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A Charpentier

Publications and source records attributed to A Charpentier.

60 records · Page 4Linked to original sources
PubMedDate not supplied

What is the place of pulmonary embolectomy today?

From 1.1970 to 31.12.1989, 134 patients with pulmonary embolism were treated by pulmonary embolectomy (74 women and 60 men) of mean age 55 years (23-78 years); 93 (69%) of these patients developed embolism during the postoperative period following surgery for another condition. In 12 cases the embolectomy was performed without circulatory assistance by a modified Trendelenburg operation after an average delay time of 2 hours. In 122 cases, extracorporeal circulation (ECC) was used, preceded in 64 cases, by a femoral-femoral bypass (the average delay interval of operation being 16.9 hours). At operation, 23 patients were in complete circulatory failure needing external cardiac massage, 34 were in cardiogenic shock with systolic arterial pressures (SAP) less than 60 mmHg, 42 maintained their arterial pressure between 60 and 100 mmHg, and only 35 were seen with SAP higher than 100 mmHg under vasopressive drugs. No haemodynamic and angiographic investigations could be undertaken in 31 patients because of their dramatic clinical state. In the other 103 patients who had invasive angiographic investigations performed the pulmonary bed was obstructed from 65% to 90% (mean 79.4%) according to Miller's index. The mean arterial pulmonary pressure was 51.2 mmHg. The survival rate at the 30th postoperative day showed 113 patients were alive (84.3%) with 7 among the 12 operated by the Trendelenburg's modified method and 106 among the 122 operated under ECC. The main causes of the 21 deaths were: peroperative 8, neurological 4, cardiac 4, respiratory 1, recurrent embolism 1, acute thrombosis of the IVC 1. Our results of pulmonary embolectomy can be compared favorably to those obtained by thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Traumatic lesions of the thoracic aorta. A report of 73 cases.

In a 24 year period we treated 73 traumatic lesions of the thoracic aorta; 36 of these were acute ruptures and 37 post traumatic pseudo-aneurysms. All these cases were associated with violent, sudden deceleration and in 68 instances the cause of this was a traffic accident. Fifty two patients (70%) had severe associated lesions involving the cranium, abdomen, thorax or leg fractures and dislocations but in 5 patients the aortic rupture was the only injury observed. Thirty four patients with acute aortic lesions were operated upon; 30 with extracorporeal circulatory assistance (CA) and 4 with aortic cross clamping alone. Twenty one were repaired by direct suture, 13 by prosthetic graft interposition and there were 8 deaths (23.5%) and one case of post-operative paraplegia. Thirty six traumatic aneurysms were operated upon; 34 with CA and 2 with cross clamping. Only two were repaired by direct suture, 5 by prosthetic angioplasty and 29 required prosthetic interposition grafts; there were no deaths or paraplegias in this group. Aortic rupture demands early diagnosis and immediate surgery. Associated abdominal injuries are easily missed and therefore exploratory laparotomy should be considered after every acute aortic repair.

Accidents, Traffic↗
PubMedDate not supplied

[Acute dissection of the ascending aorta. Can the risk of reoperation be reduced?].

From January 1974 to October 1993, we operated 113 Stanford type A acute dissections of the ascending aorta. There were 19 cases of immediate death but overall mortality was low (17%). During the last 10 years, mortality was reduced to 12%. There were 94 survivors who were followed for 2 months to 19.2 years. Mean follow-up was 6.6 +/- 4.77 years. Total follow-up time was 583 patients/years. There were 21 secondary deaths occurring within 2 months of surgery and the 10th post-operative year. Actuarial survival rate, including operative mortality, was 80 +/- 3.7% at 1 year, 70 +/- 4.6% at 5 years and 53 +/- 6% at 10 years. There were 17 vascular complications during the follow-up including 12 requiring reoperation. There were no vascular complications in 90% of the patients at 3 years, 78% at 6 years and 60% at 10 years. Three cases of aortic insufficiency developed subsequently and required reoperation with prosthetic valve replacement. Operative techniques changed between the first and second decade of this series. During the second decade, cardioplegic protection of the myocardium, open distal anastomosis, systematic exploration of the aortic arch and finally extension of the resection to the isthmus when required were introduced successively. In the absence of sufficient follow-up in the patients operated during the second decade, it is not possible to establish whether these modifications have actually reduced the number of post-operative vascular complications commonly reported.

Acute Disease↗
PubMedDate not supplied

[Evaluation of coronary risk in patients with subrenal abdominal aortic aneurysm].

Atheroma lesions are often found in multiple localizations. In addition, operative mortality for aneurysms of the non-ruptured sub-renal aorta is mainly related to coronary risk. In an attempt to reduce coronary risk, coronarography was performed in all patients (n = 297) from January 1989. Operation for the aneurysm was performed in 192 patients (reasons for not operating were small size of the aneurysm, other contraindication). There were 5 deaths, all related to coronary artery disease. Coronary bypass was performed in 42 patients either before (n = 38) or at the same time (n = 4) as the operation for the aneurysm of the aorta. There were no operative deaths. These results clearly demonstrate the importance of search and treatment of associated coronary lesions in all patients with an aneurysm of the subrenal abdominal aorta. Coronary lesions should be treated whenever morphology allows.

Adult↗