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Biomedical subjects

A Saint-Pierre

Publications and source records attributed to A Saint-Pierre.

At least 19 recordsLinked to original sources
PubMed1991

Latissimus dorsi cardiomyoplasty in severe congestive heart failure: the Lyon experience.

Eleven male patients, New York Heart Association (NYHA) Class III, have undergone cardiomyoplasty (Chachques and Carpentier technique). There were no deaths. Two patients suffered from low cardiac output, one patient suffered a massive aortic bifurcation embolism, and one patient had a Legionella pneumonia. All patients recovered well. The follow-up was 6.9 +/- 2.3 months. One patient had a Cardiomyostimulator Pulse Train Generator failure and had it replaced. The first seven patients were evaluated 6 months after surgery. They all improved (Class II) except for one, who was transplanted. The maximal level of exercise was improved (92 +/- 18 W vs 60 +/- 24 W), as was the heart rate-systolic blood pressure product (30,262 +/- 3,119 vs 19,908 +/- 4,190), mainly due to an increase in systolic blood pressure (200.0 +/- 25.5 vs 141.5 +/- 20.3 mmHg). Echographic parameters, maximal oxygen consumption, left ventricular ejection fraction (LVEF), cardiac index, oxygen arteriovenous difference, and cardiac filling pressures did not change. The left ventricular (LV) angiography always showed good contraction of the latissimus dorsi. A problem needing investigation is the principle of cardiomyoplasty (CMP) itself, as the muscle acts more as a lift than as pincers. Our patients, and patients from other series, improved functionally, and they exercised more. Improvement in survival can be studied only by a randomized clinical trial.

Aged↗
PubMed1990

[Radiation-induced pericarditis. Long-term outcome. 45 cases with thoracotomy and biopsy].

Between 1970 and 1989, 45 cases of pericarditis consecutive to thoracic irradiation for cancer were studied to determine their long-term outcome and the course of their pericardial lesions. All patients were symptomatic and required surgery on account of cardiac dysfunction or, more rarely, for diagnostic purposes, i.e. to distinguish between pure autonomous pericardial complications and recurrent mediastinal neoplasias, the latter being excluded from the study. All patients were explored by thoracotomy which permitted histopathological examination of the pericardium and the pericardial fluid, at the same time as therapeutic surgery (pericardial decortication for constriction in 22 cases, creation of pleuro-pericardial windows to ensure drainage of major effusions in 23 cases). The outcome was often poor owing to associated post-radiotherapy myocardial and pulmonary lesions: there were 20 deaths, 5 of which were directly due to the neoplasia and 13 to the radiotherapeutic complications; 5 patients remained with impaired cardiorespiratory function.

Adolescent↗
PubMed1989

[Value of the positive exercise test without angina (after myocardial infarct)].

In order to determine the value of a positive exercise test (ET) (i.e. ischaemic ST depression) without chest pain observed after a myocardial infarction (MI), 102 ET's were reviewed. ET was performed without anti-ischaemic drugs. The mean time-lag between MI and ET was 51 +/- 55 months. The MI was inferior in 26 cases, inferior and/or posterior in 74 cases and of undetermined location in 2 cases. Thirty patients had both ST depression and chest pain (group 1); 35 had electrocardiographic signs of ischaemia without pain (group 2), and 37 had neither chest pain nor signs of ischaemia (group 3). Age, sex ratio, site of infarction and time-lag between MI and ET were similar in all three groups. The post-ET follow-up period was 33 +/- 18 months (range: 6 to 66 months); 2 patients in group 3 were lost sight of. There was no significant difference between groups 1 and 2 as regards total duration of ET, workload attained, heart rate, systolic arterial pressure, pressure-rate product and amplitude of ST depression at maximum exercise level. Group 3 differed from the other 2 groups in workload attained (p less than 0.05) and in pressure-rate product (p less than 0.05 vs group 1, p less than 0.01 vs group 2). There was no significant difference between groups 1 and 2 as regards post-ET events (recurrent angina, reinfarction, coronary bypass, transluminal angioplasty).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Methods of evaluating myocardial revascularization surgery].

The quality of revascularization is evaluated by measurements of blood flow and various imaging methods. The quality of the anastomosis and the graft flow are evaluated per-operatively by ultrasounds and by measurements of intramyocardial pH. After surgery, Doppler velocimetry and radioisotope scanning assess the basal coronary flow and the coronary reserve. Graft patency can be studied by noninvasive methods (Doppler and kinetic CT with contrast injection), but conventional or digital angiography is irreplaceable for visualization. Residual myocardial ischaemia and left ventricular function are evaluated by the usual methods. Angina is not sensitive enough to serve as an indicator of residual or recurrent myocardial ischaemia. ECG at rest detects most peri-operative infarctions; Holter recordings may reveal a silent myocardial ischaemia; exercise stress ECG evaluates (albeit with insufficient sensitivity) post-bypass changes in myocardial ischaemia. Myocardial scintigraphy with thallium-201 is more sensitive, and it locates low perfusion areas. Cardiac wall kinetics and left ventricular function at rest and during exercise are studied by echocardiography and contrast or isotopic ventriculography, pending advances in nuclear magnetic resonance imaging. Surgical results have never been compared with other methods of direct myocardial revascularization, but only with medical treatments. Outstanding among the controlled studies carried out are a European study (E.C.S.S.) and two North American studies (V.A.S. and C.A.S.S.); they have shown what can be expected from coronary bypass, globally and in some subgroups of patients.

Angiography↗
PubMed1986

Non-neoplastic stenoses of the rectum.

Rectal stenoses, often accompanied by a simple, non-specific symptomatology, have multiple and varied causes. The clinical picture is far from specific and can go from absolute latency to the full picture of a distinct colic occlusion. The clinical examination mainly relies on the data from the proctologic examination and, in particular, the rectal touch that enables detection of the lesion. This proctologic examination is completed with a uro-genital clinical check-up. The complementary endoscopic, X-ray and biological examinations are dominated by rectoscopy, barium enema and, if necessary, scanner, ultrasonography and anatomopathology. The etiological forms comprise stenoses by extrinsic compression; inflammatory or non-inflammatory pseudo-tumoral stenoses; inflammatory cryptogenetic (RCH, Crohn) or specific (infectious, parasitic and venereal) stenoses; ischaemic stenoses; traumatic stenoses by internal or external traumatism and medical iatrogenic, post-physiotherapeutic or post-surgical stenoses. The therapeutic problems depend on the type, age and size of the evolution as well as the cause (etiology) of the lesions. Depending on the case, we have to "make do with it", circumvent the problem, force or remove the obstacle.

Constriction, Pathologic↗
PubMed1985

[Prognostic value of the exercise test performed less than 40 days after the first infarction].

Stress testing was performed in 159 men (mean age 49.83 years) between the 10th and 40th day after primary myocardial infarction. The average work achieved was 79 watts with a heart rate of 121/min, systolic blood pressure of 169 mmHg, and a double product of 20 544. The result was negative in 53 p. 100 of cases, and positive in 47 p. 100: the positive response was ischaemic in 23 p. 100 and non ischaemic in 24 p. 100 of cases. In the 2 years which followed, post-infarction angina was observed in 44 p. 100 of cases (14 p. 100 unstable angina), recurrent infarction in 7 p. 100 and death in 4 p. 100; coronary angiography was performed in 19 p. 100 of cases and coronary bypass surgery in 6 p. 100; 53 p. 100 of patients remained asymptomatic. The difference in predictive value between negative stress testing for an asymptomatic outcome and a positive ischaemic test for post-infarction angina and bypass surgery was important (p less than 0.001). The correlation was not as significant for death and recurrent infarction. The non-ischaemic positive result was of less value. There was no relationship to age but the prediction was more accurate in postero-inferior (p less than 0.001) than anterior infarction (p less than 0.05). The timing of the test affected the performance and patient comfort but had less influence on the results. Nevertheless, the predictive values were less good at 2 weeks than later on and significantly improved when testing was performed between the 10th and 11th week. However, early stress testing was valuable for identifying high risk subgroups.

Adult↗
PubMed1979

[Anomaly of the origin of the circumflex artery. Effects on the risk of mitral and mitro-aortic valve replacement].

An anomalous circumflex coronary artery arising from the main right coronary artery is an added risk in mitro-aortic valve replacement. The infortunate history of a patient with an anomalous circumflex artery visualised on pre-operative cineangiography who underwent a double valve replacement is reported. The first 10 post-operative days were uncomplicated with no haemodynamic disturbances. Thereafter, major ventricular arrhythmiad 54th post-operative days) without signs of myocardial infarction, which were responsible for her death. On autopsy a large anomalous circumflex artery arising from the main right coronary artery was shown. In its course, posterior to the aorta, it was literally wedged between the rigid sewing rings of the two prosthetic valves. No thrombus was found within, and there were no myocardial lesions. The only apparent cause of the arrhythmias and death of the patient was the compression of this large circumflex artery.

Adult↗
PubMed1976

[Tachycardia-dependent paroxysmal block in the bundle of His. Electrophysiological demonstration].

The authors report the case of a patient who presented with angina of effort followed by transient loss of consciousness or syncope. Clinical examination yielded little information. The electrocardiogram showed signs of an old antero-septal infarct, and a slightly prolonged PR interval at 0.22 s. A recording of the activity of the bundle of His showed a double H potential, whose two components were separated by an interval of 80 ms. This interval increased progressively under the influence of atrial stimulation. At a critical frequency of 125/mn, a complete block below the bundle of His was produced; this only reverted after slowing or cessation of stimulation. The same phenomenon occurred at rates between 125/mn and 150/mn. By contrast stimulation at 170/mn was followed by a 2:1 block below the bundle of His. It is to be presumed that the complete A-V block was occasioned by latent conduction of the impulse in the injured area. If the rate was increased yet again, the level of the block became displaced to the upper limit of this area. The absence of latent conduction then allowed the abnormal fibres to recover. The present study thus demonstrates the existance of a special type of paroxysmal A-V block: a bundle block which is dependant upon tachycardia.

Aged↗
PubMed1976

[Thrombosis of the coronary sinus due to right endo-ventricular stimulation].

In a patient with a primary cardiomyopathy, anatomical investigation allowed us to find a total old organised thrombosis of the coronary sinus associated with the presence of a right ventricular stimulator of a pacemaker. A brief review of the literature reveals that cardiac thombosis is a surpising and rare complication of a residual intracavitary pacemaker, even if it is located in the coronary sinus.

Aged↗