequency of ischemic recidivism (33% vs 10%; p less than 0.05), and more frequent indications for secondary revascularization (50% vs 20%; p less than 0.02).

Adult↗
PubMed1989

[Coronary bypass after thrombolysis].

Owing to the development of transluminal angioplasty, coronary bypass surgery has now well-defined indications in patients who underwent thrombolysis. It may need to be performed in an emergency, but fortunately this only occurs in a few cases: in case of occlusion of the left main coronary vessel or equivalent lesions, when thrombolysis has failed and in case of failure of angioplasty with obliteration of large vessel and a still viable myocardium, and when the patient continues to suffer or shows signs of heart failure. The operative risk and the risk of haemorrhage then reach 10 p. 100. The installation, prior to surgery, of an intra-aortic counterpulsation system is useful in case of shock or left ventricular failure. Delayed coronary bypass is indicated mainly in case of three-vessel lesions with a less than 40 p. 100 ejection fraction, in case of stenosis of the left main coronary vessel or equivalent lesions, and in patients whose lesions are not amenable to angioplasty on a good caliber vessel, with a still viable myocardium. The operative risk in such cases is distinctly lower (2.4 p. 100). The long-term results obtained confirm the value of coronary bypass surgery when it becomes necessary after thrombolysis.

Coronary Artery Bypass↗
PubMed1987

[Hepatic coma].

Explore the source record for details and available documents.

Hepatic Encephalopathy↗
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

[Acute degenerative mitral insufficiency caused by rupture of the chordae in the elderly patient].

Five cases of degenerative mitral incompetence due to rupture of the chordae tendinae in patients over 70 years of age were reviewed to determine the clinical features of this pathology which is not rare in elderly patients. Chordal rupture usually involves the posterior leaflet and is a sign of generalised disease of the mitral apparatus of two main types: myxoid infiltration or pellucid degeneration. Although the clinical syndrome of rupture is rare (10 p. 100), the mechanism of the mitral regurgitation can be identified by 2D echocardiography with a sensitivity of 92 p. 100, and the consequences of regurgitation on the left ventricle can also be evaluated. Rapid progression to acute cardiac failure is often observed and early surgical cure may be necessary (valvular replacement with a bioprosthesis is more common than mitral valvuloplasty). Further justification for this surgical approach is the improved myocardial protection which has reduced the perioperative mortality rate to less than 10 p. 100.

Acute Disease↗