PubMed Health⌕ Search

Biomedical subjects

C Le Pailleur

Publications and source records attributed to C Le Pailleur.

At least 19 recordsLinked to original sources
PubMed1979

[Intravenous trinitroglycerin during acute myocardial infarction with cardiac failure. Cooperative study of 68 patients (author's transl)].

Intravenous trinitroglycerine was administered in 68 patients in cardiac failure during the acute phase of myocardial infarction. With a mean hourly dose of 1.58 mg, trinitroglycerine was effective against signs of left and right heart failure after about ten minutes for almost all the teams involved, its tolerance being excellent. Mean capillary pressure fell by 33% (from 22.4 +/- 0.71 mmHg to 15.5 +/- 0.60 mmHg; n = 68; p < 10(-9), as did mean pulmonary artery pressure. Mean right atrial pressure fell by 25% (from 9.96 +/- 0.53 mmHg to 7.48 +/- 0.58 mmHg; n = 68; p < 10(-9). Cardiac output increased by 10.7% (from 2.48 +/- 0.07 l/mn/m2 to 2.74 l/mn/m2; n = 68; p < 10(-7). Since cardiac output was unaltered, systolic index was improved, as was cardiac index, by 11.5% (from 28.4 +/- 1.08 cm3/syst/m2 to 31.7 +/- 1.15 cm3/syst/cm2; n = 68; p < 10(-5). Mean arterial blood pressure was slightly decreased (-9.3%; p < 10(-9), as were systemic resistance (-13%; p < 10(-6) and pulmonary resistance (-27%; p < 10(-6). Systolic work index was significantly improved by 8.37% (from 31.3 +/- 1.73 g-m/m2 to 33.7 +/- 1.74 g-m/m2); n = 68; p < 0.01), which reflects, in view of the decrease in the total work supplied by the heart, a redistribution in favour of more useful work. Treatment must be adapted for each patient, in order to determine the optimum hourly dose of TNT,. which ensures the best cardiac index whilst adequately reducing capillary pressure to levels of the order of 14 to 18 mmHg. Treatment must be closely observed and altered several times a day in relation to values of cardiac output and pulmonary capillary pressure.

Acute Disease↗
PubMed1979

Angiocardiographic and haemodynamic studies in chronic haemodialysis patients with cardiomegaly.

Twenty-one chronic haemodialysis patients with cardiomegaly and repeated episodes of heart failure were selected for left ventricular cineangiography and haemodynamic studies. Left ventricular end-diastolic (LVED) volume was augmented in eleven, LVED pressure increased in fourteen, and ejection fraction decreased in nine patients. A decrease of maximum velocity of myocardial fibre shortening was observed in fifteen, and of normalised ventricular rigidity index in eleven. Many patients had diminished cardiac performance in the absence of demonstrable coronary heart disease, hypertension, or chronic volume overload. The diagnosis of congestive cardiomyopathy of unknown aetiology, possibly related to uraemia, was reached in ten patients.

Adolescent↗
PubMed1978

[Optimum flow of intravenous trinitrine during the acute stage of myocardial infarct with cardiac insufficiency: its effects on survival].

Twenty-one patients were treated during the acute stage of a myocardial infarction for failure of the left or right ventricle. The systematic use of varying rates of flow of intravenous trinitrin (between 0.6 and 4.8 mg/h) was designed to find out for each patient the optimal effect on the cardiac index. The fall in pulmonary capillary pressure, obtained within 10 to 15 minutes, is proportional to the flow rate of trinitrin, and reaches 48% of its original value at a perfusion rate of 4.8 mg/h. The lowering of systemic arterial pressure is also proportional to the flow rate, and reaches 13% at a flow of 4.8 mg/h. The cardiac index and systolic index were significantly improved at flow rates of 1.2 to 2.4 mg/h, and lowered the pulmonary capillary pressure to levels of 17.6 mm of mercury and 15.3 mm of mercury respectively. Trinitrin given intravenously is very well tolerated, but it often become less effective after 24 hours of treatment, which implies that haemodynamic measurements must be made several times a day, and the speed of infusion often increased. The improvement in immediate and late prognosis is discussed relative to the initial values and Weber's index of survival.

Acute Disease↗
PubMed1978

[Comparison of 24 hours ambulatory electrocardiography and endocavitary recording in the diagnosis of heart rate disorders].

Ninety symptomatic patients aged between 16 and 90 years were investigated by ambulatory continuous 24 hour electrocardiography. 75 of these patients underwent endocavitary exploration of atrioventricular conduction and sinus node function within 48 hour of ambulatory electrocardiography. Symptoms occurred during the recording in 30% patients, enabling the mechanism of the malaise to be determined. Every time that abnormalities in the zone surrounding the Tawara node were demonstrated by endocavitary recordings, the 24 hour electrocardiogramme showed the symptoms to be due to other causes than complete heart block. In 70% patients no symptoms were experienced but 58% of them had cardiac arrhythmias and particularly sinus node dysfunction (24 out of 37 patients) on the 24 hour electrocardiogramme. Comparing the results of these two methods of investigation, continuous electrocardiography appears to be a better technique for the diagnosis of sinus node dysfunction but endocavitary study of sinus node function would seem more suited to determine its severity. Endocavitary recordings seem more reliable in the investigation of paroxysmal atrioventricular blocks. These results demonstrate the complementary nature of these two methods in determining the causes of syncope and dizziness.

Adolescent↗
PubMed1977

Congestive cardiomyopathy in uraemic patients on long term haemodialysis.

Five uraemic patients who developed progressive cardiac failure with clinical evidence of congestive cardiomyopathy at the start or during haemodialysis treatment were studied. The diagnosis of cardiomyopathy, for which there was no apparent cause, was confirmed by angiocardiographic and haemodynamic studies. These showed a significant increase in left ventricular end-diastolic volume over normal values obtained in 12 patients without uraemia. The mean velocity of myocardial fibre shortening was significantly decreased, as was the index of normalised rigidity. Three of the five patients presented the complete picture of the disease. The other two also had considerable ventricular dilatation and a decreased index of normalised rigidity but normal ejection fraction and only moderately decreased myocardial contractility indices. This suggests that there may be primary involvement of normalised heart muscle rigidity followed by secondary changes in myocardial contractility in uraemic patients with congestive cardiomyopathy.

Adult↗
PubMed1977

[Phonomechanographic evaluation of the severity of pulmonary stenosis].

External phonomechanographic methods allow us to obtain a fairly precise estimate of the degree of obstruction to the pulmonary outflow, whether such an obstruction is a single entity or associated with another intracardiac malformation. The greatest precision in this field is obtained with the cases of pure pulmonary stenosis. The findings on phonomechanographic investigation of 54 cases with pulmonary stenosis have been compared with the results of the haemodynamic tests (catheterisation and angiography) as well as with the anatomical findings after a surgical cure had been effected in a certain number of cases. This study has allowed us to pick out five phonomechanographic criteria of severity of pulmonary stenosis: an increased reduplication of the second sound, lenghening of the interval between the Q wave of the electrocardiogram and the maximum portion of the systolic murmur, an increase in Furuta's ratio and also in the amplitude of the jugular venous a-wave as a function of the total height t (the a/t ratio), but most especially the "corrected" Furuta ratio as a function of the length of the ejection phase of the right ventricle, as this has been shown to possess the best correlation with the right ventricular systolic pressures.

Adolescent↗
PubMed1977

[Coronary arteriography in the threatened infarction syndrome].

Although greater than in patients with stabilised coronary insufficiency, the risks of carrying out coronary arteriography during the period of a threatened infarction are still modest in the hands of an experienced team. In a series of 66 such investigations under these conditions over an 18 month period, there were no deaths as immediate sequelae. Three myocardial infarctions occurred, one of which was probably encouraged by ceasing the propranolol prior to arteriography. Analysis of the results confirms the frequency of lesions affecting all three trunks (47% of cases), the anterior descending branch being the most commonly affected. A collateral circulation was established in 23% of cases. Ventriculography was normal in one third of cases. The mean value for the ventricular ejection fraction was 0.57 over the entire series. In 58% of cases, all the arteriographic and ventriculographic criteria of operability were satisfied. It therefore appears that coronary arteriography is justifiable during the period of threatened infarction; it may be undertaken at an early stage if the angina does not respond to medical treatment. It is always best to carry it out several days after cessation of the pain where possible. The investigation may lead to urgent surgical intervention.

Adult↗
PubMed1977

[The end-diastolic pressure-volume relationship of the left ventricle. Significance for the indices of compliance and diastolic rigidity of the ventricle].

In order to evaluate the importance of the indices of ventricular rigidity and compliance (k=dP/dV.P and dV/dP), three groups of patients were studied and compared. A simplified method of calculating the diastolic compliance made use of the values of end-diastolic volume (EDV) measured by cineangiography, and of end-diastolic pressure (EDP), using the assumption that the relationship P-V is an exponential one arising from the ordinate: 0.43 mmHg. The correlation between EDP and EDV, which was positive in 19 coronary artery patients, was in fact negative in 11 patients with obstructive cardiomyopathy (OCM), and insignificant in 12 control patients. There were multiple correlations between k, EDPs and EDVs in 11 OCMs, and none in the two other groups. The ratio dV/dP decreased in end-diastole both in the OCM group and in the coronary group, and did not reflect the difference in pathology between these two groups. On the other hand k was increased in the patients with OCM, normal in the coronary patients, and represented in the former a primary modification in the relationship P-V and a primary increase in diastolic rigidity.

Cardiac Output↗
PubMed1977

[Isolated primary dissection of the right coronary artery].

A 59 year old female had unstable angina threatening infarction, together with Prinzmetal's syndrome in the postero-diaphragmatic area, and a transient second degree atrio-ventricular block. Selective arteriography revealed complete dissection, as an isolated and primary finding, in the right coronary artery. Operation consisted of dividing the coronary artery at the superior limit of the dissection, of suturing together the separated layers of the artery, and finally an end-to-end aorto-coronary bypass. The patient is living without any functional symptoms 15 months after the initial episode, but a follow-up arteriogram showed that separation of the two layers of the dissection was persisting. This condition has caused rapid or sudden death in 47 of the 51 reported cases, often occurring in females at the beginning of pregnancy. This mortality rate justifies early operation as soon as the diagnosis is made by coronary arteriography.

Adolescent↗
PubMed1976

[Sinus node function in man. Statistical analysis].

The sinus function of 60 patients was studied by atrial stimulation at a fixed rate, and also at a rate linked with the preceding sinus cycle. These patients were divided into 3 groups according to the surface-recorded ECG; 10 had clear evidence of sinus dysfunction, 23 had an isolated sinus bradycardia, and 27 were considered as controls a their sinus rate was above 60/min., with a normal PR interval. Calculation of the limits of tolerance showed that at the 5% level, 95% of the values for all the controls fell between 96.8 and 568.7 ms for the corrected post-stimulatory pause, and between 114.5 and 434.3 ms for the corrected maximum return cycle. A study of the distribution zones of the graph CT/CR-AA/AA proved that an absent zone II is a pathological finding. In the group of sinus bradycardias the limits of what constitutes pathology are less clear, and the situation is not improved by noting whether atrial "echos" are present or absent. Because there is a narrow positive correlation between the values given by the two methods, the physio-pathology of sinus dysfunction can be discussed.

Bradycardia↗
PubMed1976

[Phonomecanography in recent myocardial infarction. Ventricular mechanic curve].

Repeated recordings were made of the apexcardiogram throughout the first month after myocardial infarction in 30 patients. The classical timed intervals of the systolic wave are open to some criticism. The systolic waveforms are important. In the majority of transmural anterior infarctions there is a rounded appearance to the beginning of the wave which seems to prolong the electromechanical latency, followed by a late systolic bulge, or a domed waveform. This signifies a non-contractile area, and not neccessarily an ectasia. The early diastolic "peaktrough" appearance, found very frequently wherever the necrosis is situated, is indicative of asynergic contraction of the left ventricle. All of the diastolic phases are altered, probably by increased parietal stiffness: the TRI is lengthened; the "F" wave is flattened (and often absent later on in the condition), its duration is shortened over the anterior positions, and it may contain a shallow dip if there is LVF; the stasis wave is very feeble; the "a" wave is large when the infarct is extensive, or when there is LVF, or when there is longstanding hypertension. Enlargement of the "a" wave is especially indicative of a lowering of the performance of the left ventricle.

Age Factors↗