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J Elaerts

Publications and source records attributed to J Elaerts.

At least 19 recordsLinked to original sources
PubMed2000

[Pulmonary embolism in the child: diagnostic and therapeutic particularities].

BACKGROUND: Pulmonary embolism in children is an overlooked pathology. Yet the first description dates back to the end of the 19th century and this specific pathology is not seldom observed. The main risk factors are trauma, surgery, and foreign bodies. DIAGNOSIS: Thrombophilia can be diagnosed when a thromboembolic event occurs. The initial thrombosis may be found anywhere in the venous network. Venous sonography usually gives the diagnosis. Pulmonary embolism usually has a poor clinical expression. An unexplained situation can be the first manifestation. Echocardiography guides diagnosis confirmed by ventilation-perfusion scintigraphy. TREATMENT: Prophylaxis is achieved with small doses of heparin. Treatment is based on the use of hypocoagulant doses of heparin, potentially after systemic thrombolysis and followed by oral anticoagulation.

Adolescent↗
PubMed2000

Use of the PFA-100 apparatus to assess platelet function in patients undergoing PTCA during and after infusion of c7E3 Fab in the presence of other antiplatelet agents.

The PFA-100 (Dade) is a new functional whole blood analyzer, the accuracy and reliability of which have been evaluated in von Willebrand disease and during acetyl salicylate acid therapy. This new test has the advantages of rapidity and simplicity. It may be useful to monitor new antiplatelet agents, such as GPIIb/IIIa receptor antagonists. The objective of this study was to assess the PFA-100 in comparison with aggregometry and with the percentage of blockaded receptors GPIIb/IIIa during and after c7E3 Fab infusion in fifteen patients undergoing PTCA. Our results showed a change of closure time values from normal to abnormal within a small margin of flow cytometric values (60-75% of blockaded receptors), and moreover a variable platelet response to long-term low dose aspirin treatment in agreement with aggregometry. No influence with heparin was observed. In conclusion, this study shows that PFA-100 may be helpful in the decision making for additional antiaggregant therapy before PTCA or in monitoring long-term GPIIb/IIIa receptor antagonist treatment.

Abciximab↗
PubMed2000

[Comparative evaluation of hydrophilic and standard guide wires for retrograde catheterization of severe aortic stenosis].

The feasibility and safety of using hydrophilic guide wires were compared with those of standard guide wires for retrograde catheterization of aortic stenosis in a prospective randomised study. The performances of the guide wires were assessed by the time taken to catheterize the aortic valve (minutes) and the duration of radioscopy (minutes: grays). The success of the procedure was defined as presence of the guide in the left ventricle in less than 8 minutes. The two patient groups were comparable with respect to the severity of the aortic stenosis. Two failures of catheterisation were observed in the "standard guide wire" group compared with three failures with the hydrophilic guide wire. The mean catheterisation time of the "standard" group was 2.56 minutes compared with 3.12 minutes with the hydrophilic guide wire (p = 0.35 NS). This result was correlated with the duration of radioscopy and number of groups (respectively p = 0.18 NS and p = 0.5 NS). One case of tamponade and a transient ischaemic cerebral attack were observed in the "standard" group. This study does not show the hydrophilic guide wire to be superior to the standard guide wire for catheterisation of aortic stenosis. However, the hydrophilic guide wires were perfectly innocuous for this procedure.

Aged↗
PubMed1999

[Incidence and predictive factors of mitral insufficiency in surgically treated aortic stenosis. Transthoracic and transesophageal ultrasonographic evaluation].

Mitral regurgitation is common in adults with aortic stenosis. When severe, it may aggravate the clinical condition and pose an additional therapeutic problem. The authors studied 40 consecutive patients with severe surgical aortic stenosis prospectively by transthoracic echocardiography and pre-operative transoesophageal echocardiography to determine the incidence, mechanism and degree of mitral regurgitation and its eventual relationship to the aortic stenosis. Mitral regurgitation was detected in all cases when both investigations were taken into consideration. It was usually mild, evaluated grade 2 by measuring the surface of the colour Doppler regurgitant jet, or mild to minimal of transoesophageal echocardiography in 35/40 patients (87.5% of cases). Rarely, a case of significant, autonomous mitral regurgitation (2 cases of valvular dystrophy, 1 pure severe mitral stenosis). On the other hand, calcification of the mitral annulus is common (14/40 patients, 35% of cases). The severity of the regurgitation in univariate analysis was significantly correlated mainly to the age of the patients (p = 0.027). The severity of the aortic stenosis (p = 0.0082) and the parameters related to the effects of stenosis, such as ventricular wall thickness and left atrial size. In multivariate analysis, the severity of the aortic stenosis and of its consequences were confirmed to play a role in the genesis of mitral regurgitation, the severity of which was correlated on transthoracic echocardiography to the aortic valve surface area and the left ventricular ejection fraction and, on transoesophageal echocardiography, to the transvalvular pressure gradient.

Adult↗
PubMed1999

Free and total platelet glycoprotein IIb/IIIa measurement in whole blood by quantitative flow cytometry during and after infusion of c7E3 Fab in patients undergoing PTCA.

A quantitative flow cytometry assay was used to evaluate the ex vivo kinetics of c7E3 Fab platelet effect in 16 patients undergoing PTCA treated with abciximab and compared with aggregometry assay. Immunolabeling of platelets was directly assessed on whole blood, using in parallel two monoclonal antibodies (Mabs) raised against GPIIIa, Mab1, the binding of which is inhibited by c7E3 Fab, and Mab2, the binding of which is not affected by c7E3 Fab. We found a severe and sustained inhibition of both GPIIb/IIIa receptors and platelet functions. The inter-individual variation in response to abciximab was low. A significant transient increase at H24 and H48 in the binding of Mab2 was found as an unexpected result, and confirmed in vitro. Results demonstrate that flow cytometry is a reliable method in agreement with aggregation. In addition, our results show that it is a standardized tool and a time-saving technique.

Abciximab↗
PubMed1999

[Extensive mycotic coronary aneurysm detected by echocardiography. Apropos of a case].

The authors report the case of a large mycotic right coronary aneurysm detected at echocardiography in a 45 year old patient with AIDS. Although emergency surgery was planned, the patient died of rupture of the aneurysm with cardiogenic shock and sudden pericardial tamponade. This case underlines the diagnostic value of echocardiography, by the transthoracic approach for para-cardiac masses and with the transoesophageal probe for accurate localisation and demonstration of the coronary origin. In this case, the CT scan was less useful than transthoracic echocardiography. Coronary angiography confirmed the strongly suggestive echocardiographic diagnosis and helped decide management strategy. Atheromatous coronary aneurysms may be treated by stenting but mycotic aneurysms require surgical management.

Acquired Immunodeficiency Syndrome↗
PubMed1999

[Dobutamine doppler echocardiography in severe aortic stenosis with left ventricular dysfunction. Comparison with postoperative examination].

The association of left ventricular dysfunction with aortic stenosis worsens the spontaneous prognosis and increases operative mortality. The aim of this prospective study was to assess the predictive value of dobutamine Doppler echocardiography on the indices of left ventricular contractile function in patients with aortic stenosis and left ventricular dysfunction (LVEF < 0.45) undergoing aortic valve replacement. Eighteen patients, including 9 with coronary artery disease, were included in a protocol consisting of analysis of left ventricular function and of the severity of aortic stenosis before, during dobutamine infusion, and after valvular replacement. The dobutamine was given in progressive increments of 5 micrograms/Kg up to a maximum of 20 micrograms/Kg. During pharmacological stress, the functional aortic valve area increased from 0.46 +/- 0.15 to 0.56 +/- 0.23 cm2. Tolerance of the procedure was good. All but 2 patients improved their postoperative ejection fraction with values equivalent to those observed during the last increment of dobutamine (r = 0.73; p < 0.003). The patients with initial mean pressure gradients > 50 mmHg normalised their LVEF after valve replacement. The authors conclude that dobutamine echocardiography is useful for predicting the values of postoperative left ventricular contractile indices when severe aortic stenosis is associated with systolic dysfunction. It allows evaluation of the expected short term benefits to these indices after aortic valve replacement.

Adult↗
PubMed1999

Immediate femoral sheath removal after 6 French routine coronary angioplasty with a weight-adjusted low-dose heparin: results of a prospective registry.

This study assesses the feasibility and safety of immediate sheath removal after coronary angioplasty with the use of 6 French (Fr) guiding catheters by the femoral route and weight-adjusted low-dose heparin (100 IU/kg). We prospectively evaluated such a strategy among a single-center cohort of 261 consecutive patients undergoing routine percutaneous transluminal coronary angioplasty (PTCA). Immediate sheath withdrawal was performed in cases when post-PTCA residual coronary stenosis was less than 30%, with or without stenting. One hundred eighty-two (70%) of the enrolled patients were eligible for immediate sheath removal. When compared with non-eligible patients (sheath removal 4 hours or more post-PTCA), we observed a reduction of hematoma occurrence (15% vs. 30%; p < 0.01), time to manual hemostasis of the puncture site (13.8 +/- 7 vs. 19.7 +/- 12 minutes; p < 0.0001), and time to hospital discharge (2.2 +/- 1.9 vs. 2.8 +/- 1.8 days; p < 0.02), while ischemic event rate was similar (1 vs. 2 non-Q wave myocardial infarction; 2 vs. 1 repeat PTCA for out-of-lab acute vessel closure). In conclusion, a good angiographic result at completion of PTCA using a 6 Fr sheath, even without stenting, makes an immediate sheath removal feasible at no increased risk and with a potential reduction in minor bleeding complications.

Aged↗
PubMed1998

Comparative efficacy of a two-hour regimen of streptokinase versus alteplase in acute massive pulmonary embolism: immediate clinical and hemodynamic outcome and one-year follow-up.

OBJECTIVES: This study sought to compare the efficacy of 2-h regimens of alteplase and streptokinase in acute massive pulmonary embolism. The primary end point was immediate hemodynamic improvement, and secondary end points included early clinical efficacy and safety, as well as 1-year clinical outcome. BACKGROUND: Several thrombolytic regimens have been compared for the past 10 years in randomized studies, showing that 2-h infusion regimens of alteplase or urokinase lead to faster hemodynamic improvement than former 12- to 24-h administration protocols in acute massive pulmonary embolism. Many trials have focused on immediate hemodynamic and angiographic outcomes, but none has addressed long-term follow-up after thrombolysis. METHODS: Sixty-six patients with acute massive pulmonary embolism (Miller score > 17 and mean pulmonary artery pressure >20 mm Hg) were randomly assigned to receive either a 100-mg 2-h infusion of alteplase (n = 23) or 1.5 million IU of streptokinase over 2 h (n = 43). In both groups, heparin infusion was started at the end of thrombolytic infusion and adapted thereafter. Total pulmonary resistance was monitored over a 12-h period. Pulmonary vascular obstruction was assessed 36 to 48 h after thrombolytic therapy. One-year follow-up information included death, cause of death, recurrent pulmonary embolism, chronic thromboembolic pulmonary hypertension, stroke and bleeding. RESULTS: Both groups had similar baseline angiographic and hemodynamic characteristics of severity, with maintained cardiac output in 64 (97%) of 66 patients. The results (mean +/- SD) demonstrated that despite a faster total pulmonary resistance improvement observed at 1 h in the alteplase group compared with the streptokinase group (33+/-16% vs. 19 16%, p = 0.006), a similar hemodynamic efficacy was obtained at 2 h when both thrombolytic regimens were completed (38+/-18% vs. 31+/-19%). There was no significant difference in either pulmonary vascular obstruction at 36 to 48 h or bleeding complication rates. One-year event-free survival was similar in both groups, as most events were related to concomitant diseases. CONCLUSIONS: These results suggest that a 2-h regimen of streptokinase can be routinely used in patients with massive pulmonary embolism and maintained cardiac output without obviously compromising efficacy or safety.

Acute Disease↗
PubMed1998

[Acoustic quantification of right ventricular dimensions and systolic function].

In view of the important prognostic significance of right ventricular systolic function, there have been many non-invasive studies of this subject. The majority of these studies have been limited by difficulties in modelisation of this geometrically complex cardiac chamber. Automatic border detection by acoustic quantification based on the back scatter of ultrasound provides a "direct" method of analysing right ventricular dimensions and functions. The authors undertook a prospective study of 34 patients to evaluate the reliability of this technique in measuring the surfaces and fractional shortening of the right ventricle. The feasibility was 92%. The correlation coefficients between the manual two-dimensional technique and automatic border detection were 0.81 for the end diastolic surface areas, 0.85 for the end systolic surface areas and 0.74 for the fractional shortening. Compared with the isotopic ejection fraction, the correlation coefficient was 0.73. The authors conclude that acoustic quantification is a feasible and reliable technique of measuring right ventricular dimensions and its contractile function.

Adult↗
PubMed1998

[Peripheral embolic arterial accident due to pulmonary vein thrombosis revealing bronchial carcinoma].

The authors report a case of left superior pulmonary vein thrombosis discovered on transoesophageal ultrasonography in the context of aetiological assessment of a systemic vascular accident. This unusual site of a thrombus on an anatomically perfectly normal left atrium led the authors to perform a more detailed assessment, revealing a previously undiagnosed lung cancer on thoracic CT scan.

Aged↗
PubMed1998

[Postpartum myocardial infarction induced by Parlodel].

The authors report the case of a 28 year old woman who developed antero-septoapical myocardial infarction in the post-partum period. This was detected by surface ECG and echocardiography performed after a systemic embolism. The infarction followed treatment with Parlodel for inhibition of lactation. Coronary angiography, performed one month post-partum, was normal and the methergin test was negative. The physiopathological mechanism of myocardial infarction resulted from the association of an iatrogenic spastic phenomenon favourised by the patient restarting to smoke and the physiological arterial hyperactivity of the post-partum period. This mechanism raises the question of preventive measures in cases of inhibition of lactation in the post-partum period, notably stopping smoking.

Adult↗
PubMed1997

Comparison of 6F with 7F and 8F guiding catheters for elective coronary angioplasty: results of a prospective, multicenter, randomized trial.

A group of 460 patients was considered in our prospective study of assessment of the efficiency and safety of 6F (internal diameter 0.062 inches) guiding catheters to perform elective percutaneous coronary angioplasty by the femoral approach by using conventional balloon systems. The patients were randomly assigned either a 6F guiding catheter (first group, n = 231; 247 coronary lesions), or a 7F or 8F guiding catheter (second group, n = 229; 252 coronary lesions). The exclusion criteria were the ongoing myocardial infarction, the marked reduction of left ventricular function, and the decision to treat the lesion with a device not fitting the 6F guiding catheter. The angioplasty success rates (87% in the 6F group vs 88% in the 7F or 8F group) and the stent implantation rates (21% vs 25%) were similar in both groups. The ischemic complication rates (death, 2 vs 1 ) were also similar. The incidence of the femoral complications was significantly less important in the 6F group than in the 7/8F group (13.8% vs 23.5%; p < 0.01). Significant differences also were noted for the procedural time (36 +/- 22 vs 41 +/- 28 min; p < 0.01), the fluoroscopy time (11 +/- 10 vs 14 +/- 4 min; p < 0.05), the volume of contrast injected (136 +/- 68 ml vs 168 +/- 95 ml; p < 0.0001), and the time of femoral compression after the introducer sheath removal (11.7 +/- 9 vs 14.1 +/- 12 min; p < 0.01). Our data suggest that 6F guiding catheters for elective coronary angioplasty are more effective than are the larger diameter catheters. Besides a significant decrease of vascular complications, angioplasty with a 6F guiding catheter reduces the procedural time and the amount of contrast.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Transthoracic echocardiography and diagnosis of acute pulmonary embolism. Change in the diagnostic valve with respect to thresholds of classification].

The diagnostic value of transthoracic echocardiography in acute pulmonary embolism is not well established. Although many parameters are abnormal, the thresholds used vary according to the authors, limiting the contribution of the investigation to the diagnosis. In a prospective study of 70 patients with suspected acute pulmonary embolism without previous cardio-respiratory disease, the authors tried to determine the diagnostic thresholds using discriminating linear analysis and ROC curves. Parameters easily recorded in an emergency were analysed: end diastolic ventricular dimensions, ratio of these diameters and maximal velocity of tricuspid regurgitant flow. Thirty-one patients had pulmonary embolism quantified by the Miller index (average: 16 +/- 7, range 2 to 28). Measurements of left ventricular dimension were disappointing (sensitivity: 0.52, specificity: 0.73 for a threshold value of 45 mm). The right ventricular dimension was a better predictive parameter (sensitivity: 0.70, specificity: 0.86 for a threshold value of 25 mm). However, the ratio of right to left ventricular dimension had a better diagnostic value (sensitivity: 0.85, specificity: 0.78 for a threshold value of 0.5). The best diagnostic parameter was the maximal velocity of tricuspid regurgitation (sensitivity: 0.93, specificity: 0.82 for a threshold value of 2.5 m/s). The authors conclude that the maximal velocity of tricuspid regurgitation with a threshold of 2.5 m/s and the ratio of the ventricular dimensions with a threshold value of 0.5 are valuable diagnostic indicators for acute pulmonary embolism.

Acute Disease↗