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J Fajadet

Publications and source records attributed to J Fajadet.

50 records · Page 3Linked to original sources
PubMed1988

[Transluminal angioplasty of the coronary vessels in patients with pluritruncular unstable angina].

Between October, 1979 and August, 1987, 489 patients with multivessel coronary disease and unstable angina underwent transluminal angioplasty of coronary arteries with the following results: primary success in 90 p. 100 of the patients, emergency bypass surgery of occlusive dissection in 1.8 p. 100, myocardial infarction in 2.9 p. 100, death in 1.4 p. 100. These results were similar to those obtained in 369 patients with stable angina whose coronary vessels were dilated by the same group during the same period. The death rate was significantly higher in elderly people and in women. 398/489 patients were followed up for 2 to 45 months: 1.8 p. 100 died, 2 p. 100 developed myocardial infarction and 2.3 p. 100 underwent coronary bypass. 46 patients had repeat angioplasty for restenosis. After single or repeat angioplasty, 68 p. 100 of the primary success patients followed up were asymptomatic, and 73 p. 100 had lasting clinical improvement. Among 221 patients studied with different numbers of vessels treated, the degree of revascularization did not make any significant difference in the percentage of symptom-free patients. Data from the literature concerning the medical treatment of unstable angina indicate a high incidence of complications and a mediocre long-term functional benefit, while data concerning surgical treatment show a better long-term functional result. Compared with these two types of treatment, transluminal coronary angioplasty appears as a satisfactory method to treat unstable angina in patients with multivessel coronary disease.

Adult↗
PubMed1988

[Unstable angina in patients over 70 years of age].

Between October, 1985 and June, 1987, 125 patients aged 70 years or more were admitted to the Cardiology Department of Purpan Hospital, Toulouse for unstable angina pectoris. 107 of these patients have been followed up, i.e.: 76 men and 31 women aged from 70 to 85 years (mean 74.5 +/- 3.2 years). 49 patients (46 p. 100) had angina at rest of the intermediate syndrome type; 46 (43 p. 100) had rapidly progressive effort angina, and 12 (11 p. 100) had effort angina de novo. The patients' general condition was preserved in 85 p. 100 of the cases and altered in 15 p. 100. ECG was normal in only 10 p. 100 of the patients; it showed signs of established ischaemia in 70 p. 100 of the cases and sequelae of infarction in 23 p. 100. The mean cardiothoracic ration was 49.9 +/- 4.8 p. 100. The ejection fraction was 62 +/- 14.6 p. 100, the end-diastolic volume 86.9 +/- 32.2 ml/m2 and the left ventricular end-diastolic pressure 15.8 +/- 7.2 mmHg. 69 patients (64.5 p. 100) had calcifications in their coronary arteries. At coronary arteriography 21 patients (19.6 p. 100) showed stenosis of the main stem, 11 patients (10.3 p. 100) had a single vessel disease, 28 (26.2 p. 100) a two-vessel disease and 47 (43.9 p. 100) a three-vessel disease. Treatment was medical in 41 patients (38.3 p. 100) and surgical in 44 patients (41.12 p. 100); transluminal coronary angioplasty (TCA) was performed in 23 patients (21.5 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

[A new procedure for the study and treatment of myocardial infarction in the acute phase: percutaneous coronary angioscopy].

The recent development of small diameter optical fibers, which are also very flexible allows us to realise percutaneous coronary angioscopy. First of all we visualized normal dog's arteries, bifurcations, origin of small branches; then we created and visualized intimal tears, dissections and experimental thrombi. The second part of this work consisted in applying this new technic in three patients who had an evolving myocardial infarction and an occluded right coronary artery. In all three cases a clot has been visualized, occluding the lumen of the artery. This small experiment shows that percutaneous angioscopy is a feasible, quick and save procedure. Its developments will be very important according to the development of percutaneous interventional therapies.

Animals↗
PubMed1987

Emergency percutaneous transluminal coronary angioplasty without thrombolysis as initial therapy in acute myocardial infarction.

Thrombolytic treatment in acute myocardial infarction does not influence the atheromatous coronary lesions which form the basis of thrombosis. The remaining stenosis may be responsible for recurrent ischemic symptoms or reinfarction. Percutaneous transluminal coronary angioplasty without thrombolysis was attempted in 19 anterior and 24 inferior wall acute infarctions, within the first 4 hours from the onset of symptoms. The aim was to achieve optimal myocardial revascularization and prevent reocclusion of the infarct-related vessel. Significant stenosis or complete occlusion was found in only one major coronary artery in 25 patients, in two arteries in 7 patients and in three in 11 patients. Angioplasty was only applied to the vessel supplying the infarcted muscle. Recanalization was achieved from 14 to 50 minutes (mean 23) from the start of catheterization in 95% (41/43 cases). Two of the patients died in cardiogenic shock. Four patients died between days 5 to 15 of hospitalization. There were no other deaths. Thirty (81%) of the 37 survivors remained asymptomatic, 3 required bypass surgery for recurrent angina. Follow-up hemodynamic studies were done on average 2.5 months after angioplasty, and showed that, in 78%, the dilated coronary artery remained patent. Restenosis was found in five patients, and was successfully dealt with using angioplasty in three cases. In those patients with improved segmental wall motion, the global left ventricular function also increased. This applied to both anterior and inferior infarcts. Our results suggest that immediate coronary angioplasty in acute impending myocardial infarction is effective and avoids the need for prior thrombolytic therapy.

Adult↗
PubMed1987

Intraaortic balloon counterpulsation and coronary angioplasty in high risk coronary heart patients.

Fifteen patients with severely damaged coronary circulation required temporary intraaortic balloon counterpulsation for pharmacologically uncontrollable chest pain and poor haemodynamic state (hypotension or shock) in connection with the transluminal coronary angioplasty procedure. Twenty-five angioplasties were attempted (1.75 artery stem/patient) with a primary success rate of 96%. Emergency surgery was performed only once (6.6%) and no death occurred after the percutaneous therapeutic procedures. One patient died due to a cerebrovascular accident, two other patients suffered sudden death 1 and 3 months later. Two patients finally required coronary bypass surgery, and one patient a repeated angioplasty. In the follow-up period (mean = 11 months), two patients presented moderate symptoms of stable angina pectoris, and 10 patients (83%) remained in satisfactory condition. Temporary diastolic counterpulsation provided in patients with pharmacologically refractory myocardial ischaemia and hypotension or shock an important protection for performing transluminal angioplasty in a good condition, with improved remaining coronary circulation and haemodynamic state, assuring a favourable hospital survival.

Adult↗
PubMed1987

Percutaneous transluminal coronary angioplasty without thrombolytic therapy in acute myocardial infarction.

Percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction (AMI) was performed in 42 patients (37 males, 5 females, average age 53 years). Recanalization of the stenosed or occluded infarction-related coronary artery was achieved within the first 14 to 50 min from the start of catheterization in 95% of cases. Three patients were transferred for emergency coronary bypass graft surgery (CABG) because of major multiple coronary lesions, immediately after angiographically successful PTCA. One of the patients died in cardiogenic shock. Four patients died between days 5 to 15 of hospitalization. Repeat coronary angiography was done in 27 of the 37 survivors at a mean interval of 2.5 months after AMI. Total reocclusion was found in 6 patients. The recanalized coronary artery had prevented its patency in 78% of the cases; restenosis was found in 5 patients, and was successfully dealt with renewed angioplasty in 3 patients. While the ejection fraction (EF) had remained largely unchanged, there was some improving tendency of left ventricular segmental kinetics, particularly in case of anterior wall infarction. PTCA without thrombolytic therapy seems to provide an effective and relatively prompt recanalizing procedure in the complex management of AMI.

Adult↗
PubMed1986

[Coronary recanalization by transluminal angioplasty in the acute phase of myocardial infarct].

Recanalization by transluminal coronary angioplasty (TCA) was attempted as the first measure in 41 patients having symptoms for less than 4h. The obstruction could rapidly be removed (between 14 and 50 min) in 38 patients (92%). Five patients (12%) died: one in shock at the end of the operation, two died on the 5th and 8th postoperative day and two from heart failure on the 8th and 15th postoperative day. Three patients were urgently operated on for severe tritruncal lesions after a successful TCA. Among the 27 patients under control between 1 and 12 months, six reocclusions were noted (5 asymptomatic, 1 with clinical recurrence), 5 had recurrent stenosis (3 of them were treated by a 2nd angioplasty) and 16 (60%) exhibited permanent good results. The global ejection fraction was not modified, neither the telediastolic and telesystolic volumes. A significant improvement in segmental kinetics was observed in 6 patients with anterior and in 5 patients with inferior infarction. In this group of patients the ejection fraction was improved (67.2 +/- 2.3 vs 52.8 +/- 2.2, p less than 0.001), the IVDT was unchanged (81.7 +/- 6.8 vs 90.7 +/- 5.1, NS). IVTS was lower (27.5 +/- 3.5 vs 41.9 +/- 2.8, p less than 0.001). Further work is, however, needed to confirm these results.

Adult↗
PubMed1985

Complete patency in thrombus-occluded arteries two weeks after laser recanalization.

The potential problem of rethrombosis after laser recanalization was studied in 16 thrombus-occluded canine femoral arteries. Balloon de-endothelialization and thrombin-human blood injection produced adherent, completely occlusive thrombi 4.13 +/- 1.54 cm in length; laser exposure of the thrombi occurred at 18.35 +/- 22.1 hours. The argon laser catheter was introduced via a proximal arteriotomy and a power of 3.83 +/- 0.58 W delivered for 411.3 +/- 296.87 seconds. Follow-up period was 14 days. All arteries were patent immediately after and 14 days following lasing, as demonstrated by angiography. There was no vessel perforation. Seven of the dogs were maintained on aspirin and dipyridamole 4 days before and throughout the study, but there were no differences in thrombus length, laser power, or duration of laser exposure between these dogs and those receiving no anti-platelet therapy. Control thrombosed arteries (without laser energy application) showed no autolysis within 14 days in all dogs and up to 95 days in three dogs followed for this period of time. These data show that rethrombosis of totally occluded, thrombosed arteries is not present up to 2 weeks later after laser recanalization, with or without the aid of anti-platelet therapy.

Animals↗
PubMed1985

[Prognostic indices of the normalization of left ventricular function in chronic aortic insufficiency following valve replacement].

The aim of this study of 31 patients was to identify M mode echocardiographic parameters predictive of normalisation of left ventricular function after valvular replacement for chronic aortic incompetence in order to determine the optimal time for surgery. Only patients with chronic, pure aortic incompetence (ventriculo-aortic pressure gradient less than or equal to 30 mmHG) were considered. At the time of investigation 4 patients were in functional Class I, 6 in Class II, 10 in Class III and 11 in Class IV (NYHA). M mode echocardiography was performed on an Echovideorex or an Irex System II echocardiograph. The following measurements were made and corrected for body surface area according to the recommendations of the American Society of Echocardiography; end systolic and end diastolic dimensions (mm), fractional shortening (%), end systolic and end diastolic wall thickness (mm), diastolic radius to wall thickness ratio, short axis myocardial surface area (cme), wall stress, end systolic stress (mmHg). The study comprised pre and postoperative studies with an interval of 22.7 +/- 12.5 months (range 5 to 46 months); the data obtained was compared with a control group of 10 normal subjects. The results showed that preoperative fractional shortening less than 28% was associated with an increased risk of persistent postoperative left ventricular dysfunction.

Adolescent↗
PubMedDate not supplied

[Echocardiographic evaluation of intravenous streptokinase in myocardial infarction in the acute phase].

The effects of intravenous fibrinolysis on left ventricular function in acute myocardial infarction were investigated by two-dimensional echocardiography in patients aged less than 70 for whom fibrinolysis was not contra-indicated and who were admitted less than 6 hours after the onset of a first myocardial infarction without heart failure. The 12 patients thus recruited were male; their mean age was 55 years and the infarct was anterior in 6 cases and posterior in 6 cases. Streptokinase was administered first by bolus intravenous injection (250,000 IU over 20 min), then by intravenous infusion (100,000 IU over 12 hours); this was followed by heparin. No other medication was given, except for intravenous lidocaine and oral nifedipine. Two-dimensional echocardiography was performed after 24 hours and on the 21st day, using the apical, two-cavities projection. The ejection fraction and the percentage of shortening in 16 ventricular segments (8 in the anterior and 8 in the inferior territories) were evaluated from systolic and diastolic ventricular contours. Ventricular angiography and coronary arteriography were performed concomitantly with echocardiography. No significant improvement in ejection fraction was observed. On both day 1 and day 21, the kinetics of the lower segments was improved and that of the anterior segments was distinctly reduced in inferior infarcts. The kinetics of all segments, irrespective of their territory, was significantly improved in anterior infarcts.

Adult↗
PubMedDate not supplied

Percutaneous transluminal therapy of occluded saphenous vein grafts: can the challenge be met with ultrasound thrombolysis?

BACKGROUND: Percutaneous transluminal treatment of a thrombotic vein graft yields poor results. We have previously reported our experience with transluminal percutaneous coronary ultrasound thrombolysis (CUT) in the setting of acute myocardial infarction (AMI). This report describes the first experience with ultrasound thrombolysis in thrombus-rich lesions in saphenous vein grafts (SVGs), most of which were occluded. METHODS AND RESULTS: The patients (n=20) were mostly male (85%), aged 64+/-4 years old. The presenting symptom was AMI in 2 patients (10%) and unstable angina in the rest. Fifteen patients (75%) had totally occluded SVGs. The median age of clots was 6 days (range, 0 to 100 days). The ultrasound thrombolysis device has a 1.6-mm-long tip and fits into a 7F guiding catheter over a 0.014-in guidewire in a "rapid-exchange" system. CUT (41 kHz, 18 W, </=6 minutes) led to device success in 14 (70%) of the patients and residual stenosis of 65+/-28%. Procedural success was obtained in 13 (65%) of the patients, with a final residual stenosis of 5+/-8%. There was a low rate of device-related adverse events: 1 patient (5%) had a non-Q-wave myocardial infarction, and distal embolization was noted in 1 patient (5%). Adjunct PTCA or stenting was used in all patients. There were no serious adverse events during hospitalization. CONCLUSIONS: Ultrasound thrombolysis in thrombus-rich lesions in SVGs offers a very promising therapeutic option.

Angioplasty, Balloon, Coronary↗