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Biomedical subjects

J C Chachques

Publications and source records attributed to J C Chachques.

At least 19 recordsLinked to original sources
PubMed1992

Revival of the radial artery for coronary artery bypass grafting.

Eighteen years after its first introduction for coronary artery revascularization, the radial artery (RA) was reinvestigated because of unexpected good long-term results in the early series. Since July 1989, 104 patients underwent myocardial revascularization using 122 RA grafts (18 patients received two grafts). The left internal mammary artery (IMA) was concomitantly used as a pedicled graft in 100 cases and the right IMA in 19 cases; a free IMA graft was used in 29 cases and a saphenous vein graft in 24 cases. A mean of 2.8 grafts per patient were performed. Nine patients underwent associated procedures: carotid endarterectomy (3), aortic valve replacement (3), Bigelow procedure (1), and mitral valve repair (2). The target artery receiving the RA was the circumflex (n = 59), diagonal (n = 29), right coronary (n = 27), and left anterior descending (n = 7). One patient died (0.96%) and 2 had perioperative myocardial infarct. Sternal wound infection was noted in 3 cases of double IMA implantation. No ischemia of the hand was observed. All patients received diltiazem started intraoperatively and continued after discharge. In addition aspirin (100 mg/day) was given at discharge. Early angiographic controls (less than 2 weeks) were obtained in the first 50 consecutive patients and revealed 56 of 56 patent RA grafts, 48 of 48 patent left IMA grafts, 11 of 11 patent right IMA grafts, 14 of 18 patent free IMA grafts, and 8 of 9 patent vein grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Cardiac pheochromocytomas.

Cardiac pheochromocytomas are rare. Thirty cases have been reported in the literature. We report the cases of 2 more patients in whom the diagnosis was established using coronary angiography and who underwent surgical resection using cardiopulmonary bypass. We also review the literature on the subject.

Adult↗
PubMed1992

Dynamic cardiomyoplasty for long-term cardiac assist.

The principle of cardiomyoplasty is long-term electrostimulation of a latissimus dorsi muscle (LDM) wrapped around the failing heart. Technically, this procedure consists of placing the left LDM flap around the heart via a window created by partial resection of the 2nd or 3rd rib, and subsequent muscle electrostimulation in synchrony with ventricular systole. The aim of cardiomyoplasty is to support ventricular function in ischemic or dilated cardiomyopathies, or to partially replace the ventricular myocardium after large aneurysm or tumor resections. Our clinical experience at Broussais Hospital involves 44 patients. The functional class and quality of life improved after cardiomyoplasty. Improvement of the ventricular performance and limitation of cardiac dilatation were demonstrated over the long-term. The actuarial survival at 6 years was 71%. Risk factors influencing perioperative mortality were: age > 65 years, associated surgical procedures, pulmonary vascular hypertension, and patients hemodynamically unstable or on inotropic drug support. Preoperative risk factors influencing the long-term mortality were: permanent NYHA functional class 4, cardiothoracic ratio > 0.60, LV ejection fraction < 15%, bi-ventricular heart failure, and atrial fibrillation. Cardiomyoplasty does not preclude the use of future orthotopic heart transplantation.

Adolescent↗
PubMed1992

Traumatic mitral insufficiency following percutaneous mitral dilation: anatomic lesions and surgical implications.

Percutaneous mitral dilation is a widely accepted technique for treating pure mitral stenosis. Traumatic mitral insufficiency may occur secondary to this technique raising the problem of the feasibility of mitral valve repair. Twenty patients were operated on for traumatic mitral insufficiency following percutaneous mitral dilation. Three patients required emergency operations (within 6 h). In the other cases, surgery was carried out within the following days or weeks. Operative analysis of the mitral valves showed the following lesions: tear of the anterior leaflet (n = 4), tear of the posterior leaflet (n = 2), anterior (n = 4) or posterior (n = 9) paracommissural tear and papillary muscle rupture (n = 1). Associated chordal rupture was found in 3 patients. Septal perforation secondary to transseptal puncture was found in all cases. A septal tear of more than 10 mm was present in 4 patients. Surgery consisted of mitral valve reconstruction (n = 12) or mitral valve replacement (n = 8). Anatomic lesions following percutaneous mitral dilation may affect all the elements of the mitral valve apparatus. The possibility of repair depends more on the degree of calcification of the valve than on the extent of the leaflet tear.

Adult↗
PubMed1991

Comparative anatomy and histology of the radial artery and the internal thoracic artery. Implication for coronary artery bypass.

Anatomical characteristics of the radial a. were compared to those of the internal thoracic a., considered as a gold standard in coronary surgery. The length, the diameter, the collateral distribution and the wall thickness of these two arteries were studied comparatively. In addition, a comparative histological analysis was carried out. Anatomical and histological characteristics of these two arteries have important implications for coronary artery bypass.

Angiography↗
PubMed1991

Mycotic aneurysms of the carotid arteries--case report and review of the literature.

Mycotic aneurysms of the extracranial carotid arteries are rare. We report a new case with a mycotic aneurysm of the carotid bifurcation associated with acute bacterial endocarditis of the aortic valve. A concomitant treatment of both lesions was performed. Twenty-six cases of mycotic aneurysms of the extracranial carotid arteries have been reported in the literature. We present a review of all these cases.

Acute Disease↗
PubMed1991

Patient management and clinical follow-up after cardiomyoplasty.

The purpose of this article is to provide an overview of patient management following latissimus dorsi cardiomyoplasty, based on clinical experience with 34 patients operated on between 1985 and 1990. Postoperative patient care includes: (1) clinical follow-up, (2) electrostimulation management, and (3) management of complications. The efficacy of cardiomyoplasty is principally evaluated by the quality-of-life before and after cardiomyoplasty (New York Heart Association [NYHA] functional class), number of rehospitalizations due to congestive heart failure, amount of pharmacological support, exercise capacity, postoperative reintegration and adaptation to working life, and late survival.

Assisted Circulation↗
PubMed1991

Valve extension with glutaraldehyde-preserved autologous pericardium. Results in mitral valve repair.

Preliminary experimental studies in our laboratory have shown that autologous pericardium treated with glutaraldehyde prevents late deterioration and calcification of the tissue. For this reason, glutaraldehyde-treated autologous pericardium has been used in a series of 64 patients who underwent operations for leaflet extension of the mitral valve between 1980 and 1989. Ages ranged from 2.5 to 60 years (mean 19 +/- 15). The causes of mitral valve insufficiency were rheumatic fever (69%), bacterial endocarditis (17%), congenital (8%), endomyocardial fibrosis (4.5%), and trauma (1.5%). The autologous tissue was fixed in a 0.62% glutaraldehyde solution for 15 minutes and rinsed in saline for an additional 15 minutes. Patching techniques varied depending on the site and the extent of the lesion. Associated mitral valve repair techniques (Carpentier's techniques) were mandatory in all patients. The period of follow-up extended from 6 months to 9 years (mean 3.1 +/- 2.5 years). There were no operative deaths in this series, and there was one late death (2%). In the six patients (12%) who underwent reoperation, there has been no case of calcification of the pericardial patch. Postoperative mitral valve function was assessed by bidimensional color Doppler echocardiographic techniques. Mitral valve insufficiency was trivial or absent in 80% of the patients. This experience permits us to conclude that leaflet extension is a simple and safe technique in valve reconstruction, allowing repair of mitral valves that otherwise would need to be replaced. It permits use of an adult-size prosthetic ring in children. Glutaraldehyde-treated autologous pericardium is the material of choice for this type of repair.

Adolescent↗
PubMed1991

[Postoperative iatrogenic coronary-ventricular fistula].

Acquired coronary cardiac fistulas are rare. To date, thirty cases have been published in the literature, all secondary to thoracic trauma. The right cardiac chambers were more frequently involved. A recent continuous cardiac murmur is the most constant finding. Nontreated, these lesions tend to induce coronary insufficiency and congestive heart failure. 22 of the 30 reported cases were managed surgically. We hereby report a case of postoperative coronary cardiac fistula secondary to left ventricular venting, in which the fistula involved the left ventricular cavity.

Coronary Vessels↗
PubMed1991

Temporary mechanical circulatory support for severe cardiac failure: experimental study.

We describe a technique for mechanical cardiac assistance in an acute model of severe cardiac failure. Cardiac dysfunction was induced by a high dose of halothane in 13 dogs. Seven served as controls. Following median sternotomy, a pneumatically driven device was implanted in the other six dogs in a para-aortic position, using a simple surgical technique without cardiopulmonary bypass. The aorta was cross-clamped during cardiac assistance. During hemodynamic studies, the seven control animals with induced cardiac failure showed high end-diastolic left ventricular and right atrial pressures with low cardiac index and systolic left ventricular and aortic pressures. All dogs in this group died within 30 minutes. Use of a monovalvular cardiac assist device in the experimental group of six dogs to pump blood from the aortic root to the descending aorta in a counterpulsation manner, confirmed good preservation of systemic hemodynamic parameters after induction of heart failure. All animals in this treated group survived more than 45 minutes. Hemodynamically, the device acts as a new ventricle and the impaired left ventricle functionally becomes a left atrium. This condition is clinically appropriate for recovery of left ventricular function in severe acute myocardial failure.

Animals↗
PubMed1990

Preliminary report: follow-up after dynamic cardiomyoplasty.

Five patients were studied 5-13 months after dynamic cardiomyoplasty for refractory heart failure. In two, muscle flap stimulation caused a pronounced increase in cardiac index (mean 55%) and ejection fraction (mean 75%); no patient showed improvement in cardiac filling pressure. 2 years after surgery, one of the patients with haemodynamic improvement died from ventricular fibrillation, and histochemistry of the stimulated muscle flap revealed predominantly fatigue-resistant type I fibres, without evidence of fibrosis. In selected cases, dynamic cardiomyopathy could be of long-term benefit.

Adult↗
PubMed1990

Dynamic aortomyoplasty to assist left ventricular failure.

The efficacy of skeletal muscle contractile force to augment left ventricular function has been demonstrated experimentally and clinically by the cardiomyoplasty procedure. Another approach in biomechanical cardiac assistance is the use of electrostimulated skeletal muscle in an extracardiac position. We describe an autologous counterpulsating device using the native ascending aorta as a ventricular chamber wrapped by an electrostimulated latissimus dorsi muscle flap (LDMF). This model avoids thrombotic complications observed in skeletal muscle neo-ventricles associated with prosthetic chambers. In 8 goats, a right LDMF was transferred to the thoracic cavity by removal of the second rib. In 4 goats, the diameter of the aorta was enlarged by surgical implantation (using lateral clamping) of an autologous pericardial patch. The LDMF was wrapped around the ascending aorta and electrostimulated using an external diastolic pulse generator connected to a sensing myocardial lead and to LDMF pacing electrodes. Hemodynamic studies were performed (left ventricular, aortic, and pulmonary artery pressures and rate of rise of left ventricular pressure). The LDMF diastolic counterpulsation was performed using a burst of 30 Hz, with a delay from the R wave adjusted to provide optimal diastolic augmentation. Percent increase in the subendocardial viability index was calculated during unassisted and assisted cardiac cycles (1:2) at baseline and after acute heart failure induced by the administration of high doses of propranolol hydrochloride (3 mg/kg intravenously). Diastolic aortic counterpulsation by the stimulated LDMF resulted in a significant improvement in the subendocardial viability index both at baseline and after induced cardiac failure in both groups, though the increase was greater in the group with aortic enlargement.

Animals↗
PubMed1990

Operative findings after percutaneous mitral dilation.

Ten patients were operated on within one hour to 3 months after percutaneous mitral dilation. Operative analysis of the lesions demonstrated hemopericardium (n = 3), acute mitral insufficiency (n = 7), left atrial thrombus (n = 2), and atrial septal defect (n = 3). A conservative treatment of the mitral valve lesion was performed in 6 patients. All patients had uneventful postoperative courses. The complications presented in this series were either due to technical error or occurred in patients with relative contraindications to percutaneous mitral dilation (calcified commissures).

Acute Disease↗
PubMed1990

Absorbable rings for pediatric valvuloplasty. Preliminary study.

Secondary valvular stenosis is a significant risk of annular ring implantation during valvular repair in children. To avoid this problem, we have developed an absorbable prosthetic ring (APR), which induces the generation of a biologic fibroelastic ring with mitotic capability and thereby allows atrioventricular annulus growth with age. Twelve polydioxanone (PDS) biodegradable APRs were surgically implanted in immature goats. To avoid possible embolic complications from ring fragments during the absorption period, APRs were covered with an extensible sewing sheath of high-porosity polyester, allowing contact between the PDS, blood, and endocardium. Four APRs were implanted into the right atrial cavity, four in the tricuspid position, and four in the mitral position. Histological studies at 6 months showed a considerable amount of remaining PDS. At 1 year, only small residual fragments of PDS were present, surrounded by collagen and elastic fibers as well as fibroblasts with mitotic activity. This histological structure represents a new biologic fibroelastic ring, which has originated from PDS rings. Echocardiography at 12 months showed that the elasticity of APRs and fibrotic tissue allows normal systolic and diastolic valve motions. These findings, which demonstrate histological changes in native valve annuli as well as stable and elastic annuloplasty without secondary stenosis in growing animals, call for new studies involving hearts with valvular disease.

Animals↗
PubMed1990

[Dynamic cardiomyoplasty. Hemodynamic study of 3 patients].

Dynamic cardiomyoplasty is a surgical operation aimed at compensating for a loss of substance or a severe deficiency of the left ventricular myocardium by implanting around the heart the latissimus dorsi muscle the contraction of which, synchronous with that of the ventricles, acts on the heart in the manner of a massage or milking. The operation, which in its present form is recent, consists of applying Onto the heart, or wrapping that organ with, a skeletal muscle that keeps its neurovascular supply and its high insertion, and of installing the appropriate electrodes and a pacemaker. We report the haemodynamic data collected in 3 patients operated upon for severe cardiac failure 13, 8 and 9 months ago respectively and who are now in NYHA functional stages I and II. During 1/1 stimulation of the latissimus dorsi systolic pressures remain unchanged while diastolic pressures rise; cardiac output increases satisfactorily in two of the patients (cases No. 1 and 3) and is unmodified in the third one (case No. 2). We conclude that cardiomyoplasty seems to give favourable results but its future and indications remain to be determined.

Adult↗
PubMed1990

Atrial cardiomyoplasty after Fontan-type procedures.

The purpose of right atrial cardiomyoplasty is to increase atrial-pulmonary flow in patients undergoing Fontan-type procedures. We developed two surgical techniques to bypass the right ventricle, followed by right atrial cardiomyoplasty with a stimulated latissimus dorsi muscle flap (LDMF). In 10 goats, the left LDMF was transferred into the chest by removal of the second rib. After sternotomy, the right atrial appendages of five goats (group 1) were connected to the distal main pulmonary artery with polytetrafluoroethylene tubing and the proximal pulmonary trunks were ligated. In the other five goats (group 2), under cardiopulmonary bypass, bioprosthetic valves were implanted into the inferior venae cavae. The tricuspid orifice was closed, and the atriopulmonary connection was performed. The left LDMF was sutured over the right atrium and stimulated using synchronous 30-Hz bursts of impulses delivered by a Medtronic Cardiomyostimulator. Hemodynamic studies were performed in the acute phase. Right atrial, pulmonary arterial, and aortic pressures were assessed. Cardiac output was measured using ultrasonic flow studies. LDMF stimulation restored pulsatile pressure patterns in the pulmonary artery and increased the cardiac output. These observations were more evident in the model with caval valvular implant. This functional "ventricularization" of the right atrium could improve long-term results after Fontan-type procedures and extend operative indications. Chronic experimental studies are necessary to evaluate the diastolic and systolic functions of the neo-right ventricle.

Animals↗