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Biomedical subjects

F Godart

Publications and source records attributed to F Godart.

At least 19 recordsLinked to original sources
PubMed2006

[Percutaneous angioplasty of native coarctation of the aorta. Results in children and young adults].

The authors report the experience of one centre in the treatment of native coarctation of the aorta by percutaneous angioplasty. Between 1999 and August 2005, 22 patients (7 girls, 15 boys) underwent dilatation of their coarctation by a balloon catheter at an average age of 11.8 +/- 5 years and body weight of 44 +/- 21 kg. In 20 patients, balloon angioplasty alone was performed and, in the other two, the angioplasty was associated with the insertion of a covered CP stent. The dilatation was performed with a balloon/coarctation ratio of 2.18 +/- 0.6 (1.7 to 3.5) and a balloon/isthmus ratio of 1.0 +/- 0.23 (0.7 to 1.87). After the procedure, ascending aortic pressure decreased from 134.7 +/- 23.4 mmHg to 125 +/- 22.7 mmHg (p= 0.0003); descending aortic pressure increased from 93.4 +/- 14.9 mmHg to 104.8 +/- 21.7 mmHg (p= 0.003); transisthmic pressure gradient decreased from 41.7 +/- 14.1 mmHg to 19.8 +/- 9.5 mmHg (p< 0.0001) and the diameter of the coarctation increased from 5.9 +/- 2.6 mm to 9.3 +/- 2.6mm (p= 0.0015). The two patients treated by covered CP stents had excellent immediate results without significant residual gradients. After dilatation (sometimes repeated, N= 13), a gradient > 20 mmHg persisted in ten patients (36% of cases) but no predictive factor was found on statistical analysis. There were no cases of acute aneurysm. In one patient, the femoral pulse decreased but returned to normal with heparin therapy. No patient required emergency surgical treatment after the angioplasty. During the clinical follow-up, echocardiography and MRI showed no signs of aneurysm and one patient had mild irregularity of the isthmic region. Three patients underwent surgery by resection suture for persistent coarctation (one combined with a Ross procedure); another patient was treated by a CP stent. In conclusion, percutaneous angioplasty of native coarctation of the aorta gives satisfactory results with few complications in bigger children and young adults. The results can be improved by using a slightly higher balloon/coarctation ratio.

Adolescent↗
PubMed2006

[The effect of an endothelin receptor antagonist in Eisenmenger syndrome: a single-center experience of 11 patients].

The Eisenmenger syndrome is a complication of congenital heart disease with significant left-to-right shunts, such as large ventricular septal defects, and corresponds to fixed pulmonary hypertension with shunt reversal. Bosentan, an inhibitor of endothelin A and B receptors, is a new molecule previously validated in the treatment of primary pulmonary hypertension. The authors report their monocentric experience of bosentan in 11 consecutive patients with the Eisenmenger syndrome treated for at least one year. This retrospective study comprised 7 females and 4 males with an average age of 34 years (range 17 to 51 years). The underlying lesion was ventricular septal defect (n = 4), atrial septal defect (n = 3), pulmonary atresia with septal defect (n = 4 of which 2 were treated palliatively). Before treatment, the patients were classified according to the NHYA functional class (I, II, IIIa and IIIb, IV or, respectively from 1 to 5) with a distribution in this series between Classes IIIa and IV (average 3.81 +/- 0.75) and from 3 to 10 on Borg's dyspnoea scale (average 6.54 +/- 2.29). The ambient oxygen saturation (SaO2) at rest was, on average 77 +/- 9%, the haemoglobin concentration 16.6 +/- 2.4 g/dl; hepatic transaminase levels were normal. The 6 minute walk test before treatment was 216 +/- 111 m with marked desaturation on exercise (49 +/- 18%). With Bosentan, patients were globally much better clinically with a decrease in dyspnoea, improvement in NHYA class and increased 6 minute walking perimeter. Improvement in NYHA class was observed from 3 months' treatment (3.0 +/- 0.8, p = 0.0002) and was sustained to one year (2.54 +/- 0.7, p< 0.001). An improvement of dyspnoea on Borg's scale was observed from the second month's treatment (5.56 +/- 1.65, p = 0.0201) and persisted throughout follow up to one year (3.81 +/- 1.32, p < 0.0001). Similarly, the 6 minute walking perimeter increased from the first control at 6 months (323 +/- 82 m, p < 0.0001) and at one year (322 +/- 62 m, p <0.0004). Finally, although a significant increase in SaO2 was observed at 6 months (p = 0.0032), this was hardly significant at one year (82 +/- 10 %, p = 0.0512). Transaminase levels did not rise significantly at the follow up visits (p = ns) and the haemoglobin concentration was unchanged. No patient died during the study period. This study showed a clear functional improvement in patients with Eisenmenger's syndrome treated with bosentan. The drug was well tolerated clinically with few adverse effects and a good safety margin of usage.

Adolescent↗
PubMed2005

[Pulmonary atresia with an intact interventricular septum].

We report this centre's experience of the treatment and follow up of pulmonary atresia with an intact septum. 35 infants were seen during the neonatal period. Opening via catheterisation was attempted in 21 patients with initial success in 10, and 11 failures leading to urgent surgery (surgical opening, n=9) and isolated Blalock-Taussig anastomosis (n=2). Fourteen other patients underwent immediate surgery: surgical opening, n=3, and Blalock alone, n=11. Four patients died in the neonatal period: 1 after successful opening via catheterisation, 3 others after Blalock anastomosis. Five others with a Blalock anastomosis died suddenly later. By the end of follow up, 16 patients had undergone biventricular type repair, of which 7 required additional procedures. 10 others had undergone cavo-pulmonary type repair, including 4 infants in whom the initial strategy of biventricular repair had failed. The only predictive factors at birth for subsequent progression to biventricular type repair were: larger tricuspid diameter at echography (10.9 +/- 2.25 mm versus 6.34 +/- 1.74 mm, p = 0.0007) or at angiography (10.07 +/- 2.09 mm versus 8.04 +/- 2.42 mm, p = 0.039), and the right ventricular morphology (p = 0.0011) with more tripartite ventricles, and less bipartite or even unipartite ones in the biventricular group.

Anastomosis, Surgical↗
PubMed2003

[Placing an endoprosthesis to maintain arterial canal permeability in lamb neonates].

Placing an endoprosthesis in the arterial canal in order to maintain permeability is a possible alternative to performing a modified Blalock-Taussig type surgical systemico-pulmonary anastomosis. This was studied in an animal model. Twelve newborn lambs, weighing from 1.8 to 3.5 kg, were catheterised in the neonatal period in order to place a stent. Three had a partial ligature of the pulmonary artery in utero. During the initial angiography, the canal was occluded in ten of them. Different types of coronary endoprosthesis were used: Multi link tetra TM and RX Herculink TM (Guidant Europe SA), Niroyal (Boston Scientific International), Bx Velocity (Cordis, Johnson and Johnson), Jostent (Jomed). The length of the endoprostheses varied from 12 to 18 mm and the diameter from 3.5 to 6 mm. Implantation was successful 10 out of 12 times: in one case, implantation was complicated by a fatal haemopericardium, and in another by pulmonary artery embolism. Nine animals out of 10 were followed up for 1 to 2 months. At autopsy verification, the canal was permeable in 7 cases with the development of a neointima and zones of moderate stenosis with intimal hyperplasia. In 2 animals the canal was occluded at the aortic level in a zone not covered by the endoprosthesis. Three animals died after implantation: the 2 implantation failures. A third animal with a well inserted prosthesis and a permeable canal died on day 1 from an unknown cause. Placing a stent in the arterial canal is a possible alternative to performing an aorto-pulmonary shunt. Coronary stents seem well adapted and this study does not allow any conclusions to be made at this time on the best type of stent. Further studies will be necessary in order to validate this concept before its use in congenital cardiopathies.

Animals↗
PubMed2003

[Pulmonary valvulotomy with the Nykanen radiofrequency guide in pulmonary atresia with intact interventricular septum].

We report 2 cases of pulmonary atresia with intact interventricular septum where perforation of the pulmonary valve was performed using a new Nykanen radiofrequency guide from Bayliss. The valvulotomy was successful in the two neonates, but one required secondary surgery to enlarge the pulmonary infundibulum. Moreover, in one of the two cases, this anomaly was associated with a right aortic arch without systemico-pulmonary vessels, which is a rare combination in this pathology. This technique is effective and safe, and represents a good alternative to open surgery in the forms with tripartite right ventricle and without coronaro-cardiac fistulae.

Aorta, Thoracic↗
PubMed2002

[Criteria for percutaneous non-closure of interatrial communications of the ostium secundum type by the Amplatzer septal occluder].

The aim of the study is to recognise the criteria preventing the percutaneous closure of an interatrial communication of the ostium secundum type for the Amplatzer septal occluder device. From January 1999 to December 2000, 121 consecutive patients with an average age of 24.8 +/- 19 years affected with an interatrial communication of the ostium secundum type underwent echocardiographic examination with transthoracic Doppler to evaluate the maximal diameter of the communication, the border dimensions, and the length of the interatrial septum; 92.5% of them underwent haemodynamic investigation to evaluate the shunt and the stretched diameter. Comparison of the umbrella group averages with the surgical group was performed by the Student test, and the frequencies by the Chi 2 test. ROC curves were drawn for the numeric parameters. After these 2 examinations, 68 patients underwent an attempt at percutaneous closure with 61 successful (84.7%) and 53 had a surgical closure straight off. The surgical group was younger, with a more significant shunt and a wider communication. The criteria for non-closure apart from abnormal pulmonary venous reflux were: insufficient border (59% of cases), diameter too wide (16%), multiperforate septum (16%) and insufficient septum length (9%). Percutaneous closure could be performed in 2/3 of interatrial communications without abnormal pulmonary venous reflux. Candidates for surgery were younger, with a more significant shunt and a wider diameter. In retrospect 8 patients of the surgical group could have had percutaneous closure and 7 patients of the umbrella group could have been sent straight for surgery.

Adolescent↗
PubMed2002

[Important of magnetic resonance angiography with gadolinium injection in pulmonary vein diseases].

The study of the pulmonary veins by echocardiography is sometimes difficult especially when the ultrasonic window is restricted. Conventional angiography is the classic reference examination but it exposes the patient to ionising radiation and requires the injection of an iodine contrast product. Another technique that can provide the essential information is magnetic resonance angiography (MRA) with injection of gadolinium. It was performed in 9 patients for suspected congenital or acquired anomalies of the pulmonary veins between June 1999 and December 2001. The patient's ages varied from 1 month to 10 years. The examinations were carried out on a 1.5 T Vision machine (Siemens, Erlangen, Germany) without "cardiac gating" or apnoea after parental consent. MRA with gadolinium injection showed 5 drainage anomalies (3 partial pulmonary venous refluxes in the superior vena cava, 2 scimitar syndromes) and 3 stenoses (one due to compression by an aneurysm of the left pulmonary artery, a second secondary to pericardial agenesis, and a third secondary to hypoplasia of an isolated vein). MRA allowed three dimensional visualisation of these anomalies. This is a rapid, non-invasive and certain imaging technique which does not expose the patient to ionising radiation. It is therefore of significance in the investigation of anomalies of the pulmonary veins complementing echocardiography, and could in future replace cardiac catheterisation.

Child↗
PubMed2002

[Interventional catheterization in congenital heart disease in the adult].

Interventional catheterisation comprises performing a palliative or curative procedure during arterial or venous cardiac catheterisation. This procedure can be performed at any age, equally well in the newborn or adults affected by congenital cardiopathy: in order to definitively treat a congenital cardiopathy, unrecognised in infancy but diagnosed in adulthood, such as pulmonary valvular stenosis, coarctation of the aorta, persistent ductus arteriosus, ostium secundum type interatrial communication, coronaro-cardiac fistula, pulmonary arterio-venous fistula, and patent foramen ovale; in order to improve the haemodynamic state of a complex congenital cardiopathy, for example by creating an interatrial communication, or by opening the pulmonary route in a complex cardiopathy which cannot be completely repaired; in order to complete a surgical procedure, to treat recurrence of peripheral pulmonary stenosis or recurrence of coarctation, and to embolise the systemic vessels leading off the aorta or veno-venous anastomoses after cavopulmonary intervention. Paediatric cardiology can lead to occlusion of a left-right or right-left shunt with different devices, alleviation of an arterial or venous valvular stenosis with dilatation catheters, or implantation of endoprostheses in arterial or venous stenoses.

Adult↗
PubMed2001

[Percutaneous closure of patent ductus arteriosus with the Amplatzer duct occluder. Results of 29 patients].

The authors report their experience of percutaneous closure of large patent ductus arteriosus with the Amplatzer duct occluder. The age of the patients ranged from 3 months to 72 years (average 24 months) with body weights of 3.9 to 74 Kg (average 16 Kg). The smallest angiographic diameter of the ductus was 4.0 +/- 1.3 mm at angiography (range 1.8 to 6 mm). The occluder was inserted under local anaesthetic with control aortography in all but one case who required general anaesthesia. In two small babies, the implantation was performed after venous puncture alone with transthoracic echocardiographic monitoring. The implantation was successful in all but one case in which there was a distensible duct. Early angiographic control showed suppression of the shunt in 61% of patients. Secondary haemolysis was observed in one case and was corrected by a second catheterisation 4 days later, with occlusion of the duct with a balloon catheter. The patients were followed up clinically, radiologically and echocardiographically. Doppler echocardiography showed absence of a residual shunt in 24 patients (86%) one month after the procedure, in 25 patients (89%) 3 months after the procedure and in 26 patients (93%) one year after the procedure. Two patients were left with mild or moderate shunts 12 and 16 months after the attempted occlusion. No cases of aortic or pulmonary obstruction were observed. The authors conclude that the Amplatzer duct occluder is a reliable device for closing large patent ductus arteriosus. It may be proposed in young symptomatic children over 4 Kg in body weight. A high rate of occlusion is obtained with a minimal risk of complications.

Adolescent↗
PubMed2001

[Left monoplegia revealing pulmonary arteriovenous fistual in an adolescent: occclusion with an Amplatzer occluder].

A 16 year old adolescent was admitted to hospital for investigation of a transient left monoplegia. The clinical, electric and radiological examinations were all normal. Echocardiography showed no abnormality of cardiac structures or function. Contrast echocardiography was performed and showed a right-to-left shunt suggesting a pulmonary arteriovenous fistula which was confirmed at angiography. The fistula was closed at catheterisation by a detachable balloon: in a second procedure, the balloon was deflated and contrast studies showed a recurrence of the right-to-left shunt. An Amplatzer 8/6 duct occluder was implanted with excellent results and no recurrence at 3 months.

Adolescent↗
PubMed2000

Echocardiographic follow-up after Ross procedure in 100 patients.

The Ross procedure could provide an ideal aortic valve replacement method in children and young adults. We evaluated midterm echocardiographic results to assess pulmonary homograft function as well as pulmonary autograft dimensions and function. In all, 105 patients (26 women and 79 men) underwent the Ross procedure; median age at implant was 29 years. All patients underwent free root replacement. Transvalvular gradients and autograft dimensions were measured at 3 levels (annulus, sinuses of Valsalva, and proximal aorta) at discharge, at 6 months, and annually thereafter. Perioperative mortality was 4.7%. The mean period for echocardiographic follow-up in 100 patients was 32.7 months (range 0.5 to 7 years), during which 4 noncardiac-related deaths occurred. Two patients underwent late reintervention. No moderate or severe regurgitation was recorded. There was 1 case of mild homograft regurgitation and 4 of mild autograft regurgitation at late follow-up. Autograft peak gradients were low and reproducible (5 +/- 2.8 mm Hg at discharge vs 5.5 +/- 3.5 mm Hg at last follow-up, p = NS). Homograft peak gradients increased significantly without severe obstruction (7.8 +/- 5.7 mm Hg at discharge vs 15.8 +/- 9.2 mm Hg at last follow-up). The diameter of the autograft annulus was stable during follow-up, whereas autograft dimensions at sinuses and proximal aorta increased significantly. One group of patients was identified with sinus diameter increases >20% (group A). The 90 remaining patients were classified into group B. The only parameter significantly different between the 2 groups was the sinus diameters measured at discharge (1.74 cm/m2 (group A) vs 1.92 cm/m2 (group B); p = 0.036). In 100 patients and with echocardiographic follow-up for up to 7 years, the Ross procedure showed excellent results. For 10% of patients, we observed a 20% dilation of sinus diameters, but in only 3 patients (3%) was this beyond the upper normal limit.

Adolescent↗
PubMed2000

Identification of seven novel nucleotide variants in the hepatocyte nuclear factor-1alpha (TCF1) promoter region in MODY patients.

Maturity onset diabetes of the young (MODY) is a heterogeneous subtype of type II diabetes mellitus. To date, five MODY genes have been identified. Mutations in the hepatocyte nuclear factor-1alpha (HNF-1alpha) gene are associated with MODY3. In the present work, we implemented the HNF-1alpha promoter region in the screening of MODY-suspect patients and identified seven variants not detected in control subjects. The family was available for the -119delG variant, and segregration between MODY and the variant is observed. Most of these variants are located in highly conserved regions and may alter HNF-1alpha expression through binding alteration of nuclear factors or other mechanisms. We demonstrate by functional studies that the transcriptional activity of the -283A>C and -218T>C variant promoters were 30% and 70% of the wild type activity, respectively. These data suggest that HNF-1alpha promoter variants could be diabetogenic mutations, and emphasize that the accurate HNF-1alpha expression is important for the maintenance of normal pancreatic beta cell function.

5' Untranslated Regions↗
PubMed2000

MR-guided balloon angioplasty of stenosed aorta: in vivo evaluation using near-standard instruments and a passive tracking technique.

The purpose of this study was to assess the feasibility of magnetic resonance (MR)-guided balloon angioplasty of a stenosed aorta on an open low-field magnet using a passive tracking technique. Visualization of vessels and position of instruments were realized by using a fast low-angle shot (FLASH) sequence. Catheters and guidewire were prepared for susceptibility-based MR visualization. Standard balloon catheters were inflated with diluted gadolinium, and nitinol guidewires were modified by incorporation of iron oxide markers into their walls. After validation on a flow phantom, balloon angioplasty was performed on an in vivo model of arterial stenosis. Creation of abdominal aorta stenosis was realized in five piglets. MR-guided balloon angioplasty of the aorta was performed with success in all but one. In one of them, stent implantation was achieved in the descending aorta. Balloon angioplasty using a passive tracking technique is a simple concept that can be realized with near-standard instruments and any MR imaging system. This represents an advance toward MR-guided vascular interventions in the future.

Angioplasty, Balloon↗
PubMed2000

Accurate localization of needle entry point in interventional MRI.

In interventional magnetic resonance imaging (MRI), the systems designed to help the surgeon during biopsy must provide accurate knowledge of the positions of the target and also the entry point of the needle on the skin of the patient. In some cases, this needle entry point can be outside the B(0) homogeneity area, where the distortions may be larger than a few millimeters. In that case, major correction for geometric deformation must be performed. Moreover, the use of markers to highlight the needle entry point is inaccurate. The aim of this study was to establish a three-dimensional coordinate correction according to the position of the entry point of the needle. We also describe a 2-degree of freedom electromechanical device that is used to determine the needle entry point on the patient's skin with a laser spot.

Biopsy, Needle↗
PubMed2000

[Arm ischemia revealing Kawasaki disease].

UNLABELLED: An aneurysm of the medium arteries is one of the major complications of Kawasaki syndrome. Eleven cases of giant coronary aneurysm have been reported. CASE REPORT: We report a new case in a nine-month-old child. Ischemia of the left hand was the first symptom. Diagnosis was made 30 days later. Anticoagulant and fibrinolytic treatments did not prevent necrosis of four fingers. CONCLUSION: The prognosis of Kawasaki disease depends on early diagnosis and management. Infants younger than seven months of age are more susceptible to developing coronary and midartery aneurysms, which therefore justifies a close observation during the acute phase and later on. In the case of a coronary artery aneurysm, Doppler echography of the upper and lower limbs is mandatorily recommended. Anticoagulant therapy should be started once the diagnosis of mid-artery aneurysms is made. Ischemia of the extremities can lead to necrosis and amputation. Until now, anticoagulants, vasodilators and fibrinolytic agents were not proven to be effective.

Amputation, Surgical↗