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Biomedical subjects

H Eltchaninoff

Publications and source records attributed to H Eltchaninoff.

At least 19 recordsLinked to original sources
PubMed1997

A new treatment for severe pulmonary embolism: percutaneous rheolytic thrombectomy.

BACKGROUND: The rheolytic thrombectomy catheter has been specially designed to remove intravascular thrombus from coronary and peripheral arteries. It demonstrates a practical application of Bernoulli's principle relating to a low-pressure zone in the region of a high-velocity jet. In this device, this effect is created by direct high-pressure saline jets located at the tip. Thrombus is drawn into this region and, because of the large pressure difference, undergoes mechanical thrombolysis due to the powerful mixing forces. The resulting microparticles are aspirated through the same catheter and removed from the body. METHODS AND RESULTS: We report the use of this device in two patients presenting with severe pulmonary embolism and contraindications to thrombolytic therapy. The two procedures were successfully performed with an excellent immediate angiographic result at the site of the rheolytic thrombectomy. In both cases, the clinical improvement was maintained at follow-up with the same good angiographic result and a decrease to a normal level of the systolic pulmonary pressure. CONCLUSIONS: This preliminary results suggest that this easy technical method may be useful in the treatment of life-threatening pulmonary embolism in patients with absolute contraindications to thrombolytic therapy. A larger cohort of patients is necessary to determine whether this treatment should be proposed as an alternative to the use of fibrinolytics in selected patients.

Aged↗
PubMed1997

Adaptation to myocardial ischemia during coronary angioplasty demonstrated by clinical, electrocardiographic, echocardiographic, and metabolic parameters.

It has been shown that brief episodes of myocardial ischemia can render the heart more resistant to a prolonged subsequent ischemic episode. This phenomenon, called "preconditioning," has been described in human beings during coronary angioplasty with the use of clinical, electrocardiographic (ECG), or metabolic parameters. The goal of this study was to assess this phenomenon further with the use of echocardiographic and metabolic parameters in addition to clinical and ECG parameters. Eighteen patients with isolated stenosis of the left anterior descending coronary artery and a normal left ventricular function were included. Angioplasty consisted of four consecutive balloon inflations. Sequential changes in clinical, ECG (intracoronary ECG), echocardiographic, and metabolic parameters of myocardial ischemia were compared between the first and the fourth balloon inflations. Improved tolerance to myocardial ischemia with repeated coronary occlusions was demonstrated by a significant reduction in the severity of angina, ST-segment elevation, wall motion abnormalities, and lactate production. This study confirms the adaptation of myocardial ischemia to repeated coronary occlusions through measurement of clinical, ECG, echocardiographic, and metabolic parameters.

Angioplasty, Balloon, Coronary↗
PubMed1997

Angioscopic evaluation of rotational atherectomy followed by additional balloon angioplasty versus balloon angioplasty alone in coronary artery disease: a prospective, randomized study.

OBJECTIVES: This study sought to compare, by angioscopy, the morphologic changes induced by rotational atherectomy, followed by additional angioplasty, with those observed after balloon angioplasty alone. BACKGROUND: Rotational atherectomy and balloon angioplasty act by different mechanisms, which could explain the difference in morphologic changes induced by these two techniques. METHODS: The study group included 50 patients with 50 lesions who were randomly assigned to undergo rotational atherectomy (n = 24) or balloon angioplasty (n = 26). Rotational atherectomy with a single burr (approximately equal to 70% of coronary diameter) was systematically followed by additional balloon angioplasty. Angioscopy was performed immediately after the procedure. Abnormal angioscopic findings were 1) flaps, graded from 1 to 3 (1 = intimal flap; 2 = flap protruding into < 50% of the lumen; 3 = flap protruding into > or = 50% of the lumen); 2) thrombi, graded from 1 to 3 (1 = flat deposits; 2 = protruding but nonocclusive thrombus; 3 = occlusive thrombus); 3) subintimal hemorrhage; 4) longitudinal dissection. The two groups were comparable for clinical and angiographic baseline data. RESULTS: On angioscopy, flaps were observed less frequently after rotational atherectomy followed by additional balloon angioplasty (8 [33%] of 24 lesions) than after balloon angioplasty alone (14 [54%] of 26 lesions, p = 0.08) and were also less severe (grade 1 in 6 lesions, grade 2 in 2 and grade 3 in none vs. grade 1 in 4 lesions, grade 2 in 5 and grade 3 in 5). Longitudinal dissections were also significantly less frequent: one versus six (p = 0.05). There was no difference in the incidence of angioscopic thrombi (p = 0.16) or subintimal hemorrhage (p = 0.15), but the power to detect a significant difference was low for these variables (37% and 26%, respectively). CONCLUSIONS: Rotational atherectomy followed by additional balloon angioplasty leads to fewer angioscopic dissections and a trend toward fewer intimal flaps than balloon angioplasty alone. However, our angioscopic differences did not lead to an outcome difference between the two groups.

Aged↗
PubMed1997

[Peripheral and coronary artery dissections in a young woman. A rare case of type IV Ehlers-Danlos syndrome].

Spontaneous coronary dissection is rare and the diagnosis is usually post-mortem. Less than 60 cases have been diagnosed at coronary angiography. The authors report, to the best of their knowledge, the first case of multiple spontaneous coronary artery dissections in a type IV Ehlers-Danlos syndrome in a young woman admitted to hospital for acute myocardial infarction. She had a previous history of regressive complete tetraplegia due to dissection of the basilar artery and episodes of dizziness related to a dissecting aneurysm of the left vertebral artery. The diagnosis of type IV Ehlers-Danlos syndrome was established after skin biopsy had shown typical histological changes. The patient died several months later after an acute abdominal syndrome probably related to dissection of the aorta. An autopsy was refused by her family. The authors believe this to be the first case of spontaneous coronary dissection related to a type IV Ehlers-Danlos syndrome.

Adult↗
PubMed1997

[Primary treatment of left coronary artery diseases by percutaneous implantation of stents].

Left main coronary artery (LM) stenting has only been reported in bail-out situations or absolute contraindications so surgery. The authors report the immediate and midterm results of primary Palmaz-Schatz stent implantation in two young patients without contraindication to surgery. The first patient, 58 year-old, was admitted for unstable angina in October 1994. Coronary angiography showed an isolated severe ostial lesion of the LM. After conferring with the surgical team which remained on stand-by, angioplasty and stent implantation were performed with excellent results, no complications and no restenosis on angiographic controls at 3 and 12 months. The patient remained asymptomatic 24 months later. The second patient, 38 year-old, was admitted in June 1995 for unstable angina, and coronary angiography showed a severe isolated stenosis in the middle of a long and wide LM. Primary coronary stenting was also performed with excellent results, no complication and no restenosis on angiographic controls at 4 and 8 months. This patient was still asymptomatic 16 months after stenting. These excellent immediate and medium-term results are encouraging and suggest that this form of treatment might be extended to patients with an isolated whether primary LM stent implantation could become a suitable alternative to surgery in the future.

Adult↗
PubMed1996

Effects of prolonged sequential balloon inflations on results of coronary angioplasty.

In percutaneous transluminal coronary angioplasty (PTCA), prolonged balloon inflations using perfusion balloon catheters have shown a higher procedural success rate and fewer in-hospital complications than short balloon inflations. However, perfusion balloons have well-recognized limits for routine use. This study assessed the effects of a prolonged cumulative occlusion time obtained with sequential balloon inflations using a routine balloon catheter, applicable to all lesions, and compared these results with those obtained with standard short balloon inflations. Three hundred ten lesions (in 289 patients) were randomized to either standard (3 to 5 inflations < or = 1 minute each; n = 161) or prolonged (3 to 5 inflations of 3 to 5 minutes each; n = 149) balloon inflations. Angiographic success (residual stenosis <50% and no dissection > or = D1) was assessed at the end of this "protocol" phase. Further dilatation was performed if required ("adjunctive" phase). Systematic repeat catheterization was scheduled 4 to 6 months later. Cumulative inflation time was 198 +/- 58 seconds in the "standard" group versus 782 +/- 303 seconds in the "prolonged" group. At the end of the protocol phase, the success rate was higher after prolonged than after standard dilatation (92% vs 80%; p <0.002), with less frequent dissections (14% vs 30%; p = 0.0009). At the end of the adjunctive phase, required for 12 patients in the prolonged group and 32 patients in the standard group (p = 0.003), results were comparable in the 2 groups and the restenosis rate was similar at 6 months. The prolonged cumulative occlusion time achieved with sequential balloon inflations using a routine balloon catheter improves the immediate results of PTCA. Repeat catheterization shows no effect of prolonged sequential inflations on the restenosis rate.

Aged↗
PubMed1996

[Myocardial adaptation to ischemia. A study during repeated prolonged coronary occlusions in angioplasty].

Coronary angioplasty provides an ideal model for studying ischemic preconditioning in humans. Four coronary occlusions, each lasting 5.2 +/- 1.3 min, separated by 3 min of reperfusion, were performed during angioplasty of isolated stenosis of the left anterior descending artery of 18 patients with stable angina and normal left ventricular function. The ischaemia was evaluated and compared during the first and fourth coronary occlusion with the aid of clinical, electrocardiographic, echocardiographic and metabolic parameters. We analysed: 1) interval to chest pain and its intensity; 2) degree of ST change on the intracoronary electrocardiogram; 3) regional wall motion abnormalities on 2D echocardiography; 4) coefficient of myocardial lactate extraction. The results showed that during the fourth occlusion: chest pain occurred later (93 +/- 57 vs 60 +/- 49 s; p < 0.05) and ST elevation was less (0.69 +/- 0.5 vs 1.03 +/- 0.8; p < 0.05). During the fourth occlusion, there was a delay in appearance and a decrease in the regional wall motion abnormalities: anterior wall hypokinesia occurred later: 26 +/- 15 vs 19 +/- 19 s (p = 0.08). Akinesia observed in 10 patients out of 13 (77%) during the first occlusion, was only observed in 8 patients (62%) and dyskinesia, observed in 5 patients out of 13 (38%) during the first occlusion was not observed thereafter in any patient. The production lactate was less important during the fourth occlusion than during the first one: -3 +/- 17% vs -12 +/- 19% (p < 0.05). This study confirms that, in man, preconditioning allows myocardial adaptation to successive episodes of acute ischaemia.

Adaptation, Physiological↗
PubMed1995

Early and 1-year survival rates in acute myocardial infarction complicated by cardiogenic shock: a retrospective study comparing coronary angioplasty with medical treatment.

Cardiogenic shock remains a frequently lethal complication of acute myocardial infarction. Early revascularization of the infarct-related artery by coronary angioplasty has been suggested to significantly improve patient survival. In-hospital and 1-year survival was assessed in 50 patients hospitalized for acute myocardial infarction complicated by cardiogenic shock. All patients received medical treatment and intraaortic balloon pump support. Thirty-three patients underwent coronary angioplasty (PTCA group), while 17 patients remained on conventional therapy (no PTCA group). The two groups were comparable for all baseline characteristics. Survival was significantly better in the PTCA group than in the no PTCA group: 64% versus 24% in-hospital survival (p = 0.007) and 52% versus 12% at 1 year (p = 0.006). When angioplasty was successful in achieving reperfusion, survival was further enhanced: in-hospital survival rate was 76% versus 25% in patients with unsuccessful angioplasty and 60% versus 25% at 1 year.

Aged↗
PubMed1995

Angioscopic evaluation of prolonged vs standard balloon inflations during coronary angioplasty. A randomized study.

UNLABELLED: To study the immediate effects of prolonged total balloon inflation during PTCA, 41 patients (44 lesions) with chronic stable angina were randomized for prolonged sequential inflations (three to five inflations of 3 to 5 min each, for a total duration of > or = 12 min, group 1, n = 20 lesions) or 'standard' sequential inflations (three to five inflations of < or = 1 min each, for a total duration of < or = 3 min, group 2, n = 24 lesions). The mean duration of total balloon inflation time was 958 +/- 129 s in group 1 vs 205 +/- 46 s in group 2. Results of angioplasty were assessed on both angiography and percutaneous transluminal coronary angioscopy performed immediately after the procedure. High quality imaging of the coronary lumen and lesion morphology was possible on angioscopy in all patients without any complications. Post-PTCA angiographic percent diameter stenosis was significantly less in group 1 compared to group 2: 26 +/- 10% vs 36 +/- 8% (P < 0.05). On angioscopy, flaps were seen in 16 patients in group 2, but in only six in group 1 (P < 0.02). There was no difference in the incidence of thrombi on angioscopy between the two groups (group 1: nine cases, group 2: 10 cases). Sensitivity of angiographic detection of flaps and thrombi was poor: 10% and 12% respectively. One patient in each group developed a longitudinal dissection, detected on both angiography and angioscopy. CONCLUSIONS: (1) prolonged sequential balloon inflations lead to less residual luminal stenosis after PTCA, with a decreased incidence of intimal flaps in comparison with standard inflations. (2) Post-PTCA transluminal coronary angioscopy is safe and offers better assessment of luminal effects of PTCA than angiography.

Adult↗
PubMed1995

Balloon aortic valvuloplasty in elderly patients at high risk for surgery, or inoperable. Immediate and mid-term results.

Although aortic valve replacement is undoubtedly the treatment of choice for aortic valve stenosis, balloon aortic valvuloplasty may represent the only possible treatment for some frail elderly patients who may have additional medical problems. We evaluated immediate and 1-year results of balloon aortic valvuloplasty in 86 patients > or = 80 years with severe aortic stenosis. Mean age was 84 +/- 3 years. Forty-four % were 85 years or older. Mean gradient decreased from 68 to 26 mm Hg and valve area increased from 0.53 to 0.96 cm2 (P<0.05). There were two per-procedural deaths. No local vascular complication was observed. During the follow-up (13 +/- 9 months), 27 patients died, four had repeat balloon aortic valvuloplasty and eight underwent aortic valve replacement. Persistent clinical improvement was observed in 78% of the surviving patients. One-year actuarial survival rate was 73%. Balloon aortic valvuloplasty appears to be a safe and valuable technique in cases where surgery cannot be performed or carries a very high risk.

Aged↗
PubMed1994

Late results of coronary angioplasty in patients with left ventricular ejection fractions < or = 40%.

Left ventricular (LV) function is the most important independent predictor of long-term survival in patients with coronary artery disease, and results of bypass surgery improving survival in the setting of depressed LV function are well documented. Data regarding long-term outcome in patients undergoing coronary angioplasty are limited. From 1983 through 1989, 343 consecutive patients with an ejection fraction (EF) < or = 40% (mean 34% +/- 5%) undergoing elective coronary angioplasty were evaluated, retrospectively. The mean age was 61 +/- 10 years and 80% were men. Angiographic success (469 of 496 narrowings) was 95%. Major complications occurred in 26 patients (7.6%): emergency bypass surgery (n = 11), nonfatal myocardial infarction (n = 8), and death (n = 9). Follow-up was available for 99% of patients with clinical success (mean = 36 +/- 22 months). Fourteen patients (4.5%) developed nonfatal myocardial infarction and 72 patients (23%) had symptomatic restenosis, 32 patients requiring repeat angioplasty or atherectomy and 29 bypass surgery. Fifty-six patients (18.2%) died. Three-year survival was 84%. EF was a significant predictor of death: 3-year survival was 69%, 83% and 92%, respectively, in patients with EF < or = 30%, 31% to 35%, and 36% to 40% (p = 0.0001). A high angiographic success rate and an acceptable procedural risk were encountered in patients with depressed LV function undergoing angioplasty. The 3-year mortality rate, however, is substantial and directly related to the degree of LV dysfunction.

Adult↗
PubMed1994

[Angioscopic evaluation of the immediate result of coronary angioplasty in relation to balloon inflation time].

The aim of this study was to assess the effects of coronary angioplasty on the intima with respect to the duration of balloon inflation by percutaneous angioplasty. Twenty-seven patients were randomized according to the total duration of balloon inflation: Group I "standard" duration (total duration < or = 3 min, N = 13) and Group II: prolonged duration (total duration > or = 12 min, N = 14); the type and distribution of the lesions were comparable in the two groups. The results of angioplasty were evaluated immediately after dilatation by angiography and angioscopy. Angioscopy was performed without failure or complications with perfect definition of the images in all cases. Angioscopy showed 1) intimal tears, 2) thrombi, 3) longitudinal dissections. A classification in three grades was used taking the apparent gravity of the lesions into consideration. The mean duration of balloon inflation in Group I was 205 +/- 45 s and 958 +/- 129 s in Group II. The residual stenosis was 36 +/- 8% in Group I and 26 +/- 10% in Group II (p < 0.05). Angioscopy showed the frequency of intimal tears to be twice greater in Group I (9 cases) than in Group II (4 cases) (p = 0.05). Intravascular thrombi were observed in 13 cases, 6 in Group I and 7 in Group II. One case of longitudinal dissection was observed in each group: only one of these two cases was detected at angiography. The authors conclude that repeated and prolonged balloon inflations improve the immediate results of angioplasty with less residual stenosis at angiography and a lower incidence of intimal tears at angioscopy.

Aged↗
PubMed1994

[Effects of repeated and prolonged inflations on immediate angiographic results and complications of coronary angioplasty. Prospective and randomized study].

The effects of the duration of balloon inflation on the immediate and mid-term results of angioplasty were assessed in a randomized study initiated in June 1992. To date, 239 lesions in 224 consecutive patients were allocated randomly into 2 groups according to the duration of balloon inflation: short duration (123 lesions): 3 or 4 successive inflations, each < or = 1 mn, for a total duration < or = 3 min; long duration (116 lesions): 3 to 5 inflations, each of 4 to 5 minutes each for a total duration > or = 12 min. Patients with acute myocardial infarction, restenosis and lesions of bypass grafts were excluded. Stenosis (% of reduction of the internal diameter) was calculated with a digitalised Philips DCI system. Success was defined by < 50% residual stenosis in the absence of severe complications: death, emergency bypass surgery, infarction and extensive and/or occlusive dissection. The baseline clinical, haemodynamic and angiographic parameters of the two groups were comparable. The residual stenosis after angioplasty in the "short duration" group was 33 +/- 11% and 29 +/- 11% in the "long duration" group (p < 0.05). The primary success rate was 75% in the "short duration" compared to 89% in the "long duration" group (< 0.001). Angiographic dissection after angioplasty was observed in 38 cases in the "short" but only in 17 cases in the "long duration" group (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Immediate and long-term results of coronary angioplasty in patients with low ejection fraction].

Left ventricular function is the main predictive factor for survival in coronary patients and the results of coronary bypass surgery in left ventricular dysfunction have been widely reported. The authors undertook a retrospective study of the success rate, the risks and clinical outcome after coronary angioplasty of 182 patients with a left ventricular ejection fraction < or = 35% (30 +/- 4%). The average age was 61 +/- 10 years and 78% were men. One hundred and fifty three patients had a history of myocardial infarction. The primary success rate of angioplasty was 95% (271/284 lesions) including the multiple procedures in 24% of cases. There was a 7.1% frequency of major complications (7 deaths, 3 non-Q wave infarctions, 4 emergency coronary bypass procedures). An average follow-up period of 32 months was obtained in 98.4% of patients. Seven patients developed a myocardial infarction and 14 patients were rehospitalized for cardiac failure (N = 6) or severe ventricular arrhythmias (N = 8). A control coronary angiography was performed in 100 cases either as a routine investigation or for recurrence of symptoms. Restenosis was demonstrated in 33 cases, an aggravation of lesions on another vessel in 12 cases and restenosis associated with aggravation of other lesions in 5 cases, leading to redilatation in 26 cases, atherectomy in 2 cases and coronary bypass surgery in 16 cases. Forty-one patients died (25%). Ten patients died before the 6th month and 31 died secondarily. The only parameter which was significantly correlated with survival was the value of the ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1994

[Ablation by radiofrequency in the treatment of atrial arrhythmia].

Atrial arrhythmias resistant to medical therapy are still a common indication for ablation of the normal atrioventricular conduction pathway (Tawara node and His Bundle). However, the development of catheter techniques of intra-atrial ablation to destroy arrhythmogenic myocardial zones enables radical cure of the arrhythmias with the respect of the nodo-hisian pathway. With respect to common flutter, a number of series, including our own, show a 50 to 75% long-term success rate. We believe that a very high success rate in the ablation of flutter will probably be achieved in a reproducible manner but this will require a more accurate understanding of the tachycardia circuit and technological developments allowing controlled radio-frequency destruction of bigger atrial myocardial zone. Experience of radio-frequency ablation atrial of atrial extrasystoles is more limited than that of flutter and there are fewer published series. Globally, catheter ablation of atrial tachycardia remains a more difficult and a less well codified procedure than that of accessory pathways or of intra-nodal reentry. Radio-frequency ablation in this indication is not without danger in view of the thinness of the atrial wall. We believe that radio-frequency catheter ablation for atrial arrhythmias should, for the moment, be reserved for centres specialised in the techniques of electro-physiological investigation and ablation.

Atrial Flutter↗