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A Thévenet

Publications and source records attributed to A Thévenet.

At least 19 recordsLinked to original sources
PubMed1996

Influence of post-surgery time after cardiac transplantation on exercise responses.

Influence of post-surgery time after cardiac transplantation on exercise responses. Med. Sci. Sports Exerc., Vol. 28, No. 2, pp. 171-175, 1996. To test the hypothesis that exercise response changes with time after cardiac transplantation, we investigated the cardiorespiratory responses of nine orthotopic heart transplant patients (52.4 +/- 2 yr) during graded exercise tests (30 W.3 min-1) done at 1, 3, 6, 9 and 12 months post-surgery. At peak exercise, 1) oxygen uptake per kg of body weight (VO2), minute ventilation (VE) and oxygen pulse (O2 pulse) did not change significantly between 1 and 12 months postsurgery; 2) transplanted heart rate (HRt) and delta heart rate (peak exercise heart rate--resting heart rate) increased significantly over time (P < 0.01; P < 0.05) with a marked increase between 1 and 3 months (P < 0.05); and (3) a significant negative correlation existed between O2 pulse and HRt (r = -0.36, P < 0.05), whereas no correlation was found between delta heart rate and delta VO2 (peak exercise VO2- resting VO2, l.min-1). During submaximal exercise, HRt increased significantly over time (P < 0.001); VO2, VE, and O2 pulse showed no significant change; and the VO2-HRt relationship shifted toward higher values of HRt. We conclude that, in the absence of formal physical training, the exercise response of denervated transplanted heart increases in relation to post-surgery time but does not affect oxygen uptake at submaximal and peak levels of exercise.

Blood Pressure↗
PubMed1994

Surgical treatment of extracranial internal carotid artery aneurysm.

Aneurysms of the extracranial internal carotid artery are rare but can be responsible for severe complications such as rupture, thrombosis, or embolism. Between 1961 and 1985 we operated on 38 aneurysms of the extracranial internal carotid artery in 35 patients, 22 males and 13 females, whose ages ranged from 6 to 73 years. The underlying causes of aneurysm included atherosclerosis (12 cases), fibromuscular dysplasia (eight cases), a congenital defect (five cases), infection (one case), and trauma (six cases); in six cases aneurysm was secondary to spontaneous dissection. Signs of cerebral ischemia were present in 26 (74%) patients and a cervical mass was found in six. The aneurysm was proximal (i.e., below the angle of the mandible) in 16 patients and distal (i.e., above the angle of the mandible) in 22. After resection of the aneurysm, arterial continuity was restored in 37 patients by resection and grafting (12 cases), resection and anastomosis (11 cases), or arteriorrhaphy (14 cases). One death occurred 13 days after operation due to myocardial infarction. Two patients experienced a reversible neurologic event. Transient paresis of cranial nerves was observed in eight patients. During a follow-up period that ranged from 6 to 30 years, four patients were lost to follow-up and 25 patients remained asymptomatic. Three patients had asymptomatic thrombosis of the carotid artery detected at follow-up investigations. The potential risks of cerebral ischemia and rupture and the satisfactory long-term results achieved with surgery are strong arguments in favor of surgical treatment for aneurysms of the extracranial internal carotid artery.

Adolescent↗
PubMed1994

[Floating thrombus in the right atrium and severe pulmonary embolism. Value of intravenous thrombolysis].

Mobile right atrial thrombi carry a high risk of pulmonary embolism which may be massive and are a medical emergency. Although surgery is commonly indicated, treatment with intravenous thrombolytics is an alternative and was successful in 4 out of 6 cases reported by the authors. Six patients, admitted for severe pulmonary embolism confirmed by pulmonary scintigraphy (6 cases) and by angiography (2 cases), underwent echocardiography which demonstrated a mobile right atrial thrombus. One patient was operated as an emergency and died immediately afterwards. Another, treated with heparin because of contraindications to surgery and thrombolysis had a recurrent fatal pulmonary embolism. In the other four cases, intravenous thrombolytic therapy was started immediately after echocardiography with 250,000 IU of streptokinase in 30 minutes, followed by 100,000 IU per hour for 48 to 72 hours associated with heparin 300 to 500 IU/kg/day. The biological efficacy of the treatment was confirmed in all cases (fibrinogen < 1 milligram; TCA > 60 s). A clinical improvement with improved blood gases was rapidly obtained in all 4 cases. The thrombus had totally disappeared at control echocardiography 8 to 12 hours after the initial examination. There were no complications, in particular no haemorrhages. After 6 months' follow-up, the outcome was good with oral anticoagulants (4 cases) associated with implantation of a caval filter in 1 case. Thrombolysis seems to be an effective alternative to surgery as there four cases demonstrate.

Aged↗
PubMed1993

[Dilated cardiomyopathy in acromegaly worsening under octreotide treatment. Apropos of a case].

Dilated cardiomyopathy associated with acromegaly is rare, but may improve with octreotide, a somatostatin analogue. The authors give the first description here of paradoxical worsening in cardiac function during such treatment, with the onset of episodes of acute decompensation following each attempt at starting treatment. Thus worsening was confirmed objectively by a challenge test with octreotide: increased dyspnea, fall in shortening fraction and in echocardiographic cardiac output (of 17 to 14% and 4 to 3 l/min respectively), a decrease in isotopic ejection fraction from 15 to 6% and this in parallel with efficacy regarding hormone levels of GH and IGF1 and a reduction in tumour size by CT scan. No further episode of decompensation occurred after treatment was stopped permanently. The patient underwent a transplant 3 months later. Suppression of the positive inotropic effect of GH by octreotide, associated with an increase in peripheral resistance is suggested. A negative inotropic effect of this hormonal analogue on too advanced a case of heart disease is also a possibility.

Acromegaly↗
PubMed1992

Superior mesenteric arteriovenous fistula after ileal resection.

Postoperative superior mesenteric arteriovenous fistula is very rare. We report the case of a 55-year-old woman in whom the discovery of an abdominal bruit led to the diagnosis of superior mesenteric arteriovenous fistula seven years after ileal resection. The clinical and pathophysiological aspects, as well as the therapeutic modalities, of this rare lesion are reviewed.

Angiography, Digital Subtraction↗
PubMed1992

[Comparison of the effects of epsilon-aminocaproic acid and aprotinin on intra- and postoperative bleeding in heart surgery].

Excessive bleeding during and after cardiac surgery with cardiopulmonary bypass is a real problem in this kind of surgery. The use of prophylactic high doses of aprotinin (APROT) reduces blood loss in this context but this treatment is expensive. Some investigators have advocated that epsilon-aminocaproic acid (EACA), a cheaper antifibrinolytic drug, could reduce blood loss in cardiac surgery. The goal of this prospective study was to determine if EACA is as effective as APROT for this clinical condition. Sixty patients undergoing elective surgery for cardiac disease were randomly allocated to one of the two groups. Drugs were administered after induction of anesthesia at a dose of 2.10(6) UIK in the APROT group or 5 g in the EACA group. The same dose was added to the priming of the cardiopulmonary bypass circuit. Until the skin closure the patients received 5.10(5) UIK/h of APROT or 2 g/h of EACA. Bleeding during and after surgery was not different between the two groups. No complication, directly due to the treatment administered, was observed. EACA seems to be as effective as APROT to reduce intra and post cardiac surgery blood loss. EACA has the advantage of being cheaper (treatment is approximately 200 times cheaper), therefore allowing a wider use.

Aminocaproic Acid↗
PubMed1991

Femorofemoral crossover bypass for noninfective complications of aortoiliac surgery.

Between 1973 and 1989, 39 femorofemoral crossover bypasses were performed to treat unilateral noninfective complications of aortoiliac surgery. The initial revascularization procedure, performed an average of 79.5 months previously, was an aortobifemoral bypass in 29 cases, an aorto- or iliofemoral bypass in six cases, an inlay graft for abdominal aortic aneurysm and aortoiliac endarterectomy in two cases each. The indications for femorofemoral crossover bypass included prosthetic occlusion in 35 cases, thrombosed false aneurysm in two, and further degradation after endarterectomy (iliac stenosis and occlusion in one case each). There was no operative mortality. One patient with acute ischemia upon admission and another with distal gangrene required below-knee and forefoot amputations, respectively. No amputations were required during the rest of the follow-up period. Three repeat aortobifemoral bypasses were performed because of occurrence of aortic or inflow vessel lesions. Primary and secondary actuarial five year patency rates for femorofemoral crossover bypasses were 59.7% and 78.4%, respectively. Femorofemoral crossover bypass can extend the benefits derived from direct aortoiliac surgery with low mortality and morbidity in the absence of associated aortic pathology (false aneurysm at the aortic implantation site or severe obstructive lesions).

Aged↗
PubMed1990

[Role of x-ray computed tomography in the preoperative evaluation of aneurysm of the abdominal aorta].

The authors have studied the files of 50 consecutive patients (1987-89) operated for abdominal aortic aneurysm (AAA) and examined with CT. The criteria for inclusion were surgical features. CT can be made more accurate for the study of AAA: Thus the location of the neck of the aneurysm relative to the renal arteries was defined in 94% of all cases. In addition, CT yields information about the wall of the aneurysm, whether it be thickened (3 inflammatory aneurysms were properly diagnosed) or, mor importantly, weakened (solution of continuity in the wall in the "prior-to-rupture" appearance). Owing to the quality of its performances and to its noninvasive character, the authors regard CT with contrast injection as an essential technique for the preoperative assessment of abdominal aortic aneurysm in most cases. The examination must be carried out strictly, especially for the contiguous sections of the renal arteries and their extension to the crural arch. As it demonstrates weakened areas more easily, a more accurate study of the aneurysmal wall with CT might increase the surgical indications for some smaller aneurysms, the potential evolution of which does not seem to be associated with their diameter only.

Aged↗
PubMed1989

[Cardiovascular complications of Marfan's syndrome: long-term results of surgical treatment].

Surgery has changed the prognosis of the Marfan's syndrome. Cardiovascular manifestations (aneurysmal dilatation of the aortic root and its risk of dissection, aortic insufficiency, mitral insufficiency due to valvular anomalies) represent the vital risk of the disease and reduce the life expectancy in one-third of these patients during the first 32 years. Twenty seven patients (22 to 53 years of age, mean 38) surgically treated have been followed up to 14 years (mean 6.5 years). 12 had aortic valve and ascending aorta replacement with reimplantation of coronary arteries, 9 had mitral valve replacement and 6 had simultaneous correction of aortic and mitral lesions. All patients survived the operation and late mortality was 18.5% to 14 years, with a long term survival of 90% at 5 and 70% at 10 years. Echocardiographic studies permit nowadays to measure the aortic root diameter, to appreciate the left ventricular function, to reveal a mitral prolapse and to precise valvular insufficiency, in young patients with Marfan's syndrome and during family investigation. Indication of surgical repair can be stated at the right time to prevent dissection, aortic rupture or cardiac failure with excellent and durable long term results.

Adult↗
PubMed1987

[Pre- and postoperative Doppler ultrasound findings in coarctation of the aorta].

A retrospective study was done about 73 patients who had undergone a surgical operation for correction of coarctation of the aorta, between 1975 and 1985. Among these patients, 45 had both pre- and post-operative continuous wave Doppler ultrasound examination of cervical, upper, and lower limbs arteries, with pressure measurement. The age was under 14 years for 18 patients, between 14 and 25 for 10 patients, and more than 25 for the remaining 17 patients. The surgical procedure was resection with end-to-end anastomosis for 27 patients, tube graft insertion for 8 patients, dacron patch for 7 patients, subclavian arterioplasty or shunt for the others. Systolic Pressure Index and femoral Pulsatility Index showed a highly significant increase after operation (P less than 0.001) (tables I, II) regardless of the age or the surgical technique, thus demonstrating a satisfying hemodynamic efficiency of the correction (fig. 1-6) (2-6, 9). Nevertheless, 17 patients had, after operation, a greater than 15 Hg mm pressure gradient between left and right arm: the retrospective study showed that most of them had congenital abnormalities involving the left subclavian artery and/or had undergone a surgical procedure using the left subclavian artery for arterioplasty (10).

Adolescent↗
PubMed1984

[The Sparks-Mandril arterial prosthesis. An ingenious concept, a total failure. What can we learn from it?].

In spite of its ingenuity, the Sparks-mandril concept has failed to generate a satisfactory arterial substitute. Pathological analysis of prostheses retrieved from humans and explanted from dogs as part of a controlled laboratory study has demonstrated that the tissue laid down during the autogenous generation stage contains neither elastin fibers nor smooth muscle cells capable of providing the required dimensional stability of a blood vessel. The supporting polyester mesh tube has been found to stretch in vivo, resulting in dilation and lengthening of the prosthesis and the formation of aneurysm and thrombosis. It is recommended that the use of devices relying on the Sparks-mandril concept not to be reintroduced until such time as the mechanism of growth promoting factors for angiogenesis are fully understood.

Adult↗
PubMed1984

[Leiomyosarcoma of the femoral vein. Apropos of a case].

A 51 years old woman developed an edema of the right lower limb. Phlebographic examination revealed an occlusion of the femoral vein. This was a tumor at operation. A leiomyosarcoma was diagnosed by microscopic study. The authors emphasize the difficulty of diagnosis, value of phlebography and discuss the treatment.

Adult↗