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Biomedical subjects

F Funck

Publications and source records attributed to F Funck.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Spasm of the left main coronary artery resistant to intracoronary vasodilators. Apropos of a case].

Coronary spasm is essentially and angiographic diagnosis. Catheter-induced spasm is frequent during coronary angiography and usually regresses after the administration of intracoronary vasodilators. The authors report a case of coronary spasm with subocclusion of the left main coronary artery: the coronary narrowing remained significant after intracoronary vasodilator therapy, suggesting an organic component. The spasm was relieved only after a prolonged intravenous infusion of isosorbide dinitrate.

Angina Pectoris, Variant↗
PubMed1989

[Cardiotoxicity of 5-fluorouracil: coronary spasm? Apropos of 2 cases with normal coronarography].

Five fluoro-uracil (5-FU) is a cytotoxic drug which has been extensively used for chemotherapy since 1957. Ischaemic heart disease resulting from its administration is rare. Spontaneous angina during infusions of 5-FU was observed in two patients with electrocardiographic changes suggesting coronary spasm. After treatment, clinical examination, electrocardiogram, echocardiogram, stress test, coronary angiography with left ventriculography were all normal. An Ergonovine test was performed in one patient but failed to elicit coronary spasm. In the other patient, intravenous trinitrin and diltiazem were ineffective in preventing the ischaemic changes. A review of the literature is presented (51 cases). The pathophysiology of 5-FU-induced ischaemic heart disease is not fully understood. In 9 cases, coronary angiography was normal and coronary spasm was suggested as a possible cause. However, antispastic drugs are usually ineffective. It has been shown experimentally that 5-FU has a direct toxic effect on the myocardium.

Adult↗
PubMed1988

[Hemodynamic effects on intravenous propafenone in hypertrophic myocardiopathy].

None of the medical treatments of hypertrophic cardiomyopathy is perfect. In the present study conducted on 11 patients with hypertrophic cardiomyopathy in whom the usual treatments were either ineffective or badly tolerated, the haemodynamic effects of propafenone administered intravenously were investigated. The drug was injected centrally in doses of 2 mg/kg over 10 minutes, then by continuous intravenous infusion of 1.5 mg/min during 30 minutes. Various parameters were recorded before and after propafenone treatment by right and left cardiac catheterization. This anti-arrhythmic drug, which has beta-blocking and amiodarone-like properties, reduced left intraventricular obstruction but had no beneficial effect on diastolic function. The baseline and induced left intraventricular gradients were reduced from 30.4 to 17.7 mmHg and from 74 to 43 mmHg respectively. Diastolic function values showed a fall in dp/dt min from 1470 to 1307 mm/sec and an increase in T value from 0.066 to 0.084. The use of propafenone in hypertrophic cardiomyopathy must be accurately determined by long-term oral studies.

Adolescent↗
PubMed1986

[Angiographically tight coronary stenoses without transstenotic pressure gradient].

The availability of coronary angioplasty catheters has made it possible to measure transstenotic pressure gradients. This parameter provides direct information on coronary haemodynamics. In 2 patients with proximal concentric stenosis of the left anterior descending artery the gradient was zero in spite of a more than 50% reduction in vascular diameter. The reason for this emerged from a study of the characteristics of these stenoses: they were short, and the vascular area at their level clearly was superior to 1 mm2. None of the 2 patients suffered from angina. One had negative exercise ECG, the other had an inconclusive exercise test without pain but with ST segment depression on anterior leads. This patient had a history of posterior infarction with postero-inferior dyskinesia at angiography, and exercise scintigraphy with thallium showed no decreased uptake in the antero-septal territory. The presence of coronary transstenotic pressure gradient implies a fall in coronary blood pressure downstream of the stenosis, a pressure which constitutes the perfusion pressure in the territory fed by the narrowed artery. on the value of this perfusion pressure depends the possibility of coronary blood flow autoregulation in the territory threatened by ischaemia.

Blood Pressure↗
PubMed1986

Percutaneous coronary angioplasty of a left anterior descending artery implanted on a Dacron coronary prosthesis on an aortic conduit.

Certain surgical techniques may make it difficult to catheterize the coronary ostia and perform percutaneous coronary angioplasty. We report the case of a 48 year old patient who developed unstable angina four years after a Bentall's procedure with reimplantation of the coronary arteries on a Dacron coronary prosthesis. The anginal pain was related to very severe stenosis of the proximal segment of the left anterior descending artery. The difficulties encountered during the dilatation procedure were due to: (a) the ectopic position of the ostium of the prosthesis on the anterior aortic wall; (b) the forces exerted on the aortic prosthesis wall and on the valvular prosthesis during positioning of the guiding catheter which were poorly tolerated and induced a vagal reaction; (c) the direction taken by the distal tip of the guiding catheter, perpendicular to the wall of the aortic prosthesis; (d) the sinuosity of the arterial trajectory: the left coronary segment of the coronary prosthesis was directed towards the left circumflex artery rather than towards the left anterior descending artery. Coronary angioplasty succeeded after relatively complex technical procedures: special guiding catheter, unusual intra-aortic manoeuvres for positioning the guiding catheter, dilatation catheter change on a 3-metre long guide wire in order to cross the stenotic segment; this was performed with a super low-profiled dilatation catheter. There were no complications and anginal pain disappeared.

Angina Pectoris↗
PubMed1986

[Phase variations in the left coronary transstenotic pressure gradient before and after dilatation by percutaneous coronary angioplasty].

The concept of significant coronary stenosis may be approached by studying the effects of the narrowing not in absolute values of pressure and flow but by studying the mode of blood flow across the stenosis. Ten patients with isolated stenosis of the LAD were studied for phasic variations of the transstenotic pressure gradient before and after dilatation. The material used was a ST 3.7 catheter with a 0.12 inch guide. Instantaneous pressure recording throughout the cardiac cycle were obtained using a computer. After dilatation, the area of the stenosis minus the area of transverse section of the dilating catheter increased from 0.5 +/- 0.3 to 2.2 +/- 0.3 mm2, the average gradient between the aorta and the post stenotic LAD decreased from 75 +/- 10 to 12 +/- 8 mmHg, and the ratio between the mean diastolic gradient and mean gradient increased from 75 +/- 7 to 245 +/- 30% (p less than 0.01 for the 3 parameters, paired t test). These results show that the LAD transstenotic pressure gradient is not phasic in severe stenosis. It becomes phasic, only in diastole, after dilatation of the stenosis (slight residual stenosis due to the catheter). This difference may be due to the type of flow, continuous and dependent on the stenosis before dilatation, or phasic dependent on the distal coronary circulation after dilatation. Analysis of the phasic changes of coronary flow may be useful for the evaluation of the severity of left coronary stenosis in the absence of pressure measurements.

Adult↗
PubMed1985

[Evaluation of 100 attempted percutaneous coronary angioplasties in the treatment of coronary insufficiency].

Between November 1983 and June 1985, 100 coronary angioplasties were performed in the department of cardiology of the Pitié-Salpêtrière hospital, in 96 patients and 101 vessels. 71 attempts were successful (70%). There were no deaths. 8 bypass grafts were performed because of a symptomatic occlusive dissection in 3 cases, arterial trauma proximal to the stenosis in 2 cases and coronary artery thrombosis following a failed attempt at dilatation in 3 cases. There were 3 infarcts. The success rate improved from 56 per cent in the first 25 patients to 77 per cent in the last 25 patients. The success rate was maximal in patients with stenosis of the IVA, where it was as high as 90 per cent in the last 50 patients. In this last series, the success rate was identical in cases of stable and unstable angina. The rate of re-stenosis was low: 12 per cent in patients with a follow-up of at least 6 months.

Adult↗
PubMed1983

[Chylopericardium, chylothorax and cystic lymphangioma. Review of the literature apropos of a case].

One case of chylopericardium associated with chylopneumothorax is reported. Published data make it clear that the pathogenesis of effusions of chyle is imperfectly known and still highly hypothetical. With the exception of tamponade, there are few pathognomonic and dramatic signs. TM and cross-sectional echography is of paramount importance, since it provides a qualitative and quantitative diagnosis of effusion, the nature of which is determined by chemical analysis. Effusions of chyle may be idiopathic or may developed after oesophago-cardio-pulmonary surgery, or even after blockade of lymphatic vessels or as a result of increased lymphatic flow rate or pressure. Although the course of the disease is usually favourable, infectious or haemodynamic complications (e.g. tamponade or constriction) may aggravate the prognosis. Treatment is exclusively surgical and consists of partial pericardectomy, which is unquestioned. There is no consensus of opinion about simultaneous ligature of the thoracic duct.

Adult↗
PubMed1983

[Predictive value of the exercise test after primary infarction].

The predictive value of exercise stress testing was assessed by correlating the results with coronary angiography in a group of 100 patients 50 with inferior and 50 with anterior wall infarction. The following observations were made: --The exercise ECG was positive in 57 p. 100 of cases, more commonly in the inferior infarction group (74 p. 100), ST depression representing over 3/4 of the responses to exercise. On the other hand, the test was only positive in 40 p. 100 of anterior wall infarctions, ST depression again being the most commonly recorded response (65 p. 100). --The overall incidence of post-infarction angina was 45 p. 100; it was more common after inferior (70 p. 100) than anterior infarction (22 p. 100). --Multivessel disease was also more severe in the inferior infarction group (86 p. 100) than in anterior infarction (46 p. 100). However, ventricular aneurysms were twice as common in the anterior infarction group. --Exercise testing detected 80 p. 100 of cases with multivessel disease, especially when the LAD artery was involved, in the inferior infarction group. In the anterior infarction group, almost 50 p. 100 of patients with multivessel disease were not diagnosed. Despite an overall sensitivity of 73 p. 100 the predictive value of exercise stress testing was excellent (84 p. 100). In conclusion, in the presence of persisting angina after myocardial infarction coronary angiography should be performed to determine the severity of the multivessel disease. Exercise stress testing is a useful but imperfect method of detecting this high risk group. Its predictive value is however better in inferior (94 p. 100) than in anterior wall infarction (65 p. 100). Persisting angina was found to be a parameter of very high specificity (100 p. 100) for the presence of multivessel disease.

Adult↗
PubMed1982

[Echocardiography in pericardial effusion and tamponade (author's transl)].

The role of echocardiography in the diagnosis and quantitative assessment of pericardial effusion was demonstrated in 57 cases, 10 of which were confirmed by surgery. With this highly sensitive method all effusions equal or superior to 50 ml could be detected and their volume measured with accuracy. There were no false positive results. Two specific signs of tamponade came out very clearly: a decrease in EF slope, which was less than 50 mm/sec, and a notch in the anterior wall of the right ventricle which occurred 0.04 +/- 0.01 sec after QRS.

Adult↗