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Biomedical subjects

D Crochet

Publications and source records attributed to D Crochet.

70 records · Page 4Linked to original sources
PubMed1978

Left main coronary artery stenosis: the influence of aortocoronary bypass surgery on survival.

A retrospective study was carried out in 114 unoperated and 197 operated patients having left main coronary artery (LMCA) stenosis greater than or equal to 50%. Including the operative mortality of 9.1%, survival at seven years was significantly greater following pure aortocoronary bypass graft surgery, 77.5% as compared to 48.5% for the unoperated patients (P less than 0.01). The surgical mortality was significantly less during the last five years (1972-1976), 6.2% as compared to 17% during 1969-1971 (P less than 0.025). The three year survival in patients operated since 1972 was 90.2% as compared to 60.4% for unoperated patients. Survival remained significantly higher in the operated patients when studied as subsets on the basis of the severity of the LMCA stenosis (less than 70% as opposed to greater than or equal to 70%), and on the extent of associated obstructive disease of major coronary arteries (0-1 versus 2-3 arteries). It was significantly higher, however, only in operated patients with associated stenosis greater than or equal to 70% of the right coronary artery. Survival was higher following surgery only when the ejection fraction was at least 0.45, or the left ventricular end-diastolic pressure below 20 mm Hg.

Adult↗
PubMed1978

[Intimal coronary fibrous dysplasia and Prinzmetal's angina].

It is currently considered as exceptional for there to be arterial pathology other than atheroma in Prinzmetal angina. The authors have found five cases of coronary fibrous dysplasia in the literature. They add a case, in a woman, of intimal fibrous dysplasia diffusely involving the three main coronary vessels. Coronary arteriography showed that spasm of the right coronary artery was the cause of attacks with the clinical and electrocardiographic features of Prinzmetal angina. The whole coronary tree was otherwise normal angiographically and also macroscopically at autopsy. The dysplasia was only discovered by histological study of serial sections of the three coronary vessels. Histological examination showed no evidence of an atheromatous lesion. The authors place these coronary artery lesions within the general classification of arterial fibrous dysplasias. It remains hypothetical whether there is a relationship between the occurrence of spasm and this very special histological feature of the coronary artery wall.

Angina Pectoris↗
PubMed1978

[Secondary coronary fistulas].

These fistulae are very rare: 8 to 11 p. 100 of all coronary fistulae. Three types are recognised: right coronaro-ventricular, left coronaro-ventricular, and coronao-pulmonary. The two first types are found most frequently in association with a sigmoid atresia on the orifice, and with ventricular hypoplasia in the presence of a functional atrio-ventricular valve. The fistula then serves as a means of ventricular ejection. Of the secondary fistulae, the right coronaro-ventricular type is the most common (73 p. 100). The authors have found 30 cases in the published literature, and add 2 of their own. They have also reviewed the clinical features and the findings on coronary arteriography and post mortem studies on such fistulae. They discuss their etiology, pathogenesis, and physiopathology. Surgical correction involves repairing the fistula in one stage. Fistulae of the left coronaro-ventricular type are exceptions to this rule (9 p. 100), as they are always associated with a rapidly fatal hypoplasia of the left side of the heart. Coronaro-pulmonary fistulae (18 p. 100) are usually found in association with extreme forms of Fallot's tetralogy, and a relatively simple surgical correction can form part of the total correction of the tetralogy.

Coronary Vessel Anomalies↗
PubMed1976

[Endomyocardial biopsy. Innocuousness and clinical value. A 5-year experience].

The authors present their experience of the endomyocardaial biopsy procedure by Konno's technique; they have carried out 180 biopsies in 94 subjects. When the person taking the biopsy is experienced, the procedure is trouble-free, and yields tissue fragments of good quality which are suitable both for histological study and for study of ultrastructure. Biopsies from 47 cases of primary congestive cardiomyopathy have formed the basis of a precise histological study, and have been compared with the findings of a control group comprising various cardiac defects and three normal hearts. The diagnostic and prognostic value of the method are discussed.

Biopsy↗
PubMed1975

Postoperative changes in aortocoronary saphenous vein grafts revisited: angiographic studies at two weeks and at one year in two series of consecutive patients.

Comparison of aortocoronary saphenous vein graft status at two weeks and at one year was made in two series of patients. The early postoperative evaluation includes 122 patients of the first 138 operated in our institution (182 grafts) and 83 subjects from a second series of 100 patients operated after modifications of surgical techniques (184 grafts). The one-year follow-up study was obtained in 105 patients of the first series (154 grafts) and in 67 of the second (152 grafts). The patency rate at two weeks was not significantly different between the two groups: 86.3% vx. 91.8%. A marked decrease of steonses noted early at anastomotic sites was observed: 15% to 5.5% (P less than 0.025). The patency rate at one year improved from 67% to 85,5% (P less than 0.0005). Grafts having flows at operation of at least 50 ml/min had patency rates of 90% in both series. The patency in grafts with initial flows below 50 ml/min increased from 28% to 73% (P less than 0.005). The incidence of late localized graft stenoses greater than 40% decreased from 16.5% to 6% (P less than 0.025), and diffuse narrowing greater than 40% was found in only 12% of the patent grafts at one year in the second series as compared to 31% in the first (P less than 0.001). These improved results do not appear to have been influenced by selection favoring better distal run-off in grafted arteries nor by the introduction of sequential grafts to multiple coronary arteries in the second group. Modified surgical techniques may explain the improved results.

Adult↗
PubMedDate not supplied

Plasma treatment effects on the tantalum Strecker stent implanted in femoral arteries of sheep.

PURPOSE: To evaluate the effects of plasma treatment, a cleaning process for removal of organic contaminants from the knit-wire surface of tantalum Strecker stents, on biocompatibility and thrombogenicity. METHODS: A treated or untreated stent was randomly implanted in both femoral arteries of 15 sheep studied for periods of 4 (group 1), 15 (group 2), or 42 (group 3) days. Patency, histological changes, and mechanical effects were compared by means of radiologic and pathologic controls. RESULTS: Plasma treatment did not influence overall patency (93.3% vs 86.7%), maximal neointimal hyperplasia in groups 2 and 3 (801 +/- 123 vs 733 +/- 179 microns), or media thinning in any group (254 +/- 92 vs 285 +/- 72 microns), but modified the elastic properties of the stents by limiting (p = 0.01) shortening at implantation. CONCLUSION: Plasma treatment does not affect the biocompatibility and thrombogenicity of Strecker stents implanted in normal femoral arteries of sheep but modifies their elastic properties. Further studies are needed to account for this effect.

Animals↗
PubMedDate not supplied

Transcatheter closure of patent foramen ovale in patients with platypnea-orthodeoxia: results of a multicentric French registry.

BACKGROUND: Dyspnea and the decrease in arterial saturation in the upright position in elderly subjects is described as platypnea-orthodeoxia syndrome (POS). POS is secondary to the occurrence of an atrial right-to-left shunt through a patent foramen ovale (PFO). METHODS: This French multicentric study reports on 78 patients (mean age 67 +/- 11.3 years) with POS who had transcatheter closure of the PFO; frequently associated diseases were pneumonectomy (n = 36) and an ascending aortic aneurysm (n = 11). In all patients, the diagnosis was confirmed by transthoracic or/and transesophageal echocardiography. Five different closure devices were used: Amplatz (n = 45), Cardioseal (n = 13), Sideris (n = 11), Das Angel Wings (n = 8) and Starflex (n = 1). Closure was successful in 76 patients (97%). RESULTS: Oxygen saturation increased immediately after occlusion from 84.6 +/- 10.7% to 95.1 +/- 6.4% (p < 0.001) and dyspnea improved from grade 2.7 +/- 0.7 to grade 1 +/- 1 (p < 0.001). A small residual shunt was immediately observed in 5 patients (3 with the Cardioseal device, 1 with the Sideris and 1 with the Amplatz) leading to the implantation of a second device in one case (Cardioseal). Two early deaths occurred unrelated to the procedure (one due to sepsis probably related to pneumonectomy, another due to respiratory insufficiency). Other complications were: a small shunt between the aorta and the left atrium, two atrial fibrillations and a left-sided thrombus which disappeared with anticoagulant therapy. At a mean follow-up of 15 +/- 12 months, there were 7 late deaths related to the underlying disease. CONCLUSION: Percutaneous occlusion of the foramen ovale is safe and gives excellent results thanks to continuing improvement in available devices. This technique enables some patients in an unstable condition to avoid a surgical closure.

Aged↗
PubMedDate not supplied

Caval incorporation of the LGM Vena Tech filter: an experimental study.

PURPOSE: To analyze LGM Vena Tech filter incorporation and the rapidity of the process. MATERIALS AND METHODS: A filter was inserted into the infrarenal inferior vena cava (IVC) of 15 ewes assigned to one of three groups depending on the length of follow-up (2, 4, or 8 weeks). Radiologic data concerning IVC diameter and filter patency, stability, and incorporation were obtained before and after insertion and before euthanasia. Histopathologic analysis concerned wall thickness and smooth muscle cell area (SMCA) at three levels of the filter and at one point outside the filter. RESULTS: All filters remained patent during follow-up. Incorporation of struts was dependent on time (P = .006), level of the filter (P = .0001), and strut surface (P < .0001). Neointimal thickness increased during follow-up (P = .0002), being more marked in the midportion of the filter (P = .0037). Adventitial thinning was observed (P = .0001), corresponding to a significant decrease in SMCA (P < .0001) above the struts as a function of the length of the follow-up period (P = .0021). CONCLUSIONS: The LGM Vena Tech filter was well tolerated and is suitable for incorporation into the IVC wall of normal animals without risk of any deleterious reactions due to biological incompatibility.

Animals↗
PubMedDate not supplied

[The new LEM caval filter in the prevention of pulmonary embolism. Preliminary results of a French multicenter study].

Preliminary results are reported of a prospective multicenter trial of a new caval filter (LEM*) implanted by the percutaneous jugular route in 100 patients, 55 men and 45 women, mean age 67 +/- 13 years, to produce partial interruption of inferior vena cava (IVC). Of the 100 attempts to insert the LEM* filter, 2 failures to catheterize the jugular vessel were reported, 98 filters being placed in the IVC with 82 implantation considered adequate. Of the remaining 16 cases, the filter was inclined (7 cases) or incompletely open (9 cases) with total lack of success in 3 cases. Overall efficacy was obtained therefore in 95 cases. Follow up included 94 patients seen after one week, 63 after 3 months and 10 after 6 months: 3 embolic recurrences were noted (3.2%) of cases. None of the 8 deaths reported was related to the thromboembolic disease. Standard frontal abdominal radiographic images showed migration of filter in 13 cases (13.7%) not exceeding the height of a vertebral body: 9 were caudal and 4 proximal, the LEM* filter remaining within the IVC. Phlebocavography in 90 cases showed the IVC to be permeable in 84 cases (93.3%). Incomplete opening or inclination of filter had no effect on the course. These findings demonstrate that the advantages of the LEM* filter include: a percutaneous introduction allowing rapid, certain insertion, and a form studied for limitation of inclination and avoidance of perforation of the IVC.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗