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Biomedical subjects

F Godart

Publications and source records attributed to F Godart.

48 records · Page 3Linked to original sources
PubMed1996

[Percutaneous implantation of endoprostheses in stenosis of the pulmonary branches].

Between July 1992 and October 1995. 10 Palmaz stents were implanted in 6 patients aged 2 to 25 years with stenoses of pulmonary artery branches. The stenoses were located on the right (n = 2) or left pulmonary artery (n = 3) or both branches (n = 1). Stenoses of the right pulmonary artery were secondary to a Waterston (n = 1) or Blalock-Taussig (n = 1) anastomosis or to surgical plasty with Dacron (n = 1). Stenoses of the left pulmonary artery were secondary to surgical plasty with Goretex (n = 2), pericardium (n = 1) or Dacron (n = 1): three of these patients had undergone a left Blalock-Taussig anastomosis before complete correction. After implantation of the stent, the pulmonary artery diameter increased from 4 +/- 2 mm to 11 +/- 2 mm (p = 0.0117) and the transstenotic gradient decreased from 44 +/- 18 to 15 +/- 12 mmHg (p = 0.0277). Similarly, the percentage of homolateral pulmonary perfusion at scintigraphy increased from 22 +/- 13% to 53 +/- 17% (p = 0.0431). There were no deaths. The major complication was migration of the stent, observed in three patients at the moment of implantation in two cases and in the hours following implantation in the other case. In these 3 patients, the embolised stent was left in the pulmonary arteries with no adverse consequences on pulmonary perfusion. Two of these patients later successfully underwent further catheterisation for implantation of another stent. Implantation of a stent is a therapeutic alternative in pulmonary artery stenoses which often recur after surgery and/or angioplasty. They increase the diameter of the stenosed vessel and reestablish the equilibrium of perfusion between the two lungs.

Adolescent↗
PubMed1996

[Percutaneous pulmonary valvuloplasty in neonates and infants with tetralogy of Fallot].

Percutaneous pulmonary valvuloplasty remains controversial as a palliative procedure in Tetralogy of Fallot. This paper reports the results of this technique with respect to clinical improvement and growth of the pulmonary arterial tree. Between June 1990 and July 1995, valvuloplasty with a balloon catheter was performed in 25 neonates or infants with Tetralogy of Fallot (13 girls and 12 boys). All patients were symptomatic with severe cyanosis associated with anoxic malaise in 14 cases. At catheterisation, the children were aged 3.5 +/- 2.6 months and weighted 4.7 +/- 1.2 kg. After dilatation, cutaneous oxygen saturation increased from 75 +/- 11 to 88 +/- 8% (p = 0.001). However, 3 children were referred for early surgery (one complete correction and two systemico-pulmonary anastomoses because of persistent desaturation. There were no lethal complications. A control (catheterisation or surgery) allowed evaluation of the growth of the pulmonary tract, on average 5.5 +/- 4.3 months after dilatation. The pulmonary artery diameter increased from 6.17 +/- 1.26 mm to 8.66 +/- 1.22 mm (p = 0.0015). Expressed as a Z score, the annulus diameter changed from -3.93 +/- 0.91 to -2.54 +/- 1.2 SD (p = 0.0019). The mean Z score of the right pulmonary artery increased from -3.01 +/- 0.69 to -1.98 +/- 1.12 SD (p = 0.0251) and the Z score of the left pulmonary artery from -2.68 +/- 0.85 to -1.61 +/- 1.46 SD (p = 0.0357). At complete correction, 50% of patients had had correction of their malformation without section of the pulmonary annulus. In conclusion, pulmonary valvuloplasty in Tetralogy of Fallot enables growth of the annulus and pulmonary arteries and is a valuable alternative to palliative systemico-pulmonary anastomosis.

Blood Gas Analysis↗
PubMed1995

[Agenesis of the pulmonary valves. Experience over 20 years].

Absent pulmonary valve is a rare cardiac malformation, usually associated with a tetralogy of Fallot. It features aneurysmal dilatation of the pulmonary arteries which may compress the bronchial tree and lead to respiratory distress. The experience of our group over a 20 year period (20 patients) is reported. The diagnosis was usually made in the neonatal period in the presence of cardiomegaly and a systolic and diastolic murmur at the left sternal border. The diagnosis was made at antenatal echocardiography in 2 cases. Ten patients were not operated and 4 of them died in the neonatal period of respiratory distress and 2 others of extracardiac causes. Three children are on the waiting list for surgical correction and the remaining child is asymptomatic. The other 10 cases were operated with a minimum closure of the ventricular septal defect and widening of the pulmonary tract. The latter procedure was performed with an infundibulo-pulmonary patch (6 cases) and insertion of a pulmonary valve (4 patients) (monocusp patch in 3 cases, pulmonary heterograft in one case). Eight patients underwent a reduction procedure of the pulmonary arteries to relieve branchial compression. Of those who were operated, two died during follow-up: the first of complete atrioventricular block and the second of infectious endocarditis of the stenosed pulmonary heterograft. These results show that reduction procedures of the pulmonary arteries are promising approaches which should improve the future prognosis of young patients with respiratory distress. The need for insertion of a pulmonary valve remains debatable.

Aneurysm↗
PubMed1994

[Residual shunt after percutaneous occlusion of patent ductus arteriosus by Rashkind's device. Echographic aspects, outcome, prognostic factors and management].

Percutaneous occlusion of patent ductus arteriosus with the double umbrella Rashkind prosthesis is an alternative to surgery. The authors report the results of a series of 40 patients aged 16 to 203 months, who underwent transcatheter occlusion of patent ductus arteriosus between January 1989 and March 1993. These children were followed up regularly, clinically and by echocardiography to determine the presence or absence of a residual shunt. Immediately after implantation, angiography showed a residual shunt in 75% of cases. However, the shunt progressively regressed during follow-up. Three types of shunt were described using colour Doppler based on the diameter of the transductal jet at its origin and its extension in the pulmonary artery: type I, a wide jet (> 3 mm), type II, or minimal shunt, with a jet diameter of 2 to 3 mm and an extension to the pulmonary valve (flame-like), and finally the type III, or punctiform shunt with a jet diameter < 2 mm and extension in the main pulmonary artery < 1.5 cm. During follow-up, a transition between the 3 types was observed in 37% of cases. Kaplan-Meier actuarial analysis showed a residual shunt rate of 33% at one year and 19% at 2 years after implantation. The search for predictive factors of residual shunt showed that very young patients at the time of catheterisation was the only indicator of a residual shunt (p = 0.03). Occlusion of a patent ductus arteriosus with a Rashkind device is a reliable method which gives good results. The essential problem remains that of a residual shunt but this disappears in 3/4 of patients during follow-up. When the shunt persists, a 1 to 2 year interval is advised before considering implantation of a second occluder.

Actuarial Analysis↗
PubMed1994

[Scimitar syndrome complicated by stenosis of the right pulmonary vein. Apropos of 4 cases].

The authors report 4 cases of the scimitar syndrome with pulmonary hypertension by stenosis of an abnormally draining right pulmonary vein and they also review the literature. All cases were symptomatic from infancy. The diagnosis was confirmed by catheterisation which showed a significant pressure gradient between the right pulmonary vein and the inferior vena cava, and by angiography which demonstrated the stenosis. None of the treatments proposed (interventional catheterisation with dilatation and eventual implantation of a stent, surgery with treatment of the stenosis and reimplantation of the right pulmonary vein in the left atrium, or pneumonectomy) were satisfactory. However, it is possible that earlier treatment could be effective as changes in the pulmonary vascular bed seem to occur very early in these patients.

Catheterization↗
PubMed1994

[Natural history and prognostic factors in primary endocardial fibroelastosis in infants].

Over a 33 year period, 127 patients under 2 years of age with dilated cardiomyopathies and appearances compatible with the diagnosis of primary endocardial fibroelastosis were admitted to the paediatric cardiac unit of the CHRU of Lille. The average follow-up was 8.9 +/- 6.7 years. Ninety-four children (74%) were cured, 16 (13%) had persistent cardiomegaly and/or left ventricular dysfunction on echocardiographic examination, and only 17 (13%) patients died (10 in the year following their initial hospital admission including 5 in the first week). The outcome of patients was not related to age at diagnosis, sex, cardiothoracic index, initial shortening fraction of the left ventricle or the period at which the patients were seen for the first time. On the other hand, the presence of a family history of cardiomyopathy was associated with a significantly worse prognosis. A recurrence of symptoms was the factor most closely correlated with a bad prognosis: 12 of the 19 patients (63%) with this evolution died, and 4 others (21%) had persistent myocardial dysfunction at the end of the study. These recurrences were often observed after premature withdrawal or after use of ineffective dosages of digitalis. In the authors' experience, dilated cardiomyopathy in neonates with clinical features of primary endocardial fibroelastosis is associated with a relatively high number of cures. Prolonged treatment with high doses of digitalis seems a determining prognostic factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiomyopathy, Dilated↗
PubMed1994

[Calcification and healing of infectious myocardial pseudoaneurysms. Apropos of 2 cases].

The authors present two cases of infectious myocardial pseudo-aneurysms: the first was secondary to an intracardiac foreign body with mitral valve endocarditis; the second to septicaemia of urinary origin. Both cases progressed to calcification of the pseudo-aneurysm which appeared to be a mode of healing. Reviewed 20 and 19 years respectively after the initial episode, both patients have normal cardiac appearances apart from the residual myocardial calcification.

Aneurysm, Infected↗
PubMed1993

[Percutaneous implantation of endoprosthesis for stenosis of branches of the pulmonary artery. Apropos of a case].

The authors report the case of a young man operated for tetralogy of Fallot and in whom surgical treatment of severe stenosis of the origins of the right and left pulmonary arteries had failed. Correction of these stenoses was obtained by implanting percutaneously an endoprosthesis in the right pulmonary artery with a good result: control angiography showed that the stenosis had disappeared and an increase in the right pulmonary artery diameter from: 5 to 11 mm, and the left pulmonary artery diameter from 7 to 14 mm. Perfusion pulmonary scintigraphy showed equal flow in the two lungs.

Adolescent↗
PubMed1992

[The single coronary artery].

Single coronary artery is a fairly rare entity which may nevertheless be found in 0.4 per cent of coronary arteriograms. The authors report 3 cases seen in 2 departments of cardiology. In each patient, despite the existence of definite cardiovascular risk factors, this distribution was a factor worsening coronary ischemia, leading to complete thrombosis in one case. Although most often a chance discovery, a review of the literature justifies the attribution to this anomaly of the onset of angina, infarction or even sudden death.

Adult↗
PubMedDate not supplied

Effects of transdermal nitroglycerin in children with congestive heart failure: a Doppler echocardiographic study.

The aim of this study was to evaluate by Doppler echocardiography whether administration of transdermal nitroglycerin (NTG) to children with congestive heart failure could modify mitral flow velocity profile with redistribution of left ventricular filling to late diastole, suggesting preload reduction of the left ventricle. Twelve children with congestive heart failure, aged from 6 months to 6 years (2.83 +/- 2.24 years; mean +/- SD), were recruited. Patients were randomly allocated either a NTG patch (study group; n = 6) or a placebo patch (control group; n = 6) in a double-blind procedure. The NTG patch was a 10-cm(2) patch releasing 5 mg of NTG per day. NTG patches were adjusted to a dose of 1 cm(2)/kg/day (0.5 mg/kg/day). Peak velocity and time--velocity integral (TVI) of E and A waves of transmitral flow, the ratio of the velocities of the A wave and E wave, and the ratio of the TVI of the A wave to the TVI of the E wave were measured. Doppler measurements were determined before treatment (H0) and 4 hours (H4) and 23 hours (H23) after the patch application. Relative changes of these parameters were not significantly different between these two groups. In the NTG group, mean NTG plasma concentration was 1.08 +/- 0.47 microg Liter(-1) at H4 (n = 5) and 1.18 +/- 0.81 microg Liter(-1) at H23 (n = 5). No patient had a NTG plasma concentration greater than 2 microg Liter(-1) either at H3 or at H24. These data suggest that 1 cm(2)/kg transdermal doses of NTG may have a limited bioavailability or a higher clearance and minimal hemodynamic effects in children with congestive heart failure already receiving other medications, implying that higher doses should be used.

Administration, Cutaneous↗
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↗