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Biomedical subjects

J L Guermonprez

Publications and source records attributed to J L Guermonprez.

At least 37 records · Page 2Linked to original sources
PubMed1997

Increased incidence of moderate stenosis among patients with diabetes: substrate for myocardial infarction?

Persons with diabetes are at higher risk for myocardial infarction and sudden death than are persons without diabetes. It has been demonstrated that the artery that occludes during acute myocardial infarction generally had less than 75% stenosis on a previous angiogram. The extent of coronary artery stenosis was analyzed for 820 consecutively examined patients who underwent coronary angiography at our institution. The patients were categorized according to the presence or absence of diabetes mellitus. The severity of stenosis was taken into consideration. Patients with diabetes had moderate (50% to 75% narrowing) stenosis much more frequently than patients without diabetes (50.6 versus 30.3%, p < 0.001). Moreover diabetes mellitus was an independent risk factor for moderate stenosis. The lesions were more frequently located on distal arteries, more frequently had a pattern of three-vessel disease, and had a trend toward more diffuse disease than described 25 years ago. This greater amount of moderate stenosis may be considered a substrate for future acute plaque rupture. It may explain the high prevalence of acute myocardial infarction and sudden death among patients with diabetes without an increase in the incidence of angina pectoris.

Aged↗
PubMed1997

First international new intravascular rigid-flex endovascular stent study (FINESS): clinical and angiographic results after elective and urgent stent implantation. The FINESS Trial Investigators.

OBJECTIVES: The purpose of this study was to determine the feasibility, safety and efficacy of elective and urgent deployment of the new intravascular rigid-flex (NIR) stent in patients with coronary artery disease. BACKGROUND: Stent implantation has been shown to be effective in the treatment of focal, new coronary stenoses and in restoring coronary flow after coronary dissection and abrupt vessel closure. However, currently available stents either lack flexibility, hindering navigation through tortuous arteries, or lack axial strength, resulting in suboptimal scaffolding of the vessel. The unique transforming multicellular design of the NIR stent appears to provide both longitudinal flexibility and radial strength. METHODS: NIR stent implantation was attempted in 255 patients (341 lesions) enrolled prospectively in a multicenter international registry from December 1995 through March 1996. Nine-, 16- and 32-mm long NIR stents were manually crimped onto coronary balloons and deployed in native coronary (94%) and saphenous vein graft (6%) lesions. Seventy-four percent of patients underwent elective stenting for primary or restenotic lesions, 21% for a suboptimal angioplasty result and 5% for threatened or abrupt vessel closure. Fifty-two percent of patients presented with unstable angina, 48% had a previous myocardial infarction, and 45% had multivessel disease. Coronary lesions were frequently complex, occurring in relatively small arteries (mean [+/-SD] reference diameter 2.8 +/- 0.6 mm). Patients were followed up for 6 months for the occurrence of major adverse cardiovascular events. RESULTS: Stent deployment was accomplished in 98% of lesions. Mean minimal lumen diameter increased by 1.51 +/- 0.51 mm (from 1.09 +/- 0.43 mm before to 2.60 +/- 0.50 mm after the procedure). Mean percent diameter stenosis decreased from 61 +/- 13% before to 17 +/- 7% after intervention. A successful interventional procedure with < 50% diameter stenosis of all treatment site lesions and no major adverse cardiac events within 30 days occurred in 95% of patients. Event-free survival at 6 months was 82%. Ninety-four percent of surviving patients were either asymptomatic or had mild stable angina at 6 month follow-up. CONCLUSIONS: Despite unfavorable clinical and angiographic characteristics of the majority of patients enrolled, the acute angiographic results and early clinical outcome after NIR stent deployment were very promising. A prospective, randomized trial comparing the NIR stent with other currently available stents appears warranted.

Aged↗
PubMed1997

[A comparative study of 4 diagnostic strategies in coronary artery disease. A theoretical approach].

The prognosis of patients with coronary artery disease is constantly improving mainly due to better control of risk factors, to improved methods of myocardial revascularisation and better follow-up. For effective management, the diagnosis of coronary disease has to be established. The authors used a statistical model to study the efficacy of 4 diagnostic strategies used in daily practice: (i) three investigations in two stages: exercise stress testing, stress echocardiography or stress scintigraphy followed by coronary angiography when positive (EE, ECHO, SCINTI): (ii) one stage investigation: coronary angiography of first indication (CORO). When the a priori probability is low or moderate (less than 0.5) the efficacy of EE, ECHO and SCINTI is excellent as there are few false negative results. When the a priori probability of coronary disease is high (0.7 or more), the percentage of false negative results (patients with undetected significant coronary disease) becomes very high. At this level of risk the CORO strategy avoids the false negatives without increasing the costs with respect to the other strategies. In conclusion, the choice of diagnostic strategy of coronary artery disease should take into account the "a priori" risk of the patient. When high (> 0.7), coronary angiography of first intention seems to be statistically justified.

Adult↗
PubMed1993

A double-blind comparison of the long-term efficacy of a potassium channel opener and a calcium antagonist in stable angina pectoris.

The efficacies and safety of nicorandil, 20 mg b.d., and diltiazem, 60 mg t.d., in the treatment of stable angina pectoris were compared in a double-blind randomized parallel group study involving 123 patients. The duration of the study was 3 months. Exercise tolerance tests were performed by the patients when on placebo (day 0) and at the end of the study period (day 90). Both groups were comparable at day 0 in terms of demography and cardiovascular status. Nicorandil and diltiazem were both found to decrease the frequency of anginal attacks and the consumption of nitroglycerin tablets (P < 0.01). Maximum exercise capacity, the amount of work that could be performed before reaching ischaemic threshold, and the amount of work required to reach onset of angina were significantly increased for both groups of patients on day 90 compared with day 0 (increase in maximum exercise capacity: nicorandil--6.9 +/- 18.9 kj, diltiazem--9.6 +/- 16.2 kj, P = 0.44 ns; increase in work to ischaemic threshold: nicorandil--9.4 +/- 18.1 kJ, diltiazem--14.7 +/- 15.4 kJ, P = 0.10 ns; increase in work to onset of angina: nicorandil--10.0 +/- 20.1 kJ, diltiazem--11.4 +/- 14.9 kJ, P = 0.68 ns). Differences between the two groups were not significant. The double product of systolic blood pressure x heart rate and peak exercise for both drugs was either unchanged or slightly decreased at ischaemic threshold.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Early angiographic evaluation of coronary bypass using arterial grafts].

The aim of this study was to evaluate the early postoperative angiographic features of arterial coronary bypass grafts in 83 asymptomatic patients referred consecutively from the surgical unit. The patients aged 33 to 78 years (average 62 years) were operated between August 1989 and March 1992 and received only arterial coronary bypass grafts: 209 arteries bypassed (121 internal mammary including 10 sequential grafts, 46 radial, 36 epigastric including 4 sequential grafts and 6 gastroepiploic arterial grafts), an average of 2.4 bypass grafts per patient. Selective angiography of the arterial grafts was performed systematically between the 7th and 15th postoperative days in patients with uncomplicated recoveries. The native coronary arterial network was opacified only when a graft was "non-functional": haemodynamic (> 70%) stenosis or occlusion. 3.8% of pediculated mammary grafts were occluded. On the other hand, 16.6% of free internal mammary grafts were occluded. None of the radial artery grafts were occluded, but 8% were stenotic. Finally, 30% of epigastric and 50% of the gastroepiploic grafts were occluded. These results confirm the good function of in situ mammary artery grafts by suggest that systematic multiple arterial grafts should be used with caution. Radial artery grafts give very encouraging results which require long-term evaluation. Early postoperative evaluation of coronary arterial grafts provides important information and should be considered a routine procedure.

Abdominal Muscles↗
PubMed1993

[Use of the radial artery for coronary artery bypass. A new experience after 20 years].

Twenty years after its first introduction by A. Carpentier, the use of the radial artery (RA) for coronary bypass was reinvestigated because of unexpected good long term results in some patients. Since July 1989, 158 patients (pts) underwent myocardial revascularization using 189 RA grafts (31 pts received 2 grafts). The left internal mammary artery (LIMA) was concomitantly used as a pedicled graft in 151 cases and the right internal mammary artery (RIMA) in 31 cases, a free IMA graft was used in 29 cases and a saphenous vein graft in 40 cases. A mean of 2.8 graft/pt was performed. The target artery receiving the RA was: circumflex (n = 93), diagonal (n = 39), right coronary (n = 47) and LAD (n = 10). Two patients died (1.3%) and three presented a perioperative myocardial infarct (2.5%). Sternal wound infection was noted in three cases of double IMA implant. 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 (< 3 weeks) were obtained in the first 60 consecutive patients and revealed: 73/73 patent RA grafts, 58/58 patent LIMA grafts, 16/16 patent RIMA grafts, 15/19 patent free IMA grafts and 10/11 patent vein grafts. Six patients presented a localized narrowing of the RA conduit unrelated to the anastomotic lines (spasm). Late angiographic control (6 to 24 months) was obtained after a mean follow-up of 11 months in 37 patients: 42/46 RA grafts were patent (91.3%) and free of spasm and 4 were occluded.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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↗
PubMed1990

Is pulsed Doppler echocardiography an adequate method to evaluate left ventricular function during filling in hypertensive patients?

Pulsed Doppler tracings of the mitral inflow are often proposed to describe left ventricular function during filling in hypertensive patients. The tracings are determined by the complex interaction of left atrial pressure and left ventricular relaxation, diastolic compliance and contractility of the left atrium. They strongly depend on preload and, thus, do not allow precise characterization of the left ventricle. In addition, they vary with age, heart rate and the site of measurement. The modifications caused by the presence of hypertensive hypertrophy are not specific: similar changes are seen for example, in the presence of hypertrophic cardiomyopathy or coronary heart disease, but are absent in highly trained athletes in spite of very significant physiologic hypertrophy.

Aging↗
PubMed1990

[Percutaneous valvuloplasty of congenital pulmonary stenosis in adults over 50 years of age].

The authors report three cases of congenital pulmonary stenosis in adults over 50 years of age treated by percutaneous balloon valvuloplasty. Three symptomatic women aged 74, 80 and 51, had systolic pressure gradients ranging from 107 to 113 mmHg between the right ventricle and pulmonary artery. After valvuloplasty with two balloons or one trefoil balloon, the transvalvular pressure gradient fell to 25 to 30 mmHg. It was only 14 mmHg in one patient controlled after one year's follow-up. The cardiac index was initially decreased and did not change very much immediately after the procedure, increasing from 1.68 1/m2/mn to 1.77 1/m2/mn. The pulmonary valve surface area increased from 0.22 to 0.43 cm2. There were no complications and in one patient, reviewed two years later, the clinical improvement was maintained. Percutaneous valvuloplasty is indicated in severe and/or poorly tolerated pulmonary stenosis. With the 10 other previously reported cases of patients over 50 years of age, the procedure was successful in 12 out of 13 patients (92%). In these patients of 51 to 80 years of age, the systolic pressure gradient between the right ventricle and pulmonary artery was reduced from 112 +/- 46 mmHg to 43 +/- 26 mmHg (-62%). Slight pulmonary regurgitation appeared in 5 out of 9 cases. Valvuloplasty was usually well tolerated and there were no fatalities. There were no signs of restenosis in 5 cases controlled 10 days to 1 year after dilatation. In the future, systematic Doppler echocardiographic examinations should help comparison of cardiac haemodynamics before, immediately after valvuloplasty and at long-term.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Percutaneous brachial approach for transluminal coronary angioplasty.

Transluminal coronary angioplasty from the arm is performed generally with cutdown and brachial arteriotomy. We describe a brachial percutaneous technique for coronary angioplasty, almost similar to the femoral one, with a special focus on the prevention of induced vasoconstriction. Our preliminary results are satisfactory and without complications: 13 procedures in 11 patients have been performed over a 30 month period, with the sheaths left in place for 4-6 h after the procedure. This method could be an easy alternative to the Sones technique for operators who are essentially familiar with the femoral percutaneous arterial approach.

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PubMed1988

Percutaneous femoral transluminal angioplasty of a right brachial artery occluded after Sones coronary angiography.

A case of percutaneous transluminal angioplasty (PTA) from the groin to a 7-cm right brachial artery occlusion in a 41-year-old man, having previously undergone Sones coronary angiography 2 months earlier, is presented. The post-PTA angiogram shows near-normal reconstitution of the total obstruction, persisting after 6 months with complete loss of collateral circulation. In a case of total obstruction of the brachial artery, femoral PTA should be considered before resorting to surgical treatment.

Adult↗
PubMed1987

Doppler imaging of regurgitant jet in aortic insufficiency: experimental validation and preliminary clinical evaluation.

Aortic insufficiency induces the development of a jet within the left ventricular outflow tract. The diameter of a laminar jet is a well-defined hydraulic parameter. This study was designed to evaluate, both experimentally and in patients, the accuracy of its measurement using a Doppler imaging performed with a multigate pulsed Doppler velocimeter. The experimental validation was conducted on a water tank pulsatile model including calibrated orifices. Jet images appeared clearly delineated and were not modified when changing imaging angulation (from 85 degrees to 65 degrees), pump frequency (from 60 to 100 c min-1), pump output (from 0.5 to 3.8 l min-1), wall filtering, orifice shape, or signal-to-noise ratio. The measured jet diameter (jd) correlated closely with the orifice diameter (od): jd (mm) = 1.22 + (0.79 X od), r = 0.98. A preliminary clinical evaluation was performed on jets of aortic insufficiency on a series of 26 patients. Jet cross-section was studied within the left ventricular outflow tract using a parasternal approach. A high setting of wall filters allowed good quality imaging in 24 patients. In the absence of a diastolic jet, jd was taken equal to 0. Measured jet diameters were compared to the angiographic grade (ag): jd (mm) = 2.7 + (3.9 X ag), r = 0.86. In conclusion, jet diameter measurement using M-mode Doppler imaging is experimentally accurate and potentially valuable in patients with aortic insufficiency.

Aortic Valve Insufficiency↗
PubMed1986

Coronary artery restenosis following transluminal coronary angioplasty.

Morphological changes are described in a case of coronary restenosis occurring three and ten months after transluminal coronary angioplasty. The lesions consisted of severe narrowing of the previously mechanically dilated coronary segments. This narrowing was produced by fibrocellular intimal hyperplasia associated with rupture of the media whereas the atheromatous plaque was not involved. This suggests that medial injury associated with healing intimal hyperplasia could be the major factor resulting in late coronary restenosis.

Angioplasty, Balloon↗