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Biomedical subjects

F Lacour-Gayet

Publications and source records attributed to F Lacour-Gayet.

At least 109 records · Page 6Linked to original sources
PubMed1989

[Middle-term result of surgery in 78 cases of complete atrioventricular canal before one year of age].

Between 1970 and 1985, 78 children with complete atrioventricular canal were operated upon before the age of one year at the Marie-Lannelongue Surgical Centre. Forty-seven survivors were followed up for periods of 3 months to 13 years after the initial operation; 2 were lost of following. Among the 13 children who survived banding, 1 died spontaneously, 1 had Blalock-Taussig anastomosis and 11 underwent full repair with 5 deaths; out of 6 survivors, 4 are doing well without any treatment, 1 was reoperated upon twice and died during the second operation, and 1 was lost sight of; the survival rates at 5 and 10 years are 46 +/- 23 p. 100 and 29 +/- 23 p. 100 respectively. Among the 34 children who survived an initial complete repair, 2 were reoperated upon 3 months after the repair, with 1 death, 7 subsequently died of infection (6 had trisomy 21); out of 26 survivors followed up for 3 years and 3 months on average after the complete repair (2 to 13 years), 18 show an excellent result and 3 a mediocre result; the survival rates at 5 and 10 years are 45 +/- 9 p. 100 and 30 +/- 27 p. 100 respectively. Whether the patients initially had banding followed by complete repair or complete repair from the start, the probability of survival at 5 and 10 years was the same. The presence of trisomy 21 is an unfavourable prognostic factor at medium-term.(ABSTRACT TRUNCATED AT 250 WORDS)

Down Syndrome↗
PubMed1989

[Desinsertions of aortic valve prostheses treated by subcoronary implantation of the valve].

Thirteen patients requiring emergency surgery for desinsertion of their aortic valve prostheses were treated by subcoronary aortic valve grafting, using a procedure based on Danielson's method. The particularity characterizing this technique consists in obtaining direct revascularization of the left coronary artery via a coronary sinus approach, thereby reducing the complexity of the surgical operation. All the patients presented valvular ring lesions, associated with aortic root degeneration accountable for failure of conventional artificial aortic valve replacements; in 8 patients, this had been their third aortic prosthetic surgery. The mean survival period for eight patients was 44 months. Considering the highly critical aspect of such lesions, this technique apparently constitutes a working solution, barring all chances for relapse.

Adult↗
PubMed1989

[Anatomical repair of transposition of the great vessels in the neonatal period. 5 years' experience. 246 patients].

In the period between april 1984 and march 1989, 246 newborn children with transposition of the great vessels benefited from anatomical repair of their heart disease. 221 children had simple transposition with normal interventricular septa. These were aged 2 to 23 days (mean age 7.8 +/- 3.5 standard deviation). 25 had transposition of the great vessels associated with a large interventricular septum defect. These were aged 7 to 30 days (mean age 18 +/- 8.3 S.D.). Associated lesions included a small interventricular septum defect in 20 cases which was not treated at the time of the operation; tricuspid insufficiency in 3 cases; and isthmic coarctation of the aorta in 10 cases. According to Yacoub's classification relative to the anatomical distribution of the coronary arteries, all the children fell into the following groups: type A, 172 cases; type B, 8 cases; type C, 12 cases; type D, 40 cases; type E, 14 cases. Preoperative catheterization was carried out in all the children. 96% benefited from Rashkin's atrioseptostomy, 90% had a prostaglandin infusion continuing through surgery. The surgical technique included the use of continuous extracorporal circulation at 20 degrees C, without circulatory arrest. Protection of the myocardium was ensured during aortic clamping by injecting of a crystalloid cardioplegia-inducing solution. The main steps of surgical repair were repositioning of the coronary arteries onto the ancient aortic stump and reconstruction of a pulmonary shunt. Repositioning of the coronary arteries was carried out in accordance with Yacoub's technique in all cases except for the 10 first patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1988

[Complete repair of the interrupted aortic arch by an anterior approach. Apropos of 9 cases].

Interrupted aortic arch is a duct-dependent heart disease, and this is why the use of prostaglandins E, which keep the ductus arteriosus open to feed the descending aorta, has transformed its formerly sombre prognosis. The authors report the cases of 9 neonates and infants presenting with interrupted aortic arch associated with ventricular septal defect who underwent total repair of the malformations under extracorporeal circulation. Five children were less than 10 years' old. The aortic lesions were of type A in 2 cases (interruption distal to the left subclavian artery) and of type B in 7 cases (interruption between the left carotid and subclavian arteries). In the second group the lesions were of type B1 in 5 cases (without retro-oesophageal right subclavian artery) and of type B2 in 2 cases (right retro-oesophageal artery distal to the interruption). There was one death (11 p. 100). So far, no child has been reoperated upon for residual aortic obstruction or reopened ventricular septal defect. This technique of total repair in one stage, with closure of the ventricular septal defect, seems to be preferable to the two-stage technique in which stage one includes, in addition to aortic arch repair, cerclage of the pulmonary artery, a procedure with numerous disadvantages and a higher overall mortality rate.

Aortic Arch Syndromes↗
PubMed1988

Switch operation for transposition of the great arteries in neonates. A study of 120 patients.

From March 1984 to January 1987, anatomic surgical correction was performed on 110 newborn infants (2 to 23 days old, mean 7.8 +/- 3.5, standard deviation) with simple transposition of the great arteries and 10 additional neonates (7 to 30 days old, mean 17.9 +/- 8.3, standard deviation) with transposition and a large ventricular septal defect. All had preoperative catheterization. Ninety-six percent of the patients underwent balloon atrial septostomy and 90% received prostaglandin E1 infusion until the time of the operation. The anatomy of the coronary arteries according to the Yacoub classification was as follows: type A, 82 patients; type B, 5 patients; type C, 4 patients; type D, 23 patients; and type E, 6 patients. Continuous hypothermic bypass with no circulatory arrest was used for all patients except two. Myocardial protection was ensured by crystalloid cardioplegia. Coronary artery relocation was performed according to the Yacoub technique with some modifications, and pulmonary artery reconstruction was done according to the Lecompte maneuver in all patients, even when the great vessels had a side-by-side relationship. The proximal pulmonary artery was reconstructed with two circular patches for the first 10 patients and with a single large posterior patch for the last 110 patients. Tanned heterologous pericardium was used for the first 25 patients and autologous native pericardium for the last 95 patients. The perioperative mortality rates were 8.3% for the entire series and 5.4% for the last 110 patients, with no deaths in the group having transposition plus ventricular septal defect. Late death from acute myocardial infarction occurred in two patients in the second month after operation. No patient was lost to follow-up, which ranged from 2 to 46 months (mean 16 +/- 11.2, standard deviation). The follow-up included sequential noninvasive evaluations and 32 catheterizations performed 10 to 18 months postoperatively. Two patients were reoperated on for pulmonary stenosis caused by retraction of the two heterologous pericardial patches, but neither died. Six others have mild to moderate pulmonary stenosis. Two patients have trivial aortic regurgitation. None have aortic dilatation or supravalvular aortic stenosis. The 108 survivors have no cardiovascular symptoms. They all are in sinus rhythm, have normal left ventricular function, have no ischemic problems, and receive no medication.

Coronary Vessels↗
PubMed1987

Anatomic correction of simple transposition of the great arteries in 50 neonates.

From April 1984 to January 1986, anatomic surgical correction was performed in 50 newborn (2- to 23-day-old, mean 8 +/- 5 [SD]) infants with simple transposition of the great arteries. Before surgery, balloon atrial septostomy was performed in all patients, prostaglandin E1 was infused in 42, and left ventricular shape on a two-dimensional echocardiogram was considered "satisfactory" in 48. Surgery was performed in patients on cardiopulmonary bypass without cardiac arrest; the pulmonary artery was reconstructed by end-to-end anastomosis according to Lecompte's maneuver with a pericardial patch. In all but one patient coronary artery transfer was possible regardless of the distribution of these vessels. There were eight early deaths (16%), but only four (10%) of the last 41 patients treated died. There was one late death (2%) due to a secondary myocardial infarction caused by compression of the left coronary artery. Reoperation was successfully performed in two patients for supravalvar pulmonary artery stenosis. The only late medical complication was a transient episode of myocardial ischemia 6 months after surgery. The 41 late survivors were in excellent condition, were in sinus rhythm, and had a normal left ventricle 1 to 22 months after surgery (mean 7.2 +/- 5.4 [SD]). Aortic growth was normal; pulmonary artery supravalvar stenosis occurred in six patients (mild in four). We conclude that anatomic correction can be applied successfully in the first few days of life in newborns with simple transposition of the great arteries, regardless of coronary distribution.

Cardiopulmonary Bypass↗
PubMed1986

[Surgical anatomy of the interventricular communications of the septal trabecula].

Muscular ventricular septal defects (VSD) are a special anatomical and surgical entity. They are observed in 85% of cases of multiple VSD. This study was based on the operative findings in 70 patients and 20 pathological specimens of muscular VSD. A surgical topographic classification is proposed, superior, intermediate and inferior, with a specific surgical approach for each of the three types. The superiorly situated muscular VSDs are approached through the right ventricle, the intermediate ones through the right atrium and the inferior through the right atrium or left ventricle. Section of the moderator band greatly facilitates the exposure of the intermediate and inferior segments of the septum through the tricuspid valve. Left ventriculotomies should be reserved for inferiorly situated muscular VSD with right ventricles of small volume.

Heart Septal Defects, Ventricular↗
PubMed1986

[Results of anatomical correction of simple transposition of the great vessels in 46 newborn infants].

Between the 4th April 1984 and 6th December 1984, a strategy of anatomical correction of transposition of the great arteries was undertaken in the newborn if three criteria were respected: parental consent, patient's age of less than 15 days and satisfactory left ventricular geometry. We report our results in 47 consecutive cases operated by the same surgeon at an average age of 8.2 +/- 5.3 days. Atrioseptostomy was performed in all cases before surgery, with a ratio of left to right systolic ventricular pressures greater than 0.66 (m = 0.8) and an infusion of prostaglandin E1 was maintained until surgery in 40 cases. The geometry of the left ventricle assessed by echocardiography was considered to be normal in 23 cases, satisfactory in 22 cases and unfavourable in 2 cases. Except for one case with the great vessels situated in the frontal plane in which an atrial correction was decided upon during surgery, all the patients underwent detransposition under cardiopulmonary bypass without cardiac arrest, irrespective of the coronary anatomy. The pulmonary tract was reconstructed by direct anastomosis with a piece of tanned (first 25 cases) or autologous (following 21 cases) pericardium. There were 18 immediate deaths (17%) but only 4 out of 37 after September 1984 (11%); the causes of failure were: 5 technical errors, 1 irreducible postoperative pulmonary hypertension and 2 probable left ventricular failures. The 38 survivors were followed up for an average of 6.8 +/- 5.4 months (range 1 to 21 months; 28 cases were followed up for over 3 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta↗
PubMed1986

[Surgical treatment of complete atrioventricular canals, regular and irregular forms, in 75 patients].

The cases of 75 consecutive patients operated for complete atrioventricular canal between 1/1/1978 and 1/1/1985 at Marie-Lannelongue Hospital were reviewed. The age ranged from 1.5 months to 16 years. Forty-nine per cent of patients were operated in the first year of life in the period 1982-1984. Seventy-eight per cent of patients were operated before one year of age. Certain anatomical characteristics enable regular and irregular forms of the condition to be distinguished. Regular forms are characterised by the association of a defect of the inter atrio-ventricular septum, of a common atrioventricular orifice and of ventricles of equal volume without other associated malformations. Irregular forms include the parachute mitral valve, the double mitral orifice, deficient mitral valvular tissue, ventricular hypoplasia, subaortic stenosis, abnormal right ventricular muscular bands, associated cardiac malformations and pulmonary obstructive vascular disease. Surgery comprises repair of the ventricular septal defect and the ostium primum with two separate patches, respecting the anterior and posterior valves and partial or complete closure of the cleft valve. The hospital mortality rate was 33 p. cent. It was 16 p. cent in regular forms and 58 p. cent in irregular forms (p less than 0.01). The hospital mortality of patients operated before 1 year of age with the regular form of the malformation was 22 p. cent. Six children were reoperated secondarily with 2 deaths. Four pacemakers were implanted for complete atrioventricular block. The secondary mortality was 10 p. cent. Thirty-nine patients were followed up for an average of 28 months (range 3 months to 5.5 years).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Aortic uncrossing for compressive circumflex aorta. 3 cases].

Three children with circumflex aorta developed signs of tracheobronchial compression. Dividing the arterial ligament was ineffective. At endoscopy, the right side of the trachea and the tracheal bifurcation were found to be severely obstructed by the aorta itself. The aortic arch was approached through a median sternotomy and freed from mediastinal adhesions. The aorta was divided below the point of origin of the right carotid artery, then uncrossed and reimplanted on the left surface of the ascending aortic segment. Cerebral protection was ensured by deep hypothermia and cardiopulmonary bypass. Post-operative angiography showed good reconstruction of the aortic arch.

Aorta↗
PubMed1983

[Aortocoronary bypass with 10 years' follow-up. Apropos of 183 cases].

Between 1970 and 1972, 183 patients were admitted to the CMC Foch (Pr D. Guilmet) for saphenous vein aorto-coronary bypass surgery. Ten years later a questionnaire was sent to the patient and his cardiologist and the two replies were analysed. Before surgery, all patients had invalidating angina: 12 p. 100 had unstable angina, 61 p. 100 had previous myocardial infarction. Preoperative coronary angiography showed triple vessel disease in 64,5 p. 100, double vessel disease in 18,6 p. 100 and single vessel disease in 14,2 p. 100. There hundred and thirty two grafts were performed (average 1,8 per patient); 42 endarteriectomies were also carried out, 35 on the right coronary artery. Complete revascularisation was achieved in 95 cases (52 p. 100). The incidence of perioperative infarction was 17,5 p. 100 and operative mortality was 7,6 p. 100. Thirty two patients (19 p. 100) died during the 10 year study period; 11 deaths were of cardiovascular origin. The 10 year actuarial survival rate was 66 p. 100. Half the patients are asymptomatic and nearly two thirds take no anti-anginal therapy. The patency of the grafts was chacked in about half the cases and was found to be 72,8 p. 100 at one year. From the professional point of view, two thirds of patients returned to full time working one year after surgery. The degree of activity at 10 years is only known in 87 cases; half these patients are working and a quarter have retired normally. This study shows that: --coronary bypass surgery has excellent long-term effects on symptoms; --the incidence of infarction and survival are comparable to other reported studies; --patients with triple or double vessel disease may have lived longer after surgery than had they been treated medically.

Adult↗
PubMed1979

[Remote results of ostial coronaritis surgically treated].

This study comprises 15 patients operated for syphilitic coronary ostial stenosis by Dubost's team between 1959 and 1975. Three operative deaths (20%) were observed. Three other late deaths occured, but only one of his coronary pathology. Of the nine survivors, seven have been reviewed and five have undergone control coronary angiography. The long term results of the 9 survivors, reviewed from 3 1/2 to 11 years after operation, illustrate the difficulties of disobliteration of the right coronary ostium, the necessity of changing the aortic valve systematically when incompetent and the maintenance of the good results obtained by this surgery.

Adult↗
PubMedDate not supplied

Effects of potassium conductance inhibitors on spontaneous diastolic depolarization and abnormal automaticity in human atrial fibers.

The capability of generating spontaneous diastolic depolarization and automaticity was investigated in vitro by means of standard microelectrode techniques in 50 human atrial preparations. Samples were classified within two groups: group 1 was composed of 12 well-polarized preparations exhibiting action potentials that were fast responses (mean maximum diastolic potential: -75.5 mV and Vmax greater than 100 V/s); group 2 was composed of 38 partially-depolarized samples (mean maximum diastolic potential: -50.3 mV and Vmax less than 10 V/s) and was further divided into two subgroups. Subgroup 2A consisted of 20 spontaneously beating preparations and subgroup 2B consisted of 18 non-automatic partially-depolarized specimens. Highly-polarized fibers from group 1, although exhibiting a slight diastolic depolarization which was almost entirely suppressed by 2 mM caesium, never presented spontaneous activity under our experimental conditions. 90% of automatic fibers from subgroup 2A were sampled from dilated atria. In automatic preparations, diastolic depolarization was usually separated into two phases: an initial phase, also present in non-automatic fibers, and a late phase. Changes in the initial phase were not accompanied by concomitant changes in the spontaneous rate. Abnormal automaticity was clearly related to the late diastolic phase (absent in non-automatic fibers), the generation of which appeared to be a specific property of automatic fibers. The use of K conductance inhibitors (caesium, 4-aminopyridine, barium, low K solutions) provided indirect evidence that neither delayed outward ix current nor if type inward current are principally responsible for abnormal automaticity.

4-Aminopyridine↗