[Disappearance of a 35 mm film in coronarography: chronicle of an announced demise].
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
D Crochet
Publications and source records attributed to D Crochet.
[The cost of a surgical videotape and its financing].
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Humans↗
[Detection of residual myocardial ischemia by Thallium-201 myocardial scintigraphy after myocardial infarction. Apropos of 53 patients treated with thrombolytic agents during the acute phase and with coronary transluminal angioplasty].
The prognosis of silent ischemia after myocardial infarction is similar to that of post-infarction angina. In order to detect this condition two stress myocardial scintigraphies were performed: three weeks after hospital admission for myocardial infarction treated by thrombolytic therapy without any complications or recurrence of chest pain; one month later, after percutaneous transluminal coronary angioplasty on the infarct-related artery in 24 patients or after medical therapy alone when this procedure was not possible (29 patients). Silent ischemia, initially present in two thirds of patients, was less frequently observed in the patients undergoing angioplasty (p < 0.05). In the remaining one third of patients with no silent ischemia, myocardial scintigraphy was unchanged at the follow-up procedure whether or not angioplasty had been performed. These results show that silent ischemia is commonly observed during stress myocardial scintigraphy after acute myocardial infarction treated by thrombolysis, but that this condition can be significantly reduced by coronary angioplasty. When no silent ischemia is observed, coronary angiography and angioplasty do not seem to be indicated.
Adult↗
[A rare and curable cause of acute respiratory insufficiency after a pneumonectomy. The platypnea-orthodeoxia syndrome by the reopening of the foramen ovale].
We describe a case of a 54 year old patient who had developed a right to left shunt due to a patent foramen ovale as a late consequence of a pneumonectomy; this was responsible for acute respiratory insufficiency and respiratory failure. This is a rare complication, but its clinical presentation as platypnea-orthodeoxia should lead to the correct diagnosis. The diagnosis can be rapidly confirmed by a non-invasive examination, namely contrast echocardiography, coupled with color doppler. The treatment is surgical with excellent results. The pathophysiological mechanism is also discussed.
Coronary Angiography↗
[Percutaneous aortic valvuloplasty. Long-term outcome apropos of 85 patients with successful dilatation].
The outcome at 2, 6, 12, 18 and 24 months in terms of clinical status and Doppler echocardiographic parameters of 85 patients successfully dilated out of 116 patients undergoing percutaneous aortic valvuloplasty is reported. The objectives were to determine the survival rate, degree of clinical remission, the restenosis rate and its predictive factors. The 31 patients considered to be primary failures were excluded from the study. The global survival rates were 90 +/- 2% at 2 months, 84 +/- 4% at 6 months, 78 +/- 5% at 12 months, 69 +/- 6% at 18 months and 60 +/- 8% at 2 years. Patients in clinical remission and with clinical relapse were compared at the 6th month: relapse was significantly, related to prevalvuloplathy, low cardiac output (p = 0.05), low ejection fraction (p less than 0.03) and low fractional shortening (p less than 0.01), but the clinical relapse was independent of aortic valve surface area before and dilatation. In the relapse group, 14 patients (12%) were operated without complications in the first month of follow up, 6 patients underwent repeat valvuloplasty with 4 immediate failures and 2 improvements. The other patients were treated medically. The restenosis rate (loss of greater than 50% of initial gain in surface area or return of pre-valvuloplasty maximal pressure gradient +/- 25%) increased up to the 12th month in both groups (remission and relapse) and reached 78% at 12 +/- 3 months and seemed more pronounced in the less severe aortic stenosis. The incidence of restenosis was independent of gain in surface area after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)
Actuarial Analysis↗
[Nuclear magnetic resonance imaging in cardiology].
Magnetic resonance imaging (MRI) is particularly well suited to cardiovascular studies since the spontaneous contrast between circulating blood and the cardiac and vascular structures is excellent. The theoretical principles and technical modalities of MRI are summarized prior to describing its cardiovascular applications. Owing to the quality of its anatomical images MRI was first used in daily practice to complete or replace other imaging methods. Its applications are illustrated here. They include aortic pathology (aneurysm, dissection, postoperative control), complex congenital cardiac pathology, hypertrophic cardiomyopathy, heart tumours, post-infarction ventricular aneurysms, and pericardial pathology. The applications of MRI that are currently being evaluated or developed are described. Due to the recent acquisition of cinematographic images MRI is now capable of evaluating the cardiac function. As for the use of MRI to characterize the cardiac muscle, this is a highly original application which may soon become an interesting diagnostic tool.
Aortic Diseases↗
[Comparative results of coronary angioplasty performed at the time of coronarography and at a later time].
Between January 1986 and December 1988, 558 patients underwent percutaneous transluminal coronary angioplasty (PTCA) of whom 40 per cent were dilated at the time of diagnostic coronary arteriography. In order to assess the value of this therapeutic strategy we compared the results of 221 patients dilated at the time of diagnostic coronary arteriography (Group 1) with those of 337 patients who underwent deferred PTCA. In Group 1, the incidence of stable angina was lower (26.7% vs 46.3%, p less than 10-5), that of thrombolysed myocardial infarction was higher (24% vs 2.7%, p less than 10-9) and a higher proportion of patients had previously undergone PTCA (29.4% vs 3.2%, p less than 10-9). The proportion of patients with single vessel disease was higher in Group 1 (84.6% vs 74.7%, p less than 0.01) as was that of angioplasty of a single lesion (97.7% vs 88.1%, p less than 10-4). There were fewer dilations of the left circumflex artery in Group 1 (17.2% vs 27.3%, p less than 0.05) which was compensated by a higher number involving the right coronary artery (26.1% vs 15.5%, p less than 0.01). The immediate results were comparable in the two groups with 87.8 per cent primary successes, 3.6 per cent of myocardial infarcts and 1.3 per cent of coronary bypass operations with no fatalities in Group 1. These favorable results encourage the development of PTCA at the time of diagnostic coronary arteriography in the following indications: unstable angina, thrombolysed myocardial infarction and restenosis irrespective of the patient's symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)
Angina Pectoris↗
[Comparison of magnetic resonance imaging, echocardiography and catheterization in the diagnosis of congenital heart diseases].
The authors compared the diagnostic value of magnetic resonance imaging (MRI), echocardiography and cardiac catheterisation with angiography in 66 patients with congenital heart disease, to determine a diagnostic strategy in the use of these methods of cardiac imaging. The patients were 8 days to 44 years old. The congenital cardiac malformations were classified in three groups: 29 isolated vascular malformations (Group 1), 17 isolated intracardiac malformations (Group 2) and 20 complex malformations (Group 3). MRI was performed in all patients using a high field (1.5 tesla) magnet and spin-echo sequences in multiple incidences. The results were compared with those of echocardiography in 60 patients and/or cardiac catheterisation in 39 cases. Technical evaluation of MRI showed images of diagnostic quality in 62/66 cases (93.9%). MRI provided a diagnostic contribution in 56 cases (85%) which was less important in intracardiac malformations than in the other groups (p less than 0.05). In comparison with other imaging techniques, globally, the diagnostic value of MRI was lower than that of cardiac catheterisation (p less than 0.005) but there was no significant difference between MRI and echocardiography. When the type of malformation was taken into account, MRI was not as useful as catheterisation and echocardiography for the diagnosis of isolated intracardiac malformations (p less than 0.01) but gave comparable results in other malformations. On the other hand, MRI associated with echocardiography was more useful (p less than 0.05) than catheterisation in the diagnosis of complex congenital lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Coronary aneurysm after transluminal angioplasty. Report of 13 cases].
The aim of this study was to determine the incidence, angiographic characteristics, clinical consequences, therapeutic implications and evolution of coronary arterial aneurysms after percutaneous transluminal coronary angioplasty (PTCA) based on a series of 13 cases out of a total population of 752 patients undergoing balloon dilatation. Before BTCA, 10 patients had unstable angina and 3 had stable angina. The stenoses were of type A in 6 cases and, more complex, type B, in 7 cases. The results of PTCA were good except in 1 case in which the procedure was complicated by a rudimentary infarct due to an extensive intra mural rupture. The frequency of coronary aneurysms evaluated in a series of 150 patients dilated and controlled systematically was 4 p. 100. This complication was observed relatively late, 2 to 13 months after PTCA. The length of aneurysm ranged from 2 to 13 mm (3.9 +/- 2.9 mm). Nine aneurysms were sacciform and 4 were fusiform. They were isolated in 6 cases and associated with restenosis in 7 cases. The predisposing role of an oversized angioplasty balloon was a probable etiological factor; the balloon/artery ratio was over 1.1 in 4 cases and over 1.2 in 3 cases. Intramural rupture observed at the time of PTCA (8/13 cases) did not seem to be a predisposing factor as the incidence of coronary aneurysm was not significantly different in patients without this complication in the group of 150 patients dilated and controlled systematically by angiography (5.8% vs 3%; NS). In the 6 cases of isolated coronary aneurysm the patients were asymptomatic and were followed up with medical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Transluminal coronary angioplasty at the same time as or separate from coronarography. Comparative results].
Frequency of PTCA performed at the time of initial coronary angiography has increased to 47% of all PTCA performed in 1988. The aim of this study is to assess the efficacy and safety of this strategy by comparing the results in 2 groups of patients: in group 1 (179 patients), PTCA was performed at the time of initial coronary angiography and in group 2 (549 patients) PTCA was performed, 15 to 30 days after initial coronary angiography. Clinical differences between the two groups concerned: stable angina (25.1% vs 41%; p less than 0.001) and myocardial infarction treated with thrombolytic therapy (23.7% vs 7.7%; p less than 10(-9)). The extent of coronary artery disease was similar in the two groups but the incidence of single vessel PTCA was higher in group 1 (96% vs 90%; p less than 0.01). The immediate results of PTCA were similar and led us to develop this strategy for unstable angina, myocardial infarction treated with thrombolytic therapy, as well as total coronary obstruction and restenosis whatever their symptoms and signs. This strategy requires high quality fluoroscopic and video replay images, and allows a reduction in hospital costs.
Angioplasty, Balloon, Coronary↗
[Aortic valvuloplasty in the elderly. Immediate and medium-term results].
Between January 86 and February 88 we attempted percutaneous aortic valvuloplasty in 100 patients. 68 patients could be dilated with hemodynamic success: the aortic valve area increased from 0.52 +/- 0.17 cm2 to 0.78 +/- 0.27 cm2 (p less than 0.001). Cardiac output did not change significantly (4 +/- 1.1 l/mn). In the remaining 32 patients: 8 patients (8%) died in hospital and the morbidity rate was 11%: arterial injury (9), stroke (1) and major cardiac event (1). Sixty patients regarded as initial success were followed for 6 months: 3 patients (5%) died without cardiac events, functional improvement persisted in 41 patients (68%) and clinical failure was observed in 16 patients (27%): 4 patients died and in the remaining 12 patients, the recurrence of symptoms required medical treatment (5), surgery (5) or repeat percutaneous valvuloplasty (2). Echo-Doppler maximum aortic valve gradient was significantly less in improved patients (55 +/- 21 mmHg) than in deteriorated patients (78 +/- 36 mmHg) (p less than 0.02). One year after valvuloplasty: actuarial survival was 74 +/- 6%, clinical improvement was 53 +/- 7% and clinical recurrence was 41 +/- 7%. Thus percutaneous aortic valvuloplasty may be proposed only to non surgical patients.
Aged↗
Percutaneous transvenous caval interruption with the "LGM" filter: early results of a multicenter trial.
From September 1985 to December 1986, 100 patients undergoing percutaneous placement of a transvenous "LGM" caval filter were included in a multicenter prospective trial. Peripheral venograms completed by pulmonary arteriography or scintigraphy were obtained for all patients. Eighty-five patients had experienced pulmonary embolism, 59 had iliocaval thrombosis, while 40 had venous thrombosis confined to the lower limbs. In two instances, insertion or passage of the catheter was impossible. Ninety-eight "LGM" filters were placed percutaneously through the internal jugular vein, 82 of which were correctly positioned in the infrarenal inferior vena cava. Eight filters were positioned with a tilt of more than 15 degrees with respect to the vertical axis, five failed to open correctly, and three were incompletely open and tilted. No postoperative deaths were observed; there were two recurrent embolisms, and seven caval thromboses occurred during the year that followed insertion of the filter. The "user-friendliness" and efficacy of this percutaneous filter makes it a treatment of choice in the partial interruption of the inferior vena cava.
Aged↗
[Lateral tracheal indentation or compression by the brachiocephalic arterial trunk in children].
Three cases of compression of the right wall of the trachea by buckling of the innominate artery in childhood are described. A coarctation of the thoracic aorta is associated in two cases, and a left cervical aortic arch in the third one. In one case, a severe tracheomalacia occurs following the surgical repair of the associated coarctation. This lateral indentation of the trachea is suggestive of right aortic arch but the absence of posterior oesophageal indentation excludes the diagnosis. Angiography is helpful and echography is unable to demonstrate the vascular origin of the tracheal compression. The authors analyse the correct diagnostic approach, emphasize the risk of tracheomalacia and the high rate of associated cardio-vascular malformations.
Brachiocephalic Trunk↗
[Coronary intramural ruptures caused by transluminal angioplasty. Incidence, significance and development controlled by coronary angiography].
The authors report their experience of coronary intimal rupture (CIR) observed at control angiography performed at the end of transluminal angioplasty in a series of 150 cases. This lesion was observed in 34 p. 100 of cases. Two subgroups were established according to the presence (Group I: 51 cases) or absence of CIR (Group II: 99 cases) in order to try and identify any predisposing factor. The following features were compared in each group: age, sex, number of risk factors, duration of the disease, its severity, the site and morphology of the lesions (calcification, length, excentric or concentric) on the artery dilated and the technique used (number of inflations, maximal pressure, guidable catheter). The only significant feature associated with CIR was the morphology of the stenosis. Intimal rupture was statistically more frequent when the stenosis was long, calcific and excentric (p less than 0.05). The excentric character was highly predictive of CIR +/- 0.02) and even of complicated CIR (p less than 0.01). The CIR was complicated in 10 cases (19.6 p. 100) with a higher incidence than in the rest of the population (p less than 0.05). These complications were immediate presenting as attacks of angina leading on to 4 myocardial infarctions (7.8 p. 100) but no deaths. The treatment consisted in an attempt to redilate the artery with effective angioplasty in 3 out of 4 cases. Medical therapy alone was sufficient in 2 cases and 4 patients underwent coronary bypass. There were no complications in cases of initially asymptomatic intimal rupture. The 6 months outcome was controlled by coronary angiography in 131 angioplasties.(ABSTRACT TRUNCATED AT 250 WORDS)
Angioplasty, Balloon↗
[Long-term effects of transluminal coronary angioplasty. French multicenter study].
Although transluminal coronary angioplasty is now acknowledged as an effective treatment for coronary artery disease, the long-term outcome of patients treated by this method is still under evaluation. A french multicenter trial was set up and the long-term efficacy of transluminal coronary angioplasty was assessed in 546 patients undergoing the procedure before the 31/3/83. 380 initial successes (69 p. 100) were followed up for a period ranging from 6 to 48 months (average 19.9 +/- 10.4 months). A control coronary angiography was carried out in 88 p. 100 of cases. Restenosis (loss of over 50 p. 100 of initial angiographic improvement) was observed in 27 p. 100 of cases. Including the repeat procedures, the patency rate of the dilated vessels was 82 p. 100. Progression of atherosclerosis on another coronary artery was observed in 1.3 p. 100 of cases. After transluminal coronary angioplasty, 72 p. 100 of patients remained improved, 11 p. 100 underwent repeat angioplasty, 8 p. 100 underwent coronary bypass surgery, 1.3 p. 100 suffered myocardial infarction and 1.3 p. 100 died. Restenosis was associated with recurrence of angina pectoris in 90 p. 100 of cases (within 3.3 +/- 1.6 months) and a positive exercise stress test in 87 p. 100 of cases. Recurrence of angina due to progression of disease on the dilated vessel was observed in 24.2 p. 100 of cases; repeat transluminal coronary angioplasty was carried out for this indication in 38 p. 100 of cases, coronary bypass in 34.8 p. 100 and medical treatment was continued in 27.2 p. 100 of cases.(ABSTRACT TRUNCATED AT 250 WORDS)
Angina Pectoris↗
[Changes in left ventricular dP/dt during transluminal coronary angioplasty].
The authors studied changes of LV dP/dt during transcutaneous coronary angioplasty (TCA). The aim of the study was to detect the alterations of LV function during coronary occlusion and to evaluate the immediate effects of PCA on myocardial function. Six patients with incapacitating angina and isolated left anterior descending disease were successfully treated by TCA using Gruntzig's technique. The study protocol included several recording sequences per patient during the phases of balloon inflation at progressively increasing pressures from 2 to 10 hours. Each sequence comprised a recording under basal conditions and every 5 seconds during inflation (20 seconds) and deflation (45 seconds) of the following parameters: heart rate, aortic and LV pressures, positive and negative peaks of LV dP/dt, and the intracoronary pressure gradient at the beginning and the end of each sequence. The first part of the results based on 27 recorded sequences analysed the bad effects of myocardial ischaemia; coronary occlusion induced a significant fall (p less than 0.01) in the positive and negative peak dP/dt values and on elevation (p less than 0.01) in LV end diastolic pressure, without affecting LV systolic pressure or heart rate. These changes have the following characteristics: they are early, occurring within seconds of coronary occlusion; they affect LV contraction and relaxation simultaneously, but the effects are more marked on LV relaxation; the severity is proportional to the duration of occlusion; they are totally reversible; the disturbances of relaxation return to normal more quickly than those of contraction.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Reliability of pulmonary perfusion and ventilation scintigraphy compared with angiopneumography for the diagnosis of pulmonary embolism].
Fourty-six patients suspected clinically of having a pulmonary embolism (PE) were investigated by angiopneumography (AGP) and perfusion (99m-Tc aggregates) and ventilation (99m-Tc colloid) scintigraphy (SPV Tc). Findings were assessed under blind conditions. A positive diagnosis of pulmonary embolism was made in 19 patients. The SPV Tc was considered as positive if perfusional deficiencies were greater than ventilatory defects, and this was evaluated as such in 23 cases (19 true and 4 false positives). False negatives were not observed. The 4 false positive results corresponded to scintigraphic anomalies suggestive of pulmonary emboli subsegmental in size; true positives were either subsegmental (8), segmental (6) or lobar (5). Sensitivity of the SPV Tc wis therefore 100%; its specificity, all results considered was 76%, but was 100% if only images of lobar or segmental lesions are considered.
Aerosols↗
[Beneficial effects of coronary transluminal angioplasty on resting left ventricular systolic function].
Resting left ventricular systolic function was studied by cardiac catheterisation before and 6 months after effective transluminal coronary angioplasty (TCA) to evaluate the myocardial effects of this procedure. The global left ventricular systolic function was assessed by measuring ventricular volumes, the ejection fraction, the mean velocity of circumferential fibre shortening (m VCF) and mean normalised systolic ejection rate (MNSER). The regional function was studied by dividing the left ventricle into 8 regions using the Stanford radial model and measuring the percentage shortening and velocity of circumferential fibre shortening (VCF). These parameters were obtained from selective left ventriculography filmed at 100 frames/second in the RAD plane. Left ventricular function was analysed from the whole of systolic ejection and then sequentially during each third of systole (early-mid-and end systole). The 10 patients studied had an average age of 45 years. Coronary angiography was performed for unstable angina (6 cases), stable angina (3 cases) and post-infarction angina (1 case). Except for 1 patient with associated LAD and right coronary disease they all had single vessel disease. TCA was performed on the LAD artery in 8 cases, on a dominant left circumflex artery in 1 case and on a right coronary artery in 1 case. The efficacy was demonstrated by angiographic reduction of the degree of stenosis (85 to 25 p. 100 immediately after TCA, and 30 p. 100 at control angiography at 6 months), and by a reduction of more than 40 p. 100 in the average transstenotic pressure gradient.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗