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Biomedical subjects

J J Bonnier

Publications and source records attributed to J J Bonnier.

At least 19 recordsLinked to original sources
PubMed2001

Value of fractional flow reserve in making decisions about bypass surgery for equivocal left main coronary artery disease.

OBJECTIVE: To investigate the value of coronary pressure derived fractional flow reserve (FFR) measurements in supporting decisions about medical or surgical treatment in patients with angiographically equivocal left main coronary artery stenosis. DESIGN: A two centre prospective single cohort follow up study. INTERVENTIONS: FFR of the left main coronary artery was determined in 54 consecutive patients with angiographically equivocal left main coronary artery disease. If FFR was >/= 0.75, medical treatment was chosen; if FFR was < 0.75, surgical treatment was chosen. MAIN OUTCOME MEASURES: Freedom from death, myocardial infarction, or any coronary revascularisation procedure. RESULTS: In 24 patients (44%), FFR was >/= 0.75 and medical treatment was chosen (medical group). In the remaining 30 patients (56%), FFR was < 0.75 and bypass surgery was performed (surgical group). Mean (SD) follow up was 29 (15) months (range 12-65 months). Survival among patients at three years of follow up was 100% in the medical group and 97% in the surgical group. Event-free survival was 76% in the medical group and 83% in the surgical group. CONCLUSIONS: FFR supports decision making in equivocal left main coronary artery disease. If FFR is below 0.75, the decision for bypass surgery is supported. If FFR is above 0.75, a conservative approach is justified.

Adult↗
PubMed1999

The ARTS study (Arterial Revascularization Therapies Study).

The rising costs of health care have forced policy makers to make choices, and new treatments are increasingly assessed in terms of the balance between additional costs and additional effects. The recent recognition that stenting has a major and long-lasting effect enhancing balloon PTCA procedure has made it imperative to compare in patients with multivessel disease the standard surgical procedure with multiple stenting in a large scale multinational and multicentre approach (19 countries, 68 sites). Selection and inclusion of patients is based on a consensus of the cardiac surgeon and interventional cardiologist on equal 'treatability' of patients by both techniques with analysis of clinical follow-up (event-free survival) on the short (30 day), medium (1 year), and long-term (3 and 5 year) with analysis of cost-effectiveness and quality of life (EuroQol and SF-36). Of the entire trial, the primary null hypothesis which needs to be rejected is that there will be no difference in event-free survival or effectiveness (E), at 1 year and also that the direct and indirect costs (C) per event-free year are not different between surgery or stenting. For this to become significant with a power of 90% one needs 1200 patients. Between April 97 and June 98, 1205 patients have been randomized with a monthly recruitment of 83 patients. Expected costs, effects and cost-effectiveness ratio (CE ratio) are: Stent high costs 2 VDStent high costs 3 VDStent low costs 2 VDStent low costs 3 VDCABG costs (C)$19.297$24.566$16.638$20.456$21.350 effects (E)81%81%81%81%88% CE ratio$23.876$30.397$20.586$25.322$24.348 Clinically, stenting is not expected to be more effective than CABG, but should be cost effective in both the 2- and 3-VD group when using the lower cost estimate and in the 2 VD group when using the higher cost assumptions.

Angioplasty, Balloon, Coronary↗
PubMed1999

Laser angioplasty of restenosed coronary stents: results of a multicenter surveillance trial. The Laser Angioplasty of Restenosed Stents (LARS) Investigators.

OBJECTIVES: This study evaluated safety and efficacy of excimer laser angioplasty for treatment of restenosed or occluded coronary stents. BACKGROUND: Balloon angioplasty of in-stent restenosis is limited by a high recurrence rate. Debulking by laser angioplasty is a novel concept to treat in-stent restenosis. METHODS: A total of 440 patients with restenoses or occlusions in 527 stents were enrolled for treatment with concentric or eccentric laser catheters and adjunctive balloon angioplasty. RESULTS: Laser angioplasty success (< or =50% diameter stenosis after laser treatment or successful passage with a 2.0-mm or 1.7-mm eccentric laser catheter) was achieved in 92% of patients. Adjunctive balloon angioplasty was performed in 99%. Procedural success (laser angioplasty success followed by < or =30% stenosis with or without balloon angioplasty) was 91%. There was neither a significant difference in success with respect to lesion length, nor were there differences between small and large vessels or native vessels and vein grafts. Success was higher and residual stenosis lower using large or eccentric catheters. Serious adverse events included death (1.6%, not directly laser catheter related), Q-wave myocardial infarction (0.5%), non-Q-wave infarction (2.7%), cardiac tamponade (0.5%) and stent damage (0.5%). Perforations after laser treatment occurred in 0.9% of patients and after balloon angioplasty in 0.2%. Dissections were visible in 4.8% of patients after laser treatment and in 9.3% after balloon angioplasty. Reinterventions during hospitalization were necessary in 0.9% of patients; bypass surgery was performed in 0.2%. CONCLUSIONS: Excimer laser angioplasty with adjunctive balloon angioplasty is a safe and efficient technology to treat in-stent restenoses. These data justify a randomized comparison with balloon angioplasty.

Adult↗
PubMed1995

The autoperfusion balloon catheter with special attention to its use as a bail-out device.

The most serious complication of coronary angioplasty is acute vessel closure and/or persistent major dissection. In these cases the autoperfusion balloon is probably a good solution to "tack" the dissection flap against the vessel wall and to establish flow with prolonged inflations. In this short overview we review the literature and give guidelines for the use of autoperfusion balloon catheters as a bail-out device.

Aortic Dissection↗
PubMed1994

[Appropriate use of balloon angioplasty; a study in the Eindhoven region].

OBJECTIVE: To gain insight in the volume of PTCAs in the region of Eindhoven and in the appropriateness of the intervention. DESIGN: Descriptive. SETTING: Department of Cardiology in the Catharina Hospital at Eindhoven. METHODS: The number of PTCAs was counted in Eindhoven and surrounding area. Peer review was carried out of 50 randomly chosen patients. General practitioners were asked about their opinion of the appropriateness of the intervention in their patients. RESULTS: In the region of Eindhoven 91.5 PTCA's are done per 100,000 inhabitants yearly (the national average in 1993 in the Netherlands is 71), 38 in the rural and 133 in the urban subregions. Peer review (by two (intervention) cardiologists, three public health doctors) showed that in 82% of the cases the indication for PTCA was appropriate. According to the Working Group for Interventional Cardiology 34% of the cases were classic indications, 64% were indications in development, and 2% were wrong. In the urban region there were more indications in development than in the rural regions. The general practitioners agreed with the cardiologists about the appropriateness of the PTCAs in their patients. CONCLUSION: Although the number of PTCAs is relatively large in the Eindhoven region, the indications for the intervention were in accordance with accepted rules.

Adult↗
PubMed1993

Blood viscosity during thrombolytic therapy with anistreplase in acute myocardial infarction.

It has been postulated that a reduction in blood viscosity due to degradation of plasma fibrinogen may be of benefit to patients with acute myocardial infarction (AMI), who are treated with thrombolytic agents. The aims of this study were to investigate the time course of rheologic parameters, to identify the principal factors determining blood viscosity, and to find possible correlations between viscosity and cardiac function during thrombolytic therapy with anistreplase. Therefore, the viscosity of whole blood and plasma and the hematocrit were measured before and at 10 time points after thrombolysis in 10 patients with AMI. In addition, plasma fibrinogen and fibrin(ogen) degradation products were determined. Immediately after the start of thrombolysis, the viscosity of blood (both at high and low shear rate) and plasma decreased significantly and continued to do so for 24 hours. The mean hematocrit also decreased markedly, and even after correction for these hematocrit changes, the reduction in blood viscosity remained significant: it decreased to 72% of pretreatment (measured at low shear rate), whereas the high-shear viscosity decreased to 95% of baseline. The viscosity of plasma significantly decreased from 1.39 +/- 0.13 mPa.s (mean +/- SD) before thrombolysis to 1.22 +/- 0.08 mPa.s after 2 hours. There was a rapid, nearly complete depletion in fibrinogen, followed by a striking rebound after the second day. The decrease in blood viscosity lasted for 2 days after anistreplase and was mainly accounted for by the reduction in hematocrit. The contribution of fibrinogen to blood viscosity appeared less prominent. Despite these rheologic changes, no improvement in cardiac output was noticed in the patients.

Aged↗
PubMed1993

Absence of beneficial effect of intravenous metoprolol given during angioplasty in patients with single-vessel coronary artery disease.

In a double-blind, randomized, placebo-controlled trial, the possible anti-ischemic effect of metoprolol during percutaneous transluminal coronary angioplasty was tested. Electrocardiograms, hemodynamics, and metabolism were studied in 27 patients with a stenosis in the left anterior descending coronary artery. Measurements took place before angioplasty, after each of four 1-minute occlusions and 15 minutes after the last balloon deflation. Patients were randomly given placebo or metoprolol (15 mg as a bolus intravenously, followed by an infusion of 0.04 mg/kg/hr). At the end of the procedure, the rate-pressure product had decreased by 15% (NS) and 23% (p = 0.001) in the placebo and metoprolol groups, respectively, mainly due to similar decreases in heart rate. Metoprolol tended to lower chest pain and reduce precordial ST-segment elevation due to angioplasty, but the effects were not statistically significant. Lactate, hypoxanthine, and urate release immediately after deflation was similar in both groups. Metoprolol reduced arterial plasma hypoxanthine throughout the procedure by about 30% (p < or = 0.02 vs. placebo). Thus, intravenous infusion of metoprolol did not significantly attenuate chest pain and ST-segment elevation, and failed to decrease cardiac lactate and oxypurine release. It did, however, reduce arterial hypoxanthine concentrations during angioplasty, possibly indicating that the beta-blocker inhibits extracardiac ATP catabolism.

Adult↗
PubMed1991

Histidine-rich glycoprotein in thrombolytic therapy: has it clinical relevance?

The plasma concentrations of histidine-rich glycoprotein and plasminogen were measured and those of free plasminogen calculated in 34 patients with acute myocardial infarction treated with thrombolytic drugs. We investigated whether the plasma levels of histidine-rich glycoprotein and free plasminogen were associated with clinical parameters such as the occurrence and time of successful reperfusion, the incidence of reocclusion and the presence and extent of the systemic lytic state. The mean (+/- SD) pretreatment concentration of histidine-rich glycoprotein was 1.08 +/- 0.24 U/ml, which was almost identical with the normal reference values. After thrombolysis, the mean level decreased slightly. We found no support for a role of these proteins in achieving therapeutic success and only a faint suggestion that histidine-rich glycoprotein might contribute to reocclusion. Surprisingly, the non- or only limited occurrence of systemic lytic state appeared to be associated with a low level of histidine-rich glycoprotein, instead of the high level expected on theoretical grounds. It is therefore unlikely that histidine-rich glycoprotein is of clinical relevance for thrombolytic therapy of acute myocardial infarction.

Anistreplase↗
PubMed1990

Myocardial protection by intravenous diltiazem during angioplasty of single-vessel coronary artery disease.

The possible cardioprotective effect of diltiazem during ischemia caused by percutaneous transluminal coronary angioplasty was tested. Electrocardiograms and myocardial lactate, hypoxanthine and urate production were determined in 26 patients with a stenosis in the left anterior descending artery without angiographically demonstrable collaterals. Measurements took place before angioplasty, after each of 4 occlusions and 15 minutes after the last balloon inflation. Patients were randomly given placebo or DL-diltiazem (0.4 mg/kg as a bolus intravenously, followed by an infusion of 15 mg/hr). During angioplasty the ST-segment elevation for the anterior wall leads V2, V4 and V6, and the intracoronary lead was similar for both groups, as was lactate release. Diltiazem significantly reduced cardiac hypoxanthine release immediately after angioplasty from 63 to 88% (p less than 0.05). The drug diminished urate production after the last dilatation by 82% (p less than 0.05). In conclusion, intravenous infusion of diltiazem reduced cardiac adenosine triphosphate breakdown during angioplasty as shown by diminished hypoxanthine and urate production. In contrast, diltiazem was unable to attenuate ST-segment elevation and lactate release.

Adenosine Triphosphate↗
PubMed1989

Myocardial infarction and sudden death after sport: acute coronary angiographic findings.

Thirteen patients, seven with acute myocardial infarction and six survivors of sudden death after sport, underwent coronary angiography within a mean of 104 min after the onset of symptoms. The admission electrocardiogram showed transmural myocardial ischemia in all patients. The ischemia-related vessel was occluded in all cases of sudden death and in three cases of acute myocardial infarction. Reperfusion was achieved in eight vessels: after intracoronary streptokinase in three, after intracoronary nitroglycerin in three, and mechanically in two. Coronary spasm was demonstrated in three vessels, and coronary thrombi, in four. The coronary lesion was described as either concentric in two or eccentric with irregular borders in eight. There was a high incidence of eccentric lesions consistent with ruptured plaques. The acute coronary angiographic findings of acute myocardial infarction and sudden death after sport are similar. Physical exercise can provoke myocardial infarction and sudden death probably by inducing plaque rupture that can evoke coronary spasm, thrombosis, or both.

Adult↗
PubMed1989

Urate production by human heart.

Xanthine oxidoreductase has been demonstrated in the heart of various species. However, its presence in human heart is still debated. In the literature, high to undetectable levels have been reported. We studied the arterial-venous urate difference across the heart of patients undergoing both routine cardiac catheterization and percutaneous transluminal coronary angioplasty. Urate is the end product of the reaction catalysed by xanthine oxidoreductase. In 10 patients, studied before angioplasty, the plasma urate level in the great cardiac vein exceeded the arterial one by 26 +/- 10 nmol/ml (P = 0.028). In a further 13 patients, urate production was maximal immediately after the last of four consecutive occlusions (23 +/- 8 nmol/ml, P = 0.018) and concomitant with increased coronary sinus hypoxanthine levels. We conclude that xanthine oxidoreductase is probably present in the heart of patients, suffering from ischemic heart disease, and responsible for the increase in urate production during transient myocardial ischemia.

Aged↗
PubMed1988

Aortic valve replacement in the second trimester of pregnancy: a case report.

A 36 year old woman with left heart failure and right-sided hemiparesis due to endocarditis of the aortic valve underwent urgent aortic valve replacement during the 24th week of gestation. High-flow high-pressure normothermic perfusion during cardiopulmonary bypass was performed. Peri-operative fetal heart rate and uterine contractions were monitored. Severe fetal heart rate decelerations and loss of variability as well as uterine contractions were observed during surgery. Uterine contractions were treated medically. Pregnancy was carried to term and a healthy baby was delivered vaginally. The effect of the nonpulsating cardiac pump during extracorporeal circulation on the fetus will be discussed. Recommendations for the peri-operative management of the fetal unit are made.

Adult↗
PubMed1987

Comparison of intravenous anisoylated plasminogen streptokinase activator complex with intracoronary streptokinase in acute myocardial infarction.

In a randomised trial the efficacy and safety of anisoylated plasminogen streptokinase activator complex (APSAC) administered intravenously and streptokinase administered by intracoronary infusion were compared in patients with proven acute myocardial infarction. Occlusion of the infarct-related vessel, reperfusion and reocclusion were all assessed angiographically. Fibrinolytic therapy was started within 4 (mean 2.4) hours of the onset of symptoms. 85 patients entered the study; 42 were treated with a single intravenous injection of APSAC (30U) given over 3 to 5 minutes and 43 with an intracoronary infusion of streptokinase (250,000U) given over 60 minutes. 12 patients were excluded because of protocol violation. Reperfusion at 90 minutes was confirmed in 23/36 patients (63.9%) in the APSAC group and 25/37 (67.6%) in the streptokinase group; at 24 (+/- 6) hours reocclusion had occurred in 1/22 (4.5%) and 4/23 (13.0%) patients in each group, respectively. These results indicate that APSAC (30U intravenously) is as effective as intracoronary streptokinase (250,000U). The major advantages of APSAC in acute myocardial infarction are its rapid, convenient administration and its low rate of arterial reocclusion.

Adult↗
PubMed1987

Systemic effects of anisoylated plasminogen streptokinase activator complex and streptokinase therapy in acute myocardial infarction. Coagulation aspects of the Dutch Invasive Reperfusion Study.

The systemic effects of intravenous anisoylated plasminogen streptokinase activator complex (APSAC; 30U) and intracoronary streptokinase (250,000U) were compared in 54 patients with acute myocardial infarction. In 3 patients, no signs of a systemic lytic state were observed. In all other patients, significant reductions of coagulation and fibrinolytic factors occurred: fibrinogen levels decreased by 86% in the APSAC group and 81% in the streptokinase group; for plasminogen the decreases were 68 and 66%, and for alpha 2-antiplasmin activity greater than 95 and 94%, respectively. Fibrin(ogen) degradation products were increased 68- and 38-fold, respectively. Although there was a trend for the lytic state to be more profound in the APSAC-treated patients, there was no difference between treatment groups with regard to bleeding complications or therapeutic efficacy, the latter being 79 and 73%, respectively, for APSAC and streptokinase. Total fibrinolytic activity, measured as euglobulin clot lysis time, was sustained for longer in the APSAC group, which may explain the low reocclusion rate in this group in comparison with the streptokinase group.

Anistreplase↗
PubMed1986

Inadvertant balloon extrusion through a side hole in a guiding catheter.

A patient presented with an acute inferior myocardial infarction. Coronary angiography in the acute stage revealed total occlusion of the right coronary artery. Reperfusion was obtained after intracoronary infusion of 250,000 units of streptokinase. Angioplasty was subsequently performed because of a high grade residual stenosis. An 8-French right Judkins guiding catheter with a single side hole (USCI), a 3.0 mm balloon dilatation catheter (ACS), and a 0.018 high torque floppy guide wire (ACS) were used. After successful angioplasty angiography was repeated with the guide wire in the RCA, but the balloon was withdrawn into the guiding catheter. After injection of contrast, it was impossible to withdrawn the balloon catheter out of the guiding catheter. Fluoroscopy revealed extrusion of the balloon through the side hole in the guiding catheter.

Cardiac Catheterization↗