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Biomedical subjects

G Drobinski

Publications and source records attributed to G Drobinski.

At least 91 records · Page 5Linked to original sources
PubMed1988

[Treatment by redilatation and thrombolysis of occlusion occurring during percutaneous coronary angioplasty].

In patients who develop acute coronary occlusion during or after percutaneous coronary angioplasty, surgery is not mandatory, and other treatments may be considered, namely redilatation and/or thrombolysis. Between June, 1984 and January, 1988 we performed 500 dilatations of coronary arteries, not counting the attempts made in the acute phase of myocardial infarction. Acute coronary occlusion without angiographic image of occlusive dissection occurred in 31 patients (6.2%) and was treated by attempted redilatation and intracoronary thrombolysis. In 10 patients (group A) either the occlusion could not be removed and emergency surgery was tried (5 cases with 2 infarctions and 1 death), or the occlusion was removed but myocardial infarction took place (5 cases). In 21 patients (group B), the occlusion was removed and the outcome was favourable without myocardial infarction. Altogether, myocardial infarction or death occurred in only 8 cases, or 26% of acute occlusions. The clinical and angiographic features of the two groups before and after angioplasty were compared; two of them differentiated group A from group B: (1) unstable angina, 7/10 in group A, 4/21 in group B (p less than 0.01), and (2) degree of stenosis, 93.1% in group A, 78% in group B (p less than 0.01). When coronary occlusion occurs during or after coronary angioplasty and is poorly tolerated with fall in blood pressure, surgery must be contemplated at once, even after recanalization of the vessel and subsidence of ischaemia. In all other cases, treatment with both redilatation and thrombolysis should restore the benefits of angioplasty without myocardial infarction.

Adult↗
PubMed1988

[Remote results of aortic valve replacement with the St. Jude medical prosthesis].

The St Jude Medical prosthesis on the aortic valve was evaluated in a 7-year prospective study which involved 49 patients. Survivors were followed up for 2,577 patient-months, meaning a mean follow-up of 5 years per patient and a minimum follow-up of 4 years per patient. The overall survival rate at 6 years was 79.6 +/- 5.7 p. 100. All deaths occurred during the first two years, and none of them was ascribable to the prosthesis. The left ventricular systolic and diastolic echocardiographic diameters were significantly greater in the patients who died. The linear rate of thromboembolic accidents was 0.93 p. 100 per patient-year, and that of accidents due to anticoagulants was 3.26 p. 100 per patient-year. The probability of freedom from all complication at 6 years was 71 +/- 9 p. 100. In the totality of patients, 10.2 p. 100 required pacemaker implantation; these patients had aortic stenosis exclusively, and all were alive at 7 years. The quality of live, assessed during consultations, was altered in one-half of the survivors. The good results obtained with the St Jude Medical prosthesis are marred by a high initial mortality rate, notably in patients with left ventricular enlargement, by the frequency of accidents due to anticoagulants and by the mediocre quality of life of survivors.

Actuarial Analysis↗
PubMed1988

[Development of left ventricular function following aortic valve replacement].

Changes in left ventricular function were evaluated in twelve patients with aortic valve stenosis and in eleven patients with aortic valve regurgitation in order to find out whether the results obtained soon after aortic valve replacement persisted over a long period. All patients had been provided with a St-Jude Medical valve. Evaluation included electrocardiography, radiography of the chest, phonocarotidography and echocardiography and was performed preoperatively, then three months and five years on average in each patient after surgery. In patients with aortic valve stenosis, the left ventricular mass clearly regressed during the first three months (p less than 0.01) and continued to regress, albeit not significantly, over five years. In patients with aortic valve regurgitation, the left ventricular volume and mass regressed significantly during the first three months and remained normal for five years. No significant variation in systolic performance was observed in both groups. In spite of good overall results, 26 p. 100 of the patients had an unfavourable long-term outcome as they developed major left ventricular dilatation. Nos prosthesis dysfunction was observed, and the St Jude Medical valve caused little obstruction. Thus, with this little obstructive prosthesis the postoperative improvement obtained persisted for five years in most cases of aortic valve stenosis or regurgitation.

Aortic Valve Insufficiency↗
PubMed1988

[Reproducibility of myocardial ischemia induced by atrial stimulation].

Reproducibility of myocardial ischemia induced by atrial pacing (P) was investigated in 25 patients (pts) without previous anterior myocardial infarction and showing a positive exercise stress test. The second period of atrial pacing (P2) was exerted 20 minutes after the first (P1). During P2, a reduction in the parameters reflecting myocardial oxygen requirements (maximal left ventricular pressure, dp/dt max, TTI*HR values) was noted, while the signs of ischemia were less pronounced (ST depression decreasing from 2.3 +/- 1 mm to 1.6 +/- 1.0 mm; % of lactate extraction (%L) decreasing from - 6.4 +/- 25.5 to + 8.5 +/- 19.2; p less than 0.5). The 25 pts were divided into 2 groups according to the ejection fraction (EF greater than .55 16 pts Gr.F+; EF less than .55 9 pts Gr.F-). The distribution of coronary lesions was the same for the 2 groups. During P1 GR.F+ registered a negative % L as opposed to Gr.F-. During P2, the difference in the % L between the 2 groups was also significant (2.6 +/- 19.9% F+ vs 18.9 +/- 14.3% F-; p less than .05). Collateral circulation had no effect upon the results, neither for P1 or P2. This study shows that a second period of atrial pacing, 20 minutes after the first, induced lesser ischemia than the first period of atrial pacing. This phenomenon could explain the paradoxical improvement observed in certain patients after a first episode of angina. These results have implications as regards the necessity of double blind studies compared to placebo when using this technique in the evaluation of the effects of anti-ischemic drugs.

Coronary Disease↗
PubMed1987

Emergency percutaneous coronary dilatation for acute myocardial infarction in Behçet's disease.

We describe a young man with Behçet's disease who presented with acute coronary insufficiency: emergency coronary arteriography revealed 2 coronary aneurysms and a left anterior descending (LAD) artery stenosis which was successfully dilated. The reduction of the coronary stenosis by balloon angioplasty induced immediate relief of chest pain and decrease of ST segment elevation, and was probably responsible for the satisfactory evolution, with limited myocardial infarction on the ECG and no akinetic segment on the left ventricular angiogram 3 weeks after the acute event. Cardiac surgery was performed to avoid possible relapse or aneurysmal rupture with hemopericardium. Surgery confirmed the destructive arterial lesion of Behçet's disease with false aneurysms of the LAD and left circumflex arteries.

Adult↗
PubMed1987

Results of percutaneous catheter valvuloplasty for calcified aortic stenosis in the elderly.

Percutaneous catheter valvuloplasty was performed in 37 patients between 60-88 years of age (mean age 74.5 years): 16 of these patients were in functional class IV, with pulmonary oedema at the time of the procedure. A good haemodynamic result was obtained in 32 patients, but 3 of them had to be operated upon subsequently, because of persistence of their symptoms. Two successfully dilated patients died in the hospital, one of cardiac failure following myocardial dysfunction caused by multiple infarcts which had no relation to the aortic dilatation, the other of neurological complications after dilatation. Thus, the primary success rate was 27/37 (73%). The first 10 patients with good initial results have been followed up for more than 6 months. The functional result has been maintained in 8 cases with moderate myocardial dysfunction (left ventricular ejection fraction 0.41 to 0.7), one with restenosis at Doppler assessment. Two patients with severe myocardial dysfunction (left ventricular ejection fraction 0.22 and 0.25) had recurrent cardiac failure, with valvular restenosis in one case. One of them died at home. Percutaneous aortic valvuloplasty is therefore an effective means of treating calcified aortic stenosis in elderly patients. The benefits of this procedure have been maintained for as long as 6 months provided myocardial dysfunction was moderate. At its present stage of development, the technique allows only partial reduction of the aortic stenosis, which may explain the absence of long-term improvement in patients with severe myocardial disease.

Aged↗
PubMed1987

[Results of percutaneous valvuloplasty in calcified aortic stenosis in the adult].

Aortic valvuloplasty by percutaneous valve dilatation was attempted in 52 patients aged from 60 to 88 years, 20 of whom were in functional stage IV with pulmonary oedema at the time of the procedure. Forty-seven stenoses could be dilated, with haemodynamic success (50 p. 100 increase of aortic valve area) in 44 patients. Among these 44 patients, 3 had to be operated upon because of persistent functional symptoms and 3 died during their stay in hospital (2 as a result of the procedure or the cardiopathy, 1 of heart failure unrelated to the aortic stenosis or the dilatation). The primary success rate therefore was 38/52 attempts, or 72.9 p. 100. The first 11 patients regarded as initial success could be followed up for at least 6 months: functional improvement with moderate myocardial alteration persisted in 9 of them, but Doppler examination in one showed restenosis. Two patients with severe myocardial dysfunction relapsed into cardiac failure; restenosis could be dilated in one of them. Percutaneous aortic valvuloplasty is an effective treatment of calcified aortic stenosis in elderly people who remain improved for at least 6 months when myocardial lesions are mild or moderate. The procedure incompletely reduces the aortic stenosis, which may account for the left of improvement in left ventricular function in patients with severe myocardial damage prior to dilatation. For this subgroup of patients, the choice lies between percutaneous valvuloplasty, which avoids surgery, and surgery which ensures a more complete haemodynamic result in the valve.

Aged↗
PubMed1987

[Echocardiographic diagnosis of plurivalvular prolapse. Apropos of a case].

Sonocardiography, especially bi-dimensional, currently represents an examination of choice in the detection of valvular prolapses. The authors report one case of a triple aorto-mitral-tricuspid valvular prolapse, diagnosed with the ultrasound technique. In light of this report and the data from the literature, the frequency and the distribution of valvular affections are discussed. The technical difficulties of recording and interpreting sonographic images responsible for false positive or false negative diagnostic errors are also studied.

Adult↗
PubMed1986

[Detection by contrast ultrasonography of patent foramen ovale before neurosurgery].

Air embolism may occur during neurosurgery if performed in the seated position. Paradoxical systemic air embolism represents a potentially severe complication in case of patent foramen ovale. Contrast echocardiography detected such a malformation in 10/100 patients, which contra-indicated the sitting position in these 10 patients. No episode of paradoxical air embolism was observed in the 90 remaining patients, although 16 cases of pulmonary air embolism were detected during surgery.

Adult↗
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

The timing of paradoxical wall motion in ventricular aneurysms and in asynergic ventricles.

The timing of paradoxical wall motion was investigated in the left ventricular cineangiograms of 15 patients in whom ventricular aneurysm was diagnosed or excluded at surgery. Eight had aneurysm and 7 had asynergic ventricles without aneurysm. Areas of paradoxical motion and inward motion were planimetered in each quarter of ejection. In both aneurysmal and asynergic ventricles paradoxical motion occurred within large akinetic areas. The extent of paradoxical motion was small, constituting only 3.4 and 2.6% of end-systolic areas. Over 80% of the maximal paradoxical motion occurred in the first half of ejection. In the latter half of ejection, further changes in paradoxical motion were small and inconsistent. There were no significant differences in the extent of quarterly paradoxical wall motion between the two patient groups. These data suggest that in the presence of marked left ventricular asynergy, the extent and timing of paradoxical wall motion from cineangiograms may not be useful in detection ventricular aneurysm.

Cineangiography↗
PubMed1986

Left coronary artery aneurysm and anteroseptal acute myocardial infarction following blunt chest trauma.

After a suicide attempt (fall from the ninth floor) a 28-year-old man presented with a blunt chest trauma. Electrocardiographic and enzymatic changes were characteristic of an acute anteroseptal myocardial infarction. A thallium myocardial scan showed decreased uptake of thallium over the septal area. Coronary angiography performed 6 weeks after the injury demonstrated aneurysmal dilatation of the left anterior descending artery which was patent, intramyocardial haemorrhage in the septum, and septal akinesia. The other left and right coronary arteries were normal. The patient remained asymptomatic 8 months later under medical treatment.

Adult↗
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↗
PubMed1986

[Study of segmental ventricular contraction by the analysis of the radius of curvature].

We have developed a procedure for segmental contraction analysis in the left ventricle based on the study of the radius of local curvature. This method has the advantage of non-necessitating the determination of basal reference values. The problem of optimal homogenisation of the raw date was resolved by developing a method based on a mobile average of 5 points by introducing a ponderation by second derivations. This method allows to describe various types of possible segmental contraction in ischemic cardiopathies and obstructive cardiomyopathies. Among the possible anomalies, inversion of the curvature radius has a particular importance (Laplace's law). If localized, it produces an increase in the parietal constraint with a possible extension of the ischemic process. If more extended, a pressure instability (CMO) ensues, independently of the parietal constraint developed.

Cardiomyopathies↗